Last year, I authored a white paper entitled, "On Becoming a Profession: The Challenges and Choices that will Determine Our Future." This provided an overall analysis of how the field of massage therapy was organized, in relationship to the structure found in mature, or fully-formed professions. There were also policy recommendations directed to the leaders of the stakeholder organizations for foundational changes that would bring greater consistency and congruence to teaching, practice and regulation of massage therapy. In the 18 months that have elapsed since the publication of that paper, there has been a considerable amount of activity on the massage therapy landscape.

The report card is mixed, however, as there are signs of excellent progress along with some troubling trends. At this juncture, it makes sense to look beyond our own field and get a clear model of the structure (and function) of what is called a profession. This will facilitate understanding of where we collectively stand, and will inform the work that must still be accomplished over the years ahead.

While each mature profession has its own developmental history, culture, and methods of operation, there are six basic components that are common to all. These are: 1) membership association; 2) independent organization of colleges or schools; 3) accrediting commission; 4) federation of state licensing boards; 5) specialty certification boards; and 6) research center.

To visualize this model, it is helpful to view these components as a set of interlocking hexagons that fit together in an interactive matrix. (See Figure 1.)

As you can see, this creates a geometric structure that is inherently strong, and that has a well-defined center. Each component organization functions independently, according to its own bylaws and strategic plans. At the same time, each is part of a unified whole where individual actions directly influence the entire profession.

The health of a given profession depends upon the ethical and efficient operation of each entity, as well as its relationships with the others. To address the collective needs and challenges of the profession, there must be ongoing dialogue, planning and cooperation among the leaders of these organizations. This provides a crucial integrating function.

Here are descriptions of each of the basic components, along with the identification of the stakeholders in the massage therapy field that fit into each category:

Membership Association. This is the central meeting ground for practitioners in a field. A professional association represents its members and provides an array of services and benefits to them. It also serves as the "face" of the profession to the public. These associations may also participate in the determination of standards of practice, and are often active in the area of government relations. Most (but not all) professions have a single organization that provides this function. In the massage therapy field, we have two major groups: Associated Bodywork & Massage Professionals, and the American Massage Therapy Association. AMTA has been in existence for 66 years, and currently has around 57,000 members. ABMP was launched in 1988, and recently passed the 70,000 member mark. 

Independent Organization of Schools. This entity is comprised of the colleges or schools that provide the education that is required to enter a profession. These associations represent the interests of its member institutions, and provide information, resources and forums for networking. There has been a recent shift in this arena for the massage therapy field, as AMTA disbanded its Council of Schools on October 1, 2009 through a change to its bylaws. In September of this year, the Alliance for Massage Therapy Education was launched, which is structured as a fully independent organization that will serve as an advocate for massage schools and educators. The Alliance is positioned to "fill in" this key piece in the overall structure.

Accrediting Commission. In most professions, there is a single accrediting agency that operates a quality assurance process for the educational institutions of that discipline. These agencies must go through their own "accreditation" process with the US Department of Education to be officially recognized to perform this oversight function. It is the norm, rather than the exception that all training institutions in a given profession must be accredited. However, accreditation is not broadly required for massage therapy schools. Approximately 40% of our schools are accredited, and there are seven different USDE-recognized agencies that are involved. The Commission on Massage Therapy Accreditation (COMTA) is the only agency that was established solely for the massage field. ABHES, ACICS, ACCET, ACCSCT and COE are all broad-spectrum vocational accreditors that also oversee certain massage programs. NACCAS deals primarily with the field of cosmetology, but expanded its scope into massage therapy a few years ago.

Federation of State Licensing Boards. Most mature professions have 50-state licensure with consistent regulations among all jurisdictions. This makes possible what is known as "portability" or professional mobility. An association of state licensing agencies is the structure that coordinates activity and helps establish standards among its member boards. In addition, it commonly provides the entry-level national licensing examination that boards utilize for the mandatory process of licensure. In 2005, the Federation of State Massage Therapy Boards (FSMTB) was established for this purpose. It developed and currently administers the Massage and Bodywork Licensing Examination (MBLEx), that is in use by many of the state boards.

Specialty Certification Boards. The structure found in most professions is one of mandatory licensure at the entry level, and then a set of specialty certification programs at the post-graduate level. These voluntary programs are the means by which practitioners earn "advanced" credentials in recognized areas of practice. In some fields, these programs are maintained by professional membership associations. In others, there are national certification boards organized solely for this purpose. These agencies may be dedicated to just one area of specialized practice, or may choose to operate programs in a range of specialties.

This is one of the areas where the massage field is farthest from the model of mature professions. The National Certification Board for Therapeutic Massage & Bodywork (NCB) has been operating an entry-level certification program since 1992, but our field still lacks recognized specialty certification programs. NCB's National Certification Examinations have been utilized by most states at one time or another in place of a dedicated licensing exam. However, the landscape has changed with the advent of the MBLEx - which properly shifts the administration of entry-level testing to FSMTB. With this first-stage credentialing being handled by FSMTB and its state massage boards, NCB has the opportunity now to shift its operating model to become the provider of a series of specialty certification programs for the massage field. This would certainly bring us further down the road towards becoming a full-fledged profession.

Research Center. Evidence-based practice is the watchword these days, and it is research that provides the evidence of what works and what doesn't. Some professions have a dedicated research institute or entity, while others have research components built into academic institutions, hospitals and other stakeholder organizations. In our field, we have the Massage Therapy Foundation that serves as an advocate for research in our field, and for making grants to research studies and community outreach programs. The Foundation also supports the education of massage students and therapists in gaining greater research literacy.

What happens when any one of these components is missing from the overall structure? Or how is the entire profession affected when one organization is not running well, or begins to act in its own self-interests to the exclusion (or detriment) of the others? (See Figure 2.)

This graphic illustrates the result: the interlocking connection between and among all components is absent, which causes each organization to focus inwardly on its own domain. In short, it's a random structure that lacks a center.

As we assess the status of the massage therapy field, it's essential to be honest about where we are. Despite the common use of the phrase massage therapy profession, we are not yet operating at that level. While our field has grown dramatically in size over the past 30 years, it is plagued by incongruities in the domains of education, practice and regulation. It will take the concerted and well-coordinated efforts of all stakeholder organizations to move us in that direction.

One bright spot in the current picture is the Massage Therapy Body of Knowledge Project. In my white paper, I wrote about the need for such a project, which optimally would be carried out by an independent commission of subject matter experts from our field. I'm happy to say that this foundational effort that is being backed by a consortium of six organizations. The work itself is being performed by an eight-member independent Task Force, and facilitated by an experienced project manager. The first phase of the BOK project will determine the knowledge, skills and abilities for an entry-level practitioner of massage therapy, and will outline the scope of practice. These are the essential elements that will make possible the future establishment of more consistent standards in all aspects of our field. This is evidence of significant movement towards becoming a profession.

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Editor's note: The 2008 white paper "On Becoming a Profession: The Challenges and Choices that will Determine Our Future," may be accessed at: www.massage.net/articles/pdfs/Rosen_On-Becoming-a-Profession.pdf.