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Summary: Answers to frequently asked questions about the massage (bodywork) profession.
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Archive-name: backrubs/faq/part4
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Copyright: (c) 1994-2002 J. Blustein.  All rights reserved.  See question 0.7 for details.

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Section 4 -- Professional Massage

   This posting contains answers to the following questions:
    4.1)  What about licencing, certification and professional training?
    4.2)  Professional issues (table suppliers, organizations, etc.)
    4.3)  Finding a good professional massage
    4.4)  Advice for a recipient of professional massage
    4.5)  How much will it cost?  Should I tip?  Can I get it cheaper?
    4.6)  I've got the following symptoms.  What do you advise?

        The complete lists of subparts of all questions is in part 0 of
this FAQ list.

        Each question begins with `Subject:' on a line of its own.  Users
with suitably equipped newsreaders can automatically skip to the start of
the next question, e.g. trn will display the start of the question when you
press ^G (control-G).  Of course if your newsreader doesn't do this
automatically, you can still use a search command to find the next
question.
        To find the answer to question 4.2 search for a line beginning with
`Q4.2)', there will be only one.

------------------------------

        Your suggestions for changes to these articles are welcome.  Please
see section 0 (entitled Administrivia and Acknowledgements) in the earlier
posting for information about whom to contact and what changes are planned.

        The questions are divided into the following general sections.
Questions from each section are answered in articles of their own.  A list
of all questions appears in the first article (section 0).
        Section 0  Administrivia and Acknowledgements
        Section 1  General Questions
        Section 2  Basics of Massage
        Section 3  Novice Questions
        Section 4  Professional Massage
        Section 5  Other Sources of Information

---------------------------------------------------------------------

Section 4 -- Professional Massage

Subject: What about licencing, certification and professional training?
Q4.1)    Licencing is, of course, only relevant if you are looking to charge
for giving massages.  The restrictions and regulations differ from state to
state in the USA and province to province in Canada.  If you have
information about regulation in other countries, please post it to the
newsgroup.
        Some jurisdictions have no restrictions, some provide two-tier
regulation (distinguishing between so-called technicians or bodyworkers and
therapists), some just want to make sure massage is not being used as a
cover for prostitution.  Some even require a level of training level
equivalent to what a physical therapist would have.
       The rest of this question is in two parts: the first part is about
various resource guides that are available; the second part is about the
two major organizations that are frequently discussed in alt.backrubs.

a) Books, magazines and other resource guides
        Two books have been mentioned in alt.backrubs: _Massage: a career
at your fingertips_ and _International Massage & Bodywork Resource Guide_.
        Martin Ashley's book _Massage: A Career At Your Fingertips_
(published by Station Hill Press with ISBN 0-88268-135-4 in 1992) used to
be recommended often in alt.backrubs.  It provides a thorough overview of
career choices for bodyworkers and massage therapists and a career-planning
guide.  The extensive section about legal requirements, schools and
equipment may be out of date by now.  A Table of Contents (for the first
edition) is in the archive's `getting.registered' file.  Information
about the second editon is available on the WWW at
<URL:http://www.cloud9.net/~martash/massage.htm>.
        According to Keith Grant, the _International Massage & Bodywork
Resource Guide_ compiled by Robert Calvert and Noel Abildgaard and
published by Noah Press (with ISBNs 1-879933-04-7 and 1-879933-03-9 in
1991) contains more than 520 listings of schools, associations, seminars
and laws related to the healing arts of massage, bodywork and holistic
health along with tips on choosing a school, a glossary of techniques and a
book review section.
        Massage magazine (also published by Noah Press, with ISSN
1057-378-X) contains a section for paid advertisements about massage
schools and training centres.  Because they only accept paid ads I can't
tell how complete the listings are.  It seems that Massage is aimed
primarily at American markets.  The magazine publishes a brief list of the
most basic regulations for registered massage therapists in each of the
United States of America.  The list includes telephone numbers for
additional information.  Noah Publishing's address is
   P.O. Box 1500,
   Davis, CA 95617
   USA.
They can be reached by telephone at [phone] or [phone].
The magazine has e-mail address <[e-mail]>.  Their webpage is at
<URL:http://massagemag.com>.
        Informative postings about massage schools may be found in the
archive's `mas.schools' and `esalen' files.  More information, and much
discussion, is available in part b) below and in the archive (see the
category about certification; information about the archive appears in
question 5.1.2).
        The AMTA (American Massage Therapy Association), the ABMP
(Associated Massage and Bodywork Professionals) and the COMTAA
(Commission on Massage Training Accreditation/Approval in the USA) often
come up in discussions of massage schools in alt.backrubs.  For that reason
only, the following address and telephone numbers are included here.  They
were extracted from the archive's `mas.schools' file.  If you have more
accurate information please tell the archive maintainer.
  American Massage Therapy Association (AMTA)
  820 Davis Street, Suite 100,
  Evanston, IL 60201-4444
  USA
  [phone]
  [phone]  (for a list of COMTAA schools)
  The AMTA's web page is at <URL:http://www.AMTAmassage.org>.
N.B.: inclusion of this information does not imply approval (or
disapproval) of the AMTA, the COMTAA, the USA or any other organization,
their policies employees, fashion sense, etc.  It is here because it is
part of an answer to a frequently asked question.

