These sexual assault prevention guidelines provide a road map for massage clinics, day spas, franchisors, franchisees, or those looking to expand their solo practice to maximize the safety of both clients and therapists and minimize the risk of sexual assault. Additionally, if you are a massage therapist looking for a job in a massage clinic or spa—or a client looking for the safest spa to go to for a massage—these guidelines will give you the knowledge to help you decide which type of business to work with. (These guidelines are also valuable for any practitioner who needs a refresher in therapist-client interaction, ethics, and protocols.)

Standards of care in the massage therapy profession and health care in general develop and evolve over time. Comprehensive and strong models are then followed by the most ethical and professionally led massage clinics and spas, both large and small. While adhering to standards of practice may not fully eliminate the risk of sexual misconduct, it puts in place safeguards that greatly reduce the likelihood of sexual assault or inappropriate behavior. It gives the business the tools to weed out therapists with poor boundaries and predatory tendencies. These safeguards include a rigorous screening and hiring process, thorough orientation and training of new therapists about the culture and values of your business, ongoing supervision of therapists to spot problems before they escalate, and inviting honest feedback from clients through regular email surveys.

To be effective, most of the policies and actions described in these guidelines must be put in place and done authentically—with honesty and sincerity. They should not just be incorporated as lip service to prevent lawsuits, but consciously implemented to protect the clients you serve, as well as the therapists you have hired. Often, I’ve seen policies and procedures that look good on paper but aren’t followed up on by clinics, owners, managers, franchisees, or franchisors. Guidelines and rules are meaningless if they are not enforced.

Once these measures are put in place, the way to avoid harm to your business and its reputation is to document how you met or exceeded the industry standards. Although it might seem like a lot of work, it is worth investing the time to clearly put in writing all of your policies, procedures, hiring processes, and training. Also, always document your verbal and practical interviews with clear notes, and safely store them in each practitioner’s personnel file until three years after their employment ends. This will protect not only your business, but also your therapists and clientele in the long run. Just one lawsuit can tie you up in court for years. The resulting stress and expense can be incredibly draining physically, emotionally, and financially.

The following is a detailed list of steps you can take to adhere to the safest standards of practice in massage therapy. Many of the suggested processes have additional information or templates you can use in your business. Find all these resources at abmp.com/keeping-clients-safe.

Verbal Interview

A skilled interviewer should ask every massage therapist applicant the same set of interview questions, including some challenging ones, as well as run through six or seven role-play scenarios. Role playing often gives you more information and insight beyond just asking questions.

A thorough interview should take between 30 and 60 minutes. Effective interviewing is not easy, but rather a skill that can be learned and will greatly benefit your business. Take detailed notes on the verbal interview so that it is clear why you hired the interviewee or not. Questions should address the applicant’s understanding of boundaries and communication skills, in addition to the standard questions about customer service, modalities they are skilled at, and the number of hours they can work. (Additional resources: see “25 Verbal Interview Questions,” and “Role-Play with Prospective Employees” at abmp.com/keeping-clients-safe.)

Practical Interview

An experienced, senior massage therapist should conduct the practical interview with each applicant. This means a hands-on demonstration of the prospective therapist’s work, with criteria specific to skill, knowledge, and your business needs and expectations. The interviewer needs to be very knowledgeable about the massage therapy profession, not just whoever is available at the time. They should ask to receive a massage from the prospective therapist as if they were giving it to your clientele. It is imperative that they are well-versed in technique and appropriate client interaction. Ideal interviewer candidates include a previous instructor at a massage therapy school or the lead therapist on staff.

If the interview is done by the business owner or manager, they should have years of experience within the environment and/or have received countless massages, giving them good sensing and perceptual skills. Owners and managers should watch a skilled therapist do the practical interviews over at least a period of a year before doing it themselves. If an owner or manager is not familiar with the terms and criteria that should be used in a practical interview and are not able to recognize the nuances of the hands-on techniques, they are not the appropriate person to be doing the practical interview. (Additional resource: see “Practical Hands-On Interview Checklist” at abmp.com/keeping-clients-safe.)

