Tuesday, June 2, 2009

The Ethics of Professional Practice

Fundamentals of Massage

Describe ethical and legal considerations in massage practice
Describe the scope of massage practice

Task 4 – The ethics of Professional practice Due Date: 20 May

Version 2

There are many ethical considerations that a massage therapist needs to consider within the operation of their practice. Understanding these issues is imperative as they will hugely determine the success of the practice. Poorly implemented they may be the demise, whilst implemented successfully they will lead to a reputable and trusted practice. I have outlined the common considerations a massage therapist will encounter below.

Client-centered care is the focus of the treatment towards the greater benefit of the client. Aspects which should be considered are;

• The relevance of the treatment to the presenting issue of the client
• The consideration and respect of the clients goals, boundaries, ethical, cultural and religious beliefs and emotional state
• The Awareness of power differentials (D. McQuillan, personal communication, 2009).
• Benefits should outweigh the costs of treatment (Perle, 2006)
• Communication should be with compassion, respect of the client and strictly professional.

Informed consent from the client is an essential initial measure in massage practice. It is essential that we ensure that our clients have a full understanding and be in agreement to my treatment procedure and scope of practice, my terms of payment and effects of treatment.

I as a therapist need to inform the client prior to the massage session of their treatment intentions and to which areas of the body I will be applying massage. More importantly my client needs to give the me consent to the treatment. There may be areas that the client is not comfortable being touched and I need to respect this. During the treatment itself it is also necessary to inform the client which areas they would like to massage and again to gain consent before doing so. I have treated a variety of different people already and it is interesting to discover insecurities they may have about certain areas of their body. Some have preferred not to be treated in those areas, some have allowed treatment but were initially hesitant.

Scope of practice. This is defined as the therapists ability knowledge, skills and limitations of application as their role as a therapist in relation to their education, qualification, experience, competency and training. It is vital that the therapist is honest about their abilities and that they are safely able to perform the treatment required by the client. The client should be informed of the therapists scope of practice during the informed consent stage so that there are no inhibitions or misunderstandings about what the roles are of the therapist and those of the client and that the clients goals are appropriate to what the therapist can offer as treatment.

The therapist is responsible for ensuring that they:
• provide a service relevant to their knowledge and ability and any limitations are
acknowledged to the client where necessary. This may require referring clients to a more appropriate health care provider. In my case I need to outline that I am able only to perform relaxation massage at this stage.
• that they conform to the scope of practice as stated by Massage New Zealand
• the treatment and techniques used are appropriate to the clients requirements.

Confidentiality is an integral factor a massage therapist should employ in their practice. Not only is it part of the Privacy Act 1993 to protect the privacy of the individuals concerned it is also important to build trust between the therapist and client.

I have filed all of my client details forms in a safe filing cabinet to ensure client confidentiality as far as record keeping. It is intriguing how much some clients feel compelled to share with me about their personal lives. By opening up as they have, they are showing that they trust me with this information and so I will ensure that what is said between my clients and myself is kept strictly confidential.

Massage therapists should comply with the following points as indicated by the Privacy Act 1993;
“It is your responsibility as your client's therapist to ensure the privacy of their records. This may be achieved by storing client records in a locked filing cabinet, and never leaving them lying around when you are not in the room.” (Massage practice, 2008)
Massage prctice is also bound by the Privacy Act in that apart from the therapist and the client involved, no-one else shall have access to any of the clients personal information or records. The exception to this is if the client has given authorization to someone else in writing to access their information. The client is entitled to have access to their own records.
“The only times that it is acceptable to breach confidentiality is when you believe that your client may endanger someone else, or be in danger themselves in the future.” (Massage practice, 2008)

Boundaries are personal values which will affect the way in which the massage treatment is performed and the establishment of the relationship between therapist and client. They may include sexual, religious, cultural beliefs, area of personal space, touch, touch to certain body areas, inappropriate language or conversation topics or any range of personal morals or beliefs. Boundaries should be defined during the informed consent stage of the massage treatment. These should include the clients personal boundaries as well as the therapists boundaries. Honesty and assertive communication is essential in relaying these boundaries so they can be understood and respected throughout the massage treatment. Everyone is different and has individual boundaries. What some people are sensitive to or may be offended by can be completely different to anothers so it is important to establish an understanding of what is appropriate and what is not early on in the relationship. Again informed consent should be used in communications throughout the session to ensure these boundaries are respected.