------------------------------

b) What are the ABMP and the AMTA?
        Before you decide to join any organization you should read part a)
above and possibly the relevant archive files.  If you want to know what
the various abbreviations used in alt.backrubs mean then you should be
reading question 1.3.
        In the USA and Canada, the AMTA (American Massage Therapy
Association) and the ABMP (Associated Bodywork and Massage Professionals)
are major organizations offering malpractice insurance and forms of
professional accreditation.  It is entirely possible that these
organizations also offer these services in other countries, but those are
the only ones of which I am aware.  If someone from those organizations
will supply more information then it will be used to update this
document.  See question 0.2 for information about whom to contact.
        The AMTA and the ABMP are competing organizations with different
approaches to massage, massage and bodywork regulation and many other
issues near and dear to the hearts of professional MTs.  If you are
thinking of getting certified (within or without the USA and Canada) then
you might find the discussions in the files in the archive's certification
category helpful.  The archive and its categories are the subject of
question 5.1.2.
        Please feel free to submit an unbiased summary of the posts in the
archive files relevant to this question.  If such a summary is received it,
or some version of it, will replace this answer.
        The AMTA's web page is at <URL:http://www.AMTAmassage.org>.
        The ABMP's web page is at <URL:http://www.ABMP.com>.

----------------------------------------------------------------------

Subject: Professional issues
Q4.2)
a) The alt.backrubs newsgroup has had many discussions of issues
related to massage as a profession and tools and techniques for massage
professionals.  Copies of many posts on these topics are available in the
alt.backrubs archive (see question 5.1.2).  For example, the archive
contains information about massage tables, professional organizations,
exams and draping standards.
   The BODYWORK mailing-list aims to be for discussion amongst bodywork
practitioners.  If you are a professional MT or studying to be one then you
might be interested in the list.  Question 5.2.4 b) has details about the
list and how to subscribe.

------------------------------

b) Emotional response considerations
Keith Grant, a massage instructor (amongst many other things), has
submitted the following notes about emotional response considerations in
professional massage.  More information about this topic is available in
the archive file `emot.release' (see question 5.1.2 for information about
the archive).

                     EMOTIONAL RESPONSE CONSIDERATIONS

        As a massage professional you should be aware that some
     clients might suffer strong emotional release during massage.
     You need to be able to recognize signs of such sublimated
     emotions and to know how deal with such issues when they arise in
     your massage practice.

     Background
        Unresolved emotions can become anchored in the body as a
     result of physical and emotional traumas.  One can think of the
     body as maintaining `physical memories' of such emotions in the
     tension of muscles.  The condition is especially common with
     those who suffered physical or sexual abuse as children.  It can
     be that over time, the body becomes habituated to the unbalanced
     muscle tensions.  Eventually, patterns of body usage and posture
     are changed in an unconscious attempt to compensate.

        Massage can bring anchored emotions and associated memories
     back to conscious awareness.  Indeed some psychotherapies involve
     forms of bodywork intended to focus the patients attention on
     tension in their body (more information is available in the
     `mas.vs.psychotherapy' file in the archive, which is the subject
     of question 5.1.2).  While the re-awakening of emotions is a
     process that can contribute greatly to re-integration and
     healing, it is important as a massage practitioner not to assume
     the role of emotional therapist or become caught up in listening
     to verbal stories.