Background Checks

Most states include a criminal background check as part of the licensing process. However, they do not usually include a sex offender check, so it’s always safer to do your own background check, especially if it has been six months or more since the therapist was licensed. Be sure to include a National Criminal Background check, an Unlimited County Background search, and a search of the National Sex Offender Registry. Crimcheck and other companies provide this service for spas and massage practices, as well as verifying an applicant’s massage license, for a reasonable price.

Licensing

Check with the appropriate city or state agency to verify that the therapist is licensed; this information is generally available online and takes only a few moments to verify. Licensing boards often keep records of complaints about therapists, so call the board to check if this information is available. If you do hire the therapist, keep a copy of their license as well as their liability insurance document for their file until three years after employment ends. Also, be sure to check your state licensing board’s requirements, as some require individual licenses to be visibly displayed on the premises.

Online Presence

In addition to your background and reference check, it should be standard practice to check prospective therapists’ activities online and on social media platforms. Training is available on how to scour for this information, although you can often find out a lot with a quick search of Google, Facebook, Instagram, and Twitter, and possibly other heavily trafficked, specific-interest platforms such as Parler, Reddit, and Twitch. A search like this would have saved one business a lot of grief in one case I worked on as an expert witness. This particular business did not include this investigative step during the hiring process of a prospective employee. Had they done so, they would have discovered (with a Google search) an arrest for rape just three years earlier on this man’s record. Because of this oversight, the man was hired, and as a result, the business was sued after he sexually abused several women. (Additional resource: see “How to Conduct an Online Search for Prospective Employees” at abmp.com/keeping-clients-safe.)

Reference Checks

Always request and check at least three references for the applicant. The best ones are from previous employers or clients, not friends or family. If there is not a long employment history, ask the applicant to supply contact information for the school they attended and at least two of their teachers. Directly ask the employer if they would hire the applicant again. If a previous employer is not forthcoming, analyzing the tone of their voice may give answers. Sometimes you have to be persistent to get someone on the phone who will talk to you. It’s worth the extra effort. Document your calls and the responses you get in the employee’s file.

Additionally, review the school the student graduated from and the number of training hours they completed to earn their diploma. (Most state licensing boards require a minimum number of hours.) The absolute minimum should be 500 hours, but 650–1,000 hours is better. Additionally, find out if the school curriculum included at least 90 total hours of education in ethics, communication, and business courses combined. Many of today’s corporate schools have eliminated these important courses, which means you will likely have to do some extra training with this new therapist. Also, ask if the therapist has taken continuing education courses and what they were; this shows an interest in developing and increasing their skills.

Code of Ethics

Adopt a code of ethics that includes explicit statements that no sexual contact of any kind can occur between the practitioner and the client, and include it in your new-hire training manuals. Each therapist should read and sign a copy to be kept in their employment file.

Also display the code of ethics so that it is visible to both therapists and clients. This establishes safety and acts as a deterrent, as well as being a signal to employees and customers that your business values and upholds ethical behavior. For reference, some massage organizations that include a clear statement about sexual contact in their code of ethics are Associated Bodywork & Massage Professionals (abmp.com/abmp-code-ethics), College of Massage Therapists of Ontario (cmto.com/about-the-profession/code-of-ethics), and the National Certification Board of Therapeutic Massage and Bodywork (ncbtmb.org/code-of-ethics).

Zero Tolerance

Have a brief yet explicit zero tolerance statement regarding sexual abuse or harassment of clients in the workplace. Having a series of clear, unambiguous statements about which actions and behaviors are totally unacceptable makes your values and policies resoundingly clear. Each hired therapist should read and sign the statement, in front of the manager, which will be added to their employment file. (Additional resource: see “Sexual Misconduct Policy” at abmp.com/keeping-clients-safe.)

Impact of Sexual Assault on Victims

Recognize that the victim will most likely be in shock, suffering from a form of posttraumatic stress disorder (PTSD). Their memory of the details of the incident may not be as clear until a few days later when they are somewhat recovered.

For a summary list of potential physical and psychological effects of sexual abuse and assault, I recommend you read the following short article: https://www.healthyplace.com/abuse/sexual-assault/effect-of-sexual-assault-on-women-sexual-assault-victims. This article would also be an excellent tool to print and handout at the all-staff zero tolerance meeting.

