What is Complementary Therapy?

This article aims to answer all the common questions about our profession and hopefully to shed some light on what we do as well as dispel some myths. Over the past 30 years, I have worked as a complementary therapist and have also had the honour of serving on several national councils and working groups, helping to shape the education and standards that we should all work to. This included helping towards the development of voluntary self-regulation. I have also taught at both further education and higher education, written courses for awarding organisations and been an external assessor in various complementary therapies. Therefore, I hope my credentials gives the reader confidence in my following overview.

What are complementary therapies?

Complementary therapies are a form of treatment from a trained therapist in a wide range of modalities. It depends on

the type of therapy as to what the study is, but as our therapies should complement other forms of healthcare, including medical care, we should all have a level 3 (equivalent to A level in England), qualification in anatomy, physiology with understanding of pathology. We do not aim to heal or cure but to support people on an individual basis who may be going through some healthcare issues, and this includes physical, emotional and mental conditions. I will cover a section on training later in this article.

The most common form of complementary therapy is probably massage therapy and it is the one most people will have heard of. The term “masseur and masseuse” are no longer used, and we would not refer to our clinics as a “massage parlour”. These are old-fashioned terms often with a completely different connotation. Another outdated title is “Holistic Massage”, although some beauty courses may still use this title (more on that later). Training in massage is expensive and involves a great deal of study, and case studies. There are many different styles of massage, and we used to refer to it as “Swedish Massage”, but again, the profession has moved on from this old term, and we now call ourselves a massage therapist. Within this skill set, therapists will do further training in different types of massage, to include lymph drainage, scar work, myofascial release and may specialise, such as with the elderly, for pregnancy care or for specific types of conditions.

Sports Massage Therapists will train to work with athletes and other sporting people, but it is not limited to sporting injuries. It depends on the level you train and if you want to work on professional athletes, then a level 5 qualification is required. However, anyone can go for a sports massage, especially if they require deeper work. You can seek out the services for a sports massage therapist if you have specific musculoskeletal injuries (including but not limited to neck, back and joint pain), or you go to the gym on a regular basis and put your body under high physical stress.

Other popular bodywork therapies include aromatherapy and reflexology. Aromatherapy usually involves massage with essential oils. The therapist will blend oils individually suited for the needs of their client. They can also create bespoke products for their clients to use in between massage appointments. There is a great deal of research affirming the effects of essential oils, which are natural chemicals from various parts of plants. They can be harmful if misused and should not be taken internally. It usually takes around a year to study aromatherapy part time; however, as an aromatherapist, you never stop learning and researching new information on essential oils. Reflexology is not just a massage of the feet but works on specific points that reflect parts of the body. The whole body is mapped out on the feet (and on the hands). Thus, the reflexologist can target specific areas but will always treat the whole body. It is also very relaxing to receive. There is some 2021 research that shows reflexology can reduce pain in labour and current research by Kevin Kunz is using fMRI scans to prove that unexpected areas of the brain are activated when reflexology is applied to the feet.  Both therapies are great for reducing stress and anxiety, reducing pain, lifting your mood and helping to improve and maintain general wellness.

There are lots of other bodywork therapies available, and often these are aimed at specifics. There is Neuroskeletal Re-alignment Therapy, Craniosacral Therapy, Bowen Therapy and the EMMETT Technique that are light touch therapies that work to help with back and joint pain. We should include osteopathy and chiropractic in this section as they also specialise in this field but are manipulative therapies that require training through at least a three-year degree level qualification.

Acupuncture is a Chinese therapy that uses needling and moxibustion and again, this is a degree level qualification over at least 3 years. However, some sports massage therapists may use dry needling techniques, which is a more westernised approach to acupuncture techniques for pain and inflammation. Acupuncturist will also use Chinese herbs in different ways and a Herbal Medicine Practitioner, will also need to undertake a three-four-year qualification. Degrees in Acupuncture and Herbal Medicine have dwindled over the past few years and Lincoln University are one of the few left to offer it. We will link to training options at the end of the article.

