It is the proverbial elephant in the room when it comes to massage therapy as a profession. Sex and the role it plays in our profession, the history and misperceptions of massage, awkward moments … these issues are the hardest ones to deal with. I mean, it’s a sensitive subject and a hot button issue, right? It’s hard to even write about, especially when sexual metaphor and innuendo seem to slip into every sentence.
Let’s agree that it’s a serious area of professional ethics for MT’s (we are adults!), but let’s also agree to laugh and assume every pun is intended. Because if we can’t laugh about it and speak frankly among ourselves, then we’re already in trouble.
This article is geared towards helping new massage therapists with issues involving sex, arousal, and what to do to limit ethical dilemmas.
Why is legitimate massage still sometimes confused with prostitution? Laura Allen says the answer has something to do with the history of the massage profession. “It’s only been in the past 20 years that massage has even remotely been viewed as health care. It’s a perception problem for the profession and it depends on generations and locations.”
She says thanks to The Massage Therapy Foundation and the serious research that is being done in the community, as well as professional associations like AMTA and ABMP, massage is slowly being accepted as a legitimate form of health and wellness care. Allen notes that location is a factor, as well. In big cities, they’ve had “massage parlors” for a long time, and they still exist. The burden is on massage therapists and professional associations like AMTA and ABMP to continue educating people and keeping those boundaries separate.
Older folks might still use old terminology, as well. “I had a 97-year-old client the other day who called her son and said ‘Come and get me, I’m at the massage parlor,” Allen said with a laugh. “It made me cringe, but she’s 97! I didn’t correct her.”
Cherie Sohnen-Moe has spent years dealing with the topic of sex and ethics in massage therapy. “I have a different attitude about this,” she said. “Some people get very defensive and afraid about it. Part of it is our society and people have strong emotions and fears about sex. We get embarrassed. We get afraid. I feel like unless someone is threatening you, it’s just a simple response to say ‘No, I don’t do that.’ Be professional.”
Wait, what are we talking about? Let’s back up.
Massage therapists occasionally get asked to perform sexual favors.
Massage therapists sometimes have clients who get aroused during a massage.
It happens, and both Allen and Sohnen-Moe say it may not be a frequent occurrence, but if you practice massage therapy long enough, it will probably happen to you.
How Do You Deal With Arousal?
First, Sohnen-Moe says you have to recognize the difference between arousal and intention.
“There’s a big difference. It would happen to me… male clients would get aroused and then become extremely embarrassed. I would just give them the speech: ‘It’s nothing to be embarrassed about. This is the way the body responds; it’s just a physiological reaction.'”
She would then ask if they wanted to continue, give them time to compose themselves or move to a different area. She set them at ease.
Laura Allen was hilariously irreverent about this particular aspect of massage. She said in her North Carolina drawl:
“My favorite mentor, on the first day of school told me, ‘If they get an erection and they don’t acknowledge it at all, or if they acknowledge it as if they are embarrassed about it, or they’re snoring like a pack mule… why get upset by it?’ If you’ve been around men long enough, you know they get nocturnal erections and yeah, you’ll see it waving around like a flagpole under the drapes. Now, if they start bumping and grinding on the table, that’s a different story.”
The point, they both say, is that you might feel awkward, the client might feel embarrassed, but deal with it in a professional manner and try to put your client at ease.
Sometimes the situation is not just accidental arousal. Intentions matter; a request for sexual favors, a blatant touch, sly comments, body language, or anything that sets off alarm bells for the therapist must be taken seriously.
“First things first,” says Sohnen-Moe. “If someone is on your table and you get a feeling something is questionable, first you break physical contact. Hands off and step back from the table.”
Have a plan and know how you’ll respond when it’s time to take action. When an incident occurs, the first moments are crucial in keeping a very clear boundary.
- Break physical contact and step away.
- Make eye contact.
- Change posture. Don’t stand close and use a power stance.
- Clearly communicate expectations. “I don’t do that. I practice therapeutic massage.”
