18 Aromatherapy worldwide
The practice of and knowledge in aromatherapy vary widely across the globe. In some countries, such as France and Belgium, phytotherapy (which includes aromatic medicine – see Ch. 9) is an established branch of medicine for which essential oils may be prescribed by the doctors concerned and used by application to various parts of the body (usually without massage, and very often orally, per rectum and per vaginam, in compresses and in gargles); or in diffusers. In other countries, such as Croatia, aromatherapy is in its infancy; it is practised in hospices using mainly massage, often on a voluntary basis, by aromatherapists and interested nurses.
Aromatherapy is a popular complementary therapy, widely used in nursing practice, with increasing cooperation between complementary and conventional practitioners. Although still having applications in beauty care, use is increasing in care of the elderly, palliative care and midwifery. Some aromatherapists are employed by aged care facilities, although most are in private practice and contract services to individuals or health service providers.
Although there is no legislation as yet, there may be some changes affecting aromatherapy education, practitioner regulation and the labelling of products. Chiropractors and osteopaths require some governmental oversight – other complementary therapies do not require this. In most states, therapists are self-regulated through their relevant professional associations, who offer practitioner liability insurance. A number of private health insurance companies will offer some level of rebate for aromatherapy treatments given by qualified practitioners.
Allopathic medicines, complementary medicines and essentials oils are regulated through the Therapeutic Goods Administration (TGA), under either Therapeutic Goods Listing or Registration. Under Listing, whether inhaled, ingested, topical applications etc., one may claim to ‘relieve the irritation of eczema’ but not ‘to cure it’ – this would require registration.
Listed products must make a lesser therapeutic claim, do not require a prescription and are considered safe for general use when used according to the directions. However, a supplier of TGA-listed essential oils can provide more in-depth information about the therapeutic properties of essential oils to qualified practitioners, compared to what can be advertised to the public.
Practitioners do create their own preparations for clients, but in this situation TGA requirements do not apply with regard to advertising and for what purpose the preparation is intended – there is greater latitude when practitioners are dealing directly with their clients.
Companies that have a therapeutic goods manufacturing licence must follow good manufacturing practice (GMP) pharmaceutical standards – internationally recognized, including a regular audit by a TGA auditor. In the case of an essential oil they must be able to analyse and demonstrate that it is genuine and meets authentic standards, e.g. those of the British Pharmacopoeia (BP) 2010.
There are a few large suppliers of essential oils and other natural materials with little or no background in aromatherapy that do not follow TGA standards, and if they do not make a therapeutic claim the TGA has no authority over them. Some adulterated oils are promoted as ‘100% pure and natural’, sometimes even ‘therapeutic grade’, with nursing homes and naive therapists buying them. Hopefully the Australian Competition and Consumer Commission (ACCC) will take an interest and deal with these obvious cases of fraudulent misrepresentation.
There is now an approved standard for a Certificate level 4 aromatherapy training (about 1 year), Diploma (about 2 years) and an Advanced Diploma in Aromatic Medicine (about 3 years). In 2008, aromatherapy training was finalized as a ‘training package’ by the Community Services and Health Industry Skills Council (CS and HISC). This means that any approved college (registered training organization) must use the full training package courses and demonstrate the competencies gained. The CS and HISC comes under the Department of Education, Employment and Workplace Relations.
Almost all colleges offering aromatherapy training in Australia are approved registered training organizations. There are a few non-approved training courses, but they need to meet the same training standards in order to obtain membership with the lead association, the International Aromatherapy and Aromatic Medicine Association
A plethora of short aromatherapy courses of a few hours, days or a week reflect the growing popularity of aromatherapy. Nurses are major participants in these courses, and although they are important professional development programmes, they are insufficient for autonomous aromatherapy practice.
A number of aromatherapy-specific policies/guidelines for nursing practice have been developed, and these include position statements by the Royal College of Nursing, Australia, and the Australian Nursing Federation. Nurses are regulated in each state through nursing authorities which issue licences to practise nursing, but not aromatherapy. Nurses have a duty of care under their professional standards and codes to practise at the level of their knowledge and competence – and this includes aromatherapy.
