In a recent Massage & Bodywork Table Lessons column (“Hope. Trust. Faith.,” January/February 2020, page 26), Doug Nelson relates working with a client who had been living with pain secondary to surgery.
Although Nelson said the client didn’t have results right away, the secondary pain did not surprise him “given the characteristics of neural sensitivity.” Nelson then explained to his client the dynamics of neural irritation, bidirectional feedback loops, and how precise soft-tissue therapy might be beneficial. Nelson says, “I also shared my previous experience with this condition and the research underpinnings of what I was doing, and why.”
What Nelson was actually describing is how to be a health-care provider—which, to him, is what massage therapists do—but his 40 years of practice did not transform him into a caring practitioner of health care. Instead, paying attention, reading and understanding research, and focusing on the therapeutic relationship did. I’m certain Nelson did some very specific things with his hands, but I would argue that what made the biggest difference for this client was Nelson’s understanding of what he was doing, what he thought was happening in this client’s body, and his dedication to helping his client not only understand it but also to feel a part of the process.

The Skills You Need

State licensing requirements do not lead to increased competency in our bodywork careers. The state’s only concern is to protect the public from harm, not to ensure that members of the public receive exceptional care. If you meet the bare requirements to hold a massage therapy license, your sign may as well read, “It’s really unlikely that I’ll seriously injure you.” We have to set a higher bar as professionals.
To date, our profession does not offer meaningful, credible, and renewable credentialing to which consumers can look to find safe, clinically effective massage therapy for those with health issues. So, how do we get there?
First, we need to decide we want to get there, and then we need to get over the “I don’t want to be a health-care provider” story. Remember, being a health-care provider does not mean you take insurance. It means you are a responsible, ethical practitioner providing evidence-based interventions to improve the experience of a fellow human.
Second, you need to consider whether you want to work with clients who have chronic illness, nerve pain, or myriad other ailments afflicting humans. If you don’t, I think you may be in the wrong business.
Even if you decide to limit your practice to “healthy” people, being a provider of health care means getting good at making responsible referrals. To do this well, you’ll need to talk to people . . . and listen to them, as well.
The skills you need to be a health-care provider are not in your hands, unless you’re using your hands to cover your mouth. If you want to make your way to advanced practice and quality care, seek out courses in listening, how to cultivate meaningful therapeutic relationships, and how to integrate new information—especially when it conflicts with what you were sure you already knew.