The first step in protecting yourself as an RMT is to ensure you’re never completely alone. Therapists working in clinical settings will often be located across or down the hall from other employees, while those who work from home or therapists who visit others’ homes should take heed.
Giving massages in hotel rooms are another situation where therapists are taking risks, says Pamela Fitch, RMT and faculty member at Algonquin College in Ontario.
Many mobile massage services serve to protect therapists by requesting photo identification from clients booking through them, and a credit card so therapists never carry any cash. But ultimately many veterans in the industry feel uncomfortable suggesting it as a way to work.
“There are a number of mobile massage companies that suggest that it is safe to send therapists to client hotel rooms. This situation carries serious risk for therapists, particularly women who don’t have the same upper body strength as a man in the event of an assault. I’m concerned about therapists accepting these working conditions frankly,” Fitch says.
Dr. Cidalia Paiva, executive director of the West Coast College of Massage Therapy, agrees. “Your opportunities to set boundaries are extremely poor [when you’re alone]. You don’t have the ability to remove yourself from a situation in a hotel room or in somebody else’s home in the same way you do in a clinical setting where other people are present.”
In general, those most at-risk of being targeted are more likely to be younger, newer therapists, according to Paiva. She also says it’s “mostly men targeting women, versus women targeting men. But again, that’s a generalization.”
What exactly is inappropriate?
First, it’s important to determine what an “inappropriate situation” is, and where to draw the boundary. Paiva says there are some scenarios that appear to be inappropriate, but may actually not be.
For example, she says sometimes therapists get uncomfortable when a male client has an involuntary erection on the table. “This may simply be a physiological response with no sexual intent.” Being uncomfortable is totally normal, and it’s likely both parties are uncomfortable here.
Another example of a perfectly appropriate situation that may be taken in the wrong context involves draping.
“Sometimes therapists do not provide appropriate instruction with regards to draping,” Paiva says. “This can result in some clients removing too much or all clothing when all they really needed to do was undrape a particular area and maintain appropriate draping protocols for the rest of the body. Because the therapist did not provide clear instructions regarding draping, a client may be draped in a way that could be [interpreted as] suggestive, but there is no sexual intent here – it’s simply a lack of clear direction with regard to draping protocols.”
[Fitch would like to note that draping is entirely the responsibility of therapists and those who do not drape properly (in Ontario) would have broken a standard of practice.]
Along with intent comes the realization that sexual massage still exists, so some people don’t look at regulated massage therapy treatments as a healthcare or well-being option, at least at first.
This was an awakening for Linda Menzies, RMT and owner of the Morden Massage Therapy Centre in Manitoba. Menzies was surprised when her receptionist new hire told her she wasn’t allowed to work there – her visa stated she couldn’t work in a massage parlour.
“It’s simply a lack of education, or a possible language or cultural misinterpretation – they don’t mean harm, they just don’t understand in some cases,” Menzies says. “I think as long as we have the word ‘massage’ in our titles, there’s always that room for misinterpretation.”
“There’s no shame in mistaking therapeutic massage for sexual massage, because we know other cultures do it,” Fitch agrees. “And it’s really important we’re not shaming people who have been raised in that kind of culture because ultimately it’s an opportunity for education.”
Establishing a therapeutic relationship
Boundaries should be set from the first visit with a new client. If someone is predating – that means actively seeking out a sexual encounter or exploitation – they will continue taking advantage: You give an inch, they take a mile. Someone who is predating another person will look for vulnerability.
That’s one of the reasons why therapists shouldn’t brush off inappropriate questions, or laugh along with sexual jokes. (Allowing clients to behave in this way may be misinterpreted as flirting.) By setting boundaries early on, it saves you from trying to set a boundary when you’ve already allowed them to do something that makes you uncomfortable.
“If [therapists] don’t establish the therapeutic relationship at the beginning and what their purpose is, how can you expect the client to behave appropriately?” Paiva says. “Be self-aware. It’s not about being friends, or about someone praising you for being a wonderful therapist, it’s for one purpose only – to serve and protect the patient and provide them with the best care.”
Fitch says communication is the first essential skill many students need to learn (and what therapists need to continue to practice).
“Therapists need to know how talk to people first,” she says. “They need to know how to give commands – ‘please turn over, put your leg here’ – or ask questions clearly. These communication skills take confidence in order to master.”
Fitch has open discussions within her classes at Algonquin College for students to share stories, helping them realize that certain situations are unacceptable.
“It is common for clients to attend the student clinic with the idea of baiting students or seeking a ‘happy ending’ (being masturbated to climax). We deliberately prepare students for these scenarios because we want them to be able to respond professionally, while at the same time ensuring their safety,” she says.
While therapists will have different reactions and scripts for dealing with inappropriate behaviour depending on their experience and confidence level, a good rule of thumb is to use the three-strike rule. At the first sign, let the client know their line of questioning, remarks or behaviour is making you uncomfortable. Or, the therapist may also choose to ignore them and change the subject – again establishing the medical/therapeutic components of massage.
The second time, remind them that their behaviour is inappropriate and if it continues you will have to discontinue treatment. By the third time, it’s time to leave the treatment room and file a report. Don’t make hollow threats.
When a client is abhorrently inappropriate (ex. grabs a therapist on the breast(s) without warning), it can trigger a couple of emotional responses: Mainly shock, followed by shame. Therapists may find themselves asking: “How did it happen and what did I do wrong?”
Finding the right words, communicating and establishing the therapeutic relationship are the first steps, but only self-awareness and self-confidence can get you there.
“Sometimes young women don’t have the confidence to respond to a male client who may say something inappropriate to them, or they’re not able to articulate their own responses. I suggest starting with a prospective script and then over time they can make that script their own as they build their experience and confidence.”
Menzies agrees, citing fear prevents success.
“Although therapists have extensive health-care training, when they first start in the field they are often on contract and there may not be a whole lot of collaboration that happens,” she says. “For a month or so after they first graduate, they may start out being fearful of making a ‘wrong’ assessment. If they don’t tackle this fear and then never practice the orthopedic skills they’ve obtained, laziness often sets in and they continue their career providing a relaxation massage instead of orthopedic treatment.”
Ultimately, keeping your therapeutic skills at the forefront of each treatment and remembering your purpose as an RMT can help keep you safe. Taking the opportunity to build up your self-development and working your own “psychological emotional muscles” can help inside and outside of the treatment room, too.
QUICK TIPS FOR HANDLING INAPPROPRIATE BEHAVIOUR
- Remember, don’t simply look at the action – look at the intent of the client.
- Always provide clear instructions regarding draping and treatment when treating a client.
- Reiterate to the patient you are a healthcare professional and talk about the different ways massage can help with their concerns.
- Practice “scripts” for different inappropriate behaviours, and talk with other RMTs – it’s unlikely you will be the only therapist to encounter these situations.
- Don’t be afraid to decline answering something too personal, or telling a patient their questions are inappropriate.
- Ensure you never practice alone and have a reason to excuse yourself from the room if the client is breaching the therapeutic boundary relationship.
- Therapists shouldn’t try laughing off odd statements or sexual remarks – stay clear and direct in your tone.