Massage Ethics Classes are often a required part of massage licensing renewal. They are also a part of renewing your National Certification through the NCBTMB if you are required to have that.
Ethics classes used to seem like the most boring part of being a massage therapist but studying ethics now seems like the only thing we should have to do as a massage therapist. The techniques don’t really matter much if you don’t have clear boundaries and relationships with clients.
Ethics is just about relationships. Relationships are the core of building a successful massage business or being successful in your massage job. Studying ethics will help you if you are male and in this female dominated profession helping you to understand your role. Women can benefit from studying ethics to help them deal with the many challenges of working on men (yes the dreaded E!) .
Ethics is just the process of uncovering your values and learning about relationships and how your work as a massage therapist can influence those relationships. The clients that fall in love with you and want to marry you, the people who want to always get a discount or will hate it when you raise your rates.
People who are under stress and in pain and are half naked underneath a sheet are vulnerable. As a massage therapist it is your responsibility to understand your role and understand where they are coming from or at least be able to not interfere in their lives. I remember Oprah saying once on TV that she just wished massage therapists would shut up!
Ethics requires rational thought about what it is that you are doing or what is happening in your massage world. Many may first think that they know what to do when a client asks them out on a date and may think there is no harm in dating clients or even just being friends with clients. Educating massage therapists as to what happens in the therapeutic relationship can help them make more informed decisions about their actions.
It isn’t about being right or wrong. It is about making a decision that supports you and your massage business. There is also a legal side to being a massage therapist and working within your scope of practice. What is legal is not always ethical and what is ethical is not always legal. Ethics is about striving to be the best you can be and about treating people decently and respectfully.
Taking massage ethics classes is the most important thing you can do for yourself and the massage profession.
It is fairly common knowledge that emotions are a part of bodywork and massage -isnt’ it? I was once again shocked by the massage therapists on indeed.com who had never heard that the two were related. Feelings are all in the body which is why there is so much focus on ethics, boundaries and learning to use touch safely with people. No matter what technique or method is used the client only knows how it feels to them. They don’t care if you are doing sports massage, deep tissue massage, triggerpoint massage or cranial-sacral therapy. Their feelings are what tell them where they are at and teaches their body that it can relax and heal.
The body stores memories of feelings in it’s cells. It starts at an early age when we hold back our feelings and emotions. It is often taught that it is not good to have feelings and emotions. People will buck up and keep their feelings inside. Touch has a way of allowing these emotions to come to the surface. As massage therapists it is out of our scope of practice to deal with the emotions. We of course have to learn how to deal with them when they do come up or it could cause further problems.
Emotions can be anything from anger, sadness, grief, panic, anxiety, frustration and even laughter and joy. It can be a simple sigh of relief or a deep breath. It can be heat or cold in an area of the body. It can be people who ask for extreme deep tissue sessions because they actually can not feel and are numb both physically and emotionally. People may say they have a high tolerance for pain and won’t feel pain or will ignore it for a long time before doing anything about it. Anyone can experience emotions on the massage table. Elliot Greene in his book The Psychology of the Body (Lww Massage Therapy & Bodywork Educational Series)
says that people who suffer from chronic pain are also somewhat more likely to experience emotional release. When the massage therapy begins to disrupt the underlying physical patterns behind the pain, then emotional patterns related to the chronic physical pattern may surface.”
Sexual, physical and emotional trauma at an early age or in any stage of life for that matter can leave it’s mark on a persons body and emotions. People with a history of abuse of any kind have a high likelihood of having body armor. It includes people who have been traumatized in war, natural disasters and things like car accidents or crime victims. Armoring in the body is a natural result of trauma. It is defined as chronic patterns of involuntary tension in the body that dampen or block emotional expression, alter perception of both the outer and inner psychological world, diminish or eliminate kinesthetic awareness and other sensations and restrict the range of motion according to Greene in the “Psychology of the Body”. The war vet will think that everyone is following them and be sent into fight or flight when someone touches their neck if they sat in a trench for awhile waiting for the enemy to come from behind. People in car accidents that experience intense physical impact while they turn their head may years later recall the sound of the crash every time they turn their head in the same way. Stress can build up so much in tense muscles that just the lightest touch can bring tears to the eyes of many.
To be able to work with people who are undergoing emotional release requires that you be able to be present with the client. This basically is staying in a non-judgmental open state and not ask questions or direct peoples conversation. It is a state where you totally allow the experience to unfold and focus on the client without letting your emotions and agendas (if any) to get in the way. To do that requires that you do your own personal emotional work either through massage and bodywork or with a skilled therapist. Supervision can also help you in learning to deal with emotional releases on the massage table.
