The process of professionalization includes the process of obtaining the sanction of the community as a valued and needed service. While reflexology practitioners have achieved the informal sanctioning of the community, reflexologists in many areas are currently involved in the process of obtaining official (governmental) sanctioning for their professional practices.
At the core of issues involving any profession is that of definition. A definition can serve a number of purposes ranging from that of focus for informal discussion to that of legally mandated scope of practice.Listed below are views of definition from sociologists and lawyers about the role of definition in the formal sanctioning of a profession and a professional:
"A professional is not merely skillful. His basis of judgement on how and when to act is grounded in a body of knowledge that is internally consistent; in short a theory.... "(The community grants professional authority to a profession) only to the area the professional is trained in.... "Formal approval may come in the form of legislation, licensing and an examination system." (Schneider, Jill, "A Definition of a Profession and Some Notes Pertaining to Reflexology," Reflexions, Vol. 6, No. 2, Jul./Aug./Sept, 1985, pp. 3-4)
"No profession survives without formal sanctioning of a 'legal scope of work.' One must be created to ensure the survival of the professional practice.
(Luecks-English, J. A., Health in the New Age, A Study in California Health Practices, University of New Mexico Press, 1990)
"Malpractice liability protects patients' expectations that providers will shield them from harm by following the standards of diagnosis and treatment accepted by their profession. Legislatively defined scopes of practice ensure that practitioners confine their interventions to those they are trained to offer. Informed consent obligations ensure that providers let patients know of the risks involved in specific treatments before they give consent to treatment."
(Dumoff, Alan, and Cohen, Michael H., ed., "Malpractice Liability of Alternative / Complementary Health Care Providers, Part One," Alternative and Complementary Therapies, June/July, 1995)
In exchange for the formal sanctioning of the community, the profession and the professional accept the role of protector of the public good in relationship to the professional practice. Through their expert opinions, professionals create definition and ethical structure to safeguard the public. To some extent, definition serves to create boundaries within society for a profession. It also creates a niche of expertise unique from all others.
Examples are available of a definition process for reflexologists and a state registration process for alternative practitioners.
The process of defining reflexology in the US began in 1982, following the conviction of an Illinois reflexologist for practicing medicine and podiatry without a license. In response, Kunz and Kunz researched the issue of professional reflexology practice. Specific concerns included (1) an attorney's opinion that reflexology could not be practiced legally subsequent to the decision and (2) increasing questions about the differences, if any, between reflexology practice and massage practice. A definition was created following a review of written works and reflexology practices in the US by Kunz and Kunz. See below.
In 1989, definitions were created during peer group discussions of the Foot Work Categorization System (FWCS). The goal of the group discussions was to create a "city hall" definition of reflexology &emdash; a generic definition that could be utilized to describe reflexology to government officials. The net result would encapsulate: (1) a description of reflexology practice, (2) the differences between reflexology and massage practices, and (3) inherent safety of reflexology practice. The bottom line would be a description of (1) what the consumer could expect in the purchase of reflexology service and (2) what a city inspector, if any, would see if he or she walked into a reflexology workplace. (Reflexologists in Chicago and Colorado Springs are subject to the no-knock inspections required of massage practitioners.)
Examples of Definitions Adopted in the US
1. Kunz and Kunz, 1983:
"Reflexology is the physical act of applying pressure the feet (and hands) with techniques that do not utilize cream, lotion or oil, assessed on the basis of zones and areas with the premise that such work effects a physical change."
2. California Conference of Reflexologists, 1989
Foot and hand reflexology is the physical act of applying pressure to reflex areas and zones in the feet and hands with specific thumb, finger and hand techniques performed without oils, lotions or creams; with the premise that a physiological change can take place in the body."
3. North American Reflexology Conference, 1989
Foot and hand reflexology is a scientific art based on the premise that there are zones and reflex areas in the feet and hands which correspond to all body parts. The physical act of applying specific pressures using thumb, finger and hand techniques performed without oil, lotions or creams results in stress reduction causing a physiological change in the body."
