The Boundary Waters

Amanda Barp, a licensed massage therapist in Portland, Oregon, remembers one session that completely blindsided her. It was her second session with this particular client, and as she began, he asked her: “Do you do anything erotic at the end of this massage?” Barp was stupefied. Then angry. Then confused.

She decided to be direct. “I looked him straight in the eye and said, ‘This is a therapeutic massage only. If you want something else, this isn’t the place to find it.’”

The session proceeded without a hitch and, by mutual consent, they never worked together again. However, she learned a valuable lesson: Awkward happens, especially in massage therapy. And when it happens, you need to rely on your own clear boundaries.

Here are a few tips from teachers and fellow massage therapists that can help you better define your personal boundaries and deal with some common situations that can be uncomfortable. Additionally, sample dialogues from William Scarpino, founder/editor of, provide you with potential responses for times when you’re just, well, speechless.

1. A sexual element has entered the massage session

Alana Eve Burman, licensed massage therapist and owner of Boulder, Colorado-based JoyLife Therapeutics Inc., encourages massage therapists to be clear from the get-go about sexual boundaries, perhaps by specifically outlining the guidelines of a professional massage on the intake form.

Be vigilant in how you present yourself in your words, dress and touch. Be prepared to speak directly to the matter. Still, you may run into trouble, and it may be deceptively subtle. “People want to relate and be friendly, and can take it over the line,” says Burman.

When this happens, Burman redirects the conversation. “If someone asks you what you’re doing this weekend, for example, your response can be, ‘Let’s focus on the session. I want to help your shoulders relax.’”

You’ll be better able to respond quickly and effectively, explains Suzanne Scurlock-Durana, a Reston, Virginia-based craniosacral therapy practitioner, if you ground yourself first-literally.

“Rub your feet on the floor, go from foot to foot,” she says. “Then feel your spine against the chair, or just notice it if standing. This drags you back to your center.” Both of these exercises allow you to claim your benign power in the room.

“If you don’t feel as though you’re the largest energy field in the room,” she adds, “then there’s a boundary issue right there.”

As added insurance, role play with a friend. Nina McIntosh, author of Educated Heart: Professional Boundaries for Massage Therapists, Bodyworkers and Movement Teachers, knew a massage therapist whose very first client tried to undrape himself during the session. “It made such a difference to the therapist that he had role played this exact situation in school,” she says.

Dialogue 1:

“As a professional therapist, I do not offer that service.” If this does not resolve the situation, then firmly end the session. “I am sorry, that is a service we don’t offer and I am no longer comfortable being your therapist. I will credit you for the time remaining, but the session is over.”

2. Your long-time client isn’t paying you on time.

Not speaking up about money-including not getting paid on time-can affect more than your bottom line. This problem can also stress you out.

To start, be clear on your fees and policies. “Make it clear in the first phone call,” McIntosh says. “And then during the first intake, have your financial policies written out, and have your clients read and initial them.”

If someone is “forgetting” his checkbook, promising to mail in payment and not doing so, talk to him directly. “Be upfront and ask what is causing the problem,” says Scarpino. By doing this, he says, rather than just demanding payment, you may save a customer.

Being direct about financial matters may also positively impact your practice in other ways. “If you let something like [unpaid balances] go, it tends to grow,” says McIntosh. “If you treat yourself as a professional, your clients will treat you as a professional.”

Practical reminders don’t hurt either. Provide a preprinted reminder at the client’s next appointment. Or offer a self-addressed envelope, and ask “Could you put the check in here?”

Dialogue 2:

“I enjoy the time we spend together, but this is my job. When you fall behind in your payments it hurts me personally. Please understand that I have bills to pay like everyone else, and I rely on your prompt payment.”

3. You’re raising your rates.

First of all, give yourself permission. Raising rates does not a mercenary make. “Everyone knows costs escalate over time,” says Scarpino.

Next, do your research. What is the going rate in your area?

Finally, give your clients advance notice. When Barp recently moved from one massage studio to another, she used this opportunity to add five dollars to her rates-which had been static for two-and-a-half years. “I let clients know a month in advance,” she says.

She typed a note outlining the increase and placed it on the table next to their after-session water. Present your proposal in a way that will gain empathy, suggests Scarpino, such as indicating that you’ve tried to contain costs against inflation. “You will make the client an ally,” he says.

