ŠKunz and Kunz 2004
The Emerging Reflexology Service Provider
Among those currently considering the providing of reflexology services are massage licensing boards in many cities and states. These boards have acted to alter the "scope of practice" of the licensed massage practitioner to include reflexology in recent years for a variety of reasons. The Texas state massage law has included reflexology since 1992. Rumor has it that use of "reflexology" as a dodge for prostitution lead to the change. Connecticut massage law includes reflexology practice as of February 1, 1994. The new law requires that reflexology service providers meet standards established by the American Massage Therapy Association.
In addition, members of the massage community are currently undergoing debate on the merits of an occupational designation of "body worker" or "somatic practitioner." The resulting practitioner would provide services within a scope of practice widened beyond one service, such as massage.
The Emerging Reflexology Profession
Questions are asked of and by members of any emerging profession. As reflexology has emerged as a professional practice questions have arisen, such as, (1) What is reflexology? (2) What constitutes the providing of reflexology services? (3) What is the profession to do about future growth and discoveries?
As the years have gone by, reflexologists have infused their reflexology work with a variety of extensions. Whether or not these extensions will be generally accepted by the reflexology community is a matter of ongoing discussion within the profession. Whether or not any addition to the reflexology belief system will be accepted by formal community sanctioning bodies, such as city councils and state legislatures, is another issue.
The recent discussion is, in essence: (a) Certainly any work in reflexology is to be respected, because, after all, we are a community of believers and certainly one is entitled to his or her beliefs and work, however, (b) why should all reflexologists take the responsibility for the additions to reflexology work by fellow reflexologists? Some practices raise ethical questions; some raise legal questions; some raise "fringe belief" questions.
Basic questions arise from the discussion of such issues: First, is there a scope of practice for the professional providing of reflexology services that is (a) generally accepted by the reflexology community and (b) ethically and legally acceptable by the formal sanctioning bodies of the community? Secondly, does the addition of new work create conflicts for the practice of reflexology within informally and formally sanctioned communities?
Answers to such questions are drawn from research by those interested in professions; sociologists, anthropologists, and regulating bodies as well as court cases. Information in this issue of Reflexions is the result of ongoing study of professionalism and reflexology by Kunz, Kunz, and Schneider that has spanned fourteen years.
Creating a Scope of Practice
No profession survives without formal sanctioning of a "legal scope of work." One must be created to ensure the survival of the professional practice. (J. A. Lueck-English, Health in the New Age, A Study in California Health Practices, University of New Mexico Press, 1990)
Scope of practice describes the activities included in the professional's practice. A professional, as defined by sociological studies, receives training about and practices a unique body of knowledge within ethical and legal boundaries. A profession as a whole is granted the right to provide services by the community as a whole. Community sanctioning is conferred informally as well as formally.
"Formal approval may come in the form of legislation, licensing, and an examination system, all enforced by the police power of the community. Informal may come in the form of prestige and status accorded the professional by the community. The community will also relinquish its judgment on technical aspects of the professional's work. It will concede that such matters can only be judged by another professional in the same realm. Following from this, the community will grant control of the training centers to the only one capable of judging the adequacy of training&emdash;the professionals themselves. In exchange for this the community will be assured that those bearing the professional title will be able to render a superior service and those without the title are not only importers, but may also do harm. As you can see, it will be very important for reflexologist to obtain the community mandate to practice." (Schneider, Jill, "Definition of a Profession and Some Notes Pertaining to Reflexology," Reflexions, Jul./Aug./Sept., 1985, p. 2)
The medical doctor is traditionally used to illustrate a formally sanctioned professional. His or her scope of practice was defined by Medical Practices Acts enacted in all fifty states early in the twentieth century. The doctor, thus, plays a formally, legally sanctioned role in society with regards to a specific body of knowledge and a specific service provided to the community. He or she is licensed to diagnose illness, prescribe a remedy, and treat for specific illness.
So important to society and its formal sanctioning bodies is this defined scope of practice that other health practitioners, such as dentists and nurses, actually receive a waiver from the medical practices act to be licensed for their professions.
Current-day health professionals who seek formal sanctioning compete with established medical professionals. In addition, massage and cosmetology licensing includes a scope of practice that allows for the addition of reflexology services. The challenge for the emerging reflexology profession, thus, becomes, the defining of a unique systematic body of knowledge over which the reflexologist has achieved mastery and which he or she practices ethically and legally.
Defining a Professional Practice
Professions share certain characteristics. Researchers vary in their descriptions of a profession but common traits emerge.
