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Chapter 2 / Ethics and Professionalism 41
code of ethics is only a guideline for behavior. The extent to
which you follow the code depends on your conscience and
your willingness to be responsible for your behavior.
Accountability
Accountability is the quality of accepting the consequences
of your actions and claiming responsibility for your
decisions. Accountability requires that you look beyond the
immediate moment or situation and consider all the consequences that may be your responsibility. Ethical behavior is
influenced by our accountability when we choose to behave
a certain way and are willing to accept the results of that
behavior. Professional massage therapists understand the
generally accepted scope of practice, they understand the
repercussions of unacceptable behavior, and they make
their own choices about what happens in the treatment
room. Inaddition to holding yourself accountable for your
behavior, you can also be held accountable by your clients,
by a professional organization, by the profession as a whole,
by your community, or by the law.
You have to be honest with yourself and others regarding the techniques and services you provide. Going outside
your scope of practice is unethical behavior and, depending upon the situation, may be illegal. For example, telling
a client to take ibuprofen for inflammation from an injury
may be considered diagnosing, prescribing, or even practicing medicine without a license. These activities are out of
the massage therapist’s scope of practice, and it is against
the law to perform them. On the other hand, recommending that the client apply ice to an area that has received specific massage treatment is most likely within the scope of
practice for massage therapy.
Rules exist in all aspects of life, but it is an individual’s
choice to follow them. It is your responsibility to keep yourself within the limits set by regulation, certification, scope
of practice, or membership in a professional organization.
Your words and actions will affect the world around you and
the massage therapy profession as a whole. Make thoughtful
decisions based on accountability to maintain your integrity
and stay within your scope of practice.
Ethics for the Profession
Professional ethics are rules for acceptable behavior that are
set forth for all members of a profession to follow to ensure
a client-centered philosophy and maintain the integrity of
the profession. You not only have a responsibility to use professional ethics in your own practice but also have a responsibility to make sure your peers are practicing professional
ethics. The reputation of the entire profession is at stake,
and unethical behavior on the part of one massage therapist
can quickly spread through a community and damage the
reputation of massage for years.
At some point during your career, you may suspect a
colleague of unethical or illegal behavior. This can be an
awkward and difficult position. Sometimes we have been
taught to mind our own business and that nobody likes a
tattletale, and sometimes we feel compelled to rectify an
inappropriate, unfair, or improper situation. If you suspect
that a colleague has behaved unethically or illegally in some
way, you have to decide whether you will attempt to investigate the situation further. It may be possible to resolve
the situation without help, but it is probably better to let an
outside source, such as a professional organization or the
government, resolve the issue.
Reporting Unethical Activity
Professional organizations want to uphold their codes of
ethics and are willing to spend time and resources to make
sure that their members maintain a good reputation. The
AMTA and the ABMP both have formal grievance procedures. The first step usually requires you to submit a description of the facts and nature of the suspected violation in
writing. Once the grievance has been filed, the therapist in
question will be informed of the suspected incident. From
there, the rest of the resolution process is kept confidential,
usually handled by the board of directors unless objective
mediation or legal action is deemed necessary.
Resolving an ethical dilemma can be complicated if
the therapist in question is not a member of a professional
organization. You may need to look into the local or state
laws that apply to massage therapy. In the states that do
not regulate massage therapy with licensure, local regulations govern the practice of massage therapy. State licensure laws usually supersede the local regulation, meaning
that the state laws carry more weight and are more consequential than the local laws. Each locale or state has its
own process for filing and handling complaints and suspected illegal activity.
An example is Washington State’s Department of
Health Complaint and Disciplinary Process, which designates more than a dozen people to be the decision makers.
They review incoming complaints and determine whether
public safety or a person’s health may be affected by the
situation in question. If health or safety is in danger, an investigation will be made. Disciplinary action can be applied
in the form of a lawsuit, fines, limitations imposed on the
practice, or suspension from practice. The Washington State
Department of Health claims responsibility to public protection by imposing the disciplinary action and also attempts to
rehabilitate the healthcare professional with counseling and
retraining.
