The general picture

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.

Regulation

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.

Essential oils

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.

Education

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

Education curricula include theoretical and clinical hours as well as home study. Courses are no longer based on hours per se, but on the competencies (or learning outcomes) that are gained.

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.

Use of essential oils in medical establishments

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.

Associations

Research/pilot studies

Since the establishment of the Office of Complementary Medicine much laboratory-based research has been conducted into the chemical constituents and properties of essential oils.

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.

Warnke and Sherry have done work on essential oils for infections, using first the MAC concentrate and then their own mixture.

The general picture

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.

Many people practise self-medication with plants and essential oils – unlike in Britain, they have never lost that part of their culture.

Aromatherapy can be divided into two sections:

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.

Regulations

Internal use is discouraged: it is limited by HACCP (Hazard Analysis of Critical Control Points) – international standards on food and food supplements rules. http://www.haccp-guide.fr/

Non-medical personnel are not allowed to practise internal medicine; medical doctors and pharmacists are allowed to do so with personalized preparations called magistral formulas on prescription.

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.

Education

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.

Some training centres, often linked to essential oil wholesalers, give quality courses in scientific aromatherapy.

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:

Hydrolats are always taught and used mostly in paediatrics.

A certificate is given at the end of the course, but has no professional recognition.

Essential oils

Essential oils are available in organic health food shops, pharmacies and online.

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.

Such oils guarantee good results without the side effects created by solvent-extracted, deterpened, rectified or adulterated products.

Essential oil use

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.

Use of essential oils in medical establishments

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.

Associations

Because the profession of aromatherapist does not really exist as in the UK, there is no professional association or society.

Research and/or pilot studies

Research is limited; Philippe Gerard is working on a project with Leuven University concerning plants for the treatment of neurodegenerative diseases.

The general picture

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.

Regulations

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.

Essential oils

Although the sale of essential oils is not regulated, there are licences for homoeopathic and phytotherapy products.

Education, including standards of training

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.

Unfortunately, a number of aromatherapy teachers who have little or no formal training give courses, which does not help the general level of quality of training that exists in the country.

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.

Education

Use of essential oils

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.

Hydrolats are not used to any great extent at present, but hopefully this will change as training progresses.

Methods of using essential oils

Essential oils are used in various ways:

Internal application is limited to a small number of experts, there being no proper training for this method of use at present.

Associations

Research

Some research has been carried out at UNISUL University and also at Anhembi Morumbi University on the following:

This research was carried out in 2009 and coordinated by Professor Marcia Fernandes. The results are yet to be made available.

Aromatherapy development

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.

Regulations

There are no regulations for the practice of aromatherapy in Canada.

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.

Education

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.

To graduate from a CFA-approved programme, students must complete 400 educational hours and pass the standardized national CFA examination.

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

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.

Essential oils are used in all the usual ways except internally, as no school teaches the ingestion of essential oils.

Hydrolats are used in baths, compresses, gargles, sprays and cooking, but not internally as there is no education as yet on this practice.

Use of essential oils in medical establishments

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.

Associations

Research

There is no known research on aspects of essential oil properties and/or their effects.

The general picture

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.

Regulations

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.

Education

The basis for all professional courses follows the syllabi of two British and one American associations:

Associations

At the time of writing, there is no Chinese professional association for aromatherapy.

Research

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.

The general picture

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.

Regulations

There are no regulations in Croatia concerning the application of essential oils in clinical practice.

Essential oils

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.

Education

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 concentrates on preventive measures and conditions such as stress management, emotional blockage, anxiety, neuroses, and support for personal and spiritual development.

When aromatherapists finish the course they can obtain a work permit, which allows them to practise legally.

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.

The training schedule is as follows:

Use of essential oils in hospices and hospitals

AromaVita collaborates with social health institutions (homes for the elderly and infirm) for student practical training.

Research/pilot studies

No research has as yet been carried out on essential oils. However, pilot studies have been carried out in the following areas:

The general picture

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.

Regulations

The laws concerning the whole field of complementary medicine are in the process of being finalized, based on a working group set up in 2000 (see below). Currently there are several laws covering cosmetics, medicine and malpractice, which apply indirectly to the use of essential oils. This means that the use of essential oils and products containing them come under cosmetics legislation and that claims of medical benefits cannot be made.

General use of essential oils

The public is now becoming aware of aromatherapy through aromatherapists, beauty and massage therapists, magazines, books and courses. As a result, the use of essential oils and aromatherapy products containing them is steadily growing with the increase in natural self-care.

As a rule, aromatherapists work as private practitioners in their own businesses or in spas. There is a wide range of essential oils available in Finland, some organic or natural, and some of unspecified quality, as well as some synthetic aromatics; unfortunately, the general public is not sufficiently informed to discriminate between them.

Education

The umbrella association Luonnonlääketieteen Keskulsiitto (LKL, The Central Association of Natural Medicine) is the accreditation body for all natural medicine training. The LKL gives recommendations concerning minimum teaching requirements for the different complementary medicine disciplines. To become a member a therapist’s training has to conform to the standards set by them. In aromatherapy these recommendations cover the in-class training in essential oils and full-body massage with a large number of documented case studies, clinical practice, exams, essays, and a final thesis requiring some original research. The thesis has to cover a medical problem from an allopathic point of view, and a treatment plan with an aromatherapy case study has to be completed, with a report on the results. Some students make several case studies within the thesis and then collect the information to report on how the different cases compared with each other.

Curriculum. A basic curriculum is mandatory for all; the non-medical students take courses in anatomy, physiology, pathology, neurology and psychology. In addition, all students are required to take two or more modules of natural medicine subjects, e.g. phytotherapy, nutrition or other natural remedies.

Currently there are two schools in Finland registered with the LKL, one of which is also a member of the International Federation of Aromatherapy (IFA).

At the beginning of 2000 a working group was set up by the Ministry of Education comprising representatives of orthodox medicine and a few leading aromatherapists. Basic guidelines have been agreed for teaching aromatherapy to massage therapists, foot specialists and beauty therapists at the level of professional further education. The guidelines include treatment protocols and lists of recommended essential oils according to the needs of the different treatment areas and clients.

Use of essential oils in hospitals

Aromatherapy training at basic nursing level in the mainstream medical schools is limited to short courses, which are not obligatory but are part of a free choice selection of study subjects.

Nevertheless, although aromatherapy is not accepted in hospitals, the use of aromatherapy treatments in hospices and handicapped care is increasing. The method of application in hospices varies, with massage being the most popular form; full or part body treatments are carried out with the permission of the clients and senior staff on the ward.

There are many residential homes, both private and local government run, which actively use aromatherapy for the benefit of the residents.

Aromatherapy associations

There are two aromatherapy associations in Finland, Suomen Aromaterapeutitry (SA), with membership which is independent of the training establishments, and UMG-Aromaterapiayhdistysry, which is the association for students qualified by the Finnish College of Aromatherapy.

Public, product and malpractice insurances are available from LKL for those trained to the required standard, and IFA insurance is available through the Finnish College of Aromatherapy for students who have taken the IFA examination.

Research

Currently there is no scientific research on essential oils or their systematic use in the mainstream allopathic healthcare in Finland.

The general picture

Among the most common natural therapies in France, only acupuncture and homoeopathy are officially recognized, and then only if practised by doctors. Many doctors practise other therapies, such as osteopathy and phyto-aromatherapy, but these are ‘unofficial’ therapies as they are not covered by French law. Essential oils are used more and more by masseurs/physical therapists, osteopaths and physical therapists, but non-medical persons can use essential oils on condition that they do not claim therapeutic effects.

Aromatherapy, massage and the law

Any non-medical person using a therapy designated as having a therapeutic effect is in effect practising medicine without a licence and thus illegally, even if they are working alongside – and with the support of – a medically trained person.