There are also the mind-body therapies, and these do include song therapy, counselling, meditation, mindfulness, hypnotherapy, biofeedback resonance and dance therapy. We should also include the Rosen Method here as it is a bodywork therapy that although very light and gentle and is described as a somatic approach to addressing physical and non-conscious tension to help release stress and tension. Mind-body techniques are therapeutic methods that emphasize the connection between mental and physical states to promote health. Yoga Therapy is also seen as a form of complementary therapy. This is an ancient modality that started life as a spiritual practice but has evolved into a form of wellness practice that helps bring balance to the mind and body. The word 'Yoga' is derived from the Sanskrit root 'Yuj', meaning 'to join' or 'to yoke' or 'to unite'.

In terms of energy therapies, you will see reiki, crystal therapy, sound therapy, healing etc. These therapies aim to interact

with a client’s biofield with the belief that all living things have a natural flow of energy that surrounds their physical body. Blockages in the flow can lead to disharmony and energy therapies aim to recreate balance of the energy flow.

Nutritional Therapy is a complementary therapy that focusses on supporting client’s wellness through diet, lifestyle changes and can help with people who have eating disorders. Nutritional Therapists are trained to identify and address imbalances in the body that may be contributing to symptoms or health conditions from a holistic perspective. It is another diploma that takes around 3 years of study and there are some UK universities that offer it as a degree program.

Other therapies that we have not mentioned above are the Alexander Technique, Colonic Hydrotherapy, Kinesiology, Naturopathy, Shiatsu and Sports Therapy are all considered types of complementary therapies. We can also include Ayurvedic Medicine in this category.

How does complementary therapy differ from beauty therapy?

Beauty Therapy is a completely separate industry from that of complementary therapy. There are qualifications in the beauty sector for massage, aromatherapy and reflexology, but these are aimed at general wellness and relaxation, not to work as a complement to mainstream healthcare. Beauty Therapy qualifications are overseen by the Hairdressing and Beauty Industry Authority (HABIA) whilst the voluntary self-regulatory body that sets the standards for currently 18 complementary therapies in the Complementary and Natural Healthcare Council (CNHC). The CNHC holds a register for public protection and like with other healthcare registers, it is overseen by the Profession Standards Authority (PSA), which is answerable to Parliament. You can view the core curriculum for the complementary therapies it regulates on the CNHC website.

For training providers offering continuing professional development (CPD) in complementary therapies, they need to check that the potential student has the right qualification in the first place as the training for beauty differs significantly and is not necessarily suitable. Anatomy and Physiology studies in beauty is much less and there are no studies in pathologies. Beauty therapists may have trained to use pre-blended essential oils in a massage in a spa setting, but this does not make them an aromatherapist.

Some complementary therapists may also hold beauty therapy qualifications and offer both types of therapies, and this is fine as long as they make this clear to their clients and have the appropriate insurance. Members of the public should be discerning when engaging the services of a complementary therapist and check that they are either a CNHC registrant or a member of one of the professional associations that the CNHC works with. You can find a list of professional association here: https://www.cnhc.org.uk/cnhc-and-professional-associations#gsc.tab=0

The CNHC has a great webpage that gives an overview of each therapy it voluntary self-regulates which can be found here: https://www.cnhc.org.uk/eligibility#gsc.tab=0

What is Holistic Therapy?

The Oxford dictionary definition of the word “holistic” tells us that it is an adjective – a describing or modifying word. It means “the parts of something are interconnected and can be explained only by reference to the whole”. I always thought it should be spelled “wholistic” as this better shows that it represents the whole. In complementary therapies we look at the whole person and not just the sum of its parts. Many people will tell you that this means the mind, body spirit, but this is too vague and how would we assess and treat the spirit? The word “spirit” could be off putting in a professional clinical practice. I have heard the term used in businesses, such as the IT company my husband worked for - "the solution demands a holistic approach and a strategic vision of what can be achieved". One hears it in education where a holistic approach looks at all aspects of a child’s development, such as healthy social skills, character development, emotional development, basic manners, conflict resolution and critical thinking skills as well as core academics. So, the term “holistic” is not exclusive to our profession. In Medicine it is characterized by the treatment of the whole person, considering mental and social factors, rather than just the symptoms of an illness and "many people conclude that a holistic approach to health is more beneficial".

