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The BPS model has been criticized for indulging in “undisciplined eclecticism.”2 Psychiatrist S. Nassir Ghaemi uses the analogy of replacing a recipe for a specific food with a mere list of ingredients, chosen with no rhyme or reason, and indeed, close to home, we’ve seen the harm that undisciplined eclecticism has done to massage’s credibility. In 2014, massage therapy social media was lit with fear and speculation about Ebola, when the decision was made to bring a person with Ebola to the US for treatment. (Ironically, the Democratic Republic of the Congo is experiencing a much worse outbreak right now, but without the mainstream press whipping up a frenzy about it, there’s not a word about Ebola on the same social media outlets.)
Without sufficient education in public health to know how little risk they were at and what to do about it, and without policy guidance regarding infectious disease from employers and spa owners, massage therapists were publicly declaring what they were going to do to protect themselves from Ebola. Suggestions ranged from not accepting any clients from Africa to taking the temperature of all clients arriving for an appointment. Refusing to treat on that basis were floated as serious plans, and reality checks on why these plans were—at best—ineffective, and—at worst—actively harmful, were ignored. This kind of undisciplined eclecticism damages the massage profession even more in the public’s eyes.
However, we can turn this around, and use the BPS model to the spa environment to align massage therapy with modern health care and to act in the best interests of our clients. Ghaemi claimed that the BPS model’s fatal flaw was that it led to undisciplined eclectism, but that’s not quite right. It can lead to undisciplined eclecticism, to be sure, but it doesn’t have to be so. All of the disciplines represented in the BPS model contain validated relevant knowledge. There—not in the triangle—is where the recipes exist that keep treatment from being just a random list of ingredients, or a loose rope swinging in the wind.
Physics and chemistry determine what can and does exist in biology, which in turn
determines what can and does exist in
biomedical sciences and social and behavioral sciences. So a task analysis, informed by the bodies of accredited and validated knowledge underlying the BPS disciplines, can build a BPS model to inform the spa environment.
Intake and health history are informed by physics, chemistry, biology, and biomedical sciences. So clarifying what these disciplines have to tell us about which factors are important in a spa environment (pregnancy, infectious diseases, prescription medication for bleeding disorders), and which ones are not (screening for Ebola on intake). They also inform what valid claims we can make about the benefits of spas, and which of the old claims were just myths. Also, they clarify why—even though Lysol or Clorox
wipes are perceived as “harsh”—massage therapists can’t just substitute witch hazel and tea tree oil to clean surfaces that come into contact with clients’ bodies because they like them better.
Psychology and other behavioral sciences inform how we interact with our clients, and what claims we are justified in making to them about the effects of spa treatments such as massage. For example, in a rigorous meta-analysis, massage therapy was reliably demonstrated to have strong effects in reducing anxiety and depression, and not to reduce cortisol in any meaningful way.3 So we can tell our clients about massage therapy’s effects on anxiety and depression, and drop the incorrect claim about cortisol (which most clients don’t care about, anyway). Social sciences can inform what we know about how social support improves quality of life, protects health, and encourages healthy behavior changes. It bears implications for how massage can advocate for clients in promoting access and addressing the effects of social determinants of health and illness.4
The recipes exist. We just have to reach out, adapt them to our clients’ needs, and make use of them. And there are people who will help us do that. We just need to trust them and reach out.
References
1. Engel, GL (8 April 1977). “The need for a new medical model: a challenge for biomedicine.” Science. 196 (4286): 129–36.
2. Ghaemi SN. The rise and fall of the biopsychosocial model. Br J Psychiatry. 2009 Jul;195(1):3-4.
3. Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004 Jan;130(1):3-18.
4. Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010 Apr;64(4):284-91.
Dr. Ravensara has been a licensed massage therapist in Washington state since 1992. In 2006, she completed her PhD in Biomedical & Health Informatics at the University of Washington School of Medicine. She practiced at the Refugee Clinic at Harborview
Medical Center in
Seattle for more than
eight years, providing
massage therapy for
pain relief, insomnia,
and other symptoms
for refugees living
with the after effects
of having survived war,
genocide, and other forms of trauma.
She has served the profession as a Board Member for the Massage Therapy Foundation and as Chair of the Best Practices Committee.