Difficulties facing non-medical aromatherapists:

The Syndicat National des Masseurs-Kinésithérapeute Rééducateurs (SNMKR) protects its members’ rights, particularly kinésithérapeutes (physiotherapists), by challenging practitioners through legal proceedings. Similar organizations include the Confédération Nationale des Masseurs Kinésithérapeutes Libéraux and Action Kiné-Massage (which promotes massage exclusively through kinésithérapeutes).

French law (2000) clearly states that only those who have a State-recognized diploma as a Masseur-Kinésithérapeute may practise massage or medical gymnastics. The exclusion also includes the practice of manual lymph drainage (MLD). A German-trained MLD practitioner (Vodder technique) was taken to court in 1996 for illegal practice, despite receiving direct referrals from a French medical doctor. She was found guilty, ordered to pay damages and banned from practising.

Even though aestheticians learn body massage techniques during their state-approved training, they are not legally permitted to practise them. Only light effleurage of the face for beauty purposes can be practised.

Numerous practitioners have attempted to continue their work, calling themselves ‘practicien de toucher’ (touch practitioner), ‘modelage’, ‘technique manuelle anti-stress’ etc., but even then they are skating on thin ice.

The Association Soutien Massage Bien-Etre (www.asmbe.com) was recently formed in response to the case against Joel Savatofski, taken to court for illegal practice of massage. Both he and some of his students (www.toucher-massage.com) were prosecuted for giving seated massage to drivers in an autoroute stop, to refresh and relieve tension.

This case was one of the few success stories, and despite an appeal by the SNMKR it was upheld that on-site massage did not come under the monopoly above.

In spite of this, there are hundreds of non-medical practitioners of natural therapies in France, reflecting the enormous public demand. It is hoped that with increasing collaboration between countries in the European Union, the French legal system will permit the practice of aromatherapy and other forms of CAM.

Education

Complementary/alternative training for doctors, pharmacists and other healthcare professionals varies in depth and duration. As aromatherapy is recognized as a branch of phytotherapy/herbal medicine, studies usually include herbal extracts, not just essential oils.

One main centre is the Faculty of Medicine at the University of Bobigny, Paris.

Two of the university diplomas offered relevant to essential oils are:

Montpellier University has a more liberal view – phyto-aromatherapy can be studied by doctors, pharmacists, dental surgeons, kinésithérapeutes, veterinarians, midwives, nurses, pharmacy assistants and healthcare students at the end of their studies. The period of study is over 2 years during six weekends, or 1 year with two blocks of study, each of 10 days. Successful participants are awarded a university diploma in phyto-aromatherapy from the Faculty Pharmacy of Montpellier University.

Aromatherapy training is offered for non-medical personnel by the Institut Méditerranéen de Documentation d’Enseignement et de Recherche sur les Plantes Médicinales (IMDERPLAM) (www.imderplam.net), where the study is over 3 years and includes three weekends (24 hours) on aromatherapy.

The Lyonnaise School of Medicinal Plants (www.ecoledeplantesmedicinales.com) also offers training in applied aromatherapy over three weekends and is open to all, the principal teachers being doctors in pharmacy.

The Plantasanté school, located in Obernai in Alsace and in the Drôme, offers a certificate in medicinal and aromatic plants (phyto-aromatherapy) over 2 years (weekends or weeks), developing all aspects of herbal medicine and aromatherapy. It also offers training in intensive aromatherapy over 24 hours.

The Faculty of Medicine in Paris not only offers several options of natural and ethno-medicinal training (mostly to doctors and paramedic personnel) but also weekend courses for families and herbal shops, some including aromatherapy, some only aromatherapy.

Learning via correspondence is well established and accepted within France; training in phyto-aromatherapy by e-learning is now available, principally open to medical personnel. A leading college offering this form of learning and awarding a diploma in phyto-aromatherapy (300 hours over 2 years) is Hippocratus (www.hippocratus.com).

Essential oils

Most essential oils are freely available, except those with a risk of toxicity, which can be issued only on prescription. They used to be largely obtainable only from pharmacies (behind the counter). Recently, there has been an increasing trend for pure essential oils to be sold in parapharmacies, health and beauty stores and numerous markets in the south of France; the range is limited, blends for massage, diffusion, skin care etc. being more commonly available. Occasionally, essential oils can be found in supermarket chains.

Most practitioners in France obtain their essential oils direct from French laboratories, thereby having access to GC/MS analyses. The idea that it is easier to access good-quality essential oils in France than other countries is not necessarily true, particularly in the north.

Since 2007, essential oils (common and botanical names) restricted to pharmacies include:

Fennel, star anise and aniseed oils are also restricted by Customs law to avoid the illegal fabrication of alcoholic drinks such as pastis.

Aromatherapy in medical establishments

The use of aromatherapy by medical personnel is largely conducted in general practice. The aromatherapeutic approach varies, from a rigorous ‘allopathic’ approach, using essential oils as medicaments in much the same way as drugs to a more holistic methodology.

Formulations often consist of capsules or solutions for oral use, suppositories or pessaries for rectal or vaginal application, and lotions or preparations for application to the skin. The percentage of essential oil in these is generally significantly higher than those used in the UK.

The cost for a visit/consultation (about 40 minutes) with a doctor/aromathérapeute varies from approximately 60 to 90 euros, and in most cases part of the expense (excluding an essential oil prescription) can be reimbursed by French health insurance.

The majority of illnesses successfully treated with essential oils are infectious or inflammatory in nature, with an increasing tendency to treat children (ear, nose and throat), thereby reducing recourse to antibiotic therapy. Much attention is paid to the health of the liver, so the prescription is often accompanied by measures (dietary or otherwise) to drain and decongest it.

Occasionally an aromatogram is used to discover the most effective oil for an infectious illness. Aromatograms have been used since the 1970s by medical aromatherapists such as Valnet, Belaiche, Lapraz and Duraffourd to identify the most appropriate essential oils for individual client needs. The pioneer of this technique (and the person who named it) was Doctor Maurice Girault, whose work was particularly recognized in the field of gynaecology. He was the first clinician to use the aromatogram to test the antimicrobial powers of essential oils with a view to treating patients from his surgery.

Aromatherapy research in France

There is a considerable amount of essential oil research conducted, but not all is published in the international scientific press; more and more is found only in the French scientific magazine Herbal Medicine, which is then issued in universities throughout the world. Most of the research concerns antimicrobial effects, anti-inflammatory and dermocosmetic aspects or other essential oil activities.

The way ahead

Since the 1980s there has been an enormous shift in public awareness as people become more informed and more prepared to exercise their rights to all forms of health provision. There is a clear need for clarification of roles between kinésithérapeutes and other professionals who use touch in their work. The current situation with regard to the law needs to evolve in parallel with public demand and other European countries.

The general picture

Aromatherapy became known in Germany in the 1980s and has grown rapidly, with increasing support from the general public, as well as nurses and alternative practitioners, some of whom also use essential oils.

Regulations

Aromatherapy can only be practised legally by doctors and alternative practitioners. A few doctors use essential oils in their own practices; nurses and occupational therapists working as aroma-care therapists offer ‘wellness’ and preventative treatments.

Essential oils are considered to be covered by domestic regulations as ‘objects for improving the odour of rooms’ and not as medicines, which come under pharmaceutical legislation.

No medicinal claims can be made on essential oil labels and the European Union has introduced many restrictions regarding their use, with special labels for oils containing more than 10% hydrocarbons; these carry the warnings: ‘Harmful to health, ‘Causes lung defects’, ‘Keep away from children’, ‘Take medical advice’. Cosmetic companies have to show the contents of so-called sensitizers on the label. Estragol and safrol are not allowed as ingredients of cosmetic products, the content of methyl eugenol having been reduced to 0.0002% in leave-on products. Except for personal use only pharmacists are permitted to mix and label essential oils for hospitals and medical practices etc.