     Indications
        It is equally important, however, to bring your focus and
     awareness to bodywork sessions.  A massage professional should be
     aware of their client's overall way of inhabiting their body.
     Watch how they hold themselves, walk and gesture.  Projections of
     being overly rigid, collapsed, or inanimate/dissociated can be
     indications of past abuse.
        Abuse survivors can have trouble `owning' their bodies.  They
     may feel loss of breath or voice.  If their physical memories are
     triggered, such clients may remove all of their conscious
     awareness from their body. Not feeling able to `own' parts of
     their body can lead to discernible splits in the use and vitality
     of their body, e.g. left/right or upper/lower.
        Be aware that a client may verbally agree to a technique while
     disagreeing with their body language.  An example could be saying
     yes while shaking their head or retreating slightly from your
     hand.  Such incongruence in presentation is a subtle indicator of
     the incongruence between their conscious and unconscious thoughts
     and feelings.  Try to be attentive to subtle changes in
     breathing, tension level and small movements, that might be early
     indicators of emotional responses during a session.

     How you should react
        In the event that one of your clients has a strong emotional
     response to deep tissue work, you may need to forego further work
     planned for the session.  Keep your own centre, stay calm, and
     remember that your goal is neither to `fix' the problem nor to
     add your own emotional reaction to the client's process.  Instead
     assume a role of offering the quiet acceptance and support that
     will enable the client to reach an acceptable level of
     equilibrium by the end of the session.  This may include gentle
     grounding work around the head, neck, shoulders, or feet and
     ankles.  Remind the client to breathe. Often the most important
     thing you can do is to quietly convey to the client a sense of
     connectedness and support.

     Aside: The words people use
        Although many people do refer to storage of memories in the
     body I tend to avoid referring too literally to this as a
     mechanism. I prefer to think of memories, not necessarily
     available via conscious cognitive paths being indexed (hence my
     phrase `bookmark') or reached by the more primitive and
     unconscious sensory paths from touch. It's not necessary to
     understand the mechanism or location of memory storage for the
     metaphor to useful.  I've come to this view, partly from some
     training I've had in Ericksonion trancework.
        In a similar vein, I try to avoid limiting the bodily causes
     to habitual tension. The interactions are complex. The original
     abuse could have been any (or all) of: physical abuse, emotional
     abuse, sexual abuse, or neglect.  The abuse or neglect survivor
     often loses both their voice (in the physical and metaphorical
     senses) and possession of parts of their body.
        Many times they lose all conscious sensation in parts of their
     body.  The physical outcomes can include tension, disruptions in
     movement, breathing and speech.  However you should not assume
     that these symptoms are necessarily a direct result of tension.
     One of the outcomes can be muscular collapse that leads to a lack
     of normal tonality or tension.  On the emotional level, the
     ability to establish normal boundaries may be lost or never
     learned.  Incongruence between verbal and nonverbal responses
     (e.g. saying yes and shaking the head no) often indicates the
     resulting conscious/unconscious split.

----------------------------------------------------------------------

Subject: Finding a good professional massage
Q4.3)    In many jurisdictions, people may advertise as giving massage when
do not provide a good massage.  Some provide substandard services and
others provide sexual services under the guise of massage.  Many people
post to alt.backrubs seeking advice about how to tell where they can get a
skilled massage before they have paid for the services.  Three questions
are answered here: (a) how can I find someone who will give me a massage,
or other bodywork treatment, rather than some sexual service; (b) how can I
tell if they are any good before I pay them; and (c) what referral services
can I call upon for recommendations?
        If you are not sure what to expect from a professional massage you
might find some of the information in the archive (question 5.1.2) of
interest.  The files in the professional category and the `what.to.expect'
and `what.price' files should be of especial interest.  If you'd like to
summarize that information for inclusion here, please see questions 0.3 and
4.4.

------------------------------

a)      Either way typical advice is to get a referral from a trusted
friend, physician or other health care professional, local massage school,
health food store or Chamber of Commerce.  Steve Brooks
<[e-mail]> suggested (in article
<3eco5n$[e-mail]>) that major hotel chains that cater
to Japanese tourists should be able to refer you to reputable Japanese
style massage therapists.  How you're supposed to locate such hotels is
left as an exercise to the reader.  Some people like to search
advertisements in the telephone book and so-called New Age or Holistic
Health stores and publications.  Other people say this is a terrible way to
find a MT.  I suppose it depends on where you live and what your local
publications are like.
        If all you care about is whether you are going to get a
professional massage or sexual services then ask.  Be aware however that if
they are using massage as a cover for sexual services then they probably
won't answer direct questions about whether or not they offer sexual
services.  Many of the suggestions in this answer come from the
`finding.a.MT' file in the archive.  The archive is the topic of question
5.1.2.
        Someone suggested some questions that might help you detect whether
the prospective masseur offers such services as `relief massage' (often a
codeword for masturbation).  You might also ask what professional
organizations they belong to as members of the AMTA (American Massage
Therapy Association) and ABMP (Association of Bodywork and Massage
Professionals) are strictly forbidden from sexual involvement with their
clients.  Not all professional MTs belong to either of these organizations
-- you can read some of the arguments in the archive (see question 5.1.2)
if you're really interested.  Those arguments appear in the `certification'
file.  The `medical.model' and other files in the Professional category may
also be of particular interest.

