Editor’s note: This article is the beginning of a series on what you can do to adhere to the safest standards of care in massage therapy. Developed by the Massage Ethics Council, a volunteer group dedicated to sharing clear, ethical standards for the profession, this series focuses on how to keep practitioners and clients safe. Learn more about the council at themassageethicscouncil.com.
Predatory sexual behavior by a client is a serious issue and not something a therapist, male or female, should ignore or try to manage on their own. Therapists are entitled to work in an environment free of sexual abuse, whether that’s in a private practice or as an employee. If violations happen, they have the right to make themselves safe, remove themselves from the situation, and take all available steps to have the abuser reported and held responsible for their actions.
Unfortunately, formal reporting of violations remains rare. Therapists stay silent because they fear not being believed, worry about retaliation from employers who prioritize client retention over staff safety, or simply don’t know that reporting is an option. Therapists need to know they are not alone and not powerless.
There are instances where a client might not be a predator, yet could cross sexual boundaries due to poor impulse control, ignorance of proper boundaries, or because they are in a vulnerable personal situation. The therapist needs to be able to protect themselves in all situations.
The following are examples of inappropriate client behavior collected by surveying dozens of currently practicing massage therapists:
While good intentions and many years of practice by the MT might seem to guarantee safety, a client may still cross boundaries. The ethically safe touch experience doesn’t just happen; it must be created, structured, and sustained. This means consistently demonstrating absolute professionalism in all aspects of practice, particularly in matters of sexuality and touch. There are actions therapists can take to help mitigate clients’ inappropriate behavior and boundary crossings.
The physical environment differs depending on whether a therapist is in a professional office, a home office, or doing outcalls.
Be aware that sight, sound, smell, and touch all have the potential to create emotional or sexual responses. Practitioners may aim to create a relaxing environment with a darkened room, candles, and soft music, but these can send confusing messages—particularly to new clients or people in vulnerable situations regarding their romantic relationships. Ideally, start with a well-lit room and ask clients whether they want the light dimmed or an eye pillow. Choose soothing music that isn’t sensual or romantic. Use quality equipment and supplies. Consider hanging pertinent anatomical charts and other health-related posters. Limit displays of personal photos and keepsakes.
If the practitioner works in a home office, follow the above guidelines and comply with local ordinances (if applicable). Keep the treatment room separate from the living space (if possible) and decorate it to make it feel professional. Minimize clutter in the waiting area. Be sure the treatment room windows are covered. If possible, have a separate bathroom that’s free of personal belongings.
When doing home or hotel visits, set up a space that feels like an office. Avoid working in a bedroom unless there is no other option, such as a hotel room or if the client is severely injured or ill. Professionally display your supplies and equipment. Consider investing in a hard case on rollers that holds your supplies. Those items can be displayed on top of the case; this helps make the space look more office-like.
The therapist’s appearance reflects their professional standards. Make sure the therapist’s image projects competence and doesn’t sexualize them.
Therapists also need to establish sound business practices that support their professional boundaries.
In general, it’s important to have clear written policies that address the types of services offered, hours of operation, cancellation and late fees, communication guidelines, what to expect during treatment, draping, hygiene, sanitation, confidentiality, and which body parts are off-limits. It’s also wise to include a statement such as: [Your company name] has a zero-tolerance policy for sexual comments or behavior. If this occurs, the massage will be ended immediately and payment in full is expected.”
Policies are designed to prevent boundary crossings, but when prevention fails, the therapist must address the issue immediately as it arises. If the therapist doesn’t do this, they have given the client permission to carry on with the problem behavior, whether it’s making a sexual joke or asking for something inappropriate.
Any form of advertising, whether online or in print, opens your business to the public at large. Ensure a professional image in all materials. For example:
Most people spend a significant amount of time on social media. Here are some things to consider:
In most massage sessions, there is minimal conversation. Keep communication professional, not personal. Limit self-disclosure, as this can blur boundaries. Avoid careless comments that could be misconstrued as flirting or sexual innuendo. Also, never discuss charged topics, even if the client brings them up, such as politics, money, sex, or religion.
