Envisioning the Future of Massage Therapy Education
Changes, Challenges, and Opportunities

By Ben E. Benjamin

Opportunity is missed by most people because
it is dressed in overalls and looks like work.
—Thomas Edison

The field of massage therapy education today is a center of tremendous opportunity. As someone who has been practicing and teaching massage for four decades, I’m gratified to see how far we’ve come—in terms of diversity, professionalism, and credibility, as well as sheer size. In the business sense, these shifts provide an obvious opportunity: increased potential to succeed, prosper, and grow. At the same time, they provide other opportunities that look a lot more like hard work: the potential to reach new standards of quality and depth in our field, not just meet but exceed the public’s heightened expectations, and make even greater strides in enhancing our credibility. To me, these are the greatest opportunities, as well as the greatest challenges, that lie before us at the present time. Therefore, while it is certainly a time to celebrate how far we’ve come, it is also a time to consider where the profession is headed next.

My perspective on the future of our profession is informed by my own experience of its past development. When I began practicing massage therapy forty-four years ago, I faced questions of educational quality and accountability in a very different context. At the time, there were few massage schools in the country, the word massage had mostly negative associations, and there were few regulations in place to govern teaching and practice in the field. Professional standards were raised and maintained primarily by individual therapists through their own study and work with clients or through the training programs or apprenticeships they created. For those of us practicing at the time, it was clear that if we wanted to see positive changes in our field, we had to take the initiative to make them happen.

Now massage therapy has grown into a multibillion-dollar industry with several hundred thousand practitioners throughout the United States and more than a thousand educational programs. Among millions of Americans who receive treatments every year, massage is no longer a word with questionable associations, but instead is viewed as a respected, mainstream therapeutic modality. States and localities pay increasing attention to issues of licensure, certification, and accreditation, enacting regulations that affect both individual therapists and educational institutions. Although, as we’ll see later, this governmental involvement has mixed effects on educational quality, it represents an important step toward accountability and consistency of standards.

Developments such as these have transformed the field of massage therapy into the thriving profession it is today. They have also led to a significant shift in the organization and management of massage therapy education in this country—bringing both benefits and risks. In addition to prompting more small massage schools to open, the dramatic growth of our field has attracted large educational corporations, career schools, and community colleges into offering massage education. Massage therapy education is being marketed to thousands of people of all ages and walks of life as a way to reap the rewards of an emerging career opportunity.

In some ways, the expansion of educational opportunities is great news. More people (as clients, students, and practitioners) are able to experience the benefits of massage therapy. Talented, motivated individuals who may never have considered this profession twenty or thirty years ago are encouraged to pursue massage as a career. Yet with this progress comes risk—the risk that in the excitement and rush to bring new therapists into the job market, educational standards will decline. Over the past twenty years, there have been several major turning points that have for the most part lifted the profession up—in the late eighties, we saw the establishment of our own accrediting agency (COMTA); in the early nineties, national certification became a reality; and in the last fifteen years there’s been a rapid increase in the number of states licensing massage therapists. Today, as we reach another key juncture, it’s a critical time to reexamine just what it takes to develop high-quality programs that send fully skilled, professional massage therapists out into the world.

Many thoughtful individuals and organizations are looking carefully at the big question—what the standards of massage education should be and who should set those standards. At times different groups reach very different conclusions about what’s best for the field. Resolving those conflicts, coming to agreement, and taking action will require some work on the part of schools, state massage boards, certification boards, legislatures, professional organizations, and individual massage therapists. However, it is clearly in our best interest to work together to meet these challenges. By doing so, not only do we demonstrate our responsibility to clients, students, and the profession as a whole, but we also help ensure that the growth we see now can be sustained over the long term. I’ll address five key areas of concern, along with my recommendations: entrance standards for massage therapy programs; length of massage therapy programs; teaching ethics, boundaries, communication, and other relationship skills; teaching business skills; and teacher training.

Entrance Standards for MT Programs
In examining criteria for effective massage therapy education, the best place to start is right at the beginning—the admission process. Do schools have established procedures for screening out inappropriate candidates? Or do they simply strive to bring in as many students as possible?

It’s vital for schools to have clearly defined entrance standards. Admissions departments should carefully screen all applicants for any conditions that may affect their potential success in the program and in the field. They should work to attract candidates who are motivated and self-directed, who take good care of themselves, who are capable of exercising good judgment, and who have the potential to become ethically responsible professionals.

Another important standard is a minimum age requirement. As the bodywork boom has emerged, some institutions have targeted ads to high school students, holding out unrealistic, ambiguous promises of great jobs and high incomes. Individuals who begin massage education at this age often fail to succeed. Once massage therapists enter practice, they inevitably find themselves working with clients whose bodies are injured, out of shape, abused, or sick. Doing this work successfully requires a high degree of emotional maturity, as well as the awareness and compassion that come from life experience. Taking off even a single year between high school and massage school can be very helpful. During that year, individuals might prepare for their career by working or volunteering in a healthcare setting, receiving massage from various practitioners, and establishing a regular schedule of self-care, including exercise and relaxation techniques.

