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Learn how to define your own boundaries, why being clear about your boundaries is important and how to deal with any boundary issues that may arise in your massage therapy practice.
By Michelle Vallet, November 15, 2011
Massage therapists understand the idea of boundaries. You agree to ethical standards in a variety of ways, ranging from the work you do everyday with your clients to abiding by state laws that regulate the practice of massage therapy to your AMTA professional membership.
As a massage therapist, the idea of boundaries isn't new. You understand you have ethical obligations— both to yourself and your clients—that govern your work in massage therapy. There are boundaries and ethical lines you can’t cross of course, and there are still others that may change over time. “Four common boundary areas in massage therapy include physical, emotional, professional and social,” Nelson says. “These areas often overlap and influence one another.”
Physical Boundaries, for example, might include anything from the set up of your practice to proper draping to understanding a client’s preferences and any contraindications that might exist.
Emotional Boundaries speak to a therapist’s awareness of both themselves and their client. “You need to be willing to refer out if you notice a client may need psychological support you can’t (and shouldn't) provide,” Nelson explains. “Likewise, you need to know when you’re facing emotional challenges that require you to distance yourself from a situation.”
Professional Boundaries address a vast array of areas, Nelson suggests. “Proper representation of your abilities, financial propriety, appropriate advertising, as well as observing jurisdictional law and regulations, to name a few,” Nelson says. “Professional boundaries also include what you consider proper attire, your communication skills, record keeping, hygiene and cleanliness.”
"Social Boundaries generally address issues that are going to preclude having social relationships with clients,” Nelson explains. “For therapists in small communities, however, where social relationships may exist, being very clear about your professional versus personal role is important.”
And although in most cases boundaries seem to comprise expectations that are imposed from external sources, Nelson believes they are far more personal—or should be, at least. “When you think about boundaries, try reading, thinking about and discussing codes of ethics from an assortment of professional associations,” he suggests. “Find out what does and does not resonate with you, and look inside of yourself to find out why some things resonate with you.”
It’s an old saying that rings through a variety of mediums, from country songs to bumper stickers: “If you don’t stand for something, you’ll fall for anything.” And, simply put, that’s why understanding your own personal and professional boundaries is critical.
“In today’s culture, we encounter multiple distractions and temptations on a daily basis,” Nelson says. “By having a firm grip on who we are, what we want and what we are willing to do and not do to achieve what we want, business and personal decisions become so much easier and our goals can be reached so much faster.”
For one, having a clear picture of your personal and professional boundaries keeps you moving in the right direction because you’re not spending your time fretting about if you’re doing the right thing or not.
Boundaries, according to Nelson, are a little more nuanced, complex and fluid than you might first think. Some, such as sexual boundaries, are clear cut and permanent. But many, says Nelson, change and evolve as the person grows both personally and professionally.
“There are clients I feel confident working with today that I wouldn't have worked on when I was just starting my career,” Nelson explains. “This boundary change was influenced by a variety of factors, including advanced training, personal study and advancements in research, for example.”
One good instance of these types of shifts, Nelson suggests, is how massage was once considered contraindicated for cancer patients but is now readily used because of the benefits it provides.
Related: Massage Therapy for Pain & Anxiety in Cancer Patients
Boundary changes might also occur following traumatic life experiences. Loss of a family member, accidents or illness might trigger a need for you to readjust your boundaries. Sometimes, these shifts in your boundaries will be permanent, while at other times, you’ll only need to temporarily adjust your boundaries so you have room to heal from the triggering event.
Adding complexity to an issue almost always increases the chances for problems, and it’s no different when you think about the professional and personal boundaries you set for yourself. From setting boundaries about when you’re available to clients to having firm policies surrounding cancellations to knowing when you need to refer a client elsewhere, you are probably going to encounter situations that test both you and your clients.
“Many boundary problems can be traced back to four situational response styles,” explains Nelson. “It’s important to be aware that these styles can be projected by either the massage therapist or the client.”
Compliance. “Compliants bow to the demands and needs of others whether it’s appropriate or not,” Nelson says. “This reaction most commonly comes from a fear of hurting someone’s feelings, making someone angry or feeling guilty.”
In these situations, boundaries become fuzzy and indistinct. “Examples of this behavior might be a client who tells you the pressure is ‘just fine,’ even when it’s causing pain,” Nelson says, “or when a massage therapist cancels their own plans because a client calls at the last minute and wants an appointment.”
Avoidants. “People who avoid have trouble recognizing their own needs or letting others help,” explains Nelson. “They withdraw when they are in need and do not ask for assistance.” Massage therapists that tend toward both compliant and avoidant are at a high risk for burnout,
Nelson suggests, because they aren’t able to accept the support they need to replace the energy they expend helping others.
Controllers. “Whether aggressive bullies or manipulators, controllers motivate others to carry their load, projecting responsibility for their lives onto others,” says Nelson. “They have a lack of respect for the boundaries of others, and often see someone saying no as a challenge to change their mind.”