According to sociologist Schneider, the characteristics of a profession are:
1. A systematic body of theory or knowledge
2. Professional authority over the body of knowledge obtained during specialized training
3. The sanction of the community to provide a valued service and to train service providers.
4. A regulative code of ethics to ensure the safety of the public
5. A professional culture of beliefs, performance, and symbols of practice. Schneider, pp. 2-3.
According to anthropologist Lueck, the characteristics of a profession are:
1. Lifelong commitment
2. Mastery of a body of knowledge
3. Formal and lengthy training
4. Control of licensing
5. Control of educational requirements
6. Internal policing
7. Control of legal scope of work
8. Possession of mechanism for legal, economic and political survival.
"The greater the compliance to this list, the higher the social standing." Lueck, p. 156.
Defining a Systematic Body of Knowledge
The body of knowledge or theory forms the core any profession. Kunz and Kunz created a method to consider such issues during research into professionalism in the early 1980's. The Foot Work Categorization System (F. W. C. S.) is a systematic method of defining, contrasting, and compare foot work systems. Any foot work system can be described in terms of its: Theory, Technique, Assessment, Charts, Professionalism, History, Practicum/Clinical work.
Categorization of the Universal Definition of 1983, for example is: "Reflexology is: (a) the physical act of; (b) applying pressure to the feet; (c) with specific thumb, finger, and hand techniques; (d) which do not use oil, lotion; (e) based on an assessment of zones and reiterative areas; (f) with a premise that such work evokes a physical change in the body." Kunz and Kunz, p. 1, is thus categorized as: Theory, (a), (c) and (f); Technique (b), (c), and (d); Assessment (e).
The opportunity to define reflexology as a unique profession is available today thanks to the improved climate for alternative health practices in the U. S. Whether or not reflexologists will survive as masters of their own destiny will evolve from the willingness of individual practitioners to take the responsibility to define the nature of his or her work.
Economic Survival and The Practicing Reflexologist
As reflexology moves towards orthodoxy and formal acceptance, will all practices and practitioners of reflexology make the move into the professional arena? Interviews with full-time professional reflexologists reflect the real world of practicing reflexology and hint toward the future of successful practice.
These reflexologists have made a lifelong commitment to their career of reflexology. They have succeeded in doing what few have done in the United States - they have made a living as a full time practicing reflexologist. It has not been easy.
In addition to building reflexology skills and surviving as a small business, reflexologists in most big cities are required to meet massage licensure to practice. The cost and time of obtaining a massage license, expensive and lengthy in some areas, is then followed by meeting the requirements of massage practice erected by cities and states as anti-prostitution measures. For example, many Orange County, California cities require AIDS and VD testing of massage practitioners. Late night calls to individuals listed in "Yellow Pages 'Massage' " heading are common around the country. Callers include those seeking illicit services or the police seeking to determine the possibility of illicit massage services.
Concerns of the Practicing Reflexologist
Why should any one reflexology professional be concerned about what his or her fellow "professional" practices as reflexology? The answer from the full-time professional is immediate and to the point, "The image of reflexology projected by other reflexologists' work can financially impact me and the twenty years of work I have put into developing my reflexology skills and practice. Practices that smack of quackery or poor ethics reflect on the credible reflexology practice that is my life work."
Mechanisms for Survival
Peer review is a necessary feature of professional practice. It allows the systematic description of and addition to the core body of knowledge. It is an acknowledgment that those who have invested a lifetime of effort in education and practice have a right to comment on the scope of practice of fellow "professionals." In addition, fair and just means of commenting on individual practices and their impact on the overall professional is achieved. The goal of peer review is to provide a means of acting together to jointly to develop a professional image.
Developing a Professional Image
Any professional aspires to hold and maintain a professional image that is credible and a professional practice that is legitimate. For the common good of the overall profession, the professionals act within boundaries established to project a favorable image. The trappings of a professional project his or her image. For example, the business card, the professional brochure, reporting of one's work - all become of interest to fellow professionals.
Recent undercover camera investigations aired on national television, CNN and ABC, showed the impact of media exposure on the image of a profession. The sale of vitamins following an iridology "diagnosis" illustrated questionable ethics to the investigative reporter from CNN in August 1993. The inclusion of Touch for Health work with chiropractic work was featured on ABC in February 1994 as an example of a "questionable" professional practice, use of an alternative modality to care for the health problem of a child.
The Down-Side of Additions
Just as every addition to reflexology practice has an up-side, a report of better results for example, every addition also has a downside. And that down side impacts all reflexologists.
