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An Issue of Ethics: Spring 2003

The die is cast for a new era in the very young life of massage therapy as a regulated health care profession. The challenging and promising future of massage therapy today is confidently grounded in a vision that includes higher education, national accreditation and research and publication.


September 17, 2009
By Cidalia Paiva

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The die is cast for a new era in the very young life of massage therapy as a regulated health care profession. The challenging and promising future of massage therapy today is confidently grounded in a vision that includes higher education, national accreditation and research and publication.

The path for massage therapy is becoming increasingly clear and portrays us emerging as a vibrant part of the newest buzzword and concept in health care, integrative medicine. Traditionally and significantly some of the most formative attributes of credible and highly recognized health care professions include higher education, national accreditation including standardization of licensure requirements, and research and development.

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The recent partnership between WCCMT and Kwantlen University College in British Columbia in order to create a Bachelor’s Degree in Massage Therapy will unequivocally and historically raise the level of
massage therapy education and create career mobility within the health care sciences for graduates
of massage therapy programs. This innovative partnership will begin to bridge the gap that has previously existed for graduates of Canada’s private massage therapy colleges.

It will also dramatically contribute to our public profile as a health care profession as we endeavour to bring massage therapy on par with nursing, physiotherapy, chiropractic and naturopathic medicine. Similarly, the desire to create a national accreditation body and organization that includes both an institutional, and in time, logically and sufficiently a programmatic accreditation component will assist us in acquiring this necessary professional attribute.

Finally, and with no understated synchronicity, as the International Symposium on Touch and the research issue of Massage Therapy Canada both highlighted, we are taking another giant step forward towards creating a research agenda for the profession of massage therapy in Canada.

Following consciously and unconsciously in the tried and proven social and political “shoes” of our colleagues in physiotherapy we are earnestly emulating the best aspects of this profession that has resulted in their survival, continuity and continued growth.

We are moving with unprecedented speed towards becoming what we need to be in order to meet the challenges of a changing socio-economic reality and in the face of a growing crisis in health care and a failing Canadian health care system. We are likely to try and find our way much like our first cousins the physiotherapists.

We embrace our future in the hope that science can enhance and validate our hands and the clinical skills that are the body heart of what we do. We place much in the hands of science and its faithful facilitator, higher learning and research.

Proactively and with conviction we are integrating clinical skill and science as two separate but related sides of the same coin we call the future of massage therapy. It is a labour of love and perhaps a magnificent preoccupation, yet there remains a missing piece in this dramatic puzzle.

Even a rudimental and cursory reading of curriculum offerings in the field today clearly demonstrates a significant lack of focus and development of the art as distinct from the science of massage therapy.

We seem to have forgotten or at least put aside the part of massage therapy that gave birth and the
breath of life not just to our healing profession but also in fact to all health care professions.

The vocational heart of massage therapy and the healing professions can be found in the Hippocratic Oath, the Pledge of Florence Nightingale, and perhaps the lesser known Oath of Maimonides, a Jewish philosopher of the 13th century.

As the poignant words of this oath state, “May neither avarice nor miserliness, nor thirst for glory, nor for great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good for my patients. May I never see in a patient anything but a fellow creature in pain.”

The physician was moved to heal by his desire to respond to human suffering in a compassionate human way. The flame of his passion was not science or even skill but rather science and skill were the dedicated facilitators of his vocational calling.

Historically speaking at least then intent which has formed and informed the art of massage therapy (and arguably I suspect all health care professions) marked our beginning and the earliest expressions of the professional promise.

It may perhaps be qualified that this is simply a historical truth that has become antiquated and therefore not really applicable today. That is to say massage therapists today honour a very different first premise.

However, unwaveringly when students at our college are interviewed for admission and asked why do you wish to pursue a career in massage therapy and what do you have to contribute to the profession, they respond steadfastly and consistently that they want to help others.

Science and clinical skill at least upon entry into professional training for massage therapy students remain the humble facilitators of their noble aspiration. Their commitment, though not always particularly sophisticated or eloquent in its expression remains the same: “I want to help others. What I have to give is that I am a caring person.”

Likewise, the historical roots of massage therapy as an esoteric and even fringe therapy finds its place
in an older vocational group who sincerely sought to “help” others in a personal way. In fact much of the early curriculum which evolved in the private massage therapy colleges, included a naive but sincere effort to offer courses emphasizing caring and the affective component of therapy. In fact, in our innocence, we naturally and enthusiastically merged the touch of life with our vocational intent. 

The art of massage therapy articulated in terms of the affective intent of the therapist is in historical fact part of the very core identity of massage therapy and as much a part of what we do as our hands. To separate art from science, clinical from affective is to fall back into the dreaded Cartesian dualism that we have sought to eradicate.

In 1642, French philosopher Rene Descartes published a book which has played a central role in both modern philosophy and science.

The book, titled “Meditations on First Philosophy,” provided a comprehensive worldview based on the separation of body and mind.

Descartes believed that the world could be divided into two separate and distinct realms, the realm of thought and the realm of things.  Mental phenomena, like thoughts, ideas, images and emotions, occupied the first realm. Physical objects, like trees, rocks, plants, houses, etc., occupied the second. 

In this scheme of things, thoughts could not affect things, and things could not affect thoughts. The human body was part of the realm of things, while the mind was assigned to the realm of thought. Three hundred and fifty years of science and philosophy have been built on this Cartesian split between body and mind.