In the end, low entrance standards hurt students, schools, and the field as a whole. A school’s acceptance of unsuitable applicants leads to increased attrition rates, as students either drop out of the program or fail to succeed in private practice or finding a job. Eventually, with a poor track record and few sources of referrals, the school itself will fail as well. Appropriate standards of admission are a necessary basic requirement for us to maintain and enhance the credibility of our schools, our graduates, and ultimately our profession.

Recommendations
• MT school owners and program developers. Recognize that the admission criteria that work well for some vocational trainings are not sufficient for professional massage therapy programs. Set reasonable yet high entrance standards, and admit only those students who can truly benefit from your program and succeed in the profession.

• Potential MT students. Beware of ads that sound too good to be true; they probably are. While a career in massage therapy can be rewarding both personally and financially, it can also be physically and emotionally demanding. Becoming a good therapist takes dedication and time, and building a successful practice generally takes a few years.

Length of MT Programs
Another area of concern is the length of programs in massage therapy. Twenty years ago five-hundred hours was thought to be the minimum standard. In my experience, between seven-hundred-and-fifty and one thousand hours are required in order to develop the educational competencies needed to be a professional therapist. Legislation regarding the minimum number of educational hours for massage therapists varies widely among states. While Ohio requires a thousand hours for licensure, some states require only three hundred. Some towns require just one hundred and fifty hours, and other localities have no requirements at all. It’s not surprising that many schools design their curricula to meet, and not exceed, these minimum standards; it can be difficult for a seven-hundred-and-fifty-hour program to succeed when surrounding programs graduate students in just three hundred hours. Thus, in essence, state legislatures, massage boards, and local health departments are legislating the length of educational programs in massage therapy.

Massage therapy programs need to be long enough to enable students to acquire the knowledge and skills they will need as practicing therapists. I’m speaking here not only about book learning, but also about the learning that comes through experience. Compressed programs lasting just a few months are not sufficient to provide a solid foundation. For example, students need time to acquire a mature awareness of their own bodies and of how their touch affects others. It can take quite a while to develop a touch that is gentle and kind, yet also firm and confident. Students also need to become increasingly aware of their communication style and of their ability to connect with others. This awareness develops slowly, in classes that accent quality of touch, grounding and centering, developing a treatment plan, boundaries, ethics, learning styles, relationship building, and communication skills.

Finally, to fully develop all of these skills, it is crucial for students to get experience practicing in a student clinic—preferably doing at least fifty or sixty treatments over several months. In a supervised clinic setting, students can safely put into practice the knowledge and somatic awareness they have gained, learn to identify their own strengths and weaknesses, and take these insights back to their faculty and classrooms to improve their capabilities.

By giving adequate time and attention to all the skills and experience required to work well with clients, we prepare our students to be confident, competent professionals. Only then are they able to express the true power and potential of massage therapy.

Recommendations
• State legislatures, massage boards, and local health departments. Establish professional requirements for massage therapy that truly reflect the quality of practitioners you wish to license or certify.

• MT school owners and program developers. Dare to design your educational program to exceed licensing and certification requirements. In particular, develop a sufficiently long clinic program that allows students to develop professionally before entering the workforce.

• Practicing MTs. Work with your professional organizations to encourage your state and local legislators to improve licensing regulations, and take an active role in improving the program of the school you graduated from.

• Potential MT students. Don’t expect certain success and big rewards from taking shortcuts. Look for an educational program that will fully support you in becoming the best therapist you can be, even if it takes longer and costs more than programs based on minimum requirements.

Teaching Other Relationship Skills
All bodywork practitioners must be skilled at creating and maintaining strong, healthy therapeutic relationships. Without this ability, even a therapist with great technical expertise will have difficulty building a client base. In addition, an understanding of ethics and healthy boundaries in relationships helps to protect the physical and emotional safety of both clients and practitioners. It’s my belief that massage programs offering coursework on these issues have helped to lower the number of therapists reported for sexual abuse over the past fifteen years.

In my opinion, it’s essential for massage therapy schools to cover topics of ethics, interviewing, listening skills, assertiveness, conflict resolution, boundaries, sexuality, dual relationships, sexual abuse, sexual misconduct, and building a therapeutic relationship. However, it’s often very challenging to build such person-centered skills into a curriculum. It’s certainly easier to assess students’ knowledge of anatomy or physiology than to measure their competence in communication, relationship building, or ethical behavior. Schools may also have trouble finding the time to teach these topics. For instance, a school that adds hours to its science-based offerings—either to comply with an externally imposed mandate or simply to strengthen its coverage of that material—may look to make cuts elsewhere; ethics or communication courses may seem to be the easiest to eliminate. It takes determination, creativity, and passion to develop a massage therapy program that excels at providing the softer skills needed for the therapeutic encounter.

