Be Excellent

Translational Education: The Two-Way Exchange Between Massage Schools and Massage Practitioners

By Ruth Werner

What does it take to be an outstanding massage therapist? This is a question every massage educator should revisit on a regular basis. In my many years of observing our profession, I have noticed a few things that I think address this issue. Successful bodyworkers often have qualities that are both predictable and paradoxical.They are private and outgoing; they are analytical and intuitive; they are intensely in the present and able to anticipate what comes next; they are confident and humble. Without these fascinating contradictions, many massage therapists fall by the wayside.

They have a hard time attracting clients, become bored with their job, or simply find an alternative that works better for them.

Most of us who have lasted in this field have had to work hard to develop our strengths in order to find the balance we need to survive. Our profession simply demands it. Our massage training didn’t create those qualities in us, but if the schools we attended were good, then they helped us to identify our strengths and weaknesses and provided an environment where we could grow in some exciting and unanticipated ways. And, in the best-case scenarios, those discoveries continue to influence the way we work and live.

Back in My Day

This has been a particularly reflective year for the massage therapy profession. The fact that many organizations, including Associated Bodywork & Massage Professionals, are celebrating important anniversaries has provided some of us old-timers an opportunity to look back on where we’ve come from, in an attempt to predict or even to influence where we may be going next. This exercise has a lot of appeal for someone who has watched our profession make some major changes in the last two decades. My own 25-year interface with massage has been much more in the realm of education than in practice, from that perspective I am happy to add my two cents to the discussion.

People who were educated in massage along with me will remember what massage school was really like back in the day: classes were informal and were often conducted in someone’s basement, living room, or large office. A particularly rigorous program might have a skeleton in the classroom. We bought or made our own tables and schlepped them to class with us every day. (My first table cost $25 and five massages. It was homemade of ¾-inch plywood, 2 x 2s, and a piano hinge. It had no face hole or cradle, and it weighed 50 pounds.)

In those primitive, pre-lotion days, we used cold-processed almond oil from the health food store, until people started getting hives. Then we used cold-processed walnut oil, which is hypoallergenic, but it goes rancid really fast, so you have to keep it in the fridge—a special treat for massage on a cold night.

In those dark ages before education requirements, I thought my program was extremely demanding. After getting a college degree that allowed me to avoid the sciences like the plague, massage school was my first exposure to anatomy and physiology, and it certainly felt like I was learning a lot. My first transcript, however, touts a whopping 125 hours of classroom instruction. We had no core textbooks written for massage therapists. Our reading assignments were jury-rigged from texts for other professions: premed students, physical therapists, etc. And our pathology text was the American Medical Association Family Medical Guide. My school had one wonderful, inspiring teacher, and he taught everything. When we finished school, we were proficient in Swedish massage and had enough experience with deep-tissue techniques to know that we had much more to learn. Our school had no administrators, student deans, financial aid liaisons, or admissions directors. The cost of my first program was $350.

Compare this to massage education today. The school where I teach has a core program of 780 hours, and we desperately need more time. There might be 24 faculty members on the staff and five administrators. We have a large selection of fabulous textbooks and other resources created specifically for us. Students graduate with exposure to—if not mastery of—many modalities and certainly more knowledge of business, ethics, and how to work in a clinic than we did in the old days. And tuition has risen a little: it is typically in the tens of thousands of dollars.

What Happened in that Quarter-Century?

Two of the most profound shifts in massage school education between then and now include the availability of government-sponsored financial aid and the change of many schools away from proprietary and owner-operated organizations to larger corporations or community college settings that often have an open enrollment policy. One consequence of this, as many massage educators can attest, is a change in the demographics of our students. While we still get mature students who are picking up massage as a second (or third, or fourth) career, we now get students who are barely out of high school. This changes the classroom dynamic in some key ways.

It is possible to find both positives and negatives in these changes. It’s easy to list all the bad things about the up-sizing of massage education: “puppy mill” schools that churn out graduates who do the same rote session with little insight or inspiration to explore the art of massage; students lured with the promise of an easy education leading to an effortlessly lucrative career; new massage therapists entering the market who have little chance of long-term success in this profession. We look for, and often find, a race to the bottom in academic and practice standards, as we see students graduate who are unlikely to succeed because of a lack of maturity, experience, or a sense of personal investment.

But this is just one perspective. Large, corporate-owned or vocational schools are here to stay. This can be a huge benefit to the profession, and here’s why: with volume comes power for positive change. Perhaps one of the most important ways large schools have influenced the massage profession is by making semi-public, low-cost student clinics readily available, accessible, and appropriate to people who otherwise would not have considered receiving massage: every practicing therapist has benefited from that shift. Furthermore, large schools work with hundreds, instead of dozens, of students, which puts them in a position to qualitatively influence the massage education industry. They can require the creation of targeted texts and supportive materials. They can invest in teacher training and educator support. They can create expectations and, even more importantly, brand identifications. Try this for a massage school advertisement: Don’t come here for the easiest education. Come here for the best. In this way, large schools are in a position to set the pace for the rest of the massage education industry.