4
42 INTRODUCTION TO MASSAGE THERAPY
To locate other information regarding the governmen-
tal regulation of massage therapy, you can search the internet with state name ⫹ regulation ⫹ massage. If you prefer
to have a hard copy version of this information, you can
contact your local department of health to see if they can
direct you to the appropriate regulatory body. Additionally,
your massage school or training program will most likely be
aware of the appropriate regulatory agencies you will need
to contact upon graduation.
Resolving Ethical Dilemmas
There will most likely come a time when you, as a professional massage therapist, will be faced with making an ethical decision regarding your practice. Codes of ethics serve
as guidelines for these decisions, but they do not guarantee
that the decisions will be easy to make. When faced with
an ethical dilemma, it is helpful to make a decision that is
based on the highest good for all. The decision-making
process outlined below, which is only one of many equally
helpful methods, involves a series of steps for resolving ethical dilemmas:
1. Identify the problem or situation and gather any
relevant information.
2. Identify the nature of the conflict: legal, moral, ethical,
or a combination.
3. Identify the person, condition, or results that will be
affected by the decision.
4. Brainstorm different decisions and the potential outcomes of each.
5. Consider different perspectives: your intuition, community, peers, legal.
6. Determine whether rules, codes of ethics, or laws
invalidate any of the decisions.
7. Determine the best course of action. Will the client or
you be harmed? Is it the most helpful thing to do?
Box 2-6 shows an example of using the 7-step guideline
to ethical resolution.
An Example of Ethical Resolution Using the 7-Step Guideline
DILEMMA
A client insists that you use a skeletal adjustment technique that
you have not learned. How should you handle this situation?
1. Identify the problem or situation and gather any relevant
information
You have to decide whether to try an unfamiliar technique
or disappoint your client.
2. Identify the nature of the conflict: legal, moral, ethical, or a
combination
The technique is outside your scope of practice, which
makes it a possible legal conflict, and you are unfamiliar
with a technique, making it ethically wrong to try it because
it may harm the client.
However, your client is insisting that you use the technique,
and your client-centered philosophy encourages you to
serve the client’s needs.
3. Identify the person, condition, or results that will be
affected by the decision
Your client could get hurt, your professional membership
could be revoked, or your practice could be suspended by
law if you attempt the technique.
However, the client might not return because you will not
address his or her needs, thus affecting your practice.
4. Brainstorm different decisions and potential outcomes of
each
a. You could explain your professional and ethical
commitments to scope of practice and hope the client
understands.
b. You could attempt the technique and hope that it works
and that the client does not get hurt.
c. You could pretend to perform the technique and hope
the client does not continue to push you.
d. You could adamantly state that you will not attempt the
technique because it is not a massage technique and
tell the client that if he or she is not happy with your
massage services, he or she can go elsewhere.
5. Consider different perspectives: your intuition, community,
peers, legal
Intuition tells you to explain things to the client and hope
for understanding, which is probably the same thing your
peers and community will suggest.
The law does not have a preference how you handle it, as
long as you do not attempt the technique.
6. Determine whether rules, codes of ethics, or laws invalidate
any of the decisions
By law, skeletal adjustments are outside the scope of
practice for massage therapy, so you may not attempt the
technique.
Pretending to perform the technique and lying to the client
about the technique not working is unethical.
7. Determine the best course of action: Will the client or you
be harmed? Is it the most helpful thing to do?
The best course of action is probably to gently explain
scope of practice and hope for understanding. It protects
the client from being hurt, it protects your practice from
being sued or suspended, and it allows you to practice
yourethics.
Chapter 2 / Ethics and Professionalism
43
Professionalism is defined as the conduct, goals, and qualities that generally characterize a profession. There is often a
sense of maturity, patience, and awareness that accompanies
professionalism. Typically, professionalism refers to conduct,
business practices, legal and ethical responsibilities, and membership in professional associations that create your public
image. You never get a second chance to make a first impression, so the image you portray when people first come in contact with you on a professional level should be a good one.
Conduct
A respectable and reputable professional image is influenced
by appropriate conduct. There are codes of ethics to provide
guidelines for professionalism, which are discussed above,
but there are other factors that contribute to your public
image. Any input people receive with their eyes, ears, and
nose will be used to develop an image of you as a professional, so your conduct includes the visual, auditory, and
olfactory cues you project.
