Regulation of Touch Therapies Is Not An Easy Thing.

By Linda Diane Feldt
Originally published in The Crazy Wisdom Calendar May-August 2002

In an effort to weed out prostitution, the city of Ann Arbor is considering an ordinance which might potentially regulate massage therapy and bodywork – who can practice and what training is required – in an effort to be certain that massage therapists and bodyworkers are not sex workers. We asked a leading local holistic health practitioner to comment on the issues involved.

(Editor's note – Linda Diane Feldt is a Past President of the American Polarity Therapy Association, and a former Board member of the NationalCertificiaotn Board for Therapeutic Massage and Bodywork. A student of the healing arts since 1973, Linda Diane has had a full time private practice in ann arbor for 22 years. She is the author of Dying Again: thirteen Years of Writingand Waiting and Massage: Learning to Give and to Receive.)

Ann Arbor's reputation as an "alternative friendly" place is widespread. In the area of alternative health and healing, Ann Arbor has been a prime location for conferences and trainings, and has nurtured many leaders in the field of complementary and alternative medicine.

The Ann Arbor area is home to approximately 1,000 practitioners in the fields of massage therapy, bodywork, skilled touch, movement education and somatic practices. The presence of a National Institute of Health Complementary and Alternative Medicine Research Center affiliated with the University of Michigan has further cemented our reputation as a hot spot for alternative therapies. For two years, the University of Michigan Medical School has required that all first year medical students be exposed to information, lectures, discussions, and a personal visit to observe and consider CAM practitioners. I had the privilege to be a part of the faculty for a popular graduate level interdisciplinary course on Complementary Therapies and Alternative Healing last semester.

Readers of the Crazy Wisdom Calendar would not be surprised that there are over 100 types of healing work being practiced nearby. The Eisenberg studies of 1993 and1996 reported in the New England Journal of Medicine showed that 42% of the population had used CAM therapies, and that number was even higher for women. It would be reasonable to assume that Ann Arbor – which has supported CAM practitioners for decades -- would boast an even higher rate of CAM use, and that a substantial portion of that would be with hands-on therapies, similar to what Eisenberg found.

All of this exists within the non-regulated climate of the state of Michigan. Consumers have had success finding the practitioners they want, reasonable prices are charged, and people generally confine their work to what they are trained to do. We have been helping people. We have been contributing to our community through our work, by being dedicated healthcare providers, and by living and contributing as everyone else does – volunteering, paying taxes, supporting local businesses.

How, then, did we ever end up in the situation we now find ourselves in – fighting to stop a proposal to regulate massage and bodywork, a regulation proposed for one reason only – for bodyworkers to prove that they are not prostitutes.

Many years ago, but recently enough that it affected my work when I first began to practice in Ann Arbor 20 years ago, massage and prostitution were often linked. Claiming to be and advertising as a "massage parlor" was a well-recognized euphemism for the sex trade. In the seventies, when I began my training, Ann Arbor had a number of massage parlors in operation, where sexual services were also for sale. They were closed. A few "health spas" continued to be operated, rather openly and blatantly, were sexual services were presumed to be available. These spas were recently closed after an Ann Arbor police investigation. Neighbors of these closed spas I have talked to have noted that they were not surprised that the spas had illegal activity going on, only the extent of the exploitation of the women involved.

It is notable that the closed facilities used the term "health spa" rather then "massage parlor". This is part of a national trend, which would appear to be the result of successful work on the part of many professionals in the field over the last few decades to legitimize the term massage. Research and consumer surveys leave no doubt that massage is now thought of first and primarily as a legitimate, legal, and honorable profession. Skilled touch and bodywork are also gaining recognition and their share of consumer awareness and respect.

We have won the war, but suddenly have been challenged to a new battle, here in our aware and supportive community. The Ann Arbor Police response to the closing of these health spas, and the attention on prostitution, is to inexplicably determine that massage therapists and possibly bodyworkers, should now be regulated as the most cost effective way to prevent future episodes of prostitution in Ann Arbor. No new attention or regulation of escort services (another euphemism often used by the sex trade) health spas (where the alleged illegal activity took place), or others who have a direct association with adult entertainment has been announced, and in a meeting with the Chief of Police he affirmed that the only plan was to regulate the legal profession of massage.

Regulation of a profession is most often accomplished at the state level. Doctors, lawyers, dieticians, social workers, contractors, cosmetologists, are all licensed by the state. To single out a profession for more stringent local attention is rare indeed. It is however something that massage therapists have been subjected to nationwide. Over the last decade this has been gradually changed to state regulation, more than 30 states now regulate massage and sometimes bodywork on the state level. Massage therapy and bodywork are emerging professions, still in a somewhat state of adolescence. Repeal and replacement of local regulation with state oversight that conforms to how other professionals are treated is a part of that maturation process.

In this case we have a progressive community, with a great acceptance of alternative therapies and bodywork, turning back the clock thirty or more years to address an association that no longer exists. If this local ordinance to regulate massage therapists passes, it will link massage and prostitution by law – a link that hasn't existed in the minds of the general population for at least a decade, and more nearly thirty years.

