As a massage therapist we work with our clients at a very personal level. So because of the nature of our work laws and code of ethics have been put in place to help avoid conflicts of interest. As a profession we want to be giving the best service to our clients in a safe environment. To help us do this we need to establish boundaries with our clients, define our scope of practice and always have clear communication so there is no confusion about our work. “In general, ethics in somatic therapies involve behaving honourably; adhering to prevailing laws; upholding the dignity of the profession; respecting each client; staying committed to high-quality care; working within the appropriate scope of practice; being client-centred; and remaining service-oriented.” (Benjamin, 2002).
It all comes down to giving client-centred care. Taking into consideration client goals and treating the client with respect and compassion. The client is coming to us for a service, although we will develop a relationship with our client it is that of a therapeutic relationship rather than a friendship. This means that the relationship is unequal and it needs to stay that way in order for us to maintain our professionalism. We give the treatment and although we get money in return it is the client that needs to be getting all the attention. We only do what is in the best interest of the client.
There is a power differential in the relationship because the therapist has education and training in massage over what the client has. We can therefore be treated as almost a teacher figure so being aware that some clients may take everything we say as gospel we need to make sure we don't abuse this power. “Self-accountability is the cornerstone of ethics: it is who you are and what you do when no one is watching. When you have a well-developed sense of self-accountability, you are honest with yourself, and are answerable and responsible for what you say and do. You have the ability to look beyond the immediate moment to consider the consequences and know if you are willing to pay them. You have personal ethics. Personal ethics is the precursor to professional ethics, since we are not likely to be more ethical in our professional life than our personal life.”(Benjamin, 2003).
As well as it being in the clients best interest it is also in the Health and Disability Act 1994, that we receive informed consent from our clients before being treatment. This means not just getting consent to give a massage but also explaining what areas you will be working and why you may want to work in these areas. There are many areas of the body that a client may not feel comfortable with being massaged eg gluts, abdomen, feet. Although we can educate our clients to help them understand why it may be beneficial to work in these areas we can only work there if we get consent. Educating our clients helps our client still feel in control. Make the plan of treatment together. Its a good idea to inform our clients of our qualifications, training and policies of our practice. This will help to eliminate surprises and misconceptions in our treatment.
Clients also need to be informed of our scope of practice. We know ourselves what our limits are. Sometimes we may be perceived to have more qualifications or experience than we do. We cant afford to get caught in the trap of doing things out of our league otherwise we could end up harming the client. Its important that we work within our scope of practice and that we have communicated to our clients what are limitations are.
Confidentiality is always important. This is part of the Privacy Act 1993, that client records are kept confidential but records may be given to authorised people. It also could be a good idea not to greet a client in public. We may acknowledge them with a smile but it should only be the client that initiates contact as they may wish to avoid us so nobody realises they are a client and we must respect that decision.
Boundaries are in place to clarify our roles and responsibilities. We need to be clear what our boundaries are, sticking to our scope of practice. This is where communication is also important. It is a common mistake to start giving advice in areas such as psychology in which we are not trained. “Healthy relationships always involve healthy boundaries.” (Salvo, 2007).
Transference and counter transference can occur in the relationship. Transference is where the client has become dependant on the therapist or are trying to take the professionalism away from the relationship and turn it into a personal one. Warning signs could be when the client extends a dinner invitation or buys you a gift. You need to address the situation without offending the client maybe by having policies about not excepting gifts or spending time with clients outside of work. On the other hand you as the therapist could become over attached to the client. Warning signs could be frustration when client is not advancing in their program as you would have liked. Having a “need to fix” can impair you ability to be client focused. Someone who has always lived in a lot of pain may not be interested in working towards fixing it but rather just having a relaxation massage to feel good. It always comes back to the clients goals. In either instance it is ideal to have some sort of supervision, a confidential outsider that may be able to pick up on these warning signs before anything to serious results from it. They can make us see if there is a need arising on either side and give us advise and support on how to deal with it.
So in conclusion, ethics always come back to acting professionally and making decisions with the clients best interests in mind. Having clear boundaries, scope of practice and communicating with your client can avoid any confusion. Keeping your relationship as a therapeutic one helps you to give the best treatment possible.
Benjamin B. (2002), Ethics, Values and Principles, retrieved May 18, 2009 from
Benjamin B. (2003), Ethics and Self-Accountability, retrieved May 18, 2009 from
Salvo S. (2007), Massage Therapy Principles and Practice (3rd Edition), Missouri, Saunders Elsevier