Ethics can be defined as the moral and legal guidelines which govern professional behavior.
Scope of Practice
As defined by Florida Statutes chapter 480, massage therapists may perform the following treatments.
1) Manipulation of the soft tissues of the human body using the hand, foot, arm or elbow
3) Colonic Irrigation (with additional licensing)
4) Thermal therapy
5) The use of any electrical or mechanical device
6) The application to the human body of a chemical or herbal preparation
Informed consent defines the client/practitioner relationship and empowers the client by allowing them to make a knowledgeable decision about their treatment options based upon the therapist's credentials and experience. The following parameters should be addressed.
1) Session goals and objectives, number of treatments needed
2) Type of services provided and any specialized training and experience you have
* session length
* cancellations and late arrivals
* innapropriate behavior/ sexual misconduct
Any personal information revealed by the client, both verbal and written, is considered private. Files should be properly secured and client information should not be shared with anyone, except under the following conditions.
1) Client is a minor (parent or guardian must authorize and stay informed)
2) Other professionals are treating the client. The client must sign a release of information form authorizing the distribution of information
3) Court ordered release
Clients enter into the therapeutic relationship with life experiences and personal opinions that will affect their comfort zone. Some ways to minimize this are as follows.
1) Ask the client if there is any part of the body that they would prefer not to have massaged, i.e. feet, head, etc.
2) Be sure to employ secure draping and offer blankets and table-warmers.
3) Be attentive to verbal and somatic cues regarding pressure, type of massage, music, room temperature, and lighting.
As therapists we also bring our own prejudices and emotional baggage into the the therapeutic relationship. One way to minimize this is to make every client a member of your extended family. This allows you to see everyone from a position of love and compassion. For example, the elderly man with bad hygiene becomes your grandfather. The obese lady who unloads all her troubles onto you, becomes your aunt. You get the idea.
Right of Refusal
A client has the right to terminate the session at any time (even before it starts), should they not feel comfortable receiving a massage from the therapist. They do not need to explain why.
Therapists also have the right of refusal, but need to disclose to the client why they cannot work on them properly. A referral should be given to a therapist more capable of being objective.
Transference occurs when the client tries to personalize the professional relationship. A certain amount of familiarity is bound to occur as the client becomes comfortable with the therapist and begins to share personal aspects of their life. Transference becomes a problem when the client projects unrealistic expectations unto the therapist. This can manifest in different ways:
1) Offers of friendship- Going out for coffee or lunch might sound innocent, but still changes the dynamic of the relationship.
2) Wanting to date the therapist- This client has crossed the line and should be referred to another practitioner. If the feeling is mutual you should not have any contact for at least twelve weeks (some sources say six months) and then proceed at your discretion.
3) Gifts- Cash tips are appropriate (and greatly appreciated) but personalized gifts in lieu of cash are suspect. Expensive gifts like jewelery and event tickets should be refused.
4) Placing the therapist on a pedestal- Fill in the blank. You are the only one who ____________
a. understands them
b. can help them
c. makes them feel better
This can only end badly!
Countertransference occurs when the therapist loses perspective of the professional relationship.
Stay objective- You can't get emotionally involved. When the client is on your table you need to be one hundred percent present and focused on using all of your knowledge and skill to help the client. When the session is over do not think about the client again until their next appointment. If you cannot relax in the evening or you wake up thinking about a client, you are too emotionally involved.
During a massage session, everything we think and feel is transferred through our hands and into the client. Anger, worry, sadness and other negative emotions have no place during a session. We should clear our minds of all mundane thoughts and place our focus purely on the clients muscles and what we feel. In this way, massage becomes a meditative practice where the therapist can benefit as much as the client.
Codes of Ethics
Professional organizations usually adopt a code of ethics for its members. Here are several I have compiled.
AMTA Code of Ethics
Massage therapists shall:
1. Demonstrate commitment to provide the highest quality massage therapy/bodywork to those who seek their professional service.
2. Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues.
3. Demonstrate professional excellence through regular self-assessment of strengths, limitations, and effectiveness by continued education and training.
4. Acknowledge the confidential nature of the professional relationship with clients and respect each client's right to privacy.
5. Conduct all business and professional activities within their scope of practice, the law of the land, and project a professional image.
6. Refrain from engaging in any sexual misconduct or sexual activities involving their clients.
7. Accept responsibility to do no harm to the physical, mental, and emotional well-being of self, clients, and associates.
National Certification Board for Therapeutic Massage and Bodywork
Massage and bodywork therapists shall act in a manner that justifies public trust and confidence, enhances the reputation of the profession, and safeguards the interest of individual clients. To this end, massage and bodywork therapists in the exercise of accountability will:
1. Have a sincere commitment to provide the highest quality of care to those who seek their professional services.
2. Represent their qualifications honestly, including education and professional affiliations, and provide only those services that they are qualified to perform.
3. Accurately inform clients, other healthcare practitioners, and the public of the scope and limitations of their discipline.
4. Acknowledge the limitations of and contraindications for massage and bodywork and refer clients to appropriate health professionals.
5. Provide treatment only where there is reasonable expectation that it will be advantageous to the client.
6. Consistently maintain and improve professional knowledge and competence, striving for professional excellence through regular assessment of personal and professional strengths and weaknesses and through continued education training.
7. Conduct their business and professional activities with honesty and integrity, and respect the inherent worth of all persons.
8. Refuse to unjustly discriminate against clients or health professionals.
9. Safeguard the confidentiality of all client information, unless disclosure is requested by the client in writing, is medically necessary, required by law, or necessary for the protection of the public.
10. Respect the client's right to treatment with informed and voluntary consent. The certified practitioner will obtain and record the informed consent of the client, or client's advocate, before providing treatment. This consent may be written or verbal.
11. Respecting the client's right to refuse, modify, or terminate treatment regardless of prior consent given.
12. Provide draping and treatment in a way that ensures the safety, comfort, and privacy of the client.
13. Exercise the right to refuse to treat any person or part of the body for just and reasonable cause.
14. Refrain, under all circumstances, from initiating or engaging in any sexual conduct, sexual activities, or sexualizing behavior involving a client, even if the client attempts to sexualize the relationship.
15. Avoid any interest, activity, or influence which might be in conflict with the practitioner's obligation to act in the best interests of the client or the profession.
16. Respect the client's boundaries with regard to privacy, disclosure, exosure, emotional expression, beliefs, and the client's reasonable expectations of professional behavior. Practitioners will respect the client's autonomy.
17. Refuse any gifts or benefits that are intended to influence a referral, decision, or treatment, or that are purely for personal gain and not for the good of the client.
18. Follow all policies, procedures, guidelines, regulations, codes, and requirements promulgated by the National Certification Board for Therapeutic Massage and Bodywork.
To complete this class please take the self test and check your answers at the bottom of the page.
The following reference material was used in the making of this class.
Mark F. Beck
Theory & Practice of Therapeutic Massage Fifth Edition
New York 2010
Mosby's Fundamentals of Therapeutic Massage Third Edition
Chapter 480 Florida Statutes