The thing to know about working with people is that the goal is not to try to get an emotional release. The feelings can actually be released without having emotions come forth. Because it is inevitable that a client will have an emotional release at some time on your massage table it is important to get further training in this area to be able to support the client appropriately.
Massage Ethics are really what building a massage business or being a massage therapist is really all about. To have a successful and rewarding (both financially, emotionally, mentally and spiritually) studying ethics and learning more about yourself and your values can help you in doing just that.
Many professional associations have a so called “Code of Ethics” which members are supposed to abide by. The thing is that they are so general in nature that they can be widely interpreted. Here are some sample code of ethics statements of professional associations:
This Code of Ethics is a summary statement of the standards by which massage therapists agree to conduct their practices and is a declaration of the general principles of acceptable, ethical, professional behavior.
Massage therapists shall:
Demonstrate commitment to provide the highest quality massage therapy/bodywork to those who seek their professional service.
Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues.
Demonstrate professional excellence through regular self-assessment of strengths, limitations, and effectiveness by continued education and training.
Acknowledge the confidential nature of the professional relationship with clients and respect each client’s right to privacy.
Conduct all business and professional activities within their scope of practice, the law of the land, and project a professional image.
Refrain from engaging in any sexual conduct or sexual activities involving their clients.
Accept responsibility to do no harm to the physical, mental and emotional well-being of self, clients, and associates.
I shall endeavor to serve the best interests of my clients at all times and to provide the highest quality service possible.
I shall maintain clear and honest communications with my clients and shall keep client communications confidential.
I shall acknowledge the limitations of my skills and, when necessary, refer clients to the appropriate qualified health care professional.
I shall in no way instigate or tolerate any kind of sexual advance while acting in the capacity of a massage, bodywork, somatic therapy or esthetic practitioner.
Professionalism
I shall maintain the highest standards of professional conduct, providing services in an ethical and professional manner in relation to my clientele, business associates, health care professionals, and the general public.
I shall respect the rights of all ethical practitioners and will cooperate with all health care professionals in a friendly and professional manner.
I shall refrain from the use of any mind-altering drugs, alcohol, or intoxicants prior to or during professional sessions.
I shall always dress in a professional manner, proper dress being defined as attire suitable and consistent with accepted business and professional practice.
I shall not be affiliated with or employed by any business that utilizes any form of sexual suggestiveness or explicit sexuality in its advertising or promotion of services, or in the actual practice of its services.
Scope of Practice / Appropriate Techniques
I shall provide services within the scope of the ABMP definition of massage, bodywork, somatic therapies and skin care, and the limits of my training. I will not employ those massage, bodywork or skin care techniques for which I have not had adequate training and shall represent my education, training, qualifications and abilities honestly.
I shall be conscious of the intent of the services that I am providing and shall be aware of and practice good judgment regarding the application of massage, bodywork or somatic techniques utilized.
I shall not perform manipulations or adjustments of the human skeletal structure, diagnose, prescribe or provide any other service, procedure or therapy which requires a license to practice chiropractic, osteopathy, physical therapy, podiatry, orthopedics, psychotherapy, acupuncture, dermatology, cosmetology, or any other profession or branch of medicine unless specifically licensed to do so.
I shall be thoroughly educated and understand the physiological effects of the specific massage, bodywork, somatic or skin care techniques utilized in order to determine whether such application is contraindicated and/or to determine the most beneficial techniques to apply to a given individual. I shall not apply massage, bodywork, somatic or skin care techniques in those cases where they may be contraindicated without a written referral from the client’s primary care provider.
Image / Advertising Claims
I shall strive to project a professional image for myself, my business or place of employment, and the profession in general.
I shall actively participate in educating the public regarding the actual benefits of massage, bodywork, somatic therapies and skin care.
I shall practice honesty in advertising, promote my services ethically and in good taste, and practice and/or advertise only those techniques for which I have received adequate training and/or certification. I shall not make false claims regarding the potential benefits of the techniques rendered.
The basics of ethics is uncovering your own beliefs and values and understanding what motivates your actions and thoughts. In doing so you can create a massage business or find your ideal massage job that is a clear reflection of you and your values. It is an ongoing process because most of our values are ‘inherited’ from our early upbringing and not really chosen by us. They are taught to us by our parents and in school.
Massage clients also come to a massage therapist seeking help. The dynamics of the helping relationship recreate the dynamics of the parent/child relationship. It is important to be clear about what is what to become an effective massage therapist. Situations will arise on a daily basis as a massage therapist that will constantly challenge your values and your core beliefs about yourself. To help you unravel the underlying needs and perceptions participating in peer supervision groups or individual supervision classes can help you to do that.