I believe that giving sixty hours of classes on ethics and therapeutic relationships is a minimum and offering one-hundred hours is even better. Currently, some schools offer a total of just six hours on these topics. Schools that do not offer extensive coursework in these areas will graduate practitioners who are not prepared to work in the real world and who may, in fact, cause a great deal of damage to their clients, themselves, their schools, and the profession as a whole. In contrast, schools that excel at teaching this material play an important leadership role. Their faculty and students set an example of professional conduct and responsibility, helping to earn the respect and consideration of practitioners throughout the bodywork community and other healthcare fields. Most important, they help ensure that massage therapy remains a safe, supportive practice for both clients and therapists.

Recommendation
• MT school owners and program developers. Ensure that your curriculum has a full one-hundred hours of coursework in ethics, boundaries, communication, and relationship skills. If this means your program is longer than the minimum requirements for state, local, or national entities, pat yourself on the back for a job well done.

Teaching Business Skills
Being an excellent massage therapist is only part of the skill set necessary to succeed in this growing profession. Business skill is often a crucial missing piece for practitioners. The majority of graduates from massage therapy programs start their own businesses, but many have no idea how to initiate and maintain a practice that will enable them to make a living. Of the practitioners who work as employees or subcontractors in spas, medical settings, or group practices, many don’t fully understand how to manage their finances or negotiate with those they work for. I firmly believe that massage therapists need to be proficient in the specific skills that will allow them to be professional business people—skills that are quite different from those required to perform massage. A responsible massage therapy school trains its students in business practices.

Business courses in a massage therapy program ideally teach students how to develop a private practice, negotiate with contractors, work effectively in an employer-employee relationship, and attract clients and keep them. In my experience, including thirty hours of coursework on business topics is a minimum and including fifty hours is better. Students who leave school with a fully written business plan that they can realistically put into effect immediately upon graduation have the best chance of succeeding.

Educating people to work in a field where they have to function as businesspeople without providing instruction in business skills is simply unwise. Graduates who have received minimal or no coursework in business skills are much more likely to fail in their endeavors. Those who receive thorough preparation in these skills leave school with a much greater potential to maintain sustainable, successful practices throughout their lives.

Recommendation
• MT school owners and program developers. Recognize that the success or failure of your school depends on how well your graduates perform as businesspeople. Establish a course in business skills that will enable graduates to enjoy their new career long term, and allow your institution to establish and keep its place in this profession.

Teacher Training
So far I’ve addressed a number of factors related to a massage school’s curriculum. Of course, the way this coursework actually reaches students is through teachers. To succeed, all schools need to hire and retain competent faculty—faculty who have the potential to excel not only in their knowledge of the subject matter, but also in their ability to teach effectively. An individual may have a very high level of skill and a strong base of knowledge and yet not be adept at conveying those skills and knowledge to others. Many educational institutions—from universities to vocational schools—fail to take this into account. When practitioners know a subject well, they are frequently hired to teach regardless of whether they have any training in education. Admittedly, some people are natural-born teachers, but most are not. Being a consistently good teacher requires education courses on topics including classroom management; the organization, planning, and presentation of subject matter; and the use of student assessment tools.

At present, official regulation of teacher qualifications is rather loose. Some accrediting agencies establish requirements for faculty at their member schools. However, the requirements are sometimes vague, and schools may be given great leeway in how they meet these guidelines. For example, schools may be able to hire practitioners who have no teaching experience or coursework in education as long as they provide them with in-house teacher training. Such a system may work well, but only if each school shows a sincere commitment to the quality of its programs and provides strong support for all individuals hired to teach its courses. A failure to do so is a disservice to both teachers and students and will end up hurting the school in the long run.

Recommendations
• MT school owners and program developers. Recognize that teacher qualification is measured not only by experience and skill in the subject matter, but also by experience and skill in teaching. Establish rigorous standards for your teachers and offer continuing teacher training for all faculty—with particularly strong support for those who do not have prior teaching experience.

• Practicing massage therapists. At some point you will probably be approached by a massage therapy program to teach the subject you know and love. Prepare yourself for this exciting development in your career. Seek to learn the skills of public speaking, lesson planning, and student assessment with the same passion and dedication you brought to your education in massage therapy.

Looking Toward the Future
Massage therapy enjoys a status today that was difficult to imagine when I entered this field many years ago. With dramatic surges in the popularity and credibility of massage, more people than ever before are able to experience the benefits of our work—both as clients and as practitioners. As we share the excitement of that progress, it’s important to remember the principles and commitments that made this growth possible and that will help keep it going. By addressing each of the issues discussed in this article—from the admission of fully prepared students to the training of outstanding teachers—we can help preserve the strides we’ve made and prepare for even greater advances. All of us who love this profession have the opportunity to help make our best vision a reality and to ensure that the future of our field is equal to its promise.

Ben E. Benjamin, PhD, holds a doctorate in education and sports medicine. He is senior vice president of strategic development for Cortiva Education and founder of the Muscular Therapy Institute. He has been in private practice for more than forty years and is the author of Listen to Your Pain, Are You Tense? and Exercise Without Injury and coauthor of The Ethics of Touch. He can be contacted at bbenjamin@cortiva.com.

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