Sexual Assault Resources

• RAINN.org (Rape, Abuse & Incest National Network)

• Trauma and Recovery by Judith Herman, MD

• Effect of Sexual Assault on Women Sexual Assault Victims by Samantha Gluck

• The Ethics of Touch by Ben E. Benjamin, PhD, and Cherie Sohnen-Moe

• What I Learned as an Expert Witness by Ben E. Benjamin, PhD

• Clients Crossing Boundaries by Ben E. Benjamin, PhD

Sexual Offender Types

There is a spectrum of types of sex offenders. One primary example is a sexual predator who is seen as continuously trying to obtain sexual contact with another person in an abusive manner. Analogous to how a predator hunts down its prey, the sexual predator is thought to seek out or “hunt” for their sexual objects. Sexual predators usually commit multiple sexual assaults throughout their life.

Another type of sex offender is the person with very poorly developed interpersonal, physical, and/or sexual boundaries. This individual can mistakenly think or feel that the person they are drawn to is interested in sexual contact with them. They act on those sexual impulses without explicit agreement from the other person, often with dire consequences. For this type of sex offender, a sexual assault may be a one-time event.

Of course there are other categories of sex offenders that fall on either side of these two. None of these individuals should be in the massage therapy profession.

All-Staff Zero Tolerance Meetings

Whenever an accusation or complaint of sexual assault, verbal impropriety, or inappropriate physical contact is reported to a spa or massage clinic, a general meeting of the entire staff and therapists should be called as soon as possible. To protect the privacy of all concerned, the names of clients or therapists involved in the incident are never mentioned in these meetings.

These mandatory emergency general meetings let all employees know the organization truly enforces its policies of zero tolerance for sexual assault or sexual impropriety by either clients or therapists. They reinforce all written policies available to the staff and therapists that may be overlooked or ignored over time. They also create a greater sense of safety for everyone. An atmosphere of openness and honesty must be encouraged from the organization’s management and leaders to have an effective sexual assault prevention policy.

If the inappropriate incident was initiated by the client, they should have been permanently banned already. If the accused was a therapist, they should already be suspended from working at the organization pending an investigation and should not be present at this meeting. The alleged incident should be described by management in detail to all attendees.

Employees are asked to come forward at that time, privately afterward, or anonymously with any information they may have about this or any other incident they know of where a therapist or client has been inappropriate. They should also be encouraged to reach out to management or file an anonymous report any time they become aware of any such behaviors—not just in response to a meeting. Otherwise, employees often never say anything, and the inappropriate incidents go uninvestigated or completely unreported.

Who Should Run the Meeting? Likely two people—the most skilled meeting facilitator you have and the person most knowledgeable about ethics and sexual assault issues. It could be your location director and the head of human resources. If these types of skills are not present on your staff, hire a consultant from outside your organization.

Meeting Length. Depending on the number of employees, the meeting would likely need to be at least 90 minutes long to cover everything and give staff and therapists enough time to speak.

Sample Meeting Agenda Outline

1. Define the goal of the meeting.

• Keeping clients and therapists safe

• Ensuring the integrity of the profession

• Upholding the values of the organization

• Protecting the reputation of the spa or clinic

2. Emphasize why sexual assault prevention is so important.

• Describe in detail how damaging a sexual assault or boundary violation can be to a client’s life.

• Distribute to all employees articles that detail the ramifications of sexual assault.

3. Refamiliarize all employees with the company’s policies and how possible consequences are termination of employment, loss of license, arrest, being added to the sex offender registry, and imprisonment.

Discuss Who Specifically Should Be Contacted to Make a Complaint: Management, Supervisor, Police

• What online systems are in place at the organization for reporting an assault?

• How can someone report anonymously about an assault?

• When you describe the incident, do it in detail. Don’t be subtle. Speak the whole truth.

It’s often useful to have the therapists and staff meet in pairs for approximately five minutes so they feel freer to speak and encourage each other to come forward with information.

Open the Discussion to the Full Staff and Therapists. Ask for reactions to the incident. It’s often useful to start the conversation with a discussion about times when clients may have been inappropriate with the therapists or staff. This often opens the door to allow therapists in particular to speak more honestly about uncomfortable experiences they have had and ones they have heard about from their clients.