Since we need to take ethics to meet continuing education requirements and to build successful careers finding the best massage ethics classes isn’t always so easy. There are a handful of online classes that you can read some material and take a test. While this fulfills the requirements for continuing ed having a live interactive class or participating in supervision will help you in creating your own code of ethics and help you in learning to live by your values and create meaningful therapeutic relationships with you clients. It is the therapeutic relationship that will help you build your career.
I have started an small directory of the online massage ethics classes where you can post your class and also write a review on the class and rate it. There is also some more information on massage ethics that I have started and will be adding too on my www.massage-career-guides.com website. I also have some earlier writings on ethics in the massage profession on this site and in my blog posts on ethics for massage therapists.
When you learn about self care in massage school or read current articles on self care for massage professionals they teach proper body mechanics, proper posture, eat right, exercise, meditate or do some type of movement and of course getting regular massage to help stay grounded. While these things can help, they are really just the tip of the iceberg – the external components of self care. But knowing what things to do for self care and doing them are usually two different things. What leads you to take action or not take action is the underlying unconscious beliefs about whether you are worthy or need self care.
The best thing you can do to take care of yourself is to become more conscious of your unmet needs and repressed/suppressed feelings so that you can be more present in your massage sessions for your clients. That is what they pay you for really. Your unmet needs and old emotions are what get projected onto others and onto clients in the form of counter-transference. I have written about countertransference before here.
Your unmet needs and old emotions are projected into your practice, your money issues and your personal relationships. Self care that addresses these issues and helps you to become more aware of these issues can often reduce the physical stress of doing massage. The more you take care of yourself in that way, the more confident you become in asking for what you need and creating boundaries to take care of yourself in the client/massage therapist relationship.
Being financially responsible is one such method of self care which usually is not mentioned in self care classes/articles. Having the money that you need to live and run your business is the highest form of self care possible. The other way to take care of yourself is taking care of your personal needs for appreciation, love and nurturing. When you combine the two things you won’t have to worry about body mechanics or how hard you work on clients or working more than the agreed upon time.
Helping has a way of bringing up our unmet needs. It shows up in counter-transference. The reasons why massage therapists want to help others is usually filled with unconscious unmet needs and old feelings. Countertransference influences the client interactions and the healing process sometimes hindering it. When you are in a state of countertransference , projecting your old issues and feelings onto a client it can cause you to lose the objectivity you need to see the client clearly and hear the client clearly.
In simple terms, projection happens when you are not aware of your feelings or needs so you ‘project’ them onto someone else. Projections can cause reactions such as always giving advice to a client. To become more present means to be able to feel the feeling that is causing the projection (are you following this? It is hard to understand since it is unconscious.)
Remember – this is an unconscious process. Everyone is unconscious most of the time. Since it is unconscious you are not aware of what you are really doing. Becoming more conscious is a very complex process. We live our lives with many blind spots. Some people won’t even believe they are doing something unconsciously because it seems so real. It is real.
The way to track your thoughts and beliefs is through your feelings and becoming more aware of them.
Supervision is one such way of interaction that helps you to become more self aware. Supervision is not someone telling you what to do in the regular definition of supervision in the workplace. Supervision is the process of working with a more experienced massage therapist in order to understand your practice issues more and help you become more aware of yourself. You can learn more about the process of supervision on the website.
Working with a skilled psychologist can also take you deeper into your old patterns of behaving onto can do wonders for your massage practice and personal life. Since all relationships start in transference and the therapeutic relationship has a way of intensifying that transference it is important to find out more about your unmet needs. For the most part all we can do is grieve the loss of never having had them met as it is too late to get them met. Then it is a matter of taking personal responsibility for yourself and actions. The more you take care of yourself, your unmet needs and deal with the emotions, the more present you are able to be in your sessions and be there for clients. The more you take care of your internal self the easier it is to do those external self care things like setting boundaries around your time and financial needs.
Transference is one of the most important concepts to understand for a massage therapist but the least understood and talked about. It is usually covered in a few hour workshop in massage school. Transference is a very complex phenomenon that comes from the psychology profession. The reason that it is so important to understand is the fact that the process of transference is actually what can lead a person to becoming more aware of their thoughts and issues. Transference is what heals.
Ben Benjamin author of the book “The Ethics of Touch” defines transference as this:
Clients defer to the practitioner’s judgment because they desire to be helped by an authority figure that possesses greater knowledge, healing ability and, therefore, power.
