A Little About Mental Health

Our overall longevity, health, and quality of life depends largely on a few factors: getting shelter, food, social interaction, and security – the last being the highest level of cognitive health…and I think, also the highest level of existence.  When humans do not experience long-lasting, healthy, and quality security, it affects their perception of the world – the other three – which ALL have a physical impact on the body.

Depression is one of the most inaccurately and inadvertently diagnosed dis-eases in modern times.  This does not assume that depression or any other form of mental distress are any less important or don’t have as much an impact on a human’s health than an acute or chronic injury, viral or bacterial infection, or sources of imbalance received into the body from an outside source.  Because of the power of the patient to manage, or rather “mismanage” as medical diagnosis seems to imply, depression is also one of the most difficult psychological disorders with physical manifestations to “cure”.  Maintenance of lower levels of depression are what many humans are challenged with and achieved on a daily basis – some examples of daily rituals that humans use to maintain good mental health might include religion, motivational reading or listening, and expression of gratitude, and all the practices & rules therein.

May is Mental Health Awareness Month

Who says In 1949, Congress passed a Bill recognizing May as Mental Health Awareness Month in the U.S. in a effort to raise public awareness and discourse about the existence, role, and maintenance options for mental illness in society.  Today, the World Health Organization and the National Institute of Mental Health concur: approximately 1 in 4 adults develop, at some point, degree, or length of time, a mental disorder.

What does it mean In the world of health care options, there are a rapidly growing number of methods that have been noted as successful.  As it is with “fixing” things, not every person responds the same way to a method and not every method works for everyone.  The discourse and repeated awareness is to engage the public in the current options, successes, and reasons for addressing mental health as an important part of quality life – for the person and those people surrounding them.

Why it’s important our attitude and ability to rebound from events that affect us physically and mentally are the two most important qualities to be aware of when finding non-pharmaceutical or alternative methods of healing.  A healthy ego, self-esteem, and perception of the big picture are just a few ways that people get from depression that is moderately imbalanced to depression that is at-risk of existing in a void, beyond help from outside sources.

How Massage Therapy Affects Mental Health

Massage therapy can help a person overcome or recover from physical & mental addictions or conditions that are supported by physical imbalances (hormonal, pain management, restricted range of motion, etc) and feed depression or various other psychological elements to your health.  It has been used and recommended by medical doctors to alleviate mental stress for patients and recommended by massage therapy professionals in the field by the nature of the physical effects that correlate improved physical function with improved mental faculty.

Anyone can search the internet to find articles, blogs, stories, anecdotes, and research to support the use of massage therapy to better or enhance the quality of life for those addressing their mental or psychological imbalances, but there are a few places that I recommend you search and decide for yourself.

For quantified results (before:after, test pilots, research studies):

• National Institute of Health’s PUBMed:  http://www.ncbi.nlm.nih.gov/pubmed?term=massage%20therapy
• International Journal of Therapeutic Massage and Bodywork’s database:  http://www.ijtmb.org/index.php/ijtmb
• Massage Therapy Foundation’s Research Database:  http://www.massagetherapyfoundation.org/protected/rd_search.aspx

For anecdotal results (what works for me, industry statements, experienced practitioner reports):

• MASSAGE Magazine, first of many articles:  http://www.massagemag.com/News/massage-news.php?id=10056
• LiveStrong.com:  http://www.livestrong.com/article/40315-mental-benefits-massage/
• HelpGuide.org (with some self-massage techniques):  http://helpguide.org/mental/stress_relief_meditation_yoga_relaxation.htm
• Yahoo!Answers (UK & Ireland):  http://uk.answers.yahoo.com/question/index?qid=20100822231046AAL5tub
• an AMTA Position Statement, RE: wellness program:  http://www.amtamassage.org/statement3.html
• ABMP’s MassageTherapy.com (“Traumatized Bodies, Restorative Touch”, and more):  http://www.massagetherapy.com/articles/index.php/article_id/1175/Traumatized-Bodies-Restorative-Touch

In 2002, Cathy Wong at About.com published an article called What Do Physicians Think About Alternative Medicine?  Amazing results of a 276-Colorado-Physican pool (published originally in the Archives of Internal Medicine):  48% of the 276 MDs recommend Massage Therapy to their patients AND 60% of the MDs wanted to learn more about alternative medicine/therapies.

Massage therapy can be a method of release of muscle memories resulting in (possibly) either physical or emotional discomfort or trauma but definitely reprogramming – the intent of the work is to balance the chemical, virtual, real, and spiritual body and the methods used to achieve balance are some of the most diverse and effective known to humans – from touch therapy (bodywork) to medical massage (soft tissue manipulation).

Be careful: getting regular massage may seem or actually be addictive – the endorphins that are naturally produced from an activity such as exercise, good food, and good social interaction are also produced during a massage session in your favorite place or using your favorite massage modality.  But this kind of addiction can be managed in a way that makes it a moderate form of healthy healing time for your mind, body, and soul.

More info about mental health:  National Institute of Mental Health (NIMH), National Alliance on Mental Illness (NAMI), Mental Health America (MHA)

The Plan

Clients often respond to their therapist’s question “What areas would you like me to work on today?” with designating specific areas that they have recently been feeling pain in or having issues with.  It is common for the therapist to devise a plan to address those areas with some specific work, using a specific method.  This need expressed by the client and solution presented by the therapist is very often verbally communicated, but sometimes is expressed through body language during the massage session.

Your massage therapist can and should comply with verbal direction…immediately. It is critical that for a successful session, for the client to experience relief without pain, that the therapist be aware of the boundaries of the muscle that s/he is addressing at any given time.

Intent. Deep Tissue massage, when done correctly, allows the most pressure to be delivered for proper physiological response – a “release” to occur – and leaves the tissue specifically worked undamaged.  Too much pressure can damage tissue, causing micro-tears in the fibers or bruising.  Too little pressure is simply ineffective for the purposes of release and resetting of the fibers.