Wrap up the meeting by having each person speak for a moment about the usefulness of the meeting. Be sure to state that people can pass if they wish to. Invite those who are too shy to speak in public to come to a designated person in management after the meeting to speak privately.

Surveys

Set up simple surveys to be automatically sent to every new client after they receive a session from one of your therapists. Send the survey again every two to three months. A victim of sexual abuse often needs time and physical distance from the event to process it and decide to report an incident. The client is often in shock and not thinking clearly.

Surveys are an effective method for spotting inappropriate behavior and boundary crossings before they escalate into sexual misconduct. Small boundary crossings and violations are often the precursors to gross sexual assault. The surveys should have an option for the client to remain anonymous.

If an issue presents itself in the survey or there is a question about possible misconduct, there should be immediate follow-up with the therapist. For example, if they had loose, sloppy draping or asked the client inappropriate personal questions, follow-up training may be all that is needed. However, if a pattern of poor boundaries is spotted, or if the client was inappropriately exposed, even momentarily, due to poor draping, the therapist should be put on probation and carefully monitored. If warranted, your business can begin an investigation of this therapist and/or use a mystery shopper (see below) to gain further information. (Additional resource: see “Sample Client Survey” at abmp.com/keeping-clients-safe.)

Training

Take the time to orient and train every new hire both during onboarding and then approximately every two or three months. Since 2001, large corporations purchased many of the best massage schools in the United States and proceeded to cut most of the ethics, communication, and business skills courses to save money.

Many of these new owners often let go of the most experienced teachers because they were paid at a higher rate. These were the only instructors who were capable of teaching the subjects above. The corporate schools often began to hire new graduates who had virtually no training in how to teach.

Being a massage therapist is a different profession than teaching. Don’t assume that your new therapist learned everything they need to know within their schooling, since many curriculums have been slashed on these vital topics. The previous standard of the most professional schools was to train new teachers for six months to a year, and then closely supervise them. This is no longer necessarily the case.

Spas and massage clinics need to put more into training their therapists because of a deterioration in the quality of many massage schools. Many skills need to be put into action through experience on the job, including ethics, boundaries, sexual assault prevention, reporting therapist or client inappropriate behavior, dealing with difficult clients, attraction to clients, and dealing with sexual arousal. It is an investment to take the time to train each hire so they adhere to your standards, provide work that is consistent to the services you offer, and to make sure they are part of a cohesive team.

Video training on ethics, sexual issues, and communication must be supplemented by robust discussions led by a skilled person who is knowledgeable about these issues. Also, within the onboarding orientation, there should be training about boundaries, communication, sexuality, and ethics, with explicit conversations and role plays around a number of scenarios. These might include:

• Recognizing and respecting boundaries

• Power dynamics of the therapist-client relationship

• What to do if you are attracted to a client

• How to politely avoid dual relationships

• How to respond if a client asks you to engage in an activity outside the workplace—whether online or in real life

• The zero-tolerance policy for sexual comments, jokes, or actions

• Responding to off-color jokes or sexual innuendo

• Dealing with overly personal client questions

• Effective draping

• Dealing with clients who don’t want a drape

• Never working under the drape

• Never working on the inner upper thigh more than three to four inches from the groin

• Always allowing the client to undress and dress in private (which would include how to make all clients comfortable with how much clothing they wish to remove)

Additional areas to note are:

• How to handle clients who cross boundaries or behave inappropriately toward the therapist

• Qualifications for working with cancer survivors

• Qualifications for working with pregnant clients

• How to write and file a report to the employer about an inappropriate client behavior or interaction

• How to report inappropriate behavior of another therapist

Inappropriate behavior of another therapist may come to the attention of a therapist from a client or in an interaction with a coworker. It is important to have a reporting and complaint process for clients, and also for therapists so that either one feels safe to speak up if inappropriate behavior occurs.

At the end of the initial orientation and training sessions, have the therapist sign off on a document stating they have completed the orientation, and have them take a challenging test to check their comprehension and understanding of the material. Do not assume they understood what you have taught.