It is interesting that the word “health” that originates from the Old English word “hǣlth” which itself comes from the Germanic root “hal”, meaning “whole or wholeness”. Therefore, if we write “holistic health”, we are basically saying whole wholeness! When we explore this further, the term Holistic Therapist means whole therapist and holistic is describing or modifying the noun – the therapist rather than what we do! Also, you cannot make adjectives plural in the English language, so saying you do Holistics makes no sense. This is one of the many reasons we have moved away from using the term holistic to describe ourselves and our profession and we prefer now to be complementary therapists. The word complementary means to complement and we are complemented other forms of healthcare.

Working in complementary healthcare considers all the “biopsychosocial factors”. This is what the holistic approach is. The biopsychosocial model is a general model positing that biological, psychological (which includes thoughts, emotions, and behaviours), and social (e.g., socioeconomical, socioenvironmental, and cultural) factors, all play a significant role in health and disease. In many ways, it has replaced the old term “holistic” and looks at all factors that affects a person’s wellness or indeed illness. This contrasts with the biomedical model of medicine that suggests every disease process can be solely explained in terms of a deviation from normal function such as a physiological processes, infections, genes, developmental abnormalities, or injuries, which is how orthodox medicine views illness.  At the practical level, it is a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. As complementary therapists we should be looking at all potential causes for a person’s illness, such as their emotions, feelings, social aspects of their lives, cultural aspects of their lives, their environment, family issues, genetic tendencies, medications, everything in fact that could be impacting them and causing their symptoms. This is why the taking of a thorough consultation is so vastly important in our work.

The difference in spelling: complementary v. complimentary

This is the perfect opportunity to clarify this common faux par within our industry, and it really infuriates me when I see this written incorrectly! The word complementary means “combining in such a way as to enhance or emphasize the qualities of each other or another”. In the context of healthcare, we use this to show that we are not a replacement for mainstream healthcare but work alongside it to help support and enhance the health and wellbeing of people with diagnosed medical issues.

The word “complimentary” means to express a compliment through praising or approving and it also means to give something free of charge. A person who advertises themselves as a complimentary therapist is expressing that they are either great at giving praise or provides free services! So, watch your spelling!

What is the difference between complementary therapy and alternative therapy, integrated therapy and traditional medicine?

In brief as I have already explained what a complementary therapist is, the term alternative medicine or therapy is an outdated term we no longer use in the UK. The problem was that what we do is not an alternative to other forms of healthcare. We cannot and should never claim to cure or heal and never advise a client to stop taking prescribed medication. We always refer clients back to their medical practitioner (GP, midwife or consultant) if they have a medical issue. We are not an alternative to medical advice or treatment. You will see the term used in the US. There it is described as therapies that are not recognised by conventional, evidenced-based Western medicine. That is why we sometimes see acupuncture and Ayurveda described as being “alternative medicine”. Sometimes these are described also as “Traditional Medicine”. This is because they are traditional within the culture in the country from where they originated.

“Integrated Healthcare” is a good term as this aims for well-coordinated care among different providers and institutions by bringing conventional and complementary approaches together to care for the whole person. It aims to combine conventional medicine with complementary therapies to create a more efficient and cost-effective healthcare delivery system. It involves patient-centred healthcare, which means treating a person receiving healthcare with dignity and respect and involving them in all decisions about their health. Everyone wants to be treated with dignity and respect. Person-centred care means treating clients as individuals and as equal partners in the business of healing; it is personalised, coordinated and enabling. Working together as part of a multi-disciplinary team helps to empower the client rather than them becoming victims of their disorder or passive recipients of care. Together, mainstream healthcare and complementary therapies combined can be life-changing and we are already seeing this in cancer care where many hospitals are using complementary therapies to help support clients through their challenging journeys.

