History of National Certification in Massage and Bodywork

The creation of national certification for massage therapy was a monumental undertaking, aimed at establishing a valid credential that would enhance professional respect and consumer confidence within the growing field. Conceived as a self-regulatory mechanism and a method of self-definition for the profession, national certification also sought to provide an internally generated standard that could serve as a model for external regulators, thereby helping to preserve the autonomy of the profession. This initiative was a crucial component of the American Massage Therapy Association’s (AMTA) Strategic Plan for Professional Development in the 1990s.

Certification Corner: Fall 1989

National certification will be an effective means of upgrading our professional status and standards. With national certification we will be taking a vital step in protecting our freedom to practice and having control over our future. Perhaps another great contribution we can make to our society is to show how we can demonstrate our abilities, yet remain true to our heritage and retain our caring values. National certification is healthy for everyone.

I. Inception and Early Momentum

The foundational concept of a “national examination” for massage practitioners gained significant momentum in the mid-1980s. It had been previously suggested as far back as 1949, but was dropped in the 1950s (See archive.org article PDF). This period saw the convergence of two key forces: the existing AMTA membership entrance examination, which already set professional exam standards, and a concerted campaign by AMTA members Susanne Carlson and Susan Rosen to advocate for national certification for massage therapists. In 1988, the National Certification Program received official authorization and funding from the AMTA, with Elliot Greene appointed as its Project Director. Greene began initial research into the program’s development processes in the winter of 1989. (Elliot Greene, M.A., NCTMB, served from 1990-1994 as national president of the American Massage Therapy Association.)

Communication to the massage therapy community began in September 1989 with the mailing of the “Update on the Certification Program”(archvie.org) newsletter. By December 5, 1989, this mailing garnered a “phenomenal” 23% response rate, with over 2,000 reply cards returned. Concurrently, a press release and information package from the newly formed National Certification Steering Committee were distributed to over 150 influential individuals and organizations, including leaders of associations, school directors, and AMTA State Chapter Presidents.

II. Formation and Initial Work of the Steering Committee

The National Certification Steering Committee was formally appointed in November 1989 by the AMTA Board of Directors. This committee was entrusted with overseeing the initial developmental phases of the entire certification project. Its members were carefully selected to ensure a balance of expertise in professional credentialing, diverse massage therapy approaches, varied geographic locations, and gender representation.

The committee held its crucial inaugural meeting in Chicago from March 2-4, 1990. A significant outcome of this meeting was the selection of Joan Knapp and Associates to conduct the essential initial research, specifically a comprehensive job analysis of the massage therapy profession. Additionally, a liaison program was initiated to gather input from various massage therapy/bodywork organizations, regulatory boards, and schools.

III. The Core: Conducting a Comprehensive Job Analysis

The job analysis was a foundational step, designed to determine the entry-level knowledge and skills necessary for competent practice in massage therapy and bodywork. This rigorous process ensures that the certification examination accurately reflects the actual work performed by practitioners, thus providing content validity.

The methodology for the job analysis involved several key steps:

1. Establishment of an Advisory Committee: A 12-member Job Analysis Advisory Committee, a subcommittee of the Steering Committee, was established. It included three additional individuals: Jeffrey Maitland, Mary Grassel, and Nandi Hobbins. This committee was crucial for developing the job analysis instrument and ensuring the comprehensive and accurate representation of professional responsibilities and knowledge areas across various disciplines and backgrounds. (Hands On, Summer 1990)
2. Literature Review: Knapp and Associates, with staff members, reviewed documents provided by the National Certification Steering Committee and Advisory Committee, along with existing job descriptions, training manuals, and reference materials. This review helped identify initial professional responsibilities and knowledge skills.
3. Interviews with Practicing Professionals: After an initial compilation of responsibilities and knowledge areas, Knapp and Associates staff conducted interviews with several experienced massage therapists/bodyworkers across various practice environments. These interviews helped to verify, revise, and add to the preliminary lists, ensuring their comprehensiveness and accuracy.
4. Development of a Draft Inventory: Based on the literature review and interviews, a draft survey instrument was created, containing 73 professional responsibilities and 91 knowledge areas. This draft also included demographic questions to characterize the survey sample.
5. Revision of the Draft Inventory: The Advisory Committee met in May 1990 to review and approve the draft inventory, incorporating their recommendations.
6. Pretest of the Draft Inventory: The revised inventory was sent to 15 additional massage therapists/bodyworkers not affiliated with the Advisory Committee or Steering Committee. Thirteen responses were received, which helped identify and resolve any procedural issues before the main survey.
7. Final Version of the Job Analysis Survey Instrument: After final revisions and pretest approval, the survey instrument was printed for nationwide distribution.