Visual Cues
Clients will see facial expressions, eye contact, posture,
cleanliness, what you wear, and how you dress. Your
facial expressions can convey emotion, exhaustion, stress,
distraction, interest, or disinterest. Eye contact can express
interest or disinterest, confidence, patience, and self-esteem.
Posture can indicate your level of exhaustion, self-esteem,
depression, shyness, or self-consciousness. Cleanliness of the
practice, treatment room, equipment, your body, and your
clothing may illustrate the level of pride in your practice or
how careful you are.
Clothing is always used to evaluate people, both what
they wear and how they wear it, so keep that in mind as you
consider your professional image. The following are some
guidelines for appropriate clothing and appearance for a professional massage therapist:
disruptive. Why breathable fabric? Massage is physical work
that creates body heat, and cotton, linen, or cotton blends
are cooler and more comfortable. Why loose clothing?
Tight, form-fitting clothes restrict movement and can distract the client from the professional atmosphere. Why tie
back long hair? Pushing hair out of your face throughout a
massage is distracting, and you do not want your hair to accidentally touch the client during the treatment, for sanitation
and hygiene reasons. Why limit jewelry? Excessive jewelry
is a visual distraction that can also interfere with massage
strokes and scratch skin. Why clean and intact clothes?
Holes, tears, and stains are visually distracting. Visual input
is the primary ingredient for a professional image. Figure 2-1
shows examples of professional attire.
There are some visual aspects of the practice that will
also contribute to your professional image. Business cards
and brochures are intended for public use, and they significantly influence your image. The quality of these marketing
tools is measured by the paper, the colors, the layout, and the
included information. Business marketing tools are covered
in more detail in the professional massage practice chapter.
Auditory Cues
The words you speak; the tone you use; the volume, pace,
and clarity of your speech; and the emotions you convey
with your speech all contribute to a client’s perception of
your professional image. From the moment you exchange
the first spoken words, whether over the phone or in a faceto-face meeting, you are creating a professional image that
your client will associate with you. The fact that communication skills are critical may seem like common sense,
so we address this topic very broadly. Discuss your policies
and procedures with your clients and make sure there is no
• Short sleeves
• Breathable fabrics
• Loose, comfortable clothes
• Long hair tied back
• Minimal or no jewelry
• Clean, intact clothes and shoes
Why short sleeves? Long sleeves interfere with massage
strokes and pushing sleeves up throughout the massage is
Figure 2-1. Examples of professional attire.
44 INTRODUCTION TO MASSAGE THERAPY
confusion. Use your answering machine, voice mail box, or
email as a communication tool. Let your clients know that
you will return their messages within 24 to 48 hours, or let
them know if you are unavailable for an extended period
of time. Tone and attitude can be interpreted through your
voice, so be careful to speak clearly and audibly, with a
friendly and professional tone.
The sounds of your practice’s environment add to your
professional image. Traffic noise, nearby conversation, clocks,
alarms, televisions, radios, bathroom noises, and pets may
be distracting and detract from a professional image. Gentle
music with a slow tempo and the natural sounds of water,
birds, and wind can provide a more tranquil atmosphere that
will encourage clients to relax and let go of their stress.
Olfactory Cues
Odors can evoke strong, emotional responses. Try to stay
aware of any odors that might be present in your practice.
Body odor, breath odor, and foot odor are especially offensive to a lot of persons, so check throughout the day and
take preventive measures to avoid these problems. Many
persons are sensitive to scented products, so perfumes and
colognes should be used sparingly, if at all. Environmental
smells will also affect your professional image. Garbage,
food, pets, air fresheners, and chemical cleansers have odors
that will be noticed, and not necessarily in a good way. You
may want to ask a friend with an objective nose to check the
surroundings of your practice and identify any odors that
should be eliminated.
