Introduction
When is it appropriate to give a client advice? What’s the difference between making a therapeutic recommendation, giving advice, and practicing medicine without a license? What does your massage therapy license entitle you to do? In the interest of ethics and professionalism, this writing presents food for thought and reflection on these important questions.
It can be very easy to fall into the “Advice Trap” with clients. This is where we share our opinions, judgments, beliefs and ideas with our clients about things other than massage-related matters. The possible reasons for this tendency are understandable: we are typically very knowledgeable, nurturing, compassionate people who want to help our clients in every way we can. Add to that the fact that the longer clients come to see us, the more they trust us and tell us about their lives. As they experience more and more of the safe touch we offer them, and they trust the healing intimacy of the session, they give us many opportunities to share our ideas and make suggestions. This is a very slippery slope.
While it’s obviously inappropriate to advise a client on such personal matters as relationship issues or financial problems, it may not be so easy to recognize inappropriate advising when our suggestion and recommendations have to do with their health. For example, we may want to share information with our clients about products or methods that we have personally found to be effective. Or, in contrast, we may want to caution clients about products or methods that we have personally found to be ineffective. Furthermore, our other life experiences and education may encourage us to feel qualified to offer information that we believe will be helpful, when in actuality, to do so would be stepping outside of our scope of practice. Several situations come to mind that may help explain this point. These are actual cases that have been conveyed to me in recent past years:
- A client was seeing a chiropractor for low back problems. The client decided to also see a massage therapist at the same time, thinking that the two modalities would work well together. At the first visit, the massage therapist advised the client not to continue seeing the chiropractor until she had at least 3 massages to “give massage a chance, since massage therapy was less invasive.” The client, confused about what to do, canceled her appointment with the chiropractor and explained the reasons to the receptionist. The chiropractor is in the process of taking legal action against the massage therapist for practicing medicine without a license.
- A client went to see a massage therapist for neck and left upper extremity pain. In giving her medical history, she reported that she was taking antidepressant medication. The massage therapist, a proponent of herbal remedies, cautioned the client about the side effects of the medication and recommended that the client experiment with an herbal antidepressant that she, herself, had found to be highly effective. The massage therapist went on to say that the left upper extremity pain could be a manifestation of the client’s relationship issues with a parent; the therapist had seen this to be the case with many clients. The client, feeling angry and violated, never returned for another visit with the massage therapist.
- A massage therapist, who had devout spiritual beliefs and practices, freely shared her views and ideas with her clients. At some point during the massage, she brought this topic into the conversation and she often encouraged her clients to adopt a more spiritual lifestyle. She had spiritual literature in her office and she offered to help clients learn how to pray and meditate for stress reduction. Clients soon sought out other massage therapists in her area and reported to the new therapists that they felt pressured and turned off by her approach.
- A bodywork professional who worked out regularly offered his clients advice on how to strengthen muscles. He had no formal education or credentials in personal or athletic training. A client, who happened to have an undiagnosed rotator cuff tendonitis, followed the therapist’s advice and it resulted in further injury to the tendon. The client may need surgery.
Clearly, in all of these cases, it is understandable that the massage therapist did not intend to cause harm to the client. Yet, despite the intention to be helpful, the suggestions, feedback and advice were inappropriate and out of the scope of a massage therapist’s practice. In each of the above situations, consider the following guidelines regarding scope of practice and appropriate professional behavior:
- A massage therapist has no right to impose his/her own beliefs and judgments about whatever healing modalities a client decides to explore. It is never appropriate to tell a client not to follow the directions of a doctor, chiropractor, physical therapist, or other primary care health provider. In the event that we are concerned about the judgment of another primary health care provider, we must tread very cautiously if we choose to present our views, taking care to emphasize that we have no authority or professional opinion in the matter and that our comments are based solely on our opinion.
- A massage therapist must never tell a client to start or stop taking medications, and recommending herbs is the same as prescribing medicine, which is out of a massage therapist’s scope of practice. No judgments should be made about the emotional or psychological status of a client and massage therapists should refrain from sharing their opinions unless they have professional training and qualifications to do so.
- Discussion of religious beliefs or spiritual practices ought not be brought into the client/therapist relationship by the massage therapist. Such matters are highly personal and confidential. Moreover, If the conversation in a session is directed toward this, or any other aspect of your life, it is likely that your focus is in the wrong place. The most effective sessions are client-centered, not therapist-centered.
- The teaching of muscle strengthening exercises is not within the scope of practice of a massage therapist. Professionals such as physicians, chiropractors, physical therapists, athletic trainers, and personal trainers are qualified to do so. If a client would benefit from such measures, the safest and most ethical action would be to refer them to the professionals who are qualified to educate them properly.
Advice-giving is a trap that is easy to fall into and difficult to get out of. Remember that, in general, when we share comments, opinions, helpful ideas, and judgments about any non-massage matters we are sharing “our stuff”, and we have most likely moved into unethical and perhaps illegal territory.
— by Dianne Polseno, President of Cortiva Institute – Boston massage school
