Originally published in Massage & Bodywork magazine, October/November 2002.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

Before the age of structured classroom settings, national exams and governmental standards, massage therapists learned their craft simply by apprenticing with a master. The healing arts were handed down from mother to daughter, father to son, or elderly shaman to some younger, tribal member possessing an extraordinary sensory perception or marked for training by surviving a cataclysmic event, such as a lightning strike. Apprenticeship, in the ancient way, was a lifetime commitment with the apprentice learning at his or her master's side for many decades before taking on the title of healer.

The growing popularity of complementary and alternative medicine (CAM) in our stress-laden society has heralded a concomitant growth in the number of massage schools - now more than a thousand in the United States alone. These schools offer a wide variety of training, from basic massage therapy to specialized modalities. Today, the opportunity to contribute to the field is open to anyone willing to pay for classes, successfully complete the required hours of training and hang out a shingle. For many, this will also include passing the National Certification Exam (NCE) or some other exam to meet requirements of state regulations.

Is apprenticeship a lost art? Is our current 21st century approach turning out well-qualified healers with the necessary hands-on experience? Does the structured classroom setting address the great diversity in learning styles of students? Does our current training system place more emphasis on passing the NCE than on preparation for actual practice? And, are students being prepared psychologically to handle the emotional and practical demands of a business?

In an effort to take a closer look at the current state of massage and bodywork education, these questions were posed to massage therapy experts across the country. The responses reflect, in a sense, the struggle of an emerging profession to fine-tune its approach to an art that has slowly made the transition from apprenticed entitlement to a legally-sanctioned, legally-controlled occupation of modern commerce. How the industry has handled this transformation and the proper future educational direction is the subject of much debate.

Dr. Keith Eric Grant, head of sports and deep tissue massage at McKinnon Institute in Oakland, Calif., recently wrote a white paper titled: "A Review of Issues in Massage Governance." Grant's doctorate in applied science, physics and mathematics combined with his massage training background has earned him respect not only as an authority in massage physiology, but also as a major voice in massage politics and education. In his paper, Grant addresses a number of issues, among them current and proposed educational requirements to practice massage therapy. He wrote: "Proposals for regulation often contain entry criteria that are arbitrary in terms of educational basis and public benefit - essentially a syndrome of requiring some number of 'round hours' without basis of needed content or ultimate benefit to the consumer. These do not constitute standards in that they neither set particular performance criteria for practice nor provide a necessary and sufficient means by which criteria could be implemented and measured."

Of education itself, he wrote, "Much of what is considered to be improving the quality of massage education flies contrary to recent concepts of optimum educational methods. Cognitive research indicates that learning occurs most effectively in contexts of formal learning interspersed with practical experience and in situations of apprenticeship and mentoring."

It was, in part, Grant's writings that inspired M&B to bring this discussion to the forefront - to examine the way things are and to ask if we can open the door for change where needed. This discussion will of necessity flow into issues of competency, regulations and requirements, but its intended focus is more on the very nature of learning itself. For Grant and others in the field, the present system doesn't exactly work for everyone, especially those whose educational backgrounds or learning styles are not compatible with empirical, text-book academics. Some students are adept at memorizing and spitting out answers on a test, but does that knowledge transfer to the massage table, especially once they are out practicing on their own? And what of the gifted massage student whose hands work like magic, but whose brain virtually freezes when faced with questions on an exam? Who we are teaching and how we are teaching is, in a sense, as vitally important as what we are teaching. As Grant noted in his paper, "Foremost, we should remember that massage, like musicianship, is primarily a kinesthetic skill coupled with supporting skills of communication, rapport building, observation and entrepreneurship."


How We Teach, How We Learn
In Feb. 2002, Massage Today published results of a reader poll. The question, "How would you rate the training you received in massage school?" brought a response from 328 therapists. Nearly half (45.4%) rated their education as poor, with another 9.8% rating it as fair. These numbers may or may not be representative of those practicing massage across the country. And certainly they would not apply to every school. But the question has been raised, "Are we teaching students well?" Self-examination is not always easy, but it is often a necessary step to growth.