What It Is. Many times, therapists will ask a client “do you bruise easily?” to clarify the client’s propensity for damage to the tissue, if they are aware and may have a prior experience with bruising after a deep tissue massage.  The client may be advised that, if they do bruise easily, that it may be a result of the deep tissue work they’re about to perform, the unusual pressure that will be delivered to any specific area, and that the response or failure of the tissue to release during or before the eventual lengthening effect the work will have this effect.

What it “could be”. Most times, it is the non-verbal communication by the client that presents a challenge to the therapist in understanding what muscles and systems need and have the ability to be addressed on a deeper level, by both the client and the therapist.  I believe that effective, non-verbal communication is crucial to delivering a well-planned and effective deep tissue session.

Receiving a Deep Tissue Massage

for the massage client

During the massage, although you may have a ‘knee-jerk’ reaction initially, first try to consciously and verbally express any discomfort – you may allow the therapist to “dig in” and allow the elbow, knuckles, or pointed tool (like finger tips), to access the areas where you’re feeling the chronic or acute pain, thereby increasing the sensation of pain that often accompanies the massage work.  BUT, if you anticipate or there is sharp pain or increased, persistent pain, you should tell your therapist…it is commonly understood by therapists: this is not the intent of deep tissue massage.

Why not? When there is pain, the body automatically (on a conscious or unconscious level) enters a protection mode – during this time, the brain is trained to respond to the type of pain in the area of the body where it is being experienced, and will, over time, automatically respond in the same, defensive manner by splinting, or tightening up, the muscle that is being targeted for massage.  When a muscle is engaged, or shortened, massage has a substantially less (if any) effect on the targeted, now short, muscle.

Since the intention of a [deep tissue] massage is to relax, or lengthen, muscles, this response to pain – the shortening, contraction, or engagement of the muscle, (spoken or not, conscious or unconscious) does not help the tissue or the therapist to get where they need to be, organically or procedurally, to release the tissue.  Longer times or multiple sessions with the same muscle are needed for massage therapy to be applied if the threshold of pain is crossed too often, resulting in little or no effect on the target muscle or muscle group.

Pressure needs to be lessened or another technique used to relax the tissue, so ‘deep tissue’ becomes a modality that is ineffective if it is no longer used during the session due to the body protecting the muscle.

So, communicate verbally and non-verbally with your therapist so s/he understands that deep tissue massage techniques are or are not appropriate at the right times.

for the massage therapist

Clients may not understand, be able to tell you, or even want to tell you about the pain they may be anticipating or actually experiencing because s/he may believe it is a part of the healing process.

Therapist Awareness. Beingness can be defined as the therapist’s state of awareness – a ‘listening’ state – that includes anticipation of what the tissue needs (or doesn’t, when it comes to pressure) – simply being aware of how the tissue reacts to touch, pressure, and manipulation is SO important.

Before the session. To avoid micro-damage to the targeted muscle or surrounding area and to avoid any long-term discomfort from the massage or a complaint phone call, explain to them your understanding of pain as associated with deep tissue massage, ask their understanding, and then come to an agreement of what it is that’s in your scope to practice and what they can expect to be a “deep tissue” massage from you.

Coach them on how to communicate with you during the session, verbally.  It is much better to be able to respond immediately to verbal and non-verbal cues from your client – be in a ‘listening state’.

Always ask for feedback if you felt the session was intense for your client, based on their comments or their body language.  It is better to address the concern closer to the session on which the feedback is based so you can effectively help them recover, avoid, or even expect what they may perceive as a negative experience.

• If you get feedback immediately following the session, respond immediately: a simple suggestion on how to clear the interstitial space that harbors blood causing the appearance of a bruise will help them recover more quickly.
• Ask them to wait a few days to update you or observe how they feel: often times the client will feel much better than before the massage, even though there are some sensitive bruises present.

If you get feedback from your client that they bruised last time you worked on them, be ultra-sensitive to that fact and recall the amount of pressure you delivered last session with him/her and start off with conservative pressure.  The client should be able to remind you or make you aware of any thresholds they are getting ready to cross based on their experience with you.  Compassion and action will guide you to deliver a conservative yet effective pressure.

some explanations of a “bad” deep tissue massage

Therapist Inexperience. There is one saving grace for a therapist that technically is not experienced or experienced enough in a client’s eyes.  That is: the ability to ‘listen and act.’  Verbal and non-verbal cues given by a client receiving deep work are ALWAYS important information that a trained therapist needs to be able to act on.  A good therapist, no matter their tenure in practice, will immediately respond/act on the client’s given information.  How they act can always be in the best interest of the health of the client.

Client Inexperience. In my experience, when someone tells me they ‘like it really deep’, a flag goes up…the acceptance or need for pain to achieve a psychological level of relief is not within my scope as a massage therapist to address, and this is something I advise my clients of.  So, here are some of my thoughts on ‘why people tell their next therapist that they’ve had massage that hurt in the past:’

On the other hand, in the case a client does not like pain as a side-order of their deep tissue massage, I believe some clients wait to tell their next therapist that their last massage was “too deep” for any one or more of these reasons:

• Politeness. They may not have been able to mentally bring themselves to tell their last therapist during the session.  It’s not the therapist’s fault or it’s not in the client’s nature to say something to cause what the client his/herself would perceive as conflict in an environment that they want to be stress-free.  If the MT did a good job of creating that environment of relaxation and trust, then the last thing I think the client wants to do is rain on anyone’s parade.
• Bad Customer Service. Generally, “bad” experiences are related more quickly and often than good ones – it is a customer service fact, proven time and time again in many types of business, including a massage therapy practice.  It could be a form of release for the client, but if we communicate with and coach them to properly assess and classify their massage experiences, there’s less reason for the client to complain to the next MT (who can themselves literally do nothing to change the client’s previous experience).

