Ethics, Knowledge, and Skill Check

A good massage therapist understands the importance of maintaining the highest ethical standards. Your professional Code of Ethics outlines the principles that define appropriate therapist behaviors so that clients can feel safe.

Ethical principles encourage excellent service and provide direction in challenging or confusing situations. For example, some clients behave inappropriately without knowing any better. Therapists with strong ethical principles are clear in their behavior and communication with clients and can guide clients toward appropriate behavior as part of the therapeutic relationship. In cases where clients are seeking massage for illegitimate reasons, ethical principles help therapists determine when a session should be terminated.

In school, you may be held to a class or school code of ethics. When you graduate, you will be held to a professional code of ethics by your professional membership organization (e.g., ABMP), and by your state board of massage. When you graduate, expect to be tested extensively on ethical terms, concepts, and principles on the national exam in order to obtain your massage credentials.

This outline of ethics knowledge and skill components* will serve as a guideline during your massage training. If you master these knowledge and skill components, you will be ready to pass the ethics section of the national exam, as well as handle challenging client situations when they arise in your professional practice.

Knowledge Components

• Define the term ethics.
• Outline the purpose of ethics in a massage practice (e.g., creates an environment where the client feels safe, encourages excellent treatment, ensures the rights of clients and therapists are protected, etc.).
• Define the term values.
• List two commonly held values of massage professionals (e.g., worth of all people, right to positive touch, etc.).
• Define the phrase character traits.
• List two character traits that might positively influence the practice of good ethics in a massage practice (e.g., autonomy, honesty, self-control, etc.).
• List two character traits that might negatively influence the practice of good ethics in a massage practice (e.g., need to please others, lack of self-confidence, etc.).
• Define the phrase client rights.
• List two rights of clients in a therapeutic relationship (e.g., the right to determine what happens to one’s own body, the right to end the session if one feels uncomfortable, etc.).
• Define the phrase therapist responsibilities.
• List two therapist responsibilities in a therapeutic relationship (e.g., to set and maintain appropriate boundaries, to ensure sessions stay client-centered, etc.).
• Define the term law.
• List one difference between ethics and laws.
• Define the phrase ethical dilemma.
• List two possible ethical dilemmas that might arise in a massage practice.
• Outline the steps in the school-selected ethical decision-making model.
• Define the phrase code of ethics.
• List two organizations that provide codes of ethics for the massage profession (e.g., ABMP and the state board of massage).
• Match these common ethical principles to their written descriptions: commitment to high-quality care, inherent worth of all people, honest representation of qualifications, practice within limits of training, do no harm, respect dignity and rights of all people, practice confidentiality, uphold appropriate boundaries, practice honesty in business and finances, maintain the highest standards of professional conduct.
• Define the phrase standards of ethical practice.
• Match each ethical principle to a written description of its standards of practice (e.g., the ethical principle to respect the inherent worth of all people might be matched to a written description that states: treat all clients with respect, regardless of personal beliefs related to ethnicity, politics, or religion, and strive to understand and identify discriminatory or prejudicial thoughts or actions and eliminate them).
• List two therapist behaviors that desexualize massage (e.g., wear a uniform and name tag, cover the upper chest area, etc.).
• Define the phrase ethical violation.
• List three ethical violations therapists should avoid.
• List two behaviors of a therapist who fails to practice confidentially with clients.
• Define the phrase conflict of interest as it relates to a therapeutic relationship.
• Define the term kickback.
• List three therapist behaviors that demonstrate a lack of attention to sexual innuendo (e.g., making complimentary comments about a client’s body or accepting client compliments about the face, body, or hair; having nude artwork anywhere in the massage practice; making sexual jokes or allowing clients to make sexual jokes; etc.).
• List four therapist behaviors that demonstrate sexual impropriety and can lead to sexual harassment or sexual assault charges (e.g., any immodest behavior or behavior that encourages immodesty in clients, draping loosely or not using a drape, using nicknames of a sexual or romantic nature with clients or allowing clients to use a nickname for the therapist, telling or allowing sexual jokes, requests for a date or accepting a request for a date, etc.).
• Define the term sexual abuse as it relates to a therapeutic relationship (e.g., any sexual innuendo or impropriety on the part of a therapist is sexual abuse because of the power differential at play in a therapeutic relationship).
• List two possible outcomes of sexual abuse allegations by clients (e.g., jail, payment of damages, loss of massage credentials, etc.).
• Review the information in an informed consent form.
• Define the term referral.
• List two instances where referral to another health-care provider demonstrates ethical practice (e.g., when the massage therapist does not believe massage can benefit the client or the client needs treatment beyond the ability of massage to benefit the condition, etc.).
• Define the term boundaries.
• Explain in one’s own words the meaning of personal space.
• Match these types of boundaries to their written descriptions: permeable, semipermeable, impermeable.
• Give one example of when to use each of these types of boundaries: permeable, semipermeable, impermeable (e.g., use a permeable boundary with close friends and family, a semipermeable boundary with most clients, an impermeable boundary with a client who is crossing therapist boundaries, etc.).
• Match these boundary forms to their written descriptions: physical, emotional, mental, spiritual, sexual.
• Define the term boundary violation (or boundary crossing).
• Give one example of a way a therapist might cross each of these client boundaries: physical, emotional, mental, spiritual, sexual (e.g., a therapist might cross a client’s physical boundary by hugging the client without having enough history with the client to warrant that level of physical intimacy, a therapist might cross a client’s spiritual boundary by sharing personal views of religion or by practicing energetic bodywork on the client without informed consent, etc.).
• Explain one client behavior that might violate a therapist’s boundary during a massage session.
• State two methods that help clients establish healthy boundaries during a massage session.
• Recall three therapist behaviors that establish the boundaries of a therapeutic relationship during a massage session.
• Review the phrase dual relationship.
• List one type of dual relationship that is prohibited in the massage profession.
• Identify ways to obtain external guidance on issues related to therapeutic relationships (e.g., supervisors, mentors, peer groups, etc.).

