Ethics for the Massage Therapist
Based on NCBTMB Code of Ethics
4 CE Hours
By Stacey Potter, LMT, Texas CE Provider, BS.
First Smashwords Edition, 2011
Published by Smashwords
Copyright © Stacey Potter 2011
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How this works.
It’s as easy as 1,2,3 . . .
1. Read the document.
2. Email the completed assessment to mspttr@gmail.com
3. Receive your certificate via email.
Learning Goals
Goal 1: The students will dissect the Code of Ethics for massage therapists, using the NCBTMB Code of Ethics.
Goal 2: The students will review contraindications and benefits of massage, including recent studies regarding the effectiveness of massage.
Goal 3: The students will modify their own ethics to fine-tune any areas of concern..
Please refer to the National Certification Board for Therapeutic Massage and Bodywork Code of Ethics.1
Goal 1: The Students will dissect the Code of Ethics for Massage Therapists
A poster once read “Character is who you are when no one is looking.” Ethics can be defined as a set of moral principles, especially ones relating to or affirming a specified group, field, or form of conduct. As massage therapists we need to be more careful than other professional groups in defining our ethical practices.
Qualifications
When a massage therapist starts out in their practice they are qualified to perform services to clients including massage. However, some states have a larger Scope of Practice than others. For example, in Louisiana massage therapists are licensed to practice Shiatsu2 while in Texas it requires additional training. In Florida it falls with their Scope of Practice to perform colonic irrigation and electrical devices. So an ethical practitioner will know what their local Scope of Practice is and stay within them. As an ethical therapist it is vital to know what the law allows within the locality where you practice.
What qualifies a therapist to perform modality? This is a grey area. Most states have no legislation saying in order to be a qualified Reflexologist one must do A, B, and C. A good rule of thumb is to have an educational program that allows academic background as well as hands on experience including some kind of assessment that tests both areas of competency. We have to know what we are doing, and we have to practice the modality skillfully.
In order to be qualified to perform a modality it is vital that the massage therapist has a high quality educational experience. This may mean completion of a certain number of hours of education and a written examination. Once one has completed the formal education it is important to think of this as a springboard to learning more about the modality. This is a big area of ethics because the therapist needs to be self-accountable to continue their education and increase competency.
It is also important to recognize that there are limits in knowledge and don’t be a ‘know-it-all.’ I know often times in the classroom setting I have a student ask a question I don’t know the answer to. When this happens, I get the opportunity to learn more about the topic. It is also important to recognize the client knows their injury well and may be asking a question to see if you know it as well as them. If you don’t know don’t fake it.
I had a client who wasn’t responding the way I thought she should to my treatment, I didn’t know what was going on and told her so. I referred her to a doctor and found out she had a severe disease he needed to address medically. I am so thankful she went to the doctor because her illness could have been life threatening. “When in doubt, refer out!”
As massage therapists we do not: diagnose, prescribe, and adjust joints, spine, or skeletons.
It is vital that we stay within the Scope of Practice for the locality including; educational requirements, use of lotion, use of oil, use of heat and cold.
Goal 2: The students will review contraindications and benefits of massage, including recent studies regarding the effectiveness of massage.
Informing others
Often times when I say I am a massage therapist in a social setting I have someone ask what ‘parlor’ I work in. Most of what we do as therapists is education of the people around us about massage. We may just be working on talking about contraindications to massage.
Some of the Contraindications of massage are:
1. Pregnancy. It is generally not considered safe to massage pregnant women. During the first three months of pregnancy the chance for miscarriage is higher. With proper training in pregnancy massage, a therapist may practice pregnancy massage.
2. Fever is a sign that the body is fighting something. It is important to ‘do no harm.’ If a massage is performed it may make the sickness worse by dumping the toxins into the body. This could cause the illness to intensify.
3. Open wounds, cuts and bruising demonstrate that the body has an injury. It is important to know the severity of the inured area and avoid the area. If the injury is within 2 weeks the best rule is to keep hands off. When in doubt, ‘do no harm.’
