Ethics Violation, or Communication Breakdown?

This year I wrapped up five years of service on the North Carolina Board of Massage & Bodywork Therapy. Anyone who has ever sat on a board will probably agree with me that disciplinary hearings involving massage therapists are one of the most stressful parts of that job. It was for me. I estimate that during my time on the Board, I had to sit through approximately fifty of them. It was very distressing to see my fellow massage therapists trying to defend themselves–and in a few cases, just outright admitting to the violation–whenever they were accused of something.

Nine times out of ten, the accusation was of a sexual nature. 99 times out of 100, it involved a male therapist. I’m dead certain there are female therapists out there performing sexual favors every day, but most men won’t come forward to complain about it. Go figure.

My question to myself at those hearings was always this: “Did this person have an intent to do something evil, or was this a communication breakdown or simple mistake that could have happened to you or me?”

If you’ve been practicing longer than a year or two, the chances are good that in spite of your best efforts, you have accidentally exposed a body part. Or you have said something that the instant it left your mouth, you thought “why did I say that?” The very first massage I ever gave, I accidentally touched the man’s penis. I went to tuck in the drape, and all I can say is there it was. He was supine on the table, his eyes were closed, and when my hand grazed it, I saw his eyebrows shoot up. I said “I’m sorry,” and carried on. If I had made a big deal out of it, I could have just made it worse than what it was.

If your only intent is to give a therapeutic massage, then your major obligation is not just about giving the massage; it is clear and direct client communication. This has come home to me again and again, and most recently when one of my friends was accused of a sexual violation. The case has not been settled yet; it hasn’t even been to court, but he has been crucified in the press and by a number of bloggers–none of whom were present in the room and have no idea what truly happened there, but I’ve been watching what amounts to a feeding frenzy by a bunch of sharks who are determined to hang him from the highest tree. He is apparently guilty until proven innocent. And since no one was in the room except for him and the alleged victim, I am fearful of the outcome. Of course I do not want a sexual predator turned loose on the public. But after a career that has spanned about 30 years with no previous complaints, it’s a shame to see that going down the tubes. He has loyal clients who are still patronizing him (including women), but what do you think the chances are of him getting any new ones while this is going on? Zilch.

You can’t be too careful. Let’s be realistic. Most massage tables are set up so that the table is at about crotch-level. That’s a fact. We lean over people. We use our body weight on people. Some therapists get on the table with people. In my younger, skinnier days, I’ve crawled up on the table when someone was prone. I’ve done pelvic work on people of both sexes. I’ve done pectoral work on people of both sexes. I’ve worked on the gluts of both sexes. If you’re performing medical massage, you’re going to find the need to touch those areas–with the client’s informed consent.

Think for a moment about the muscles that originate on the pelvis. If you want to make the belly of a muscle relax, you need to make the origin and insertion relax. That’s just the way it is. If you’re ignoring the origin and insertion, you might be giving a relaxing massage, but you’re not getting to the root of the problem. However, if you abruptly touch someone’s pelvic bone without discussing that with them beforehand, you’re the next disciplinary hearing waiting to  happen.The general public doesn’t know squat about origins, insertions, and actions of muscles. It’s up to you to educate them. And it’s up to you to abide by their comfort level. If they prefer not to have their gluts worked on or you getting near their pubic bone, then you don’t do it, period. I have found it helpful to have a muscle flip chart in the treatment room. That allows me to pick it up while someone is on the table and show them the muscle, where it begins, and where it ends. It’s a professional thing, to me.

There is also no excuse for careless draping. The law in my state says that “the drape may be temporarily moved in order to accommodate treatment.” Yours probably says something similar–or not. Working through the drape may not be ideal, but if that’s the law in a your state, then I suggest you abide by it. Don’t expose more than you need to expose, and don’t leave it exposed. If you have moved the drape in order to work on the gluts, that doesn’t give you license to perform the whole massage with someone’s butt shining. Get it done and cover them up.

Be aware of the comments you make. It’s okay to tell someone they have taut bands or active trigger points in the gluts. It is not okay to tell someone they have a tight ass. You might be thinking it, but keep your mouth shut.

You may think you’re all above-board as a therapist and that you’re never going to be accused of anything. Guess what–all those people who have been accused didn’t expect it to happen to them, either. Two things that did become apparent to me during my  years on the Board…one, there are indeed predators out there who decided this profession would be a good place to meet a fresh crop of victims, and two, there are just therapists out there who are guilty–of failure to communicate. Don’t let it be you.

13 Replies to “Ethics Violation, or Communication Breakdown?”

  1. Informed consent is key, I think, in being successful as well as in simply avoiding complaints. The more we educate our clients about *why* we do what we do, the more confident they feel in our skill.

  2. Have you considered attending John Barnes’s Women’s Health Seminar? “some…techniques may not be in your scope of practice” – “coccygeal pain”, “episiotomy scars”, “painful intercourse”…

    I have to call one of my former co-workers from both the Jewish Community Center
    & Evo Spa in Marin County, CA today… to “talk”… She’ really into “colour therapy”… and used to wear a jewel on her forehead/third eye…

    …and make a $450 payment on the student loan I took out for Law School last year…

  3. John Barnes is a PT, and he most assuredly does some things that are not in the scope of practice of an MT. In NC, the law actually gives permission to work in body cavities below the waist, providing there is a doctor’s prescription, you have been properly trained in the technique, and there is detailed, specific, written consent. For personal protection, I would also have a third party present in the room.

  4. There are indeed plenty of females performing sexual favors. However, there are not near as many men sensitive to the point of complaint.

    My clients actually complain I am TOO careful! I always ask, check, and remind them to tell me if anything I do is uncomfortable, and I always explain what I am doing.

    Would rather be on that end of the complaint….=D

  5. This is such an unfortunate area of our field. As a therapist I’m always conscious of the fact that I’m working alone and that is so important to choose your words wisely when discussing any part of the therapy/work I’m doing. Clients can react and act in such strange ways sometimes…and unfortunately like you stated in the article there are just too many little things that can and do go wrong. The best thing is always to be very clear and confident in your communication with your client. If your language comes from a place of knowledge and confidence then it should never be taken the wrong way.

  6. ….and I will now be getting a muscle flip chart as soon as possible! Thank you, from a new MT. These are excellent reminders and insights.

  7. Muscle flip chart does sound like a good idea. Where did you get that or a website that you got it from?

  8. It is sad that this has to happen so often to male therapists, unless of course, they are guilty. But I have the opposite problem on occasion of a male client saying suggestive things or asking me out. I always either cut the session short, if they are being out of line. Or I make it clear that I do not date my clients. It has only happened a few times, but nothing too serious has occurred. I rarely think about it or worry about it.

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