Be Honest with Yourself and Your Clients

Hello, friends! What say we just get to it this time? Let’s walk through two simple and common scenarios where we could do better. 

Scenario 1: The Comfortable Rut

A client has been coming weekly for two years for stress and upper back tension. They tell you they always leave feeling relaxed. They always rebook. You’re proud of this. The client hasn’t had adverse reactions, there’ve been no complaints, and their feedback has been consistently positive. You see them every Monday. You do the same thing. They respond the same way. The client’s tension always returns by Wednesday, but isn’t that normal? Rinse. Lather. Repeat. 

There’s nothing wrong with ongoing care. The issue is ongoing, unexamined care. You’ve never suggested movement work or asked if they’d be interested in seeing a physical therapist to augment the work you do together. You haven’t asked about resources to explore, whether their workstation might be part of the problem, or whether weekly massage is addressing anything beyond temporary symptom relief. 

The ethical pillar of “nonmaleficence” is being met here on a basic level. The client is satisfied. Nobody’s getting injured. But beneficence asks that we seek to improve the situation in which our clients find themselves. I’m not sure the dynamic described above is fully scratching that itch. Is the client better off or just predictably and temporarily more comfortable in a pattern that isn’t changing?

Then there’s the question of nonphysical harm that rarely pops up on our radar. The nonphysical harm here is that over time, patterns like this can unintentionally foster dependency. There is also the possible harm inherent in the financial cost of a recurring service that functions more as maintenance of the status quo than genuine therapeutic progress. There is also the murky underside that you may be unconsciously avoiding a referral because if the physical therapist can create meaningful improvement, you may lose a regular client, and you can’t afford that. I understand that for many of us, referring out a weekly client isn’t just an ethical question, it’s a financial one, and that tension requires a level of thoughtfulness that can be hard to apply.

Scenario 2: The Enthusiastic Overreach

A client mentions they’ve been feeling depressed and that their visits with you are helpful. You’re a genuinely caring person, so you lean into this, extending sessions just a bit, checking in by text between appointments, and framing the massage as “healing work” for the depression. Your client reports they feel seen and supported.

Inviting a client to seek additional support while standing in our own value is no easy task.

No physical harm is occurring as far as we can tell, but you are quietly and likely unintentionally repositioning yourself as a mental-health-adjacent support figure without the training, supervision, or ethical framework that role requires. If the client deteriorates, you have no protocol. The relationship has also drifted into a territory that could make it harder for them to seek actual mental health care, partly because this feels like enough and partly because you’re both now invested in how “helpful” the massage therapy is, creating the possibility that seeking additional support could feel disloyal or disappointing.

This kind of harm is relational and structural. That’s not going to show up on any intake form or session notes.

Thinking Beyond the Session

These scenarios feel so benign, don’t they? Certainly, in the big scheme of harms that demand our attention, it’s easy to ignore these kinds of slippery choices and the harm they can do over time. But I also invite you to notice that both scenarios share something: The therapist’s self-assessment stops at the body and stops at the session. “Did I hurt anyone today?” is a much easier question to answer than “Did I move this person toward a better condition?” or “What else could I be doing to improve this person’s situation?” These questions require acknowledging effects that extend beyond the table and may require us to act and think in new ways. 

When we talk about the importance of advanced communication and emotional self-regulation, these types of situations are what we’re talking about. Inviting a client to seek additional support while standing in our own value is no easy task. Being willing to lose a client if we refer them to a practitioner who can better meet their needs is our ethical responsibility. And being able to feel in ourselves when a relationship is codependent or otherwise out of balance is an essential skill best met by the ability to do something about it. 

Our ethical work doesn’t end when the session ends. If we want to elevate this profession, we have to be willing to ask more difficult questions than “Did I hurt anyone?” We have to ask, “Did I help them?”

Nonmaleficence keeps us safe. Beneficence makes us professionals. 

A Deeper Dive—A Beneficence Check: Questions for Ongoing Care

Beneficence isn’t about grand gestures. It’s about small, consistent decisions that move our clients toward greater agency and better or restored health. If you’re unsure whether your work is doing that, consider running through the questions below quarterly for your long-term clients or when you notice yourself in a “comfortable rut.” I find that asking myself questions that I’m willing to answer honestly helps (self-honesty is another indispensable skill that can only be built with practice).

Q.     Is this client meaningfully better off than when we began? Not just relaxed after sessions but functionally, emotionally, and behaviorally better. Hold yourself accountable. What has actually improved? When we meet questions like this with honest answers, they suggest an action plan. For instance, if you ask yourself the question above and the answer is “no,” you get to wonder, “What could I do differently that would make this a yes?’’

Q.     Have I introduced at least one strategy that increases their autonomy? Movement, self-care, referrals, ergonomic changes, nervous system skills, communication practices—anything that reduces exclusive reliance on your work and invites clients into their own healing and process. It’s possible that when you ask this question, you may realize it never occurred to you that (a) you had reinforced a pattern of reliance, or (b) there was anything you could do to shift that. 

Q.     Are we measuring progress in a meaningful way to the client? Even informal tracking (range of motion, symptom frequency, stress ratings) prevents maintenance from becoming mindless repetition and invites the client to keep track of their experience, making them an active participant in the process.

Q.     Have I avoided suggesting something because I fear losing this client? This includes referrals, collaborative care, frequency changes, or even discharge. 

Q.     Does this relationship expand the client’s world or subtly narrow it? Are we encouraging broader support systems and resources or becoming the primary (or only) place they process stress and distress?

Q.     If this client stopped seeing me tomorrow, would they leave with tools or just temporary relief? This is a question of autonomy, which is both easy to downplay and easy to assume we are using to guide our work. In the scenarios in this column, the honest answer would be that you haven’t given them tools. You’ve narrowed their autonomy. The first client feels they will always “need” you to give them the relief they are getting, and the second is not only feeling that you are possibly saving them but also that they may not be free to seek additional support. 

Q.     Am I still challenged and growing in this work or just repeating what I already do well? Yep, beneficence also applies to your development. The more you grow your skills (not just techniques but listening, communication, referring, etc.) the more likely you are to be able to be guided by beneficence.