When I began as a therapist in 1977, Swedish massage, shiatsu, Rolfing, Aston-Patterning, reiki, Feldenkrais, Alexander work, polarity, and craniosacral therapy were the modalities one mostly encountered.1 There was a broad umbrella under which they all easily coexisted. As the massage and bodywork field grew,2 its proliferation gave rise to new modalities, new educational standards, more schools, more organizations, and various interest groups. Sometimes it has been difficult to see the forest through the trees, but it’s still there.
Lately, the tree of science, or evidence-based massage, has been somewhat overshadowing other approaches. We have seen an emphasis on science and evidence-based massage and a relative de-emphasis on the artistic and the energetic side of bodywork. This is partly due to the excitement with which the field has tried to attain clinical competence and get respect from the medical industry. In addition, through more than just national interactions, massage in the United States, which has traditionally been accepting of an eclectic mix of therapies, has been confronted with, for instance, the Canadian model, which is more of a European physiotherapy, allopathic model of massage.
Other influences are those of testing, national certifications, and licensing. It is vastly easier to test for scientific knowledge than for art and hands-on skills. National exams do not contain—understandably—an examination of hands-on skill, energetic sensitivity, palpatory literacy, or actual therapeutic benefit because it is recognized as nearly impossible to objectively judge hands-on work. But the deeper insight here is that what constitutes the highest skill level in our field is indeed something that has as much to do with art as it does with science. Though we don’t test for the art, that doesn’t mean it isn’t of equal or greater importance.
Progress in both the art and science, both energy and structure, is a precious legacy of modern massage therapy. Of late, the scientific perspective has been wonderfully emphasized. It is the purpose of this article to contribute to balancing this emphasis with an understanding of the essential role energy, art, and integration play in our knowledge and therapy.
Energy Work Defended
On the one hand, energy is too important a subject to be defined only by its devotees—some of whose ideas or practices have been shown to be false or dangerous— or with claims made for scientific validity where there is insufficient scientific evidence or disproof.
On the other hand, energy work has been negatively defined by its detractors. These are people who act as if anything that is not scientifically proven or evidence-based is false and/or offensive to the rational mind. Energy and energy work, to some extent, must be defended from both its devotees and its detractors.
Here, though we primarily explore the energetic standpoint, we will be often reminded that “both/and” thinking—integrating both structure and energy—is more accurate than describing something as structure or energy alone. Let’s see how we can cultivate a more inclusive vision and not take sides.
The Union of Energy and Structure
Let’s first make clear that energy work and structural work are two sides of the same coin. Most likely, the most effective therapy will arise from an approach that respects and unites the structural and energetic aspects of both therapist and client. The various arguments for and against energy work, and for and against excessive insistence on evidence-based therapy, are certainly passionate.
But the best answer to most passionate debates is often a more overriding vision. The assumption that the scientific/structural view of massage is the correct one is as one-sided as the assumption that the artistic/energetic approach to massage is correct. It is comparable to arguing which one of your two eyes you ought to see out of.
Each person is both physical and more than physical (e.g., having also mind and emotions). Therefore, an approach that is most likely to foster the deepest experience of health will be one that takes the whole person—physically and more than physically—into account.
As we explore the realm of energy, my goal is to clarify the energetic realm and make it more likely that massage therapists and bodyworkers be even more empowered to join art and science in their work. The separation or antagonism between energy work and structural work often seems a waste of time and, at worst, a real tragedy. It would be like separating health from care. We practice health care. We are responsible both for caring, which is energetic, and for being skilled in promoting health through soft-tissue manipulation.
The union of art and science, of energy and structure, of health and care is a triumph of historical proportions. Our field needs this triumph in the realm of the union of clinical excellence with palpable care.
Energy in Physics
The concept of energy in bodywork has historically, and I think wisely, had a wide definition. In physics, it is understood that phenomena can be looked at in terms of being particles or matter versus waves or energy. Energy, to some extent, can be measured. It is commonly defined as “work done.”
In general, this view leads us to say that energy is more connected to action, waves, and movement than to particles and matter. Commonsensically, since mass and energy are in fact a unity—and nothing would exist without both—we can see that they are simply two ways of looking at or describing the same thing. You may look in the ocean and say, “Look at that wave!” or you can also say, “Look at the water waving.” So is the wave a thing or a process, a noun or a verb? Well, it is both/and, not either/or. When we think we see a thing, we are looking at the phenomenon from the particle standpoint. When we think we are looking at a process or motion, we are looking at it from an energy standpoint.
