Monday, June 15, 2015



 Next year Mosby’s Fundamentals of Therapeutic Massage with be available in it’s 6th edition.  A textbook is an evolving process. Each edition requires revisions.   The process of revision is interesting.  Each edition of a textbook must create a pathway from the past through the present into the future. A textbook must grow and respond to the growth and changes of the topic and it must remain current through the lifespan of the edition which is usually 5 years.

  A lot has happened in the massage profession over the span of time between the 5th edition and the upcoming 6th edition.  Those changes should have been anticipated during the revisions of the 4th edition and reflected in the fifth edition.  I am completing revisions for the 6th edition now. A major aspect of the revision process is to sift carefully through the textbook, fact check everything, fix mistakes, update content and  compare what was anticipated to occur with what actually happened. I believe I did a really good job capturing the future when writing the 5th edition. There are things I missed.  I was supportive of the Massage Therapy Body of Knowledge document ( The 5th edition of Fundamentals included the MTBOK content. I believe it remains an important contribution to the evolution of massage therapy education and practice.  I did not anticipate the ELAP-Entry Level Analysis Project ( I thought the MTBOK would evolve through the next steps to support professional development . I expected to an analysis  of the distinction between entry level and advance level practice.  In fact the Alliance for Massage Therapy Education did a thorough analysis of the MTBOK and it can be found on it' website.  The next step would have been development of competencies and then that information translated into curriculum recommendations. Instead two projects were initiated. The Federation of State Massage Boards began work on the Model Practice Act and the Coalition of Massage Leadership Organizations commissioned the ELAP.   Change is messy and the intent of this blog is not to rehash all of that.  If you want the history then read Laura Allan’s and my past blogs.  What is important is that the end result seems to be two documents that reflect profession wide agreement (for the most part) about what content should be included in an entry level education and what licensure requirement are recommended for entry level practice.  I do not agree with everything in the ELAP and the Model Practice Act. BUT—overall , as I worked diligently to cover the content reflected in these documents for the 6th edition, I am confident that the massage profession is moving in the right direction.

The landscape for career entry into the massage profession is changing.  Massage therapy students must be prepared to enter profession practice according to their future and not my or the professions past.  The 6th edition of Fundamentals must delve into employee based career development as well as self-employment for massage graduates.  There needs to be clear direct content that explains the difference in relationships and income calculation including attempting to help educators and students understand that you cannot compare an hourly wage used as compensation for employees to gross and even net income in being self-employed. What is charged for each massage session cannot be considered an hourly income. I have written multiple blogs about this topic and I encourage you to go back through the blog posts and read them.  This paradigm shift is one of the most current concerns facing the massage community.  The ability to earn a sustainable income as a massage therapist directly relates to the volume of massage sessions a massage therapist can provide each day/week/month.  The student must graduate with the ability to work full time, meaning equivalent to a 40-50 hour work week and providing 20-30 massage session during that work period. If an individual wants to work less then that is fine but as educators we need to prepared them for fulltime.

We also have to come to grips with the vocational and service nature of our entry level educational standards. It is unrealistic to expect that a 625 hour education, based on the ELAP recommendations and reflected in the Model Practice Act,  prepares graduates for  the same wage category as an occupation that requires an associate’s degree or higher for entry level practice.  

The textbook also must provide information related to the variety of practice settings for massage. Unlike most occupations, massage therapy can be provided in the spa setting, franchise setting, sport and fitness setting, and acute or chronic medical setting. Developing a massage therapy career pathway is unique because of the availability of multiple work environments  and forms of business models.

Massage therapy is moving away from a reliance on forms and styles of bodywork to outcomes. Clients want to relax or manage stress and pain or move their body with ease.  It is more practical to teach students fundamentals of massage application, that are similar a crossed the variety of forms and styles of massage that have potential to target physiological change.  There is so much confusion and miss information about named methods such as deep tissue, neuromuscular, Swedish/classical, myofascial and so forth. The ambiguity of  terminology is a major obstacle to advancement.  Both the MTBOK and the ELAP support this position and during the writing of the 6th edition I have addressed this shift.  When the goal of the massage session is to achieve client outcomes, student must be taught assessment procedures as part of the foundation of massage.  Teaching a form or style of massage based on a routine does not necessary require assessment beyond determining cautions and contraindications.

