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Ethics Q& A

You know your massage therapist friend is having sex with clients. What would you do? Read on for Dianne’s advice.

Q: I am a new massage therapy student. My dilemma is about my friend, a professional massage therapist, who is having sexual relations with some of her clients. I know this because she admitted it to me, and we have discussed it. This weighs heavily on my mind.

I had an honest talk with her about my concerns and feelings about the situation. She minimized the issue, but also told me she’s seeing a counselor. While I believe her, I wonder if she’s talking about this particular issue. During our conversation, she informed me that she just wants to be alone—no close friendships, only acquaintances. I would like to believe that this is her way of beginning to establish boundaries, yet I know it can also be her way of distancing herself from me because I confronted her.

While I care for my friend and don’t want to hurt her legally, I recognize that her behavior is unacceptable, but I’m not sure how to proceed. Do I ask for assistance from the director of my massage school? Is peer supervision available through AMTA (which I know my friend is an active member of)? Or, now that she is in counseling, do I trust that she will make her own way through this, now that she is becoming aware of her issues?

I fear there is no one else in her life who is prodding her to get help with this, and that it will continue. What is my responsibility in this? What would you do if it were you in my shoes??


A. Sexual misconduct is a serious matter that must be attended to. Although your loyalty to your friend is understandable, be careful not to allow it to stand in your way of taking appropriate action. You may feel burdened by this situation; however, the true burden is not yours. Keep it simple: you know information that you must act upon; your friend has the burden of sexual misconduct.

It would be helpful to speak to the director of your school so you can get support as you navigate your way through this. Taking action against a friend, no matter how justified and necessary, is not likely to be easy or without trepidation. Support for yourself will be helpful in keeping you clear about your responsibility, since guilt and discomfort may hinder your determination to proceed with the right action.

AMTA will support you by taking immediate action on the report of a member’s misconduct. The term used for reporting a complaint about a member is called the “Grievance Procedure.” The circumstances that you explain fulfill the requirements that must be met for the Grievance Committee to take action on a complaint, namely that your friend told you the information firsthand (it cannot be hearsay), and that she is a member of AMTA.

You asked what I would do if I were in your shoes. If I had spoken honestly to my friend and still had concerns that she was continuing the behavior, I would inform her that because I was not comfortably certain that the behavior had stopped, I was taking action to file a complaint to initiate the AMTA Grievance Procedure. Then, I would get support from a trusted colleague and file a written complaint to begin the process with AMTA. The AMTA Grievance Committee will take over from there. I’d rather live with any awkwardness and discomfort I might feel from filing a complaint than live with the knowledge that I knew of sexual misconduct and failed to report it.

Good luck with your process. In this situation, no option is easy.

Q: I am a client with a question about professional protocol for dealing with well-established clients who make a mistake and forget an appointment. What is the ethical manner taught to massage therapists in regards to charging or not charging for missed appointments?

I had a long-standing professional relationship with a local therapist; I have seen her regularly for massage therapy for more than a decade. I have also referred my family and friends to her. She and I grew closer in  our professional relationship over the years as one might expect—it’s easy to know about the life of  someone you see on a regular basis. This was true of our relationship, and most recently, she knew all the details about a distant trip I was planning to take for the birth of my grandchild. It happens that I was out of town for the birth on the day of my massage, but I did call her several hours before my appointment to tell her I was unable to make it, and asked if I could reschedule. Her response was that she would have to charge me for the appointment because I failed to give her 24 hours notice, which is her policy.

This has affected me greatly. First of all, I have been a very faithful client who has requested more than once that she give me a confirmation call the day before my appointments. She has given confirmation calls in the past, but not for this one. Secondly, she once cancelled an appointment with me at the last minute because she had a bad cold. I was expected to understand that legitimate unforeseen things happen that do not allow time for 24 hours notice, but I wasn’t offered the same understanding. I mailed her a note that expressed my feelings and informed her that I will take a break from seeing her for massage due to the discomfort of the situation.

Is her response to my late rescheduling needs professional? Is this what most professional therapists would do in dealing with longstanding clients who have given them much loyalty and business over the years? Am I unreasonable to hope that exceptions can be made, even in the face of a cancellation policy??