------------------------------

b)      When you're satisfied that you have found an above board MT you
should try to find out if they will be suitable for the type of treatment
you want.  Be clear about what your needs are and tell the MT.  Perhaps you
want massage for relaxation or you have a specific area that needs
attention, for example.  A good MT will help you pinpoint what it is you
want from the session, often just by talking about it with you.
        If you are at all uncomfortable with the thought of being
unclothed, then discuss draping with the MT before the massage begins.
Absolutely no professional MT will demand a client remove any clothing that
the client is not comfortable removing regardless of what impact this will
have on the massage.  Are you comfortable with a male (or female) MT, or
would you prefer a MT of the other sex?
        Please note however that just because a MT graduated from a
professional school they aren't necessarily going to give you a great
massage.  It has been said many times in alt.backrubs that some MTs have
the technical knowledge of what to do but lack the sensitivity to detect
what clients really need.  Corrina Perrone has written that, in her
experience, it almost always takes at least two years of practice after
graduation for MTs to a develop a truly professional calibre of massage.
        Once you have a short list of MTs you want to consider, then you
should ask questions to determine what services these unknown massagers
really provide, and how skilled they are in the type of massage you want
(see question 2.1).  You could ask about their professional education,
e.g. how many hours of training have they had (this varies from about 250
to 2000), which massage school did they attend, what their favourite course
was and what types of massage they prefer.
        Corrina Perrone <[e-mail]> recommends:
   If you still have doubts about the qualifications ask direct
   questions about the types of bodywork they do -- and expect some
   technical answers [such as those in question 2.2].  Ask them to
   describe these techniques, and how they use them in a session.
   You'll get a lot of `it depends' answers, but a good therapist will
   be able to give you an example, such as, `I warm the muscle tissue
   up using mostly Swedish massage strokes, and then use deep tissue
   techniques to work out tightness.  If there is limited movement I
   might use NMT [neuromuscular massage therapy] work on the muscle
   attachments, and some Trager techniques to integrate the work.'
   Find out how long they have been in practice.
      If you are screening the therapists by phone, look for qualities
   that indicate they would be a good person with whom to work:
         Do they listen to what you are saying and respond to it?
         Do they ask questions about your needs?
         Do they impress you as professional?
         Do you feel like you are being listened to, or do you feel
           like you are getting a lecture in physiology?
   Take some time to consider those questions strategically.  You want
   something from the bodywork, and you are picking the best partner
   to help you achieve that goal.  You should also be clear in your
   mind about what you want.  The MT's answers will tell you something
   about them and their massage practice.

------------------------------

c)      In the `finding.a.MT' file mentioned above Brother Bernard Seif
<[e-mail]> noted that the Associated Bodywork and Massage
Professionals (ABMP) offer a free referral service.  To use the service
call [phone].
        Please note that the inclusion of information about a commercial
organization (the ABMP in this case) does not indicate in any way approval
or disapproval of the organization in any way by anyone responsible for
this document.  The information is included because it is deemed useful to
the readers of alt.backrubs and is part of the answer to a frequently asked
question.  If you have corrections to the telephone number or additions
(e.g., the number of another referral service) then please inform the FAQL
maintainer.

----------------------------------------------------------------------

Subject: Advice for a recipient of professional massage
Q4.4)    Much information about what you should expect as a massage client
is available in the archive file `what.to.expect'.  The archive is the
subject of question 5.1.2.  In addition, Corrina Perrone
<[e-mail]> recommends:
      If you aren't comfortable with the MT touching you the treatment
   isn't going to help you regardless what techniques they use.  Be
   sure to tell them if something makes you uncomfortable, and feel
   free to ask questions about anything they do. You should feel
   respected and honoured, and the session should provide
   opportunities for you to relax and get back in touch with yourself.
      Remember that any MT needs to know if you are seeing another
   practitioner, in order to make sure the massage won't interfere.
   Many people don't know for instance that if they are taking drugs,
   even for chronic illnesses, their dosages will often need to be
   decreased if they regularly receive bodywork treatments.

