Principles of Ethics

Ethics is defined by Webster as the study of standards of conduct and moral judgment; this system or code of morals of a particular person, religion,group, profession, etc.

Since each person is unique with their own experiences and beliefs, ethics can be difficult to define. There is no concrete answer.  As a professional, we are responsible for the comfort and safety of our clients.  We can serve them best when we understand their needs and rights.  We can serve them best when we have examined ourselves and worked through our own issues. We can serve them best when we focus on the development of ourselves.  We can only guide the client  to places that we have been willing to go ourselves.  The healing process can begin only when we realize that we are just facilitators in the process itself.  The healing is the responsibility of the client alone.  They must be given the information to determine what is right for them and what they are going through.

Informed Consent
Clients need to be able to make a decision as to whether they want you to work on them and what they want you to do. Tell the client what you’re doing and why. This is informed consent.  They must be given enough information, such as : what are the goals and purpose of the session, what are the possible consequences of the treatment, what risks are involved,  what are the possible benefits of a treatment, how much time will the treatment take, how much money will the treatment cost and how will it be paid for.  With this information, a client will be able to determine if they want the treatment for themselves or do they refuse the treatment.

Informed consent is the process in which a fully informed client can make conscious decisions about their health care or massage therapy session.  An informed consent statement does just what it says: informs clients to make them aware of your services so they can actively consent or participate in the service or not.

Informed consent for doctors usually is about protecting them in case things go wrong in their treatments that are much more invasive or even life threatening.  For Massage therapists, informed consent is more about letting people know of possible contraindications and keeping them safe.  It does not release the massage therapist if harm is done as in the case of doctors.

Writing a Statement of Informed Consent is crucial to the success of a massage practice.  

Many massage therapists overlook this process.

An informed consent statement can include:

  • list of services that you offer

  • scope of practice

  • a specific definition of what those services are

  • your intentions for the massage

  • your philosophy on healing, massage and health

  • treatment plans and goals

  • risks involved in treatment/session

  • guidelines for receiving massage

After informing a client of your services and philosophy it is necessary to confirm that the client understands what you mean.  Often, clients will just agree without hesitation because they don’t want to make waves.  You can specifically ask a client to tell you what they understand will be happening.  

Being direct with a client sets up proper boundaries for creating a therapeutic relationship.  When a client is informed, they have the opportunity to be more engaged in the process of massage and healing. 

The client or therapist can end the session at any time.  This is especially helpful in cases where men request ‘extra’ favors or with clients who are continually late or don’t show for their appointments.

Articles online on Informed Consent:

Informed Consent Heart of Bodywork By Nina McIntosh, Author of  Educated Heart,  Massage and Bodywork Magazine
Informed Consent,  Elaine Stillerman, Massage Today
Heating up your Practice Safely Part 1, Dixie Wall Massage Today,  How to use hot stones safely and use informed consent

Examples of Informed Consent:

AMTA Informed Consent Agreement

Informed Consent Forms for Massage, Acupuncture, for Minors at in .doc, PDF, wpf, and rtf format that you can edit and make into your own form.

Right of Refusal
Clients have the right to refuse the service for any reason at any time.  If they determine that the session should be stopped right in the middle, their needs must be respected.  Be aware that a session interrupted before completed may also cause a problem in the financial agreement.  Does the client owe for the whole time?
This same right also applies for the practitioner. You can end a session at any time, for any reason. The bottom line is to work on only people who are nurturing to you and do not drain your energy. If your mother just died of lung cancer it may not be advisable to work on someone who smokes.

A clients information, both written and verbal belongs to the client.  Conversations that occur during a session, should not be repeated or included in the chart notes unless it is describing their physical condition. A client may also not want to be approached outside the treatment clinic.  If you see a client walking down the street and stop and say hello, this may violate their right of confidentiality, as they may not want it be known that they are seeking treatment.

A Boundary is a space within a perimeter that may be a physical, emotional or mental space.  The emotional (mental) space is determined by past experiences, values and morals. The physical space is the actual physical limits of space that is

 needed by each person to feel safe and secure.  Boundaries can be communicated by verbal conversations or body language.  Some people, especially those with a history of abuse of some sort, may not be aware of their boundaries let alone able to maintain their boundary.  Boundaries may be determined before a session to ensure the clients comfort.

Boundaries are often difficult to determine.  What may be good for one person, may not be appropriate for another.  It is important to explore boundaries and constantly readjust limits to accommodate each individual.
When boundaries are crossed, respect may be lost in the relationship.
There are a main types of boundaries we deal with include: Legal boundaries, professional boundaries, and personal boundaries.
Legal boundaries are those that of course deal with the law and the rules and regulations that are set up by each state, city or county. Your scope of practice is defined legally. Your scope of practice is the limits or boundaries that apply to your practice.  This may include areas you can work on and what you can or can not do. This will determine if you can do things like make diagnosis’s, do physical adjustments, work in the mouth or other body cavity and sell vitamins and other related items.
The laws vary so much that it is impossible to discuss here.  Make sure you contact your local authorities to determine what your legal boundaries are and that you work within the law.
Professional boundaries are determined by many things such as your type of practice, your business rules and practices.

Personal boundaries are just that- everything that determines your safety zone. They may be influenced by past experiences, beliefs and values.

Boundary violations usually begin quietly, little by little, and without many problems.  When you go through the process of looking at your values and needs and set your framework, boundary violations can be minimized.  Recognizing your own boundaries will be based on your values and needs.  There is no right or wrong here – only what is what is important to you.

Transference occurs when the client makes the professional relationship, personal.  Indications of transference are things like the client brings you additional gifts or asks to see you for lunch or outside the treatment. Personal conversation can also be an indicator.  What you do depends on each situation.  This can occur when a client is lacking in sufficient resources to take care of themselves.  Unresolved needs, feelings and issues are transferred to the helper or caretaker.

Counter-transference occurs when the therapist is unable to separate the therapeutic relationship from their personal feelings surrounding the client.  Some of examples of this is when a therapist feels inadequate if the client is not making progress or excessive thinking about the client after the treatment is over.  This occurs usually when the therapist plays the helper or fixer role.  We begin thinking that we can get rid of the persons pain when we really don’t do anything but facilitate the clients growth for their own healing of pain.  We begin to think that only we can fix the problem and we have all the correct answers.

Boundary violations usually begin quietly, little by little, and without many problems.

It is important to think of your practice as one of service to the client.
How can you serve that client best?

Knowing the basic principle of ethics is just the beginning to building a successful practice.  


Best Books on Ethics, Informed Consent: