Managing the Pain Above the Neck: Self-help for headache and migraine sufferers

Managing the Pain Above the Neck:  Self-help for headache and migraine sufferers

Offered at Circle Yoga, Sept 23, 2012-2 hr workshop

According to some estimates, migraine occurs in about 15% of the general population.  The incidence of non-migraine headaches is much higher.  Associated pain is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option.

This experiential workshop introduces a collection of self-help tools and techniques for the headache and migraine sufferer.  As with other health related concerns, headache sufferers are increasingly turning to complementary and alternative medicine practices to combat the pain and disability of migraines, tension headaches, and related symptoms.  Incorporating recent scientific evidence, this workshop offers hands-on techniques and tools that can help mitigate, reverse, and prevent the unpleasant symptoms from head pain.

I am delighted to be joined in offering this workshop with my colleagues in body-mind instruction and practice:

Joanne Checchi, LMT:  Joanne has been practicing and teaching massage in DC for over 20 years, and is in private practice in Cleveland Park.  One of her specialties is the proper use of body mechanics.

Luann Fortune, LMT, MA, PhD:  Luann holds a PhD in Human Development, and is part-time faculty at the graduate College of Mind-Body Medicine for Saybrook University.  She has been practicing and teaching massage in DC for over 20 years, and is in private practice in Chevy Chase, DC.   Her massage work incorporates western techniques, including NMT, deep connective tissue, and passive/active stretching, into various non-structural approaches, such as aromatherapy and energy modalities.

 Annie Mahon, MA, LMT: Annie is the founder and director of Circle Yoga Cooperative bringing mindfulness yoga to people of all ages.  Annie studies, practices, and teaches yoga in a mixed Anusara-mindfulness style, and teaches mindfulness in the tradition of her primary teacher Thich Nhat Hanh. Annie has a strong interest in using mindfulness, yoga, NVC, and touch to help support reduce suffering in herself and others.

This workshop is next scheduled for September 23 from 1 to 3pm at Circle Yoga in Washington, D.C.  To sign up, contact Circle Yoga at 202 686-1104.

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Embodied medical care

My dear late friend Alan said pay “attention to the coincidences.”

I recently had surgery for a structural problem that was not responding to less invasive approaches.   This event and the supporting moments could make for a great protocol on what to expect, how to support diagnosis and treatment, and how to heal  but today the more interesting frontier for me is the critical role that my surgeons somatic awareness played in the success of this venture.  This broader phenomenon— awareness,communication, and empathetic somatic resonance in the surgeon with his patient—and more vitally his team—is an important arena for mind-body exploration and education.   I think this would make for an excellent phenomenology project.

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Professionalizing Massage

Organizations that support professional massage therapy:

A Study of Industry Professionalization


Luann D. Fortune

Charles Seashore – Faculty Assessor

School of Human and Organization Development

Fielding Graduate University

March 19, 2009

As a massage therapist for over fifteen years, as well as an instructor to those aspiring to the profession, I believe in the potential impact of massage as a practice and intervention. In recent years, I have furthermore witnessed a shift in the way that massage is practiced, purchased, and perceived by related service providers. Whether in response to a changing marketplace, or under the impetus of various stakeholders in and near the massage therapy field, the industry is growing and going mainstream. Parallel to that growth runs a trend to professionalize the profession, for myriad predictable reasons. However, this move to professionalism carries inherent, and possibly unforeseen, implications for the practitioner and ultimately for the consumer.

This paper describes this movement to professionalism in massage through the perspective of the environmental factors and stakeholders that are orchestrating and implementing it. Specifically, the paper focuses on associations that support massage therapy and how their visions and actions are directing industry change. In the spirit of hermeneutic inquiry, particular groups are analyzed with progressively deeper layers of consideration. The more intimate insights were collected through individual, private interviews with association directors and key administrators. Embedded in this presentation are repeated revisits to the published data and an ongoing search for substantiation from non self-referential sources. The discussion portion considers various perspectives for understanding the data and the professionalization movement through organizational theory and parallels in other industries. Finally, alternative outcomes are considered, with speculations on possible impacts.


Professionalization of Massage

Massage is gaining increasing prominence in North America as an intervention to promote wellness as well as rehabilitation. Massage was previously more accepted in the spas of Europe (Cherkin, 1998), the protocols of Chinese medicine (Carlson, 2006, p. 5), and the procedures of Ayurvedic medicine (Johari, 1996). Massage recently became more popular in the U.S. Frequently cited surveys (Eisenberg, et. al, 1993; Barnes, Bloom & Nahin, 2008) estimate that over a third of the U.S. population purchases alternative treatments for wellness, including massage therapy. Other estimates claim that 24 percent of adult Americans get a massage at least once a year (AMTA, 2007). Massage is now commonly employed to address a wide range of needs and symptoms, across populations that vary from the very aged to the very young (Field, 2001, p. 131). There is not just one channel for this impact, and in fact, there are many ways to practice this skill and art. There are estimated to be over 250 types and modalities of massage from which to chose (ABMP, 2008), and equally as many reasons for people to purchase the various types of treatments.

In the US, most professional massage is purchased by adults who self pay for the service (Field, 2001, p. 91) outside conventional health care channels (AMTA, 2006; Field, 2001, p. 91) at an average of $60 per session (AMTA, 2007). In 2004, massage therapy was projected to be a $6 to $11 billion a year industry (Barnes, Powell-Griner, McFann, Nahin, 2004). In 2008, estimates increased to $11 to 16 billion per year (ABMP, 2008). Some argue that the service might be recession proof (McGinn & Sterling, 2008) as increasingly stressed, debilitated, dysfunctional, and otherwise needy people seek out the service for the various remedies it offers (Kent, 2008, p.18).

Massage therapy as a profession is growing beyond the national average, at an estimated 20 percent per year (Bureau of Labor, 2007).  Currently, there are an estimated 265,000 to 300,000 massage therapists and massage school students in the United States (AMTA, 2007). The number of state approved schools increased from 637 to 1,529 between 1998 and 2007 (ABMP, 2008).

With wider public acceptance and consumption of alternative wellness methods, (AMTA, 2006; Field, 2001, p. 91) massage delivery channels are changing. Surveys of one national association membership (ABMP, 2008) claim that the therapist’s private office is the most common venue in which to purchase massage. The percentage of massage therapists who work in spa settings is dropping, from 41.8 percent in 2003 to 28.9 percentage in 2007 (ABMP). Perhaps this shift to a more therapy-based setting is demonstrated in the increased presence of licensing. In 1980, nine states regulated massage (AMTA, 2009a). Today, 42 states and DC regulate the practice of massage therapy (Crownfield, et. al, 2008, p. 1; AMTA, 2009). With increased regulation comes a focus on tighter standards and other measures of professional conduct.

An in-depth investigation of organizations that support professional massage therapy offers insight into the development of the market and the profession. In the past ten years a formal movement has developed amongst industry stakeholders to “professionalize” (Kahn, 2002, p. 2) the business of massage. One strategy of the movement involves standardizing the cornerstones of regulation and examination, certification, research, and education. At the forefront of that movement are a handful of professional associations.

An important aspect of the movement involves expanding research and introducing “evidence based practice” (Kahn, 2002; Bondurant, 2008, p. 1) into the process of massage. There is a new focus to fund and develop research that provides evidence of efficacy for various massage indications, protocols, and conditions (Bondurant, p. 3). The studies are primarily situated in the context of empirical research, similar to that found in medical science (Kahn, 2002a, p. xv-xvi). Research topics vary from examining efficacy of specific techniques for particular structural rehabilitation, to protocols for supporting systemic disorders such as cancer or ADHD (Field, 2001, p. 134-136), to more generalized explanations as to why massage helps relieve stress (Field, 2001, p. 87-89). A related project is presently being launched to prescribe “body of knowledge” (MTBOK, 2009) standards for training and practice. Underlying the call for evidence is the suggestion that proof will not only validate the field of massage but also direct individual treatments, as practice protocols based on the evidence become the standard.

In most practices, I think the application and interpretation of massage therapy is highly individual, variable with the therapist as well as the client, and can be considered through many coexisting metaphors (Morgan, 1997). Medical science’s empirical research offers only one such metaphor. Are the demands for evidence-based practice coming from the market, the therapists, or some other force? In depth consideration of the market perspective is beyond the scope of this paper. The impact of the movement to professionalize massage is a likely topic for my own dissertation. But the role of the associations could prove to be key. This investigation focuses on who are the stakeholders driving this movement to professionalize, what is the place of evidence-based practice in their vision, and where do their marching papers come from.


Professional Massage Associations

This study is not an expose. It does not purport to reveal what the associations actually do with their constituency, but rather what the associations report that they do. Therefore, it assumes that vision and perception guide the evolution of the associations, and potentially of the industry. Working hermeneutically (Bentz & Shapiro, 1998, p. 40) based on published text and interviews, the following sections present in successive layers: first the material details and the vision of the association, and next the underlying arguments and philosophies that propel the foremost associations.

In selecting which associations are most influential, membership size was first considered.  Also, longevity and scope of presence among therapists as well as consumers is considered.  A balance of purposes, ranging from educational to regulatory, is embodied in the complement of associations discussed. Some of these organizations are relatively young but serve an important role or function, especially in how they interact with the changing industry climate.

This paper identifies several national associations that are influential in North America, particularly in the US. Almost all practicing massage therapists are directly impacted by at least one of these organizations, either through training, licensure, certification, or association membership that also provides professional insurance. There are several professional support groups, the larger two being the Associated Bodywork and Massage Professionals (ABMP), and the American Massage Therapy Association (AMTA), which includes various influential committees such as the Council of Schools. Two smaller groups, the International Massage Association (IMA), and the American Organization of Bodywork Therapies of Asia (AOBTA) are mentioned superficially, as they are more limited in their membership and scope of influence.

There is an independent research foundation dedicated to massage, the Massage Therapy Foundation (MTF). The specialty certifier of massage schools is the Commission on Massage Therapy Accreditation (COMTA). The national certifying group is the National Certification Board of Therapeutic Massage and Bodywork (NCBTMB), which was initially the sole examining organization.  However, the Federation of State Therapeutic Massage Boards (FSTMB) has recently introduced its own proprietary exam and is replacing NCBTMB in that role.

Professional Support Association Profiles

Approximately 40 percent of practicing massage therapists subscribe to one of two professional associations (ABMP, 2009a), the ABMP or the AMTA. There is no prohibition against dual membership, though this is seldom done. The primary objective of membership, insurance coverage, is satisfied with a single subscription. Although insurance coverage is a concern for practitioners, I can find no malpractice legal cases filed against a massage therapist. Yet, the National Practitioner Databank, a tracking mechanism for complaints, lists six medical malpractice reports regarding massage therapists in the US from 1990 to 2004 (NPDB, 1992-2004, as cited in “Massage Therapy”, nd). Nonetheless, the threat of malpractice, both on behalf of consumers and as a precaution for therapists, is one motivator for professionalization tactics.

Associated Bodywork and Massage Professionals

The privately owned ABMP reports approximately 71,000 members (ABMP, 2009; England, 2007), the largest professional membership of the associations. ABMP was founded in 1987, and has steadily increased its domestic membership each year (ABMP). A foundational tenet of the organization, which continues today, is to accept a wide range of practitioners with “diverse practice choices” (ABMP, 2009a), most of who work at massage part-time (ABMP, 2009).

ABMP offers a range of membership options, according to varying educational and practice-related standards. Approximately 22 percent of their membership (Massage Today, 2005) subscribe to the highest professional category, Certified, although other options do not require continuing education or local licensing. Annual fees range from $199 to $229 per year (ABMP, 2009). Membership benefits vary with membership level, and include professional and liability insurance, subscription to ABMP publications, and marketing support. In the past two years, ABMP has also expanded its offerings of educational programs (Bondurant, 2007), including its Massage Schools Alliance geared to massage educators (ABMP). Although 31.6 percent of members have taken the National Certification exam and remain certified, as explained below, another 64.2 percent have never taken the exam (ABMP).

