Articles and Publications
When is it OK to Date Clients?
When is it Not?
When LaRue Lundeen and Kirk Fjellman began dating, neither had a clue that Lundeen would be accused of breaking the law because of their relationship. But up until four months before the relationship began, Fjellman had been Lundeen's massage-therapy client—and in Minnesota, where both live and where Lundeen practices, a therapist must wait two years before engaging in an intimate relationship with a former client.
Kirk Fjellman's former wife turned in the couple (who had married in September 2003) to the state which then ordered the now-named LaRae Lundeen Fjellman to not have sex with any former client and to pay a civil penalty, according to an Associated Press article [2016: URL no longer exists]. The state of Minnesota rescinded its order against her in February 2007, but not before Lundeen Fjellman had spent more than $13,000 in legal fees, another AP article [2016: URL no longer exists] stated.
Many therapists haven't given much thought to the issue of sequential relationships and may be unaware, as this therapist was, of the potential risks.
In the sections that follow we look at various aspects of dating former clients—including the types of risks involved, factors that increase or decrease those risks, relevant government regulations and codes of ethics, as well as practical guidelines for therapists who find themselves attracted to clients or discover that clients are attracted to them. The information we present is drawn from our own experience and training as well as from discussions with several experts who have examined this issue in massage therapy and psychotherapy contexts.
What's at Stake?
When a therapist dates a former client, the client is the person most obviously at risk as a result of issues relating to power and transference. All therapeutic relationships involve a power differential. The practitioner is the authority figure and has the power to directly affect the client's well-being. This differential is amplified by the physical aspects of massage therapy. The client is in a much more vulnerable position—usually fully or partially unclothed and in a lying or seated position that gives the practitioner access to his or her body. During the course of an evaluation or treatment, the client's physical safety is literally in the therapist's hands. In the shift to an intimate personal relationship, there's a risk that the therapeutic power dynamic continues so that the individuals cannot relate as equals in a balanced partnership.
Additional risks arise around the issue of transference. (See Signs of Transference.) Transference occurs when the client unconsciously transfers attitudes, feelings, and desires related to other important authority figures (most commonly parents) onto the therapist. The transference may be positive (e.g., adoration or idealization of the therapist) or negative (e.g., feelings of anger or a sense of betrayal). There's some anecdotal evidence that physical contact (particularly intentional, caring touch) can stimulate regressive experiences which may make transference more likely.
Transference is common and it typically does not cause serious problems in a massage therapy context. Most mature adults who recognize their emotions and desires can keep them contained within a therapeutic setting. In addition, skilled therapists assist with containment by maintaining clear boundaries. However, with clients who are less mature or who have less awareness of their own responses, transference reactions may become more pronounced. The clients' thoughts, feelings, and behavior toward the therapist may be driven by their early experiences with little or no connection to present reality. For example, some people may feel compelled to continually seek the therapist's approval, just as they did with their parents.
When a professional relationship turns into a personal one, such responses leave the client highly vulnerable. As psychotherapist and educator Sonia Nevis, Ph.D., explains, "The danger is that the person might not be doing what's necessarily best for them, because they want to please you."
A further complication is countertransference which is transference occurring from the therapist onto the client (See Signs of Countertransference.). Like clients, some practitioners have unresolved feelings and needs from their past that may be stirred up in the course of treatment. A therapist's positive or negative responses to a client may have less to do with that particular person than with someone from the therapist's past. As with transference, countertransference creates serious complications for intimate relationships significantly increasing the risk that one or both individuals re-enacts their early traumas, conflicts, or family dynamics.
The risks of sequential relationships apply not just to clients but also to therapists. Issues related to transference or countertransference may cause just as much emotional distress for the practitioner as for the client. Moreover, it's the therapist who's held liable for any legal or ethical violations that may occur.
"Although the literature, ethics codes, and licensure standards have focused on the danger to the former client, professionals need to be aware of their own liability and vulnerability," explains psychologist Gary Schoener, a respected expert in the field of ethics, boundaries, and sexual abuse issues. "If something goes wrong in the eventual relationship, the professional may be liable civilly and criminally, and stand to lose a great deal. Once lines are crossed, the professional is at considerable risk if the former client becomes angry or frustrated, and especially if the relationship ends."