Since a power differential exists in any health care relationship, the client may be inclined to respond to the practitioner as he or she would other authority figures, and in doing so, may recreate elements of similar past relationships. This situation is known as transference, a normal, unconscious phenomenon that appears during a therapeutic process. Professional helping relationships usually have a strong transference element in which the parent-child relationship is unconsciously re-established. In transference, unresolved needs, feelings and issues from childhood are transferred onto the helper.
Elliott Greene author of the book “The Psychology of the Body” writes this:
Transference is the displacement or transfer of feeling, thoughts, and behaviors originally related to a significant person, such as a parent, onto someone else, such as the massage therapist. It is a common reaction of clients to their therapists. A bit of transference happens in most relationships in which there is feeling present. Usually, transference-related feelings were formed in the past, so it could be said that these feelings transfer from the past to the present. In transference then, the client relates to the therapist and present moment as if the therapist were the significant person. In this sense, transference is a projection of the internal drama of the client, and the therapist is assigned a particularly important role and script.”
Nina McIntosh in her book “The Educated Heart” says this about Transference.
“Transference may sound complex and unusual, but it’s actually part of our everyday life even outside of our offices. It’s normal for any of us to bring the past into our present relationship. In fact it happens all the time. They are magnified ina manual therapy session because of the intimacy of the setting, the clients altered state and the way that the practitioner/client roles mimic those of the parent/child.”"Transference isn’t a rational process.
Terrie Yardly-Nohr in her book “Ethics for Massage Therapists” says this:
“The very nature of the therapeutic relationship allows transference to happen easily. Bodywork can trigger a variety of emotions from clients such as anger, frustration, sadness, fear, or joy. These feelings are generally the result of some emotion the client felt in the past towards another person.”
Cidalia Paiva in her book “Keeping the Professional Promise” says this:
“Transference refers to those situations where the patient projects onto the therapist old feelings or attitudes they had about significant people in their past, often parental figures. Transference is often referred to as ‘the unreal relationship in therapy’. The roots of transference are most often found in early childhood, and it constitutes a repetition of past conflicts with significant people in our lives.
So what is transference then?
Simply put, transference happens when there is difference in authority that resembles the parent-child relationship. The client who comes to a massage therapist receives the nurturing that they never received as a child and puts the massage therapist on a pedestal. The nurturing touch brings out the old feelings and emotions that were repressed or suppressed in early childhood. The client unconsciously begins to see the massage therapist as the nurturing parent and it can bring up feelings of attachment that were not resolved growing up. It is when the client unconsciously thinks that the massage therapist is their mother or father or other significant caretaker. Note the word – UNCONSCIOUS.
Attachment is what happens between a mother and child that allows the child to grow and build self esteem. The infant knows learns about themselves through touch. There are various stages of attachment that occur in child development where the infant feels like they are one with the mother. (And of course they once were in eutero.) As a child grows they learn that they are separate from the mother. This is where things often go astray. If a secure attachment is not formed in their early part of life, they will have life long challenges that result from that.
Massage and nurturing touch re-enacts the process of development. I actually think this is also why spa treatments are so popular with the use of healing waters and body wraps. Getting regular massage and developing a relationship with a massage therapist in which the client feels nurtured and cared for as if they were receiving it from their mothers can help heal the grief of not ever getting those early childhood needs met.
Transference is really important yet difficult to understand. The best way to understand it is to experience it. You may or may not have had some of these feelings arise when you were getting a massage from someone:
Feeling like you don’t want the massage to ever end
Not wanting to leave the office
Seeing the massage therapist outside of the office and wanting to follow them where ever they go.
Or from the other aspect seeing it in your clients:
bringing you flowers or special gifts
hearing about people’s personal problems
being asked to make exceptions in scheduling and payment options.
inviting you out socially as a friend
asking you out on a date or making other advances on you.
Or if you ever worked with a psychologist or mental health professional in therapy, you can come to learn more about transference from seeing your own. Becoming aware of your projections in a therapy setting can be a painful experience. It is a matter of getting a look at your unconscious thoughts through relationship. It can be a very eye-opening process and really lasts a lifetime.
While some of these things may just seem like normal things, it is difficult to know the difference. You probably won’t know the difference.
What you can do is create a code of ethics and a set of policies and procedures for your practice that will help you make proper decisions in any situation. It is having boundaries that teach people when they are in transference that you are separate from them is what will allow the person to heal and build self esteem.
The other thing about transference is that it not only occurs in these helping types of relationships but almost all relationships. Friendships, significant others, family members and the person who checks you out at the grocery store who seems to ‘look just like your mother”.
Reading and learning everything you can about transference can also help. These are some of my favorite books:
