Mica Rosenow, PhD, LMT

I wonder if massage therapy has spent so much time borrowing legitimacy from healthcare that we've overlooked something we may actually have to contribute:

Embodied consent.

Massage therapists routinely negotiate access to another person's body.

--> Where can I touch you?
--> Where don't you want to be touched?
--> Is this pressure okay?
--> Are you comfortable with this position or level of undress?
--> Would you like this area addressed?

And consent doesn't end with those questions.

Something that was comfortable five minutes ago isn't anymore? We change it.

A yes to one thing isn't automatically a yes to another.

An involuntary physiological response isn't permission.

And changing your mind after we've started doesn't mean it's too late to say no.

Massage exists at an unusual intersection of touch, vulnerability, undress, physiological response, interpersonal trust, power, and communication. Yet we've spent enormous professional energy distancing ourselves from the conversations those circumstances uniquely position us to have.

We've sought legitimacy by emphasizing that massage is healthcare, therapeutic, evidence-based, and nons*xual.

But what if we're overlooking knowledge developed within our own practice?

Consent is specific, contextual, ongoing, behavioral, renegotiable, and withdrawable. Massage gives us a setting in which those principles aren't theoretical—they're embodied.

That doesn't mean massage therapists are already experts in consent. Our profession has plenty to learn from s*xuality and consent scholarship, particularly in our education, ethics, boundaries, and response to s*xual harassment.

But that exchange should go both ways.

What has working with human bodies taught massage therapy that other disciplines might benefit from understanding?

Maybe professional legitimacy doesn't only come from proving we belong within someone else's framework.

Maybe it also comes from recognizing what we have to contribute.

There is a conversation we desperately need to have in massage therapy:

S*xual harassment is not evidence that we have failed to “de-s*xualize” massage.

Every time a client behaves s*xually toward a massage therapist, we seem to collectively respond by defending the legitimacy of massage.

Massage is therapeutic.
Massage is professional.
Massage is healthcare.
We aren't those kinds of workers.

But none of those statements actually explain why s*xual harassment is wrong.

S*xual harassment is wrong because a person crossed the boundaries of a service and subjected a worker to s*xual behavior without their consent.

That's enough.

We don't need to prove that massage is medicine first.

We don't need to establish that “real” massage therapists are sufficiently respectable.

And we certainly don't need to distance ourselves from s*x workers to establish that massage therapists deserve protection from s*xual harassment. S*x workers have boundaries and deserve protection from nonconsensual s*xual behavior, too.

The problem isn't that massage involves bodies, nudity, touch, intimacy, physiological responses, or any of the other realities we sometimes become uncomfortable acknowledging.

The problem is entitlement to another person's body.

A massage therapist provides a specific service with specific boundaries. S*xual access is not implicitly included because someone is touching your body. A client's attraction, arousal, assumptions, fantasies, or misunderstanding of the profession do not alter the terms of that service.

And when someone violates those terms, ending the session isn't protecting the “purity” of massage therapy.

It's a worker exercising autonomy over their own body and workplace.

That distinction matters.

Because as long as we frame s*xual harassment as something that threatens the legitimacy of massage therapy, we keep asking massage therapists to prove that we are legitimate enough not to be s*xually harassed.

We already are.

The conversation needs to move from defending the profession against s*xualization to defending the people working within it against s*xual entitlement.

"Sometimes people use the word 'respect' to mean treating someone as a human. Sometimes they use it to mean treating someone as an authority.

And sometimes people who are used to being treated as an authority say, 'if you won't respect me, I won't respect you' and they mean 'if you won't treat me as an authority, I won't treat you as a human.'

And they believe they are being fair."

- Brenna Twohy

Part 3

By then, another pivot was taking shape.

My original dissertation proposal was a mixed method interview study designed to quantify the physiological and psychological stress response associated with s*xual harassment while giving massage therapists the opportunity to describe those experiences in their own words. I wanted to connect measurement to lived experience.

The direction encouraged for the project, however, focused on prevalence. While documenting how often s*xual harassment occurs is important, I could not justify spending years of my doctoral training simply counting incidents. Prevalence tells us that a problem exists. It does not tell us how those experiences shape people, why individuals respond differently, or how we measure those changes well enough to build meaningful interventions.

So I pivoted again.

Instead of conducting a prevalence study, I shifted my dissertation toward psychometric validation. If this field was ever going to move beyond descriptive statistics and begin studying mechanisms, outcomes, and interventions, it first needed a scientifically sound instrument. Before researchers could ask better questions, they needed a better way to measure them.