ABMP conducts regular membership surveys.  In 2007, ABMP sent out 4,962 electronic invitations to its then 67,432 membership (ABMP, 2009).  They received 976 responses, or 19.7 percent, which were used to construct the bi-annual membership profile data (ABMP, 2008). It is not clear from the published findings how respondents were selected, although “invitation” (ABMP, 2008) connotes less than random selection. Survey results represent 1.4 percent of their member population, and thus, the statistical significance and viability is not clear.

Based on this 2007 data, ABMP suggests a profile for their typical ABMP member. She works part-time in massage, supplements her income with another job for at least 25 hours per week, and is an independent practitioner motivated by “genuine desire to improve the well-being and healthfulness of their clients” (ABMP, 2009a). Some 83 percent of these therapists are women, the majority of whom are married, with a median age of 45 (ABMP). She has a college degree 56.5 percent of the time. She reports working in various settings, although primarily in her own private office (ABMP). She is less likely to work in a medical office now than in 2005, down from an incidence of 32.9 percent to 24.3 percent (AMBP). She uses a variety of techniques and modalities, primarily deep tissue massage some 33.1 percent of the time, but also Swedish, reflexology, and “energy” work  (ABMP). Her client contact hours are dropping, averaging 14.4 per week, down from 15.4 in 2005 (ABMP). Most of her clients result from personal referrals, and she wishes that she had more of them (ABMP). The top five reasons listed for seeking massage were “stress management, relaxation, relief from acute pain, management of chronic pain, and rehabilitation from injury” (ABMP).

American Massage Therapy Association

The AMTA is a non-profit organization, and operates under a complex set of governance bylaws and chapter-supported volunteerism. It was founded in 1943 and claims approximately 56,000 members in the US and 27 other countries (ABMP, 2009; AMTA, 2009). Until several years ago, when it was overtaken by ABMP, it led in membership numbers. It offers similar benefits as the ABMP: professional and liability insurance, publications, and marketing support.  Fees are similar; annual membership fees are approximately $255, varying slightly according to local chapter supplemental dues. However, professional membership is not offered in different levels: all members are required to meet a single set of criteria similar to ABMP’s strictest standards, including accredited training, certification, and licensing. AMTA members are required to hold valid licenses in states that regulate massage. Although not identical measurements, this demonstrates a difference in the ABMP membership where only 31.6 percent have taken the exam required for licensure. In contrast, AMTA’s vision is integral to promoting higher standards of practice.

AMTA last published their membership demographics in 2006 (AMTA, 2006), They annually publish an industry Fact Sheet based on data compilations from various sources (AMTA, 2009) that appear quite similar to the ABMP data (ABMP, 2008). The demographic profile suggested by the 2006 data is almost an exact parallel to the ABMP’s members: 85 percent are women, has a median age of 44, and works part-time as a massage therapist, spending a median of 12 hours per week massaging. The AMTA average prototype is slightly less likely, about 15 percent, to have a college degree than the ABMP member.  As with the ABMP data, the method and sources are not clearly explained or transparent.

AMTA is also dedicated to industry development, as stated in its mission: “…to serve AMTA members while advancing the art, science and practice of massage therapy” (AMTA, 2009). AMTA authored its first code of ethics in 1960 (AMTA, 2009), changed its publication name in 1986 from Massage Journal to Massage Therapy Journal, and employs a large professional staff to provide regulatory advocacy and lobbying, encourage education principles, develop practice standards, create demand for massage in the public sector, and more recently, promote massage therapy research (AMTA, 2009). AMTA’s strategic plan includes proactive pursuit of licensure in every state, and promoting brand name consumer preference for AMTA members (AMTA, n.d.a).

In 1982, AMTA established a branch, the Council of Schools, to take a leadership role in support and development of massage training institutes. Member schools must adhere to curriculum standards and meet legal requirements in their jurisdiction. In 2008, there were about 300 member schools (AMTA, 2008), down from 350 in 2001 (Barrett, 2006). AMTA’s interest in elevating industry standards is manifest in the formation of separate entities to accredit, certify, and examine. Offshoots of the AMTA, which now operate as stand-along organizations, are discussed below.

International Massage Association

The IMA is a proprietary organization based near Washington, DC. Annual fees are $199, also offered for $149 without insurance coverage. Established in 1984 as an alternative to the large associations for providing affiliation and insurance, it claims that its membership numbers are in the tens of thousands (IMA, n.d.). But industry experts (Sweeney, 2008) estimate that IMA membership is a small fraction of the ABMP or AMTA. The actual counts remain proprietary information.

American Organization of Bodywork Therapies of Asia

Founded in 1989, the AOBTA has approximately 1,500 members (Spuller, 2008). Members practice some form of oriental bodywork, such as Japanese Shiatsu or Chinese Tuina. The practice paradigms foundational to AOBTA are different from western massage, and the role of the association is to protect their membership’s scope of practice and right to work. AOBTA has been effective in getting non-western techniques included in national exams. AOBTA provides insurance and marketing support to its membership.


Accreditation Agency: Commission on Massage Therapy Accreditation


In 1989, AMTA established the Commission on Massage Therapy Accreditation Approval (COMTAA) (Barrett, 2006) in order to “improve the quality of education through an accreditation process “ (Osendorf, 2006, p. 7). COMTAA eventually transitioned to independence as COMTA and is the only accrediting agency dedicated to massage therapy education (COMTA, 2008). In 2002, the US Department of Education granted COMTA federal authority to accredit massage programs including those offered in conjunction with associate degrees (OEDb, n.d.). COMTA employs a small staff, and is governed by a twelve member volunteer Board of Commissioners (COMTA, n.d.). Competency standards that were adopted in 2003 (Ostendorf, 2006, p. 1) direct the examiners; they are based on a grass roots orientation of  “what do these people need to know and what do they need to be able to do to be successful” (Ostendorf, 2006, p. 6).

COMTA’s role is to ensure that schools meet industry “competency-based standards” (Hymel, 2003) for basic training. COMTA includes in its curriculum standards a research competency component (Hymel, 2005) in order to “call the profession to a potentially heightened level of credibility” (Hymel, 2003, p. 194). Of approximately 1,300 domestic schools or programs in massage (PubMed, 2009), COMTA has accredited only a small fraction, approximately 100. This proportion is in part due to the rapid increase in massage training programs in non-dedicated schools, such as those now part of college offerings.

National Certification Board of Therapeutic Massage and Bodywork

In 1992, AMTA created the NCBTMB in order to promote national standards and certification, specifically through licensing. Over 91,000 massage therapists are now certified through NCBTMB (NCBTMB, 2007). NCBTMB, a non-profit organization, separated from AMTA and established its own charter in 2007 (NCBTMB, 2007a). It is currently recognized by the National Commission of Certifying Agencies (NCCA) (Barrett, 2006; NCBTMB, 2007).

NCBTMB promotes higher standards of “ethical and professional practice through national certification” (NCBTMB, 2008). They advertise a pledge with four tenets: safe conduct, confidentiality, professionalism, and ethics and accountability  (NCBTMB, 2008), and claim an important role in setting standards “to protect consumers, employers, and the profession” (NCBTMB, 2007). They promote this role as enabling increased national mobility for the professional massage therapist. They also provide a grievance process for investigating complaints.

In order to take NCBTMB’s exam, applicants must complete a minimum 500-hour accredited massage training program. After passing the initial exam, credentials must be renewed every four years.  Criteria for certification renewal include an annual minimum of 200 hours of massage therapy contact (Bureau of Labor, 2007) and 48 hours of continuing education over a four year period (NCBTMB, 2007).

Until last year, NCBTMB’s examination was the standard requirement for licensure in most states.  However, an examination recently introduced by the FSTMB is quickly being adopted as the preferred vehicle for licensure. In seeking to retain some segment of the business, NCBTMB is positioning itself as the certifying body. According to one local massage licensing board member (Casperson, 2009), NCBTMB’s future could include certifying in advanced techniques or modalities, but at the moment the situation presents a quandary. Since NCBTMB is currently the only certifying option, any massage therapists wishing to be certified must first take the NCBTMB exam. Yet many states are now asking for the new FSTMB exam in order to license.

Regulation: Federation of State Therapeutic Massage Boards

In 2005, a handful of state regulators initiated the formation of the FSTMB to support member massage therapy licensing bodies. Their intention was to establish compatible requirements and cooperative procedures between jurisdictions, and also share data, such as that related to disciplinary history (FSMTB, n.d.). Of the 43 states that regulate massage today, 39 and the District of Columbia and Puerto Rico are members.

Consistent with other regulated professions, states require that applicants have passed a recognized examination in order to be licensed as massage therapists. In 2008, FSTMB introduced its own examination of entry-level competence, the Massage & Bodywork Licensing Examination (MBLEx). It has already been adopted by 17 states.  The MLBEx, is likely to become the national standard for the industry.

Research: Massage Therapy Foundation

In 1990, the AMTA established a separate research arm, the MTF that transitioned to a separate 501c3 non-profit corporation. Today, it has an annual operating budge of about $250K, four dedicated staff, and is governed by a volunteer board of 11 trustees.  Despite fiduciary independence, MTF still shares its executive director with AMTA, being allotted about ten percent of the director’s time (Thompson, 2008).

MTF raises independent funds, and distributes grants to massage therapy dedicated research, education, and community outreach. The AMTA is still their largest contributor (Thompson, 2008). Since 1993, MTF has granted $245,000 for community service projects, and $441,000 in research grants (MTF, 2008). MTF recently introduced a program to teach massage educators to incorporate research literacy into their curriculum (AMTA, 2009c). In addition, MTF provides a massage therapy research database with over 5,000 entries (World Massage Forum, 2007), and last year launched a quarterly peer review journal, the International Journal of Therapeutic Massage & Bodywork (IJTMB), which is offered free from an online platform.  IJTMB is only one of two scholarly journals to focus on massage and bodywork, the other being the Journal of Bodywork and Movement Therapies.

MTF funds projects based on an established research agenda that has evolved since 1999 (Cassidy, 1998/1999) and is further articulated in the Massage Research Agenda (Kahn, 2002).  Fundable research is based in the empirical medical science paradigm, and focuses primarily on disease or dysfunction (Thompson, 2008). MTF plans a symposium in May of 2010 to update the agenda.

Spiraling deeper into the professional stakeholders

In keeping with the hermeneutic method employed for this study, a review of the published information identified threads for deeper inquiry. This resulted in a series of interviews with principals of key stakeholder organizations. Since AMTA is seminal to most of the entities, a pivotal interviewee was AMTA Executive Director Liz Lucas. Related threads of investigation lead to interviews with Diane Thompson, MTF President, Glenn Hymel, IJTMB Editor, John Gosse, Acting Director of COMTA, and Les Sweeney, Executive Director of ABMP. Interviews were tape recorded when possible, and are transcribed in Appendix 1. Gosse also provided additional COMTA reports documenting interviews conducted in 2006 with prior commissions and directors. These appear in citations in the text and the reference section. Finally, a locally assembled group of massage therapists shared their insights as to how they see their work. Notes from the discussion (2009) appear in Appendix 2.


AMTA’s Agenda: Four Cornerstones of Professionalism

Based on their mission and formational role in advancing a fellowship of support organizations, the AMTA is an orchestrator of the movement to professionalism (Lucas, 2006). A personal interview with Executive Director Liz Lucas (October, 2008) confirmed and elaborated this position. Lucas considers the domestic pool of currently practicing massage therapists to be roughly 260,000. AMTA represents about a quarter of the practitioners, but Lucas implies that her organization interprets to and promotes with the entire marketplace (Lucas, 2008).

According to Lucas, AMTA is not simply driving the movement but reacting to changes in the environment. The information age has fed maturation of the marketplace; demand for massage, which is mostly urban, increases as it is better appreciated and understood (Lucas, 2008). As demand proliferates, employment opportunities increase creating the potential for slipping standards as a byproduct of rapid growth. Subsequently, there is a “cry from regulators” (Lucas) for consistency in entry-level education. Lucas suggests a model for incorporating the key industry stakeholders into Four Cornerstones of Professionalism: licensure, certification, accreditation, and research.