Nonresponsives. Unlike with controllers who know there are boundaries but simply choose to ignore them, nonresponsives fail to recognize there are boundaries at all. “Sometimes, a person feels incomplete themselves so they have a critical attitude toward the needs of others,” Nelson explains. “Other times, people are just so absorbed in their own desires and needs, they fail to acknowledge those of the people around them.”
If you recognize yourself or some of your massage therapy clients in the above descriptions, don’t panic. Understanding and maintaining boundaries can be tricky work, especially because some change with time and experience. Knowing you need to think more deeply or reassess how you think about your personal and professional boundaries is a great first step.
“Having written policies and procedures in place, and reviewing them regularly, can really help,” says Nelson. “Most poor decisions aren't the result of not knowing what is right but being tempted to blur a boundary we've defined for ourselves.”
And there’s the key, for both people who struggle with boundary issues and those who have their boundaries clearly outlined: reviewing your boundaries regularly. Doing so reinforces your boundaries, as well as giving you the opportunity to refine boundaries that might not be working for you anymore.
Nelson also believes it’s helpful to find someone that you can hold yourself accountable to. “This can be a business partner, a spouse or even a friend,” he says. “Set up a regular schedule to report back to these people and talk about the successes and failures you've had surrounding boundaries.”
For some, too, creating what Nelson describes as a “reminder ritual” might help keep boundaries at the forefront, particularly in times when they find themselves prone to lapses in their boundaries.
“I have found this approach useful in controlling my innate desire to talk too much during massage sessions,” he says. “To keep myself from backsliding, I touch base with myself at certain times during the session to privately ask myself, ‘Are my words for myself or my client?’” And though Nelson describes the experience as humbling initially, checking in with himself in this way ultimately proved beneficial to both his practice and his clients.
Creating personal and professional boundaries isn’t always easy work. Doing so effectively requires that you take the time to really understand your goals and priorities, as well what you will and will not accept from clients and others. When you take the time to clarify your boundaries for yourself—and your clients—however, you and your practice will thrive.
If a therapist presents themselves to others in an unethical and/or unprofessional manner, they tend to attract the type of business reflective of that behavior. This not only includes personal behavior and dress, but also how and where they advertise, the location and hours of their practice setting, their communication skills, business skills and therapy skills.
It is akin to the client who spends all day sitting at a desk and then wonders why their back, neck and shoulders hurt. If a therapist is not attracting the type and amount of business they desire, then it may be time for them to assess their approach.
It is important to be responsible to others, but it is inappropriate for therapists to be responsible for others. We can not grow for others. We cannot do their stretching exercises between massage sessions. They must do that for themselves. We can educate and reinforce good behavior, but we must also be willing to put boundaries on bad behavior. A mentor of mine advised me once, “It is not your job to push dead bears up trees.”
There are certain things we can change and certain things we cannot. The secret to using our time and efforts productively is knowing the difference. We do not have the power to change the weather, the past, the economy and especially not other people. We do have the power to acknowledge our challenge areas, humble ourselves and ask others for assistance, seek out those we have injured and make amends and forgive those who have injured us.
Respecting the boundaries of others earns respect for our own boundaries. When we condemn the boundaries of others, we expect them to condemn ours. This sets up a fear cycle that can make us afraid to set boundaries that we need. Instead of asking “Did my client do what I wanted them to?”ask yourself “Did they make a free choice?”
When setting boundaries, it is important to act from a place of love instead of fear. Working from love creates happiness and peace, where working from fear creates anxiety, fatigue and depression.
Setting boundaries can be difficult because it requires making decisions and can be confrontational. These confrontations may cause pain to others, even when helpful. Therapists need to recognize the difference between “hurt” and “harm.” Turning a client away because of contraindications may hurt their feelings, but providing inappropriate treatment may cause them harm.
Too many people define themselves by what they hate or what they do not want. This reactive method of setting boundaries can be a necessary and helpful stage—especially for victims— but it should be a stage, not a lifestyle. Create understanding and a positive environment within your practice by proactively showing others what you love and clearly defining what you do want.
Envy defines “good” as “what I do not have” and ignores the good that is present. Focusing on and feeling envious of others is a waste of time. We can spend this time constructively by taking responsibility for our own lacking and developing solution plans to address our challenge areas.
Creating positive boundaries requires activity. There is nothing wrong with trying and failing, but failing to try eliminates any chance of success. Maintaining positive boundaries also requires activity. Even if we are on the right track, if we do not keep moving, a train will eventually run us over.
We do not live or work in a vacuum. Our boundaries define us in relation to others. Many relational problems are a result of “secret” boundaries. By stepping into the light and communicating our boundaries visibly and openly, others can benefit from them and our challenge areas can be corrected. Remember that relational problems can only be solved in relationships.
Creating Healthy Boundaries
Understanding boundaries is crucial for massage therapists to create an ethical practice and build professional relationships.
A Holistic Model for Ethical Practice
This course incorporates the concept of mindfulness, or the practice of being present in the moment.