"Within the academic setting," wrote Grant, "students can learn to be successful with short-term memorization and use of 'right-answer' cues. In contrast, actual practice requires very limited memorization of facts. The massage practitioner must have the deeper understanding required to find information as needed and then to be able to use it to make therapy decisions in the face of ambiguity. Research indicates the environment that seems best able to foster the understanding leading to usability has much in common with traditional apprenticeships. In the modern cognitive apprenticeship, however, it is not just the tasks but the thinking underlying them that must be made 'visible' and reflected upon. Such apprenticeships can be created within the context of traditional schools. A modular, tiered program can move the student into early practice, while providing resources for the ongoing training and dialogue that passes from teacher/mentors to increasingly skillful practitioners. There should be a progression of successively more difficult tasks within the conceptual scaffolding and coaching provided by mentors. Testing should not be concerned with memorization and regurgitation but with the student's ability, on being presented with relevant data, to choose among conclusions that can be drawn from it. Within the profession of massage, it is time we base our training requirements on 21st century insights into how people learn."

So we start with apprenticeship, a time-honored technique. Has this approach been lost in the shuffle of massage curriculum? Rose A. Gowdey, an organizational consultant and former director of Potomac Massage Training Institute in Washington, D.C., thinks not. "It looks different," she said. "But in any schools that continue to do practical testing where the students are working on instructors, I would call that apprenticeship, although it's not exactly precisely so. With small (student to teacher) ratios, you're doing a variation on apprenticeship. It begins to communicate what can be learned from a person when one is standing next to each other, rather than one in front of the other," said Gowdey.

n the other hand, said Pat Benjamin, dean of the Chicago School of Massage Therapy in Illinois, "It's not practical or desirable to go back to apprenticeship. There's something to be gained by an institution that has a lot of people involved in it. In an apprenticeship, you are limited by working with one person." Students get a broader view being exposed to a greater number of teachers. If the class size is small enough, the student can get individual attention.

Benjamin said the predominance of schools versus apprenticeships has shifted. "Licensing has had a big impact on that, but also the expectations of the general public about what massage therapists should know. The public is more savvy about what a good massage is," she said.

Benjamin said the Chicago School has an externship program. Students get practical experience through the in-house clinic where there is a small ratio of teachers to students, as well as working in external massage therapy settings. "That's nearer an apprenticeship. By having a more personal relationship, you do incorporate aspects of that in training."

Jack Brownfield agrees with the concept of more is better when it comes to numbers of instructors. As director of education for integrative massage and deep tissue therapy at the Atlanta School of Massage in Georgia, Brownfield is a supporter of having standards for training. "The student doesn't necessarily know what is missing when working with one person. That one teacher could have great skills or could be weak in some areas," he said recently. By offering a variety of instructors, the school provides a collective experience and creates a more well-rounded education. But, he added, "Apprenticeship is very much needed after graduation." Borrowing from the fields of psychology and counseling, Brownfield advocates a form of apprenticeship in the guise of supervision, whether individual or in a group. "It's an idea that's getting established as the profession matures."

According to Deborra Clayton, administrator of the San Francisco School of Massage in California, supervision can take the form of post-graduate coaching. "In every other physical art, coaching is such an acceptable thing," she said. "Ball players and vocalists wouldn't go without a coach, for instance. It's not about learning new things, but having someone with mastery observing from the outside." Aside from her teaching role at the school, Clayton offers private coaching services to former students. Within the school setting, students are also afforded a type of informal apprenticeship if chosen by the faculty to provide teaching assistance.

Whether we use the term apprenticeship, mentoring or supervision, the concept of "hands-on" experience guided by an expert is essential to massage therapy training. How much of that experience students receive in their curriculum is determined by each individual school. For some students, this is a critical matter. As a kinesthetic art, massage naturally attracts many kinesthetic learners. So the question arises, are students who would otherwise emerge as highly-skilled therapists being weeded out by massage school curriculum geared toward passing a national certifying exam?

Grant emphasized this issue: "There is every reason to expect that there will be those who are highly competent in interpersonal and kinesthetic intelligences yet fare poorly when forced unnecessarily into the verbal-linguistic paradigm of the academic world...In continuing to unnecessarily push massage entry requirements into areas of psychometric testing and increased hours of book-based anatomical and physiological training to satisfy a medical model of massage, we are likely doing untold harm to those who would otherwise be highly competent practitioners from a more kinesthetic, experiential approach."