Aromatherapy is widely accepted in aged care facilities, largely due to the Federal Government’s 1997 policy reforms and subsequent accreditation standards for aged care facilities; in some, 53% of residents have aromatherapy treatments routinely. Aromatherapy is accepted in some coronary care units, maternity and neonatal care, mental health and palliative care.
Essential oils are used in vaporizers, on linen or clothing, compresses and/or massage to promote sleep, reduce wandering behaviour, manage ‘sundowner’s syndrome’, reduce anxiety and stress and care for wounds, especially skin tears. Sometimes the facility purchases the oils; in other cases the aromatherapists or individual patients supply them.
This is the only aromatherapy association in Australia. The IAAMA originally began as the IFA Australian branch in 1988. The association had little involvement for a number of years with the IFA UK and became the IAAMA in 2008.
The ATMS is not an independent association, but a non-profit company run primarily by ATMS-accredited colleges. The ATMS is a large umbrella group that covers many complementary therapies, including aromatherapy and especially massage. Comprehensive practitioner liability insurance is offered and a requirement for all practising members.
A number of nursing complementary therapy associations exist, for example the Complementary Therapy Special Interest Group (CTSIG) and the College of Holistic Nurses (CHN), aromatherapists making up a significant number of their members. These bodies hold regular meetings and national conferences, as does the IAAMA. Attendance at these forums contributes CPD points to both nursing and aromatherapy professional associations.
Individual aromatherapists are conducting some clinical pilot studies which can be directly applied to patient care. Examples include Guba’s and Casey and Kerr’s works in wound care, Bowles et al.’s work in aged care, Dunning’s work with people with diabetes and Dunning and James’ work in rehabilitation.
In the last few years data are being generated about the chemical composition of a range of unique Australian essential oils, particularly their antibacterial properties, primarily from Charles Stuart University.
Guba is already working with an aged care psychiatrist, O’Connor, with a study on the effects of lavender oil on agitation in those with dementia, for which he has received funding. They are using a significant dose – a 30% concentration in jojoba oil for topical application.
Aromatherapy is well known in Belgium and is practised as in France, both externally and internally; it is quite different from the common use of ‘aromatherapy’ in Britain, where it is more related to massage and external use. Aromatherapy does not exist as a profession on its own, as it does in the UK; as in France, it is a complementary training to medicine, physiotherapy, dentistry, pharmacy and nursing, and has a more scientific and medical approach than in the UK.
The former is widespread and supported by a vast number of commercial initiatives: products, wellness and health resorts, workshops and courses. The latter is limited, since it is practised by the specialists mentioned above.
Several regulations apply, depending on how they are used: raw material for pharmaceutical preparations, cosmetics or food supplements. There is no specific legislation for essential oils, but external use is regulated by cosmetic laws.
After training only in aromatherapy without medical training, alternative therapists are practising ‘medicine’ illegally – there is no aromatherapist-recognized diploma. A herbalist or phytotherapist, having knowledge of aromatherapy through their training, is sanctioned by a recognized certification, which allows him to practise.
There has been a regulatory agreement and acceptance of internally used essential oils (in preparations contained in soft gelatine capsules) in products that were already on the market before HACCP and other rules were devised.
Courses are organized by aromatherapists (no official certificate) in the use of essential oils for external use on a regular but small-scale basis. These are attended by enthusiasts, herbalists, nurses, health, wellness and beauty practitioners and paramedics.
Courses on the use of essential oils for internal use, as well as for external use in pharmaceutical preparations (for the treatment of dermatological ailments or transdermal agents), are organized by:
These courses offer a general, but qualitative and profound and fundamental knowledge on the therapeutic possibilities of essential oils, their chemistry, their uses, their toxicology and their powers. The lecturers are medical doctors, pharmacists and university professors; the courses can only be attended by dentists, doctors and pharmacists. A diploma can be obtained, after examination, after 3 years of 10 weekends.