AMTA’s goal is for licensure in all states, an objective supported by 90 percent of AMTA members (Lucas, 2006). Forty-two states and DC are now regulated. However, in other jurisdictions right to work remains an issue for therapists concerned with practice restrictions. In some venues, regulated practice now allows protection for massage therapists to practice their trade legally where affiliated professions previously challenged their legality (Greene, 1997, p. 87). Those turf battles are now maturing within regulated systems, although levels of professional recognition through license requirements remain contested (Eisenberg, Cohen, et al., 2002, p. 965).  AMTA is positioned to play a role in shaping how regulation is executed, and supports FSMTB as a partner in this function.









On the lobbying side, AMTA and its regulatory advocacy program and support staff continue to play a key role in attaining uniform and domestic licensure in every state. Although the FSMTB has an intrinsic interest in regulatory penetration, it is not a lobbying group. Instead, it fulfills a regulatory coordination role, exerting influence to impose consistence standards. It supports national mobility for practitioners, now more able to move from state to state and become licensed. One exam will lend consistency, and though “NCBTMB has temporarily filled a gap, we need to look at other regulated professions as models” (Lucas, 2008). FSTMB does not support the use of dual exams: “having a choice becomes a moot point because the MBLEx is clearly the only appropriate exam” (FSTMB, n.d.).

Although superficially this argument is practical, endorsement of a single exam by the examiner smacks of commercial or political self-interest. Also, the organic need of the proposed mobility is questionable based on the demographic data.  Since the majority of massage therapists practice as a part-time pursuit, most are not jeopardizing livelihood in moving to another jurisdiction since for most therapists, another job is their major income source. This point does not diminish the value of professional mobility, but raises the question of whether the concern is actual or projected based on stakeholder’s visions.


As the FSTMB becomes the examiner of choice, the viability of the NCBTMB arises. Lucas’ cornerstone model endorses a distinction between licensure and certification. Licensure should be the minimum standard for competency (Lucas, 2008). Advanced credentials and continuing education are certifying issues. NCBTMB is currently filling that role, but Lucas points out that this function could also be assumed through the FSMTB. In fact, the introduction of the new FSMTB exam creates a paradox for newly examined therapists who want to establish certification. They would have to take another exam, the one offered by NCBTMB, in order to obtain renewal certification. This situation is the result of stress between stakeholders, and likely to spark further debate.

NCBTMB has a history of controversy in its management, operations, and dealings with fellow associations (Razzo, 2005; NCBTMB, 2007b; Bondurant, 2009). Besides having a reputation for mismanagement and internal chaos, its contentious relations with fellow associations were apparent to the public by 2005 (Razzo). NCBTMB initially opposed the formation of the independent Federation in 2005. Its reported unresponsiveness to FSMTB’s requested changes to NCBTMB’s examination prompted FSMTB to introduce its own exam, the MBLEx. This subsequently removed NCBTMB’s virtual monopoly on this market. Currently, both AMTA and ABMP have endorsed the MBLEx as the preferred and sole professional exam (Bondurant, 2009). Hawaii and New York continue to offer their own proprietary exams.

A pre-requisite for taking any of the state exams is completion of an accredited program in massage therapy. Recent trends in providing this adult education are changing these offerings with consequences that affect the key stakeholders (Lucas, 2008; Sweeney, 2008; Gosse, 2008).


Massage education that consistently conveys standards is a critical cornerstone. While schools and programs have increased, including those accredited by COMTA, AMTAs Council of Schools membership decreased approx 18 percent (AMTA, 2008; Barrett, 2006). This is attributed to two factors. First, there is a move towards corporate ownership of schools (Lucas, 2008), e.g., the ten-location chain owned by Cortiva (Schwartz, 2006, p. 2). “what you’re seeing…is this consolidation with these big companies such as Cortiva” (Freeman, 2006, p. 8). Thus, multiple locations now count as one school. Second, many massage training programs are now contained in colleges or broader based vocational schools (Gosse, 2008). In these cases, many of the programs are accredited by a generic agency and less foundationally intertwined with the AMTA and its agenda for uniform, higher standards.

A goal of the AMTA is to have all massage therapy schools and programs accredited by a “USDE recognized agency specializing in massage therapy education standards” (AMTA, n.d.). At present, COMTA is the only such agency. COMTA is still young in its own standardization process, having adopted detailed procedures only in the past five years. Establishing a clear and consistent internal process has itself been a struggle (Gosse, 2008; Thomas, 2006). It took years to move into being a “proper accreditation agency” (Gosse, 2008).

Despite the recent focus on evidence-based practice, COMTA’s intial standards were practitioner driven. “What accreditation should really be concerned with is what can the people do on the way out, not how many people they’ve been associated with who have Ph.D.’s or how many books there are” (Freeman, 2006, p.11).  But in addition, standards lay the ground work for evidence-based practice: “coordinating the various curricular, instructional, organizational, and resource areas (is) essential to advancing massage therapy research competencies” (Hymel, 2003).

A former COMTA commissioner argues that standards are important for the employer: “…the massage industry was growing so rapidly without standards that it was important for us (COMTA) to make a stance to show employers that, hey, if your applicant has graduated from a COMTA accredited school, then you know they have X,Y, and Z competencies…. we constantly have employee retention issues, so you have to really be wise how you interview people and we need to look to the resources that are providing the right education to the therapists.” (Trieste, 2006, p. 2). This interest might not be meaningful to most massage therapists, who as noted above, are largely self-employed (AMTA, 2005; ABMP, 2009).

Greater uniformity is a likely by-product of massage school ownership consolidation. “… The extent to which more schools are owned by a smaller group of owners there’s going to be a tendency toward standardization within those institutions” (Freeman, 2006, p 8). Uniform standards also appeal to corporate reframing of massage product offerings. Larger concerns are likely to have the financial resources required to influence developments (Schwartz, 2006, p. 5).

Even if standardization is successful, there are downsides. “standardizing high quality gives you high quality.  But it does lessen the opportunity to try new things…so to the extent that creativity and diversity was a value in developing the profession’s educational processes that could be lost” (p. 8). But accreditation standards help to improve credibility outside the massage community.  Massage therapy is “far more acceptable in the healthcare profession even than it was 10 years ago. I know absolutely COMTA played a part in that” (Schwartz, 2006, p. 6).

The intertwined relationship between COMTA and AMTA continues to influence vision and practice e.g., “AMTA was HUGE in…ongoing financial support” (Ostendorf, 2006). Financial support is also linked to competitive considerations. One former commissioner claimed that COMTA’s evolution from AMTA committee to nationally recognized accrediting body was a result of AMTAs concern for competitive advantage over ABMP. “We were faced with a competitor that was an outgrowth of ABMP—I don’t know what that acronym stands for I’m sorry to say…so the commission made a decision to move forward.” (Ostendorf).

COMTA faces many challenges, including competition from the primary accrediting agencies Academy of Clinical Close Encounter Therapies (ACCET) and Accrediting Commission of Career Schools and Colleges of Technology (ACCSCT) (Trieste, 2006, p.2) . In addition, there are concerns related to evaluating the teaching of fundamentally kinesthetic skills in increasingly techno-centric learning environments. “It’s really going to be a challenge for COMTA to find the appropriate response to Distance Education….(but) just think of the ramifications if you don’t have control of the actual environment of learning” (Ostendorf, 2006, p. 7). That the COMTA commissioners are considering such complexities speaks to its inherent industry-based perspective. Accordingly, COMTA has potential to consider training elements from a more meaningful position than educators with little understanding of the massage process. However, the question remains as to whether COMTA can exert influence quickly enough to command critical mass of the massage program market. (Schwartz, 2006, p. 5).



Through certification and accreditation, “nationally uniform credentialing are necessary to ensure…more generalizable clinical research” (Eisenberg, Cohen, et. al., 2002). As massage use increases, and is increasingly positioned as a complimentary and alternative medicine (CAM) practice, allied health care professionals are calling for “accessible high-quality evidence from clinical trials to show which CAM therapies work best and for which conditions” (Manheimer & Berman, 2004, p. 268). Research is a keystone to professionalization as an adjunct medical service, although it begs the question of the overall impact of that positioning.

The MTF’s entry into the research arena is only one of recent developments. Until about 15 years ago, scientific research of massage was rare.  One early proponent of touch research, T. Field, gained national attention and funding due to her early work with premature infants (Field, 2001). Field went on to form a dedicated organization, the Touch Research Institute (TRI). Today, TRI has conducted over 100 studies on massage and touch, many focusing on infants (Field, 1999). The National Institutes of Health established their National Center for Complimentary and Alternative Medicine (NCCAM) in 1998 (NCCAM, 2009a).  In 2008, NCCAM’s total appropriation was $121,577,000. Although only a fraction of that amount was allotted to massage dedicated studies, “the scientific evidence base for integrative medicine will rest on data from both clinical trials and basic research that elucidates biological mechanism” (Briggs & Turman, 2008).

One indication of how CAM is gaining wider acceptance is that a conventional medical professional suggested it in 33 percent of the cases (PubMed, 2009). But lack of empirical research makes some allied health care professionals nervous (Cherkin, et. al, 2002, p. 378). Research, specifically that situated in the medical science paradigm, “gives credibility to massage, because Western medicine wants research-based evidence.  Massage is moving in that direction” (Schwartz, 2006, p. 7). Some scholars have acknowledged that the medical model is limited in its ability to capture the full range of benefits from massage, suggesting that a psychotherapy perspective of efficacy would be more meaningful (Moyer, Rounds & Hannum, 2004). However, critics from the more conventional perspective continue to label some modalities or techniques embedded with massage therapy as “quackery” (Barrett, 2006).

In addition to benefiting allied providers, massage research will help “all our stakeholders: insurance companies, referring care givers, pharmaceutical industry, researchers, the educators” (Thompson, 2006). Research will also force a standardization of language. Thompson asserts that currently the terms used differ amongst therapists, as well as between massage and other health care providers. Primarily, the consumer will benefit. Research will help better answer consumer questions: “should I be getting massage, how will it make me feel differently, how does this work with my medication, how does this work with my relationship with my health care provider” (Thompson). Ultimately, it will inform the therapist as to how to work more effectively, i.e. “how we can give the best care possible” (Thompson).

Thompson expresses another underlying agenda more relevant to individual practitioners: insurance reimbursement such as that provided in Washington State (2008). Research, as well as minimum professional standards, will support insurance reimbursement (Cohen, et al, 2005). “It is perfectly understandable—even just and laudable—that massage therapists of high caliber would desire professional recognition for what they are able to do, and that they would want their practices to have enhanced access to insurance payment plans that fund the vast majority of healthcare costs in this country” (Juhan, 2007, p.5). However, numerous debates now active in the health care industry dispute whether insurance reimbursement is an advantage, given the move to health care cost containment (Ziegenfus & Bentley, 2003, p. 232). “Our system has developed a technological and pharmacological expertise that is truly remarkable. And these developments in turn have made our healthcare by far the most expensive in the world “ (Juhan, 2007, p. 1-2).

In summary, research is intended to bestow legitimacy to the profession, and solidify the right of massage therapists to practice their trade. This aspect intersects with scope of practice, and is further addressed in regulatory activities. But it might have unintended and possibly uncontrollable consequences. “The result of more uniform licensure and credentialing may be excessive standardization and a decrease in individualization of services. Thus, increased standardization of credentialing for CAM practitioners may alter CAM practice substantially.” (Eisenberg, 2002) In this professionalization process, the character of massage therapy could be permanently altered. “What we could lose is the very basis of open-ended inquiry and exploration that have made us “alternatives” in the first place” (Juhan, 2007, p. 7).

ABMP: the Counterweight

ABMP often appears as a contributor and supporter to research projects (Health News, 2007) and alliances to establish industry standards (MTBOK, 2009). A personal interview with ABMP Executive Director, L. Sweeney (2008) provided further insight on ABMP’s view of the market and movement, which contrasts with the views held by AMTA.

