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Seeking Solutions to Regulatory Problems

Editor's Note: Despite the age of this document it shows some of the struggles reflexologists have been through.

Kunz, Kevin and Kunz, Barbara, Reflexions, Vol. 19, No. 2, Spring/Summer, 1998, p. 4

No one strategy worked to address the crazy-quilt of massage law problems that popped up for American reflexologists in the spring of 1998. In three months of interviewing, researching, and writing white papers, Barbara and Kevin Kunz have found that solutions to problems surrounding the regulation of reflexology are possible. Make no mistake about it -- state after state has declared its intention to regulate reflexology. The bigest surprise has been the credentialling of a "therapeutic" reflexology practice by states. Reflexologists have a choice of being involved in the process or, at best with an exemption, being consigned a non-therapeutic professional role.

In talking to reflexologists, state officials, and massage therapists, it becomes apparent that much of the current confusion has been created by a failure to communicate, misconceptions, and a general lack of knowledge about the process of certifying competency of alternative practitioners. Solutions lie in education and discussion. Issues of importance include public safety issues inherent to reflexology practice, means of regulating professions, and the impact of the state's reflexology regulation on consumers, reflexologists and massage therapists.

State officials are concerned about public safety issues involving reflexology practice. Massage officials are concerned about reflexologists who practice more than reflexology -- colonics was one example. Ear work is mentioned as a body part too far, after all where will it end? Many state regulators and massage officials are unaware of the existence of a decades-old reflexology community in America. And, since so many reflexologists practice so many things, they are not aware that the reflexology has created standards of practice.

Reflexologists' perception is that untrained massage-licensed reflexologists do pose a danger to the consumer. It has been reported that massaged-license mandated reflexologists have: applied reflexology technique with a knuckle and sent a consumer home upset about the heart condition that had been "diagnosed" during the reflexology session. Both activities are outside the standard of reflexology practice. However, weak professional standards and a lack of education in the reflexology community has contributed to a situation where reflexologists themselves sometimes stray outside of professional boundaries.

Certification in reflexology has yet to protect the reflexologist's ability to practice in the recent incidents. Neither certification from the Ingham Method of Reflexology nor certification from the American Reflexology Certification Board provided a defense of the individual's professional skills. Reflexologists have not been without defenses in the current situations, however. Negotiation, a logical argument about professional parameters, participation in legislative processes, and legal help have all been successfully utilized.

Negotiation has centered around a Kunz and Kunz professional model. For several years, Kunz and Kunz and other have argued that the best defense for the professional practice is the building of a better mouse-trap. In other words, show that reflexologists are best qualified professionals to practice reflexology because they practice with higher standards than others. The professional model has resulted in a regulatory model centered around protecting consumer interests. In three instances, this logical argument swayed state and provincial officials in Ontario, New Mexico, and Tennessee. The system consists of defined scope of practice, code of ethics, and full and fair disclosure system of informed consent. For further information, access the information on-line at

Toronto: Faced with the prospect of being issued business licenses as "body rub parlors" along with houses of prostitution, reflexologists in Ontario negotiated with officials for the right to propose a system of regulation. The reflexology industry is now designing its own registration system. The group is vying for the opportunity to be paid from insurance and govenment health care systems. Last year $1.6 billion in Cnadaian was paid for alternative health services. For this reason, the government has taken an interest in regulation.

New Mexico:The New Mexico State Massage Board is seeking to include acupressure and shiatsu in state regulation. Reflexology regulation is possible in the future. The Board is concerned about (1) the increasing liability to massage therapists for practices outside of Swedish massage and (2) consumer safety issues involved in each of the ever-growing number of bodywork professions.

Among issues: how does the consumer know what type of session he or she will receive when purchasing bodywork services? Even when purchasing massage services, he or she could receive one of several different styles of massage practice such as Swedish, Esalen, deep tissue work, or connective tissue work. The consumer is now faced with the choice of more and more bodywork services. The challenge to a regulatory body is to safeguard the interests of the consumer while fairly over-seeing professionals' practice. Kunz and Kunz have been asked to submit a regulatory proposal.

Pennsylvania: Members of the Pennsylvania Reflexology Association hope to see a culmination soon of four years work with legislation action on a bill that would create a license for reflexologists.