Essential oils

Essential oils are available in all pharmacies, although most stock only those standardized according to the German pharmacopoeia (DAB). However, some pharmacies, essential oil companies and many health shops, tea shops and markets usually stock high-quality, authentic, genuine oils and blends.

Lay people are not aware of the possible hazards of using the cheap adulterated tea tree oil available in supermarkets, which has been responsible for both minor and severe irritation.

Education

There are many professional qualifications available in aromatherapy. The syllabi of the nursing schools include the subject ‘aroma-care’.

The following institutions offer aromatherapy training:

Many aroma companies and private persons offer courses in aromatherapy for everyone, especially for pharmacists and cosmeticians.

Use of essential oils in medical establishments

From Hamburg to Munich, essential oils are in regular use in around 10% of hospitals and hospices by enthusiastic well-trained nurses. However, most doctors, not conversant with their healing properties, gain information about their curative effects from unscientific press articles, which makes it difficult for nurses to convince them of their pharmaceutically active components.

Many freelance midwives use essential oils in their work outside hospital; nurses within a hospital are allowed to use them to alleviate minor conditions such as dry skin or headaches, but must have permission from the doctor in charge if they wish to use them for more serious conditions. They must keep an up-to-date written progress report of the essential oils used – number of drops, how often, changes in treatment and any improvement.

Conditions treated include anxiety, depression, difficulty breathing, headaches, pneumonia, digestive problems, all kinds of infections, insomnia, burns, scars, wounds, ulcers, postoperative intestinal atony and Candida albicans. Essential oils are also used in terminal illness, pregnancy and birth, endocrinology and psychocancer therapy, and with patients in psychosomatic wards.

Since 1995, essential oils have become a fundamental part of nursing and healthcare in Stiftsklinik Augustinium – a hospital with departments for cardiology, pneumology, angiology, nephrology and metabolic diseases. Aromatherapy intervention is carried out with the doctors’ cooperation; it is documented and standards and protocols must be followed.

Nurses trained in aroma-care can apply essential oils using gentle stroking (effleurage) without having a recognized qualification in massage. Other methods include inhalation, sponge baths (in cases of fever), compresses, foot and hand massage and foot baths for pain control. High concentration of oils and mixtures are used for wounds and after an operation, sprays being used for decubitus ulcers (bedsores).

Associations

Research

Research has been carried out into many projects, for example at Kiel University in 1996 to compare the analgesic effects of Mentha x piperita versus paracetamol (acetaminophen) on people with tension headaches. It was found that 10% of peppermint oil in ethanol had the same effect as 1000 mg of paracetamol, leading to the development of Euminz, a commercial roll-on for the forehead and neck.

Another interesting study was published in April 2009: Essential oils of aromatic plants with antibacterial, antifungal, antiviral, and cytotoxic properties. (See: www.pranamonde.co.za/publication.pdf)

At Munich Technical University Prof. Dietrich Wabner is working in cooperation with the dermatological department at Biederstein clinics and NORA-International on several aspects of essential oils, including quality control, physiology of essential oil producing plants, use of essential oils against the hazards of hospitalization, and oil mixtures possible for use against neurodermatitis in children.

Aromatherapy development

Aromatherapy arrived in Greece in the early 1990s with the first aromatherapy book, which was translated into Greek – Practical Aromatherapy by Shirley Price. The publishers promoted essential oils together with the book to make them and their properties known, and the book has sold over 20,000 copies to date. This was followed by three other books in 1998 and several more over the years.

Today the term aromatherapy is heard not only in terms of alternative therapeutics, but also in cosmetic care. People use it in different ways (massage, hydrolats, vaporizers) to improve their daily lives: as modern life becomes busier an increasing number of people are turning to natural remedies.

Although aromatherapy is not yet used in hospitals, it is employed widely by therapists, beauticians, some hairdressers and spas to enhance their sessions. Some veterinarians and pet owners use essential oils to treat their pets, including horses.

Following the trend in most Western countries, Greece has begun to acknowledge alternative and complementary therapies in the last few years, thus enabling many physical disorders to be treated with natural methods, often with excellent results.

Aura Vitae (the author’s company) has been using aromatherapy as an alternative and complementary therapy for about 20 years, helping older people with various conditions, children with atopic dermatitis and eczema, and younger people with psoriasis, skin conditions etc.

Regulations

There is no legislation specific to essential oils. They are subject to laws according to their use, i.e. one for use in perfumery, another for use in medicinal products etc. In general, aromatherapy is considered to be neither legal nor illegal.

Essential oils

Essential oils are imported mainly from Europe (England, France and Germany); most companies guarantee the composition and purity of their products, but there are varying qualities on the market, some of which are adulterated. Essential oils are available in health stores, pharmacies and spas.

Since 2004, the author has been importing essential oils, carrier oils and hydrolats from Penny Price Aromatherapy and distributing them throughout Greece through aromatherapy outlets and those of the public who believe good oils are helpful to their wellbeing. Essential oils are used in everyday life, for relaxing after the pressure of the day – in a bath, to help sleep, to treat conditions such as dermatitis, cellulite, hair loss, weight loss etc. The public use everything: essential oils, carriers and hydrolats.

Education

Several schools teach the theory and practice of aromatherapy, how to use essential oils for common ailments, massage and everyday life. It is difficult to find the right school because aromatherapy has become ‘fashionable’ and there is a lack of consistency and integrity in training, not intentionally, but due to lack of knowledge:

Use of essential oils in medical establishments

There is no aromatherapy training in medical establishments; nurses may study the subject privately, but can only use their aromatherapy skills outside the hospital in their private practice.

Research/pilot studies/cases

No research or pilot studies have yet been carried out in Greece, but two unusual cases have had success using products from PPA, UK.

Case 1: Chalazion (meibomian cyst – swelling of a sebaceous gland in the eyelid)

The man had the cyst for 15 years, having surgery twice, but it recurred often. He visited Aura Vitae, where he was treated with compresses using hydrolat of Thymus vulgaris and Nurture Vision Eyedrops (a product of PPA). In 7 days the cyst opened up and by the 11th day it had completely healed – it has not returned.

Case 2: A deep, open wound

The woman came to Aura Vitae with a deep wound, approximately 1 cm in width, left after a caesarean operation and it had become infected with Staphylococcus. The treatment was as follows:

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The hydrolat of Thymus vulgaris was sprayed constantly on the wound; a blend was made with the following and applied directly onto the wound two or three times a day:

5 mL each of aloe vera gel and macerated hypericum oil

2 drops each of Pelargonium graveolens [geranium], Lavandula angustifolia and Melaleuca alternifolia [tea tree] essential oils.

Two drops of each of the same essential oils was taken internally on a piece of bread three times a day. The wound began to shrink within a week and is recovering well.

Aromatherapy development

Unlike most countries, aromatherapy was not introduced to Iceland by the beauty therapy profession, although it is now starting to be included in beauty therapy syllabi. Its use began in 1989, and as the number of practitioners increases, essential oils are used more and more in people’s daily life. The introduction of more advanced courses enabled a faster growth, especially in areas of nursing. Most aromatherapists either have their own practice or join complementary health centres, those who are midwives and nurses using their new-found therapy in hospitals. Although insurance is available for clinical work, there is none especially for aromatherapy.

Regulations

There are no laws governing the use of essential oils or aromatherapy practice at present, but the Ministry of Health has assured the profession that this is in progress. In the meantime, people trading essential oils have to fulfil the same requirements as those for other oils used externally, such as sun oils etc.

Essential oils

Essential oils from many different sources are on offer from various importers and private bodies importing small quantities; also, therapists bring them from the UK when visiting.

Education

Most of the aromatherapists are qualified from the Comprehensive College at Ármúli, where aromatherapy is part of a 96-unit massage education. The aromatherapy part is three units (a unit is 25 teaching hours, made up of 40-minute sessions). The students learn how essential oils enter the body, blending, carrier oils, safety, history of aromatherapy and client assessment prior to treatment as part of this pre-qualification course.

