Are you legally licensed to do “emotional work”?

This post represents a followup to my last post, “Are you qualified to do emotional work”, with additional background in this post: “Professional Boundaries, continuing a dialogue: Is it time for a change?“.

There have been many passionate responses to the first post across this blog, and on both Facebook and LinkedIn Groups. Why the passion? I believe therapists who have been doing this work feel entitled to do so, based on their training and experience. Therapists who have not been doing this work (or, who have had no exposure to the thought that this was even a possibility) feel a bit incredulous that manual therapists would even consider drifting into the emotional realm. I have certainly taken my share of heat from therapists who feel differently than I, but conversation and disagreement is part of a healthy life, and I simply delete the rude responses.

In this post, I wanted to share with you some feedback I received from therapists higher up up in two of our professional organizations. Both people who shared this information did so knowing I would be using their email reply and gave consent. Both were given three questions, which varied only in that the profession was changed. Here are the three questions:

1. Is it within a physical therapist’s (massage therapist’s) license/scope of practice to advertise that they deal with resolving the emotional, as well as the physical, aspect of pain and dysfunction?

2. Is it within a physical therapist’s (massage therapist’s) license/scope of practice to utilize modalities/techniques specifically intended to provoke an emotional response in order to facilitate rehabilitation/healing?

3. Is it within a physical therapist’s (massage therapist’s) license/scope of practice to utilize verbal dialoging techniques to aid the patient in understanding the emotional component of their pain/dysfunction?

The two people I interviewed were:

Pat Collins, LCMT, President of the New York State Chapter of the American Massage Therapy Association

and

President of the National American Physical Therapy Association Board of Directors, Paul Rockar, PT, DPT, MS (I contacted the President of the New York State American Physical Therapy Association via email, but received no response).

Here are the responses I received:

New York State law defines massage as follows – this is copied / pasted from the OPD (Office of Professional Discipline) website: The practice of the profession of massage therapy is defined as engaging in applying a scientific system of activity to the muscular structure of the human body by means of stroking, kneading, tapping and vibrating with the hands or vibrators for the purpose of improving muscle tone and circulation.

OPD also says:
“Massage therapists are licensed health professionals who apply a variety of scientifically developed massage techniques to the soft tissue of the body to improve muscle tone and circulation. Massage therapists work to enhance well-being, reduce the physical and mental effects of stress and tension, prevent disease, and restore health.”
(bolds mine (Pat).)
I can certainly call OPD and get a black/white answer for you. But in general, I would be very cautious about actually “putting it out there” that we are doing emotional work. In conversations with the Office of Professions over the years, their main concern is if someone gets hurt and any therapist without psychological training or training in counseling can very easily and very quickly get in over their heads. I know someone personally who attempted suicide after a verbally dialoged “somato-emotional release” that the therapist said went well.
New York State law says our purpose is “improving muscle tone and circulation” and applying techniques to the soft tissue of the body.
Often emotional releases happen in our hands-on work and sometimes our clients like to have conversations about what is going on with them. The safety and well being of our clients is above all the most important thing.

Pat Collins, LCMT American Massage Therapy Association NY Chapter President

and

Walt-

I appreciate your request for input regarding the physical therapist scope of practice. I would like to
direct you to resources that will outline both the APTA Board of Directors Guidelines as well as resources
found on the Federation of State Boards of Physical Therapy (FSBPT) website.

Guidelines: Physical Therapist Scope of Practice BOD G-02-14-18-12 provides comprehensive list of care
and services that fall within the physical therapist scope of practice. These guidelines were recently
updated at our February Board of Directors meeting. Of course, the Guide to Physical Therapist Practice
is also an excellent resource. This publication is available online to all APTA members at:
http://guidetoptpractice.apta.org/

I would also encourage you to review the numerous resources related to scope of practice found on the FSBPT
found at https://www.fsbpt.org/FreeResources/RegulatoryResources/ScopeofPractice.aspx. I would also recommend
you contact the State Board of Physical Therapy regarding the scope of practice definition in your jurisdiction.

In the Model Practice Act you will find the following definition of physical therapy:

―Practice of physical therapy means:
a. Examining, evaluating and testing patients/clients with mechanical, physiological and developmental
impairments, functional limitations, and disabilities or other health and movement-related conditions in
order to determine a diagnosis, prognosis and plan of treatment intervention, and to assess the ongoing
effects of intervention.
b. Alleviating impairments, functional limitations and disabilities by designing, implementing and modifying
treatment interventions that may include, but are not limited to: therapeutic exercise; functional training
in self-care and in home, community or work integration or reintegration; manual therapy including soft
tissue and joint mobilization/manipulation; therapeutic massage; prescription, application and, as appropriate,
fabrication of assistive, adaptive, orthotic, prosthetic, protective and supportive devices and equipment;
airway clearance techniques; integumentary protection and repair techniques; debridement and wound care;
physical agents or modalities; mechanical and electrotherapeutic modalities; and patient-related instruction.
c. Reducing the risk of injury, impairment, functional limitation, and disability, including the promotion
and maintenance of fitness, health, and wellness in populations of all ages.
d. Engaging in administration, consultation, education, and research.

I hope these resources will be helpful as you draft your article.

Thank you for being a member.

Sincerely,

Paul

Paul A. Rockar, Jr., PT, DPT, MS
President, APTA Board of Directors

It is my understanding that if an activity is not included in one’s practice act, then it is not allowed. If I am incorrect, I would welcome someone with deeper knowledge to post here. What creates confusion is how “emotional work” is defined. Many define it in a fuzzy manner; if they have been trained to do this work, they feel qualified, without regard for legal ability to perform the work. Unfortunately, it may only be something that a court could decide…hopefully you will not be the one that defines the boundary in court.