Sanitation, hygiene, and safety are concepts that support
massage therapy’s client-centered philosophy. Sanitation is
the act of keeping your practice clean enough to prevent disease transmission. Professional standards of practice dictate
a sanitary environment for the benefit of you, your clients,
and the general public. A similar concept is hygiene, which
is the act of keeping things clean to promote health. Safety
is the condition that prevents physical harm to a person and
applies to everything your clients will use: parking area,
walkway, steps, bathroom, treatment room, equipment,
floors, and furniture. Fire safety is specifically addressed by
law, covering fire extinguisher placement, fire escape route,
maximum capacity of people in a building, the use of open
flames, and smoke detectors. You can learn about sanitation
and safety regulations from your local regulatory agency
and fire department.
Marketing your business can be as low or high budget
as you want. Word-of-mouth advertising is possibly the least
expensive, and although it can be very effective, it is limited
by the people who recommend your services. Business cards
are an inexpensive but almost necessary marketing tool. Selfpromotion involves you, sharing and educating people about
the benefits of your services through demonstrations and
public speaking. Promotional brochures and pamphlets are
useful and attractive, but they can be expensive. Local media
can provide some other avenues for marketing your services, including newspaper articles, television interviews or
demonstrations, and radio shows or commercials. Whatever
method(s) of marketing you choose should be professional
and ethical.
Business Practices
Standards of practice for massage therapy include everyday business practices such as record keeping, sanitation,
hygiene, safety, and marketing. These topics are detailed in
Chapter 13, but they are outlined below.
The following are some aspects of your practice that
require record keeping:
• Appointments
• Client information
• Client health history
• Massage session notes
• Meetings
• Work-related travel
• Business-related purchases (e.g., equipment, lubricants, business cards)
• Business-related expenses (e.g., laundry, professional
memberships, utilities)
• Income
Legal Requirements and Ethical Responsibilities
There are legal requirements and ethical responsibilities
associated with standards of practice that influence the
foundation of the therapeutic relationship. We have covered
legalities in terms of local or state regulations, including
licensure, certification, and registration, scope of practice,
and fire safety. Additionally, there are the two important
principles of informed consent and confidentiality.
Informed Consent
Informed consent , sometimes called patient rights, is a
client’s agreement to participate in an activity after the
benefits and risks of the activity have been explained and
the client understands that he or she has the right to withdraw at any time. Basically, clients who are informed about
a treatment give their consent to try it. The concept of
Chapter 2 / Ethics and Professionalism 45
informed consent was started in the medical profession as
a way to empower patients by attempting to prepare all parties involved and avoid any unpleasant surprises. Educating
persons about their healthcare and allowing them to make
an educated decision about whether they want to participate
or not gives them a sense of comfort and control instead
of feelings of vulnerability and powerlessness. Utilizing
informed consent in a massage practice gives clients an
opportunity to be engaged in the massage treatment and
can facilitate a teamwork approach to healthcare in a clientcentered practice. Informed consent benefits and protects
clients because it:
• Provides the client the opportunity to ask questions
• Allows the client to completely understand the rules
and policies of the massage therapy session
• Clarifies what the massage session will and will not
include
• Identifies the benefits and possible contraindications
of massage or a particular technique
• Provides the opportunity to participate willingly in
their healthcare by choosing to receive massage or
specific techniques
• Allows the client to refuse treatment or stop treatment at any time
• Provides the opportunity to validate and verify the
therapist’s credentials
For the therapist, informed consent provides a signed
statement that represents the therapist’s good intentions
and the client’s education and awareness about massage. See
Figure 2-2 for different examples of informed consent.
Clients are given the right of refusal and the control for
session termination. While the therapist is ultimately responsible for maintaining boundaries and respecting limits, the client also has the capability and responsibility to do the same.
Clients and therapists must adhere to the policies and procedures of the office, and both maintain the right to terminate or refuse treatment if there is reasonable cause. Specific
conditions that would prompt session termination are often
stipulated in the therapist’s policies and procedures, which
the client should have read and accepted during the initial
intake. Generally, these situations include anything that violates or could interfere with safe and ethical treatment. Any
activity that sexualizes the massage treatment is grounds
for termination: sexual or lewd comments, gestures with a
sexual connotation, intentional genital exposure, or intentional sexual contact of any kind. Clients who are repeatedly
late or who repeatedly cancel appointments demonstrate a
lack of respect for the therapist’s practice and can be refused
treatment if the therapist feels it is justified. The client must
feel comfortable and agree to participate with a particular
therapist, but it is equally important for the therapist to feel
comfortable and agree to work with a particular client.