Courses are organized by aromatherapists (no official certificate) in the use of essential oils for external use on a regular, but small-scale basis. These are attended by enthusiasts, herbalists, nurses, health, wellness and beauty practitioners and paramedics.
This college provides training for everyone from medical professionals (doctors, pharmacists, dentists, therapists etc.) to laypersons; depending on the type of course, the curriculum and the number of hours can vary.
The quality varies immensely – as everywhere, the market is full of unscrupulous companies, although genuine oils are available. The only absolute protection for the consumer is to buy essential oils botanically and biochemically defined (EOBBD). EOBBD is a certification guaranteeing the origin and the exact nature of the essential oil by providing:
Chromatography is systematically used. Some wholesalers of ethical essential oils test samples of the essential oils they intend to buy by gas chromatography–mass spectrometry (GC-MS) and test the products delivered as well, in case they do not match the samples.
Aromatherapists, massage therapists and other holistic therapists use essential oils regularly; there is limited use in nursing homes, where they are mainly used in palliative care, oncology and comas. They are mostly applied diluted, by massage (professional therapists/nurses/beauty therapists), self-application or diffusion; they are also used in baths (after dissolving in a dispersant), gargles and compresses, but more for wellbeing than for their therapeutic actions. Sometimes they are used neat; EOBBD essential oils may be used orally. Dentists, pharmacists and GPs trained in aromatherapy or herbal medicine can prescribe them for internal use, but are not paid by the state.
Hospitals do not offer aromatherapy training, although this is beginning to change. Hospitals offer aromatherapy massages in palliative care, neonatology, oncology and comas, mostly for wellbeing rather than for their therapeutic purposes.
Aromatherapy became known in Brazil in the late 1980s, when some books were translated from English into Portuguese: first, in 1989, Practical Aromatherapy – How to use essential oils to restore health and vitality by Shirley Price, shortly followed by Aromatherapy Workbook by Marcel Lavabre.
Interest in aromatherapy gradually increased during the 1990s, and in 1993 the first aromatherapy seminar took place, when, for the first time, a professional aromatherapist from England came to Brazil to speak. During this period, more books became available in Portuguese, such as The Art of Aromatherapy (Robert Tisserand 1992), The Aromatherapy Book (Jeanne Rose 1995), Aromatherapy (Patricia Davis 1998), Aromatherapy and your Emotions (Shirley Price 1997) and Aromatherapy for Common Ailments (Shirley Price 1999). This prompted the publishing of aromatherapy books by Brazilian authors too.
By the mid-1990s essential oils could be found in beauty salons, spas and shops and the home in general; aromatherapy had become synonymous with natural. There are now a growing number of people working as aromatherapists or who offer aromatherapy treatments as part of their practice. Few people have studied aromatherapy abroad, and often those who describe themselves as ‘aromatherapists’ have only attended a short weekend course. The same situation exists in most complementary therapies.
The Brazilian government does not recognize aromatherapy as a treatment or as a profession, so it is not regulated. Some academic institutions are attempting to build greater awareness and acceptance by incorporating the therapy into naturopathy, whereby aromatherapy is given equal importance alongside other complementary therapies such as reflexology and Bach flower essences. At present, only homoeopathy and acupuncture are officially recognized as complementary therapies.
Complementary therapies or ‘integrative practices’ as they are known, include aromatherapy, homoeopathy, flower essences, phytotherapy and acupuncture. They are also part of the Unique Health System (SUS) contained within the National Policy of Complementary and Integrative Practices (PNPIC), which has only a partial presence in Brazil.
Formal teaching of aromatherapy started in the early 1990s and is now available at different levels, from basic 1-day courses up to courses of 50 hours or more. More advanced courses (100 hours) are taught at two private universities, which although approved by the Ministry of Education, are not endorsed by the Ministry of Health.
In 2010, the Penny Price Academy arrived in Brazil, bringing with it an internationally certified course,the Associate Diploma in Clinical Aromatherapy. This responds to a growing demand for quality training which carries global value and recognition and which gives the practice, teaching and study of aromatherapy a much-needed credibility alongside the other more established complementary therapies.
The University of South Santa Catarina is a Brazilian Educational Foundation. This complementary therapy degree at UNISUL carries a 60-hour component of aromatherapy, with four assessments (written and oral).
The aromatherapy component of this 260-hour course is 100 hours; the naturology course here considers aromatherapy a complementary and integrative therapy, which allows study leading to an understanding of how aromatherapy integrates with other complementary health disciplines – Bach flower essences, massage, reflexology and others.
This company has been involved with aromatherapy education for over 16 years. The proprietor graduated in 2006 at the Penny Price Academy in the UK and it is now a satellite PPA school – it is the only school which offers a course with an internationally recognized qualification.
Essential oils are generally found only in some homoeopathic pharmacies and health food stores. Unfortunately, much of what is available is of low quality, but those who know the importance of having genuine essential oils can find quality products from a small number of reliable suppliers. It is also possible to buy essential oils from an aromatherapist, although it is not easy to verify their origin. Therefore, much care has to be taken by the consumer when purchasing essential oils – only a few brands are of a high grade.
Naturopaths, aromatherapists, massage therapists, holistic therapists, and some physicians, dentists, psychologists and physiotherapists use essential oils in their practices – and some veterinarians use them to treat pets and large animals.
Brazilian Association for Studies and Research in Aromatherapy. This is a non-profit organization whose purpose is to expand the level of public awareness of the benefits of aromatherapy. It endeavours to promote and raise educational standards and professional practice, enhance the awareness and knowledge of aromatherapy, and educate people in the safe, effective and responsible application of essential oils in daily life.
Although it is not known exactly when aromatherapy first appeared in Canada, essential oils have been available in health stores – and one or two schools have been teaching aromatherapy for several years.
The provincial government of British Columbia recognizes aromatherapy as a distinct profession, granting Occupational Title Protection to the members of the British Columbia Alliance of Aromatherapy (BCAOA – see Associations, below), enabling its members to call themselves Registered Aromatherapists (RA).
In 1996, the Canadian Cosmetic, Toiletry and Fragrance Association (CCTFA) started working with Health Canada officials to develop and implement mandatory ingredient labelling for cosmetics and personal care products, including aromatherapy products.
The Canadian Federation of Aromatherapy (CFA) formed an Education Committee in 1999 and over the years has set standards for certification (updated in 2009), safety and professional conduct for its members. A core curriculum that the schools must follow has been established, and passing the CFA National Exam is a requirement for membership. Members are entitled to use the legal designation CAHP (Certified Aromatherapy Health Professional), which is only available and applicable to CFA members.
Approved diplomas are licensed through the Ministry of Education in Ontario, Canada, entitling the successful therapist to use the letters RAHP (Registered Aromatherapy Health Practitioner) after their name.
Aromatherapists can apply for a business licence, allowing them to practise in their own area – depending on the Government bylaws of that area. To receive this holistic business licence and practise as an alternative healthcare provider, aromatherapists must prove that they belong to a complementary healthcare organization, which can then supply them with an Errors and Omissions/Malpractice insurance.
Essential oils are available in stores and health shops, some being therapeutic grade, some poor grade. People wanting to be sure of quality buy their essential oils from an aromatherapist. The general public use essential oils for beauty and health and in vaporizers.
Although doctors are wary about using alternative medicine, nurses are leading the movement towards incorporating essential oils into medical practice. Two hospitals in British Columbia are known to accept aromatherapy at present, although it is offered in many private clinics, but there is no knowledge of aromatherapy being practised in hospices.
This federation was formed in early 1993 by a group of individuals from varying backgrounds who recognized that there was no governing body or organization that the public could contact for information, or to verify that those claiming to be aromatherapists were indeed qualified.
It aims to foster continuing growth, quality and high standards of education and practice within the aromatherapy profession, and provide ongoing information about the quality of aromatherapy products and services to the public.
To maintain membership, all members must complete ongoing educational programmes and be active in aromatherapy work. Credit Education Units (CEUs) are applied to a large variety of courses, retreats, workshops and lectures across Canada, and ensure that CFA members are continually increasing their breadth of knowledge.