- Depending on how you’re feeling, it may be fine to continue if they understand expectations and agree to behave appropriately. It may be a case of ignorance or fuzzy expectations or impulse.
- Trust your instincts and end the session if necessary.
- DOCUMENT the incident.
Setting the Right Tone
Although there isn’t a 100% guaranteed way to prevent a sexually-charged incident, there are ways to reduce risk by setting a professional tone and taking other measures.
Look for clues. Allen says, “You get the occasional call from someone who wants a FULL BODY MASSAGE, and you can just tell by the way they say it what they’re looking for.”
Use a professional intake form (you can download our template here). Your client will know immediately that they’re in a place that focuses on healthcare. “I’ve been to some places where they give you an index card and they ask you to put your name and phone number on it,” Allen said. Not exactly professional.
Speaking of intake forms, discuss your therapeutic treatment services in detail and in a professional manner during the intake. Discuss a treatment plan and set expectations for the session. These processes are vital to your client’s perception of you as a wellness practitioner.
Both Allen and Sohnen-Moe agree: professional dress is important. Allen uses this illustration, “What would you think of your doctor if he or she arrived in sandals, shorts, and a tank top to examine you?” Doctors wear a white coat for a reason: It communicates authority and professionalism, and makes a distinct boundary between doctor and patient.
You project an image with tone of voice, posture, body language and attitude. Allen says “No flirting!” Ask yourself, “What image am I projecting?”
Let’s be very clear: A client is responsible for his or her actions. Period. This is not to set up blame for a therapist: “Well, if only she hadn’t worn shorts or giggled with him all the time…it’s her own fault.” Absolutely not. We’re talking about projecting a professional image in order to maintain a clear boundary. All of the above are measures you can take to reduce risk.
When It Gets Serious
“I would rather the therapist be more cautious than less,” said Sohnen-Moe. She admits that it’s a tough balancing act. You don’t want to overreact to something small, like unintentional arousal, but you also don’t want to get stuck in a dangerous situation where you feel threated or one where the client can use something to bring a complaint against you.
One of the most vulnerable positions you can be in as a therapist is when you’re working with a client alone (that is to say, no one else in the building with you or you’re alone at the client’s home). It’s not the best idea, but sometimes it’s unavoidable. Allen has this advice for therapists when they’re working alone:
- Keep your phone and keys on your body while doing massage.
- It’s best to take referrals only.
- Have an escape route.
- Always tell someone where you’re going and when you’ll be done. In fact, make a call in your client’s hearing so they’re aware of your backup.
Protect Against Ethical Complaints
There is an entire industry in the medical world devoted to malpractice, ethics hearings, lawsuits and misconduct. Massage therapists aren’t immune. Laura Allen has sat on her board’s ethics hearings for five years, and she’s seen a lot.
“During a student clinic, the sheet fell off me completely while I was being massaged by a male student (in a room with lots of other people, who were also getting massage, so it wasn’t a big deal and no one noticed). I told the class later, if that had happened in the privacy of a treatment room and a client took it the wrong way, that could have been the end of his career.” She’s seen it happen.
This is not to say that every client is suspect! Again, it’s a balancing act. Therapists need to protect themselves, but clients need to protect themselves too.
Regulations about draping are different in every state. For some states, draping is mandatory. For others, it’s up to the client, and they have that option. Draping exists as a boundary between you and a client. Allen encourages practitioners to always use draping, as an extra “insurance” against any misunderstandings and to protect both parties.
Sohnen-Moe has a slightly different take on draping. “A drape is a boundary, but some clients hate draping and will request less draping because of overheating or claustrophobia, or prefer other options like towels. There are cultures where draping is optional, clothing is optional. Get your ego out of the way and figure out what the client needs and what they are thinking. If they request no drapes, it probably has nothing to do with sexual intent. Still, unless you are in a sanctioned, clothing-optional environment, draping is required.”