Confidentiality
Confidentiality is the principle that information revealed
to a massage therapist during an appointment is to be kept
private except under limited circumstances when that information is to be disclosed to a third party. Keeping client
information confidential, or private, helps establish trust and
respect between the client and the therapist. If clients want
to tell people what is said or experienced in the therapeutic
setting, it is up to them to do so. It is ethically, and maybe
legally, wrong for you to share that information without the
client’s permission because you have promised to keep the
information private. It is professionally wrong because you
have agreed to uphold the professional standards of practice,
which include confidentiality. Generally, as long as there
is no direct or implied association to any specific person’s
identity, the shared information is probably allowed. There
are many situations in which confidentiality may need to be
broken, and each such circumstance will require that you
make an ethical decision.
For example, you may want to discuss a client’s condition
or treatment plan with another healthcare professional and
would need to share specific and thorough details about the
client’s condition. The best course of action would be to have
a conversation with your client, explain your intention, and
obtain the client’s permission to disclose the information. The
client should identify the details that can be shared, including
names, dates, locations, conditions, treatments, or outcomes,
as well as any limitations on where, when, or how you plan to
use the information. To allow professionals to exchange information, you can ask the client to sign a standard release form.
See Figure 2-3 for examples of release forms.
You must break confidentiality in any situations that
indicate a clear and imminent danger to someone’s life, such
as intended suicide, murder, personal endangerment, or
abuse or neglect of a child, elderly person, or mentally challenged individual. It is your ethical responsibility to report
these situations, but many states have established laws that
require certain professionals to report suspected abuse.
Courts of law can subpoena any of your client files.
Names, contact numbers, health histories, treatment notes,
and account balances are all subject to being surrendered by
subpoena. This situation does not occur frequently, but it
does happen. Records should always be accurate, organized,
and thorough, and extraneous and irrelevant notes, such as
client’s emotional state or comments on behavior, should
never be kept in client files.
There are confidentiality issues to manage outside the
treatment room as well. Unless clients approach you in public first, try to refrain from greeting them. They may not
want people to know that they are receiving massage treatment, or they may not want their relationship with you to
be public. Take your cues from the clients. If they openly
acknowledge their professional relationship with you,
46 INTRODUCTION TO MASSAGE THERAPY
I understand that the massage therapy given here is for the purpose of stress reduction,
relief from muscular tension, spasm or soft tissue injury, or for increasing circulation and
energy flow. I understand that massage therapists do not diagnose illness or disease, nor
do they prescribe any medical treatments or perform spinal manipulations. I
acknowledge that massage is not a substitute for medical examination or diagnosis, and
it is recommended I see a healthcare professional for that service. I have stated all
medical conditions and will update the massage therapist with any changes in my health
status. I understand that sexual advances and/or comments will result in immediate
termination of the massage session with full payment due. I understand that massage
sessions are available by appointment only, and if I am unable to keep my appointment, I
will inform the massage therapist within 3 hours of the appointment or I will be charged a
cancellation fee.
Signature: ____________________________________________ Date: __________
I understand that massage therapy is intended to maintain and improve my general health
by increasing circulation, reducing stress, and promoting relaxation. In order to minimize
any health risks, I have provided all my known medical information and will inform the
therapist of any new medical information I acquire as long as I am under the therapist’s
massage treatment. I acknowledge that manual therapy is not a substitute for medical
treatment and that the massage therapist cannot diagnose or prescribe any medical
conditions.
Signature:_____________________________________ Date: _____________
I promise to participate fully in my healthcare as part of a team of professionals. I will
make choices about my treatment based on the information provided regarding the
benefits, risks, and procedures involved. I agree to help choose and participate in any
self-care activities that may be recommended in order to promote health and healing. I
promise to inform my therapist(s) if I feel uncomfortable or that my health is being
compromised during any treatment. In turn, I expect my therapist(s) to provide safe
and effective, knowledgeable care that is in the best interest of my health and well
being. I promise to keep my therapist(s) informed of any health or medical concerns,
conditions, or treatments while I am receiving massage therapy in order to minimize
any risks.