4. Blood Clots are hands off because massage could move clot possibly causing a heart attack or stroke.
5. Varicose Veins and thrombosis. No massage is indicated over broken or varicose veins, as the blood supply is impaired in this area. Massage will increase blood flow and flood the over-worked capillaries and veins, possibly causing coagulation and affecting blood flow to the heart.
6. Skin infections including bacterial infection, Lymphangitis, Fungal infection, viral infections, Herpes. Massage may also add to skin irritation for eczema or psoriasis.
7. Cancer can spread through the lymphatic system. Massage may spread the disease. Always check with a doctor first.
8. Broken bones / fractures. It is contraindicated to do massage on healing bones.
9. Acute back pain especially when an injury is involved.
10. Other chronic conditions and diseases. Consult a qualified medical practitioner if you having high blood pressure, diabetes or any heart disease prior to receiving massage therapy.3
11. Sunburn is also a contraindication for massage.
12. Migraine headaches are a contraindication because the hormones involved in this pathology can make the headache worse.
Aside from informing people of the contraindications for massage, it is vital that we talk up the benefits of massage.
What are the benefits of massage in neonatal babies?
Neonatal Case Study
The initial uncertainty and gradual acceptance by Nicholas of the massage experience is clearly depicted. At the end of the massage, Nicholas was relaxed and asleep in a semi-fetal position. The behavioral change in this infant indicates that he made a transition from touch aversion to touch acceptance.4
So even if the baby didn’t know that the massage was supposed to reduce his stress and relax him. It did!
Massage has also been shown to reduce anxiety in the workplace.5 Massage can also reduce high blood pressure.6 In autistic children massage has also been effective.7
This highlights the stress reducing benefit of massage. Another physical benefit if massage is relieving muscle tension and stiffness. Massage reduces muscle spasms and increases joint flexibility. It also reduces stress related headaches. Sometimes when a client has muscle pain due to lactic acid, massage can provide some relief.8
There are also many emotional benefits of massage. Some emotional benefits include helping foster peace of mind, reducing stress, and helping clients feel caring appropriate touch.9
It is important to remember the massage client is seeking your services because they are looking at the aforementioned benefits of massage. As ethical professionals we need to do our best to highlight and offer these benefits. The father of medicine Hippocrates talked about “two special objects in view with regard to disease, namely, to do good or to do no harm.”10
Education Requirements for Massage Therapists
Consistently maintain and improve professional knowledge and competence, striving for professional excellence through regular assessment of personal and professional strengths and weaknesses and through continued education training.11
Most localities have continuing education requirements for the re licensure of massage therapists, however, it is vital that as practitioners we maintain our knowledge. In medicine, what we know is always changing. It is important to know what has changed. For example, I took CPR ten years ago when renewing my license for Emergency Medicine. Recently I took the class again and found the basic fundamental information of ventilations to compressions had changed because new studies had shown the effectiveness of more ventilations wasn’t valuable. Had I not updated, I would have not known that I didn’t have to risk blood borne pathogens while doing CPR.12
Although the practice of massage is over 3000 years old, we are learning more about the human body every day. There have been numerous studies in regards to massage therapy within the past few years and it is important that we as professionals continue to educate ourselves to strive for excellence in what we do. 13
The most difficult thing for any of us to think about is the possibility that we may have weaknesses that hinder our care to the clients. We need to make a concerted effort to make sure that we are always improving our education and practice. Some states require minimal if any education. However, if we have been out of the classroom for a while it might be a good idea to renew the knowledge of anatomy, pathology, or whatever modality being used just to make sure we are up to date professionals. I try to make a point to do at least 1 hour of education with every 100 hours of work time. This just keeps my skills up to date.
Honesty, Integrity, and Respect
As a professional in business it is important to maintain honesty. My father used to always state that, “I don’t have a good enough memory to tell a lie, because I have to remember the stories I told to whom I told them.” He is right when we lie we have to remember more than when we tell the truth to the best of our knowledge.
“There’s one way to find out if a man is honest,” Groucho Marx once remarked. “Ask him. If he says, ‘Yes,’ you know he’s a crook.”14
It is much easier to keep honesty and integrity when we do our best to never tell a lie, in paper, in person, in print. Try to maintain the highest level of straight forwardness possible.