Be a Proactive Therapist When Faced With A Complaint About “My Last Massage…”

Here are a number of things I may ask of and communicate to a client that has had a bad deep tissue experience and who is now relating it to me:

1.      Empathize/Sympathize with his/her situation

2.      Educate, through asking key questions, like:

a.      “Did you tell your therapist?  If you did, then you need to stop the session next time“

b.      “Did you tell your therapist afterward?  There might be other considerations in your physical condition that the therapist can further advise you on how to resolve if massage causes pain for you…”

c.      “Did you drink enough water before your massage? (Do you think you might have been dehydrated?)“…and then tell them the effects of ‘not enough water’ on tissue during a massage…

d.      “Did you have an injury in the area or anomaly that you didn’t have in previous sessions that could have been negatively affected by massage?“  The client could have a condition that they don’t know about of which peripheral neuropathy is a symptom, like Fibromyalgia Syndrome or Lupus or Diabetes.  Or they could’ve had a couple of alcoholic drinks or were on medication that reduces mechanical sensory input.

e.      “How long was it since your last massage (before your bad massage)?“…and then tell them about tissue memory & elasticity and how ‘getting back into the groove’ can be a factor in what depth they can receive after a long stay away from deep massage.

3.      Define my relationship with this client (in so many words, and without saying: I am not “their last therapist”) – assure him/her that I will be aware of their needs and requests at all times during the deep tissue massage.

Avoid a potential ‘bad’ massage because of ineffective communication

A massage therapist’s depth can be perceived as invasive, intrusive, and inconsiderate, BUT – when I understand why Clients complain to the next therapist, I realize there is NOT A THING I can do about it…eg. to change their behavior.  All I can do is change my own.  Following are some scenarios I’ve experienced and consider when I think there is [going to be] a ‘too deep’ issue:

1.      Problem: The client didn’t tell the therapist ‘it’s too deep’ – It could be that the client didn’t feel like they could say anything to their MT about the discomfort – maybe they didn’t feel like their feedback would be welcome.  so they go ahead and receive a massage that’s ‘too deep’.

Solution: In reply to the question “how’s that pressure?’ a client says “good” in that monotone voice, change something: either go deeper, change speed, go lighter, slow down – something’s not satisfactory to the client.  Now: you can’t squeeze it out of them, so ask again about the pressure at another point – while you’re touching the client, doing the deep work.

2.      Problem: They haven’t had a massage in a while – often, getting a massage after not having one for a while is like getting back into the gym after you’ve been out several months after previously going 3 times a week.  Muscles are stretched, poked, and pressed…and the fibers are not always as flexible or elastic as the client thought they would be.

Solution: Preset your ‘deep scale’ to a lighter mode – and tell them that’s what you’re doing!  If you set the expectation, they will be happy…because what you said would happen, is happening during the massage

3.      Problem: The client didn’t drink enough water before the massage – water is a medium that is essential for the muscle tissue and fascia to move easily over itself.  Without the lubricant internally as well as externally, friction causes irritation and possibly inflammation on, at least, a microscopic level…thus, the discomfort.

Solution: give them water – tell them why you’re suggesting water for them…that minute!  Explain that preparing for a massage with drinking water can reduce the pain they might experience after a deeper massage.

4.      Problem: The client is experiencing changes in their metabolism or other physical changes are occurring.

Solution: be aware of conditions, considerations, and contraindications for doing massage.  If you have a question about practicing on a person with or in a particular condition, you might always want to preface

Some bottom line solutions for me, as a massage therapist:

• I am open to constructive and even negative criticism – I realize that I am there to facilitate his/her healing.
• If I don’t exercise due diligence in making sure at any point that my client is happy with the pressure, I risk a client complaining later, either to me (after the fact) or to another therapist.

Ultimately: What Works

Some clients like the ‘hurts so good’ feeling, and they always are sore the next day – this can be a sought after feeling for some clients who psychologically are subjecting themselves to pain inflicted by another for something that is out of the scope of the MT’s control.  Maybe after they’re sore the next day, the following day they feel great!  This could be a method of healing for them, psychologically and physically.

There are conditions that I’ve seen that benefit from being sore during the massage or even the next day – one condition of the client is that of fibromyalgia.  FibroMyalgia Syndrome (FMS) patients take the pain in order to feel great the next day – there are some FMS patients that have enough experience to realize that the positive effects of the pain experienced during a deep tissue massage are worth experiencing the pain of the moment (during a massage, deep tissue or otherwise).

When I look at the overall meaning of the term “deep tissue”, it means to me a level of awareness and that I need to have a heightened sense of listening and responsiveness to my client’s needs.  When a client requests this as a modality (on a menu, for example) I think they have been trained to understand, through experience or explanation, that “deep tissue” is a mode of performing a massage.  In fact, I understand “deep tissue massage” to be a technique of Swedish massage or a technique encompassed by another modality which indicates a level of superficial or profound system or musculature address.

The client misperception of the term “deep tissue” also indicates to me that the client is expecting a predetermined protocol and that they are willing and able to compromise their comfort level of receiving, risking tissue damage, to order what they perceive as a higher level of massage session.  Why would a professional set up an expectation for their client of “more pain(ful), more gain(ful)” in what is perceived as a predetermined and traditionally-accepted menu format?  For me, the depth and need for any specific level of pressure is always determined per client AND by session, and can vary greatly from health condition to season.

I have always been a proponent for a “one price massage”, removing what I believe is a misconception that the depth of a massage is more valuable the deeper it is.  Deeper does not necessarily mean “more therapeutic” – appropriate depth IS more therapeutic.  You could be an athlete that just ran a marathon: deep tissue is not appropriate up to 24 hours post-event.  You could be a cancer patient and deep tissue could NOT be appropriate only in certain areas or affecting certain systems.  You could be suffering from edema or lymphedema, whereby a diagnosis and working with the client’s doctor is more appropriate before applying deep strokes that can be damaging, or at the least, ineffective.