Signature: _____________________________________ Date: ________________
Figure 2-2. Examples of informed consent.
Chapter 2 / Ethics and Professionalism
47
Figure 2-3. Examples of release forms. (Reprinted with permission from Thompson D. Hands Heal: Communication, Documentation,
and Insurance Billing for Manual Therapists. 2nd ed. Baltimore: Lippincott Williams & Wilkins, 2002.)
48 INTRODUCTION TO MASSAGE THERAPY
Figure 2-3. (continued)
Chapter 2 / Ethics and Professionalism 49
respond with a professional demeanor. If you make eye contact with clients who do not openly recognize or acknowledge a relationship with you, let them go. It is possible that
they do not remember you, but it is also possible that they
are not interested in a public relationship.
Confidentiality is a standard of care that is imperative
to the professional therapeutic relationship by guaranteeing
the clients that whatever happens in the therapeutic setting
is private and protected. There are ethical and legal responsibilities that massage therapists should be aware of and
understand.
Professional Associations
A professional image is often supported by membership
in professional organizations. The original massage associations were established to protect the massage profession,
and they have since evolved to provide a number of benefits
to their members. Different levels of insurance coverage,
marketing and promotional media, networking groups, and
continuing education are just some of the options available
to members of professional massage associations.
Professional Associations
inBritain
Chapter 1 described the British Medical Association’s discovery of unethical massage practices and how the massage profession prevailed, despite its tarnished reputation.
At that time, if a massage therapist was associated with a
physician or hospital, the massage was still considered legitimate. Agroup of four women in Britain decided to protect
the massage profession by forming the Society of Trained
Masseuses in 1894. Lucy Marianne Robinson, Rosalind
Paget, Elizabeth Anne Manley, and Margaret Dora Palmer
founded the society using the standards for the medical profession as their model. They established academic prerequisites for training, outlined criteria for qualified instructors,
and inspected schools on a regular basis. Massage instructors
and graduates were required to take written and practical
examinations before a board, which included a physician.
They maintained high standards and set membership regulations, requiring the massage professionals to only accept physicians’ referrals and to avoid advertising through the media.
Many members abided by the many rules and regulations of the society, but there were still a number of massage therapists who continued to practice unethically. By
1900, the group became the Incorporated Society of Trained
Masseuses. In 1920, a Royal Charter was granted, the group
joined forces with the Institute of Massage and Remedial
Gymnastics, and the Chartered Society of Massage and
Remedial Gymnastics was established. With several branches throughout Britain, the widely respected society reached
a membership of 12,000. In 1944, the society changed its
name to the Chartered Society of Physiotherapy, which
remains its name today.
Professional Associations
inAmerica
Soon after the British started the movement toward professional massage therapy, a flurry of professional activity
began in the United States as well:
• 1927—The New York State Society of Medical
Massage Therapists was America’s first professional
massage association to be established
• 1939—The Florida State Massage Therapy
Association was organized with 85 charter members
• 1943—The first Massage Act was passed by the
Florida legislature
• 1943—The American Association of Masseurs and
Masseuses (AAMM) was formed in Chicago
• 1949—AAMM established the Massage Registration
Act, a state law requiring massage therapists to register with the state
• 1958—AAMM became the American Massage and
Therapy Association (AM&TA)
• 1983—AM&TA became the current AMTA
• 1987—ABMP was founded in Colorado
The AMTA still exists today, providing massage therapists with professional liability and other insurance, membership standards for education and continuing education, a code
of ethics, and standards of practice. The AMTA promotes
research studies, supports involvement in regulatory efforts,
and prints promotional information, among other benefits.
The AMTA’s state chapters offer opportunities for community
education, continuing education, and volunteer involvement
in the organization. Therapists can volunteer in any capacity, from handling registration at a chapter meeting to being
a national committee chairperson or director on the board.