Next, the students have to complete 25 units of clinical work before receiving their massage and aromatherapy degree. The author of this text used her teaching and CPD diploma from the Shirley Price International College of Aromatherapy to give courses to health professionals such as nurses, midwives, massage therapists and reflexologists at her clinic, Fyrir Fólk, www.fyrirfolk.is.

The Lífsskólinn School began teaching aromatherapy in the late 1990s, with professional aromatherapy lecturers. It teaches anatomy, physiology and pathology as well as aromatherapy massage.

Use of essential oils in medical establishments

Nurses caring for elderly people have shown great interest in aromatherapy, taking it into their hospital work. At the University Hospital of Iceland aromatherapy and massage is accepted as a complementary therapy, to be given only if requested by nurses or doctors. It is used for people with all kinds of dementia, particularly those who are very agitated or difficult to communicate with. These patients receive massage with essential oils on their shoulders, feet and hands, with positive results. Patients in the geriatric area are also treated. Icelandic midwifes have shown a great interest in using aromatherapy before, after and during birth.

Associations

Research

Although the existence of research on essential oils is not well known, Sagamedica have been doing research on Icelandic plants for therapeutic use.

The general picture

Complementary therapies are very popular in Ireland, aromatherapy being introduced not long after it came to the UK. It is becoming more common for GPs to recommend aromatherapy treatments for stress-related illnesses even though such recommendations are normally made on a personal level, where the GP knows the therapist and/or the therapy.

Public health nurses (the equivalent of health visitors) and specialty nurses are showing a great interest in training, although the majority of aromatherapy is carried out in private practice at present.

Aromatherapists rarely use hydrolats as yet, as sadly, most training courses do not include their use. They are rarely sold in health stores or pharmacies, as the general public does not use them.

Regulations

Because there is now such a huge interest from the general public, the Minister for Health at the Irish Department of Health and Children started a process to regulate complementary therapies. In 2003 a working group was set up to look at ways in which complementary therapists could be self-regulated, as this would benefit the general public. The report which was produced by this working group has created two categories of therapy, based on the risk to the public. They are:

Aromatherapy, because of the power of the essential oils, is included in category 1 under Aromatic Medicine. It was suggested by the Department that professional bodies federate so that their therapies would speak with one voice. As a result of this the Aromatherapy Council of Ireland was formed. The founding member bodies are the IFPA (International Federation of Professional Aromatherapists), IMTA (the Irish Massage Therapy Association) and CThA (Complementary Therapy Association). To contact the ACI visit: www.aromatherapycouncil.ie.

Essential oils

Essential oils and aromatherapy products of generally good quality are readily available in health shops and pharmacies throughout Ireland.

Although essential oils are used mostly by aromatherapists, the general public purchase a small range, mainly for specific conditions or effects, e.g. PMT, insomnia, acne, and to brighten up their homes. A small selection is also used by massage therapists.

Most people, including aromatherapists, dilute essential oils in vegetable oils or lotion, the most popular forms of application being from a professional aromatherapist or self-application as a body cream/oil.

Education

The accredited training offered in Ireland is either from the UK International Federation of Professional Aromatherapists (IFPA) or from the International Therapy Examination Council (ITEC). No special training is offered by hospitals to nurses, who train privately, bringing their skill to the hospital. On occasions hospitals will pay for their training.

There are two IFPA-accredited schools in Ireland, the Obus School of Healing Therapies, Dublin, and the Body Wisdom School, Sligo. Both principals were trained by Shirley Price.

The internal and external use of hydrolats is covered on the Obus School syllabus.

There is good attendance on ‘introduction to aromatherapy’ courses run as night classes throughout the country, which encourage some to take an accredited course.

Use of essential oils in medical establishments

The situation is comparable to the UK in that each hospital discusses the introduction of aromatherapy with its Board of Management and Department of Nursing.

Aromatherapy is used and recommended in maternity hospitals, hospice care, nursing homes, cancer support units and some AIDS clinics, as well as in some hospitals for learning difficulties. Many hospices and hospitals are offering posts (called Clinical Nurse Specialists) to nurses who are trained in aromatherapy, making the latter available to patients in long-term and terminal care. This move is an acknowledgement of the benefits of aromatherapy in general healthcare, and together with self-regulation will see it more widely available through the health service. Positive feedback is coming from the patients themselves and their families of the tremendous benefits these treatments are having.

Teaching has been carried out throughout the country within the North Eastern Health Board, with particular emphasis on the Disability and Psychiatric Services. The calming effects of essential oils have been particularly noticed in clients with aggressive behaviour, and tea tree oil has been used to good effect to irrigate wounds that were MRSA (methicillin-resistant Staphylococcus aureus) positive, all swabs being negative to MRSA after treatment.

Associations

The Republic of Ireland has no aromatherapy associations of its own, aromatherapists joining UK associations on qualifying or multidisciplinary associations in Ireland.

Research

The subject of research has now been added to training courses run by IFPA schools, as it is an area that aromatherapy needs to address. Therapists now leave courses knowing how to carry out research, how to record findings, and most of all, with a commitment to research.

Scientists based at Sligo Institute of Technology have discovered that some essential oils are ‘highly efficient’ in the treatment of so-called hospital ‘superbugs’. The research team from the Department of Microbiology at Sligo General Hospital have found them capable of killing the most resistant bacteria, including MRSA, vancomycin-resistant Enterococcus (VRE) and extended-spectrum β-lactamase (ESBL). They are also effective against bacteria resistant to conventional antibiotics: considered by some to be ‘useless’ in the fight against superbugs, those that do have an effect are so toxic that they are administered as a last resort because of risks to other organs such as the liver and kidneys. The researchers tested a large range of oils and their components and found that among the most effective at killing strains of MRSA, VRE and ESBL were clove, lemongrass, citronella, thyme, oregano and cinnamon; tea tree oil was also found be ‘quite effective’. The list is not exhaustive – a large majority of the oils tested showed activity at relatively low concentrations. Although the results were deemed to be promising, Sligo IT hopes to carry out further research to provide viable alternatives to patients, caution always being needed when using essential oils (McDonagh 2009) http://www.irishtimes.com/newspaper/health/2009/1215/1224260710594.html

The general picture

Aromatherapy is now becoming well known in Japan, the word ‘aroma’ increasing its popularity. Since 2000 there has been a campaign to protect the environment and products that are nature friendly have become more common than those containing chemical compounds, which has increased the number of people conscious of the environment and using essential oils as part of their lifestyle.

Regulations

There are no regulations for aromatherapy. When essential oils are mixed with other cosmetics they are treated as synthetic aromatic substances, so it is necessary to trade with trustworthy and knowledgeable companies. Massage for relaxation is not considered to be a medical treatment: it is classed as an aesthetic one and therefore is not against the law. Medical establishments have started to take various therapies on board, even though the national health insurance does not cover them, employing qualified therapists belonging to an aromatherapy organization. Nurses are studying aromatherapy in order to practise in their hospitals.

Education

In the 1990s most students went overseas to countries such as the UK, as there were no organizations to give aromatherapy training in Japan. Later some aromatherapy schools were founded to give training in Japanese methods. At that time, some schools authorized by the International Federation of Aromatherapy (IFA) and/or the International Federation of Professional Aromatherapists (IFPA) started putting on courses, and the number of students who wanted to study British aromatherapy increased. Today (2010), there are 31 schools accredited by the IFA and six by the IFPA.

Essential oils

Essential oils can be purchased from department stores, health shops and drug stores. As most shops have been selling them without distinguishing between individual products, for example for medical purposes or simply for potpourris, we must take responsibility ourselves for using them. Some shops employ an assistant who is qualified as an aromatherapy instructor in Japan. Although the AEAJ has established its own standard of safety and quality, evaluating the quality of products on this basis, there is no government regulation.