Do complementary therapies really work?

It is true that research in complementary therapies is lacking and part of the problem is that our therapies do not fit the usual model used for medical research. For example, research in essential oils makes a placebo difficult when you are measuring how uplifting an oil is as the individual’s perception and association memory with a certain smell is subjective. However, there are reviews that do show efficacy in the different therapies. Our industry is one of the fastest growing healthcare sectors in the past 20 years and treatment outcomes for diseases with evidence-based complementary have been remarkably successful. As I stated earlier, there is ongoing research being done in reflexology and essential oil research is widely available. As our industry grows and becomes ever more popular, more research will happen. It is true that due to the lack of clinical evidence in complementary therapies, a GP is unlikely to recommend them to their patients. Complementary Therapists have lots of anecdotal evidence showing how well their therapies work, but it is difficult to collate all this information, and it is something we need to work on. Broadly speaking, evidence is lacking simply because complementary therapy is relatively new, and the evidence base is yet to be established. Like all other areas of health-care practice and consumption, complementary therapies need to be underwritten by rigorous scientific investigation.

Several studies on people with various types of cancer suggest that complementary therapies can improve mood, quality of life, and coping. This stress relief might help the client’s immune system function better and help them cope with medical treatment-related side effects. As stated before, complementary therapies do not heal or treat people with cancer. We are supporting their medical interventions to help them cope. The same can be said for people recovering or dealing with other medical conditions. For example, people with brain injury have used complementary therapies to help reduce chronic pain, sleeplessness and anxiety and or depression. Case Managers might use the services of a complementary therapist as part of a multi-disciplinary approach for clients recovering from complex injuries. For clients with MS, complementary therapies have been shown to help people manage their condition. From my own experiences with thousands of clients over more than 30 years of practice, I know the therapies I practice work and I feel privileged to have been able to support all those people with their health and wellbeing.

Are complementary therapies available on the NHS?

If you are a CNHC Registrant in the UK, a GP can refer a patient to you, and this is because the CNHC’s register is accredited by the Professional Standards Authority for Health & Social Care (PSA). However, it is unlikely that the cost of the complementary therapy would be covered by the NHS. We do see complementary therapists employed in some hospitals and hospices for cancer care support.

Another issue is the lack of standardisation in training and the lack of regulation here in the UK. As complementary therapies are not statutory regulated, there is no standardised training for each therapy, which means under British Common Law, that anyone can call themselves whatever they like, even without any training. With the advent of the internet, many online courses have sprung up offering massage and healing courses online, with minimal information and no in-class supervision. Think about it – would you want a massage from a person who had only trained online in this way? The public generally does not ask about qualifications when booking a therapist, but they should. I refer you to my earlier comment about using either a CNHC Registrant or a therapist who is at least a full member of one of the professional associations the CNHC works with. That at least assures you that the therapist has been vetted to check that they have met the nationally agreed standards and has signed up to a Code of Ethics that includes disciplinary procedures. The therapist will also have to provide proof of adequate insurance and ongoing annual professional development. It also gives the end-user redress should something go wrong.

In the UK, the voluntary self-regulatory body is all that we have but as it is not statutory regulation (as is seen with other forms of healthcare) it has no real power. It relies on therapists to want to register to highlight the quality standards they provide. Most therapists who work alone, often from home, with a small clientele do not see the benefit to themselves, but this is shortsighted as only full acceptance of the need for regulation of our industry will help the profession to move forward and give the NHS confidence in what we do. This includes standardisation of each discipline’s core curriculum. We need each massage therapist, aromatherapist, reflexologist, reiki practitioner, etc. to have trained to the same academic standard.

Can complementary therapies help with mental health conditions?

