Foundation of Ethics 

Emotion is natural and instinctive in each of us, however, from youth, we are taught by our parents teachers and loved ones, that many of these emotions are not allowed.   Therefore feelings of anger, sadness, fear or frustration are often suppressed.  When this happens, the emotions remain unaddressed and are free to resurface at any time.  People often forget that it is our mind which controls our body.  The brain directs our movements through our nervous system.  Because of this direct mind-body connection, when we suppress our feelings, they often manifest in our bodies.  

Think about a few of you clients who complain of chronic tension from stress.  As a therapist, you can feel the tension in their neck muscles.  This is true for all of us.  Think of a time when you tried to hold your breath to keep from crying.  At some point in our lives, we've experienced an example of the powerful mind-body connection.

With consideration of how emotions are stored in the body, we can see why bodywork tends to release them, whether we intend to or not.  As therapists, we all know that muscle tension is one of the most common ways we hold on to emotion. In fact, most of our clients seek massage to help relieve that tension knowing it’s caused by stress. On occasion in your practice, it is likely that one of your clients will experience an emotional release. The client may experience any of the following emotions; sadness, grief, anger, or fear. Your touch may trigger a client’s memories of an event.  They may or may not be able to associate their feelings with anything specific.  A client may cry or feel like crying during or after their massage.  Some emotional releases are associated with specific traumatic events while others reveal more of a reoccurring negative pattern.  Again, it can’t be stated enough that as massage therapists we are not psychotherapists, however, we can be there to support our clients through the release process by giving comfort touch and listening without judgment.  In most cases, these emotions surface and pass quickly.  The reoccurrence of or intensifying of emotional releases is a sign that it is time to refer a client to a counselor.

 

One of the most common ways emotion comes to the surface in massage therapy is through transference (the projection by a client of feelings, needs or issues onto a therapist instead of recognizing them as his or her own).  Transference can be perceived as a positive thing when the client projects good or flattering qualities onto the therapist, conversely it can be quite upsetting when a client projects negative attributes onto a therapist. As an example, if a client’s father wore a certain aftershave and a male therapist wore a similar aftershave, the client may unconsciously transfer their feelings, or emotions about their father onto the therapist.  

 

Reflection:

 

Take a moment and think of an example of if or when this has happened to you or someone you know in your massage practice.

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Unfortunately, transference is not always on the part of the client. We as therapists are susceptible to this too.  This is called Countertransference (the projection by a therapist of feelings, needs or issues onto a client instead of recognizing them as his or her own).

 

A few tell-tell signs that you are projecting emotions onto your client are:

 

•you are feeling overly-emotional about him or her

•you have lost your objectivity as a therapist, either in the positive or negative direction

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The intimacy of massage provides an opportunity for transference and countertransference.  The following are common signs that transference or countertransference is occurring:

 

•The person does not say what he or she is truly feeling.

•The person might have a hard time saying “Yes” or “No.”

•One person idealizes the other. This can become complicated when the other

person “buys” the illusion and feels that he or she is “better” than someone else.

•When the therapist “buys into” this illusion, he or she loses therapeutic curiosity, compassion, and effectiveness.

•One person in the therapeutic relationship has romantic or sexual feelings about

the other.

•One person mentally “leaves” the relationship or unexplainably becomes angry,

frightened, defensive or any other strong emotion with an intensity that is unrelated or disproportionate to anything that transpired in the current situation.

 

Dealing with transference can be tricky.  As professionals, it is most important that we do NOT point out to the client what we imagine his or her transference to be. Remember that it is happening on an unconscious level. It is arrogant to think that we know what another person’s unconscious motivations are.  While similar in many ways, our job is massage therapy, not psychotherapy, and it is out of our scope of practice to act as such.   Our job is to set and maintain clear and consistent personal and professional boundaries to be most effective and therapeutic for our client.

When we identify our transference to a client, we may benefit from talking it over with a trusted peer or mentor. One of the best ways to prevent ethical mistakes is to have an established relationship with a mentor who can provide objective feedback to our practice experiences without judgment.

 

Another ethical danger is creating dual relationships. In this context, a dual relationship is an association between the therapist and client that is outside the typical professional roles.  For example, you could be involved socially, romantically, in business, or any other “special” relationship that you do not have with your other clients. As stated earlier ethical issues are not always clear-cut, and the area of dual relationships may be the one that is the most complex.

 

Understanding your personality, professional style, lifestyle and even the size of your community are some of the factors that affect professional boundaries. However, successful massage practitioners agree that dual relationships are more complicated. “To prevent creating ethical problems for yourself and your client, set, communicate and maintain clear boundaries, avoid unhealthy rescues and make consistency a priority with your practice.”