Energy in Bodywork
The scientific method is empirical. It looks at and works with what is there. In the case of a human, there is a body, and certainly mind and emotions as well. Many people include soul and spirit, though some find their existence somewhat less obvious.
Generally, a consummate physician or therapist who consistently earns the patients’ and clients’ respect will be someone who relates not just to the anatomy and physiology of the patient/client, but also to their personhood. They care about their patients/clients: how they feel, what stresses they are under, what knowledge they have about what’s going on with them—in addition to having great skill in effectively addressing disease and injury.
Another way to say this is that they consider both structure and energy in their practice.
What is Structure? What is Energy?
When we think about structure, it includes anatomy, mass, matter, particles, and physiology—generally, the physical aspect of the person.
Structure may also be thought of as objective, palpable, tangible, and visible.
Energy, most broadly defined, is the entire realm of experience beyond just the physical. It may be thought of as subjective, intangible, not necessarily palpable, and not necessarily visible.
Energy includes action, force, movement, vibration, and waves. It also includes the realm of sensation, emotion, and mind: beliefs, consciousness, feelings, senses, and thoughts; and the realm of spirit: soul, spirit.
Some of these, of course, can be described in the language of neurological and endocrine processes. The autonomic nervous system is in many ways an energetic system, responding to feelings, thoughts, sensations, etc., by changing the overall energetic and physical state of the organism. Other energetic phenomena, particularly associations we may have with given sensations, may be described in terms of activities within the limbic system (amygdala, hypothalamus, etc.) in the diencephalon of the brain and then affecting the whole person through the neuro-endocrine response.
The Languages of Energy
Certainly languages other than physiology have been used, often fruitfully, to describe energy3: bioenergy, chakras, chi, fields, kundalini, meridians, nadis, poetry, prana, the language of beauty and esthetic philosophy, the language of psychology.
Each of these are lenses we may choose to use or not, in order to see our clients more clearly. In that sense, each way of describing energy uses metaphors—like language itself—to try to capture the facts and feel of reality.
Energetic and Integrative Modalities
Some of the many bodywork modalities that explicitly use energetic lenses as part of their theory include: acupressure, acupuncture, chakra balancing, chi nei tsang, craniosacral therapy, hakomi bodywork, lomilomi, polarity therapy, Reichian bodywork, reiki, shiatsu, Thai massage, therapeutic touch, and Zero Balancing.
Some of these are more pure energy works. Others—such as Zero Balancing—are more explicitly integrative bodyworks that fundamentally link structure and energy in their practice. Of course, this is not an exhaustive list of all the bodywork forms claiming an energetic component; that list would be very long indeed.
Many primarily structural modalities also acquire an energetic dimension when a practitioner aims at helping the client in ways more than just physically.
The Limits of Provability and Evidence
Many of these body-mind works have been questioned as to how much of their success is due to the placebo effect and how much to actual therapeutic efficacy. Certainly the offhand dismissal of the placebo effect, the power of belief, and the power of suggestion are too extreme. Many studies have shown that belief plays a powerful role in health and healing.4
Some subscribers to evidence-based therapy claim that many energetic practices have been disproven because their good results may not be objectively demonstrable, consistent, or reproducible. When we are looking at the art of massage (not just its science), we are looking at a more subjective realm. Just as a piece of music or painting may have a life-changing impact on one person and not on the next, so a given massage session may have similarly unpredictable and irreproducible results. This doesn’t disprove its premise. It just goes to show that actual therapeutic results are not always predictable.
Saying that a therapeutic result should be reproducible or the method is false wrongly applies objective standards to a situation that is both objective and subjective—the way the client integrates the therapist’s input.
To paraphrase the philosopher Martin Buber, it is not the therapeutic intention that is fruitful, but it is the meeting that is therapeutically fruitful. Every session is an improvisation in the moment, naturally guided by forethought, prior study, intuition, taking a good history, and session design. However, the proof is in the pudding, and the art is in the fascinating moment-to-moment improvisation that constitutes the therapy session.
Research and logic are valuable for guidance—so is imagination! If we weren’t meant to combine the logical and the imaginative sides of ourselves, nature wouldn’t have given us the two cerebral hemispheres.