4. American Reflexology Certification Board, 1991
"Foot and hand reflexology is a scientific art based on the premise that there are zones and reflex areas in the feet and hands which correspond to all body parts. The physical act of applying specific pressures using thumb, finger and hand techniques results in stress reduction causing a physiological change in the body."
5. Reflexology Association of America, 1996
"Foot and hand reflexology is based on the premise that there are zones and reflex areas which correspond to all glands, organs, parts and systems of the body. The physical act of applying specific pressure using thumb, finger and hand techniques to these reflex areas results in the in the reduction of stress which promotes physiological change in the body."
The Foot Work Categorization System (FWCS) by Kunz and Kunz
The FWCS was first developed in 1983 to facilitate discussion of issues involving definition within the field. The details of reflexology practice &emdash; theory, technique etc. &emdash; can be described according to the FWCS. Any definition can be analyzed and discussed. See the following "Foot Work Categorization System." Note that the Categories 1 through 4 of the FWCS have been utilized in creating "city hall" definitions.
Any definition can be discussed in the basic components of theory, technique, and assessment. (Categories 1 through 4 of the FWCS.) For example, the Kunz and Kunz definition would be categorized as:
Theory (a) the physical act
Technique (b) of applying pressure
(c) to the feet or
hands (d) with techniques that do not
utilize cream, lotion or oil, Assessment (e) assessed on the basis of
zones and reflex areas Effect (f) with the premise that such
work effects a physical change
(a) the physical act
(b) of applying pressure
(c) to the feet or hands
(d) with techniques that do not utilize cream, lotion or oil,
(e) assessed on the basis of zones and reflex areas
(f) with the premise that such work effects a physical change
The goal of a registration system is to add a layer of consumer protection to the purchasing of services. Professionals stand as experts in their field to identify public safety concerns and implement measures to protect the public. The goal of a registration system is thus to balance public safety with professional issues.
The Reflex Net Listing has been developed since 1983. The on-going goal is to create a means for the reflexology practitioner to provide to the consumer a full and fair description of his or her reflexology education and reflexology work. See "ReflexNet Listing."
Example of a Registration System: Board of Medical Quality Assurance (BMQA), State of California, 1982
A registration system for alternative practitioners was created by the staff of the BMQA and proposed as legislation. (It failed in committee.) The registration system would have been created during a change to the state's Medical Practices Act, encapsulating alternative practitioners and others into a regulation system. The mechanisms of the system included (1) a full and fair disclosure of the practitioner's educational background and service offered, registered with the state and posted in the workplace and (2) an informed consent form read and signed by the client. From this information, it was envisioned that an informed, consenting adult could make an intelligent decision in the purchase of alternative services as indicated by signing an informed consent form. See pages 3-14 of the enclosed "Proposal for Revision of Section 2052."
Legal concerns for alternative health practice have to do with public safety issues and liability issues inherent to any professional practice. Within the medical community, for example, the forms a patient signs before surgery are used as a means of indicating that the adult patient received sufficient information about the surgery to make an informed decision and is consenting to treatment. As you will see from the discussion on pages 18-19 of "Proposal for Revision of Section 2052," legal liability hinges on the physician acting within the standard of the profession (think definition) and informing the patient of risk.
Implementing a Registration System
The BMQA system cannot be simply implemented. It was devised with the premise that the California state Medical Practices Act would be changed. For a registration system where a Medical Practices Act is in effect, some effort would have to be made to ensure that the practitioner stays within boundaries which prevent him or her from contravening the Medical Practices Act. (In the US, this specifically means that the mixing of modalities, i.e. reflexology mixed with another service or product, has been construed as practicing medicine without a license. Reflexology is seen as a diagnostic tool and the other service or product as a prescriptive remedy.)
A legal scope of practice / definition and a policing system are methods utilized to create boundaries for professionals. A simple policing system is the mail-back card. A full and fair disclosure posted in the workplace would cite the reflexologist's credentials and the defined scope of practice he or she is expected to act within during the providing of services. A mail-back card available to the client in the workplace for the purpose of communication with the regulatory board about the practitioner's services. The "policing" would thus be client-generated.