Practitioners in private practice have right of refusal. They can refuse to work with a prospective client, and they can discontinue working with a client they cannot form a therapeutic alliance with, or lack the training or physical capabilities to work with. If you work for someone, your employer may not support your freedom to turn away an undesirable client—yet another reason to choose your employer carefully.

Judgment Calls
• Your regular client spent the afternoon doing yard work and is uncharacteristically dirty and sweaty.
• You have worked with a couple on an outcall basis several times. While you’re alone with the husband, he makes suggestive remarks.
• You weigh 100 pounds. Your prospective client weighs twice that and requests deep work. You don’t think you can give them the massage they want.
Reasons (outside contraindications) not to work with a client include poor hygiene, inappropriate sexual behavior, or a physical mismatch. (Granted, a small massage therapist can, with good body mechanics, handle working with any size client; it’s up to you to set your physical boundaries.) Be aware of your own limitations. You may want to limit the number of clients you see with special difficulties.
Regarding the sweaty client, most practitioners don’t mind an occasionally grimy client. Those who do should make their policies clear up front by spelling out on an intake form that the therapist can refuse to work, or terminate work, with someone because of poor hygiene or inappropriate sexual behavior or comments.
In the case of the husband who made inappropriate remarks, it depends on your prior relationship and degree of offensiveness of the remarks. If a client makes obviously offensive remarks, end the session and decline to make another appointment. If you’re unclear about the intent, you can give a warning that you will not continue working with him unless he stops being suggestive.
If he had never been inappropriate before, you could say, “I only work with clients who respect me. I’ll end the massage if you make any more inappropriate remarks.” If he continues, end the massage and let him know you won’t work with him again. You might lose the wife’s business also, but there’s never a good reason to work with a disrespectful client.
When deciding not to take on someone who taxes your physical capabilities, be straightforward about your reasons: “I can’t do justice to someone with your particular needs. May I give you the names of practitioners who would be more appropriate?”  

Laura Allen is the massage division director of Soothing Touch. A licensed massage therapist, she is an accomplished author and educator. Contact her at educatedheart@gmail.com.  
Editor’s Note: In 2017, we are delighted to print excerpts from Nina McIntosh’s The Educated Heart, 4th edition. Nina was a longtime Massage & Bodywork columnist. Prior to her death, she handed her work over to Laura Allen, who created a new 2016 edition (adapted with permission from Lippincott Williams & Wilkins). Mari Gayatri Stein’s illustrations enrich each edition of the text; she passed away on March 2, 2017.