Research literacy, evidence informed practice and critical thinking are important areas that students must understand.  These elements move a technician that is vocationally trained toward the ability to function as a therapist. Even at the 625 hour vocational training recommendation of the ELAP and Model Practice Act, it is necessary to lay the foundation for ongoing professional development.

Communication skills, conflict management, work ethic and other soft skill needed for success as a massage therapist have emerged as an educational necessarily.  These topics have always been part of the textbook.  The changes that have occurred during this revision not only address the foundation of service professional,  but extend into our more global society. Massage therapist need to be able to use respectful and appropriate language to communicate with individuals when English is not the client’s first language, those with size, visual, hearing, mobility and other situation where adaptation in communication or access to massage facilities is needed.  Even increased cultural acceptance of body art required me to rethink how to provide guidance for decision-making about the appropriateness of tattoos that are visible. Massage therapist need to learn to work in an integrated team structure with maturity. 

Technology permeates our world and requires additional skills to be able to respond and adapt appropriately. There are limits on just how big a book can become. My textbooks are bound in paper while some textbook are considered hard covers.  Paperback textbooks are much less expensive and educational costs must be considered.  At the same time, only so many pages can be paperback bound and hold together. My publisher has allowed for textbook growth through electronic  content support using accompanying web sites. Educators and students need to better use these recourses.  Electronic textbooks do not have the physical limits that a paper book has.  Elsevier, the publisher I write for, has very cool electronic versions of my textbooks. But-students still want a book as well as the electronic version.  Publishers in general are adapting but it has been a trial and error process.

Textbook revision requires deleting and adding material. A student in a continuing education class told me they came to the workshop to “unlearn”.  How profound is that?  Things change.  When I am involve in the textbook revision process the amount of design change is managed so that the book feels new and fresh but familiar. Typically instructors groan when a new edition is released because they have to change all the page numbers on the syllabus.  A fundamentals entry level textbook needs to be comprehensive and just on the edge of overwhelming. My textbooks are used in programs that are 500-over 1000 contact hours. Educators need to make decisions about depth of coverage for textbook content based on the curriculum focus and amount of course time available. .  During textbook design we try and categorize content by sections, units and chapters. That way there is individual course material based on units and chapters and one book can cover many courses. At entry level I strongly believed that too many books inhibits student learning. Less is better.  My publisher does not necessary love that I preach this, but they also support me.  Educational costs must be managed. Textbooks are expensive. I believe that an entire massage curriculum can be successfully built on my two entry level texts- Fundamental of Therapeutic Massage and Essential Sciences for Therapeutic Massage. Of course more textbooks can be integrated but is that really necessary? Besides using one textbook over multiple courses supports content integration which can be a concern when individual courses are taught by individual teachers. 

In my opinion there is too much content for one book.  That is why I have a theory and practice book and a science book.  Content amount and textbook size limitations is evident with the 6th edition of Fundamentals.  There is a page count issue. I want everything but I can’t have everything- at least in the paper version of the textbook. The copy editors are being challenged with providing a “tight edit.”  This means some of beautiful prose  and run on sentences will be edited into more direct sentence structure. I am so very thankful for copy editors.  As for the material that just won’t  fit--- my editor sooths me by telling me that they can make that content available electronically on the Evolve web site. 

The intent of this blog is to provide an inside look at the process of writing a textbook. I hope that it help those that teach, read and study have a better understanding of the people that work diligently and the process necessary to bring a book to publication.  This blog is the 3rd in a series I am doing. My next blog will focus on hints for using textbooks (well my textbooks) to teach and learn.

In closing—My rose from my grandmothers rose bush that she got from her mother.  It smells wonderful. It has not been revised and remains primarily in its first edition.

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