The BCAOA was registered in February 1999, under the Society Act of the province of British Columbia, Canada. It was formed by representatives of 16 different associations which had concerns that the practice of aromatherapy/essential oil therapy was being threatened by changes to laws and regulations at both provincial and federal level. In December 1999, BCAOA applied for registration as a professional association under the Health Act of British Columbia. The application is pending hearings.
Its mission is to provide educational and professional standards and ethics for aromatherapy/essential oil therapy in British Columbia, and to support ongoing education. It encourages a sense of community and exchange among aromatherapists, essential oil therapists, healthcare practitioners and associations.
It supports practising aromatherapists, as well as educating the public in the benefits of aromatherapy. The BCAPA has a stringent code of ethics and a high standard in professionalism and continuing education.
Around 1990, the concept of aromatherapy began to be accepted in China. It was first introduced to mainland China by the family of a Taiwanese businessman, when the basic application of essential oils and the promotion of its possibilities began to spread. Having first appeared as skin care, beauty salons then began using essential oils in face and body massage – now the most common forms of use. Although essential oils are now used in every beauty salon and spa, their quality is a concern, as they are probably adulterated.
Young women aged 18–25 went to Europe and America to study and experience essential oils, returning to spread their knowledge to others via forums and websites etc. As herbalism was already well known, aromatherapy was readily accepted. Most buyers of essential oils are over the age of 25, as they can more easily afford them: they are used mostly in vaporizers. Although essential oil use is widespread, there is a shortage of correct aromatherapy information and training in the Chinese language, making aromatherapy less easily available to people generally.
Around the beginning of the 21st century two books, P Davies’ Aromatherapy A–Z and M Maury’s Guide to Aromatherapy were imported – in English, which naturally limited the number of readers. Both books are now translated into Chinese, as are S Price’s Aromatherapy and your Emotions and L Price’s Carrier Oils for Aromatherapy and Massage. By 2010 there were over 15 aromatherapy books in Chinese, and information was also available via newspapers, magazines and the Internet. Some large aromatherapy websites have been established which include the translation into Chinese of information written in English.
Aromatherapy has been identified by the Shanghai Vocational Training Orientation Centre (SVTOC) as an area for growth, an agreement being made recently with the International Federation of Professional Aromatherapists (IFPA) to develop British-style aromatherapy training.
Many people – including the government – class aromatherapy with beauty and hairdressing, and as most practitioners were without any professional training, many mistakes occurred using essential oils, adversely affecting some clients’ health. Because of this, the government introduced an ‘Aromatic Masseurs Qualification Standard’, which came into force at the end of 2004. Aromatic masseurs have to follow these government recommendations, which will ensure that aromatherapy progresses in the right direction.
Training in China was originally carried out by an English aromatherapist, one of her trainees from Taiwan now training by distance learning. However, the training is expensive, and since little time was spent on essential oils, many graduates were found incapable of practising aromatherapy correctly. However, this lady caused an increase of interest in essential oils and aromatherapy, as she has published two introductory books on aromatherapy and appeared in many TV shows.
The Penny Price Academy (PPA), accredited by both the above associations, began distance learning courses in mainland China and now has a school there, which Penny Price and her husband visit to lecture. PPA tutors come to China from Taiwan and Japan to run courses that emphasize the UK training standards, but there will not be any IFPA-accredited Chinese tutors until 2012.
In January 2004, Shanghai JiaoTong University and the XinJiang Plant Technology Development Company together established the Shanghai JiaoTong University – XinJiang Aroma Technology Universal Research Center to improve research into aromatic materials – at present it is based more on raw materials used in perfumes, with very little on aromatherapy. The research is on a very small scale and not related to aromatherapy. The real research into and development of herbs and commercial essential oils is done by the Botanical Institute of China Science Academy; the man in charge has been appointed to promote the growth of herbs in Xinjiang – mainly Lavandula angustifolia, which has been grown non-commercially in China since the 1950s.