In 1987, two massage therapists formed the ABMP
organization in Evergreen, Colorado. The ABMP philosophy centers on the credo of “expect more” and helps
massage, bodywork, somatic, and esthetic (skin care) practitioners build and sustain successful practices. The primary
selling point for the ABMP is its claim to support the needs
of its members by providing the necessary products or services. Currently, there is a companion magazine publication,
an insurance program, and a business handbook for members in addition to its massage school relations program and
support for regulation.
50 INTRODUCTION TO MASSAGE THERAPY
Relationships can be complicated in any situation, but massage therapy can make them even more complex. Every relationship, whether personal or professional, is characterized
by physical and conceptual boundaries. Physical boundaries
describe the physical area that defines a person’s comfort zone,
and conceptual boundaries are the attitudes and behaviors that
affect a person’s level of comfort. The comfort provided by
physical and conceptual boundaries can create a safe space for
clients that allows a healthy professional relationship to grow.
Professional relationships are made with clients, with
other healthcare professionals, and in any situation in which
you are representing yourself as a massage therapist. The
physical and conceptual boundaries will play a part in each
one of these relationships, so you must be aware of boundaries and respect them to maintain professionalism.
Physical Boundaries
There is physical space around a person that is a boundary
for outsiders. Anthropologist Edward T. Hall pioneered the
field of proxemics, or the human behavioral use of space, in
the 1960s. He defined the immediate space around a person
as having four different zones:
• Intimate—for whispering and embracing, within
18inches of your body
• Personal—for conversing with close friends,
18 inches to 4 feet away from your body
• Social—for conversing with acquaintances, 4 to
10feet away from your body
• Public—for interacting with strangers, 10 to 25 feet
away from your body
Personal space is like a protective bubble that insulates
us from persons and things around us. You should respect
others’ personal space and stay out of it unless invited.
When a person comes within a zone that is inappropriate
for the relationship, Hall suggests that it makes the person
being invaded feel uncomfortable and vulnerable and triggers an avoidance response. Americans typically require
a space about 6 feet in diameter, or a little further than
an arm’s distance away, for social or comfortable public
situations. This space is commonly called personal space,
and the size of it varies with cultural, emotional, physical,
and sexual experiences.
As mentioned above, personal space may vary individually depending on perceived comfort and safety. During a
massage session, you will be moving into different zones of
your clients’ space and need to be aware of their comfort
level to make sure that you do not trigger avoidance or
resistance. Understanding and maintaining physical boundaries is essential for preserving the therapeutic process
before, during, and after the massage. Accountability is a
quality that can help you maintain a safe personal space for
your clients. It can be challenging to know for sure whether
you are too far into a client’s personal space, so do not hesitate to ask periodically during the massage and suggest that
the client respond. You can adjust the pressure and techniques according to the client’s responses. In fact, you can
inform clients prior to the treatment that during the massage you may ask about their comfort and can make the
appropriate adjustments to the massage. In addition to the
physical space that we use for protection and comfort, there
are conceptual boundaries that do the same.
Conceptual Boundaries
Conceptual boundaries, sometimes called comfort zones,
provide us with a sense of safety or comfort. The intimate
nature of massage can easily create a feeling of vulnerability,
discomfort, nervousness, or hesitancy. Clients who feel
safe, comfortable, and trusting will ultimately receive more
benefit from a massage than clients who feel unsure and
uncomfortable. Comfort levels with the issues of emotions,
intellect, energy, and sexuality are all forms of conceptual
boundaries.
Emotions
Emotional boundaries determine the extent to which we
expose emotions and feelings based on perceived levels of
trust, safety, and comfort. The term “openness” expresses
a person’s willingness to share his or her emotions openly. Massage therapists must respect emotional boundaries
as much as physical space boundaries. If you push clients
to expose more emotion than they want to share or if
you share too many of your own emotions with your
clients, you may be met with resistance and avoidance.
Clients’ emotions and the issues that surround them may
be interesting and can certainly affect the healing process,
but managing them is not within the scope of massage
therapy.
Intellect
Intellectual boundaries protect a person’s thoughts, opinions, and belief systems. Culture, religion, spirituality,