Clear Boundaries

By Kenn Howard
[A Question of Ethics]

Dear Kenn,

One of my neighbors is a guy in his mid-30s—Larry—and he has severe cerebral palsy (CP). I know this because his mother, who is his caretaker, told me all about it. This mother knows I’m a massage therapist and told me she’s looking for someone to do massage for Larry and asked me if I would be willing.

I think this would be a cool challenge, as I’ve never worked with a person with CP before. She already asks me to come over and help her with stuff around the house. I do want to work with Larry, but I don’t know if I want to get more involved with their family. Would I be getting too close? What should I do?

—Up the Street and Nervous


Dear Up,

People with cerebral palsy can certainly benefit from receiving massage. Once the condition and type of CP is understood, and a method of communication is established, massage can be useful to reduce spasm and pain. Of course, massage won’t be a cure for CP, but it could certainly help Larry’s comfort level. But this is not the issue here.

You are concerned with a blurring of boundaries. You are a neighbor who already has a personal relationship with Larry and his mother. By taking on a professional relationship with Larry, and with his mother, too, you are concerned that this relationship will mix too closely with your neighborly relationship. Your concern is that Mom wants to develop a way that she can rely on you to be a steady caregiver. 

You have a very legitimate concern. In any therapeutic relationship, we must always be aware of the potential for a dual relationship—the development of a relationship outside of, or separate from, the primary therapeutic relationship. Your case is slightly different in that you already have a personal relationship and Mom is inviting you into a professional relationship. Even so, the pitfalls are the same—one of which is exploitation. This occurs when one person in the relationship takes unfair advantage of the other. Could that apply here?

Of course you want to say yes to Mom’s request. Helping Larry feel better would be a wonderful gift you could give him. Any relief would be greatly appreciated, and you will feel good about yourself. But if you make this decision, be aware of some potentially confusing situations. Since you live only a moment away from Larry, Mom has relied on you to do chores for them. Will she then call you at any time and expect you to agree to a massage session whenever they want? Will they call you to come over “for just a minute to do some spot work”? Will they combine sessions with errands?

In making your decision, you have to weigh potential situations and expectations. How does Mom view you in your relationship with Larry and with her? Will she see you as an aide? With this close proximity and increased contact, will she start to see you as part of her family? Will she depend on you?

In order to make these decisions, you must first decide for yourself what your role will be. You will also need to take an honest look at yourself to make sure you are ready and able to draw clear boundaries about which parts of your relationship are professional and which parts are neighborly. If you don’t, you may find that, as generous as you may be, your own life might become secondary to theirs. 

Kenn Howard is a massage therapist, NCBTMB-approved provider of ethics workshops, and instructor of ethics for the past 14 years. Contact him at