The simple answer is yes, absolutely. The Charity “Mind” does have a section on its website about the use of complementary therapies, and this is likely since many people with mental health want to seek support, especially as treatment options are generally lacking within mainstream healthcare. Complementary therapies are often used to help people with anxiety, depression and with PTSD; however, the research evidence to support its use is still lacking for the same reasons already discussed. Yoga Therapy is often used for mental health as is song therapy, meditation and nutritional therapy. Changes in lifestyle has been shown to affect mood. Complementary therapists could work more with psychologists in the future as part of an integrated approach.

What qualifications exist in complementary therapies?

I will attempt to list as much as possible of quality training that will give you as a therapist the opportunity to deliver the best outcomes for your clients and help you build a successful complementary therapy practice. Remember the old saying that you get what you pay for and see your training as an investment in your future career. If you are truly passionate about your subject, then you want to do the best training possible:

Acupuncture – British Acupuncture Council accredited courses

Alexander Technique 

·         https://www.itmalexandertechnique.org/

·         https://www.paat.org.uk/paat-alexander-technique-training-course/

·         https://alexandertechnique.co.uk/learning-it/learning-alexander-technique

Aromatherapy 

·         Complementary Health Professionals (CHP)

·         International Federation of Aromatherapists (IFA)

·         International Federation of Professional Aromatherapists (IFPA)

Bowen Therapy:

·         https://bowentraining.co.uk/

·         https://www.bowentherapy.org.uk/core-bowen-training.php

Colonic Hydrotherapy - Association and Register of Colon Hydrotherapists (ARCH)

Craniosacral Therapy – Craniosacral Therapy Association

Crystal Therapy – Affiliation of Crystal Healing Organisations (ACHO)

Emmett Technique – Emmett UK (accredited by Complementary Health Professionals (CHP)

Healing

·         The British Alliance of Healing Associations

·         UK Healers

Herbal Medicine – National Institute of Medical Herbalists

Hypnotherapy:

·         Association for Professional Hypnosis & Psychotherapy (APHP) 

·         British Association of Therapeutic Hypnotists (BAThH)

·         General Hypnotherapy Register (GHR)

·         National Association of Counsellors, Hypnotherapists & Psychotherapists (NACHP)

·         National Council for Hypnotherapy (NCH)

·         National Council of Integrative Psychotherapists (NCIP)

·         National Hypnotherapy Society (HS)

Kinesiology – Kinesiology Federation

Massage Therapy:

·         Association of Biodynamic Massage Therapists (ABMT)

·         Complementary Health Professionals (CHP) 

·         Massage Training Institute (MTI)

·         Scottish Manual Therapists Organisation (SMTO)

Naturopathy:

·         Naturopathic Nutrition Association (NNA)

Neuroskeletal Re-alignment Therapy - Complementary Health Professionals (CHP) 

Nutritional Therapy:

·         British Association for Nutrition and Lifestyle Medicine (BANT)

·         Naturopathic Nutrition Association (NNA)

Reflexology:

·         Association of Reflexologists (AoR) 

·         British Reflexology Association (BRA)

·         Complementary Health Professionals (CHP)

Reiki:

·         Complementary Health Professionals (CHP)

·         The Reiki Association (TRA)

·         The Reiki Connection (TRC)

·         UK Reiki Federation (UKRF)

Rosen Bodywork Method – Rosen method UK

Shiatsu - Shiatsu Society UK

Song Therapy – Song Therapy Network

Sound Therapy:

·         Complementary Health Professionals (CHP)

·         The British Academy of Sound Therapy

Sports Massage:

·         Complementary Health Professionals (CHP) 

·         Massage Training Institute (MTI)

·         The Sports Massage Association (SMA)

Yoga Therapy:

·         British Wheel of Yoga (BWY)      

·         The Society of Yoga Practitioners (TSYP)

Finding a Complementary Therapist

As mentioned earlier in the article, check that your therapist is either a CNHC Registrant or at the very least a member of an association that the CNHC works with.