Last month, I wrote about the differing perceptions of massage and bodywork from practitioners. The words used to portray what we do have differing meanings to different people. I'd like to expand on that theme a bit, because when we get out of our own professional realm, the meaning and significance of words become even more important. This can certainly be true in our practices when our patients/clients perceive our words as meaning something different than we intended. I always find it beneficial to come to agreement with a client as to what terms mean. For example, take the word discomfort. When working a trigger point in infraspinatus, or using an elbow for compression on a piriformis attachment, that definition can become very important. Where language misunderstandings become really problematic though, is in the regulatory arena. Here wording is critical, from the standpoint of the regulators, from the practitioners being regulated, and from the public who is being protected by the regulations. Obviously in the best of all worlds, the wording chosen in statute and rules will provide all concerned parties with the protection and safety net intended by the process. This does not always happen though, as the following example illustrates.

New Hampshire has had a long and successful history of licensing massage therapists. The state's Department of Health & Human Services administers the massage licensing program. There is a three-member Advisory Board of Massage Therapy that advises the Commissioner of Health and Human Services on issues relating to massage therapy. To correct a perceived problem concerning the Department's ability to discipline errant therapists for inappropriate touch, the Department lawyer, in concert with state Legislative Services lawyers, added the following clause to the rules governing the practice of massage:

"Inappropriate sexual contact" means the intentional touching by the licensee of the client's breasts, buttocks, or genitalia when such touching:

(a) Is a therapeutic aspect of the massage, but is done without the informed consent of the client; or
(b) Is not a necessary, therapeutic aspect of the massage; and
(c) Is performed primarily for the purpose of sexual arousal or gratification of the licensee or the client.

This added definition in the rules seems pretty innocuous on quick read, but when dissected and put into the context of actual practice, the words exceed the needs of the situation and adversely impact the practice of massage in that state. There are times in a massage practice when intention can carry the day if specificity of technique comes up short, but this is never the case in a regulation! In dissection, the above definition states that the intentional touching of a client's genitalia is a therapeutic aspect of massage, and it only becomes inappropriate when done without the informed consent of the client. I don't think this was the intent of the drafters. The statement is actually true when directed toward breasts or buttocks, but I have never met anyone whose practice involved anything other than adult entertainment who would argue that touching genitalia was a therapeutic aspect of massage.

So how does one resolve the meaning gaps in language issues such as just presented? In this instance, the members of the Advisory Board each responded in writing stating that the inappropriate sexual contact definition was badly chosen because:

1. It would encourage prostitution under the guise of massage, for reasons stated above.
2. Informed consent is needed for all touch, not just certain body parts. It is not something that is needed more for breasts or buttocks than for ears or face or feet.
3. Any body part touched that is performed primarily for the purpose of sexual arousal or gratification of the licensee or the client should be considered inappropriate sexual contact.
4. The definition includes buttocks in the same context as genitalia. While there were no known therapeutic aspects of the latter, there were almost no instances in which inclusion of the gluteal region could or should be avoided.
5. Inclusion of breasts, buttocks and genitalia in the same sentence is demeaning to the massage therapy profession and would never be considered in regulations of other licensed health professions.

So was this language issue resolved? The written response from the Department was that the rule would allow the Department to do what they needed to do in the prosecution of those harming the public, that it was not intended to demean the profession, and that the language would stand as approved.

No one was really wrong in the situation cited above, but I feel it is an example of unfortunate language affecting the practice of professionals when the profession isn't regulating itself. In this instance, a state beaurocracy solved a problem against the wishes and judgment of those selected by them to represent the profession. Had there been a massage regulatory board instead of an advisory board, I doubt that this would have occurred. I am of the opinion that the massage therapy field is best served by self-regulation. Licensees should have recourse to have complaints heard and adjudicated by their peers.

Last month's Massage Today included an article by David Frostad on the National Alliance of State Massage Therapy Boards (NASMTB). The state of Mississippi has just become the 30th state to regulate massage. I would welcome 50 states; all members of the NASMTB, with common regulatory language that has been developed by massage therapists and designed to enable increasing standards of care while benefiting both the public and the practitioner.

I feel it is important for everyone reading this article to consider the power and importance of the words we use. English, as most of the world's languages, is rich in vocabulary specifically to express nuance of thought. When creating written documents designed to stand the test of time, nuance and understand become increasingly critical. In our emerging profession there has been and will continue to be creation of organizational bylaws, practice standards, efficacy claims, regulatory statutes and rules, etc. I urge everyone to remember that what you meant to say has no bearing on how others view and use your document. What you have actually said will remain for a long time. I guess I am calling for a bit of activism on your part. I suggest that it is important that you read and understand the laws that govern your practice, and the bylaws and standards of the associations/organizations you choose to join or be credentialed by. With a critical eye, determine what the documents actually say and the perceptions of meaning that might occur. Then call or write the organizations/agencies responsible for the document and state your concerns. After all, it's your practice that is affected.

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