Use of essential oils in medical establishments

Introducing aromatherapy in clinics and hospitals has caused dramatic changes to the way in which their profits are made, owing to revisions to the health insurance system. Various treatment options have now become available to both doctors and patients, especially for childbirth. Obstetrics and gynaecology are excluded from national health insurance-funded treatments, but aromatherapy treatments are now used by them. At the Angel clinic in Fukuoka most postpartum patients – approximately 1200 a year – wish to have aromatherapy, and placing aroma diffusers in their wards has resulted in less use of allopathic medicines.

At the Obitsu Sankei clinic, the chair of Japan Holistic Medical Society is offering patients aromatherapy treatments as a part of their overall treatment, thus combining modern medicine with a natural cure.

Associations

The Aroma Environment Association of Japan was established in 1996, and now has 45,000 individual members and 230 corporate members. They have a three-tier system of qualifications:

The Japanese Society of Aromatherapy is a research body that uses aromatherapy correctly in clinics and is organized mainly by medical doctors.

The Japanese Aromacoodinator Association has been developed throughout Japan mainly by correspondence courses, and has 30,000 members and approximately 800 small private schools.

Research

Today a few Japanese essential oils are being developed, such as yuzu, a citrus fruit originating in East Asia (used mainly for bath products and scented candles), and Alpinia zerumbet [shell ginger], an exotic perennial, the leaves of which make a tea with hypotensive, diuretic and antiulcerogenic properties. The universities that grow these plant materials have been researching and developing these oils.

Aromatherapy development

Aromatherapy appeared around the late 1970s, and is now found in gyms, treatment centres and beauty parlours. More and more, aromatherapists are offering massage as a complementary therapy. It is used by nursing staff in hospitals, hospices, nursing homes and care homes, and it is also possible to have a therapist visit at home.

Regulations

In 1973, alternative practitioners were permitted to practise without formal regulation.

Since 1993, only approved professionals may provide medical care, and alternative therapists are able to join a professional organization to take care of any complaints, which in turn can belong to the Natural Health Care Professions Disciplinary Law Foundation (TBNG).

As an aromatherapist cannot give a medical diagnosis, clients are referred to a doctor where necessary, when a holistic treatment plan can then be set out.

Essential oils

Essential oils can be bought in all health-food shops and they are used personally, in health and beauty salons and in public saunas.

Education

There are many good aromatherapy schools in The Netherlands and students are taught many subjects, including:

Initial study at the Mediator school (www.mediator-aromatherapie.nl) comprises 150 hours’ theory and 101 hours of practice. The training includes insurance, ethics and business studies, and there are advanced practical and theoretical training modules available after qualification.

Toxicity is covered plus detailed discussion on essential oil properties, for use both internally and externally.

In Breda, there are courses and workshops in aromatherapy. Chi International (www.chi.nl and www.chi.nl/english/homeng/homeng.html) began in 1979 and works nationally and internationally with institutes and/or businesses active in the field of education and aromatherapy.

Trade Fair Manager Jeffrey Go is also responsible for contacts with the healthcare sector at nursing homes and hospitals, where aromatherapy is regarded as complementary to orthodox treatment.

Use of essential oils in hospitals

Although this branch of natural medicine in The Netherlands is just beginning in hospitals etc., Leiden and Utrecht universities are showing huge interest and have active study groups, with the results of scientific research on essential oils being published regularly.

In 2004 there was a symposium at St Elisabeth’s Hospital in Tilburg on the care of children, where aromatherapy was referred to as ‘smell therapy’. Anneke Huisman of the cancer section at the Erasmus Medical Centre, Rotterdam, related her experience of using essential oils on various complaints, including the support of people with mental health problems.

When challenged whether she used scientific research or traditional/empirical knowledge, her reply was that responsible use of essential oils, with knowledge, could be a new area of expertise for nurses, as an addition to standard care: it is not a case of ‘one or the other’. Aromatherapy does not claim to cure, though it may benefit the quality of life.

In complementary care the patient is looked at from a holistic point of view: fighting the pain with medicine (drugs) is not enough – the patient is under a great deal of stress, sometimes with nausea and vomiting despite the use of emetics. It is impossible for them to sleep after being given bad news about their lifespan, and there are also unpleasant side effects from anaesthetics. Under such circumstances complementary care, including aromatherapy, can be used:

The next speaker, Dr Harmen Rijpkema, one of the leading aromatherapists in The Netherlands, explained that although aromatherapy has still a long way to go, it is expected that essential oils will eventually be given more priority. The oils he talked about included Lavandula angustifolia [lavender], Citrus reticulata [mandarin] and Citrus bergamia [bergamot] etc. as well as almond carrier oil.

He explained how essential oils can:

In July 2009, the fifth edition of his book, Aromecum, was published, containing the most recent findings on aromatherapy and descriptions of more than 200 essential oils.

Associations

The Federatie voor Additief Geneeskundig Therapeuten (FAGT) (www.fagt.org) is a professional association representing many complementary therapies and is the largest in The Netherlands. The public can source a therapist through them.

FAGT therapists are covered by law for the protection of therapists and clients.

Adequately trained therapists may join the FAGT, giving them the benefits of insurance.

Research/pilot studies

Research by Koot and de Lange indicated that the use of essential oils has a positive effect on rebellious and fearful behaviour in elderly people (Koot A 1979 Activities with the Elderly, HB publishers). People suffering from dementia enjoy aromas, which bring memories of the past and calm down the restless; they were found also to have a positive effect on gloomy elderly people.

The general picture

Aromatherapy was introduced in the late 1970s by Arnould Taylor, Eve Taylor and Shirley Price, becoming known by the 1980s as an effective way of treating stress-related problems, with lay people as well as professionals attending courses.

According to the NIFAB (www.nifab.no) study in 2007, 48.7% of the population had tried alternative treatments. According to the study, more women than men had tried it and the majority had seen their doctor prior to the treatment.

Regulations

Persons providing alternative treatment may in marketing their activity only give an objective and factual description of the nature of it (Norwegian Act No. 64, June 2003). The Act states that serious diseases must not be treated by non-health personnel, although they may administer treatment in cases where the sole purpose is to alleviate or moderate symptoms or consequences of the disease, e.g. side effects, or to strengthen the body’s immune system or its ability to heal itself.

Complementary practitioners are encouraged to obtain the doctor’s written permission/acceptance and to communicate with him/her when necessary, the aim being to support conventional medical treatment, to stimulate the immune system, encourage the body to heal itself and to enhance wellbeing and quality of life.

In January 2011 new VAT regulations for natural therapies came into force. Those who are not to a standard of education approved by the Norwegian authorities will not be able to register with the national voluntary registry for practitioners of natural medicine (Bronnoysundregistrene) and will have to pay the new VAT. Those who are registered will be exempt.

Education

The Norsk Aromaterapiskole (NAS) was the first school to specialize in aromatherapy (1982), followed by the Norwegian branch of the Shirley Price International College; later, several others appeared and lectures were also given to midwives and children’s nurses. In 2010 there were more than 150 practising aromatherapists recorded in the NNH system (see Associations, below). Training varies from short 2–3-day workshops to full diploma courses.

Currently, schools following the new regulations of the Norwegian Association of Natural Medicine give 772 compulsory hours of theoretical and practical training. Practical and theory examinations in aromatherapy plus courses in anatomy, physiology and pathology have to be taken before a certificate is awarded.

Some schools offer advanced short courses in medical aromatherapy, psycho-aromatherapy, aromatherapy for women’s health, aromatherapy for babies and children, aromatherapy and cancer care – to mention but a few. From January 2010 a 50-hour course on VEKS (science, ethics, communication and social studies) is compulsory. A basic education in natural medicine (110 hours) is also compulsory, and includes an introduction to the history and philosophy of natural medicine, traditional Chinese medicine, anthroposophy and nutritional studies.

