Are We at the Table, or On the Menu?

I do a lot of wondering. Lately I’ve been wondering about what happens when massage therapists get invited into (or work their way into) clinical spaces like hospitals, cancer centers, and palliative care programs.

I wonder how we know if we’re being brought in as colleagues or as a resource to be extracted.

I’m seeing a troubling pattern I want to name with care and curiosity.

There are many massage therapists who have worked incredibly hard to open doors in clinical settings. We have spent decades building trust, demonstrating value, and carving out space for our work in environments that didn’t initially (and often still don’t) understand or welcome us as practitioners of a uniquely valuable discipline. That pioneering work has created real impact for patients and laid groundwork that others have built on.

And somewhere along the way, I think we started accepting terms that don’t fully honor what we can contribute or who we are.

I’ve been in conversations recently with massage therapists working in clinical settings who are justifiably proud of their work. One described being the only massage therapist retained during post-COVID budget cuts. This was proof, in this person’s mind, that the institution valued massage therapy. Another spoke about a one-way referral dynamic in which nurses called them whenever patients had what those nurses deemed to be musculoskeletal pain. I’ve watched massage therapists protect their positions by keeping potential perceived competitors at bay because funding is always uncertain. And I have heard, more times than I can count, massage therapists say they are invited to clinical meetings and learning opportunities but they don’t go because they don’t think there is value in spending their time this way.

These are understandable responses to real pressures. And it’s time to rethink them.

When I look more closely at these situations, I notice wider ripples. In research publications about massage therapy, massage therapists often are not listed as authors or participants in study design. In the studies themselves, their work is narrowed to specific technique application in specific body areas, rather than the broader assessment, adaptation, and relational work that defines skilled practice. In program descriptions, massage therapists are often called “touch therapists” or some other euphemistic moniker.

These therapists have proximity. They’re in the room. But they’re not at the table. They have something like job security, but not professional advancement or legitimacy. They are valued for their hands, but not for their clinical reasoning, their therapeutic relationships, or their capacity to contribute to care beyond mechanical intervention.

This isn’t about individual choices or failures. It’s about a system that has learned to welcome massage therapy as a modality while keeping massage therapists at arm’s length from true collaborative partnership.

Healthcare is shifting in ways that favor exactly what massage therapists do well. Patient-centered care models prioritize patients’ lived experiences. Patient-reported outcomes explore how people feel, not just what their lab values show, and they are increasingly recognized as meaningful measures of clinical effectiveness. Burnout, compassion fatigue, moral injury, and the mechanization of care are driving a hunger for approaches that restore humanity to medicine.

We are practitioners of an inherently patient-centered, relationally-grounded, outcomes-rich discipline. The healthcare landscape is moving toward us. But if we’ve already agreed to be reduced to a technique, a modality, a nice touch in the margins, we’ll miss the opportunity to show up as the practitioners we actually are. When we allow that, everyone loses.

Integrative medicine conferences are a great example. Massage therapists are regularly invited to present. I did many of those presentations in my early years in this work. They ask us to demonstrate, to educate, to fill a program slot. But in twenty years of watching this space, I continue to watch how the leadership tables, the planning committees, and the keynote slots are occupied by the same people who are inviting us to perform for them. It’s the healthcare equivalent of being asked to offer seated massage “for the exposure.” The exposure never translates into more meaningful opportunities, compensated work or greater respect.

Most massage therapists working in or near clinical settings have a version of this story.

Ours goes like this:

There is a donor who has been funding an opportunity for integrative medicine students to receive massage therapy from Healwell therapists for a handful of years now. Last year, the physician who leads the program asked our Service Director if she would give a presentation “about massage” during one of their lecture periods. We put our heads together, looked at the integrative medicine program’s curriculum and learning objectives and created a presentation that explored the themes that undergird their existing learning and the focus on evidence-based practice that is clearly central to their curriculum. We shared about our research, about the challenges of studying massage therapy and about the ways physicians and massage therapists can be more proactively collaborative in bringing massage therapists into the healthcare setting. The students were very engaged and the session went well. At the end, the physician who had invited us said, “That was nice, but we thought you were going to teach the students how to do massage. Ya know, the strokes and techniques. Next year, let’s aim for that.”

Is that a chorus of sad trombones I hear?

I’ve written before about how many massage therapists claim a clinical healthcare identity while remaining unaware of what full participation in clinical spaces actually requires. This isn’t so much about arrogance as it is the result of being handed a map with half the territory missing. We’ve never gotten to the edge of that map, so it’s never occurred to us to ask for the rest.

We were taught to work with bodies. We were not taught to navigate institutions, collaborate in care planning, or occupy the space that could be created for a discipline with something genuinely irreplaceable to offer. That’s a curriculum gap, not a personal failing. But it is a gap that has consequences for patients, for our profession, and for our own careers.