As an educator and researcher, Grant has done his homework on learning styles and the process of learning, documenting information from such leaders in the field as Howard Gardner and Mel Levine. Gardner's work points to "multiple intelligences," the brain-based differences in the learning processes of individuals. Levine's nonprofit institute, All Kinds of Minds, provides help to students, parents and educators in identifying, clarifying and working with these differences in brain wiring and learning abilities. Levine's book, A Mind at a Time, also outlines this approach and identifies the eight neurodevelopmental systems involved in learning: attention control, memory, language, spatial ordering, sequential ordering, motor, higher thinking, and social thinking.1 For each individual learner, there may be strengths or weaknesses in any of these areas, and yet our formal education system has typically taken a "one size fits all" approach to classroom instruction.

Are massage schools addressing this great diversity of minds? Some schools are. At Lifestyles Learning Center in (where), owner Dr. Jerry Blackburn has made a point of it. A self-taught proponent of learning styles education, Blackburn has instituted a profiling process for his students to determine their learning type. He then adapts the instructional approach to address those differences. "I use it in application to myself more than anything else, techniques I have tried that actually work. It's so simple. What it does for people who have been caught in the educational problem of not being able to learn is to change their whole outlook on learning."

While not all massage schools can claim this achievement, the idea of addressing learning styles is rapidly gaining momentum in the industry. At Atlanta School of Massage, a learning skills-style inventory is used to help students understand their own learning style. "They can then take greater responsibility for their learning within the classroom," said Brownfield. In fall 2002, the school was also planning to implement a learning-styles inventory developed by Shelley Loewen called the TIPP system. "It has to do with what the person values," said Brownfield, "not only how they process information but also their character, how their personality is structured. We want to see if that yields more information." The school's instructors have also taken the inventory to gain understanding of their own learning styles, which ultimately affects how they teach. Brownfield noted that as an auditory learner tending toward verbal instruction, he also has to remember to add visual aids, to round out his approach. He expressed excitement, not only about his own school's forward movement, but that of others. "I've been going to (massage school) conferences for five years. No matter how long the schools were open, all were very interested in how to improve their schools - how they could teach better and how students could learn better. I think the majority of schools have their hearts in the right place."

Ray Siderius, president of the Oregon School of Massage, offered his take on the current state of massage education and his school's attempts for improvement. "What we found in our program was that a portion of students, those younger and/or less experienced, need more structure or guidance going through training - more focused integration. For example, they can take 100+ hours of electives (in addition to basics) in their program. Some take things that interest them and give them specific skills, but they may not be packaging their skills appropriately. Some students need the pieces woven together. Part of that is personal growth and maturity, as in any group. Has he or she been in an environment where they've had experiences developing their learning skills? Do they know their own emotional state and tensions? Maybe they can learn and not have a sense of how they've learned.

"For those of us involved in it," he asked, "are we interested in education on enough levels to recognize the diversity of cultures we work with and deal with that effectively so we can support the learning and development of our students? There are some people who work better under the apprenticeship system, who are not as adept at negotiating more formal education requirements. That's something those of us in the profession need to pay more attention to."

These school leaders recognize the diversity of ways that individual students learn most effectively and are trying conscientiously to tailor educational programs to reflect this diversity. Unfortunately, not all massage schools are so thoughtful. Too many do adopt a "one size fits all" stance, pushing students through a standardized experience, focusing laser-like on the book knowledge which must be mastered to pass the National Certification Exam.

Few school directors seem willing to challenge "the system," to ask whether our gatekeeping criteria for entry into the profession focus on the right skills and qualities. If we did, Grant would say that NCBTMB job surveys would uncover success characteristics that more effectively get at kinesthetic, observation, communication and entrepreneurial dimensions involved in establishing a practice and serving clients. And more school programs would effectively accommodate and support individuals gifted at touch but less comfortable with book-learning and test-taking.


Beyond the Academics
"I tell my students there are two kinds of massage therapists: those with clients and those without clients," said Dennis Simpson of the Colorado School of Healing Arts in Lakewood, Colo. "My question is, what makes those with clients successful? Is it the quality of education? Is it the quality of their touch? Or is it a genuine understanding, sensitivity and insight into the human condition?"

Learning to successfully apply touch for healing, and then marketing that skill goes far beyond the text books and classroom lectures, and even beyond the hands-on practical experience. Becoming psychologically prepared and business-savvy to practice on one's own is an issue affecting many students. Are schools doing a good job with this as well?