Dialogue 3:

“It’s been two years since I’ve raised my rates. I need to be able to keep up with the rising costs of gas and rent. I have cut costs to keep my rates low, but now I need to adjust them. I know you may be experiencing the same situation and can appreciate this.”

4. You’re unhappy with your salary at a massage practice or spa and want to ask for a raise.

According to Linda Babcock and Sara Leschever’s Women Don’t Ask: Negotiation and the Gender Divide, you may lose more than $500,000 by age 60 if you don’t negotiate your first salary.

However, you may have to build leverage first. “If you’re relatively inexperienced without a big following, you may have to grin and bear it and build up your clientele,” says Bob Mecca, a fee-only certified financial planner in Mount Prospect, Illinois.

When it’s time to talk, ask to speak to your boss in private. Discuss common goals, objectives and challenges. Describe ways you’ve already added value to the practice, and brainstorm about how both of you might grow the business. “By adding value, your request will be viewed as investment spending rather than gifting,” Scarpino says.

Dialogue 4:

“I’d like to discuss my compensation. When I started here I had no regular clients, but now I have at least 25. I know you have increased expenses as well, so I’d like to talk about how we might be able to increase business, together. I’m open to other forms of compensation as well, such as health care coverage.”

5. You need to fire a client for any number of reasons.

Sometimes things just don’t work out. How do you relay this to a client in a way that doesn’t leave you uttering a million “mea culpas?”

“I actually helped another therapist with this recently,” says Scurlock-Durana. “The client wanted really deep work, which the therapist could give only to limited degree.”

We decided to reframe the problem. “I said, ‘Let’s find the client a therapist who actually suits him better’-rather than saying ‘I have to fire him.’” The therapist found two to three good deep tissue therapists in her area and was able to refer her client on with no bad feelings.

It’s a good idea, says Scarpino, since people talk. “How you handle the firing may have an impact on your future business,” he says. You’re also freeing your client up to find a better match.

“In a way, I think it’s unethical to work with someone who we cannot come to care for in some way,” says McIntosh. “We don’t have to become buddies, but if we can’t find some caring we really need to say something like: “You know, I just don’t think I’m the best therapist for you. Let me refer you to [name here].’”

Dialogue 5:

“I am sorry, but this just isn’t working out for us anymore. I don’t seem to be the right person to provide you the full benefits of a massage. I am sure there is someone else who might be more in tune with you and I’d be happy to refer you.

6. You notice something suspicious on your client’s skin.

Burman takes the casual approach with clients she knows well. “I say, ‘Hey, what’s this?’” But this requires a certain level of comfort. Otherwise, you may ask if the area is sensitive to the touch as a way to begin the conversation.

McIntosh says let prudence overcome reticence when you see something suspicious. She had a friend who discovered her own case of basal cell carcinoma only through the careful eyes (and hands) of her massage therapist.

“You are obligated to tell your client, but not to make a diagnosis,” she says.

Use neutral, supportive language, and wait until after the session when the client is calm and relaxed. Be concrete and constructive, offering referrals, for example, if they ask.

Dialogue 6:

“Hmmm, this is interesting. I think this spot might be a little larger than last time. It may not be anything, but I would have it checked out if it were me.”

7. You don’t feel comfortable with an injury, ailment, or needs of client.

First, communicate with your client directly. “When I get to something out of my depth-which is not unusual,” says Scurlock-Durana, “I will engage with [the client].”

“In cranial work we have a dialogue, where the client begins having a dialogue with his or her own inner wisdom,” she says. She recommends a similar process to massage therapists, something like: “Let’s check in and see what will be more helpful to you in this situation.”

If nothing comes up, Scurlock-Durana will then talk about referrals. “I’m part of a team that’s available to them as a resource.”

McIntosh says that it’s imperative to recognize your own limits-and act on them, as she did once with a client, who, as it turned out, was in the early stages of Parkinson’s, undiagnosed. “I was taking care of my parents at the time and-although I didn’t tell him that-I was honest and said ‘I think you need more emotional support than I have to give you right now. As much as I would like to work with you, I think you need to work with someone else.’”

She says it’s important to avoid sounding like you are rejecting the client. Give the client a choice, if possible. “Offer to give names,” she says. Scarpino agrees. “Always give clients the power and responsibility to decide,” he says.