Respect is treating others better then your would expect to be treated. This means putting others first. In massage we have to keep in mind that the treatment needs to benefit the client. We need to do all we can to have that happen. I thought this was a fitting poem . . .
A Brief Course In Human Relations
The SIX most important words:
“I admit I made a mistake.”
The FIVE most important words:
“You did a good job.”
The Four most important words:
“What is your opinion?”
The Three most important words:
“If you please.”
The TWO most important words:
“Thank You.”
The One most important word:
“ We “
The LEAST important word:
“ I “
Unknown15
It is important to remember ‘I’ is the LEAST important word.
Client Information
It is vital that we keep the information confidential our clients give us. Anything related to a client’s health is confidential. As healthcare providers we would be held to the HIPAA standards of practice. A major purpose of the Privacy Rule is to define and limit the circumstances in which an individual’s protected heath information may be used or disclosed by covered entities. A covered entity may not use or disclose protected health information, except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual’s personal representative) authorizes in writing.16 We need to get written release from our clients prior to releasing any information about them. Otherwise, we are not maintaining the client’s confidence.
At this point it is important to understand that anything the client shares with us is held in strict confidence. We need to be like Vegas what is said in the treatment room stays in the treatment room. Our clients count on us to keep confidences and we are in the business of keeping the information they provide to us confidential. Below I have an example of an intake form I use with my clients. This stays in a locked file in my treatment room. This is vital. We need to maintain the files for seven years past the last treatment date. Each state varies in how long to maintain the records, so be informed about your local rules and regulations. ALL of the information on the Client Intake Form is confidential and requires client approval before giving to anyone else.
Client Information Form
Name__________________________________ Birth Date __________
Address_____________________________________________________
City_______________________________ State ___________________ Zip _________
Phone _(_____)_____________________
Present Employer______________________ Occupation________________________
PLEASE CHECK IF YOU HAVE EVER HAD:
_____Arthritis _____Bursitis _____Cancer _____Contacts _____Diabetes _____ Epilepsy _____Infection ______Heart Trouble _____ High Blood
_____Low Blood Pressure _____Migraine Headaches _____Phlebitis _____Varicose Veins _____Skin Disorder
_____Tense Muscle
Are you currently pregnant?
Have you had any recent surgeries?
Have you had any trauma or injury?
CONTRAINDICATIONS (PLEASE LIST):
1.
2.
I, ___________________________________________, understand that the massage given is for stress reduction and increases circulation and is not to be used in place of medical treatment. It is recommended I see a physician for any medical problems that I may have regarding my state of health. I also certify that my medical history provided on this form is correct to the best of my knowledge.
Draping will be used during the session unless otherwise indicated above. There will be no breast massage of female clients unless agreed to by both the client and the therapist. Swedish massage is the only technique administered in this massage. If I am uncomfortable for any reason, I may request to end the massage session. The massage therapist may end the session, if sexually harassed.
Client Signature ______________________________Date__________
Therapist Signature _________________________ Date __________
Draping
Proper draping creates a safe setting, keeps clear boundaries, follows the law, protects my client and protects myself from any misunderstandings. In accordance with your laws draping needs to be maintained.
Boundaries
Establish clear boundaries from the beginning. From the first conversation with the client it is vital that the client understands what services you provide in a therapeutic relationship.
Talk about boundaries in the intake form. ‘There will be no breast massage of female clients unless agreed to by both the client and the therapist. Swedish massage is the only technique administered in this massage. If I am uncomfortable for any reason, I may request to end the massage session. The massage therapist may end the session, if sexually harassed.’ This excerpt is from the intake form above and helps to establish the boundaries and the services provided.
Identify signals that the client may be looking for sexual services. Address them directly if they arise. One example is the question, “Do you accept tips?” A good response would be, “Yes, I accept tips and I don’t do sexual massage.” But remember someone asking, “Do you accept tips” rarely implies that they are only looking for sex, but each situation needs to be looked at individually. Don’t scream or run out of the room. Let them know that sometimes being touched results in sexual arousal but that you won’t be participating in that with them. Too many massage therapists make the mistake of making the client feel guilty about what can be an innocent action. This does not, of course, mean they can touch you or say suggestive things to you. 17 Unfortunately we need to be very cautious about the clients who think that massage is a way of receiving sexual massage.
