MLN Vol.5.No.4

Massage Law Newsletter

Vol. 5, No. 4                                      ISSN 1073-5461                                       November 1998   



Albert Schatz, Ph.D.


Part 1: The National Certification boondoggle

Part 2: An appropriate test for competence

Part 3: Monopoly control

Part 4. What we need and don't need



How it all began

"In 1988, the AMTA National Board of Directors unanimously approved a plan to develop a National Certification Examination in massage therapy."1 But national certification quickly became controversial, and encountered opposition.

The AMTA therefore distributed a brochure1 which contained "A message  from" Robert King,  "President of the American Massage Therapy Association." The message, entitled The truth about certification, stated, among other things:

"We seek to close the information gap and help separate rumor from reality.

and "avoid misunderstanding and mis-representation."

This brochure was distributed before "The first administration of the new certifying examination [was] projected to take place in the Fall of 1991."

Three years later

In 1991, the opposition was such that it motivated the Public Information Committee of the Council for the National Certification Program for Massage Therapists to respond to a major con-troversial issue which it defined, in question form, as follows:

"How can a written examination be valid as a basis for National Certification since it cannot test for essential things like hands-on work and the more intuitive aspects of massage therapy?"2

The Committee then attempted to answer this question as follows:

"The limitations inherent in using a written exam for National Certification of Massage Therapists do not negate the positive aspects of the process as a whole. It merely points out the merit of viewing National Certification within the total context of professional development strategies which also include accreditation of training programs and continuing education."2

The Committee's question

makes no sense

The Committee's question required no answer because the question had answered itself.

This is  obvious because: "A written examination" is not "valid as a basis for National Certification" since (i.e., precisely because) "it cannot test for essential things like hands-on work and the more intuitive aspects of massage therapy."

The important question is not whether "a written exam," with serious limitations, is "a valid basis for National Certification." Of course, it isn't. How can it be?

The important question is, "What kind of  National Certification, if any, can reliably evaluate competence in terms of on-the-job performance? When I use the term competence, I mean competence in terms of on-the-job performance because this  is the competence that is most important for massage therapists and other bodyworkers.

If the Committee could have validated "a written exam," which - it admitted - had serious limitations, it would have done so. But it couldn't. That's why the Committee directed attention away from the "written exam" - with its serious limitations - to what it called "the process as a whole." I shall discuss "the process as a whole" later.

The Committee's answer

makes no sense

Doing massage is a practical, hands-on application of a skill. "A written exam" that "cannot test for essential things like hands-on work" is of no practical use.

Therefore, National Certification is of no practical use in evaluating massage therapists and other bodyworkers because it does "not test for hands-on work."

The Committee tells us, "The limitations inherent in using a written exam... do not negate the positive aspects of the process as a whole."

But logic tells us, "The limitations inherent in using a written exam" do "negate the positive aspects of the process as a whole."  This is why.

Syllogism 1

All limitations are by definition limiting, or they would not be limitations.

The "written exam," which is part of "the process as a whole," has "inherent limitations."  It therefore follows, "as day follows night" (Shakespeare) that "the process as a whole" has the same "inherent limitations" that the "written exam" has.

Syllogism 2

The limitations of "a written exam" are serious because "a written exam ... cannot test for essential things like hands-on work and the more intuitive aspects of massage therapy."

 To the extent that limitations are serious, they exert a negative effect. In other words, they negate..

The serious limitations of "a written exam" negate National Certification because National Certification  is based on "a written exam."

The serious limitations negate "the process as a whole" because that process includes National Certification, which the serious limitations negate.

To the extent that "the process as a whole" is negated, it's "positive aspects" are negated.

What are the "positive aspects of the process as a whole"? And what well-documented evidence shows that those aspects are "positive"?

If "the process as a whole" does indeed have well-documented "positive aspects," why does that "process" need to include "a written exam" which admittedly "cannot test for essential things like hands-on work and the more intuitive aspects of massage therapy"? Why not omit "a written exam" which has serious limitations?

What "merit" is there in viewing National Certification within the total context of professional developmental strategies?

How do "the limitations inherent in using  a written examination for National Certification" ... point out "the merit of viewing National Certification within the total context of professional development strategies"?

Don't the serious limitations of the "written exam" point out a demerit for including National Certification in the "total context of professional development strategies"?

Despite these limitation, "a written exam" is still used because, without it, there would be  no national certification.

Academically speaking

As a professor,3 I would not accept a student's report that had inconsistencies in logic comparable to those discussed above.

I would ask the student, "Would you  buy a bag of apples if you knew it included a  rotten apple? Or, would you buy a bag with no rotten apples?

I would then tell the student: The report is unacceptable. Revise it.  

You can fool some of the people all of the time, and all of the people some of the time. But you can't fool all of the people all of the time.- J.P. Barnum

"The process as a whole" and

"professional development strategies"

"The process as a whole," to which (as I pointed out) the Committee diverted attention, has to do with what the Committee called "professional development strategies." These strategies - "which ... include accreditation of training programs and continuing education" - are very different from National Certification.

"The process as a whole" (and the "professional development strategies") apply to arbitrarily selected training and post-training educational requirements. These requirements are arbitrarily selected because there is no general agreement on what an adequate training is.That's why  regulated trainings vary considerably in the number of required training hours.

What "a written exam" measures is how much factual information individuals have memorized. That's why people who have never studied massage can pass "a written exam."

"The process as a whole" is not a standard (i.e., criterion) of competence in any predictive way. Some people - who are self-taught or have had a training of 100 hours or less -  have had many satisfied clients for many years, without harming anybody. 

There is no research which provides well-documented evidence that:

"The process as a whole" is needed in states which do not regulate massage.

"The process as a whole" is needed to protect the public from harm.

Massage has caused a significant amount of harm.5,6

Graduates from accredited schools are more competent than graduates from non-accredited schools.

Individuals who pass the national certification examination are more competent that those who fail.7,8

Individuals who pass a practicum are more competent than those who fail.7

All people who want to do massage should be required to comply with the requirements of "the  process as a whole."

There is no general agreement on what an adequate training for massage therapy is.4 This is why requirements vary considerably. For example,  the state of Arizona does not regulate massage, but Tucson, AZ, requires a 1,000 hour training.9



"Massage, like music, is what Aldus Huxley called 'a psycho-physical skill'...  Did Bach know how his muscles worked? No. But he played the organ very well and was a magnificent teacher. If proficiency in any psycho-physical skill depended on correct knowledge of physiology, there would have been no good singers, dancers, pianists, runners and so forth, until the middle of the twentieth century."10

"There are no special tricks to massage - no hours of practicing weird technics - no tedious new vocabulary to learn... And you don't need an intensive course in anatomy to lay your hands on another human being... The simple fact remains ... that you can use your hands to bring pleasure" to another human being without the coldness of traditional therapy and outside the intimacies of sex."10 This also appplies to spiritual massage healing, and massage to induce relaxation for stress reduction and for well-being.

Mary Brewster and I, in our article on massage as a performing art,7 pointed out that industrial quality control does not apply to massage therapists and other bodyworkers. We also outlined an appropriate test for competence.

There is only one test for competence which makes sense. This test has been successfully used for decades. It has no prerequisites. Anyone can take the test anytime. It is not controversial because it is voluntary, self-regulating, and self-enforcing. It is graded by people who are eminently qualified to evaluate massage therapists and decide whether they have met appropriate standards.

The test is the massage itself. The act of giving a massage is the act of taking the test. The two occur simultaneously. A massage therapist does not have to take time from work to go to a special place to take the test. Every massage is the test. Every person who gets a massage evaluates the test. Every massage therapist is tested every time she gives a massage.

In this way, massage therapists are tested frequently, by different individuals, often on an almost daily basis, and often several times a day. Massage therapists don't pay to take these tests. Instead, they get paid for taking them by the clients they work on. Each client evaluates the massage she received. She then certifies or decertifies the massage therapist by scheduling or not scheduling more appointments or finding another massage therapist.

This test worked well before states had massage laws. It still works well in those states which do not have massage laws. With this kind of test, massage therapists are not required to pay for state certification, for a training in a state-approved school, for national certification, and  for continuing education credits.

We say, "This test works well." because we are not aware of any well-designed research which provides convincing evidence that states which regulate massage (by  educational requirements, written examinations, practicums, and other kinds of quality control) have more competent massage therapists than states which do not regulate massage.  Moreover, state massage laws, which allegedly protect the public from harm, are not needed for that purpose because the risk of harm ranges from zero to negligible.`

Our reply to "Nay" sayers

Our certification test may be unacceptable to some because it gives irreproducible results. This means that people who get massaged by the same practitioner may not all give her the same evaluation. But such irreproducible results are the reality in massage. People who get massaged by the same practitioner do evaluate her differently. That is why individuals often try two or more massage therapists before they decide which one they want; and why they may change, after a while, from one practitioner to another.7

A massage therapist is not an assembly line worker, and massages are not uniform, mass-produced products. Imposing industrial quality control on massage therapists demeans their unique competence. Requiring them to take written examinations and get continuing education credits demeans their professional integrity. Many massage therapists voluntarily pay for workshops, seminars, etc. because they want to be more helpful to their clients. If this isn't professional integrity, what is?7


National certification's surprises all

involve $$$, $$$, and more $$$

If I recall correctly, national certification was originally created by AMTA for AMTA members. Surprise! It became something for all massage therapists.

First,  national certification  was  supposed to be voluntary. Surprise! In states where national certification is a requirement for licensure, massage therapists, who don't want it, now have no choice if they want to do massage legally.

First, national certification was originally for massage therapists. Surprise! Bodywork popped up, in addition to Therapeutic Massage, in the title of the Board of National Certification for Therapeutic Massage and Bodywork.

Surprise! In states which don't regulate massage, some employers  now require massage therapists to be nationally certified.

Surprise! The fee for national cer tification has increased.

