Key Point
In a recent peer support meeting, one of my colleagues shared that an older client of hers thanked her “for the excellent massage . . . and the friendship.” My colleague was stunned and a bit unprepared for this second appreciation. She had seen this client for many years, but never really thought of their relationship as a friendship. She was left wondering where she had gone wrong. What had she said or done that left this client feeling like what they have is a friendship?
Very few people would thank their dentist or their accountant for their friendship. Interestingly, even though a dentist puts their hands in your mouth and your accountant sees your very personal financial information, most of us would not call these relationships intimate. We could certainly argue that the nudity or partial nudity aspect of massage raises the intimacy stakes, but as a person who has spent a lot of their massage career working with people who are partially clothed, fully clothed, or wearing a hospital gown, I don’t think it’s about the skin. It’s about the connection.
So, does my colleague have a friendship with her elderly client? Quite possibly. Does that mean my colleague has “poor boundaries”? Not necessarily.
When we work with clients, we have the unique opportunity to do what’s called co-regulation. When we co-regulate with another human (we can do this with pets too), our nervous systems connect in a way that supports a sense of safety. When humans feel safe, that safety alone can support essential functions of homeostasis while making us more willing to be cared for without fear of threat or danger.¹
I hope this is something you experience in many settings and relationships in your life, but the truth is that many people don’t feel regulated or safe in the world. They come to us because they value the nervous system regulation we can potentially provide. I guarantee they won’t and really can’t even tell you that, but when they sigh deeply and smile after a session and thank you for being amazing . . . chances are good that at least part of what you were doing was co-regulating. Their nervous system was nourished . . . and so was yours.
According to Britannica (yep, that one), friendship is a state of enduring affection, esteem, intimacy, and trust between two people.² It goes on to talk about reciprocated affection and companionship in a shared activity. There are certainly other features of our relationships with clients that technically disqualify those relationships from the moniker of “friendship,” like the exchange of money, the power differential, and the technically obligatory nature and prescribed roles of therapist and client. That said, it’s silly to hide behind these technicalities. We cover key aspects of friendship—like intimacy, trust, and esteem—every time we enter a therapeutic relationship with a client.
The other thing I hate to admit is that many of our clients view their visits with us as similar to what they get from a visit to the salon. They get social interaction, maybe friendly banter, someone who remembers a few things about them and checks in about what’s happening in their lives. When they leave, they usually feel pretty darn good, even if they are $100 lighter. We listen. We might smile, might laugh, may even hug them a time or two during their visit. Sounds pretty friendly.
In my experience, most massage therapists’ boundaries appear in one of two ways. Either we have what I would call “flimsy boundaries,” where we have free-flowing, unfocused conversations throughout our sessions, learning personal details about our clients and sharing them about ourselves, or we were taught to basically never talk in session or talk very little and that “good boundaries” are maintained by never sharing about ourselves or connecting on a close and personal level with clients.
Humans love the imagined comfort of a right way and a wrong way, and we love to pretend that these two ways are clearly different. Unfortunately, real, therapeutic boundaries lie somewhere between these two extremes, and you need different levels of nervous system regulation with each client to find a co-regulated, balanced connection that is safe and supportive for both of you. That doesn’t just happen, usually. We have to learn how to do that, and it takes practice, modeling, making mistakes, and mentorship.
Until we meet again in the next issue of Massage & Bodywork, I invite you to sit with this idea about the nature of your relationships with your clients and your stories about boundaries. In my next column, I’ll share some of my learnings from the palliative care and meditation worlds that support clear and genuine connection while maintaining professional—yet human—relationships with clients.
Notes
1. Stephen W. Porges, “Polyvagal Theory: A Science of Safety,” Frontiers in Integrative Neuroscience 16 (May 10, 2022): 871227, https://doi.org/10.3389/fnint.2022.871227.
2. Wyndol Furman, Lisa Hohmann, and Lauren Berger, “Friendship,” Britannica, last modified December 23, 2023, www.britannica.com/topic/friendship.
Cal Cates is an educator, writer, and speaker on topics ranging from massage therapy in the hospital setting to end-of-life care and massage therapy policy and regulation. A founding director of the Society for Oncology Massage from 2007–2014 and current executive director and founder of Healwell, Cates works within and beyond the massage therapy community to elevate the level of practice and integration of massage overall and in health care specifically. Cates also is the co-creator of the podcasts Massage Therapy Without Borders and Interdisciplinary.