        What follows is adapted from some advice that MayaWay
<[e-mail]> posted the following advice for the Maine Massage Guild:

                 How To Enhance Your Treatment Experience

  - You'll feel more comfortable if you don't eat for two hours before
   your session.
  - Draping will be employed for traditional massage.  For other
   therapies wear loose fitting comfortable clothing.
  - Let your therapist know if you have any medical or physical
   conditions which might contraindicate certain types of treatment.
   (See also part b) of question 4.3, about finding a capable MT,
   above).
  - Remove any unnecessary jewelry that could cause scratching or
   interfere with having a smooth massage.
  - If you wear glasses or contact lenses, consider removing them.  It
   may add to your relaxing experience.
  - If you're concerned about getting oil on your hair, inform your
   therapist.  You won't want to miss out on a head massage!
  - Quieting yourself will allow you to tune in to your experience and
   relax more deeply.  Do give your therapist feedback regarding your
   experience and feel free to ask any questions you'd like.
  - Breathe deeply and regularly, stressing your exhalation.  Imagine
   your body becoming heavy and sinking into the table or mat.  As the
   therapist locates areas of tension, consciously allow yourself to
   breath and relax into those areas.
  - Sometimes during a massage or other type of treatment emotions
   will surface.  It may be of great benefit to release and work
   through them if you feel comfortable doing so.  (See the archive
   and question 4.2 for related information.  Information about the
   archive appears in question 5.1.2.)

        Additionally many MTs recommend that you drink water (about 250 ml
= 1 cup = 8 oz.) after your massage.

----------------------------------------------------------------------

Subject: How much will it cost?  Should I tip?  Can I get it cheaper?
Q4.5)    There are no definite answers to the first two questions.  The
answers vary by location and culture.  The `what.price' file in the archive
(see question 5.1.2) contains a record of some of the discussion of these
points that has taken place in alt.backrubs.
         That file also has suggestions for where to seek less expensive
professional massage than usual.  Some of that advice is presented here,
but is not meant to replace a thoughtful reading of that file.  Some MTs
will accept trades of good and services in place of money.  Some are listed
in the exchange file (see question 5.1.1).  MTs-in-training often need to
practice :) -- local massage schools can often put you in contact with the
trainees.   Question 3.2 is about where to find people to give (and
receive) massage.

----------------------------------------------------------------------

Subject: I've got the following symptoms.  What do you advise?
Q4.6)    The symptoms could be the result of something serious.  A health
care professional should be consulted for a diagnosis.  This newsgroup is
read by many people with great talent, however none of them can diagnose or
treat ailments or injuries solely over a network connection.  If there is a
serious problem then it should be dealt with promptly by a health care
professional.

        Richard Karasik advises:
    If you insist on asking for advice then you'll have to provide
    some details.  For example, have you ever been diagnosed with any
    osseous deformities, e.g. 6 fingers on one hand, arthritis or any
    ligamentous tears?  Do you exercise regularly?  If so, what
    exercises do you do?  When was the first time you noticed the
    pain, what were you doing in the 24 hours prior to that. Do you
    have headaches associated with the pain?  Describe the pain in
    detail -- is it sharp, radiating or local?
        The description you give may suggest muscle tests you can do
    yourself to isolate the areas of dysfunction -- the causality you
    will have to puzzle out further than that -- but even isolating
    the muscle groups affected and determining how they are affected
    will help you when you consult (in person) with a health care
    professional.

        Terry Norman advises:
        Soft tissue massage may be only one of several types of
    modalities necessary to bring about a complete rehabilitation of
    an injury.  You can't tell exactly what the appropriate therapy is
    to pursue without a complete physical exam by a competent
    physician.  It's not always a waste of time and money to consult
    one before starting on a course of physical rehabilitation.

        If you are seeking advice about treatment not diagnosis then you
might find useful information in the archive.  At the time of this writing
(April 1995) there are files about: back pain, fibromyalgia, wrist and hand
pain, massaging bruises and knots, neck aches, scoliosis, massage as an
adjunct to cancer treatments, headaches and chronic pain.  There may be
much more by now.  Information about the archive is in question 5.1.2.
--
Jamie Blustein  `No trees were destroyed to make this post'   <[e-mail]>
                 The disclaimer is the subject of question 0.6
               See also http://www.ii.uib.no/~kjartan/backrubfaq/
    This document is archived in ftp://rtfm.mit.edu/pub/usenet/alt.backrubs/