Ultimately. In my opinion, the client determines depth of stroke on a session-by-session, moment-by-moment, and stroke-by-stroke basis – and needs to be understood and applied immediately, appropriately, effectively, and compassionately – as to not do harm – by every massage therapist.

Take these thoughts and suggestions with you and see your massage become more productive – every time you get a deep tissue massage.

The American Massage Therapy Association (AMTA) is collaborating with the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) on an educational podcast about the benefits of massage therapy for stress relief.

Read more of Massage Today’s report, HERE…

Here’s the email: (Leave your comment here after you read it!)

“For many years AMTA has sought means to clean up massage listings on Craigslist and protect both the public and massage therapists who advertise legitimately on the service. Previous direct efforts with the company have had little effect. Meanwhile, AMTA has continued to cooperate with law enforcement officials in their efforts to control ads on Craigslist. Yesterday, it was announced that Craigslist will drop its ‘erotic services’ section in the state of Illinois and this appears to indicate an overall change by the company in other states.
AMTA has issued the following press release expressing its view of the decision and calls for Craigslist and others to respect the massage therapy profession and protect the professionalism and safety of massage therapists. AMTA President, Judy Stahl has already been interviewed by news media and we are convinced that our view will receive media attention.
AMTA encourages members to look at listings in the ‘therapeutic’ section of Craigslist in their area for ads that use the word massage and promote something other than legitimate massage therapy. You can flag such ads as inappropriate. Several flags of an ad usually result in the ad being removed.
Your association will continue its efforts, and its contacts with law enforcement officials, to restrict massage therapy advertising to legitimate massage therapists and protect the safety of practitioners.

For Immediate Release
May 13, 2009
AMTA Applauds Craigslist Decision
Calls for Protection of Massage Therapists
Evanston, IL – The American Massage Therapy Association® (AMTA®) views the decision by Craigslist to remove its ‘erotic services’ section as an opportunity to clarify for the public that prostitutes who claim to provide massage are not massage therapists. “The public and massage therapists have a right to know that advertising for massage should only be the right of massage therapists,” says Judy Stahl, AMTA President. “We hope this decision will ensure that massage is only advertised on Craigslist through its ‘therapeutic’ section and that any new ‘adult’ section will not allow posters to use terms related to massage therapy.” Most states regulate the massage therapy profession and restrict use of the term ‘massage’ in business and advertising to legally practicing massage therapists.
The recent publicity surrounding the murder of a call girl who called herself a masseuse on Craigslist has confused many people. Massage therapists have had clients and patients question their professionalism and raise concerns about them advertising their massage practices through Craigslist.
Unfortunately, prostitutes frequently claim to offer massage and use the term ‘masseuse’ to appear as legitimate therapists. While most massage practitioners prefer the term massage therapist, some still use the older term, rooted in European health traditions, of ‘masseuse’.
AMTA believes these terms related to massage should only be used by those with a legal and professional right to do so. The non-profit professional association wants the public to feel confident that anyone who claims to provide massage is a trained professional who practices legally. “We call on Craigslist, the media and other online services to respect massage therapists and to protect the public from misrepresentations of massage. And, we continue our support for the efforts of the state attorneys general to protect the public from inappropriate advertising,” says Stahl.
The American Massage Therapy Association is a nonprofit professional association of more than 58,000 members founded in 1943. AMTA professional members have demonstrated a level of skill and knowledge through education and/or testing and must meet continuing education requirements to retain membership. AMTA provides information about massage therapy to the public and works to improve the professional climate for massage therapists. It advocates fair and consistent licensing of massage therapists in all states.”

As prostitutes turn to Craigslist, Nassau County law takes notice (NY Times story, Sep 4, 2007)

Please: exercise your rights as a member of the Public to flag inappropriate ads that use the word “massage” as well as the inappropriateness of other text or pictures that do not represent massage therapy.

Craigslist will not accept an over-zealous flaggers of posts, and considers that terminable behavior or at least behavior that will be ignored, so if your thinking about being a ‘vigilante’ by going in and flagging hundreds of ads today, your success rate will be much lower.

If each public member and massage therapist flagged just one ad in a responsible manner, Craigslist will be busy getting the message that there are inappropriate and inaccurate listings that need to be removed – the more flags, the more messages. Getting non-MTs out of the Therapeutic Massage section entirely is impossible, but with enough monitoring, it can be reduced greatly and the safety of your client, yourself, and your industry will be better insured.  It only makes things better for the Client and for legitimate practitioners.

• Has Craigslist ‘stepped up’?
• What is your experience with Craigslist?
• Do you think the national attention on the media-touted “Craigslist Killer” has brought the medium of Craigslist under scrutiny and given the massage therapy industry the edge it needs to demand action for the safety of the people who are working in or benefiting from massage therapy?

Many MTs tell me they don’t believe that they need to have certain licenses to perform at specific [other] addresses – ‘for’ or ‘not for’ money. The fact is: MTs have to have AT LEAST a State professional license to put their hands on anyone as a certified Massage Therapist (then you are an LMT). All the other licenses are “unbelievable” but necessary to earn money or ‘volunteer’ in each jurisdiction in which your own business operates (then you are an LMT practicing in Las Vegas, Clark County, etc).

IF you are performing massage therapy outside of an employment/Employer situation, you are [also] an Independent Massage Therapist, and the second fact is: to make money doing massage (including ‘tips’), you must have a Local business license that applies to the address at which you want to practice – ‘for’ or ‘not for’ money. If an LMT is not doing it for money, s/he is promoting her/his service and providing a regulated professional service, which is considered ‘doing business’. If an LMT is giving away massage – ‘donating’ – then s/he has to be working for her/his own company (self-employment connotates an IMT business license) in order to give away ‘free massages’ and have appropriate legal means to provide massage therapy. Liability insurance is strongly suggested and sometimes required for the location at which you are providing any type of massage therapy services.