Looking back, I do not see that decision as abandoning my original vision. I see it as building the foundation my original vision required. The mixed method work could come later. First, the measurement had to exist.

Today, researchers are beginning to pursue many of the questions that originally drew me to this work. That does not diminish the importance of psychometric validation. It reinforces it. Good science is cumulative. One study creates the tools that allow the next study to ask a deeper question.

When I look back across my career, the pivots appear unrelated. Human dissection. Anatomical variation. Phantom limb pain. S*xual harassment. Psychometric validation. They are all connected by the same scientific question.

How do individual differences shape human experience, and how do we measure those differences well enough to improve care?

The methods changed. The question never did.

My commitment has never been to a particular methodology, institution, or narrative. It has always been to asking better questions and building the tools necessary to answer them.

Part 3 - later today:

Its better to walk alone than with a crowd going the wrong direction.

Part 2.

Then, second semester, COVID, with a very impressive encouragement to shift my focus from trials to subjective measurement. That just so happened to align more with what was already happening anyway.

And, hey, none of us knew what science, especially clinical trials, would look like after that anyway. So, nose to the grindstone - put together a survey study and launched late August 2020. I was hellbent on getting things done and out of there.

My stepmother died September 1st, 2020 from COVID. I'm not tooting my own horn, but I don't know many people who would have survived that semester with everything that was on my plate. Most of the work was encouraged (not my idea) and not paid for....

There's a lot more death (7 in 5 years) family health stuff, and a hip surgery in there for the rest of my time at IU. BUT, it was also when Deshaun Watson was accused of s*xually inappropriate behavior, including harassment and assault, by 24 massage therapists. Between that, the politics in the massage field, and how the NFL, society, and the massage industry had reacted - I pivoted to my own direction. And with nothing in the lab to support what I came for other than to align with more of what they were doing instead, I went forward.

This is where things start to get really interesting........

We are going to do this in a few parts. This is Part 1.

I had been working on human dissection, primarily the neck, arms, and all of the nerves for about 2-3 years. I had actually been getting very interested in the variations in how each of our wiring develops and how those differences might change how we experience injuries and pain.

At that time in my practice, I also had a man come in with debilitating back and leg pain who had been through multiple back surgeries and was facing a hip surgery. It was the work in the dissection lab and my interest in nerve variations that helped him and a local surgeon discover he had a 0.01% chance nerve variation matching all of the pain and movement dysfunction.

It was real-world translational science. From the lab to the treatment room. It was that work and that framing that took me to a massage conference to present.

I chose to pursue my PhD to get experience developing clinical trials (a trial?) in an early developing lab that had completed a pilot study and was pursuing funding for hands-on treatment in lower limb amputees experiencing phantom limb pain. What an amazing opportunity to work with people who had physical differences (variations) in the way their wiring worked and were experiencing pain that didn't correspond to a true injury. It was unique because the amputation weren't from disease. The participants were mostly healthy other than missing part of their body. It was also a hands-on deep dive into the lower body nervous system (because that is how I learn).

However, it was clear that was not the trajectory for the lab or what my work would be within a few weeks of getting settled in. In fact, the whole clinical portion of the lab (at least the part I was going to work on) was going to pivot from phantom limb pain to a disease model instead and from 'false' nerve pain heavily influenced by perception to 'true' pain created by a disease that was highly dependent on the participants' compliance with disease management to mediate the pain. And, the grant deadline to support the work was 'missed' without a communicated plan to cultivate alternate funding.

https://www.facebook.com/share/1EfmLQ9odX/

At the end of the day, I'm proud to say that my work through my time at IU was my own.

I am happy that I stayed true to myself and didn't use access to other's work and ideas that had not been published to further my own.

I am validated to know that it is possible to not use others or their ideas to move forward with my work when the systems students depend on didn't materialize.

That may be the way the game is played (and I very well was and am getting played), but it says way more about the people playing it than anything about who I am.

That's good to know, bc science (in the way I watched it function) is about WHO you know not what I was taught and loved about it my entire life.

I'm so happy I got to see that experience across multiple universities, types of communities, professional organizations, working groups, and influential people in varying fields of study.

I've been getting messages about those who aren't following the page, but still seem to want to keep an eye on me and communicate about what I'm doing.

I'm just fine with you actually being here to follow openly. The button is right up there!