Training Manual

Create a clearly written training manual stating the organization’s philosophy, values, policies, and procedures that apply to the practitioner. The manual outline not only reflects the training given to new hires, but will also serve as a reference tool during their time of employment. It is standard to include your stated policies regarding absences, lateness, dress code, cleanliness, room setup, and so forth. Expand the manual to also explicitly state policies about communicating with management, resolving conflict, giving and receiving feedback, cultivating a client-centered focus, sexual misconduct and harassment, areas of the body you never touch, prohibiting dual relationships with clients, and never making sexual contact, comments, or innuendos. The training manual should also include role plays on how to handle clients who are verbally or physically inappropriate with the therapist. By being direct and clear on all these subjects, you set the tone for your new hires and existing employees.

Supervision

There are times when a massage therapist has an uncomfortable or disturbing experience when giving a client a massage. The client may make an off-color joke or behave inappropriately in a more subtle way. Practitioners need a shame-free, trustworthy relationship with a supervisor to review and evaluate such challenging or difficult experiences. Supervision can occur in groups or in one-on-one sessions.

There are two types of supervision: technical supervision and relationship, or clinical, supervision. A technical supervisor can help guide therapists to develop their hands-on techniques. A relationship (or clinical) supervisor helps practitioners learn how to define their own boundaries, set boundaries for challenging clients, and deal with any intense feelings or sexual attraction that may develop. Offering both clinical and technical supervision for your therapists by a qualified practitioner is an asset to your business and a deterrent to underlying personal and professional conflicts. (Additional resource: see “The Role and Types of Supervision” at abmp.com/keeping-clients-safe.)

Client Educational Brochure

Provide every client a printed or digital brochure that lets them know what to expect in the massage therapy session, what is expected of them, and how to recognize and respond to signs of inappropriate conduct. This documentation creates well-informed clients and serves as a safety valve and deterrent to those with unclear professional boundaries.

Clients don’t always know what to expect or what is acceptable behavior in the massage therapy treatment room. This is especially true for clients new to massage; however, regular clients can also come across situations they do not know how to appropriately react to. For therapists who may be unclear about boundaries, knowing that a publication of this sort is given to every client may also serve as a deterrent.

If you put the client brochure on your website instead of handing a paper brochure to the client, it’s important to make sure they read it. Not everybody reads what is on the website. If the brochure is only on your website, ask each client if they have read it. If not, hand them a printed copy, or have them read it on a tablet you have at the office. (Additional resource: see “Client Bill of Rights and Brochure Recommendations” at abmp.com/keeping-clients-safe.)

Complaint Process

There should be a clear and rigorous process for complaints—either about a client’s or a therapist’s behavior. This can help protect your clients, your practitioners, and your business. Having a transparent policy cultivates trust and establishes confidence that clients are dealing with a company with high ethical standards. Often, clients who are dissatisfied with some aspect of their treatment don’t directly express their concerns; they just stop coming. Encourage every complaint, regardless of how small it may seem, and follow up on it.

If the client is inappropriate, the organization must support the therapist in terminating the session and banning that client from all of their facilities. Conversely, an inappropriate therapist should be immediately suspended and investigated by the police, an independent company, or internally. Surveys should be sent out immediately to each of that therapist’s clients over the past six months. Immediately arrange an interview with the reporting client at a location of their choosing. If the allegations are found to be true, and if the client gives their permission, the therapist should be reported to the police and should be terminated. Ethically and morally, the therapist should be reported to the massage therapy board, which would prevent them from simply relocating to another state or location to abuse again.

In most cases that end up in court, there is often a pattern of small complaints before an instance of gross abuse. Therefore, having a safe, clear avenue for complaints to be voiced can prove to be invaluable, as it can bypass a more grievous situation later. Having a robust complaint process will help discourage therapists with predatory tendencies who will be searching for an establishment with less rigorous checks and balances.

There are companies that can manage the complete complaint process for your organization. One such company is Redirect (redirectrisk.com), a company founded by a board-certified forensic psychologist that conducts investigations in the aftermath of reports of sexual misconduct. By integrating forensic psychology with professional investigation, Redirect uses a trauma-informed, fact-finding process that is driven by the hiring organization’s code of conduct policy. Redirect helps reduce the risk of future incidents by providing valuable insights and support, leadership coaching, staff training, and policy consultation. (Additional resource: see “Misconduct Complaint Process” at abmp.com/keeping-clients-safe.)

