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Massage Today
April, 2014, Vol. 14, Issue 04 >> Politics & Government

Finding a Bridge to Somewhere

By Ralph Stephens, BS, LMT, NCBTMB

In this, the third column in what I am calling the Policy Wonk Trilogy, we will look at the best solution on the block to uplift our profession, elevate our educational system and improve the quality of massage delivered to the public.

If you have not read the two previous columns, they are in the November 2013 and February 2014 issues of Massage Today. And please note the therapy tip at the end of this column.

It's time to get out the shovels and dig deep enough to find a real solution to the primary problem plaguing the profession of massage therapy. First, high-profile projects like the MTBOK or the ELAP can have no real impact because there is no way to compel implementation of their recommendations. That is probably a good thing considering their recommendations miss the mark. However, if we go down to the foundational structure, it becomes apparent to the careful observer that the real problem is how we regulate our massage schools. Most state departments of education and boards of massage do little to regulate free-standing massage schools and massage programs in other institutions. Some basic forms are filed, maybe a bond posted and that's it. In most jurisdictions, it is just a business tax and permit.

When we started passing licensing laws for massage therapists, there needed to be qualifications to obtain a massage license. Since at that time there was no accreditation agency functioning in our profession, most state licensing laws specified education hours and curriculum, and gave the Massage Board some authority to oversee massage schools. This pattern has continued over the past 15 years. However, almost universally, these boards are understaffed, have little inspection ability and neither board members nor professional staff have the requisite experience with educational administration.

bridge to somewhere - Copyright – Stock Photo / Register Mark No other profession tries to define and enforce its educational standards through licensing statues and state board rules. Ours does because we did not understand the proper structure of professional regulation as we passed our patchwork of lousy massage regulations, with a few good ones here and there. By contrast, licensure in most professions requires that an applicant has graduated from a school accredited by the accrediting agency that is dedicated to that profession. Done. You won't find specifics on the number of clock hours of classroom training in other profession's licensing laws, or any mention of the required courses in the training curriculum. THAT IS ALL HANDLED AT THE ACCREDITATION LEVEL. The system of state occupational licensing boards was created to regulate practitioners – not educational institutions. This is a fundamental flaw that must be changed. Until it is, this "achilles heel" will maintain the current inconsistencies and inefficiencies of educational regulation and will prevent massage therapy from becoming a true profession.

It is time we change our statues to require institutional or programmatic accreditation for all massage schools from one specialized accrediting agency. It's a simple solution with ample precedent in other professions. However, the path to getting there is complex and fraught with obstacles. First of all, there are seven different agencies recognized by the U.S. Department of Education (DOE) that accredit massage schools and programs. On top of that, only about half of all massage programs are offered in an accredited institution. And only four states that license massage therapy require accreditation of massage schools.

The Commission on Massage Therapy Accreditation (COMTA) is the only one of the seven accrediting agencies that is considered by the DOE to be a specialized accreditor for massage therapy and it is the only one that has developed and implemented competency-based curriculum standards. They're the home team here, but they've been under supported by the major organizations in our field and are struggling to attract and keep enough schools under their wing to remain viable.

We already have the vehicle to bring about the needed improvements in massage education – and DOE has given COMTA the blessing to do so. As the common accrediting agency for all massage institutions, COMTA could implement the teacher education standards developed by the Alliance for Massage Therapy Education. As well, its competency-based curriculum standards would create greater consistency in entry-level training programs; something that the MTBOK and ELAP are incapable of doing on their own.

As the FSMTB develops its Model Practice Act as a guide for state massage regulation, it should specify that an applicant for licensure has graduated from a COMTA-accredited institution. State massage boards do not have the expertise, the staff or the authority to bring about the educational changes we need to deliver competent professional massage to the public. Trying to integrate the findings of the ELAP and MTBOK projects into our laws will be an expensive and time-consuming effort. Even if that were to be accomplished, it would still have little effect as licensing boards cannot effectively enforce standards on massage schools.

Needless to say, this will require a huge paradigm shift, which is seldom easy and often painful. Several obstacles must be worked out and it will take time, maybe a decade. Schools that have institutional accreditation from one of the six general vocational accrediting agencies must have a way to add programmatic accreditation from COMTA in addition to their existing status. These schools cannot and will not leave their existing accrediting agency that provides the gateway for students in all of their various programs to receive Federal Student Aid.

Then there is the issue of the other half of all massage schools that are not currently accredited. Most have stayed away from this process because they do not want the headaches of administering Federal Student Aid – or simply lack the financial resources to be able to meet the DOE's eligibility requirements. For these schools, COMTA must be able to create (again with the DOE's permission), a kind of "lite" accreditation process that is not a gateway to financial aid. For those who may remember, the original acronym for this agency in the early 1990's was COMTAA, which stood for the Commission on Massage Therapy Accreditation and Approval. It's time to bring back an approval-level function to be able to bring all massage educational institutions under one regulatory roof.

I am asking for a lot here, but massage therapy has emerged in a very different way than other regulated professions. While we desperately need to move the oversight of schools to COMTA, we must do it in a way that does not unduly punish schools or cause them to perish. Instead of funding more "Bridges to Nowhere" projects like MTBOK and ELAP, our stakeholders should be funding COMTA and the lobbying necessary to accommodate our profession's transition to a properly regulated entry-level education industry.

Stimulus - Response

While some believe that we "relax" muscles by physical pressure and stretch forces applied by the common massage techniques, there is another possibility. Maybe all we are doing is some form of stimulus response. Are we merely providing a stimulus to the nervous system and that stimulus causes the nervous system to "relax" a muscle and/or vasodilate blood vessels? Do you know how the nervous system "perceives" the touch you apply? Do you know how the stimulus of a particular massage stroke is perceived by the nervous system? If not, you are working blind. Each massage stroke is perceived by the nervous system as a specific stimulus and it elicits a specific response. To get the desired response you better be applying the correct stimulus.

Might it be that we are stimulating mechanoreceptors which elicit a relaxation or inhibition response? Might there a better way to manually elicit an inhibition response than the tried and true method of sustained pressure and deep stripping effleurage causing at least discomfort to the patient and over time injury to most therapist? Stay tuned for the answer. You will be surprised.

Click here for more information about Ralph Stephens, BS, LMT, NCBTMB.


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