A. Your experience provides a valuable perspective for therapists to consider as they encounter this issue in their own practices. In reality, many therapists deal with late cancellations and no-shows as a common problem, losing hours and revenue because of clients’ forgetfulness and unexpected emergencies. In an effort to not “throw the baby out with the bath water” it’s important to highlight the appropriateness of having a written cancellation policy that all clients are aware of and then implementing it.

Where a wise business practice becomes a detrimental business practice is when it is indiscriminately enforced. Kathy Bernstein, integrated Kabbalistic healer from Rhode Island, succinctly summarizes this matter: “The difference between the poison and the cure is the measure. At what point does the cure become the poison?”

While it is a wise business practice to implement a cancellation policy, professional and ethical enforcement require situational discretion. This discretion manifests when compassion, understanding, respect, flexibility and adaptability are present. As evidenced in the case you describe, the enforcement of a policy “no matter what” hardly seems wise if it does not support the therapeutic relationship, and the client does not return as a result.

Therapists don’t have standardized policies that regulate how they are to respond to situations like yours. The way your situation was handled appears extreme, and your hopes and expectations seem very reasonable. Your ability to express yourself and act on your own behalf is commendable, even though the outcome was unfortunate. Hopefully, you will not let this situation keep you from finding another practitioner who will provide you with many more years of the benefits you received from massage therapy.

Q: isn’t a question, but a summary of a resolved ethical situation that I would like to share with other therapists so they can protect themselves. Several months ago, I found myself in an unethical and illegal situation with “respected” employers as a therapist in their private practice. While still in school, I was hired at this practice. As an employee, I was paid a percentage of each massage and no hourly wage. The therapists were asked to volunteer hours to “build up the business.” If employees left the company, they weren’t allowed to take their client names with them. Bottom line—employees did a lot of work for free.

Early in my employment, I began developing a specialized massage therapy workshop for a focal group. I worked from home on my own time doing research, protocols, etc. I went to my employers with my ideas and they encouraged me to pursue them; soon I was doing workshops and conferences for the practice. I had disagreements with my employer about what I should be paid for these ventures. I felt it was my workshop and I wanted more than my typical percentage for massaging clients, which was 40 percent. They thought I was an employee and should only be paid my regular fee. We argued for awhile, and they finally agreed to pay 70 percent.

In the meantime, I contacted three lawyers to copyright my workshop material and sent the material to the Library of Congress. The work was entirely done at my home on my time; there was no contract for hire for course development, and I received no compensation except when I presented the workshop. It was clearly my program.

Shortly after they agreed to pay me 70 percent of the workshop proceedings, it came to my attention through an e-mail I received that my employer was making  arrangements with another organization to do my program on their own and not pay me. I confronted them and confirmed my suspicions. They argued that in their opinion, I was their employee and that any work I had done belonged to them.

I refused to give them my program material, so they fired me and wrote in my records that I was terminated for insubordination. Then they hired a lawyer who threatened to charge me with theft if I did not return the materials to the employer’s office—materials that were never at the office because I always kept them at home. On the advice of my lawyer, I did not respond to the letter, and I did not provide them with any of my material. I have not heard from them since, but neither have I heard from the large majority of the clients with whom I worked while I was employed there. I know my employer lied about the situation to the other employees; fortunately, my coworkers knew better and called to support me.

I trusted my employers, so I didn’t have a contract with them regarding the workshop. If I hadn’t been as informed and as bold as I was, they probably would’ve intimidated me into giving them my work. I’ve made my peace with the situation and continue to present the workshop on my own. I really want other therapists to be informed that being an employee doesn’t mean the company owns everything you do.


A. This situation underscores and italicizes the need for written contracts, clearly spelled out particulars and the value of legal counsel.

Dianne Polseno, LPN, LMT, is the director of education at Cortiva Institute-Muscular Therapy Institute. She’s the recipient of the 2006 Jerome Perlinski Teacher of the Year Award. Send your ethical queries to ethics@amtamassage.org.

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