Exceptions to being certified and not licensed AND practicing differ slightly in each jurisdiction, and may include: immediate household residents and/or family or family up to two generations outside of the practitioners (eg. son/grandson or aunt/niece) – check with each jurisdiction for these exceptions to the licensing/practicing requirements.

The legal differences between MTs practicing as Employees and/or IMTs can be confusing. When you consider performing massage therapy, using the information you gained as a certified massage therapist, you can boil it all down to one question: “what license to i need to perform a massage at ___________(insert address here)________?”

The answer to this question may be found here, at a GIS map that is used by the City of Las Vegas and other municipalities to determine ownership and LOCATION of a property [owner] address in the Las Vegas Valley: http://major.lasvegasnevada.gov/website/clvcamps/viewer.htm

Here’s an easy, 4-Click process to find out what jurisdiction an address is in:

Step one: Visit the GIS map (link above, too) – I save this in my Bookmarks for easy access.

Step two: see the diagram below for the 4-Click process to finding out which jurisdiction the address is located

4-Click Process diagram (page 1)

4-Click Process diagram (page 2)

Step three: based on the outcome, ask yourself: “Do I have a license for that jurisdiction?” If the answer is ‘YES!’, then go to your massage therapy appointment. If not, then find out how to get a license BEFORE you attend to your client at that location.
The above method is one that I use and have success with – legal records (tax map) cross-referenced with the same jurisdiction’s massage therapy business license requirements keeps my conscious clear, and what I believe to be legalized.

Good luck!

Read more about the current state of the case here (on MSN.com news).

The common thread in Markoff’s suspected attempted robberies and assaults, and in the last case: murder, is the method of contact for the claimed ‘masseuses’ he was contacting for services: Craigslist.  Thus, he has been dubbed the “Craigslist Killer” by the media – and massage therapy is involved, as well.

It is unclear to authorities at this time as to which section of Craigslist that he obtained contact information for the victims, but contact was initiated through email first, then by phone.  All reports indicate there was a massage table, set up, in the room in Boston, but it was also indicated that Brisman rented the room in the upscale hotel under her name.

In a recent email sent to members of the AMTA, they explain that, in response to many questions coming into their organization from members about the murder and assaults; they are “continuing to research means to have Craigslist remove all advertising that links massage to illegal activity.  This includes ongoing contacts with national, state and local law enforcement agencies.”  AMTA also states that in November 2008, 40 states’ Attorneys General came to an agreement with Craigslist site owners to “clean out prostitutes and posters of other illegal activity.”  The efforts and results of the site owners have a long way to go.

Law Enforcement is encouraging any victims of assault or robbery through Craigslist or any other means of contact with a massage therapist or person that’s been a victim of crime to come forward, make their complaint, and allow law enforcement to do their job of protecting citizens from violent crimes.

As a concerned MT in an industry that is constantly fighting the battle for its own identity, disassociating itself with illicit behavior and prostitution, I STRONGLY encourage massage business owners to be aware of their surroundings, situation, and who their client really is (to the best of their ability), and act on your gut.  Intuition is often neglected or ignored and can be a driving mechanism that keeps an MT out of harm’s way…if acknowledged AND acted upon.

How do I ‘know’ who my client is?

I get new clients by referral from people that are already clients or whom I already know.  It never hurts to talk about what you do or start a conversation about massage with someone (a friend, family member, or co-worker) who will ultimately remember you as an MT and refer new clients to you regularly.  Offer an incentive to referrers to ‘help’ their memory remember you as an MT when the time is right.

I do not advertise on Craigslist or in the yellow pages, so my risk is not as high for getting in touch with people I do not know.  But I was almost a victim of fraud (that would have cost me thousands), almost been in a situation where I would have worked and not been paid, and almost been assaulted, several times.

Here are a few of my suggestions for how I know to follow my gut AND end a session when I felt it was needed (for my own personal safety):

Before The Session

How did you get your call? In spas and places of business, it’s a little easier to see them coming.  Listen for requests for a specific type of therapist:  Blonde, a particular nationality, even gender are some signs to make an MT aware of potential misconduct.  In private practice, asking “how did you hear about me?” should be answered immediately and without hesitation, as most calls are made soon after trying to find an MT by conventional advertisement means.

Do you ‘walk the talk?’ Making your client aware of your intent for the session prior to (like on the phone, talking about what they want out of the massage or what areas they want worked on) and immediately prior to (like on an intake form) the session.  Many therapists also state that it is a ‘non-sexual’ massage:  I really cringe at this statement, because if there is a question or the MT has had experiences in the past with [attempted] sexual assault or innuendo, then part of the problem could be that there may not have been effective communication prior to the session, either through advertising, conversation, or other written forms of informed consent about the session.

Do you confirm your appointments? Restating your intent by verbally recognizing the massage needs of the client on the phone the day before the appointment reaffirms your intent and the fact that you’ve ‘got their number.’  If you are responding to a call the same day, you may verify their number by calling back, something you might make a habit for every client, but especially those of whom you may be suspicious.  Remember: the gut never lies.

Do you take credit cards? Another way to identify the person with whom you are doing business is to take credit card payments…and require them for everyone whom you do not know initially, or maybe for everyone in general, or for only outcalls, or for whomever you think needs to have their identity bolstered a little more.  The cost of taking a credit card varies, but I think the cost of doing business will pay for itself if you have even 1 fraudulent or non-payment per year.  Credit cards require the person holding the card to be the cardholder and to actually have the card in their hand.  Further verification of cardholder information is open to you as a merchant and requires you’re asking for their ID and the credit card used to verify identity of the cardholder to the purchase by way of codes on the card, signature, and embossed names.  I use Paypal: free, effective for encrypted purchases (from the client’s standpoint), and secures information about the purchaser – a paper trail.