Sweeney is “not sure” about AMTA’s push for professionalization (Sweeney, 2008). Pursuit of massage therapy as adjunct health care has “not turned out to be as viable a path as some expected” (Sweeney). He predicts a “third party pay backlash” that will make insurance reimbursement a stumbling block for massage therapists already stressed financially. Sweeney further suggests that accreditation is not necessarily the “panacea”, as massage providers compete for increasingly limited disposable income. Instead, marketing is the key, which must be supported by consistent and reliable practices in massage education. Sweeney thinks that ABMP’s commitment to supply members improved marketing tools, supporting a broader array of massage opportunities, is one of their cornerstones.

From the metaphor of recognizing the political aspects of association interaction, Sweeney states “ABMP and AMTA have differences in constituencies, but still have more in common than not” (2008). From a practical standpoint, Sweeney suggests that the professional gestalt will be enhanced by medical community acceptance and that even spa-based massage could benefit from research. However, “not every school needs to embrace research and research literacy” (Sweeney, 2008).  According to Sweeney, the massage therapist “wants to be defended against the skeptics” (Sweeney), and personal experience is the critical factor. But there is room for evidence informed awareness in the variety of massage settings: even spas appreciate research (Sweeney). Whether ABMP’s partnership in some efforts is motivated by collaboration or strategic self-defense, their presence will influence the ultimate direction of professionalization developments.

Massage therapist perspective

Survey data that claims to represent how massage therapists view their work appears self-referential.  The AMTA and the ABMP quote each other’s proprietary data, and furthermore claim that other data sources, including the U.S. Department of Labor have questionable data (Sweeney, 2008).  Both associations agree that there is not, to their knowledge, any studies that investigate how massage therapists experience their work, how they decide to work on any given client, or how their choices are influenced by their work setting (Lucas, 2008; Sweeney, 2008).

In February 2009, at a small assembly of local AMTA massage therapists, I asked for metaphors for how they viewed their work with clients (Appendix 2). They suggested a breadth of possibilities, from their role as a “provider of safe touch” to that of a “re-embodier”, or one who “put(s) body together, put(s) body with mind and spirit” (Appendix 2). One metaphoric role was that of “body mechanic” (Appendix 2). They were further asked, based on their familiarity with the current movement towards evidence-based practice, how their insights related. All agreed that the move to evidence-based practice only recognized the “body mechanic” function.

Medicalization of massage could adversely affect massage therapists’ freedom to integrate various techniques and modalities. “Legitimate practice of massage therapy…can help people relax, relieve aching muscles, and temporarily lift a person’s mood. However, many therapists make claims that go far beyond what massage can accomplish” (Barrett, 2006). Barrett (2006) goes on to name various techniques that are not medically based as “quackery”, and warns consumers and regulators that such practices should be abolished. “It is very likely that conservative medical experts will have the power to say what it is, who can practice it, and exactly how it is to be practiced” (Juhan, 2007, p. 7).


The move to professionalize massage has both risen from changes in the environment and constructed its own environmental changes. Positions of the stakeholders can be examined from separate metaphorical perspectives of how organizations and entire industries operate. Although more conventional paradigms of organizational theory, based on the analogy of a machine (Morgan, 1997), are not considered here, one summarizing comment from a former COMTA commissioner invokes a mechanistic perspective.

“Massage is a sort of free-wheeling occupation.  A lot of them did not like what they were seeing in the AMTA in terms of moving toward more standardization, that sort of thing.  They thought it would be imposed on them against their will.  And that’s happened in some ways” (Thomas, 2006, p. 4).


Organizational Theory: Organization As Organism

The metaphor of the organization as an organism relies on the organic nature of human groupings, especially in context of their environment (Morgan, 1997, p. 34). This perspective tends to focus on how interactive forces shape development. A set of constructs called Population Ecology (Morgan, 1997, p. 61-64) is grounded in Darwinian principles. Survival depends on an organization’s ability to control adequate resource supplies (Morgan, p. 61) as the population progresses through phases of variation, selection, retention, and modification. From this perspective, the organization is a discrete entity interacting with the environment (Morgan, p. 64) in an ongoing, open-ended process. The organization is highly opportunistic, and monitors environmental conditions.

This paradigm particularly reflects how the ABMP sees the evolving massage industry, as well as its own role (Sweeney, 2006). One aspect of this view, developmental openness, allows increased options for innovation (Morgan, 1997, p. 65-66). ABMP’s advanced marketing efforts seek to exploit such opportunities. But the perspective also allows for reciprocal change, since not just single entities but whole eco-systems evolve (Morgan, 1997, p. 64). Assumption of scarcity indicates that evolution will occur competitively. But if the assumption becomes that resources can be self-generating, entities can collaborate (Morgan, p. 65), e.g., as ABMP’s position on alliances for accreditation and research. ABMP acts as an “agent operating with others” (Morgan, p. 69) both in its interaction with and its construction of the massage industry. Neglected aspects of the population ecology, such as consumers who still need to be introduced to massage, can be cultivated. Thus, ABMP supports the national chain, Massage Envy, in spite of a lack of commitment to higher standards. Potentially, new patterns of inter-organizational and inter-environmental relations can shape future development in a proactive way. Organizational theorists argue “social and economic resources, especially in a knowledge economy, are inherently self-generating” (Morgan, p. 63-64). Through environmental interaction, innovators can create value niches that did not previously exist (Morgan, p. 63).

Another example illuminated by the organic viewpoint concerns the language of massage therapy. As a byproduct to create evidence for practice, standardized definitions of massage terms (Thompson, 2006) are evolving out of necessity. Terms that were individual and personalized are channeled into organizational missions and process. Various outlets, such as accreditation procedures, examination protocols, and research parameters, spread the usage and application of uniform definitions. Eventually, these become homogenous and universal.

Understanding evolution in the massage industry solely through organismic perspective has limitations. Organizations are not materialistic entities (Morgan, 1997, p. 64) but rather social constructions of their members (Morgan, p. 69). The potential for self-directed organizational transformation (Morgan, 1997, p. 63) is better appreciated through another metaphor, that of organizations as agents of flux and transformation (Morgan, 1997, p. 251-300).

Organizational Theory: Organization As Agents of Flux and Transformation

Some organizations encounter problems by failing to recognize how they interact with their environment (Morgan, 1997, p. 258). Characteristic of so-called “egocentric organizations” is a self-centered perspective dominated by a narrow domain (p. 260). Subsequently, they advance the agenda of the minority, mistaking it for a force of critical mass. In the massage industry, different perspectives can claim that the proponents of professionalization are either leading the pack or being chased by it.

An alternative is for organizations to see themselves as agents of change. Astute organizations appreciate that they do not exist separately from their environments (Morgan, 1997, p. 298). Instead, they continually influence the processes that construct the atmosphere and are furthermore inseparable from it. The AMTA, along with its offshoots, explicitly embraces this metaphor. Advancing along this line of thought, they can engage the change process mindfully through collective and individual self-reflection and behavior. “The way we see and manage change is ultimately a product of how we see and think about ourselves” (Morgan, p. 298).

Change agency carries inherent risks, especially if generative efforts operate in a closed system of relations. In such cases, entities misguidedly strive to clone their goals in various incarnations, as “their own organization and identity is the most important product” (Morgan, 197, p. 253). They do this by engaging in “circular patterns of interaction that are self-referential” (p. 253). Under these criteria, the AMTA cornerstone model is vulnerable to inbreeding.

Successful change management tends to allow for value consideration, reflection, synthesis, and process integration (Hatch, 2006, p. 319-320) at all levels of ownership and influence. Open-ended collection and transfer of information can strengthen mutual learning, and help avoid common pitfalls of growth. One potential pitfall, labeled the “competency trap” (Hatch, 2006, p. 320) is when organizations fail to recognize that directed changes result in little or no competitive advantage. In this application, the change refers to the reorientation of the industry towards the medical model. If successful, this could result in bifurcation of massage therapy into either medical practice or spa setting. Where the non-medical, non-spa massage would then reside is questionable. The benefits of such an outcome are unclear.

Organizational Theory: Chaos Theory

Examining the organizations and their principals surfaced multiple incidences of inconsistencies and mis-matches. For instance, revisiting the challenge of incongruent language that MTF’s Thompson raises (2008) it is critical to note that many in the healthcare community do not equate “therapeutic” with “medical” (Juhan, 2006, p. 5). Some constructs in massage practices are clearly outside of evidence-based practice. But in defense of some “quackery” techniques (Barrett, 2006), “energy medicine”, as it is known in other circles, is practiced by many (ABMP, 2009) and purports to be foundationally supported by theoretical advancements in physics. “Undreamed of discoveries about how human beings function and heal are appearing at a rapid rate, as many researchers are breaking ground by learning to ask new kinds of questions that specifically challenge conventional scientific wisdom” (Juhan, p. 7). Some argue that forces towards professionalism, especially evidence-based practice, could be edging us toward a “trip switch that could have major unintended consequences” (Juhan, 2006, p. 5).

Invoking precepts from Chaos Theory (Morgan, 1997, p. 299), organizations and their environments are part of an “attractor pattern” (p. 265) that holds together until pushed to the edge of chaos, and then flip into new patterns that are always coherent.  Allowing for the butterfly effect, the challenge is to introduce small, manageable changes that can morph into major impacts (Morgan, p. 299). In the process, insight can be gained by examining “paradoxes and tensions that are created whenever elements of a system try to push in a particular direction” (Morgan, p. 299).

Final Thoughts from Organizational Theory

Organizational theory suggests that best the chances of transforming along with the environment is through “open-ended” evolution (Morgan, 1997, p. 261). Empirical science makes many claims, but open-endedness is not one of them. In its goals, the AMTA states two points: “Massage therapy practice will be evidence-based” and, that “People recognize the power of touch to affect the mind/body/spirit continuum” (AMTA, n.d.). Yet, AMTA offers no tactic to reconcile the incongruity between pursuing evidence situated in empirical medical science and the mind/body/spirit continuum. MTF further recognizes the value of finding another model to apply to wellness questions (Thompson, 2006). For MTF’s upcoming conference to revise its research agenda, it plans to convene a group of massage therapy experts “put them in a room and close the door” to create strategies (Thompson, 2008). Applicable organization theory suggests that they will be most effective if they remember to take practice realities into the room with them.



“I don’t know. But it’s different, and whenever the world changes, you wonder how it’s going to be.  Clearly the world is changing. (Freeman, 2006, p. 9)


Organizational theorists (Morgan, 1997, p. 63) claim that entities become extinct as a result of change that results in a less effective environmental fit. As the association stakeholders continue to respond to, as well as construct industry change, extinction could apply to any of the associations, the cornerstones, or even the craft of massage therapy as it was once practiced.

Massage therapy industry stakeholders should be mindful of the idea that change has a mind of its own. Like other developmental phenomenon, it is an “emergent phenomenon” (Morgan, 1997, p. 299) that eludes predetermination and evades control. Attempts to elevate professional standards will be effective as they match the needs and desires of the massage consumer and practitioners. But attempts to manipulate the culture in pursuit of vision that lacks consensus is ladened with unpredictability.  Stakeholders can benefit from systematic reflection and planning directly related to industry developments. Unfortunately, “order becomes apparent only with hindsight” (Morgan, 1997, p. 300).  In the case of evidence-based practice, this could be an idea that is generative.  Or it could be a residue from a prior paradigm, based in empirical medical science and practice, whose potential application has already diminished.




The author wishes to acknowledge the cooperation, candidness, and assistance of Diane Thompson, Director of MTF, Glenn Hymel, Editior of Journal of Bodywork and Movement Therapies, Liz Lucas, Executive Director of the AMTA, John Gosse, Interim Director of COMTA, Les Sweeney, Director of the ABMP, and members of the D.C. Chapter of the AMTA for providing personal, individual interviews and sharing non-proprietary industry and association information.

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Research for Massage Therapy

On Sunday, November 6, I will be presenting to the D.C. Chapter of the American Massage Therapy Association (AMTA) on the importance of research for MT practitioners, and how MTs can contribute to the growing body of research.  It will take place at Potomac Massage Training Institute, D.C. at 4pm.  The synopsis is below.