Regulation of touch therapies is not an easy thing, nor is there agreement about how and if this should be done. There are some areas of greater agreement, however, that have emerged from the ongoing debate on this subject.

Let us begin with the intent of regulation. To regulate with the sole intent of identifying and stopping prostitutes has few supporters in the bodywork community. There isn't evidence that this works, it is insulting in its premise, and prostitutes certainly have the capacity to become legitimate massage therapists – although combining the two would be a violation of ethics as well as state and local law. Ideally regulation benefits the consumer, provides information on the education and training of professionals, and standardizes the use of terms describing a profession. There is no consumer benefit that can be derived from this proposed ordinance. If anything, the costs associated with regulation would add to the costs of doing business, which is passed on to the consumer.

The current context for alternative therapies is one of exploration, evaluation, and acceptance. It is important to nurture the alternative practices in place, and that are developing. Any regulation needs to be mindful of the importance of diversity for consumers, the difficulty in defining and setting standards for new and traditional approaches to healing, and the real lack of resources that part time and other "fringe" practitioners have available. Excessive or overly encompassing regulation could easily put people out of business, undercover, or never to venture forth.

Regulation, by its nature, creates a boundary of those who are in and those who are outside of the law. This deserves very careful consideration. In Ann Arbor we have practitioners who have been in practice for years who may not meet the current "standards for practice, such as education from a state approved school. Many of us trained before there were state approved schools, often by a succession of workshops and apprenticeships. In most local and state ordinances, there is no room for recognition of this sort of training. Who is qualified to determine who is qualified to practice? While many find this question easy to answer, there is no universal agreement and those who are deemed "unqualified" certainly deserve to be heard.

Regulation also requires a very clear definition of who will be regulated, and who will not. Defining massage too broadly has resulted in some legitimate professionals in other fields of bodywork to be unable to practice in their state. With more than 100 identified "touch" therapies in Ann Arbor, drafting an ordinance to affect massage therapists and only massage therapists is not a simple task. "Scope of Practice" is a concern in many healing fields. The scope of practice is best determined and defined by the professionals, often through a professional association, who practice each modality. For your profession to be defined, and limited, by a sister profession is problematic. For a state or locality to regulate a profession without substantial agreement and input from members of that profession is also egregious.

Using a national certification exam (NCE) for regulation is another complex topic. In short, a national certification program offers the benefits of a psychometrically developed examination, restricts by having established requirements who can sit for the exam, provides an ethics document and complaint process, and continuing education requirements. Many states and cities have chosen to use only the exam part of the program. This results in the peculiar situation of having a "formerly nationally certified" practitioner, as well as allowing for those who have lost their certification to continue to be licensed. Including reference to a national certification process has to be carefully considered, with full awareness of the costs to the practitioner and the restriction inherent in the exam process. Becoming nationally certified, and continuing that certification is not inexpensive. At the state level, a professional would expect to pay hundreds of dollars for state recognition of their profession. For this investment to be limited to "legal standing" for just a few square miles within a certain city is not as clearly beneficial. A much longer article on this topic, which goes into more depth on important issues, is available from the author.

By the time of this publication, this issue may have been put to rest for Ann Arbor. It may also have heated up to the point of open conflict and argument. In either case, state regulation is very likely to be next on the agenda and we must prepare, either proactively or reactively. Creative, consumer positive, regulation would be welcome. Regulation that favors one group or approach financially or otherwise should be resisted. An essential component of any regulation is recognition and nurturance of the diversity of the touch professions in their approaches and training. The Federation of therapeutic Massage Bodywork and Somatic Practice Organizations, in their consensus document on legislation recommends that a coalition approach be used. (www.adeptsys.com/federation)

A coalition [a temporary alliance of distinct parties, persons, or states for joint action – Webster's New Collegiate Dictionary] has been formed to oppose the creation and passage of an ordinance designed to target massage therapists and bodyworkers as potential prostitutes. Information on this issue and the ongoing process can be found at www.holisticwisdom.org/aaordinance; P.O. Box 3218 Ann Arbor MI 48106-3218, or e-mail aaordinance@holisticwisdom.org

This issue is real, and should be of concern to all CAM practitioners, their clients, and their peers in allied health fields. What is at risk is our supportive climate for alternative therapies, our reputation as a leader in the field of CAM, and the livelihoods of some of your friends and peers. Ann Arbor has been a model of support for alternative therapies for decades. Help us to ensure that we will not become a national model for an archaic and outdated perspective of touch and healing that associates massage with illegal sex acts. We deserve better than that suspicion, and we have all worked too hard to give up on the understanding and acceptance we have gained.

-Linda Diane Feldt
A student of the healing arts since 1973, Linda Diane has had a full time private practice in Ann Arbor for 22 years. She is the author of "Dying Again: Thirteen Years of Writing and Waiting" and "Massage: Learning to Give and to Receive". She teaches frequently privately, for the People's Food Co-op, with the University of Michigan, and nationally.