During The Session

Got Buddy? If you are not communicating with someone that you know or whom is outside of the actual session, you may consider harnessing the power of the ‘buddy system’ when going to outcall massage sessions.  Call your Buddy while you’re in the room:  let your client know you have to check in with your Buddy/spouse/friend/etc and that the phone call/text will just be a moment.   You can do it while you’re washing up, but it is important to let your client know that you are in contact with someone who knows where you are and what time you are to be done with the session.

Especially for those going to hotels where environment is not as under control as the client you are meeting for the first time (or subsequently), checking in with the front desk or concierge may be your best buddy, as they are a direct line to help when you need it.  By them knowing you are there and what time you should be down to check in with them again after the session, they can be the fastest and most secure way of assuring that assistance is close by.  Also, if you confirm the guest name on the room (that you were told by the client), then that could be another way to dispel any suspicions.  The agent will not tell you what the room is, in case it is not the same, so be sure to ask the client PRIOR to asking the front desk in whose name the room is listed, in case the client’s name is not the same on the room.

Mobile Phone as luggage. Take your cell phone with you – in a spa, this is not possible for liability reasons…but, if you are a private practitioner, it is a necessity for safety reasons.  You may ‘appear’ to be confirming your location and attendance in the session, in front of the client, as part of your process when you go to a hotel room by calling or texting a buddy – or you may [i]actually[/i] be calling/texting someone of your location.  In case of emergency, it may be the only/fastest way for you to get in contact with someone.

Signs, Signs, Everywhere a Sign. The client is showing signs of committing or commits the act – STOP THE SESSION!  Go outside your Self, Go outside your ego, practice doing this outside the situation by having the conversation with another professional or confidant.  When it happens, STOP THE SESSION!  If you are in imminent danger, flee.  If you are not sure of the intent of the client, pack up and leave.  If you decide to ask for or wait to collect your money – if you haven’t already collected it – you are taking an unnecessary risk – your safety is worth more than your fee for one massage session!

These are just a few things that you can do to help keep you safe and practicing without risk of mental or physical harm.  If you have any things that you use to assure you peace of mind when working with clients whom you do not know (or even know), post them here – it’s sure to help out someone to see many different successful ways of being safe.

deeper pressure addresses physiological aspects of the abdomen

Massage Therapists are trained to do abdominal and pelvic massage – this type of massage on the area of the torso can be physiological or energetic in nature. A therapist can assist in the movement of blood, toxins, muscle tissue, and visceral structures physiologically, and move energies related to the Hara, kidneys (Jing), and aura.

the Hara is believed to exist 3 finger-widths below & deep to the navel

Several structures in the lower female pelvis are the apparatus that allows a woman to bear another human being. The ovaries produce and release eggs that travel down the uterine (Fallopian) tubes monthly, taking a 5-day journey to attempt to attach to the tissue nest of greatly-available blood and nutrients, the endometrium lining that the uterus has prepared all month (approximately every 28 days). The eggs are most likely to be fertilized in that journey down the uterine (Fallopian) tube. If the eggs are not fertilized within a certain amount of time, hormones communicate that the nest of blood and nutrients needs to be shed in the menses and the cycle starts at the beginning again.
No matter the reason for a massage therapist to choose to work on the abdominal and pelvic area, there are some conditions a therapist and their client need to be aware of when addressing the female reproductive system. Several conditions that women regularly and/or naturally experience in the pelvic area and that are of concern in the area of massage therapy include: use of birth control, dysmenorrhea, spontaneous and elective abortion, endometriosis, and fibroid tumors.
Birth control pills are used to tell the brain that the body is pregnant, thereby stopping the flow of hormones that prepare the body for fertilization and pregnancy. Massage in the pelvic area is appropriate when considering this form of health affectation.
Dysmenorrhea, referred to more commonly as a painful menstrual period, is defined by the woman’s experience of limiting activities for at least 1 day every month because of symptoms of dull aching or sharp severe lower abdominal pain – accompanying nausea and vomiting are also signs of dysmenorrhea. It is not advisable for massage to be done on the area of localized pain within the first two days that symptoms show – it is advisable to use reflexive techniques and massage all other indicated areas of the body.
Spontaneous Abortion, an unintentional termination of a pregnancy, can happen in many stages of pregnancy and for many reasons, many having to do with the overall & systemic health of the mother and the ability of the egg or fetus to survive in the health of the mother’s uterus. Elective Abortion, an intentional termination of a pregnancy, can also happen for many health-related reasons. In either the case of spontaneous or elective abortion, the lining of the uterus is disrupted and needs time to heal. Massage in the pelvic region is not appropriate after a spontaneous or elective abortion until after bleeding has stopped and there is no sign of infection. Client and therapist should be aware of doctor recommendations for massage therapy if an abortion occurred less than 6 weeks ago.
Endometriosis is a resultant condition of the non-exiting (in menstruation) tissue fragments of the endometrium (of the uterus) attaching to other cells and structure in the body. Circulation and implantation of the endometrial cells produces “blood blisters” or clear vesicles in early years – in later years, the implanted cells will grow over, appearing black and scarred. Massage therapy is not advised in the area of the diagnosis of endometriosis, especially during menstruation. Diagnoses have been known to displace structures in the area of endometriosis (usually in the pelvic region), so care in providing and receiving pelvic work is suggested for locally diagnosed endometriosis.
Fibroid Tumors grow in or around the uterus, mostly undetected (because of their small size) and exist in a postulated 20-30% of women between 30 and 50 years old¹. Symptoms of small fibroids are unrealized while in diagnosed cases of larger fibroids can reveal symptoms of mechanical pressure on other structures (including nerves) in the pelvic area and increased menstrual bleeding. Massage is suggested in pelvic areas other than the uterus if there is a diagnosis of fibroid tumors – as large fibroids can displace other structures in the pelvic area, massage is not appropriate in the area of the uterus.

finger-tip massage done at the transverse abdominal wall

Here are some points to consider when going for your therapeutic massage and your therapist does pelvic work:

1. Deep work in the pelvic area is not generally practiced in massage therapy, although a few modalities address the pelvic region using deep tissue techniques. A client should always ask and the therapist should always explain what the intent of their work is deep in the pelvis.
2. Deep work in the pelvic or abdominal area is generally not advised on days of heavy menstrual flow. Many other massage therapy techniques can be used by a therapist to alleviate symptomatic experiences of pain and discomfort.
3. Let your massage therapist know if you’ve been experiencing conditions related to your health as a woman, so your therapist may best serve you and deliver the most appropriate method to improve your health and well-being.
4. Your therapist may also let you know about structures s/he feels (literally) may be abnormal or out of place; the therapist may also refer you to a qualified health care provider that s/he knows personally in order to assist you in achieving a level of wellness or “peace of mind” – listen, and visit that doctor or qualified practitioner who can help you determine what the issue is and how to improve your overall health.
5. As with all other areas of the body, the pressure should be delivered by the therapist and experienced by the client at a level that is comfortable and expected. Any level of discomfort beyond acceptable standards of the client needs to be recognized and addressed by the client so the therapist can respond appropriately.
6. Most of all, enjoy your pelvic massage! It increases the internal health of the abdomen, strengthening, circulating, and stimulating movement in the organs and musculature, making your entire body healthier!

Multiple Sclerosis (MS) is a condition where the myelin sheaths around the brain and spinal nerves of the central nervous system (CNS) are initially inflamed, then are gradually degenerated, causing symptoms such as fatigue, spasticity, eye pain, tremors, and progressive loss of vision, sensation, and motor control. This condition is diagnosed in about 8,800 new patients every year – about 350,000 cases are known in the United States.¹

Sclerosis is a hardening of the myelin sheath when it is replaced by a plaque or scar tissue. Electrical impulses that characterize the method by which the body communicates through the nerves are literally “short circuited” because of the inability of the plaque or scar tissue to conduct the impulses. Symptoms are more or less depending on how much of the sclerosis occupies the nervous system, where myelin sheaths used to be. The “short-circuiting” effect causes motor and sensory paralysis, which shows in the lack of motor control and feeling in the skin and other perceptive organs.

Massage Therapy is indicated in a sub-acute stage of MS – that is, when the symptoms are not heightened and when the patient is in a remissive state. It improves many aspects of the symptoms, like inflammation control and stress or depression symptoms. Heat is not indicated at any time, as heat is an agitator of muscle activity, causing spasm in any stage of MS. In areas where there is little or no sensation, light massage (effleurage) is indicated in order to affect the neurons and keep them firing.

The Touch Research Institute of the University of Miami has issued two studies that show that massage therapy improves specific conditions shown in MS patients.

The first study, conducted with 24 adults with MS over 5 weeks, receiving a 45-minute massage twice a week, resulted in “the massage group ha[ving] lower anxiety and less depressed mood immediately following the massage sessions, and by the end of the study they had improved self-esteem, better body image and image of disease progression, and enhanced social functioning.”²

The second study showed the effect of reflexology on 71 randomized MS patients: “Significant improvement in paresthesias, urinary symptoms and spasticity was detected in the reflexology group. Improvement with borderline significance was observed in muscle strength between the reflexology group and the controls. The improvement in the intensity of paresthesias remained significant at three months of follow-up.”³

Amazing results from using massage therapy gives hope to the MS patients suffering MS’s debilitating conditions. You may read more about the details of the TRI studies at the University of Miami or visit the National MS Society to learn more about how reflexology is impacting the pain symptoms of MS patients.

In Swedish-style massages, effleurage, petrissage, compression, and muscle stripping all share the goal of moving fluids.  Fluids can be defined as blood, lymph, water, or extra-cellular fluid; all forms transport nutrients, bacteria (good and bad), and waste in and out of the body.  Effective transport indicates good health – the cells are healthier and cellular-aging and -death is reduced.

virtual arterial flow (no surrounding cells)

Massage enlivens the theory that moving blood, specifically, toward the heart increases vasodilation (venous circumference) which increases the volume of the vein which means transport of nutrients and waste in the blood will increase.  Movement is life, so moving the fluids is important for the health of the surrounding and affected cells.  Also, moving fluids toward the heart increases waste production, since the kidneys are in line to the return blood flow to the heart – needing to urinate after a bodywork session is a normal and healthy response to the work you just received.

Another aspect of blood circulation that is an important feature of healthy, comfortable, and safe bodywork is the direction of the stroke.  Since veins occur mostly toward the most-surface areas of the body, they are the most directly affected structures during a massage.  Although the direction of energy strokes is dependent on the theory in use, tissue-manipulative strokes are most effectively and safely delivered when applied toward the heart.

The reason for this is that veins have structures inside that prevent backflow of blood and fluid.  The heart is not able to effectively assist the blood return through the veins, just the blood delivery through the arteries, which is strongest at the point of origin – the pumping heart muscle.  In blood return to the heart, the body is designed to assist through contraction of muscle surrounding the veins to move the blood back toward the heart and lungs for recirculation.

Another function of and safety mechanism for preventing the back flow of blood (especially during sedentary states) is the pockets or valves on the interior of the veins.  If pressure is applied in the direction of backflow (against the direction of flow), the structure of the pockets and valves is compromised and the veins stretch and strain under the pressure.  If there is too much stress on the vein in one application or over time, damage can occur to the vein, causing it to weaken or break.  Varicosities can occur or, at worst, bruising of the area where the vein was compromised.

As we get older, the elastin is depleted and not easily replaced in our entire body.  Veins are an important place to have elastin, as they expand and contract based on our environment and state of physical exertion and health.  If undue pressure is applied in the opposite direction of blood flow, permanent damage can be caused by which it becomes more difficult to recover.