What Massage Therapy Research Means to You:And what you can do about it

With Luann Fortune, LMT, NCTMB, MA, Doctoral Candidate
An interactive workshop and discussion

For AMTA DC Chapter
November 6, 2011
In the past decade, medical science has taken an increased interest in massage therapy.  Seems like we read about a new clinical study or finding about every week in the popular press.  But other than serve as a useful marketing tool to generate new business, what application does this research have for the seasoned massage therapist?
In this hour presentation, Luann Fortune will describe how the growing body of scientific research is already impacting your everyday practice.  Find out how it is likely to continue to have an impact, how you can stay on top of the latest findings (before your clients tell you about it), and what you can do to be part of the movement to research (or not to research).
Luann has been practicing and teaching massage therapy in D.C. for over 20 years.  She has published numerous papers and articles, including a study on the impact of licensing on massage therapists (see  She is currently completing her doctoral dissertation in Human Development at Fielding Graduate University; her research examines how massage therapists conduct their work.  Luann can be contacted at

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Self Care is an ethical issue

As a massage therapist, I often work with clients who are in dire situations. My work with them becomes part of their self-care program, either in grappling with their own illness or as caregivers. Yet when faced with my own predicaments, I often forget about the tools I know.
I recently responded to a question about self-care tactics that prompted me to take a fresh look at this important topic.  I conjured some self-help tools that work for me in my life.  This list is a summary reminder of all that I can do for myself.
Everyone is different, but some ideas that can work for me (and some of my clients):
• Eat nourishing foods
• Get sleep: even if I have to take an occasional benedryl or melatonin, though acupuncture can work well to bring me balance as well)
• Eliminate or seriously limit my alcohol consumption: especially in dire circumstances, it only makes things worse later
• Exercise: especially walking helps remind my whole self that I am moving through this day, and for better for worse it too will pass
• Walk with my dog:  he is always in the present moment and glad for it
• Talk with friends/ therapist/ spiritual leader: I ask my church group to pray for my loved one, and think it helps to share the load), spend time with people and things that I love
• GET MASSAGE: I need nurturing touch, as do my clients, and believe there is no substitute
• Pray/meditate
• Write/journal
• Sing:  I have playlists for different moods and needs
• Laugh
• Self-gifting: Every day I try to give myself a gift, even if it is a better quality cup of coffee
•  Breath:  finally and firstly, remember to breath
Just like massage therapy, self care is not just a series of techniques.  I have come to realize that self-care is not just a tactic, a set of actions to make me more productive or increase my longevity.  It is an ethical and spiritual issue. It starts with an awareness and an orientation.  I really cannot take care of anyone else if I don’t take care of myself.  For me, how I travel these streams calls up a powerful dynamic on how I define myself and how I see my contributions in this lifetime.
Self care is about boundaries. As I grown, I become more aware that boundaries are not just a protective shield, but a statement of my own identity.  As a professional, I believe in exploring and crafting boundaries so I can do the best I can do. Good boundaries are good for me, but also fair to my relationships, and allow me to honor my work and my life.  This has to be true in personal relationships as well working ones, especially the really hard relationships in hard times.
Like regular maintenance, I take an occassional look at my boundaries. I love to re- read Ruiz’ The Four Agreements (1997)/ I find it to be a wonderful guide to my underlying foundation for the techniques, tactics, strategies I use as a care-giver and as a person.
I welcome ideas that my readers can share on this important question.  Please share your own methods and resources, as well as your methodology and philosophy.

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The Star and The Fish

The Star and the Fish

A sparkling glass starfish hangs over my desk, capturing the light that filters into my workspace. It was given to me by Dr Bentz at the end of the intensive that completed my teaching assistantships with her at the end of 2009. She presented it to me with praise of my stardom in the work I did for the Embodiment KA. I value it as a reminder, not only of my stardom but of my fishdom.

I reveled in my moment of stardom. I basked in the glory of my assistantship accomplishments and the broader triumphs of the Embodiment KA. Over the months birthing this multi-disciplinary course on somatics, I lead the group’s momentum, read more than I usually read in a year, and demonstrated how innovation can invigorate learning. The breath of my writings documented the group’s intellectual evolution and growth as a collaborative unit. I believe the model we created can be applied to multi-disciplinary inquiry with unlimited topics. I would like to project its advantages through a joint paper with Dr. Bentz; I hope that happens. Although I returned to my psychodynamic interpretations on various occasions, I believe my co-teaching relationship with Dr. Bentz flourished during this course. I was working at my boundaries’ edge, nearly exhausting my personal intellectual energy. But I emerged triumphant and ultimately completed the course prepared to pass on its core value.

While I was basking in the glow of my stardom, I remembered that this course began a long time ago. Perhaps it germinated during my undergraduate days with a major in Interdisciplinary Social Science. I acknowledged the various professors who planted the seed for a new paradigm search. Certainly it started at Spring RaP 2008 when Dr. Bentz suggested that we introduce a Felix informational forum for exploring somatics as a topic and method. I acknowledged the many Fielding colleagues who signed up for the forum, shared information, and participated in the subsequent workshops on somatic experience (FGU WS 2009; FGU SS 2009). I realized the crucial coaching of my cluster mentor Dr. Seashore who encouraged me to take ownership of this course offering. I appreciated how the support and encouragement of my cluster mates cheered me on in promoting the course offering and planning. I knew that the work’s depth unfolded under the collaborative creation and execution of all twelve participants. My stardom was actualized through this sea of support, nurturance, and coordinated development. I was a fish in a fertile ocean that represented my materially and temporally sculpted community.

A Haiku to Dancing StarFish

Up and coming Star

Sculpted in technicolor

Congratulates sea


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Where truth intersects with meaning: Somatic awareness as explained by neuroscience viewed through a phenomenological framework




Where truth intersects with meaning: Somatic awareness as explained by neuroscience viewed through a phenomenological framework

Presented at

Society for Phenomenology and Human Studies Annual Conference

Arlington, Virginia

October 30, 2009

Luann D. Fortune

School of Human and Organization Development

Fielding Graduate University

Luann Fortune, LMT, MA, is a doctoral student in the School of Human Development at Fielding University. She can be contacted at

Where truth intersects with meaning: Somatic awareness as explained by neuroscience viewed through a phenomenological framework


Somatics has long been a topic of conversation in phenomenology. Recently, biological science treatments have evolved to expand these conversations from describing the Brain to suggesting how the Mind operates to construct reality. This paper builds on the framework provided by neuroscience to explore potential partnerships with phenomenology for investigations of embodiment. Invoking operational descriptions of how somatic awareness is constructed, the discussion attempts to reach beyond the more simple metaphor of the brain as a master control tower. It considers aspects of somatosensory processing that can integrate body-based perceptions into consciousness, memory, intentionality, and other higher mental aspects of individual identity through a novel interdisciplinary approach to understanding experience from inside the body.

Keywords: body awareness, embodiment, somatosensory, interoceptors, interdisciplinary, phenomenology


In the animated film Wall-E (Stanton, 2008), what remains of the earth’s human population is confined to a hovering spacecraft, supposedly waiting for the earth’s eco-system to be restored sufficiently to support planetary life. Over 700 years of confined outer space living, the humans have evolved into blobs of flesh and brain. They live cradled in mechanized hover chairs that provide them their only mobility and offer them stimulation and pleasure via a virtual life on an attached flat screen.  Amongst the myriad facets of their cluelessness, they don’t even realize they cannot ambulate unassisted. In this regard at least, they are missing somatic awareness.

Bodily sensations intermingle with consciousness to create somatic awareness. Tied to the body’s alert system, it is foundational to individual and evolutionary survival. Recent developments in neuroscience attempt to explain the biological operations attached to somatic awareness through cognitive science (Damasio, 1999, p. 13-14). But directing and cultivating this body-centric awareness is ancient. Somatic cultivation figures in many therapeutic and spiritual enterprises, such as tantric yoga (Morley, 2008) and tai chi (LaFountain, 2008). In addition, since somatic function is foundational to all inquiries concerned with living human bodies focusing on its awareness affords an intersection for social science discussions from various perspectives.

Yet, a disconnect between the concepts of physiological science and philosophies of the mind contributes to linguistic inadequacies for mind-body exploration (Gendlin, 2000, p. 113). The contemporary proliferation of neuroscience data and findings (Kandel, 2006, pp. 7-8; Shermer, 2008) does not examine the quality of somatic experience. Phenomenology offers both the theoretical framework and practical approach to fill knowledge gaps (Rehorick & Nugent, 2008, p. 33) by directing attention to the essence of somatic experience.

In this paper, I consider how somatic experience is constructed in the brain and how the results can get channeled into conscious awareness. I allow for aspects of somatosensory processing that can integrate body-based perceptions into memory, intentionality, and similar higher mental aspects of individual identity as they interact with perspectives from psychology, sociology, and transcultural perspectives. I suggest that using phenomenology as a vehicle for inquiry, the constructs from neuroscience, and language borrowed from social science perspectives can interweave to suggest an interdisciplinary paradigm for exploring somatic awareness.

Brain Science on Somatic Awareness

Receptors and managing the incoming

In neuroscience parlance, somatic awareness results from an integration of the somatosensory system and consciousness to create active and passive responses. Tracing any given response begins with a stimulus. Stimuli attributed to both internal and external origins construct somatic perception (Damasio, 1999, p. 149). Identifying and describing these elementary building blocks will be useful when we consider how to apply neuroscience tenets in other disciplines.

Different sensors recognize interior and environmental stimuli. Environmental receptors monitor external data through sight, sound, smell, taste, and touch (Blakeslee & Blakeslee, 2007, pp. 34-35). Receptor functions are highly specialized, allocated to detecting variations of light and color, ranges of auditory waves, myriad and intertwined scents and tastes, tactile pressure, relative temperature, and vibration. But the receptors alone do not constitute vision, hearing, or any other sensory experience (Schwartz & Begley, 2002, p. 26-27).

Internal perception occurs in similar steps. Sensors monitor balance, proprioception, or kinesthetic, and interoception, including a sense of energy, vibration, or vitality (Blakeslee & Blakeslee, 2007, p. 204) and detect sensations of pressure or temperature (Damasio, 1999, p. 150). Movement and posture are sensed through vestibular and muscular-skeletal receptors that inform consciousness about movement and placement in space of body organs and parts (Damasio, p. 153).

Since the nervous system is hard-wired to perpetuate the organism’s survival, it must continually differentiate between signals emitted from our external environment and those internally generated (Damasio, 1999, p. 136). The physical body provides the living object with boundaries, especially important with humans equipped with limitless mental animation driven by higher capacities (Damasio, p. 143). But whether any given sensation actually results from external factors or whether it is internally initiated is less rigidly delineated than traditionally thought. Research concerning phantom limb sensation (Ramachandran & Hirstein, 1998) demonstrates how the brain can construct sensation without external stimuli and parallels discussions in philosophy.

But assuming an exclusively internal reality espouses solipsism and leads to the trap of subjective isolation (Sokolowski, 2008, p. 68-69). In this paper, both internal and external stimuli are allowed for and pertinent to somatic awareness. Developing somatic awareness to a higher level of consciousness, to better appreciate the complexities of distinguishing the internal from the external, could contribute to improved individual survival skills. This point is germane to multi-disciplinary application.

Processing incoming data

Constructing perception begins with collecting, relaying, and managing signals from the body. Constantly relayed messages that stream to the appropriate collection sights and processing centers are like foot soldiers updating bodily status (Damasio, 1994, pp. 87-88, 1999, p. 151). Conventional biology states that integrating incoming signals to achieve perception takes place in various areas in the brain, with simple sensory and motor functions localized within specialized cortical areas (Gellatly & Zarate, 2005, p. 27).