A few teachers teach the oral use of essential oils and hydrolats, which is a valuable (and in many cases, indispensable) method, although therapists cannot prescribe this to patients.

Use of essential oils in medical establishments

Aromatherapy is not officially organized in hospitals, but some will allow (and often encourage) patients to have it if they wish.

Several institutions for multi-handicapped children, youths and adults use essential oils beneficially in diffusers, massage and baths.

Outside hospital settings, a number of medical doctors encourage their patients to consult aromatherapists for problems such as fibromyalgia, headaches, rheumatism, muscular pain and stiffness. Although the majority are still sceptical, there is a growing interest in less harmful medications, especially for nervous and hormonal problems.

Associations

The Norwegian Association of Natural Medicine (Norske Naturterapeuters Hovedorganisasjon – NNH (www.nnh.no – information in English also available) was formed in late 1994 to cater for complementary therapies, e.g. reflexology, aromatherapy and kinesiology, the largest professional group being aromatherapy – the Aromaterapifaggruppen.

In cooperation with the health authorities the NNH is currently establishing a common curriculum and examination so that all complementary schools can gain official recognition. The NNH is also working to establish a distinction between aromatherapy (Aromatic Natural Medicine) as a serious complementary treatment system with genuine essential oils, and aroma massage, as practised by beauty therapists using ready-made blends and commercial products.

Research

In 2000 the National Centre of Research of Complementary Medicine (NAFKAM) was formed at the University of Tromsø for the scientific study of natural medicine, from homoeopathy to healing, including essential oils and aromatherapy.

There are currently few published studies available on aromatherapy. A thesis (Hansen Tore Magne 2000*) evaluated the psychological effects of aromatherapy, but more research is needed. Other studies have been looking into the effects of aromatherapy in various settings in workplaces, but no published reports are currently available.

The general picture

Aromatherapy arrived in Portugal during the 1990s, mainly through its use in beauty salons and spas. The majority of these practitioners have trained outside the country, as aromatherapy is not taught as part of the beauty therapy curriculum in colleges. Unfortunately, Portugal still uses the word ‘alternative’ when referring to therapies which are complementary in the UK.

Although there is much interest from the Portuguese public, as yet there is no real acknowledgement from the powers that be regarding its efficacy.

It is very difficult for practitioners of aromatherapy to obtain insurance, as most UK associations do not insure those members practising and residing outside the UK. An exception is the International Federation of Aromatherapists (IFA) www.ifaroma.org, which can offer this service. The only way forward would be to try to set up a Portuguese branch of a UK aromatherapy association and have it accredited in Portugal, although the process would be slow and costly. This was attempted in reflexology, but it seems the entire process has collapsed after many years’ hard work and huge financial cost.

Regulations

Aromatherapy is still considered to be neither legal nor illegal. Essentially, no one minds what an aromatherapist does, as long as there are no complaints. Health shops are allowed to sell essential oils because they are seen to be for external use only. There appears to be no legislation regarding their sale or quality.

Many of the bureaucratic problems and narrow mindedness in government relate back to the dictatorial regime, which lasted 46 years and only ended in 1974. During this time, the health service was only available to those who could pay. The poor masses were kept in check while the wealthy were kept happy. As a result, it would suffice to say that Portugal is behind Britain by about 20 years.

Education

Aromatherapy training for both non-medical people and nurses is slowly improving. Although it has no proper structure because its not legally recognized, there is a 3-month, 36-hour course run in Lisbon and Porto that is accredited by three associations in Portugal, the Associação Nacional de Terapeutas de Recuperação, Massoterapeutas e Auxiliares de Fisioterapia (ANAFIS); Associação Portuguesa de Naturopatia (APNA); and Conselho Federativo – Federação das Medicinas não Convencionais (CF-FMNC).

Use of essential oils in medical establishments

Aromatherapy is not generally accepted in hospitals because it is seen as an alternative form of medicine, although some hospitals and doctors are open to most things if they can ease someone’s suffering. There may be occasional use of essential oils, especially in terminal illness, where alternative methods are acceptable.

Aromatherapy is offered in some private clinics and the occasional single unit in palliative care, although hospices as such do not exist at present. In the south there are outpatient oncology units, where people simply sit on a chair while receiving a treatment.

Oncology hospitals, mainly in the north, are using a few complementary therapies as part of the voluntary sector, but unfortunately aromatherapy is not yet one of them.

Associations

There are no aromatherapy associations. However, there are many foreigners living in the country who have trained abroad and are affiliated to their own associations – for example the International Federation of Professional Aromatherapists (IFPA) and the IFA mentioned earlier.

Research

There is no research being carried out in Portugal at present regarding any alternative therapy.

Aromatherapy development

Aromatherapy first became known in 1985/6, when aromatherapists from other countries – Valerie Worwood, Shirley Price, Martin Henglein and Suzanne Fischer-Rizzi – were asked to teach the subject.

Switzerland is a four-language country (in the southeast they mainly speak Romansh), and has 26 cantons (counties), each having its own constitution, so the Federal Government is struggling to find a common jurisdiction. As far as aromatherapy practice is concerned, the German-speaking sector is comparable to Germany, the French to France – more medical (it is common there to use essential oils internally); the Italian part has only one canton (Ticino/Tessin), where the rules of practice are moderate, only registration being necessary. The practice of aromatherapy also depends on each canton’s jurisdiction in all parts of Switzerland.

The word therapy is very restricted in the German sector and only those who are legally allowed to heal somebody can use it. The most liberal canton is Appenzell, where most therapeutic activities are allowed to be practised without strict restrictions.

There are two distinct professions concerning aromatherapy, doctors and naturopaths being called ‘aromatherapists’ and those without medical training ‘aromatologists’, despite the fact that both may have received the same training in the subject.

Regulations

In most parts of Switzerland the term therapist is reserved for those in a profession approved by the Federal Government, i.e. medical doctors and certified naturopaths (Naturheilarzt); only medically trained people are legally allowed to heal and practise therapeutically (in Jura and Zürich no CAM practitioners at all can practise legally). Non-medical aromatherapists without naturopathic training are allowed neither to practise therapy nor to give any kind of massage commercially. In Appenzell, Basel and Schaffhausen naturopaths/practitioners of CAM can work without regulations from the authorities, but they must register and need to pass a ‘cantonal test’; in Luzern and Nidwalden no test is needed for this; in others (Tessin, Zug) they only need to be registered, and in two French cantons (Genf, Vaud) they are merely ‘tolerated’. It is expected to be a long time before State approval of aromatherapy practice is granted.

Recommending the internal intake of essential oils is officially permitted only by naturopaths. Unofficially, in the German and French sectors people do practise aromatherapy, declaring it as some kind of ‘wellness measure’, or ‘wellbeing touch’, or any other word their fantasy creates.

The legal use of essential oils depends on what they are to be used for and how they are used. They are allowed to be used in general nursing for caring purposes – following necessary guidelines, but if a nurse wishes to use essential oils to cure – or to heal – then he or she needs authorization from a doctor or the leading nurse of the station.

The law regulating pharmaceutical/medicinal products is the Bundesgesetz über Arzneimittel und Medizinprodukte (similar to the American FDA).

Essential oils

Essential oils of a very high quality have been sold in Zürich since 1985, although among the reputable retailers there are, as in most countries, many who sell low-quality, adulterated oils.

Essential oils are used by the general public mostly in vaporizers, on tissues (for stress, colds and insomnia) and in baths, though it is becoming popular to use them also in a carrier oil for self-application for muscular aches and pains etc.

Education

Those wishing to practise some kind of massage in Switzerland have to learn to do so officially – taking a course of 150 hours in most cantons; the certification has to be given by accredited schools.

