The Client-Therapist Power Differential

Don’t Abuse the Financial and Transference Relationships

By Laura Allen
[Heart of Bodywork]

It’s unethical to use the client-therapist relationship to take advantage of clients in any way, whether that’s taking financial advantage or taking advantage of transference the client may be experiencing.
From a money standpoint, it’s unethical to use the privilege of the therapeutic relationship to profit from a client beyond the usual and customary fee. Pressuring a client to buy a product or service you are selling, or invest in something you have a financial stake in, is abusing the relationship. The main issue is not whether the client might benefit from the product; the issue is whether you are taking advantage of the power differential that’s inherent in the therapeutic relationship to make a profit.
Many times, clients tend to view the therapist as an authority on things that are actually outside scope of practice—such as nutrition, vitamins, or herbal supplements. They may worry about hurting your feelings if they don’t buy the protein powder, cosmetics, or whatever product you’re selling that you swear has changed your life. If the client buys the product and it doesn’t give them the results they were led to expect (and bear in mind, different people experience different results with any product), ill will could result.
Selling a product of any kind automatically places you in a dual relationship with a client. Always avoid placing pressure on a client to purchase anything; never tell a client that they need something you’re selling. Avoid discussing products in the treatment room; the client is there for a massage, not a sales pitch.

Maintaining Boundaries
Taking advantage of the client’s transference often happens in small ways you may not be conscious of. If you’re going through a difficult time, it’s tempting to use a sympathetic client as a handy person to vent to … after all, you know they like you, and they won’t really mind if you talk about your impending divorce for the whole session, right?
Wrong! The client might end up feeling like they need to take care of you—when in fact, they’re paying you to take care of them. That doesn’t mean for you to act as the client’s counselor, either. Not only is that out of scope of practice, you could also unintentionally be taking advantage of the fact that they look up to you if you start giving them advice on personal problems.
In all our dealings with clients, we need to ask ourselves if our words, deeds, and actions are really the best thing for the client, and make sure that we’re not doing anything to take advantage of the therapeutic relationship.

Laura Allen is the author of Nina McIntosh’s The Educated Heart (4th ed, Lippincott Williams & Wilkins, 2016) and numerous other books. She has been a massage therapist for 19 years. Allen lives in the mountains of Western North Carolina with her two rescue dogs, Fido and Queenie.