The Therapeutic Model
In most US states, laws explicitly state that massage is not the practice of medicine and does not involve diagnosis or treatment. Rather than defining this as a limitation, we can see this as an enormous opportunity. In the United States, and in many countries around the world, massage therapists practice as health-care professionals, not disease-care professionals (unless, of course, you have dual licensure as a medical professional and massage therapist). We are required to look at health and what promotes it especially through the physical and energetic effects of touch. There are very few therapies whose mission is explicitly health promotion.
Years ago, Jeff Maitland, former faculty chairman of the Rolf Institute, proposed a model of the levels of health care in our field.5 I think it’s very helpful to be reminded of these. I’ve reworded them somewhat:
1. Wellness—this includes the basic and powerful effects of caring touch as manifested in Swedish massage, spa massage, etc.
2. Orthopedic—this includes skill in understanding injuries, postural issues, and the ways massage/bodywork may or may not help with various diseases. Orthopedic massage ideally includes a respect and knowledge of wellness massage.
3. Holistic/Integrative—this includes an understanding of psychology, as well as anatomy and physiology; a unified therapeutic approach that addresses the whole person. This ideally includes excellence with respect to wellness and orthopedic massage, and skills in touch that contact and positively affect energy, as well as structure.
Next Steps
What next steps can our field take to match the momentum in the science of massage with a balanced progress in the art of massage?
• Define more clearly the realm of energetic work and integrative work.
• Define more clearly what constitutes the art of massage. People commonly say massage/bodywork is an art and a science, but almost never explain in any detail how or why it is an art.
• Utilize research to ground energetic and integrative work, insofar as it is possible or appropriate, in science.
• Recognize that the most effective therapy will likely combine a knowledge and attention to the energetic, as well as the structural aspect of the client.
• Encourage massage education to take the “whole” more into account, and resist the tendency to be subsumed under a reductionist version of medicine practiced by the medical industry and insurance companies.
• Provide clearer guidelines for the teaching and practice of energy work, the art of massage, and integrative bodywork that unites structure and energy.
• Add questions regarding energy, energetic and integrative bodywork, and the art of massage to school and national exams.
• See a greater commitment among therapists, educators, and organizations to a revisioning of massage that explicitly honors art, as well as science, and commits equally to making progress in the art as much as in the science.
It is time for the field to recognize, rejoice in, and welcome our next steps. It is high time to proceed in a balanced way, honoring the legacy of massage therapy as the explicit union of care and knowledge, and art and science, in touch.
David Lauterstein, LMT, has been in massage and bodywork practice since 1977. In 1989, he cofounded the Lauterstein-Conway Massage School in Austin, Texas. He is certified in structural bodywork, Zero Balancing, and is the founder of Deep Massage: The Lauterstein Method. He has taught Deep Massage and Zero Balancing in England and throughout the United States since 1982. He is the author of Putting the Soul Back in the Body, Deep Massage Book (forthcoming in 2012), and more than a hundred articles on the philosophy and practice of massage and bodywork. In 2009, Lauterstein’s school was named US School of the Year at the World Massage Festival. In July 2011, Lauterstein was inducted into the Massage Therapy Hall of Fame. For more information, visit www.tlcschool.com or email davidl@tlcschool.com.
NOTES
1. A little on my background: I approach this subject as a person with curiosity about energy since childhood. I recall writing a paper titled “What is Thinking?” when I was 12. Around that time, I began an involvement with folk, rock, and classical music that lasted most of the first 30 years of my life. There were also forays into poetry, philosophy (particularly esthetics), yoga, spirituality, bodywork, psychotherapy, and social change. In the mid-1970s, this coalesced into a career in massage therapy and then teaching massage/bodywork for the last 30 years in the United States and the United Kingdom.
2. In this article, the terms massage and bodywork are used interchangeably.
3. I do think much of the use of the term energy is subject to what the philosopher Alfred North Whitehead called “the fallacy of misplaced concreteness.” I don’t think chakras exist in the sense of wheels or spheres of energy spinning in a certain direction. However, I find them very useful as a language for talking about the role different parts of our bodies play in our lives. And I have had experiences of energy flow or kundalini that I have no doubt were real experiences. I treasure some of these experiences and learn from them to this day. I have found no way more clear than speaking of them as experiences of energy flow in the body.
4. Peter Halligan and Mansel Aylward, eds., The Power of Belief. (London: Oxford University Press, 2006).
5. Jeffrey Maitland, Patricia Benjamin, Raymond Castellino, et al., “Three Paradigms—Five Approaches,” Massage Therapy Journal (Summer 1991): 21–3.