It isn’t just about sexual boundaries; it includes cancellations, no shows, and fees. I think this is my most difficult area of boundaries. We need to have a written policy and stand by it.
Keep client relationship as exclusive as possible. If they are friends try to keep the friendship out of the massage arena.
Keep your personal opinions to yourself about personal issues, religion and politics. You have friends and family to share this with. It is unprofessional to share our personal opinions with the clients.
Business Licensure
It is also important to remember to stay within all local laws and regulations for your business license, insurance, and record keeping. In some states you need malpractice insurance, while in others all that is needed is a massage licensure.
Summary:
Ethics is a way of trying make the law cover honesty and integrity. It is in a massage therapist’s best interest to stay far away from any practice or appearance of dishonesty. As a therapist we need to ask the questions: Could someone think I am doing something unethical in this situation? If the answer is in the affirmative then we need to fix this situation. We have worked too hard to get this career to loose it to false accusations. If we maintain a professional relationship with our clients, then we will have no problem with ethics.
Goal 3: The students will modify their own ethics to fine-tune any areas of concern.
Qualifications
Now it is your turn to think about your own ethical base. Think about the questions below as they relate to your qualifications as a Massage Therapist.
1. What modalities do you currently practice?
2. What kind of education and skills do you have to practice this modality?
3. Does this include an academic as well as a skills component?
Informing Others
Think about the questions below as they relate to informing others.
4. Are you a massage educator in informing others about the contraindications to massage?
5. Can you list 10 contraindications for massage?
6. Do you know the benefits to massage?
Educational Requirements for Massage Therapist
7. Do you know the local requirements regarding continuing education for massage therapists in your area?
8. What is your personal ratio of massage hours to educational hours? (Mine is 100 to 1)
Honesty, Integrity, and Respect
9. Do you maintain the highest quality of honesty, integrity and respect within your practice?
10. What does it mean to you to give respect?
Client Information
11. What do you do to gather information from your clients?
12. Do you keep the information locked up?
13. Do you keep the information confidential?
Draping
14. Do you drape your clients in accordance with local laws?
Boundaries
15. How can the intake form help establish clear boundaries with a client?
16. Do you screen clients to see if they are looking for sexual massage?
17. Why are boundaries more then just the sexual boundaries?
18. Why should we try to separate our personal lives from the client?
19. Why is it important to keep your opinions to yourself while in the client—massage therapist relationship?
20. Are there any areas you need to improve your ethical practice in?
1 http://www.ncbtmb.org/about_code_of_ethics.php 2007 National Certification Board for Therapeutic Massage and Bodywork, Revised 2008.
2 http://law.justia.com/codes/louisiana/2006/44/94207.html Louisiana Revised Statutes, Title 37 entitle Professions and Occupations, Chapter 57 (RS 37:3552).
4 Lindrea, K.B., & Stainton, M.C. (2000) "A Case Study of Infant Massage Outcomes," The American Journal of Maternal/Child Nursing, Vol. 25, No. 2, 95-99.
5 Shulman KR & Jones GE. The effectiveness of massage therapy intervention on reducing anxiety in the work place. Journal of Applied Behavioral Science. 32:160-173.
6 Hernandez-Reif M, Field et al. High blood pressure and associated symptoms were reduced by massage therapy. Journal of Bodywork and Movement Therapies. 4:31-38.
7 Field T, et al. Autistic children's attentiveness and responsivity improved after touch therapy. Journal of Autism and Developmental Disorders. 1986;27:329-334.
8 Wiltshire et al. “Massage Impairs Post Exercise Muscle Blood Flow and "Lactic Acid" Removal.” Medicine & Science in Sports & Exercise. 2009.
11 http://www.ncbtmb.org/about_code_of_ethics.php 2007 National Certification Board for Therapeutic Massage and Bodywork, Revised 2008.
12 Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S640–S656.