Modern neuroscience continues to seek the ultimate goal of identifying each brain area responsible for each function: brain mapping (Schwartz & Bengley, 2002, p. 23-24). Using recent technological advancements, such as functional magnetic resonance imaging (fMRI) (Damasio, 1999, pp. 82-83), Descartes’ image of the brain as the thought machine (Schwartz & Bengley, p. 32) can be fully diagramed. The mapping paradigm attempts to assign specific folds of cortices to functions as well as to behaviors (pp. 62-73). Recent brain maps show regions located in the parietal and temporal cortices that are thought to parse and map somatic experience (Blakeslee & Blakeslee, 2007, p. 204). Evidence demonstrates that brain maps are malleable and can be reoriented through a process called plasticity (Ramanchandran, 1998, p. 1851).

A. Damasio (1999, 2002) does not dismiss brain mapping, but rather adds an explanatory dimension. He says thoughts, experiences, and memories are dynamically constructed and reconfigured with each incidence of experience. The concept that complex thinking and behavior is assembled and involves multiple areas of the brain is traceable to J. Hughlings-Jackson (1835-1911) (Gellatly & Zarate, 2005, p. 27). The same activity can be assembled at lower or higher levels, a concept still resident in distinctions and labels used for somatosensory mapping (Blakeslee & Blakesless, 2007, p. 81). Russian neuropsychologist A. Luria (1902-1977) posited that dynamic brain assembly has a temporal dimension. Different brain area “ensembles” (Gellatly & Zarate, p. 29) working together on different occasions achieve the same function. K. Lashley (1890-1958) suggested that there is no single site of particular memory (Gellatly & Zarate, p. 99), although current thinking holds that memories live in specific circuits (Damasio, 1999, p. 21). The concept of neuroplasticity (Schwartz & Begley, 2002) whereby brain cells continue to create new alliances throughout the life-cycle, offers a remodeling mechanism for substituting and expanding particular sites in any given circuit (p. 15-16).

Progressively dynamic, the brain serves not only as a receptacle for stimuli, but intertwines with the body to create new stimuli. This applies to multiple layers of consciousness, including somatic experience and awareness (Damasio, 1999, p. 21). According to the Damasio (1999) some areas of the brain are flexible and can serve multiple purposes in mental functions. However, those areas responsible for mapping the internal body condition are dedicated and unchangeable (p. 21-22).

Sensory somatic subsystems

According to Damasio (1999), the somatosensory system is a complex series of responses, and not one single system (p. 149). Three subsystems operate in parallel to construct somatic-sensory experience: the internal milieu and visceral, the vestibular and muscular-skeletal (Damasio, p. 86), and the fine-touch subsystem (p. 151). Each subsystem deals with particular information, but they also work in tandem to create whole images and experiences.

The internal milieu and visceral subsystem monitors the chemical state of the body’s cells and baseline functions. The bloodstream serves as the transmittal channel, conveying neuro-chemical signals such as hormones that are triggered by generically termed interoceptor reactions (Damasio, 1999, p. 150-151). These are collected and interpreted at central sights including regions of the brain stem, hypothalamus, the sub-fornical organs located at the cerebral hemisphere level, and the telencephalon (Damasio,  p. 150) . Subsequent neural activation can then initiate responses. Since these regions can also initiate transmission of signals along the neural pathways, they are critical to the nexus of body-mind connection with application to cultivating somatic awareness and passive practices such as meditation and biofeedback.

The muscular-skeletal and vestibular subsystem conveys information on the state of voluntary, striated muscles and associated skeletal structures. Kinesthetic data collectors, also called proprioceptors, carry signals along neural pathways (Damasio, 1994, p. 88) to monitor movement, posture, and internally sensed bodily position from the internal perspective (Blakeslee & Blakeslee, 2007, p. 11). The vestibular system, linked to devices in the inner ear, monitors balance, equilibrium, and motion, and helps convey sense of dimension and perspective. The muscular-skeletal and vestibular subsystems work in tandem to provide continual information about where the body and its parts are in space. This subsystem is invoked in active somatic practices such as yoga.

The fine-touch subsystem relies on skin receptors to detect specific stimuli, such as deep or light pressure, heat, or cold, and is primarily concerned with describing objects and stimuli external to the body and sensed through the skin’s surface. Tactile practices, such as massage, rely on this subsystem. Scientists recently speculate on the existence of a peripersonal space, an area off the skin and around the body that is annexed by the nervous system (Blakeslee & Blakeslee, 2007, pp. 3-4).

Damasio (1999) proposes that the intersection of the somatosensory subsystems does not occur in one region of the brain, but “emerges dynamically and continually” (p. 154) out of multiple orders of neurological processing. At least a portion of the brain area designated as the somatosensory cortex is involved. Brain stem nuclei, the first nexus point in the central nervous system (CNS) are believed necessary to interpret and regulate homeostatis and map body signals. The hypothalamus and the basel forebrain are interconnected with the brain stem by their common ability to circumvent the blood brain barrier and respond to chemical indicators, such as levels of hormones, glucose, various ions, pH in plasma, and oxygen. Therefore, each of these areas is able to receive signals via both neural and bloodstream pathways, and also discharge neural signals to each other as well as elsewhere in the nervous system.

Monitoring the body’s state is not the same as experiencing and interpreting body awareness. Damasio (1999) suggests that multiple brain structures beyond the designated somatosensory cortex are invoked to construct even the most elementary self-awareness (pp. 154-156). Full integration involves activity in the forebrain, in the medial cortices and regions of the insular cortices known as S2 (Damasio, p. 156). Regions located in the parietal and temporal cortices are thought to parse and map somatic experience (Blakeslee & Blakeslee, 2007, p. 204). The myriad areas involved in this operation illustrate the various permutations of any single experience of consciousness, including somatic perception.

For example, seeing and recognizing an external object is the result of complicated and variable coordinated processing efforts (Damasio, 2003, p. 198-199). In a hypothetical instance, signals captured in the retina are integrated with information in the visual cortex in the occipital lobe (Damasio, 1999, p. 334), the dimensional perspective supplied by the vestibular system (p. 146-147), memories from the hippocampus (p. 157-158), and emotional associations from the amygdala (p. 61-62). Monitoring the internal state is equally dynamic, although possibly less at the forefront in the consciousness.

So, it is arguable whether our internal experiences are universal. Without viewfinders into another’s awareness, the most benign of sensations could be perceived with highly individualized variations.  For example, an estimated five percent of the human population (Blakeslee & Blakeslee, 2007, p. 119) has synesthesia, a biological condition where sense perceptions get mixed up. It is often not diagnosed until past early childhood.  Yet undiagnosed synesthesians have known a number of deviations, such as smelling their auditory experience or tasting their visual stimuli, for their entire lives, not realizing that this was not everyone else’s experience as well.

Progressing along the consciousness hierarchy presents added layers of complexities. But according to Damasio (1994), all somatic subsystems remain critical to constructing higher order reasoning. Signals from the internal milieu contribute to the construction of emotions and feelings (p. 48). Somatic markers (Damasio, 1994, p. 174) are reactions that result from emotions linked to bodily sensation. They are the “gut feeling” (p. 173) or the danger flag (de Becker, 1997). Damasio’s  (1999) somatic marker hypothesis (p. 41) posits that patients with damage in the somatic related brain regions consistently demonstrate difficulties navigating in their social environment. (p. 41-42). Damasio (1994) hypothesizes that areas in the pre-frontal cortices receive signals from all the sensory areas and integrate these with other information (p. 182-184) in the essential construction zone of human responses.

Various threads of research explore how the body, especially facial expression, can reveal somatic, emotional, and intellectual states. Recognizing such non-verbal cues contributes to intuitive ways of knowing (Gladwell, 2005, pp. 206-214). But in an interesting turn, some research also indicates that bodily expression can exert a reciprocal reaction to intellectual and emotional states. Research findings claim that making certain facial expressions can not only reflect feelings, but create them (Ekman & Davidson, 1992, pp. 342-345). Awareness and intentional direction of somatic markers provides a key for intersecting Damasio’s constructs with other disciplines and offers a potential avenue to explore the anecdotal tenet of where-goes-the-body-so-goes-the-mind-and-spirit.  Application of this construct provides foundational justification for practitioner approaches in multi-disciplines.

An alternate proposal (Panskepp, 1998) to Damasio’s tenets describes a parallel rather than integrated system. The most elementary level of consciousness originates in the brain stem and spans levels of consciousness via a CNS neural-network (pp. 562-582). Affective feelings may be caused by the neuro-dynamics of basic emotional circuits interacting with the neural schema of bodily action plans. According to Panksepp (1998), consciousness is developmentally and evolutionarily connected to both sensory-motor awareness and higher cognitive abilities (Panksepp & Northoff, 2007). Panksepp’s version ascribes importance to somatic awareness; Damasio’s hypothesis suggests a unified holistic mind-body paradigm.

Neuroscience Tenets at the First Degree of Application: Neurology

Similar to the more recent work of Damasio (1999, 1994) and Ekman (Ekman & Davidson, 1992), W. James (1842-1910) proposed that emotions result from bodily states (Damasio, 1999, p. 288). Neurology subsequently discredited that tenet, specifically citing spinal cord transection patients. Case studies describe that although spinal cord severance interrupts signals from the body, such patients still possess emotions. However, deeper examination and several biological factors validate the dynamic construction principles of Damasio and his forerunners concerning the critical role of somatic input for feelings.

Arguments that cite paralysis patients as possessing emotions neglect several critical considerations. First, even if the spinal cord is severed signaling occurs through the vagus nerve that bypasses the spinal cord, connecting directly to the brain stem. Next, signals from the body convey not only via the spinal cord and neuron system, but biochemically through agents such as hormones via the bloodstream. Third, damage to the spinal is seldom completely severed, and some amount of neurological signaling continues. Fourth, sensations from the head and face bypass the spinal cord and feed directly to the brain. Therefore, some incoming sensations are accommodated. Finally, there is indication that spinal cord injuries do result in diminished emotional experience, even after factoring in associated depression and traumatic response (Damasio, 1999, pp. 289-290).

Case studies describing Locked-In Syndrome (Foer, 2008) further support the body’s influence on the mind.  These unfortunate patients, suffering from full bodily paralysis while still maintaining consciousness, use their only operating body part, a flickering or blinking eye, to report an odd sense of calm. As the body shifts into stillness, so goes the mind (Damasio, 1999, p. 292-294).

Allowing for anticipated emotional dysfunction in neurologically injured patients could contribute to a framework for holism in medical treatment. But treating the mind with the body is counter to underlying premises of western science and medicine.

Brain science meets Philosophy: Why body-mindedness

Separate body and mind systems, called substance dualism (Damasio, 2003, p. 187), are consistent with Cartesian thinking (Hanrahan, 2003, p. 7). Founded in the Church’s influence in modern western civilization (Lipton, 2008), dualism provides the basis for modern western physiology. Consistent with the underlying scientific paradigm, measuring trumps more qualitative ways of understanding. But, in the words of the Merleau-Ponty (1962), science is a “second order expression of the world” that is founded on the first order of how we directly experience the world (p. ix). Phenomenological research provides methods for qualitative inquiry, a discipline for sorting and interpreting subjective accounts, and an intellectual tradition that reveals meaning so as to contribute to scholarship.

Returning to holism by crossing over other disciplines’ boundaries requires clear language. The subject of somatics offers common ground for establishing such a vernacular: “We need to reawaken our experience of the world as it appears to us in so far as we are in the world through our body” (Merleau-Ponty, 1962, p. 239). But Merleau-Ponty also observes that the language is elusive: “… language in the notion of sensation…nothing in fact could be more confused” (p. 3). Practitioners who profess to contribute groundbreaking work in mind-body intervention admit that their work needs clearer and more systematic articulation (Johnson, 1997, p. 4).

Beyond scientific exactitudes and debates to define the anatomical structure and functional source of somatic awareness (Sotnikov, 2006), somatic experience begins with a “wordless knowledge” (Damasio, 1999, p. 168). Phenomenology is well suited to investigating experience that “one cannot yet label or name” (Rehorick & Nugent, 2008, p. 33). As a practical consideration, because of its open-ended nature, phenomenological inquiry is useful for topics where research is minimal as it can serve to bridge otherwise incongruent concepts (Gendlin, 2000, pp. 116-117). It promotes understanding as it connects the experience of the one to the experience of an other (van Manen, 1990, p. 54).