The National Survey: A national survey of massage therapy/bodywork practitioners was conducted in August and September 1990 as the primary data collection method for the job analysis. The survey instrument was mailed to a sample of 6,930 practitioners, followed by a postcard reminder ten days later. A total of 2,859 responses were received, yielding a 41% return rate, with 2,574 usable questionnaires for analysis.

The survey gathered extensive demographic and practice information:

• Demographics: Respondents were predominantly women (72%), white and non-Hispanic (91.7%), and largely between ages 35-44 (44.6%). They represented various geographic regions across the U.S., with a significant portion practicing in urban or suburban areas (nearly 90%).
• Practice Characteristics: Over half of the respondents had been practicing for 3-5 years, and the majority received their initial training from school programs (72.4%). Two-thirds reported over 500 hours of training, and nearly 70% utilized workshops and seminars for continuing education. Private practice (clinic/office or home-based) was the most common practice setting (over 65%). The majority were self-employed (88.1%), and while 58% were AMTA members, less than half (40.9%) reported being state-licensed.
• Professional Responsibilities and Knowledge Areas: Respondents rated the importance of 73 professional responsibilities and 91 knowledge areas. The results indicated strong agreement across various subgroups regarding the importance of these elements for entry-level practitioners. The most important responsibilities included providing a safe environment, checking table stability, utilizing hygiene standards, and following professional codes of ethics. Highly rated knowledge areas included human anatomy and physiology, hygiene and sanitation, and the muscular system. This data defined the “core body of knowledge” required for massage therapists/bodyworkers.

An interim report of the job analysis findings was presented by Joan Knapp and Associates at the AMTA National Convention in Miami in September 1990. The comprehensive final report, “A National Study of the Profession of Massage Therapy/Bodywork,(archive.org)” authored by Joan E. Knapp, Ph.D. and Eileen J. Antonucci, Ph.D., was completed and published in December 1990, serving as the formal authorization for the National Certification Program.

IV. Evolution to the National Certification Council and Test Development

At its final meeting in Orlando, Florida, from October 10-14, 1990, the National Certification Steering Committee made pivotal decisions, including its evolution into the National Certification Council (NCC). On February 1, 1991, the NCC formally took over, holding its first liaison hearing in San Diego. (See Winter 1990. Hands On)

Concurrent with this transition, the Test Specifications Committee held its inaugural meeting, with Susanne Carlson appointed as its chair. This committee was tasked with developing the “blueprint” for the certification examination, based on the findings of the job analysis. The Public Education Committee was also convened to address public understanding of the certification process.

The process of test development involved several rigorous steps:

1. Inventory of Knowledge and Skills: Researchers reviewed existing literature and curricula to create a preliminary inventory of entry-level knowledge and skills.
2. Practitioner Interviews: Interviews with practicing massage therapists further refined this inventory.
3. Expert Panel Review: A panel of experts discussed and refined the inventory, categorizing items and clarifying terminology.
4. Practitioner Review: The refined inventory was reviewed by other massage practitioners.
5. Job Analysis Survey: The inventory of entry-level knowledge and skills was sent to a large number of practitioners for rating (the job analysis survey).
6. Data Analysis: Results of the survey were analyzed to determine the average ratings of each item.
7. Test Specifications: The test specifications subcommittee used these ratings to determine which items were important enough to be considered part of the core body of knowledge for the field.
8. Examination Content Determination: Using the job analysis survey results, the test specifications committee determined the percentage of the examination dedicated to specific topics.
9. Item Writing: Qualified item writers developed questions based on the test specifications.
10. Question Editing: The testing company edited questions for fairness and user-friendliness.
11. Item Bank Creation: Numerous questions were written and added to an item bank.
12. Exam Version Creation: Questions were drawn from the item bank to create specific versions of the exam, which were then field-tested.
13. Committee Approval: Each version of the exam was reviewed and approved by the committee.
14. Administration: The examination was administered.
15. Statistical Analysis: Candidate answers were statistically analyzed (item analysis) to identify valid questions.
16. Cut Score Determination: Passing scores were determined using accepted statistical procedures.

Psychological Corporation was selected as the testing company to conduct the certification examination. The first certification examination was projected to be administered in Fall 1991. Leading up to this, field tests for the certification exam were carried out by Psychological Corporation on January 25, 1992, in five U.S. cities. These tests involved a diverse cross-section of 50 volunteer practitioners, though it was noted that participation in these field tests did not result in scores or national certification for individuals.

