Massage Certification

I have, to put it mildly, mixed feelings about the certification and licensing of massage therapists. Oregon is middling strict for American states, requiring 500 hours of education, and passage of both a national written exam and a practical exam administered by a state board. But in some parts of Europe a four year degree program is required: it's a profession on par with (and largely overlapping with) physical therapy. Some American states, on the other hand, don't regulate massage at all. Canadian provinces vary, but they usually require much more than American states.

The main social function of certification is to give those of us who succeed in it license to treat those who don't as inferior, and I'm never sure whether that is not the main function of it, pure and simple. Human beings ache, they ache for status, to be “dress'd in a little brief authority.” I find this aspect of certification loathsome. I hate it and I don't want any part of it.

I'm not sure training makes much difference, or if it makes more difference than experience. If we knew how to study the effectiveness of massage at all (I'm not sure we do) it would not be a hard thing to study. Remember that study, a generation back, that found there was not much difference in outcomes of talk therapy, that the benefits conferred by talking to an ivy-league trained psychiatrist and by talking to any sympathetic listener were about the same? It caused a bit of a stir at the time, but it seems to have been nicely papered over, and the certification mills for mental health practitioners grind on.

I personally know of two people who were excluded from doing massage by the certification process. One was a young woman with truly magic hands, the greatest gift for massage that I've ever encountered. She also could not read very well, and had a crippling anxiety about taking exams: she failed them, one after one. Scratch one massage therapist. The other gave a very good strong massage, but had real problems with authority: didn't get on with “the man.” He got into a dispute with the school administration about his fees, and refused to pay what they said he owed. No diploma, no license. Scratch another massage therapist. On the basis of what I personally know, this process, which delivered up several licensed massage therapists who were mediocre and a couple who were downright bad, excluded two of the best.

On the other hand, I attended a talk given by someone on the state board, and according to her they failed a number of people on the practical exam who were truly dangerous, e.g. trying to make joints move in ways they weren't meant to. Those seem like good people to exclude. I wasn't in school with anyone like that, so I don't know how common they are. Another thing the board does is monitor advertising and complaints, and take away the licenses of people who sexualize their massage. You can have pretty good confidence that a licensed massage therapist in Oregon a) won't hurt you and b) won't grope you. This is a good thing. There are states where you just don't know. Someone advertising massage could be pretty much anyone.

Another effect of certification is that it excludes people from casually taking up practice. You have to want to be a massage therapist, put in some time and some resources, to get licensed. It's hard for me to judge how many people this discourages whom we want to discourage. Certainly some.

But massage is something that can be done well, even brilliantly, by people incapable of book-learning. It seems like a shame to cut them off from it. I've learned lots from books and from studying anatomy, but that's the kind of learner I am. I haven't learned to do much that a person with sensitive hands couldn't learn to do by experience and example -- by, basically, apprenticeship. I trade massage with an LMT who claims to know nothing of trigger point. In fact she does excellent trigger point work: she's gifted at finding them with her fingers and working them out. She doesn't know, as I do, that pain in the deltoids is often referred from trigger points in the teres major. But if she finds the trigger points in the teres major anyway, is that such a big deal? Someone who knows the patterns of referred pain can miss the trigger points anyway if they don't have sensitive hands. (Trigger points are surprisingly localized: a miss of an eighth of an inch can be as good as a mile.) Book learning is neither necessary nor sufficient. I don't want to denigrate it, but it's just one method of learning your way around the body.

So I end up being a very grudging supporter of certification. I'm glad to exclude sexual predators and dangerously incompetent therapists. And there's a modicum of pathology you have to learn somehow, so you can recognize, say, melanoma or scabies when you see it. But I wish we had alternate paths to certification.

Books and classrooms and exams have come to dominate our conception of what education is, to the exclusion of many other valid kinds. Skilled manual labor traditionally has been a matter of master and apprentice. Certainly the most valuable training I got in massage school was not in the classes per se – much of the book-learning I got in them, to tell the truth, I have subsequently had to unlearn – but from those moments after the end of class, when two or three avid students were still trying to get the hang of something and the teacher stayed on, demonstrating, taking turns, experimenting. I think a year spent getting massages from masters, and trying to replicate them in small, supervised groups might produce better therapists than the current education: I've learned a lot from books, but I've learned even more by watching massage, or getting massage, from people who really know what they're doing.