Even if the client was the one who initiated the relationship, the practitioner is fully accountable for whatever happens. As we mentioned earlier, the individual may be violating state laws or professional codes of ethics and could risk losing his/her license or expulsion from a certifying organization. Later in this article we'll examine these regulations in greater depth. An interesting twist is that the complainant doesn't have to be the client—as was proven in the Minnesota case when the ex-client's ex-wife filed a complaint against the massage therapist.
In addition to the personal liability involved, dating a former client could damage the reputation of an entire spa, multi-practitioner massage therapy center, or other health care facility. Gossip travels quickly and research has shown that negative information travels three to four times faster than news of positive experiences. For any organization that provides massage therapy, having an impeccable reputation is essential. People looking for massage services can choose from many options, and doubts about a business's integrity can easily drive them to seek other alternatives.
A further risk of dating former clients is the potential to strengthen old negative stereotypes about the massage field. Although massage therapy has gained increasing acceptance as a reputable health-care profession, that perception is not universal; the image of the "massage parlor" mixing massage with sexual services still persists in the public's imagination. Nina McIntosh, author of The Educated Heart, sees this as a reason to err on the side of conservatism. "We need to stay above reproach," she says. "We can't be too careful with our reputation. We don't want to sexualize what we are doing."
What makes this whole issue more complex is the great diversity of therapeutic relationships with some eliciting much more of a power differential than others. At one end of the scale (generally less risky) is a spa therapist who works on a client only once. Near the other end would be a therapist who sees a client for six months or more, performing treatment including somato-emotional bodywork or injury rehabilitation.
The most important aspect of keeping good boundaries is to listen to your inner voice.
The most straightforward factor affecting risk in a personal relationship is the duration and consistency of the professional relationship. All other things being equal, it's less problematic to transition from a sporadic, short-term relationship (such as three or four sessions during the course of a few months) than from a regular, long-term one (such as one or two sessions each week for a year).
It's also important to consider the quality of the professional relationship, including the depth of the therapeutic work and any dependence or intimacy that has developed in that context. Schoener identifies several warning signs that indicate an increased risk of harm if the relationship turns personal:
- There is significant emotional involvement or dependency;
- The therapist talks to the client about his personal life, relationships, and psychological struggles—not just physical issues;
- The therapist has become a key figure in the client's life; or
- The therapist breaks her own rules with the client.
Other relevant factors include the length of time of the professional relationship and the age, emotional stability, and level of maturity of both parties. Prior relationships also play a role. For instance, the power differential could be lessened if the therapist and client previously knew each other as equals.
In researching this article we reviewed every state's licensing requirements, statutes, rules, regulations and codes of ethics for massage therapists. Most include statements about not initiating or engaging in sexual activities with a client; only Washington D.C. and three states—Maryland, Minnesota and North Carolina—specifically address sexual relationships with former clients. All but Maryland give a precise timeframe, while Maryland's regulations's regulations refer to an unspecified "period of time after formal termination of the therapeutic relationship where the client may still be vulnerable to the power imbalance that exists in the relationship."
Some regulations refer to upholding a professional code of ethics, but those codes are rarely provided on Web sites. Several states require that massage therapists adhere to the National Certification Board for Therapeutic Massage & Bodywork (ncbtmb) code of ethics even if they are not nationally certified. Many practitioners may be unaware that the ncbtmb has a six-month waiting rule listed in its standards-of-practice document. This regulation applies to any therapist who is certified by the ncbtmb or who practices in a state requiring adherence to ncbtmb guidelines.
In general, massage therapists face much greater restrictions on their dating lives than other health care practitioners do. For example, the only expectation for nonpsychiatric physicians and nurses (where the power differential is usually much more pronounced than in a massage therapist/client relationship) is that the professional relationship has been terminated. They can stop treating a patient one day and start dating the next.
In the real world people often find themselves socially involved with people form work. In this field there are risks for both the client and the therapist. If you are contemplating dating a former client, get advice and supervision from a qualified health-care professional who has expertise in dual relationships so that you make sure you do the right thing—which is not necessarily the easiest or most expedient thing.
