January 29, 2008 R. Ann Constable, Esq., Executive Director Massachusetts Board of Registration of Massage Therapy Fax Number: 617-727-2197 Dear Attorney Constable: I would like to respectfully submit the following concerns for the purpose of the public hearing Friday, Feb 1, 2008. These concerns were introduced to the massage therapy board in an earlier letter. As I explained in that letter, I am a State Representative for the American Organization for Bodywork Therapies of Asia (AOBTA®). I am also the Chairperson for the AOBTA’s Forms Committee. This is a national committee which is responsible for representing and protecting the interests of all of the fourteen specific “Forms” of Asian Bodywork Therapy (ABT). In addition to its entry level professional member certification in ABT, the AOBTA also certifies instructors in each of these specific Forms. We define five different kinds of shiatsu, for example, such as Macrobiotic, Five Element, Zen, etc. and respect the historical lineage of each. I would like to make sure that the new massage board is aware of all of the existing AOBTA certifications for Asian Bodywork Therapy (ABT) and be informed that these all share our common scope of practice. This is also true for the national certification exam which certifies Diplomates in ABT. This exam is administered by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). Our chief concern centers on the need for the massage therapy board to more specifically clarify that there is a distinct difference between the practice of “massage therapy” and “Asian bodywork therapy” (ABT). As we first described in our earlier letter and I later explained to you over the telephone, we believe that this clarification has been made necessary by the inclusion of the clause which was inserted after the ABT exclusion and qualifies that Asian Bodywork Therapy “that does not constitute massage as defined in this Chapter” is excluded. We believe that this clause thereby suggests that some kinds of ABT are not excluded. Since we are only able to speak for ourselves we wish to point out that all of the ABT practices which the AOBTA represents should be excluded. They all engage in practices which treat the acupressure points, Qi and meridians. The AOBTA’s educational requirements for all Forms of Asian Bodywork Therapy start with 100 hours of study in Chinese Medicine Theory. This provides a comprehensive foundation for treating the acupressure points, Qi and meridians which are described in Chinese Medicine Theory. This scope of practice is clearly excluded from the practice of massage therapy in our new state law. This knowledge is what the ABT National Certification exam tests for. Our educational requirements also include a minimum of 160 hours of hands-on training in order to learn the manual techniques which are unique to each of our specific Forms. The additional requirement of at least 70 hours of clinical practice is essential in order
to ensure that each student becomes proficient enough to become a practitioner of ABT. Complete training must include a minimum of 500 hours and the details of this are attached. The attached document also explains in more detail the scope of practice and definitions used by the AOBTA. At this point we do feel assured that the practice of all of these specific AOBTA Forms should be clearly excluded from “massage therapy”. However, since these different Forms certainly include a wide range of manual technique, we are still concerned that without some specific clarification in your rules, manual techniques could end up being evaluated as a measure for what is considered “massage therapy”. Tuina provides one good example of the wide range of hand techniques which are required and expected within the ABT scope of practice. Macrobiotic Shiatsu provides another example as it requires many techniques using the foot, knee or elbow. Since we originally had a clear cut exclusion there was not any language introduced into the bill that attempted to describe us by virtue of technique. Now the language describing how the Qi and meridians are “affected” can be viewed as limiting the range of our manual technique. For this reason we feel the need to give formal clarification that ABT’s scope of practice is appropriately defined by requiring sufficient knowledge of Chinese medicine theory and an application of a treatment paradigm which is unique to that theory. It is our understanding both from reading the language in Chapter 135 of the Acts of 2006 and from listening to the thoughtful responses we have heard on the massage therapy board, that our scope of practice should clearly and legally be seen as separate from the definition and scope of massage therapy. Personally, I was very relieved to hear that the massage board is legally restricted from making statements or rules which could be construed as trying to include or in any way regulate ABT. We certainly don’t want to change or modify that approach! We would like to request that some specific clarifications could be made in your rules. We would like to suggest: 1. that an additional subparagraph be added near the beginning of the section on professional ethics 269 CMR 5:01 Code of Professional Ethics: stating that massage therapists should not use any term other than “therapeutic massage” or “massage therapy” to describe their licensed scope of practice. This would be a rule pertaining to Chapter 135 Section 235 (3) & (4), to make it clear that other titles such as “acupressure massage”; or “shiatsu massage” are not an option. 2. We request the addition of a new subparagraph which states: “In regard to advertising, Massage therapists with appropriate training who wish to use Asian Bodywork Therapy techniques or ideas must respect the legitimate credentials, titles and certifications which are national standards in the field.” We think this might be appropriate as an item (m) in the section addressing business practices with the following subparagraphs renumbered. We would also like to assure the board that we are committed to educating our own members that it is no longer appropriate to use the word “massage” in their advertising. Any of our members who wish to use the word massage are being told that they need to become grandfathered as massage therapists. We do assume that there are practitioners who are both licensed massage therapists and qualified ABTs. We hope that you will agree that while massage therapy schools should be free to include whatever portion of a legitimate ABT
program they wish, that the board’s new rules will help ensure both your schools and therapists respect the differences. Most of our members have completed their studies in Massachusetts where we have had more than five state licensed ABT schools. Most of these schools had training programs which exceeded 700 hours. These members are pure practitioners of Asian Bodywork Therapy who do not promote their practice as massage therapy and are clearly exempt from the massage licensing requirement. Since the coalition of the 1990’s, the AOBTA has enjoyed a very good relationship with the massage therapy community in Massachusetts. We have functioned as allies for a long time and made a mutual decision to pursue the current law. We would like to congratulate the massage therapy community on its having finally achieved its own state licensure. We know how difficult it was to achieve! We look forward to continuing a good relationship with one another. Attached you will find more detailed descriptions and documentation of what I have described above. Thank you so much for your consideration. Sincerely,
Cindy Banker, MA, Dipl. ABT (NCCAOM) AOBTA®-Certified Instructor in Five Element Shiatsu Chairperson, AOBTA Forms Committee Massachusetts AOBTA State Representative