Educating Massage Clients: What's Appropriate and What's Not

 by Ben Benjamin, PhD
October 1, 2014

All massage therapy experiences should be provided in a safe, comfortable and trusting environment. No one should ever do anything to your body that you have not given permission for. A therapist should never be sexual in any way with a client. That includes sexual touching, sexually explicit comments to or any sexual act whatsoever. Every well-trained massage therapist understands—or should understand—the guidelines that follow.

Client Intake

After initially greeting a new client, the therapist and client agree on the type of massage needed if discussion on the topic didn't happen at time of booking. In a spa or wellness setting, a client may have selected a particular type of treatment, for example, and this should be clear without discussion.

However, the therapist should always always ask if there are any areas a client would like particular attention paid or if there are areas they would like the thearpist to avoid.

The extent of the history-taking depends on why the client is seeking massage. If they are coming for a relaxation massage, the therapist will ask certain questions to make sure the massage session is safe. At a minimum, the therapist should ask about any surgeries, medical conditions, current medication, injuries, pain, skin conditions, allergies to anything the therapist may be using and any sensitive areas. A woman should be asked if she is pregnant or may be pregnant.

Who's In Charge?

The client is always in charge. If a therapist of any kind ever does anything that makes a client emotionally or sexually uncomfortable, the client should speak up immediately or just tell the therapist they want to terminate the session and leave.

Clients see a massage therapist for many reasons. Some come for a relaxing massage, postsurgical or post-cancer treatment, or for help managing pain or an injury.

With some types of massage techniques, there may be some physical discomfort. Be sure that you and your client have agreed on how much discomfort is okay and how much is too much, and check in with the client during a massage session around pressure.

For example, if treating for an injury, there may be some discomfort, which is part of the treatment process. If a client comes for some myofascial or Rolfing work, inform them that this kind of massage therapy can be quite painful.

Nudity and Draping

Every client should undress and dress in private; the state of undress is up to the client. Some clients remain fully clothed except for their shoes. Others wear a hospital-type gown, leave their underwear on or are nude.

A client should always be securely covered or draped with a sheet or towel, which should be tucked in or draped in such a way that it will not easily move.

Client Centered

The entire session is about the client and what they need to have in this particular session. How much pressure is used, where the therapist works and doesn't work, and if you talk or remain quiet is all up to the client. It's not about the therapist's needs.

Power Differential

There is a power differential between practitioner and client. The power differential is inherent in any therapeutic relationship. There is an implicit acknowledgment that the practitioner has more knowledge in this area than the client. The power differential exists for the purpose of bringing benefit to the more vulnerable individual.

In health care, the power differential is amplified by the physical aspects of practice. The client is usually lying down and unclothed, which has the psychological effect of increasing the imbalance of power.

Maintaining professional boundaries is the responsibility of the practitioner, even if the client requests or instructs the practitioner to behave otherwise. The practitioner also has a duty to stay aware of how the power differential may affect the client's ability to raise concerns.

What Is Appropriate and What Is Not

A massage therapist should never touch the genital area of the client. This is either sexual abuse or prostitution. In most parts of the U.S., massage of the breast is off limits. In the few states where it is legal, there must be written consent by the client.

In other countries (for example, in certain provinces of Canada), where the training is much more extensive, breast massage is part of massage therapy training and is permitted where appropriate. There are cases where breast massage may be indicated. For example, if a nursing mother has a blocked milk duct, breast massage is sometimes indicated. Or if there is a painful post-surgical scar, certain types of massage therapy may be helpful. However, it is never appropriate to perform massage on or touch a woman's nipples.

The area of the upper inner thigh, either in front or back, is an area that is also rarely touched. More specifically, the therapist never works within two to three inches of the genital area at the inner thigh, as doing so may evoke sexual stimulation, fear or both.

The only exception to this guideline is when there is an injury to the muscles or tendons in this area. In this case, the client has come to the massage therapist to work on this issue and has explicitly agreed to be treated in this area. When this is done respectfully and with draping, it is not a problem. The therapist carefully and securely drapes the client's upper inner thigh with a sheet or towel before working.

The buttock area is generally included in a massage therapy session but doesn't have to be if this is not an area a client wants to be worked on. Work on or very close to the anus or motions that clearly open the cheeks of the buttock should never happen.

Reporting an incident: If a client feels their boundaries have been crossed or violated, they should say something immediately. Some people freeze physically, emotionally and verbally, especially if they've experienced trauma or are dealing with PTSD, and this could be a problem.

Inappropriate actions by massage therapists can be reported to the police, the Massage Therapy Board of Registration and/or the District Attorney's office. These types of actions cannot be tolerated and do great harm to those in our profession who do an admirable job in helping people live more painfree lives.

Make sure your clients are educated as to appropriate behavor for them and for you so there is no miscommunication or misunderstandings and your practice can continue to thrive.