This gap is closeable, but we have to see it with open eyes and decide to close it.

Structured, competency-based training in the relational and communicative dimensions of clinical practice has historically been absent from massage therapy education, but it’s uniquely able to unlock capabilities that years of clinical exposure alone cannot. Therapists with significant hospital experience, when given the opportunity to learn about care dynamics, team communication, and integrated practice, report substantial growth in unexpected areas, leading to expanded roles and increased consultation within their own institutions.

Experience matters, but it’s not enough on its own and worse still, it can blind us to what’s possible.

Being at the table is certainly about what we’re offered, but it’s also about what we can bring and whether we show up prepared to bring it.

When you’re invited to a clinical team meeting, go. Not because you already know what you’ll contribute, but because you don’t know. That’s exactly the point. You can only learn how these spaces work by being in them. You’ll observe what’s modeled. You’ll find the colleagues who are excited to answer your questions and invite you deeper inside the dynamic of care.

Massage therapists sometimes say, “They told me I could come to the meeting, but I don’t really need to.” How would they know? They’ve never been. They have no idea what they might learn– or what they might teach– if they walked through that door.

It’s time to stow the imposter syndrome, bring your curiosity and see what’s possible when you show up.

Charting is another entry point. I have met many massage therapists who tell me they don’t chart because they “hate paperwork.” Clinical documentation is not paperwork, it’s communication. When a massage therapist charts well, they educate the rest of the team about what happened in that clinical encounter. They share what they observed, what they adapted, what mattered in their time working with that patient. That means writing in language the whole team can access, not the jargony anatomical and physiological vocabulary that makes sense among massage therapists but leaves everyone else behind.

It means understanding that HIPAA isn’t a technicality to navigate around or ignore. It’s a legal framework that defines how patient information is handled and why that handling matters. It means knowing how to share something important you just learned about a patient during your work with them that could shape how the rest of the team thinks about that person’s care in a way that is useful, timely, and well-received.

This is what full participation looks like. And knowing what it looks like before you’re in the room is part of the preparation we’ve been missing.

There’s a difference between being included and being integrated. True integration means:

• Authorship and design input in research, rather than being restricted to providing an intervention “designed” by non-massage therapists while others analyze and publish the findings

• Collaborative care planning, where our clinical observations inform team decisions rather than simply receiving referrals whose “appropriateness” is decided by people who are not massage therapists

• Compensation that reflects professional expertise and clinical value, rather than a “nice-to-have” amenity or volunteer service

• Professional development structures that support our voices and expand our scope

• Recognition as practitioners of a discipline with its own body of knowledge, rather than as technicians delivering a series of techniques

When we’re truly at the table, we’ll be guiding the conversation that defines our work. We’ll finally be among the people benefiting from our labor. We’ll be the ones shaping the future of our own field.

Whether you’re already in a clinical setting or working toward one, I want to invite you to consider these questions honestly:

Does my participation in this program, study, or initiative advance the role and recognition of massage therapists as practitioners or is it primarily about another group extracting a limited “modality” called massage for their own purposes? If it’s the latter, what could I do to shift that?

Am I being invited to contribute my critical thinking and collaborate in care decisions, or am I being positioned as someone who performs a prescribed task when directed? Again, if it’s the latter, what can I do to shift this dynamic?

Who benefits from the structure of this relationship, and is that benefit mutual? If it’s not mutual, how can I name that professionally and collaboratively to move the needle toward mutual benefit?

These aren’t questions designed to make you walk away from good work and you don’t have to take them all on at once. They’re questions designed to help you negotiate for work that doesn’t require you to stay small in order to get or stay employed.

The massage therapists who have pioneered clinical integration did, and in many cases are still doing, essential work under difficult circumstances. They proved we belong in these spaces. Now it’s time for the next phase. Let’s move from presence to parity, from inclusion to impact.

This doesn’t mean rejecting evidence-based protocols or refusing to demonstrate outcomes. It means insisting that protocols exist alongside and in tandem with advanced communication, critical thinking, care planning collaboration, and mutual respect for the breadth of our discipline.

We won’t get there by fighting with the institutions and researchers who have welcomed us in unwittingly limited ways. We’ll get there through clarity, through knowing what true partnership looks like, and by declining to accept extraction as collaboration.

We’ll get there together: experienced practitioners and emerging ones, clinical specialists and private practice therapists, educators and students. Let’s lift this tent flap wide enough that we can all come in and talk honestly about how to move forward.

Massage therapists who are ready to be engaged, collaborative, accountable and seen are what healthcare desperately needs right now. We don’t have to beg for scraps at someone else’s party.

We can set our own table.

(And if you’re wondering how to get started with that place setting, I want to offer a sincere and heartfelt invitation for you to join us in the Healwell Online Community of Practice. We’re building community, making change and plotting a new course. I think you’ll feel supported and you’ll probably have fun, too.)