V. Establishment of the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB)

The AMTA also appointed the initial National Certification Steering Committee, which was responsible for guiding the first phases of the program, including the foundational job analysis.

However, to ensure the certification was representative of the entire profession, the Steering Committee actively sought input and participation from a wide variety of other organizations:

• The Job Analysis Advisory Committee: This committee, which helped develop the blueprint for the certification exam, included representatives from organizations outside the AMTA, such as a state officer of the International Myomassethics Federation (IMF), a member of the American Oriental Bodywork Therapy Association (AOBTA), and the Faculty Chair of the Rolf Institute.
• Survey Participation: During the job analysis survey, a Liaison Coordinator contacted over 100 massage therapy and bodywork disciplines, membership organizations, and educators to invite their participation. The resulting survey included input from members of the AOBTA, the American Polarity Therapy Association (APTA), the IMF, the Rolf Institute, and Associated Professional Massage Therapists.
• Liaison Hearings: When the Steering Committee evolved into the National Certification Council, they held public liaison hearings to gather input on test construction, organizational structure, and certification requirements. Numerous organizations sent representatives to these hearings, including:
  • American Polarity Therapy Association
  • Head, Heart, and Hands Forum
  • International Myomassethics Federation
  • Bay Area Bodywork Therapy Guild
  • Hellerwork Association
  • Trager Institute
  • International Reflexology Institute
  • International Professional School of Bodywork
  • Desert Institute of the Healing Arts
  • Sports Massage Training Institute
  • CORE Institute
  • Ohio College of Massotherapy

In May 1990, the Steering Committee declared itself administratively separate from the AMTA. By the fall of 1990, the committee officially evolved into the National Certification Council. Elliot Greene resigned as Chair and was succeeded by George Kousaleos. The Council consisted of the original steering committee members plus one newly appointed member, Jeffrey Maitland, who was the Faculty Chair of the Rolf Institute

In Fall 1992, the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) was officially established. This new entity was formed as an administratively independent affiliate of the American Massage Therapy Association, marking a significant step towards the self-governance of the credentialing process. George Kousaleos was appointed as the initial chair of the NCBTMB. A subsequent meeting of the NCBTMB took place in San Antonio, Texas, from December 10-14, 1992, where Aunt Katie joined the committee as its vice-chairperson.

This rigorous and multi-faceted process underscored the commitment to creating a national certification program grounded in the realities of professional practice, ensuring high standards for massage therapists and fostering public trust in the profession.

Overview of the Controversy over this:

The liaison hearings, such as the first one held in San Diego in February 1991, were designed specifically to allow affiliated groups to present position papers, state their concerns, and debate complex topics like test construction, governance, grandfathering, and sitting requirements. The Public Information Committee acknowledged that the process generated “healthy, often lively debate” and brought practitioners together “as never before as opinions and feelings about national certification are aired”.

The sources detail several specific points of controversy that were debated during these hearings and throughout the board’s creation:

• Lack of Established Need and a “Closed Process”: Critics argued that there had never been a formal assessment or objective study to prove the profession actually needed or wanted national certification. In April 1989, 60 massage therapists signed a joint initiative asking the AMTA to halt the process until more information could be gathered, but the AMTA rejected it. Critics also claimed the process was moving “too fast,” excluded key stakeholders, and operated as a “closed process”.
• AMTA Bias and Independence: Because the AMTA initiated and initially funded the project, many questioned whether the new National Certification Program would truly be administratively independent. Furthermore, there were fears that the certification would be heavily biased toward a Swedish massage and medical orientation, alienating other modalities.
• Validity of a Written Exam: A major point of contention was whether a written, multiple-choice examination could validly test the practical, intuitive, and hands-on aspects of massage therapy. Critics feared that a single entry-level written exam would inherently favor one specific style or approach over others.
• Stifling Diversity and Encouraging Regulation: Practitioners expressed concerns that setting a single entry-level standard would stifle diversity and creativity within the field. Additionally, some practitioners resisted the attempt to standardize credentials because they feared it would encourage unwanted government regulation of the profession.
• Divisiveness and Personal Attacks: The debate became highly polarized. A 1991 National Certification Newsletter noted that “several instances of negativity have occurred around the issue of national certification, e.g., accusations of ulterior motives, and personal attacks on the integrity of individuals”.

Despite these controversies, the organizers viewed the debate as a sign of a maturing profession and utilized the liaison hearings as an arena for networking and attempting to bring different factions together to find common ground.