Minimize Your Risk
When Shifting From a Therapeutic to a Personal Relationship
The decision to enter a sequential relationship with a client demands integrity, consistency, and authenticity. It isn't always easy to determine whether a romantic involvement is truly in the best interest of the former client. According to the people we interviewed, the shift from a therapeutic to a personal relationship should never be initiated by the practitioner. There was a general consensus that taking such action is unprofessional and reflects negatively upon our field.
If you ever find yourself considering a sequential relationship with a client, we strongly recommend you follow these five guidelines:
- Familiarize yourself with the relevant laws in your state and with the codes of ethics of your professional organizations.
- Consider each of the complicating factors mentioned above to make an informed judgment about the client's vulnerability with you. How large has the power differential been? Has there been any transference? Keep in mind that the client could one day wake up and feel that you've taken advantage of him or her. These issues are not easy to assess by yourself. It is often useful to discuss them with a psychotherapist or supervisor.
- Consider your own level of involvement and vulnerability. Has there been any countertransference? Do you have trouble maintaining boundaries or find yourself breaking your own rules with clients? It's difficult to evaluate your own feelings and actions from a rational, objective point of view. Tell the facts to a trusted colleague and see what he thinks. Notice if you are reluctant to tell anybody, as that could be a sign of trouble.
Wait before taking any steps toward a relationship. This gives both you and the client some time to think more clearly. According to Gary Schoener, sex that happens within three months of termination usually occurs the day after the last session.
There's no fixed consensus on how long the waiting period should be. Nina McIntosh suggests waiting six to nine months. She says, "Most people don't know how to judge if a client is too vulnerable. There needs to be time for reality to set in." Few experts would advocate a blanket two-year rule as instituted in Minnesota.
However, in some circumstances that time period may make sense. Sonia Nevis advises waiting at least two years in any case where there's a power differential. When there isn't a power differential, she suggests waiting six months and then reevaluating the situation.
- Get some counseling and supervision. Professional supervision is invaluable for any practitioner who's trying to decide about engaging in a romantic relationship or evaluating one that has already developed. The questions that come up are often complex and difficult to answer by oneself.
Signs of Transference
- The client frequently asks you personal questions.
- The client calls you at home, knowing that calls should be placed to your office.
- After only one or two treatments, the client is overly complimentary of you and your work.
- The client tries to bargain with you for a reduced rate.
- The client regularly requests that you change your schedule to accommodate his or her schedule.
- The client brings you gifts.
- The client repeatedly invites you to social engagements and feels rejected when you explain your policy of separating your work and social life.
- The client asks you to do "a little bit more" at the end of most treatment sessions and expresses disapproval if you don't comply.
- The client asks you to help him/her solve personal problems.
- The client frequently asks you questions in areas that you've previously explained aren't within your scope of practice.
- The client often mentions that you remind him/her of someone.
- The client has difficulty maintaining a physical boundary and attempts to inappropriately hug or touch you at the end of each session.
- The client has difficulty leaving after the session and tries to engage you in conversation.
- The client gives you intimate details about his or her personal life.
Signs of Countertransference
- You feel a strong emotional charge, either positive or negative, toward the client.
- Your thinking is distorted—you may have an idealized or overly negative view of the client.
- You feel irritable or angry with the client for not changing, not improving, or not cooperating with the prescribed treatment plan.
- You think your work is much better for the client than most practitioners' work, or you feel your work is totally ineffective and worthless for this person.
- A pattern of feeling exhausted, exhilarated, depressed, or uneasy when you see the client.
- An expectation of praise exists and you are disappointed if the client does not praise your work.
- You feel guilty when the client experiences a painful reaction that lasts for an extended period after treatment.
- You frequently experience anger when the client crosses minor boundaries, questions your competence, or otherwise "pushes your buttons" in some way.
- You undergo secondary trauma upon hearing painful and graphic stories about the client's past.
- You frequently help the client in matters outside the sessions, such as offering rides and introducing the client to social contacts.