Mystery Shopper

Use of a mystery shopper is indicated when any boundaries are violated or inappropriate therapist behavior of a sexual nature is suspected or reported. Certainly, if a therapist has multiple complaints of a sexual nature, an investigation should occur. But if the complaints are more subtle and vague, a mystery shopper should be engaged. Even one inappropriate incident is enough to trigger action based on the severity of the indiscretion.

The use of a mystery shopper is an important component to keeping clients safe. It is part of a continual vetting process of therapists since it is difficult to weed out 100 percent of therapists with poor boundaries or predatory tendencies during the interview and vetting process.

Predator therapists often test verbal and/or physical boundaries of the client during a massage therapy session to gauge whether they are a good person to take advantage of. Others, with poorly developed boundaries, may gradually move from the professional to the personal, drifting into inappropriate touch or conversation. Too often, these inappropriate actions are not reported because either the client has not been properly educated by the spa or clinic to recognize such improprieties, or the client feels too ashamed or embarrassed to bring the issue to light. To counter these unreported activities, prior to initiating a mystery shopper visit, organizations need to have collected regular email surveys of their clients’ experiences with their massage therapists. These surveys are often primary indications of inappropriate behavior. (Additional resource: see “Mystery Shopper as a Preventative and Investigative Measure” at abmp.com/keeping-clients-safe.)

Call Button

Installing a call button within easy reach in each treatment room gives both the therapist and client access to the front desk staff immediately in cases of emergency or situations that require an urgent response. A small button should be placed under the edge of each massage table, just where the client’s hand rests.

At the start of each session, the therapist should indicate the location and use of this call button. Provide instructions in your training courses and training manual that include sample phrases for the therapist to use, such as: “This call button is here to keep both of us safe, if either of us wants or needs help.” This creates an immediate sense of safety for the client and the therapist. The call button also works as a deterrent for any therapist to engage in inappropriate activity or for any client who has a tendency to violate the boundaries of a therapist.

Information about the call button and its purpose should be on the company website. Also post prominent signs in the treatment rooms.

Call buttons can usually be installed for a few hundred dollars per room. Research has shown that the incidence of inappropriate touch is dramatically less when call buttons are installed, and complaints generally go down significantly.

Field Visit

If the clinic or spa is a franchise operation, the franchisor should do a field visit to each franchisee at least every three months to verify that they are adhering to all operational guidelines. After a franchise spa has been vetted, trained, and opened, the most important task for the franchisor is continued education and enforcement of its accountability standards.

If the franchisor has mandated everything in this checklist as well as others, they must be sure these standards are followed. In most cases, the franchise owner is not a massage therapist and knows little about the profession. The franchisor is their teacher, industry guide, and parent. Without the franchisor’s guidance, the owner will often falter. Every field visit is an opportunity to help the new owner get it right regarding the franchise goals, as well as the health and welfare of each employee and client.

A primary component of each field visit is to check the employee files. This lets the franchisor know if the spa is on the right path. As a part of the visit they check for interview notes, reference checks, a copy of a therapist’s license, surveys, any complaints or incident reports, and how they were dealt with.

Conclusion

We all have an opportunity to work toward reducing and eradicating sexual assault from the massage therapy industry. Franchise organizations and smaller clinics enacting policies and guidelines for the prevention of sexual assault will drive the education and thoughtful action of practitioners, their clients, and organizational management. Together, we can strive to make what we do a healthy and healing place for all involved. I hope this series of articles and its support materials give you some tools and the impetus to make improvements wherever and whenever you can.

 Ben E. Benjamin holds a PhD in sports medicine and owned and ran a massage school for over 30 years. He has studied under James Cyriax, MD, widely known for his pioneering work in orthopedic medicine. Dr. Benjamin has been teaching therapists how to work with injuries for over 35 years and has been in private practice for over 50 years. He works as an expert witness in cases involving both musculoskeletal injury and sexual abuse in a massage therapy setting. He is the author of dozens of articles on working with injuries, as well as these widely used books in the field: Listen to Your Pain,  Are You Tense?, and Exercise Without Injury.