Skill Components

1. Practice responding with appropriate language and behaviors to each of these situations:
   • Avoid counseling a client, even when the client attempts to get counseling from the therapist.
   • Refuse a client massage due to a condition that contraindicates treatment.
   • Refuse a client’s request for massage because the therapist suspects the client is under the influence of an illegal drug or alcohol.
   • Require a parent or guardian to be present during massage of a minor when the parent or guardian seeks to drop the child off alone during the session.
   • Respond to a client’s request for a date.
   • Decline a client massage when appropriate.
   • Represent one’s massage qualifications honestly and point out the limitations of massage treatment.
   • Refer clients to other health-care providers when appropriate.
   • Obtain the client’s informed consent to massage treatment.
   • Redirect a client who is talking heatedly about political or religious affiliations.
   • Redirect a client who calls the therapist by a nickname that may have a sexual connotation (e.g., sweetheart).
2. Demonstrate effective language and behaviors to establish boundaries at the beginning of a massage session.
3. Demonstrate effective language and behaviors to redirect or manage a client attempting to violate the therapist’s boundaries in these situations (other situations may be substituted or added at the discretion of the instructor):
   • A client keeps reaching out during the massage session to touch the therapist on the arm, leg, or hand.
   • A client tells a therapist a story and becomes emotional, raising the voice and swearing excessively.
   • A client shares political views in opposition to the therapist’s views.
   • A client shares her religious views in opposition to the therapist’s views.
   • A client states to a therapist, “I don’t know what I would do without you. You are the only good thing in my world. I would be devastated without you!”
   • Show a pre-developed role-playing scene in which the “client” attempts to violate the “therapist’s” boundaries and the “therapist” demonstrates effective methods to maintain boundaries given the situation.

These knowledge and skill components are based on the guidelines provided by the Entry-Level Analysis Project and outlined in the “Entry-Level Massage Education Blueprint” (2013).