Essential oils have been used in Croatia for many years as part of herbal and traditional medicine and the making of candles and aromatic substances. They are sold in speciality shops, people using them in their homes as well as for massage by an aromatherapist. The word aromatherapy was first used in 1990, after a firm began to use and sell oils. Some informal lectures are given to the public.
A small number of nurses, doctors and therapists use essential oils in clinical practice. After training with Shirley Price in England, the first aromatherapy school was opened in 2000, followed by Aromara (the Aroma Academy) in 2002, and the Citizen Open College in 2004.
Sales of essential oils have expanded over the last 10 years, people using them as a form of self-help. They are imported mainly from France and Germany, some shops putting their own label on them. Although the Institute for Public Health checks the quality of essential oils, there are no regulations regarding quality.
A few essential oils are produced in Croatia, namely: Laurus nobilis, Lavandula x intermedia, Rosmarinus officinalis ct. camphor, Salvia officinalis and Thymus vulgaris ct. thymol, All essential oils have to pass safety controls for food and cosmetic use.
Three schools in Croatia are licensed by the Ministry of Education, Sports and Science to teach aromatherapy. Although aromatherapy is not recognized by the Ministry of Health as a complementary therapy, and treatment of disease is not permitted, it can be used to support treatment with the personal consent of the patient and/or his/her doctor. The diploma of the author’s school, AromaVita, has received a licence from the Ministry of Health to practise aromatherapy in this way. The training offered by the other two schools is quite similar to that offered by AromaVita.
AromaVita cooperates with the Penny Price Academy (PPA) in the UK, through workshops and counselling for their students. The principal of Aromavita lectures in Croatian hospitals to inform and educate nurses, physiotherapists and doctors about the clinical application of essential oils and aromatherapy techniques. Students who finish both aromatherapy courses below can take an examination at PPA to obtain an international certificate.
Students are taught about 40 essential oils and 15 fixed vegetable oils. After completing this, students are trained in the application of essential oils, including massage techniques to reduce/eliminate stress, and improve health and body care.
Practical classes are conducted in homes for the elderly and disabled, to learn the clinical application of essential oils and massage. Students have to carry out 10 client case studies with five treatments on each. After completion of training students are qualified in the application of essential oils, massage and consultation for the purpose of maintaining good health, psychological support and help in self-development.
• Stress management – Results show a reduction in stress and a better attitude towards work; managers take time for aromatherapy, having learned to use essential oils to keep their psychophysical balance and growth of creativity. The most successful oils used are Lavandula angustifolia, Citrus sinensis, Melissa officinalis, Citrus bergamia, Citrus limon, Rosmarinus officinalis ct. 1,8 cineole and Cedrus atlantica.
• Emotional cleansing – Essential oils and aromatherapy techniques have helped to open up emotional expressions and their awareness, helping people to achieve a better relationship with themselves as well as with other relationships. The best results were with Citrus bergamia, Melissa officinalis, Juniperus communis, Hyssopus officinalis, Salvia sclarea, Eucalyptus globulus and Boswellia carteri.
• Pain – Back pain, aching muscles and headaches. Oils that showed the best results were Citrus limon, Lavandula angustifolia, Matricaria recutita, Mentha piperita, Zinziber officinalis, Juniperus communis, Rosmarinus officinalis ct. 1,8 cineole, Salvia sclarea and Pinus sylvestris.
• Energy/psychological support in crises – divorce, death of someone close, losing a job, etc. Aromatherapy massage, breathing techniques and creative visualization were used. Oils used were Melissa officinalis, Boswellia carteri, Thymus vulgaris ct. thymol, Lavandula angustifolia and Origanum majorana.
Aromatherapy came to Finland with the general surge of interest in complementary medicine at the beginning of the 1980s. Beauty therapists led the way by inviting an English aromatherapist to teach the use of essential oils in skin care. In 1984 a beauty/aromatherapist returning from the USA started teaching aromatherapeutic massage with ready blended oils. Holistic aromatherapy using individual essential oils was started by a Finnish aromatherapist trained in England. By the middle of the 1990s, several natural medicine institutions offered aromatherapy training.