Damasio proposes that the felt core self generates a feeling of knowing (1999, pp. 171-172) that comes before verbalization and autobiographical consciousness. This first person perspective, what has been called the “look of a feeling” (Wilber, 1996, 2000, p. 1) is ideal for generating datum on embodiment. A similar concept is found in a Phenomenological construct called being in the epoche (Husserl, 1975, p. 8). Phenomenological inquiry is designed to capture feelings and perceptions at the core of where they live: with the subjective individual consciousness. Sensations mix with memories and emotions to engender higher consciousness to the extent that the actual experience and the thoughts about the experience become fundamentally intertwined (Damasio, 1999, p. 35). In the words of Merleau-Ponty (1962): “A thing is, therefore, not actually given in perception, it is internally taken up by us in so far as it is bound up with a world, the basic structure which we carry with us, and of which it is merely one of many possible concrete forms” (p. 381).

This mixing bowl dynamic (Damasio, 1994, p. 129) substantiates nonwestern views (Nhat Hanh, 1975) that the body-mind is essentially unified. Mental life emerges from the body’s basic functions, rather than being superimposed on a separate bodily level of being (Shusterman, 2008, p. 180). This variance in thinking points to a foundational challenge in integrating positivist science’s view on somatic experience and holistic approaches.

There is also a temporal challenge (Merleau-Ponty, 1962, p. 79-80) to reconcile. As opposed to the ever-changing stream of consciousness, biology sees the body is a source of stability and relative sameness (Damasio, 1999, p. 142). In navigating through the duree of lived experience (Malhotra (Bentz), 1981, p. 111), construction of reality is always a split second ahead of the present (Damasio, 1999, p. 94). By the time consciousness captures and assembles verbal, sensory, and symbolic data to create the present, the flow has carried us beyond the temporally volatile moment. Thus, the present is forever relegated to the past (Barth, 1961, p. 48) carried forward with us as molecules of memory (Kandel, 2006, p. 241; Perth, 1997, p. 143)

But the physical body is always in the present (Blackburn, 2008, p. 2) and provides a touchstone for communications and inquiry. Husserl’s essence of being (Behnke, 1997) is grounded in the physical body’s perceptions (Merleau-Ponty, 1962, p. xi). Whether consciously or not, every body movement is recognized through a network of somatic sensors (Blakeslee & Blakeslee, 2007, p. 204). Sensory perceptions, generated by both internal and external stimuli, are building blocks of the in-the-moment experience. Perhaps in some cases, bodies function best when we ignore them rather than mindfully guide them (Shusterman, 2008, p. xi), as when a musician masters a score. But somatic awareness is achieved when consciousness is intentionally directed to mitigate bodily sensation with cognizance.

Like Damasio’s consciousness model, Heidegger’s concept of Befindlichkeit describes an implicit sense of one’s situation, both internally and in context (Gendlin, 1978) . According to Gendlin (2000), the “body as internally sensed” (p. 110), which can reveal a “gamut of responses, feelings” and ways “one becomes familiar with oneself” (p. 110), is akin to somatic awareness: Befindlichkeit reveals authenticity (Gendlin, 1978).

Consideration of bodily experience is fundamental to the work of M. Merleau-Ponty, who refered to the internal total awareness as body schema (1962, p. 113-114). Phenomenology’s relationship with body-based inquiry continued in the work of T. Hanna (1928-1990) who coined the term somatology and later somatics (Behnke, 1997, p. 664) to describe his multi-disciplinary inquiries that intersected physiology and subjective perception. Subsequently, E. Gendlin developed the concept of focusing (1978) to investigate the body’s felt sense (Behnke, p. 645), giving rise to practice applications used today. A related technique, the body scan (Shusterman, 2008) offers one potential research tool for collecting data from non-verbal sources (p. 162).

In multiple modalities, the therapist, doctor, or coach often asks the client to report on their immediate internal body sensations and experience.  Questions like, “where do you feel discomfort, tightness, aching, or tension inside your body right now” are used to solicit input for designing intervention. In the technique called Body-Scanning this line of questioning is structured into an extended inspection of the internal body experience. Verbal prompts guide the participant through a journey of their real-time felt response (Olsen, 1998, p. 17).  The instructions are geared to direct awareness and presence, beginning with differentiating between external and internal stimuli and focusing on the breath. Prompts continue to direct attention through the inner body, and ask the participant to notice what is sensed. The subject’s internal observations engender words and metaphors that provide a starting point for description (Shusterman, 2008, p. 164). Based on Damasio’s constructs (1994, 1999, 2003), somatosensory input intertwined with educated intentions will progressively increase the richness and clarity of the descriptions one can produce. The whole being can be trained to better appreciate, capture, and communicate their internal bodily experience.

Phenomenological methods provide substantive techniques to record the essence of an experience as it is unfolding (Van Manen, 1990; Bentz & Rehorick, 2008). Though not identical to the actual lived experience, protocol writing, a crisply descriptive text describing an experience, (Van Manen, p. xx) gives lived experience a voice. Text, capturing the body-scanner’s vooice, can then be interpreted. As a practice and a research tool, the body scan can be applied in multiple disciplines to collect data on lived somatic experience.

Spiraling Deeper into Multi-disciplinary Inquiry

At a pivotal point in the story line of Wall-E (Stanton, 2008), the ineffective bodies of the exiled humans hijack their space craft and return to earth, ready to rebuild their terrestrial home. Their blossoming somatic awareness, which develops gradually through the film, is intrinsic to the eventual empowerment that fosters their rebellion. According to Shusterman (2008), somaesthetic feelings that can be named can then be trained and ultimately lead to transformation (p. 130).

Whether their pari-mobile physical condition is permanent, the reported micro-gravitational bone loss due to some genetic mutation, or a reversible response to environmental circumstances that will be remedied with medical science, proper diet and exercise, remains unknown to the viewer. Will the landed people continue to reverse their lack of somatic awareness? Will improved awareness lead to stronger, more mobile bodies? Will better bodies contribute to personal fulfillment and further expansions in consciousness? What we can predict for them, as they strive to overcome or reverse their embodied circumstances, can draw from other knowledge areas.

Arguments to consider span various paradigms. These range from whether the time lapse was sufficient for a permanent change according to Darwinian evolution, to the premises in sociology and trans-cultural studies that suggest that group values act as change agents (Aronson, 1972). Biological realities affecting the body influence individual consciousness and collective cultural factors. Politico-socio environments become embodied in our being. Somatics further plays a role in spiritual enrichment, and thus serves as a source of core nourishment.

Body awareness is rich territory for interdisciplinary exploration as already demonstrated by inquiries appearing in various fields. Socio-cultural ethnography describes how norms affect the experience of body awareness (Blakeslee & Blakeslee, 2003, p. 109). Psychology offers evidence that somatic awareness can be cultivated through body-based therapy (Price, 2005). Embodiment issues are now emerging in the Interdisciplinary field of Organizational Development in the applied practice of Somatic Coaching (Flaherty, 2005, p. xv). Today, bodymindfulness (Nagata, 2008, pp. 149-150) is discussed in social science venues as varied as cultural communications studies (Nagata, pp. 143-147) and trauma treatment protocol (Rothschild, 2000, p. 3).

Striking a balance between choosing a focus and deploying a multi-dimensional framework is key to effectiveness. While too much focus leads to a reduction in complexity, too little focus results in minimal direction and insipid insights. Using phenomenology’s approach and biology’s constructs provides a concrete platform for diverse questions. A foray into possibilities begins with considering how Damasio’s neuroscience allows insights into discipline specific interests.

Somatic Awareness and Psychotherapeutics

Psychotherapeutic practices are interlinked with somatic awareness. Psychology’s attention to bodilyfocused attention and practices can be traced back to the early 20th century and the work of W. Reich, F. Perls and the Gestalt movement, and C. Jung (Davis, Eshelman, & McKay, 1988, p. 15). Progressive relaxation, a technique to internally release muscles, has its roots in E. Jacobson’s work (1938), as a method to manage stress by controlling body tension. In the mid-1970s, A. Lowen introduced Bioenergetics, to treat anxiety by focusing on internally constricted muscle patterns (Lowen, 1975). Damasio’s (1999) model provides a language for communicating the mechanics of these practices: each involve signals from the muscular-skeletal subsystem, as do the practices of martial arts, yoga, and dance-movement therapy (Behnke, 1997, p. 664). Neuroscience’s principle that controlled movements can affect feelings (Ekman & Davidson, 1992, pp. 342-345) allow an additional avenue for describing how body can shape emotional states. This scientifically based hypothesis furthermore supports the arguments proposed by T. Brennan (2004) that affect is transmitted from person to person through nonverbal channels (p. xx). This suggestion can be further explored using neuroscience’s constructs of paripersonal space (Blakeslee & Blakeslee, 2003, p. 3).

Self-help somatic practices of biofeedback, and sensory integration therapy (Behnke, 1997, p. 664) involve Damasio’s (1999) internal milieu and visceral subsystem, focusing intentionality to control bio-chemical signals. Massage therapy’s effectiveness originates by invoking signals in Damasio’s (1999) fine-touch system. Yet each of these practices demonstrates that irrespective of which subsystem manages the initial signals, the responses are integrated and perpetuate subsequent responses in the other subsystems. For instance, massage therapy starts by initiating fine-touch signals, which in turn contribute to internally generated relaxation of muscular-skeletal structures. Proprioceptive signals from relaxed musculature trigger responses in the internal milieu to release hormones to activate the para-sympathetic Relaxation Response (Benson, 2000). Hence, neuroscience offers both a language and scientifically grounded mechanics to triangulate principles garnered anecdotally from clinical practice.

A contemporary approach to psychological counseling, aptly named Body-based psychotherapy, involves interweaving talk with physical interventions such as touch and movement (Price, 2008, pp. 47-48; Staunton, 2002, pp. 107-108). Beyond channeling attention internally to collect information, the body-based psychotherapist employs soma-directed tactics for presumed inherent benefits. By intentionally cultivating client attention to their inner experience, the psychotherapist promotes recovery and personal evolution through improved self-awareness (Price, 2008, p. 51). Using the body as a staging area for self-revelation, such therapy claims to also support personal growth (Blackburn & Price, 2006, p. 68). Various case studies report memories, emotions, and trauma as being revealed and released in body memory (Damasio, 1999, pp. 118-119; Elmen, 1997, p. 109; Hall, 1997; Olsen, 1998, pp. 15-16). Hence, the in-the-present body is not only the staging area for experience, but reflects development as it serves as a resource for healing and transformation (Price, 2008, pp. 1-6).

Study participants report feelings of empowerment through improved somatic awareness (Price, 2005, p. 52). This finding suggests a useful factor for our imaginary returnees to earth in Wall-E (Stanton, 2008). Perhaps a series of body-based psychotherapy sessions would support and motivate them to the higher level of personal development needed to address their environmental challenges. Scientifically based mechanics for perception development are available in the expanding theories of plasticity and epigenesis (Lipton, 2008, p. 36-39). Lipton (2008) further suggests that perception effects belief that underlies self-agency and actualization.

Applying Brain Science in Sociology

Cultivating increased somatic awareness could have a “profound influence on all therapeutic modalities” (Blackburn & Price, 2006, p. 68). But a full appreciation of somatic awareness requires contextual consideration. For instance, neuroscience abounds with clinical benefits of touch (Field, 2001). But some cultural norms create prohibitions against touching. Sociology traditionally addresses issues of collective norms and behaviors, including those involved with somatics.

In I. M. Young’s Throwing like a girl (1980/2005), the author posits collective elements that shape bodily experience (p. 142-143). Young (1980/2005) contends that the feminine experience is not based in biology, physiology or female essence, but rather in the “particular situation of women as conditioned by contemporary society”  (p. 153). Women’s perception of themselves, resulting from socially constructed self-concept, underlies them not fully engaging their physical strength (p. 143-146). Data claims women are more prone to tentativeness (p. 146), have less motility (p.146-153), and harbor a fear of getting hurt (p. 146). Women’s underestimation of their capacity becomes a self-fulfilling prophecy (p. 147) and carries over into external aspects of life (p. 152-153). The “girl learns to hamper her movements” (p. 154) and see herself as being “physically inhibited, confined, positioned and objectified”, “rather than as a living manifestation of action and intentions” (p. 155).