Desexualize the Situation
If you’re concerned about a particular client or a new client, there are ways to desexualize the environment, in addition to the list of measures above. Candles, low lighting, soft music, and touching…for some people all of these things add up to triggering a sexual response. Sohnen-Moe recommends a few options. Consider using an eye pillow instead of a dim room. Or wait until they are on the table before dimming the lights. Nix the candles and change up the music, or use an air filter for background noise.
It’s important that your boss backs you up. If you’re working in a setting where you have an owner and you are part of a team of therapists, make sure your manager has your back and supports you. If you get into a situation where you feel uncomfortable with a client, you’ll want to have the support from management to make tough calls or to be able to refuse a client that you don’t want to work with.
Both experts agree that for new massage therapists, it can be really awkward. What helps is to practice role-playing these situations with colleagues, co-workers, and fellow students.
“I never give people a script. You have to develop your own words,” Sohnen-Moe said. Role-play different scenarios. Practice handling embarrassing situations so you can feel more comfortable knowing what to do if a situation arises.
Sohnen-Moe ends with this little kick in the butt:
“Get over yourself. Not every sexual nuance means that a client wants to have sex with you. Still, therapists do not deserve to be made to feel uncomfortable or unsafe. My hope would be to strengthen the people who react to sexual situations with fear or offense, so they react with strength and clarity. Separate the request from whatever your notions are about sex. And then educate the client so that they know what professional massage therapists do and don’t do, so if they want sexual services, they won’t go bothering another therapist in the future.”
[We want to thank Laura Allen and Cherie Sohnen-Moe for contributing to this blog post!
Laura Allen is the author of several books, including Plain & Simple Guide to Therapeutic Massage & Bodywork, One Year to a Successful Massage Therapy Practice (LWW, 2008), A Massage Therapist’s Guide to Business (LWW, 2011). Learn more about Laura on her website LauraAllenMT.com.
Cherie Sohnen-Moe is the author of several books, including Business Mastery, Present Yourself Powerfully and The Art of Teaching. She is the co-author of the ground-breaking book titled The Ethics of Touch, which is used in more than 800 schools and associations. Learn more about Cherie on her website Sohnen-moe.com]
Comments from original Massamio post:
First and foremost, trust this email finds you well. Thank you to Massamio Blog and Benjamin McDonald for the above mentioned great article posted, nice topic indeed. Also my sincere thank you to both veteran massage therapists, Laura Allen & Cherie Sohnen-Moe for the fantastic tips and sharing, it really an eye-opener for me being new to the massage therapist industry especially doing more on house-call massage. Its give me a better perspective what I would expect in reality and the proper steps of what are the “do’s” and the “dont’s” I should take in the event such situation arises. I have been turning down several male clients requesting for house-call massage even though its on referral basis, fearing that I may not be able to handle such situation however after reading this articles, it motivates me moving forward with more confident and shall carry these tips along within me at all times. Once again, my sincere thank you. Cheers. Stay safe and do take care. Warmest Regards Rukilah from Singapore — Posted @ Monday, November 11, 2013 7:09 AM by Rukilah Dasuki
Thanks for writing, Rukilah, and for sharing your experience. We’re glad you got value from Cherie & Laura’s years of experience. It sounds like your confidence is growing, and this is a cornerstone to being effective. We’d love to hear more about your practice as it grows. Best wishes! — Posted @ Monday, November 11, 2013 3:00 PM by Benjamin McDonald
fantastic article that addresses a very real problem. in my experience i have also seen this the other way, where a female client pursues a male practitioner. these issues are prevalent and more awareness is definitely needed in how to avoid and / or deal with such a situation from a professional perspective. — Posted @ Thursday, November 14, 2013 8:44 PM by Neal @ Massage Therapy
Thanks for this post. I had a question regarding this advice: “Change posture. Don’t stand close and use a power stance.” So don’t stand close and don’t use a power stance, or don’t stand close while assuming a power stance? I assume it’s the latter, but the wording is a bit confusing. — Posted @ Thursday, January 16, 2014 9:51 AM by Marlene Mayman