It is said that change is the only constant in life; and as we look at what is happening right now in societies and communities all over the world, we can only agree. Profound shifts are happening on political and social levels and the status quo is questioned and challenged everywhere we look. Global campaigns for racial and social justice extend to all people of colors and ethnicities and have brought long-overdue awareness to the oppression and injustices experienced by minority groups.
Against this background, we, as massage therapists, might also have started to think about our profession and how the concepts of equity, diversity and inclusion apply to us as well as to our massage therapy clients.
In an effort to answer some of these questions, two researchers from the University of South Carolina School of Medicine Greenville, have analyzed the current state of diversity in the massage field and initiated a discussion on how the current landscape could be expanded for established therapists, those who are interested in working in this profession, and also for clients who seek massage therapy services.
In their article, “Equity, Diversity, and Inclusion in the Massage Therapy Profession,” authors Oluwakemi Balogun, PhD, and Ann Blair Kennedy, DrPH, LMT, BCTMB (2020), openly describe the beginning of their work together—a collaboration between a black medical student and a white college professor and how important an honest conversation about race was to create a solid foundation for their research collaboration.
To establish a baseline, the research team first analyzed statistical data from the National Health Interview Survey on people who receive massage therapy treatment in the U.S. They discovered both a strong gender and racial disparity. Women and non-Hispanic whites utilized massage therapy service in higher numbers than men and Hispanic whites. Based on the reviewed data, they concluded that ethnic and racial minorities received massage therapy services less often than non-Hispanic whites.
In a next step, the authors looked at data on the diversity of massage therapists from the U.S. Bureau of Labor Statistics and found that 83.6% of massage professionals are women and over 70% are white.
Balogun and Kennedy also explored the general image of massage therapists and observed that the stereotypical images of massage therapists on the internet show white women in both roles, as therapists as well as clients, often in serene, luxurious spa settings surrounded by candles and flowers. They concluded that these representations matter and there was no diversity in these images that show only white people and portray massage as a luxury service rather than a health care modality.
This lack of ethnic and racial diversity in the massage therapy industry is concerning since there is a shortage in the variety of accessible services catering to different minority groups. A greater diversity in the spectrum of available therapists would create more client satisfaction and a more inclusive industry.
The observation that there are overall fewer massage therapists of color as well as fewer massage clients of color leads to the conclusion that these facts are interrelated. Because fewer people of color receive massage therapy treatments, there is less personal exposure to massage therapy which, in turn, could explain why fewer people of color explore professional opportunities in the massage profession.
To explore possible reasons why people of color receive massage treatments less frequently than do white people, Balogun and Kennedy focused their research on the Black community and isolated three key factors—economics, education and access—that play roles in lack of diversity.
Possible solutions that increase the availability of massage treatments for minority populations are the integration of massage therapy into primary health care settings as a way of creating easier access and providing more education. Once doctors start to refer their patients not only to physical or occupational therapy but also to massage therapy, more people of color will become familiar with the benefits of massage therapy and are more likely to utilize these health care services.
When more people of color receive massage therapy themselves, a higher number of individuals may be interested in pursuing careers as massage therapists. This would increase diversity among massage providers and, in turn, increase the variety of services and the availability of more therapists of color for massage clients.
Unfortunately, the suggested solutions to increase diversity in the massage field are not as simple and straightforward as described, since there are many additional factors that play a role in this complex system and more research needs to be conducted to gain a better understanding of the situation as well as feasible and successful pathways to sustainable changes.
“We currently have little evidence to support the idea that having a more diverse workforce in the massage therapy profession would improve health outcomes for patients, improve the profession, or know why there are populations that are under-represented in massage therapy. Ann Blair Kennedy, DrPH, LMT, BCTMB, clinical assistant professor of Biomedical Sciences at the University of South Carolina School of Medicine Greenville, told me. She said, “But this also means this is an area that is ripe for discussion about the disparities as well as future investigation and study by and for the massage therapy profession.”
We do know from the scientific literature, said Kennedy, that:
• More diverse teams have better outputs;
• Generally, when patients see a doctor who “looks like them” (i.e., a Black patient sees a Black doctor) they often have better health outcomes; and
• Representation of populations matters to encourage career seeking for those who are under-represented in a profession.
“We can use these findings from other health professions and apply those methods to stimulate dialogs, conversations and for future research on ways to improve the massage therapy profession,” Kennedy added.
Although we might not yet have many answers to questions about diversity in the massage therapy field, it has become clear that we, as massage therapists, are called to explore our own opinions, biases and competencies when working with clients from various cultures.
White massage therapists need to be increasingly aware of how to interact with clients of various races, ethnicities and cultures, and honor cultural differences in the therapy setting. This includes learning about race and racism, health disparities and ethnic stereotypes. It is also important to understand how culture, race and socio-economic status affect quality and availability of health care for minority groups and how we, as therapists, can become mindful about potential pitfalls when treating clients from diverse cultures and backgrounds.
In her blog post, “How well-meaning therapists commit racism,” published in Psychology Today (August 31, 2013), clinical psychologist Monnica T. Williams, PhD, explains that many therapists unconsciously express racism even though they see themselves as open-minded, accepting and progressive. After all, we as therapists, no matter if we work in the mental health field, massage therapy field or other health care profession, care about people and are guided by good intentions in our interactions with clients.
Williams describes a concept called microaggression that refers to short messages addressed at people who belong to minority groups that convey a devaluing or condescending meaning. These microaggressions are often delivered through unconscious words or other, often subtle, dismissive behaviors.
Some examples include sentences such as “Your English is great. Where do you come from?” or “I don’t see color in people. You are just a regular person to me.” People belonging to minority groups are often vulnerable clients and they may feel the inherent power differential in the client-therapist relationship. If the client feels stigmatized or judged, the trust between client and therapist suffers and the client may terminate the therapeutic relationship early.
Cultural sensitivity and the willingness to confront one’s own stereotypes and biases are increasingly important if we want to support the increase of equity, diversity and inclusion in the massage therapy profession and beyond.
We understand that conversations about race, racism, diversity and ethnic stereotypes are sensitive; and it is not uncommon that statements are misunderstood and misinterpreted with sometimes painful consequences for all involved. With this article, it is my intention to shine a light on the importance of having conversations around topics of diversity and cultural competency despite their sensitive nature.
By sharing current research, I want to highlight how independent studies can support a better understanding of the underlying processes as we search for solutions and strategies to create a more inclusive, fair and just environment for all people in the massage therapy industry and beyond.
Andrea Winzer, MSc, LMT, CST-T, holds a master’s degree in ecology and is a board-certified massage and bodywork therapist. She practices CranioSacral Therapy and offers a variety of holistic treatment modalities with a focus on the integration of body-mind-spirit, release of physical and emotional trauma from the body, and supporting mental health therapies through trauma-sensitive bodywork. She wrote this article on behalf of the Massage Therapy Foundation.
• Balogun, O., Kennedy A.B. (2020). Equity, Diversity, and Inclusion in the Massage Therapy Profession. International Journal of Therapeutic Massage and Bodywork, Volume 13, Number 3.
• Williams, M.T. (June 30, 2013). How Well-Meaning Therapists Commit Racism. Psychology Today.
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