Ultimately, we all know that you get out of massage school what you put into it. Some people graduate from huge, corporate-owned schools, and they excel and build a career that provides everything they dreamed of. Others graduate from tiny owner-operated schools and fail utterly. What makes the difference? Partly it’s the school, but mostly it’s the person. It’s presence of tenacity, vision, drive, motivation. Schools can’t create these qualities, but they can support them, nurture them, help them to flourish. Yes, many massage students are younger and less focused today than they used to be, but isn’t that a remarkable chance to influence the future of our culture? Regardless of whether that 19-year old is in practice 20 years from now, think of how that young person can be influenced during a year in massage school.

Raising the Bar

The massage education industry has a profound influence on how massage is practiced, but we often forget that influence flows in both directions. If large schools elevate their standards, everyone else has to rise to the challenge in order to match the competition. So the massage education industry needs a reason to raise, rather than lower, the bar for massage education.

Where can that impetus come from? It has to come from us: practicing therapists. Practicing therapists set a standard of professional expectations for the public consumer. Practicing therapists educate the public about what a professional massage (as opposed to a student clinic massage) can be. And—most importantly—practicing therapists hire new graduates. So it is incumbent upon us to expect excellence from ourselves and from our newest colleagues: we are the ones who must elevate that bar of expectation. When we set that standard high, schools have a reason to rise to the challenge. When we don’t set the standard high, schools have no reason to aim for it. In that situation we are not represented well by our colleagues, and the whole profession sinks in consumer appeal.

In a stretch of language, this circle of influence could be called “translational education.” That is to say, while the massage education industry has great influence on how massage is practiced, outstanding, highly skilled therapists also create and sustain a public expectation. In this way they have influence on how new therapists are educated, because those skills must be “translated” back into the classroom.

We live in a touch-starved, stress-fed culture. Even in a massively restructuring economy, the public wants the services we have to offer. People will continue to seek out massage as part of their healthcare, as a workplace perk, and for their recreation. They want what we have to offer, but only if we do an outstanding job.2 This is why it is imperative that we keep standards high, for ourselves and for our newest colleagues.

How do we raise the bar both for current practitioners and for schools who work to fill the ranks of new therapists? Standards are much easier to talk about than they are to identify or impose. Think of the vast and varied ways our profession is practiced. From massage as a hobby to massage in the hospital; from the spa to the sporting event; from the clinic to the cruise ship: we are all practicing under the same title. Studies show that we all look for the same core competencies, but we are all doing radically different types of work. Furthermore, bodywork practitioners and massage therapists are a notoriously difficult group of people to organize. This is a reflection of the absolutely self-contradictory traits that are required to be successful in this field.

Massage therapists must be reverent of the private and sacred space that our clients and we inhabit in the session room. And we must be gregarious and friendly enough to convince complete strangers that taking their clothes off and being touched all over is a really good idea. Massage therapists must be fluid, intuitive, and in the moment in order to be sensitive to the constant flow of information going back and forth between our clients and us. And we must be rigid about certain boundaries like time, money, and sexuality in order to retain our professional standing. Massage therapists are by nature giving, generous, and service-oriented. But we must also be rigorous, conscientious, and disciplined about self-care and professional development. We must be compassionate, nonjudgmental, and welcoming to all. And we must be completely committed to walking the talk in terms of professional and personal integrity.

Meeting the Challenge Ahead

We have an interesting journey ahead of us. We have a stake in keeping our professional standards high, but as a profession we have a hard time coming to consensus about key issues. As we grow in numbers and influence, we need to continue to develop and strengthen our sense of direction and purpose. And because we are a highly diverse population with multitudes of practice settings and few opportunities to work together, this challenge can seem overwhelming. I identify three ways we can address these challenges:

Practitioners: be excellent. Our profession needs constant support and tending to keep standards high. This support can begin in the classroom, but must also be led by active practitioners, who in turn create expectations for what should be accomplished in the classroom. Remember: every time we put our hands on a client, we need to create an expectation for excellence.

Schools and educators: don’t
dilute skills.
The massage education industry has expanded exponentially in the past 25 years. Schools have grown in size and scope, and there is a temptation with that potential to try to teach all things to all people. Size can be wonderful, but this must be accompanied by a dedication to the highest quality possible.

Know who you are and what you want in this profession. Get involved with other therapists in your area. If you have a school nearby, see if you can find a way to have some interaction with its students. Join a peer supervision group or Internet bulletin board to share your successes and challenges. All of these ways of reaching out can help us enrich our sense of what this profession can be, which feeds our self-definition.


Readers who are familiar with my pathology books may know a format that works to organize information in a succinct, easy-to-use way. It follows this pattern: definition, etiology, signs and symptoms, treatment, massage. I have applied this formula to a new condition—motivation—seen in the chart to the left.

 Ruth Werner is a writer and educator who teaches several courses at the Myotherapy College of Utah and is approved by the NCTMB as a provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Werner is available at or