"I see a tremendous lack of attention to the teaching of business basics for massage therapy practice," said Blackburn, who has a marketing background. He teaches 70 hours in business and business practice plans. "I don't know any others offering so many hours. There's far too little literature and it doesn't really address the client and therapist relationship and how it's used for business." Knowing how to present oneself when the client comes through the door is important, not in a mercenary way, he noted, but in the sense of expressing pure intent to help the client.

Siderius sees variations throughout the country, depending on whether therapists gravitate toward working as an employee or establish self-employment. "There's a world of difference in being successful along those two paths," he said. "As a school leader, I think we need to evolve our ability to assess needs a little more. It has started to happen here. There's a lot of overlap, but also an additional different set of skills needed by someone with a free-standing massage practice."

Gowdey also noted a variation among schools in addressing psychological and business issues. "There are some that have it down pat and others are still building it. I see the membership associations beginning to do some work in that area." While some schools consider psychological issues to be a built-in part of curriculum, others deal with issues as they arise, without a systematic approach.

Despite the massage schools' best intentions, not all newly created therapists will survive the rigors of the real world. "People don't realize the work that lies behind or between the sessions," said Grant in a personal interview. "You have to be willing to get out there and market yourself, have self-confidence and self-esteem, and be willing to ask for advice." There's also the need for outside social interaction and non-professional relationships. "How to develop that should be touched on in schools."


Serving and Being Served
Grant points out that the question remains as to who is being served in our current educational approach. The verbal/linguistic ability to memorize information and recognize answers on a test, said Grant, "is a separate set of skills from being able to organize that information, use it in actual practice and be able to apply kinesthetic and interpersonal skills. So I think that hurdle tends to eliminate people who could be competent practitioners." What he terms the "gentrification" of massage closes the door to some. "It's almost an issue of white collar versus blue collar, making it white collar academics, while the public just wants good service."

In his white paper, Grant wrote, "In insisting on long monolithic school-based programs, we are ignoring the opportunities to use massage for community outreach and self-help." He envisions a system in which the door to massage would be open to the economically depressed or disadvantaged. "There are people who don't work well with higher education, but can learn experientially to provide touch," he said during an interview, referring to a program now being offered through McKinnon Institute's Touch Health Association. As a community service agency, the association has established a new infant massage program, based on the successes of the Touch Research Institute in Miami in working with low-income and high-risk mothers. Through this introduction to massage, it is hoped some of these women will want to continue their study through McKinnon scholarships and be placed in nonprofit organizations to provide services to those who otherwise could not access massage treatment. The concept not only addresses those who are currently deprived of massage for financial reasons, but also conquers the financial blocks for those who show potential as healers. As Grant noted, this approach could have significant impact on our current family problems with violence and inability to nurture.

In reviewing this article, Massage & Bodywork publisher Bob Benson notes that, "Most of the school leaders interviewed who see the value of internships view those as logically being capstone experiences - either the final part of school curriculum or a post-graduation experience. Perhaps the profession might benefit from a bit more openness to Gardner's and Levine's insights and to potential value from providing an internship experience perhaps half or two-thirds of the way through a structured program."


Agree to Disagree, and Move On
In the final analysis, the experts all agree that cooperation is needed in determining the future of massage education and regulation. "I feel a real strong need," said Blackburn, "for associations to put their differences aside and start working on a national direction and policies so we can go forward with leadership that will take our profession in a direction that will include everybody from all types of disciplines, and not exclude anybody because of point of view."

Simpson said a colleague once told him at a convention that getting massage therapists together is like trying to herd cats. It made him laugh, but he also wondered if there might be some truth to the statement. He pointed to the many opinions on issues that face the profession. "None of the people I spoke with like the suggestive ads - that's something we all agree on." But when it comes to all the other issues, there are disagreements. "I always start out by asking: what's broke that we're trying to fix? I sincerely hope the profession moves forward in a positive manner," he said.

While speaking to national assessments and how the industry is approaching education, Grant brought up the old story of the man who was looking for his keys under the lightpost. That wasn't where he lost them, but the light was better there. Are we searching for answers in well-lit, familiar places while solutions are to be found by probing the dark unknown? The future of massage therapy education, as well as the industry itself, will be determined by the willingness of all participants to embrace self-examination and sound debate, and then to move forward with positive change.

Shirley Vanderbilt is a staff writer for Massage & Bodywork magazine.

References
1 Levine, Mel. "Eight Systems." Library Excerpts: A Mind at a Time. www.allkindsofminds.org/library/excerpts/ aMindAtaTime.htm.