The idea that mind could affect body has been challenged in recent years. Research findings in various fields have clearly demonstrated the effects of mental states on physical states. Specific contributions include the work of John Basmajion in the field of biofeedback and the exciting development of the field of psychoimmunology which studies the mind’s influence through the nervous system on the body’s defence system.

More specifically, for our purposes, Manfred Clynes’ studies examining the connection between feeling and thought and demonstrating that depth, direction and duration of touch are related, not only to events taking place within the body, but also to underlying emotional experience.

In landmark studies spanning several decades, Clynes studied the connection between feeling and touch. His work served to illustrate the elemental emotional qualities communicated by the body’s language of touch.

The new mind body model of health care that emerged as a result of these findings did not do away with the physical approach; but rather inspired in some cases the two to join hands. For example, in treating cancer today, psychological counselling is used in conjunction with surgery and chemotherapy.

A new term was coined to describe this union, “complementary medicine.” Though a dramatic and decisive break from the dualistic model of the past, the new medicine shared with the dualistic model their view on the essential nature of the mind. In both, mind and consciousness are generally equated with the brain and are assumed to be by-products of the brain’s chemistry and physiology.  

While health care professionals often pay lip service to the importance of the mind in health care, in practice they equate it with the brain. Support for this claim is aptly provided by our reliance on drugs in dealing with and treating mental health problems. In the 1980s, for example, anxiety was perceived as arising as a result of a Valium deficiency in the brain and in the 1990s was equated with a lack of prozac.

In the new medicine, self-ascribed as alternative to the brain body medicine, a new direction was forged.  Massage therapists, as part of alternative medicine, granted a major role for psychological and spiritual forces in health care and do not consider the mind to be identical with the physical brain. Even when utilizing physical strokes, i.e., kneading or rubbing massage therapy still recognizes the results as affected by psychological and spiritual factors.

The application of this reality, according to John A. Astin, Stanford University School of Medicine, is the main reason people gravitate to alternative medicine. In his article, “Why patients use alternative medicine,” in the Journal of the American Medical Association, he writes: “Users of alternative health care are more likely to report having had a transformative experience that changed the way they saw the world. They find in alternative therapies an acknowledgement of the importance of treating illness within a larger context of spirituality and life meaning. The use of alternative care is part of a broader value orientation and set of cultural beliefs, one that embraces a holistic, spiritual orientation to life.”

Massage therapy knew intuitively and perhaps even instinctively as psychologist Carl Jung states, “Learn your techniques well, but be prepared to drop them when you touch the human soul.” Massage therapists have embraced “integral” medicine as opposed to “wholeness,” a word and concept shunned today because of its historical affinity with some of the more fringe health care therapies.

From this awareness, this primitive unspoken but deeply felt first principle, we have created what has become an underground component of art to complement our sciences.

This art component has typically been explored in the context of a concept which we shall describe
as intentional caring.

The word intention comes from the Latin intentus and literally means to stretch out or stretch toward. 

A research project conducted by the National Institute of Mental Health measured the psychotherapeutic effects of intention. Clients were randomly assigned to either trained or untrained therapists with little or no difference in outcome during the first six months.

However, when the untrained therapists were taught and in turn practiced empathetic listening skills, their effectuality exceeded and surpassed that of their trained counterparts.

The only difference between the two groups of therapists consisted uniquely of the second group’s “intention” to support the client in a caring and compassionate way.

Patients consciously and unconsciously test and sense the therapist’s intent. Like a person testing the hot water in his bath, the patient continuously explores and assesses the therapist’s intention. When these intentions appear to create a safe environment, where the client is valued and respected, the patient emerges fully present. The integrity of the intention is communicated in the touch.

Without changing the nature of physical contact, nearly all patients can sense the change in intention.

Perhaps the most powerful form of support for the effectuality and relevance of intention is found
in the Einstein, Podalski, and Rosen paradox. The debate between the relativists (Einstein among them)
who held that reality can be described based on observations made and measured and quantum theory which held that only tendencies and probabilities about reality can be described was resolved in a research lab where a pair of particles was separated by distances too great for any known force to operate.

Nevertheless, when the spin of one was altered, instantaneously, so too was the spin of the other.

What the EPR paradox told us about intention was that in the order of reality, wholeness, or to use a more fashionable and politically correct term, integrity, not separation is fundamental. When one human being reaches out to another, the conclusion of the EPR paradox re-inforces itself over and over again.

Intentional caring involves taking our goodwill and, sincere desire to facilitate the healing of another, and making it the paramount guiding and directing energy behind our hands. It entails remembering at all times that we are after all dealing with integral people for whom presence is the greatest gift and blessing we can confer.

When we intentionally care for another, we bring our being, body, mind, heart and soul to our treatment rooms and administer in a focused presence the professional promise of serving the best health care interests of our patients. We do this because we are caring, integral people pledged in service to others.

In a dynamically changing health care world we all face a great unknown but we bring to this
challenge passion, commitment and the full and certain knowledge of who we are and where we have come from.

We are clinicians, we are becoming scientists but we have always been and hopefully always will be healers who value heart and the affective component of massage therapy.

If we wish to remain integral to what brought us to health care, fidelity of purpose, fidelity to our world view of health, and fidelity to our belief that intentionality directs and grounds technique, we must
create a conscious agenda that will support this goal.

A commitment to focus on the art of massage therapy, not to the exclusion of science and clinical skill but jointly with these must be part of our future. The veracity in the statement that the future belongs to us has never been more prophetic or true.

The future belongs to science, skill, and hopefully to integral people treating integral people in a connected and related human universe.


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