As I mentioned above in regards to informed consent, i have discovered some of my clients have areas that they prefer not to have treated. Some have indicated why, some haven't. These are boundaries that I need to respect as they are issues that the client has and it would be totally inapprpriate if I ignored their wishes.

Power differentials. There is a natural power differential between the therapist and the client due to a culmination of psychological, physical, emotional and educational parameters related to the massage setting.. These may include the positioning of the client compared to the therapist, the therapists knowledge and skills, the clients emotional or psychological state and also the clients level of consciousness during the massage session. The therapist is therefore empowered by being in control of the setting. It is important that this power differential is minimized to ensure the comfort of the client during the session and that their boundaries are not abused but also that it is present to an extent so that the client can trust the therapists abilities.

Relationships. It is important for the therapist to build a trusting relationship with the client. The relationship is influenced by first impressions and developes over time. It will promote the longevity of the custom of the client to the therapist and ensure a comfortable setting for each massage session. The relationship is the product of appropriate communication, the building of trust, compassion, respect and consideration of client goals, beliefs, boundaries and understanding of each others roles in the massage setting.

The relationship between the therapist and the client should be kept strictly professional at all times.

“A practitioner shall not enter into an intimate or sexual relationship with a patient whilst the patient is under their care”. (Massage New Zealand, 2007)

Transference and Counter-transferrence
“Transference is the personalization of the professional relationship by the client.” (Fritz, 2009)

There is a state of vulnerability within clients in a massage setting due to the power differential between client and therapist. It is important that the therapist does not abuse this situation. The client may show signs of dependency toward the therapist, offer gifts or invitations outside of the professional environment.

It is the therapists responsibility to deal with these occurrences as they arise by communicating and maintaining clear boundaries with the client. If necessary the client should be referred to an alternative therapist.

“Counter-transference is the inability of the professional to separate the therapeutic relationship from personal feelings and expectations of the client; it is the professionals personalization of the therapeutic relationship.” (Fritz, 2009)

The therapist may develop an emotional or sexual attachment to the client. Signs may include thinking about the client outside of the professional relationship and feelings of inadequacy when the client does not show signs of improvements after treatment. Common traits of people who experience counter-transference include the need to fix other peoples problems, to be perfect, need to be loved and are dependent on affirmation or acceptance.

Again it is the therapists responsibility to deal with these occurrences as they arise. They may be required to refer the client to alternative therapist. The therapist needs to think about and analyse the clients boundaries and assess your behaviour accordingly.

In conclusion, I am really enjoying the interaction I share with my clients during my massage practice. Although it is only in its early stages there are already firm ethical foundations being set so to ensure that I build my practice up in a reputable manner. As I have already outlined, it is so important to create a safe, trusting environment for my clients.


Perle, S. (2006). It’s All Greek to Me. Retreived May 20, 2009 from http://www.chiroweb.com/archives/24/02/14.html

Massage practice and the Privacy Act 1993. (2008). Retrieved 20 May, 2009, from http://www.wikieducator.org/Legislative_Acts_which_establish_boundaries_of_massage_practice_in_New_Zealand/Privacy_Act_1993"

Massage New Zealand (MNZ) (2007). Code of Ethics. Retreived May 20, 2009, from: http://massagenewzealand.org.nz/about-us/code-of-ethics/

Fritz, S. (2009) Mosby’s Fundamentals of Therapeutic Massage (4th ed.). Missouri: Mosby Elsevier.


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