The monopolization

 of masage


"Never was licensing or national  certification called for by the consumer; it has always been imposed by [the massage therapy field] as a way to protect our turf - at the expense of our clients. Licensure disempowers our clients, exactly the opposite of what we should be doing."11

"Studies of occupational licensing ... have all shown one or all of three findings: Licensing reduced the quality of the service; it reduced the availability of the service; and it increased the cost."11

It seems that proponents of licensing are hopeful that a state license would mean more money, status, and power." - Jerry A. Green, Attorney  for the California Coalition on Somatic Practices.4

 I think the move toward licensure is regrettable. I believe licensing creates state-sanctioned monopolies ... with the explicit goal of  'protecting the public,' but with the real effect of protecting those who hold the monopolies' respective entitlements, reducing information to the public, and restricting competition. - Don Schwartz.4

National certification and licensure are components of monopoly control which

1. extracts money from massage therapists, many of whom would not choose to be certified if they had that choice.

2. makes it difficult or impossible for many low income people, especially women, to do massage for a supplemental income

3. violates constitutional law and Supreme Court decisions that protect freedom of speech and freedom of the press; and prohibit  arbitrary governmental interference in lawful business, discrimination, restraint of trade, unfair trade practices, and monopolies. 4,12,13,14

We don't need the state regulation we presently have because

Massage does not cause enough harm to justify regulating massage therapists to protect the public from that harm.4,5,6Voluntary title protection and the self-regulation, that the Canadian Province of Ontario has, gives massage therapists the choice of being regulated or not.4,5



We need freedom

We need freedom for massage therapists and other bodyworkers to practice without having to comply with unnecessary regulatory requirements.5

We need freedom for consumers to choose to be treated by massage therapists and other bodyworkers whether they have met regulatory requirements or not.5

Voluntary title protection and the self-regulation in the Canadian Province of Ontario provide both freedoms.5 These two kinds of regulation have not been seriously considered as alternatives to the kind of  state regulation we have in the U.S.

We need information

We need information about the macro-economics of massage. Each massage therapist knows how much the annual fees, that she's required to pay, amount to. That's microeconomics.

However, there is little information4,14 about the total amount of money that massage therapists are required to pay to feed the monopoly, and a breakdown showing the  total amount paid to each component of the monopoly; e.g., fees paid to the state, and fees for national certification, continuing education, and insurance. That's macroeconomics.

Because these costs are passed on to clients, practitioners and consumers are both exploited by monopoly control.

Finally, we need information on the estimated number of massages and other bodywork treatments that have to be done and the total amount of time that practitioners have to expend on those massages and other treatments to feed the monopoly.

 We don't need 

national certification.

"The process as a whole"

is monopoly control.



1. Update on the National certification Program for Massage Therapists. An information service of the American Massage Therapy Association.

2. National Certification Perspective. The Public Information Committee for the Council of the National Certification Program for Massage Therapists. Massage Therapy Journal 30(1):99-103, 1991.

3. Schatz, A. Why is a research scientist involved in regulation? Why don't massage schools educate instead of train? Spiritual Massage Ministry Newsletter. 3(4):1-9. 1998.

4.  Schatz, A. Follow the money trail to find out why scare tactics tell us secular massage is harmful. Journal of Spiritual Bodywork. Special Issue No. 4. pp. 1-14. 1997.

5. Schatz, A. Massage should be deregulated because it does not cause harm. Massage Law Newsletter. 5(2):1-18. 1998.

6. Schatz, A. Guest Editorial: Massage therapists do not harm people. Massage Magazine. p. 7. March/April. 1998.

7.  Brewster, M., and Schatz, A. Massage is a performing art. Come dance with us. Massage & Bodywork Quarterly. pp. 78-81. Summer. 1998.

8. Schatz, A. Some thoughts and questions about the $3,000,000 National Certification Examination. One man's point of view. Spiritual Massage Ministry Newsletter. 2(1):1-5. 1996.

9. Schatz, A. Should the City of Tucson, Arizona, Committee of Massage Examiners be abolished? Massage Law Newsletter. 4(1):1-8. 1998.

10. Inkeles, G., and  Todris, M. The Art of Sensual Massage. Simon & Schuster. NY. 1972.

11. Eabry, S. Letter to the Editor. Massage Magazine. Nov/Dec. 1998.

12. Schatz, A. Do state massage laws and local massage ordinances violate U.S. Constitutional law, U.S. Supreme Court decisions, and the United Nations' International Bill of Human Rights? Massage Law Newsletter. 4(3):1-6. 1998.

13. Schatz, A. Does PA Senate Bill 1171 violate laws that: Protect freedom of speech and freedom of the press? Prohibit discrimination and arbitrary governmental interference? Prohibit restraint of trade, monopolies, and unfair trade practices? Massage Law Newsletter. 4(2):1-3, 1998.

14. Schatz, A., and Brewster, M. The corporatization of massage. An  economic perspective. Massage Law Newsletter. 2(2):1-7. 1997.

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