Florida: In an on-going effort to regulate reflexology as massage, the state of Florida has acted to enforce a state Massage Board decision requiring that "reflexologists" obtain massage licensing. During a January meeting of the Florida state Massage Board, reflexologist Diane Breeding made a public statement during the meeting on behalf of the eighteen reflexologists present. Following the statement, she was asked by a Florida assistant attorney general if she was a reflexologist. Diane replied, yes. She was served a cease and desist order by an enforcement officer from the Department of Health in March. At one point, a charge of practicing medicine without a license, a felony, was under consideration. Her husband Paul was subsequently issued a cease and desist order. Attorneys for the couple have responded to the state's order. During a series of interviews by Kevin Kunz with massage officials it was noted that reflexologists who can show two hundred hours of education and have them approved by a massage school as meeting educational standards can be issued a state massage license.

Tennessee: Reflexology was not mentioned in a recently enacted massage law but reflexologists were subsequently required to obtain massage licensing. Following her attorney's advice, reflexologist Sharon Shanafeld had not practiced in six months. In addition, at least one reflexologist was under active investigation by an enforcement officer. In April, Sharon reported a recent article about reflexologists and massage regulation in the state. "According to our (Tennessee) law, 'massage / bodywork / somatic means the manipulation of soft tissues of the body with the intention of positively affecting the health and well-being of the client.' " ... "The Massage Licensing Board Attorney expressed her opinion to the Board that if challenged in court, such a definition may not stand up to the narrowest judicial standard." ("Important Strategic Issue!" In Touch News, The Tennessee Chapter of the American Massage Therapy Association, Spring, 1998)

Kevin Kunz made several calls to verify the statement. Neither the attorney nor the official who quoted her would verify the statement. Kunz and Kunz were asked to submit a regulatory proposal. During a conversation with the chairman of the state Massage Board, an informal agreement was reached that reflexologists could continue work but with discussions about regulation in the near future.

New Hampshire: A reflexologist had been assured by the school that she would be able to practice in New Hampshire when she completed her course of reflexology study. When she asked local officials about in New Hampshire about requirements, it was suggested that she write the state. In response, officials in New Hampshire have declared that, while reflexology is not specifically included in the recently enacted massage law (1996), "they (the legislature) either choose not to recognize Reflexology as a separate modality, were unaware of any differences between the two practice or felt that they were similar enough to be included under the same license. ... the Department of Health and Human Services has no choice but to include Reflexology within its current Massage Licensing requirements since this practice does meet the definition of massage."

Sacramento: Legitimate massage practititoners and a coalition of "healing-arts" professionals are seeking a new ordinance in the city of Sacramento. They are campaigning for an ordinance that would seaparate health professionals from other masseuses. Currently massage practitioners are licensed as "adult entertainers" and massage establishments are zoned to one small part of the city with other "adult related" businesses. Permits cost $4000. The proposed ordinance would require a $260 intital fee and $100 annual fee with the right to practice anywhere in the city where business zoning is permitted. The "somatic practitioner" classification would require of practitioners a minimum of 250 hours of professional education and a personal background check. Some practitioners complained about the requirement of membership in a professional association for certification of competency. (Thanks to Adrienne Elliott for contributing "Coalition seeks separate law for certified massage therapists" by Ted Bell, Sacramaento Bee)

Los Angeles: For the first time in twenty years, long-time practitioner Jim Ingram of Mission Hills, California was refused the Los Angles city massage license required of reflexologists in March. Orange County south of Los Angeles is moving to implement a county-wide massage ordinance to replace the existing hodge-podge of local licenses.

Alabama: Reflexologists find themselves living in the eleventh state to require massage licensing of reflexologists as the legislative session in Alabama ended before any change was made in the recently enacted massage law.

New Jersey: Massage licensing will again be proposed before the next session of the New Jersey Assembly. Under the proposed umbrella law, reflexologists will be allowed to continue practice but not at a therapeutic level.

New York: In response to a query from Kunz and Kunz about massage regulation of reflexology, Kathleen Doyle, executive secretary of the New York Board for Massage, states "reflexology is considered a technique that falls within the defined scope of practice of massage therapy and other authorized professions. Those practitioners who claim to be specialists in the area of reflexology must be able to demonstrate they have met an acceptable standard of specialization."

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