One of the hardest components of ethics knowledge to master is communication. For example, you may know the definition of boundary violation, and even be able to identify it when you see it, but do you have the appropriate language in your arsenal to respond to it when it happens? In addition to your elevator speech about you and your practice (you have one, right?), you should also have a variety of words on the tip of your tongue to defuse sticky ethical situations.
In this third and final installment of “What’s Your Ethics IQ?,” let’s test your communication skills. Take a look at the situations presented. Think through each scenario and come up with language you could use to handle the issue at hand. Role-play using this language with classmates, coworkers, practice clients, and instructors. We’ve given you a head start on a couple. (For the rest of the answers, or to revisit “What’s Your Ethics IQ? Part 1–2,” visit our digital edition at www.massageandbodyworkdigital.com.)
Whether you are a time-tested veteran or a bright-eyed newcomer, a review of these ethics challenges for massage therapists will help you maintain a healthy practice now and in the future. Remember: ethics knowledge is a lifelong journey.

Skill Components*
Practice responding with appropriate language and behaviors to each of these situations:
1. Avoid counseling a client, even when the client attempts to get counseling from the therapist.
2. Refuse a client massage due to a condition that contraindicates treatment.
3. Refuse a client’s request for massage because the therapist suspects the client is under the influence of an illegal drug or alcohol.
4. Require a parent or guardian to be present during massage of a minor when the parent or guardian attempts to drop the child off alone for the session.
5. Respond to a client’s request for a date.
Response: “I’m sorry. I don’t date or socialize with my clients, both for the health of our therapeutic relationship and to maintain strong ethical boundaries for both of us.”  
6. Decline a client massage when appropriate.
7. Represent your massage qualifications honestly and point out the limitations of massage therapy.
8. Refer clients to other health-care providers when appropriate.
9. Obtain the client’s informed consent for massage therapy.
10. Redirect a client who’s anxious about something during a session.
Response: “Why don’t we take a minute and focus on your breathing right now?” Then lead the client through some deep abdominal breathing to move away from the charged conversation.
11. Redirect a client who calls the therapist by a nickname that may have a sexual connotation (e.g., “sweetheart”).
12. Demonstrate effective language and behaviors to establish boundaries at the beginning of a massage session.
13. Demonstrate effective language and behaviors to redirect or manage a client attempting to violate the therapist’s boundaries in these situations:
• A client keeps reaching out during the massage session to touch the therapist on the arm, leg, or hand.
• A client tells a therapist a story and becomes emotional, raising their voice and swearing excessively.
• A client shares political views in opposition to the therapist’s views.
• A client shares her religious views in opposition to the therapist’s views.
• A client states to a therapist, “I don’t know what I would do without you. You are the only good thing in my world. I would be devastated without you!”  

Anne Williams, LMT, (anne@abmp.com) is the director of education for Associated Bodywork & Massage Professionals (ABMP) and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012) and Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams & Wilkins, 2006).

Karrie Osborn is senior editor at ABMP and collaborates with Williams on various education projects, including ABMP Exam Coach and ABMP Student Life.
*Authors’ Note: These knowledge and skill components are based on the guidelines provided by the Entry-Level Analysis Project and outlined in the “Entry-Level Massage Education Blueprint” (2013) found at www.elapmassage.org.