What’s most important is that you feel good during and after your massage.  The old adage “If it feels good, do it” is most applicable when considering the direction of the massage stroke you are receiving.  If it is irritating or annoying, there is a reason it feels that way – talk to your therapist and ask why you may be experiencing that feeling or sensation.  Trust your body to tell you what is good for it – safe, effective massage “feels good.”  The circulatory system plays a major role in how you feel during or after your massage, so make it an important goal, whether it’s to invigorate or relax it, for your overall health and well-being.

In the next article, we’ll talk about another circulatory system that is affected by bodywork and massage – the lymphatic system.  We’ll see how edema, lymph nodes, and the liver, kidneys, and your tonsils all play a part in the physical response and benefits of receiving bodywork!

Although that scene could have been difficult to imagine 5 or 10 years ago, that seems to be where the massage therapy industry, where regulation is concerned, is heading.

The American Massage Therapy Association (AMTA), a leading professional association operated for and by more than 58,000 massage therapists, announced last week its support for the Massage & Bodywork Licensing Exam (MBLEx), the newest American massage therapy professional exam on the block. The AMTA has supported the industry- & jurisdictionally-recognized National Certification Exam (NCE) and  finds that the newest licensing exam, developed & administered by the FSMTB (whose membership is primarily composed of state massage boards) is the next evolutionary step and “the best choice” in national credentialing for massage therapists in America.

It seems that the AMTA (a major influence in the areas of professionalism, professional representation to other fields of healthcare, and largest representation by mere numbers of a massage-therapist-only organization) is also supporting the entity of choice of the state boards that are moving to a more unified and portable licensing situation, which I can say has been and is a dream for our industry.

Just to recap:

· The MBLEx is the test given by the FSMTB

· The NCE is the test given by the NCBTMB – two versions are NCETM (Therapeutic Massage) & NCETMB (Therapeutic Massage & Bodywork)

The Federation of State Massage Therapy Boards (FSMTB) administers the MBLEx, which is comparable to the NCETM/B, administered by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB).

Although the NCBTMB uses massage instructors, allied professionals (like chiropractors and physical therapists), the public and federal jurisdictions in developing the NCE, the development of another non-credential-bearing version of the NCB’s ‘stamp of approval’ for passers of the NCE, the NESL, has come a little late in the development of the reigning Certifiers of professionals in the massage therapy industry.

It seems that the NCBTMB does not include State Boards of Massage Therapy in the development of the benchmark testing of their NCE, and that there is not a like mind shared by all State Boards of Massage Therapy that agrees on the applicability of the NCE in each of the State Boards’ jurisdictions.

The MBLEx and the FSMTB is fast becoming state massage therapy boards’ preference for a professional benchmark to determine whether an MT is competent enough to practice massage therapy in the specific Board’s state.

Last year, the Nevada State Board of Massage Therapists (NSBMT) became a member of the Federation of State Boards of Massage Therapy (FSMTB), joining the fast-growing numbers of state boards of massage therapy in the US.

Stats:

o 42: States Massage-Regulated in the U.S.

o 32: States Massage-Regulated in the U.S. and using the NCE

o 25: State Massage Boards also FSMTB members

What does this mean to [Nevada] Massage Therapists?

In my opinion, immediately, it will mean that in the next few years, the exam taken for applying for Nevada’s massage therapist professional license will be changing. Ultimately, it will mean interstate portability for a massage therapy license. And in the big scheme of things, a national professional license. And in the universal application of the implications, the universal (intra- and inter-national) ability to practice massage professionally with the same credentials. Now EVEN BIGGER that Universal implications could be BUSINESS LICENSEs are Universal, too – but I think that’s pushing it…just a bit.

Most of us have “grown up” with either the local business license office or state board requiring the NCTM/B credential: taking the NCE and getting the certificate to take copies to their offices. It does not mean (at least to the AMTA) that the NCE is not a valid exams: the AMTA clearly stated in their email (dated Jan 26^th, 2009) to its members:

“The national certification credential needs to be an important part of any grandfathering process.”

Will the MBLEx replace the NCE?

Who knows for sure? It is an Act in a Play that we are seeing for the first time – and we/ve read no reviews! The happenings in our field are new and changing, like a road on a trip that you’ve never taken before – destination: Unity.

The process of new licensing in Nevada may be changing slightly. A note: Change is inevitable…and it is also very slow in our industry, where regulation is associated; it doesn’t happen overnight.

The State of Nevada’s NSBMT is a member of the FSMTB, but they are not using the MBLEx as a benchmark at this time for regular application, but have stated that they will consider applicants that are relying on having taken the MBLEx for their NVMT application in individual review. I project the notice of complete change of requirement from the NCE to the MBLEx will come when the Nevada Legislation is passed, changing the requirements for exam to be taken by applicants for massage therapy license. Please refer to the posted NSBMT record of minutes in the October 24^th, 2008 meeting.

One way to know where the test requirement is in the process is to keep up to date with the NSBMT by attending their meetings open to the Public or reviewing the approved minutes for each NSBMT meeting, available online here.

Viability of the MBLEx

I have no idea how the tests compare – without actually taking the MBLEx after taking the NCETMB, I have no springboard to base any opinion on which one is more credible, researched, relevant, or easy. Although…I am VERY tempted just to take the MBLEx to see how I do – It’s been so long since I’ve studied for an exam!

Learn more about the MBLEx here

Learn more about the FSMTB here

The Choice of a Premier Professional Association

Through the AMTA invention, convention, direction, and redistribution of volunteer time and non-profit funds paid for by members and vested partners, they have established themselves as a motivator and leading performer in the massage therapy and professional association industries.

In my opinion, this is a fundamental commitment on behalf of the AMTA. Which means, if, in the estimation of more than 58,000 massage therapists, more state boards are being formed all the time, the state’s MT Boards opt to become member of the FSMTB, and the MBLEx is the test of choice because of unification of regulation and legislation factors, then endorsing the MBLEx and educating all its members and making information about the MBLEx available to the public and the association’s members is a good choice.