I have a dilemma I haven’t encountered before. Doris—fifty-five years old and recently widowed—became my client several months ago. In the first session, she said she was lonely and didn’t have anyone to talk to. Her sad situation touched me, perhaps because it reminded me of how I felt when I lost my husband several years ago.

Soon after the first meeting, Doris began calling me. She started out asking questions related to massage, but then the conversations became more casual and chatty. I should have cut her off, but I guess I felt sorry for her. As the weeks have gone by, she has called me more frequently and also started to e-mail me several times a week. If I don’t respond, she complains at our next session: “Why didn’t you return my call or write back?” I’ve tried to tell her that I’m busy, but that doesn’t satisfy her.

Now I’m sorry I ever showed her such sympathy. How can I get her to quit calling and e-mailing?

Anna K., Bakersfield, California

Dear Anna,

This is a great example of how a misguided attempt to help a needy client can backfire. It sounds as if your compassion for Doris has caused you to take on her problems in a way that’s not good for either of you. She’s become too dependent on you and you’re resenting her demands. Not having set appropriate limits the first time a phone call turned chatty, you’ve given her the impression that you’re available to her as a confidante and friend. Moreover, she has taken advantage of your unwillingness to say no to her by imposing on you more and more. Setting things straight is going to be hard. You may not be able to turn this into a healthy professional relationship, but there are some things you can do to at least reestablish your privacy.

First, you need to give her a clearer message than simply not responding to her calls and e-mails. I recommend that you call to talk with her before the next session. (E-mailing would be too impersonal and taking up session time would be inappropriate, along with likely ruining the relaxing atmosphere for her.)

Be compassionate but firm. You could say something along these lines: “I’m sympathetic about the hard time you’re having and want to support you in taking care of yourself. However, I made a mistake when I gave you the idea that I could be available to you outside of sessions, because I like to keep my private time separate from my professional relationships. Our professional relationship will work better for both of us and be less complicated if we keep it within the boundaries of our sessions together. That way, you can use that time to relax and unwind and not be concerned about anything else. So, unless you have questions related to massage that can’t wait till our next meeting, it would be best if we limit our contact to just session time.”

Use your own words, and deliver your message with warmth and sympathy. If she protests, just reiterate in a caring but firm way that you can’t be available to her except during sessions. No matter how you present these new boundaries, she may feel rejected and not return to work with you—that’s a risk you have to take. If she continues as your client, she will surely test you to see if you mean what you say. You have to stand your ground while also being friendly: “I’ve got to get off the phone now. You can tell me more about (whatever it is) when I see you on Wednesday.”

At some point, you may want to recommend that, during this time of grief and transition, in addition to massage therapy she might also seek help from a mental health counselor or grief support group. If you want to make this suggestion, it would be best to do so when she’s calm and not upset or angry with you: “Have you considered getting support from a counselor or seeking out a support group?” If she’s interested and you know of such resources, you could point her in that direction.

Because this situation hasn’t happened for you before, you might want to take a look at what motivated you to go outside your usual professional boundaries this time so that you can avoid such entanglements in the future. You mentioned that you could empathize with her experience, but could there also be needs of your own that you might have been trying to fulfill by helping this client? An honest self-appraisal might show you some areas of self-care that need your attention.

Inappropriately Taking Responsibility for Clients

Clients will come to us for a number of reasons other than muscular relaxation. Like Doris, sometimes they are lonely or feeling lost and needing contact. Sometimes we can sense they have deep emotional wounds. Taking too much responsibility for a client is probably an occupational hazard in this work—we want to help our clients feel better, and in the intimacy of the work, we often “feel their pain.”

The ways that we take on too much responsibility are usually more subtle than in the situation described above. For instance, you may find yourself feeling as if you’ve failed when a client’s aches and pains don’t magically disappear. You might notice that you always work longer than usual with a client. In these circumstances, you have to keep reminding yourself that your goals are limited. Your responsibility is to do the best you can in the session time you have. Outside of that, you need to have faith in the client’s ability to solve his or her own problems.

If you feel drawn to bending over backward for a client (unless that client has legitimate special needs), that impulse should raise a red flag for you. If you find yourself wanting to help your new client in ways that you don’t usually extend to clients—feeling compelled to give her a ride home or coming in on your day off to work on her—stop and ask yourself what is going on. “An hour ago I didn’t know this client. How did I suddenly become responsible for her?”

There’s usually no problem in doing something extra for a regular client who is temporarily in a bad spot, but be careful about setting a precedent with a new client. Giving extra help to a client who is an able-bodied adult can create an unhealthy dependency that both sides will eventually come to resent. Find out what the resources are in your community so that you can steer clients toward them as the situation warrants.

Another reason to be cautious is that some emotionally unbalanced people are especially skilled at manipulating others into taking responsibility for them, and the repercussions can be greater than unwanted phone calls. A colleague reports:  “The most difficult client I ever had was one who, from the beginning, was good at manipulating me by making me feel guilty. For instance, even though she had a good job, she got me to give her a discount on my fee by telling me all the tragedies in her life. She also made me feel like I was the only person who could help her back problem and I often worked overtime to try to make it better. However, my work was never good enough for her; she never felt relief. After several months, she asked for her money back, saying I hadn’t helped her. She also began bad-mouthing me all over the community and threatening to file groundless ethics charges. In the end, I had to hire a lawyer to negotiate with her to accept a partial refund as a final settlement. It was a very unpleasant experience and taught me to be more consistent about staying within set boundaries.”

Real Help

When you find yourself going overboard for a client—feeling as if she needs a lot of advice, wanting to take extra time with her, and so forth—step back and ask yourself whether you might be taking too much responsibility. Chances are that person has managed to muddle through without you all these years. Check in with yourself about whether you’re meeting some needs of your own by rescuing this client and whether you’re really comfortable with what your relationship with her has become.

Going outside your boundaries to help clients can give the wrong message to them—and to yourself. The message to them is that you don’t trust that they can take care of themselves. The message to yourself is that you don’t trust how much help you are already giving them. Don’t get roped into feeling that you have to do more for a client than you usually do. And don’t underestimate how much healing there is in an hour of caring attention.

  Nina McIntosh combines more than twenty years of experience as a bodyworker with her previous years as a psychiatric social worker. She is the author of The Educated Heart: Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers, now in its second edition. For more information, contact Lippincott Williams & Wilkins at 800-638-3030 or visit www.lww.com. To learn more about professional boundaries and ethics, visit www.educatedheart.com.

  To learn more about illustrator Mari Gayatri Stein, visit www.mariscardsandmore.com.