13 Moyer CA, Rounds J, Hannum J. A meta-analysis of massage therapy research. Psychological Bulletin January 2004;130(1):3-18.
16 45 C.F.R. § 164.502(a)
17 http://www.wikihow.com/Maintain-Healthy-Boundaries-As-a-Massage-Therapist
Ethics Test
Student Name: ______________________________
Address: _____________________________________
City/State/Zip: ______________________________
Phone: ________________________________________
1. The text states that: “Character is. . .
a. ethical practice.”
b. having integrity.”
c. who you are when no one is looking.”
d. someone in literature.
2. Ethics can be defined as:
a. a set of rules and regulations.
b. a set of moral principles, especially ones relating to or affirming a specified group, field, or form of conduct.
c. honesty and integrity.
d. guidelines for professionalism.
3. Scope of Practice:
a. stays the same in every state.
b. doesn’t relate to the practice of massage.
c. is based on your preferences.
d. differs from state to state.
4. A good rule of thumb for a therapist to perform a modality is:
a. for the therapist to have taken a short correspondence class.
b. for the therapist to have read an article about the modality.
c. for the therapist to have heard about the modality.
d. for the therapist to have academic background, hands on practice, and assessment in the modality.
5. When the client asks a question I don’t know the answer to the BEST way to handle it is to:
a. use lots of medical terminology to make my answer sound good.
b. be honest and let the client know I don’t know the answer.
c. try to ‘fake it,’ so the client doesn’t loose faith in me.
d. none of the above.
6. Finish the statement; “When in doubt. . . “
a. refer out.”
b. study about.”
c. fake them out.”
d. hands off and walk out.”
7. Some of the contraindications for massage are:
a. Muscle hyper tonicity.
b. Medically controlled hypertension.
c. High stress job.
d. Open wounds, bruising, fever, and sunburn.
8. What are the massage benefits for neonatal babies?
a. The behavioral change in this infant indicates that he made a transition from touch aversion to touch acceptance.
b. There are no massage benefits for neonatal infants.
c. Neonatal infants aren’t massaged.
d. There are no studies about neonatal massage benefits.
9. Some other benefits of massage include:
a. Massage has also been shown to reduce anxiety in the workplace.
b. Massage can also reduce high blood pressure.
c. In autistic children massage has also been effective.
d. All of the above.
10. Hippocrates talked about:
a. Do no harm.
b. Treating the patient with respect.
c. Doing surgery on the client
d. All of the above.
11. It is important to maintain educational requirements for the massage therapist because:
a. It is never a good idea to be uninformed.
b. It is always good to learn something new.
c. Most localities have laws regulating continuing education requirements.
d. All of the above.
12. It is important to maintain honesty, integrity and respect because:
a. A dishonest therapist isn’t any good at giving massage.
b. Honesty is the right thing to do.
c. Respect is treating others, as you would want to be treated.
d. Both B and C are correct.
13. According to the poem ‘A Brief Course In Human Relations,’ the least important word is:
a. “I”
b. “We”
c. “Thank you”
d. “If you please.”
14. What is the standard for healthcare providers in keeping records private?
a. SIEEF
b. NCBTMB
c. HIPAA
d. None of the above.
15. The information on the Client Intake Form:
a. Is all confidential.
b. is not confidential.
c. can be given out to marketing companies.
d. none of the above.
16. The Client Intake Form should be kept:
a. in a locked file.
b. for a month after treatment.
c. in the massage treatment room where everyone can get to it.
d. for a year after treatment.
17. Draping creates;
a. a barrier between the client and the therapist and is completely optional.
b. a safe setting.
c. clear boundaries.
d. b and c are correct.
18. Boundaries help a client by;
a. creating a safe treatment.
b. helping a client relax.
c. letting everyone know where they stand.
d. all of the above.
19. Boundaries are important to the therapist because:
a. sets the tone for the therapeutic relationship and clears up any misconceptions about sexual misconduct.
b. allows the therapist to perform therapy without misunderstanding.
c. All of the above.
d. None of the above.
20. Why is important to remain ethical as a therapist.
a. it’s the law.
b. it’s the right thing to do.
c. all of the above
d. none of the above.
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