Outside the nursing profession, training in aromatherapy is available mostly through German schools in the German sector, each having its own training standards, although everyone would like to see a nationally recognized training for non-medical people.

Long-term education in aromatherapy and aromatology is offered by one or two schools, e.g. Woodtli Schulen, with Martin Henglein, and the Schweizer Schule für Aromatherapie.

Basic training is offered by several organizations, mainly in conjunction with well-known aromatherapy teachers from abroad.

Regarding education in the nursing profession, many changes are under way in order to meet international standards, and the first of two healthcare school training centres started its programme in 2006.

Insurance

The biggest health insurance companies have applied a standard for therapists set by the Erfahrungs Medizinisches Register (EMR) in order for them to be covered. Any therapist requiring insurance has to show a minimum of 150 hours of medical training plus at least 105 hours of aromatherapy training. Without the EMR standard, most health insurance companies will not pay for client treatments.

Use of essential oils in medical establishments

In principle, aromatherapy has begun to be accepted in hospitals, where treatment is carried out only by nurses. Some doctors use essential oils in their private clinics.

No official guidelines for nurses using complementary therapies in a hospital setting have been written, but there is an increasing interest in the possible benefits of aromatherapy, some hospital patients requesting treatment.

The Swiss professional association of nurses (SBK) originally laid down national principles of procedure and basic rules for establishments in which aromatology sanctioned by doctors is allowed. Nurses must be able to justify nursing procedures using essential oils; knowledge must include risks and limitations as well as potential benefits. The patient or relatives decide whether or not therapy with essential oils is to be undertaken.

Use of essential oils

Apart from disinfection of rooms, personal hygiene and hair care, essential oils are used for fear, anxiety, confusion, to give comfort to the dying, and physical problems such as colds, disturbed sleep, fevers, mycosis, pain, relaxation and skin problems, including burns and wounds. They are also used in midwifery. The most common method of application is inhalation (vaporizer, handkerchief, steam), but they are also used in baths, compresses, dressings and swabs, massage and frictions, using neat oils and/or blends. Washing with hydrolats is often used for fevers, and cold compresses with 3% peppermint oil are placed on the forehead for headaches.

No synthetic oils can be used, as they may cause side-effects such as headaches and nausea

Essential oils must be diluted before use (neutral liquid soap, honey, cream, vinegar, vegetable oils etc.). Exceptions are swabs in mycosis.

Essential oils, although natural, are not innocuous. Risks include sensitivity, irritation and possible toxic effects.

Essential oils should never be brought into contact with the eyes.

Oral application is the exclusive domain of medically trained aromatherapists.

A sensitivity test (inside the elbow) should be carried out on those with known allergies before each application of a new oil.

Care should be taken if a homoeopathic remedy is being taken, because of possible interferential action.

Descriptions must be kept of how to store essential oils correctly, and where they can be ordered.

The use of aromatherapy depends to a large extent on the level of acceptance of the medical staff.

Hospitals in the Canton of Bern successfully carry out fever washing for general wellbeing, reduction of fever and healthy sweating in adult patients. The mix used is 1 drop each of bergamot, eucalyptus, lavender and mint (unspecified) emulsified with a dispersant in lukewarm water. For genital and thrush-like ailments, 1–2 drops each of lavender and tea tree are used.

Local massage or compresses with essential oils are also offered/applied to ease insomnia, fear, stress and general pain.

Although aroma lamps cannot be used in hospitals, electric aroma stones or absorbent stones saturated with essential oils are used to help anxiety and sleeplessness etc.

Some psychiatric clinics use aromatherapy regularly and successfully for generalized fear syndrome, psychotic symptoms, depressions, and borderline as well as burn-out syndromes.

The first hospice to use aromatherapy was in Zürich in the 1990s, permission having being given to use essential oils in any external form, with guidelines being written in 1994.

Associations

No association gives standards of training for aromatherapists – each school has its own.

Research/pilot studies

Some studies have been made by Professor Reinhard Saller (in cooperation with his German colleagues) concerning the efficacy of tea tree oil for mycoses, bacterial and viral infections.

He was also involved in proving the antiviral and antiherpetic actions of several essential oils, together with Professor Reichling and his team from the University of Heidelberg in Germany: Essential oils of aromatic plants with antibacterial, antifungal, antiviral and cytotoxic properties – an overview

The general picture

Aromatherapy first appeared around 1990, its development relying mainly on private cosmetic companies selling essential oils. The beauty industry, big business in Taiwan, used the aromas of essential oils to attract consumers without reference to their therapeutic benefits. The key obstacle to development was the lack of knowledge of the English language, thereby limiting access to information. The books Aromatherapy for the Emotions (Price S 2000) and Carrier Oils (Price L 2006) have been published in Chinese, but now more Chinese publications are available, including those written by people who studied aromatherapy abroad. Aromatherapy knowledge was first encouraged by a few committed people who invited professional aromatherapists from other countries to teach and organize groups. Jen Chang, one of the first to do this, is now the principal of the Penny Price Aromatherapy Academy in Taiwan.

Aromatherapy has currently become more widely used, being appreciated by aromatherapists not only in academic and medical fields, but also in beauty salons, spas and leisure businesses.

Regulation

No aromatherapy regulations have been set as yet. In the early days, when knowledge of aromatherapy was not generally available, a fire occurred when essential oils were being vaporized using a candle. The result was that essential oils containing isopropyl alcohol cannot now be used, to comply with the Taiwan alcohol content law. As aromatherapy has become better known, vaporized air freshener products are no longer confused with therapeutic essential oils.

There are no regulations as yet for practising aromatherapy, even though training has been going on for many years, although in China the government introduced an ‘Aromatic Masseurs Qualification Standard’ in 2004, which aromatic masseurs have to follow. Training is difficult to achieve in Taiwan because of political issues in China.

Essential oils

Essential oils are sold mostly by aromatherapists and cosmetologists but are also available in some department stores and health shops. The oils and related products are mostly imported from France, the United Kingdom, the United States of America and Germany, but unfortunately there are many low-quality essential oil products available, due especially to dilution and unclear labelling. Many people use the term aromatherapy to sell aromatic oils containing isopropyl alcohol for commercial gain, but those promoting aromatherapy education are selling good-quality essential oils.

Essential oil use

Essential oils are used mainly by aromatherapists and cosmetologists, although some masseurs, holistic therapists and doctors also use them. They are increasingly being recognized in hospitals and care centres.

The main methods of use are by application, massage, inhalation from tissues and vaporization, although because the weather is rather humid in Taiwan, application is less acceptable.

Education

During the 1990s people went to England or Australia to study aromatherapy, returning to promote the knowledge they had learned. At the turn of the century a few universities and private training schools began to offer aromatherapy courses, many inviting members from the International Federation of Aromatherapy (IFA) and the International Federation of Professional Aromatherapists (IFPA) to lecture. In 2004, one school became a branch of the IFPA-accredited Penny Price Academy in the UK. The syllabus covers anatomy and physiology, massage, chemical profiles, the effects of essential oils and methods of use.

In 2000 the Taiwan Institute of Aromatherapy, established in 1996, was invited to lecture in hospitals and schools, also by the Ministry of Education to give an aromatherapy seminar–workshop for professors and teachers from national universities. As a result, several universities have established aromatherapy as elective or required courses. Owing to this increase in knowledge, aromatherapy is now more recognized and accepted by the medical profession, giving people more confidence in essential oils.

More and more education and training institutions come from Australia, Germany, the United States of America and the United Kingdom. The content of these courses is very different: Australian correspondence courses lack technical knowledge, German association courses contain too few hours, and too many institutions with inadequate standards are recognized by an American association. Most people are not aware of the value of belonging to an association, nor do they appreciate the necessity for an aromatherapist to have a recognized qualification.

Use of essential oils in medical establishments

Aromatherapy is used in palliative care hospices, usually on cancer patients. Some educational institutions ask trained aromatherapists to do volunteer work in hospices, which is starting to attract the attention of the medical profession. Since Dr Robert Stephen and Penny Price came to Taiwan in 2005 to give professional training courses related to cancer patients, a team from the Institute of Aromatherapy has been helping terminal cancer patients every week for over 5 years.

People with cancer experience different symptoms of distress, and in 2004 a paper was written* on the application of aromatherapy in cancer patients, discussing the following topics:

Although focused on the care of cancer patients, the Institute of Aromatherapy team’s services also extend to the care of patients’ families. Currently five or six hospitals and institutions promote aromatherapy care, and the Penny Price-trained aromatherapists are recognized by the hospitals. In 2009 aromatherapy became part of the supplementary medical outpatients’ service.

Associations

There is no independent national organization/association for aromatherapy and each school works individually, which means that at present it is not possible for therapists to gain recognition for their training, as all standards are accepted. It is to be hoped that there will be an independent national organization in the near future, although it may be difficult to establish one because of the political situation in China.

Research

Several academic or medical institutions have in recent years begun to carry out aromatherapy-related research and pilot studies: these include cancer, air quality purification and improving health problems such as depression, dysmenorrhoea, dementia in the elderly, haemorrhoids, asthma, oedema and fatigue. Hopefully, experience in aromatherapy clinics and research can be exchanged internationally, so that every country benefits.

Aromatherapy development

Aromatherapy appeared in California in the mid-1980s, America’s first conference being held in Los Angeles in 1990, followed by New York in 1994; several are now held in different states each year.

Healthcare is paid for privately and only a few insurance companies cover complementary therapies, making it difficult for hospitals to provide these services. Nurses belonging to the National Association of Nurse Massage Therapists (NANMT) were among the first to introduce aromatherapy into mainstream hospitals, and many leading healthcare institutions now use aromatherapy. The Massachusetts State Board of Nursing was the first to include aromatherapy in its Nurse Practice Act, an example followed by 25 other State Boards.

Clinical aromatherapy is gaining popularity, with widespread use by nurses throughout the country – nurses in several hospitals have written, or are writing, protocols for their facility, and the medical profession is beginning to show some acceptance. Some nurses have set up trials in medical/hospital settings (see Research/pilot studies below).

Regulations

At present there is no state registration for the practice of aromatherapy – anyone can set up as an ‘aromatherapist’.

Education

There are many bogus accreditation claims in aromatherapy education – the only legitimate accrediting bodies in the United States are those approved by the US Department of Education.

The American (formerly Australasian) College of Health Sciences was the first school in the USA to offer this government-approved certificate, although other excellent courses are available (see AIA, AHNA and NAHA websites).

Academic programmes range from study at a university (usually in phytotherapy) to distance learning, including those endorsed by accrediting bodies such as the American Holistic Nurses Association (AHNA) and approved providers offering continuing education units (CEUs) to healthcare professionals. The Aromatherapy Registration Council (ARC) provides an aromatherapy curriculum with a national examination twice a year in 30 states, open to anyone who has completed a minimum of a Level 2 aromatherapy programme (200 hours). Successful candidates qualify for insurance.

In 2008, in an effort to raise the standard of aromatherapy training for clinical settings, the AIA established Level 3 Curriculum Guidelines (minimum 400 hours). These include additional anatomy and physiology, pathologies and chemistry. Schools offering aromatherapy training programmes with less than 400 hours to nurses and other healthcare students can apply for ‘advanced placement credit’ through the AIA in an effort to bring their students to the 400-hour level.

Essential oils and methods of use

Pure essential oils are not easily available in retail shops, many fragrance oils being labelled ‘aromatherapy oils’; this makes it difficult for untrained people to know the difference. Essential oils are often associated with ‘new age’ stores (not all credible), thereby undermining the true value/properties of essential oils. Nevertheless, a few legitimate essential oil companies are trying to compete against the mass ‘aromatherapy fragrance’ market.

In the cosmetics industry the term aromatherapy is often misused, with little distinction given between essential oils and fragrance oils. In an attempt to address this problem, the Safe Cosmetics Act 2010 (HR 5786) was introduced into the House of Representatives in July 2010.

Essential oils are used in application, baths, gargles, compresses; an aromatherapy treatment is usually combined with another treatment, e.g. reflexology.

Aromatherapy organizations advise therapists against internal use of essential oils; insurance is not given for the ‘European’ practice of aromatherapy, because of the likelihood of insurance liability lawsuits.

Use of essential oils in medical establishments

Clinical aromatherapy is recognized and respected by nurses, with successful studies being set up in pain control, cardiology, psychiatry, obstetrics and gynecology, pediatrics, dermatology, oncology, senior care and immunology. Aromatherapy is also gaining acceptance for the care of the chronically and terminally ill, patients now rarely being given hypnotics to regulate sleep patterns. Several hospitals use aromatherapy to aid sore muscles, bruises and vein relief, stress and insomnia. Where essential oils are used on the elderly, the need for antipsychotic drugs has been noticeably reduced. The main methods of use are inhalers, baths, compresses and massage.

Associations

The National Association for Holistic Aromatherapy (NAHA), founded in 1990, is an educational, non-profit organization dedicated to enhancing public awareness of aromatherapy. It offers a quarterly journal and teleconferences, and has established a code of ethics for teachers, practitioners and students. It provides a listing of schools, colleges and educators offering approved Level 1 and 2 syllabi. NAHA offers professional, product and general liability insurance to its professional members.

The Aromatherapy Registration Council (ARC) was established in 1999 as a public benefit, non-profit corporation, independent of any paid membership organization or educational facility, thereby ensuring an impartial and unbiased body. The ARC provides an aromatherapy curriculum and sponsors a national examination (see Education above). Successful candidates may use the letters ‘RA’ (Registered Aromatherapist) after their name. Registered Aromatherapists, of which there are 449 (2010), have to renew their membership every 5 years and meet continuing education requirements.

The Alliance of International Aromatherapists (AIA) is a non-profit organization, officially launched in 2006 and adopting a code of ethics and standards of practice in 2007. The AIA education committee fosters high standards of safe, ethical and professional practice in the clinical use of essential oils; in 2008 it raised the standard of Level 1 and 2 education and established Level 3 guidelines, assuring the competency of practitioners of clinical aromatherapy and the promotion of essential oil research. Aromatherapy schools can submit their curriculum for AIA recognition. Educational opportunities are developed for the public and members through monthly newsletters/teleconferences and annual conferences.

The Associated Bodywork and Massage Professionals (ABMP) offers membership to aromatherapists who have completed 100 hours or more of training with an institution or educator registered by their own state. Membership includes professional liability insurance.

Research/pilot studies

In early 2010 a pilot programme was conducted by Hope’s Circle of Friends, in the children’s palliative care facility of the Northeastern Hospice of Illinois, the aim being to improve their quality of life. Many children are exhibiting a significant benefit with regard to agitation, muscle contractures, sadness, alertness and tinea. A second study was started in June 2010.

A successful pilot study was carried out at the San Diego Hospice in California, protocols being included in a guide for physicians and healthcare professionals treating palliative care patients. It is part of the Pal-Med Connect programme created by the Institute for Palliative Medicine.

A research study is currently being conducted in an Indiana hospital to reduce the effects of anxiety and depression in high-risk postpartum mothers.

Summary

In most countries (with the exception of France, Belgium and Germany) aromatherapy has developed from aromatherapy as practised in the UK. Some countries are not yet allowed to practise in hospitals, others can work with the express permission of the nurse or doctor in charge – and still others have advanced further than the UK in their freedom to work in these establishments.

Acknowledgements

The editor (S. Price) would like to thank those who responded to her request for an update to the information on their country, as well as those who sent information for the new countries. Their names appear beside their country. She is disappointed that some countries in the third edition did not respond to her request for an update and are therefore not included in this edition.