Dialogue 7:

“We’ve been working on (fill in the blank) for some time and it doesn’t seem to be getting better. What do you think? This may require more skill or experience than I can give you. There’s another therapist here who is really proficient in this area. If you’re comfortable, I will ask her to come in to see what she suggests.”

More Ways to Handle Awkward Situations

In the massage therapy profession, there is the potential for something awkward to happen. You’re dealing with clients who may be in pain or have a real need to reduce stress, and though you’re helping, these clients may feel particularly vulnerable.

The bottom line is that you and your clients are bound to run into situations that leave you both feeling less than comfortable. But there are ways to deal with these situations that won’t jeopardize the professional relationship you have with your clients. Here are a few more ideas to help you through these awkward moments.

You hear negative feedback from a client. Use this mantra, suggests Suzanne Scurlock-Durana: “Nothing is really personal.” In fact, negative feedback may be an unexpected gift.

Alana Eve Burman, a licensed massage therapist in Boulder, Colorado, agrees. “My first reaction is to thank the client and then let them know I am sorry they didn’t like the work.” You should always make the client feel she’s been heard. “In almost any interpersonal relationship, this can shift the dynamic,” Burman continues.

Some of her best client feedback has come by just paying attention when the massage is over, explains Burman. “I’ll ask them how they’re feeling and if they want to schedule again—you can get a lot of information that way,” she says.

Potential response: “I am so sorry this is a problem but I am really glad you shared it with me. Can you be a little more specific? I'd like to really understand your needs. [Listen] We need to do something about that. If you were in my place, how would you solve this problem? Is there anything else on your mind? My goal is to make you as happy as I can.”

Your client cancels appointments at last minute, is late, or “forgets” appointments. This problem is a boundary issue that needs to be addressed quickly. "We need to educate clients from the first phone call of our boundaries and stay with them,” says Nina McIntosh, author of Educated Heart: Professional Boundaries for Massage Therapists, Bodyworkers and Movement Teachers. “For example, 'If you don't give me 24 hours notice, I have to charge you for a cancelled session,'” she says.

And then, follow through! “Even with this policy, clients were surprised when I had to charge them for missed sessions,” says McIntosh. “People are concerned about making a client mad. But do you really want a client who is not respectful?”

In fact, sticking to your boundaries may increase respect. “When clients are charged for missed appointments,” says Burman, “they take it more seriously.”

Sometimes other factors are at play, such as transference. Barp, for example, had a client who consistently missed appointments, and who was ill with the same illness as one of Barp’s family members.

“She was pushing my boundaries, and I was having a hard time enforcing my policy because I felt bad for her,” says Barp. Finally, she realized this was helping neither of them. “I told her that I needed her to be respectful of my time and her time,” says Barp. She told her client she would charge her if she missed an appointment. “I really did enjoy working with her,” she says. “I just wasn’t clear with her from the get-go.”

Potential response: “You know, you've cancelled at the last minute several times now. I know that you are busy but when I lose an hour appointment, it costs me money. This is beginning to strain our therapeutic relationship. What do you think we can do? I would hate to have to start charging you for missed appointments. I hope we can come to an understanding, because I really like working with you.”

A client talks incessantly throughout the session. The lights are low and the music soft. The mood is perfect—and your client won’t stop talking. What do you do? Burman says it depends on the situation.

“Some people will talk because they feel they need to entertain you,” she says. “You can tell them that it’s OK for them to relax and unwind.”

Terrie Yardley-Nohr, author of Ethics for Massage Therapists, recommends taking three breaths with the client and redirecting the session back to its original intent. Remember, new clients may be nervous, and others just friendly, so moderate your irritation.

McIntosh agrees. “The main consideration is whether it’s helping the client relax, not whether it’s distracting you,” she says. “It’s their dime. They can talk, so instead of asking them to be quiet you might tell them to notice how tight they are getting when they talk.”

Speaking from experience, McIntosh says a client may simply be unwinding by talking. “I chatter for 20 minutes, and then they turn me over and I go to sleep,” she says.

Potential response: “Do you notice that when you talk your shoulders tense up? Can I do anything to help you relax? It's fine if you want to talk, but the complete benefits of the massage include letting your mind relax as well as your body.”

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