The concern to the full time practicing reflexologist is that his years of straight, ethical, and legal practice will be brought into question and lumped into scopes of practice that are frankly unethical and illegal.
Potential Conflicts with Other Professions
Reflexologists run the risk of conflict with the already established professions of medicine, physical therapy, chiropractics, podiatry, and massage. Each of these professions has received the formal sanctioning of a defined scope of practice. Each consists of its own body of knowledge, complete with language, techniques, assessment, theories, aspects of professionalism. For reflexology work to be taken seriously, reflexologists will need to develop their own model. To utilize the trappings of other professions is to signal weak professionalism.
Using the vocabulary and techniques of another profession serves to weaken any profession. For example, "foot alignment" as an extension onto reflexology brings to reflexology practice the idea that "alignment solves subluxations in the foot." According to Taber's Medical Dictionary, a subluxation is "a part or a complete dislocation." The scope of practice of the reflexologist, thus, becomes to realign the bones in the foot. Is this reflexology or the licensed profession of chiropractics?
A broad or undefined scope of practice results in the loss of income and additional expenses. Insurance companies follow distinct policies when determining payment for any services.
Malpractice insurance rates rise without a defined practice. With a very broad scope of practice, insurance companies may refuse the risk of insuring the practice. The practitioner is placed in legal jeopardy. The legal expenses of defending oneself from the charge of practicing a licensed profession or a civil case filed by a client for practicing outside of a scope of practice can be crippling.
The addition of extensions to reflexology practice creates the question of whether or not one is actually a practicing reflexologist. A non-standardized practice is perceived as undermining the professional image as a whole by portraying reflexology as "any old thing" rather than a uniquely defined profession skill. Consumer confidence in the reflexologist and the reflexology profession as a whole suffers.
Any technique that could injure a client is dangerous, not only to the client's well-being but also the reflexologist's reputation and that of the reflexology profession as a whole. In addition, the client can very easily sue the reflexologist. His or her case is bolstered if the reflexologist is indeed practicing the scope of practice of a licensed profession.
The issue of safety to the practitioner is also very real. For the reflexologist, the thumb is his or her basic working tool. Any technique that could damage or overstrain the thumb directly impacts income. We have met "retired" reflexologists, retired because they "blew out" their thumbs permanently. Even straining a thumb and losing a week's work time can be financially crippling.
The issue of viability is raised by additions to reflexology work. The difference between research and actual application during a professional session was questioned by the full time professional reflexologist. The pro's immediately ranked additions according to the possibility of adding to or detracting from professional image and income.
The addition of some practices was immediately judged as not viable in the presentation of reflexology services. Specifically questioned were additions that added to a "quack" image of reflexology, thus, detracting from the professional's image.
A systematic process of considering additions to reflexology work can be a means of increasing consumer confidence and encouraging economic viability. If done credibly, "new" work can add to general income and image. If done poorly, additions can cost both in income and image.
Creating a Profession: Considering Additions to Your Work
Any professional practice ultimately consists of its practitioners and their work. It is the responsibility of any professional to review any extension to the core belief system of reflexology. It is the responsibility of the professional to act with regard to his or her fellow professionals and to seek peer review of his or her work.
To consider any addition to accepted professional reflexology practice, consider the elements that add together to describe the work within the Foot Work Categorization System. To consider your extension to reflexology work, utilize the following template to review your work and the ramifications of its practice.
Theory: Is this reflexology? A professional presents a consistent body of knowledge to project his or her mastery of a specialized body of knowledge. The professional, thus, is perceived as a service provider with a logical product to sell the consumer. Additions that conflict with reflexology theory include those (1) that are outside of the nervous system, (2) that move the stress model of reflexology closer to the medical model before the practice has obtained informal and formal community sanctioning as such a practice, (3) those that move the practice away from what the consumer is used to buying. Other questions include what written works show that the practice is widespread, has survived the test of time, and is represented by written works?
Technique: Is the technique safe for the public? What are contraindications, reported side-effects and injuries, and licensing requirements? Is the technique appropriate for each and every individual's stress level? Is the technique safe for the reflexologist? What additional stress is created by the new technique? Is the technique appropriate for the wear and tear of continual application?
Assessment: Is this reflexology? Does this assessment conflict with the basic assessment of zones and reiterative areas accepted by the field? Does this assessment conflict with the practice of another profession?
Charts: Are these reflexology charts? Can these charts be used without conflicting with other professions?
Professionalism: What aspects of professionalism change with the addition of the new work? Does this extension help the image of my profession? Does it increase my professional standing?