In addition to feminist theory, bodily experience tends to generate discussion concerning factions that are marginalized. In an essay on disability sociologists B. Hughes and K. Paterson (1997) claim “sociology has discovered the body”, and at the same time, studies have “seen fit to dispense with it” (p. 326). To convey theory into practice, sociology will benefit from clearer language, and concrete methods, techniques and approaches for bringing the body into text.

Internal feelings, which can be identified and captured in body scanning (Shusterman, 2008, p. 162-164), reflect habits learned from our sociocultural formations (p. 130). They can thus be relearned (p. 130). Biologist B. Lipton (2008) agrees that perceptions, not genes, control the construction of behavior (p. xx).  Whereas social structures, such as education and parenting practices, will instruct Young’s genderbased norms, neuroscience describes a mechanism for changing such perceptions on an individual basis. Integrating recent findings from research in neuro-plasticity can offer hope for reshaping women’s experience of body, including the kinesthetic experience of throwing. Additional perspectives more aligned with applied psychology invoke visualization to re-orient team sports performance (Sheikh & Korn, 1994, p. 23). But re-orienting collective norms to shape individual experience requires more than understanding how the tools work.

Cultural crossovers: Spirituality and Somatic Awareness

Somatic awareness plays a role in some religious and spiritual practices (Kovach, 2008, pp. 941-942) as well as centuries old yoga poses such as Savasanna (Singleton, 2005, p. 289). In its essence, meditation offers a gateway for deeper self-knowing and holistic mindfulness. However, there is a common Western misconception that Eastern traditions promote somatic awareness (Morley, 2008, p. 154). In actuality, most Yogic tradition transcends somatic awareness (Morley, p. 149). At best, the body is a vessel rather than a focus. Morley argues that Tantric tradition affirms the primacy of somatic consciousness (p.155) Vipassana meditation, which professes body and mind interconnectedness, cultivates body mindfulness as a vehicle to insight through somatic awareness (Holland, 2004, p. 470).

d’Aquili and Newberg (1999) developed a neuroscience model to help explore the brain’s role in religion and mystical phenomenon. Specifically, it claims that the act of meditation serves to suspend temporal and somatic awareness in pursuit of a higher state where physical boundaries are surpassed (pp. 157-168).  However, rather than deepening real-time bodily experience, meditation posits a goal of transcending the physical body to attain an absolute unitarian state (pp. 14-15). Brain science research reinforces practice by triangulating findings with phronesis. In consciousness that is influenced daily by Western paradigms, scientifically grounded substantiation carries authority and can help establish popular acceptance of emerging constructs.

The generation of somatic awareness and meditative state both begin with a common pattern in the frontal cortex, but deviate in their subsequent directions. Recognition and response to both internally and externally generated stimuli occur through sensory receptors in the upper parietal lobe (d’Aquili and Newberg, 1999, pp. 33-36). Intentionality, including construction of somatic mindfulness, originates in regions in the frontal cortex called the Attention Association Area ( d’Aquili and Newberg , pp. 34-35) where firing neurons activate focus and concentration. The vestibular system’s dimensional data, integrated with kinesthetic and tactile perceptions, is parsed by cognitive operations that interpret and assign meaning. Somatic awareness demands focus on bodily sensation, whereas meditation strives to transcend it. Studies that monitor brain activity during deep meditation record a drop in parietal lobe activity, the brain region associated with processing somatic sensations (Blakeslee & Blakeslee, 2007, p. 122). In a process called functional deafferentation, the brain systematically blocks incoming information, including recognition of internal sensation, while it spirals into self-induced over-excitement (d’Aquili & Newberg, 1999, pp. 41-42).

Whether one accepts the specific technical aspects of the d’Aquili/Newberg model, it serves to further triangulate materialistic dimensions associated with channeling somatic awareness, and the critical role of intention. It also provides vernacular for related conversations important to a deeper question which arises through considering the spiritual dimension of somatic awareness: Cultivating somatic awareness asks me to pay attention and develop a relationship with an aspect of myself that I know will leave me in death. Aside from a discussion of the human versus the divine, why would I willingly go to an awareness that is embodied in mortality? Perhaps the answer lies in acknowledging that anticipated foundational awareness is the basis for all subsequent higher consciousness, and makes this life more than a rehearsal for a hypothetical afterlife. Focusing on somatic awareness requires that the state of being bodily mindful be valued in its own right.

Conclusions and Further Study

Whether somatic awareness can be cultivated or eliminated completely is explainable from multiple disciplinary viewpoints, and now triangulated in neuroscience theories and findings.  In addition, neuroscience offers a framework to construct a common somatic language. A more developed language is foundational to describing the wordless state of the inside out where all perception begins; a vernacular to describe the inner state is under-developed. Exact words fall prey to metaphors and images that are clearly superimposed by some sphere of the higher intellect.  For example, the descriptions of internal organs and soft tissue structures are likely images drawn from an individual’s familiarity with Western anatomy and physiology. This speaks to the value of providing basic anatomical instruction at an early age to support self-care. Science demands exactitudes, including in vocabulary and definitions (Damasio, 1999, p. 27). Other disciplines can benefit from this clarity and also use it to approach cross-disciplinary parity with various theoretical intersections with science and somatics.

Underlying the “So What” question: What I have taken for granted is not so easily named. Why, again, is increased somatic awareness valuable? In addition to therapeutic interventions and self-care, the implications for intimate relationships render wordless images of the satisfied lover, the suckling infant, the empowered warrior. Somatic awareness allows one to take better care of oneself, one’s partners, and by extension, one’s clan. Our fictional Wall-E earth returnees can cultivate somatic awareness to support their individual and collective body developments. It could provide a cornerstone to environmental survival and evolutionary success.

From another aspect, the process of conducting scholarship in body mindfulness (Nagata, 2008; Anderson, 2002-03) can enrich research results. Merleau-Ponty (1962) claimed that the body provides “significance not only to the natural object but to the cultural object like words” (p. 273). Words invoked and received, come through the body with or without awareness.  Making bodily awareness a partner to intellectualization bridges the reflective being with the embodied being.  And when one is lost, somatic mindfulness can serve as vehicle for consciousness re-orientation. “Intentionality would carry us to the heart of the object” (Merleau-Ponty, 1962, p. 277). Intentionality must begin from inside the looking glass.

Phenomenology asks us to suspend attachment to permanence. But our biological realities dictate that our body holds memory. Assuming we choose to bracket the assumptions that come with this state, bodily awareness must first be acknowledged and understood. Phenomenology tells us that the core of understanding is in experiencing.

The practical reality is that to access the epoche we must work through the body. In two final scenes of Wall-E, the resilience of human spirit is demonstrated in body-based responses: the captain draws sufficient strength to command his body to stand erect and walk several feet, thus securing safety for his passengers; and the touch of a hand, albeit robotic, restores Wall-E’s soul. Even as scholars, the body we start with is our own.


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Filed under Academic papers and publications, essays, research

Directed Body Scan

I recently conducted research on myself while experiencing a guided visualization directed body scan.  Based on my results, I constructed a paper which I am presenting at the inaugural gathering of the Interdisciplinary Coalition of North American Phenomenologists on May 8-9.

I am excited to hear what my peers think of this approach, as I continue to explore how to incorporate embodiment practices into research method.  Please try it out with your self and your clients.

Let me know what you think.

Directed Body Scan © Luann D. Fortune, September 30, 2008

Find a place that is safe and comfortable. Position yourself in that space. (Pause.) Shift or adjust your body so you are comfortable and supported. Take a deep breath in. As you exhale, allow your eyes to close. Notice how it feels to stop the flow of real-time visual signals. (Pause.) Take several more deep breaths. Allow yourself to put away thoughts and distractions from daily life, and give yourself permission to focus on yourself and your physical body in this moment.

Now, focus your awareness on the space outside your body. Notice what you hear. (Pause.)  Notice what you smell. (Pause.) Notice temperature or air flow against your skin. Notice how your clothes feel. Notice how the floor or furniture that support you feel against your body. Note what else you are aware of in the outside world.

Notice your breath as you draw air from outside your body to inside your lungs. Notice your exhalation sends air from inside you to the space outside you. Continue to breathe, focusing on the in-flow and out-flow of air. Notice that your breath connects the external world to your internal self. Notice how this feels.

As you exhale, shift your focus to your internal physical body. Follow your breath as it enters your lungs, filling your chest, expanding your abdomen. Notice your sensations inside your torso.  Notice any feelings of pressure, movement, pain, temperature, or other sensations that are there. Note any words that describe your internal experience in this area of your body.

With your arms positioned at your sides, and your elbows along your rib cage, raise your forearms so that you are suspending them unsupported in the air. Open your hands, spreading your fingers and extending your palms upwards. Focus on your hands. Notice what they weigh: are they heavy or light. What else do you notice about your hands? Rotate your hands so that the palms are facing downward; weigh them now.  What do you notice about their weight? What other sensations do you notice?

Expand your awareness to your whole body.  Notice where your attention goes next. Notice any feelings of pressure, movement, pain, temperature, or other sensations that are there. Note any words that describe your internal experience in this area of your body. Note any discomfort that you feel.  Note any words that describe this feeling in detail. Focus your attention on this place in your body.  Notice if it changes.

Allow your attention to move through your body from the inside. Notice which body parts you can feel easily. Notice which body parts express little or no sensation. Name the sensations as you continue to move your attention through the inside of your body. Notice any feelings of pressure, movement, pain, temperature, or other sensations that are there. Note any words that describe your internal experience in each area of your body.

Continue moving your focus through the inside of your body. When you have explored all of your parts, notice if any places call back your attention. If so, move your awareness there. Notice any feelings of pressure, movement, pain, temperature, or other sensations that are there. Note any words that describe your internal experience in this area of your body. Describe them in detail.

Now, shift your focus back to your breath. As you inhale and exhale, notice any feelings of pressure, movement, pain, temperature, or other sensations that are there. Note any words that describe your internal experience in this area of your body.

Gradually, bring your attention to the external world, the space outside your body. When you are ready, open your eyes.

Directions to close eyes reflects neuroscience thinking that real-time visual input can interfere with internally focused awareness due to hierarchical prioritization established by the visual cortex

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The master’s touch

While searching through a used book cart, I found a picture book whose illustrations were wrapped around the text of a 1936 poem.  I scooped up this bargain, as it has special  meaning for  me.  Some years back, a student of mine finishing the short community course on massage that I was then teaching, read this in my honor.  It is one of the greatest tributes I ever received.  The text goes like this:

Twas battered and scared, and the auctioneer

Thought it scarcely worth his while

To waste much time on the old violin,

But he held it up with a smile.

“What am I bidden, good folks,” he cried,

“Who’ll start bidding for me?

A dollar, a dollar – now who”ll make it two _

Two dollars, and who”ll make it three?

“Three dollars once, three dollars twice,

Going for three”. . . but no!

From the room far back a gray-haired man

Came forward and picked up the bow;

Then wiping the dust from the old violin,

And tightening up the strings,

He played a melody,pure and sweet,

As sweet as an angel sings.

The music ceased and the auctioneer

With a voice that was quiet and low,

Said: “What am I bidden for the old violin?”

And he held it up with the bow;

“A thousand dollars – and who’ll make it two?

Two thousand – and who’ll make it three?

Three thousand once, three thousand twice

And going – and gone,” said he.

The people cheered, but some of them cried,

“We do not quite understand –

What changed its worth?” The man replied:

“The touch of the masters hand.”

–by Myra Welch

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On Being a juror

On Being a Juror
My paper entitled On Being a Juror: A Phenomenological Self-Study  has been published in the Indo-Pacific Journal of Phenomenology (Volume 8, edition 2).  It is available online at

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