It’s essential to establish clear boundaries. If a client touches the therapist, makes a sexual comment or joke, or asks for something sexual, then the therapist must pause to firmly establish the boundary. If the client’s behavior doesn’t change, then it’s appropriate to end the session. Keep in mind that not everything is as serious as a sexual assault, but it could be worthy of dismissal.
Dual relationships should be avoided. A dual relationship occurs when a therapist has a second, distinct relationship with a client, such as a friend, employee, business partner, or romantic relationship, in addition to the primary professional one. These relationships are generally not advisable because they could impair the professional’s judgment or increase the risk of harm or exploitation of the client.
Dual relationships may be unavoidable and require careful management to protect the client’s interests, especially in small communities or during specialized training. Failure to navigate the risks involved in a dual relationship can result in personal or professional harm. Dual relationships can be a gateway to inappropriate behavior and embolden a predator. Conscious consideration of the potential risks is essential before engaging in a relationship of this nature; if so, clinical supervision is strongly recommended.
In addition to standard treatment notes, if a client is sexually inappropriate, document it immediately. Speak to a manager/supervisor (if you have one) or a trusted colleague. This type of documentation is particularly important in the event of a criminal or civil complaint.
Proper screening should be conducted before the client arrives. Always call new clients, even if they book online, to verify they are a legitimate client, clarify what they’re looking for (they might want a technique you don’t offer), and briefly review key policies. Once a client arrives, do the following:
Sexuality is a natural part of the human experience. By recognizing this, therapists can consciously choose to create a professional treatment space, maintain clear boundaries, and deal ethically and compassionately with unintended sexual responses. They can also protect themselves and their clients from sexually inappropriate behavior. By understanding the physical, social, and cultural dynamics and applying behavioral strategies, therapists can enhance their effectiveness as a safe, healing presence in the treatment setting. Following are some tips to create a safe space for therapists and clients.
How should a practitioner respond when a client has an erection during the session? It depends on the situation, the client, and your comfort level. Some practitioners wrongly believe that if a person is having an erection, the practitioner must immediately end the massage. There is the misconception that for a person to get an erection, they must be deliberately sexualizing the massage and either be mentally or physically stimulating himself. Erections may occur as a natural physiological response to being touched. When an erection occurs, it can make both client and practitioner feel vulnerable. If you respond with unnecessary disapproval and fear, you’re doing an already embarrassed client a disservice. Instead say, “I notice you have an erection. Tell me what you’re experiencing.” or “I notice you are sexually aroused. Tell me what’s happening.” If there is no sexual intent, you would go on to explain that this is a natural physiological response. Yet, you should still be on guard against the threat of a disrespectful, abusive client. It’s a tricky situation that requires tactful nuance.
If a client makes an inappropriate sexual suggestion during the session, respond to it immediately. Hesitating will give the client the impression that you are open to the idea. It’s up to you to address it in the moment; otherwise, you have given them the impression that you condone the behavior and reinforced the idea that it’s OK to try something with you or the next unsuspecting therapist they work with.
If the client is being obviously aggressive—physically stimulating themselves, grinding on the table, or trying to grab you—end the session immediately. You can say, “I’m not comfortable working with you anymore. This session is over. I’ll wait outside while you get dressed.”
Whether you are an employer, an employee, or a solo practitioner in private practice, having strong policies in place will bolster professional boundaries and make both the practitioner and client safer in this therapeutic environment. Planning and preparation are key, and we all hold responsibility in making that part of the process work.
In rare cases, a client might falsely accuse a therapist of sexual misconduct. Any practitioner can be accused of sexually violating a client. Sexual abuse and violation issues are about power, and they cross all lines of gender and sexual orientation. Most complaints are made by female clients against male practitioners. So, men, on the whole, are more at risk of accusations. All who touch people need to be cautious about sexual boundaries, and practitioners in those groups should be especially mindful.
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