Reading the impressive 58-page paper entitled Massage Therapy Body of Knowledge (MTBOK) was both exhilarating and disappointing. Developed by a coalition of six national massage organizations, Version 1 of this effort was published in 2010 and is a landmark document for massage therapy and a must-read for everyone in the profession.
The purpose of the MTBOK Project is to define the scope of practice for massage professionals and the entry-level knowledge, skills and abilities (KSA) necessary to responsibly perform massage therapy. It is intended to be a living document that is constantly modified and updated as information, understanding and perspectives change.
Unfortunately, the MTBOK effort, while commendable, is fundamentally flawed as, once again, the mainstream massage industry conflates “massage” with “massage therapy.” This is a 30-year old problem that continues to hold back our industry by presuming that all massage is massage therapy. You can read the history of how this came about and why it has been a disaster for the industry in the related articles How Massage Became Therapy and Moving from Acceptability to Accessibility.
In this article I want to use the MTBOK report to help identify the difference between “massage” and “massage therapy” and lay the groundwork for future discussion.
First, let’s start with the report’s definition of “Bodywork” on page 39. It notes, correctly I believe, that bodywork includes all forms of massage therapy. Indeed, bodywork is the umbrella term for all forms of skilled touch some of which are massage, and others of which are clearly not (e.g. Reiki, Therapeutic Touch).
Where the report fails is that it doesn’t make clear that the subset of bodywork that includes massage can be further subdivided, only one category of which is massage therapy. That is to say, while all massage therapy is massage, not all massage is massage therapy [See The Realms of Massage].
What part of massage is not massage therapy? That’s easy—personal care massage.
The MTBOK paper, like the industry as a whole, defines massage therapy (meaning all massage) exclusively as “a healthcare and wellness profession” and goes on to say, “The practice of [massage] involves a client/patient-centered session, intended to support therapeutic goals.” Really? That is not the massage I have been doing for 30 years.
I don’t serve “clients” or “patients,” I serve customers. The personal care service I perform has more in common with cosmetologists (“If you feel good, you look good”), tour guides (“Let me show you your body from the inside out”) and aerobics instructors (“Let’s get fit”) than with physical therapists or athletic trainers. Indeed, the Bureau of Labor Statistics places the largest concentration of massage professionals, by far, in the personal care service industry, not the health care industry.
So, clearly, there is personal care massage and there is health care massage therapy. Is the body of knowledge required for safe, effective practice the same for both occupations? Obviously not, but inadvertently here is where the MTBOK paper has done us a great service. Since all massage therapy is a subset of all massage then, if they did their work well, within the body of knowledge of massage therapy must be the core knowledge, skills and abilities to perform all massage, including the subset of personal care massage.
It’s all about touch
Let’s start with one of their definitions on page 6: “Massage therapy at its essence is human touch with clear intention, focused attention and the attitudes of compassion and non-judgment.” I would maintain that this is also a perfectly serviceable definition for personal care massage so let’s take the word “therapy” out of the sentence and we can all agree that the primary KSAs of all massage should revolve around touch.
So, what does it take to be a professional touch provider? Clearly far less than is required to become a massage therapist. In fact, separating personal care massage from massage therapy will finally allow massage therapy to have the growth path it so justifiably deserves—that of becoming medical massage, a health care specialty—while allowing basic massage training to focus on the simple but profound benefits of touch.
The MTBOK sections on Boundaries, Ethics and the Therapeutic Relationship along with Body Mechanics, Self Care and Massage Techniques contain a wealth of relevant suggestions about learning to be a good skilled touch provider. The in-depth knowledge outlined in Anatomy, Physiology, Pathology, Kinesiology, Assessment, Treatment Planning, Documentation, Research and Information Literacy however, are far more suited for a massage therapist.
Massage therapy training has always been too much and too little. If you read through the MTBOK recommendations, you can come to no other conclusion than that 500 hours is a woefully inadequate number of hours for training a qualified massage therapist. The 2,100-hour standard in Ontario province or the 3,000-hour standard in British Columbia are much closer to the mark.
However, 500 hours is far more than is necessary for me to train a world-class chair massage practitioner doing personal care massage. I could accomplish it in 300 hours and half of that would be supervised practice.
At this point there is ample evidence that the effort to attract the marketplace to high-priced massage therapy has failed. The only significant growth markets for the industry are the chair massage provided by the current wave of Chinese immigrants in malls and low cost suburban table massage offered by Massage Envy and its clones. Neither of those approaches, by and large, requires the full training and skill set outlined in the MTBOK. Each of those avenues could rightly be called “entry level” for both the practitioners and the consumers. I would suggest there is little point in training thousands of massage therapists for jobs that don’t exist. Better to train personal care service massage practitioners for jobs that do.
Let’s first teach all our massage students to do one thing really well—skilled touch. If they later want to specialize in massage therapy in all of its many, varied and glorious forms, great, but that is advanced training for a clearly limited market.