Reiki Center of Venice ~ Professional Ethics

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Professional Ethics ~ 2 CE's


Professional Ethics 

2 Hours




By   Francine Milford, LMT 





Copyright©2011 Francine Milford. All rights reserves. 

Updated 2020


This course provides the most recent and updated information as it relates to Professional Ethics. This course will display the most recent changes and updates and how they may affect you and your business. 


Reiki Center of Venice                                



Professional Ethics

Goals and Objectives  


Course Description-“Professional Ethics” is a home study continuing education program designed for Florida licensed Massage Therapists and Bodyworkers.  This course focuses on the rules and laws that govern and regulate the practice of massage therapy and bodywork in the state of Florida. This course is updated yearly presenting the most recent changes and updates to the Florida statutes and Florida Board of Massage Therapy.  


Course Rationale-This course was developed to give updated information to Florida licensed massage therapists about professional ethics that regulate their profession. 


Course Objectives-The student will understand:

  •  Ethics of using the social networking
  • Massage therapist scope of practice
  • Roles and boundaries 
  •  Sexual harassment
  • Records and documentation  


Upon completion of this course, participants will be able to:

  • 1.      To increase their understanding of social networking and the role that ethics play in using new technology such as the Internet
  • 2.      To instruct massage therapists on their roles and boundaries in the Massage Session
  • 3.      To present the scope of practice of massage therapy.
  • 4.      To review changes for cause of disciplinary action as a Florida licensed Massage Therapist and concurrent penalties.
  • 5.      To present to massage students all updated information that affect the practice of massage therapy as it relates to new laws in the industry governing ethic violations. 


Course Instructor-Francine Milford, LMT, CTN    


*Method of Instruction-Text based online home study course         


*Course Requirements-In order to successfully complete this course you must complete the enclosed test and earn a score of 70% or higher. If you do not receive a 70% or higher, then you may contact the instructor to receive a new test. If you not score a 70% or higher on the second test, then you will have failed this course and will not receive your continuing education hours.    


*Determination of Contact Hours- “Professional Ethics” course will require at least 2 hours to complete.  This estimate is based on the accepted standard for home study courses of approximately 10-12 pages of written text per hour.  The complete text of this course is at least 26 pages. (Excluding test)      


*Table of Contents    

Title     Page Number

About Ethics  

Code of Ethics           



             Department of Health           

Ethical Rules  

Ethics and the Internet          


Ethics of Selling Products     

Transference and Countertransference          



Test Questions           

Chapter One - About Ethics            

     When you decided to become a massage therapist you entered a very rewarding and sometimes demanding career field. By accepting this challenge, you also accepted a series of rules and laws that govern this health care profession. Among these sets of rules and laws is Ethics. Ethics govern your professional relationships both in and out of the client session.           

     The purpose of ethics is to protect the client-therapist relationship. Written, and unwritten rules of ethics can protect both the massage therapist and their clients from situation that compromise (or undermine) the client-therapist relationship. We will take a look at some of these situations in this course.           

     To define the word ethics, I turned to the Webster Pocket Dictionary of the English Language, New Revised Edition, Trident Press International, 1998, where it states that the word ethics refers to the study of and philosophy of human conduct with an emphasis on the determination of right and wrong. 2. The basic principles of right action, esp. with reference to a particular person, profession, etc. 3. A work or treatise on morals.           

     When we talk about ethical principles, we look to the word ‘principle’ as it is defined in the Webster Pocket Dictionary of the English Language, New Revised Edition, Trident Press International, 1998. The word principle means a ‘basic truth’ and ‘a set of moral standards or rules of conduct.’ In saying this, we are saying that there is a definite ‘right’ and ‘wrong’ action in our client-therapist relationship. To step out of this rule of conduct, we may then risk violating the client-therapist relationship.           

     But for many clients and therapists, there is a gray line that often makes its way into the client-therapist relationship. Each person in this relationship has their own set of experiences and belief systems that they bring to the session. Cultural beliefs may clash with state and local laws, especially as it relates to draping.           

      I have found that in my own practice, Europeans are often uncomfortable with having to be covered during a massage session (especially menopausal women). Many are used to lying nude on the table and being unrestricted with draping which may make the therapist look clumsy, prudish or unskilled. But the law here in Florida is quite clear about draping. Clients must be properly draped during the massage session. To do otherwise will put you, the massage therapist, at risk of violating the client-therapist relationship. If you are practicing in the State of Florida, then you must abide the rules and regulations in place here-and that includes proper draping.             

     Because you are the professional, it is your responsibility and duty to provide a safe and comfortable environment for your client, and to provide that within the massage therapy rules governing your profession. Many professional governing bodies will list their ethical principles on their website. These principles act as guidelines for handling yourself and your practice, and not as rules.                     



Chapter Two - Code of Ethics

     When you join any of these professional organizations and agree to abide by their ‘codes of ethics’ then you are providing a grievance process that the public can use to file complaints against you. A code of ethics is a   written document that states the beliefs and standards of an individual or group/organization. This code contains the values that the group wants to present to the public. Code of ethics can be used by both the consumer and the therapist. For the therapist, the code offers the therapists clear cut guidelines on how to act professional and what they can and cannot do in the massage session. For the client, the code of ethics offers them a professional environment of qualified and licensed therapists. That because of the code of ethics, there is a certain amount of respect and knowledge that clients can expect from their therapist.           

     Some national organizations have been put in place to oversee the professionalism of massage therapists and body workers. Two of those organizations are the Associated Bodywork & Massage Professionals (ABMP) and the National Certificating Board for Therapeutic Massage & Bodywork (NCBTMB)

      I have gone both to their websites and taken the following information from them to show you how similar these two organizations are in what they feel is a Code of Ethics for massage therapists and body workers to follow. As you read the Code of Ethics from these two large associations, look at the many similarities between them. It is these very items that they both have agreed are important and speaks to the professionalism of the massage therapist and/or body worker.         







ABMP Code of Ethics 2015 to present

As a member of Associated Bodywork & Massage Professionals (ABMP), I pledge my commitment to the highest principles of the massage and bodywork profession as outlined here:

  1. Commitment to High-Quality Care

I will serve the best interests of my clients at all times and provide the highest quality of bodywork and service possible. I recognize that the obligation for building and maintaining an effective, healthy, and safe therapeutic relationship with my clients is my responsibility.

  1. Commitment to Do No Harm

I will conduct a thorough health history intake process for each client and evaluate the health history to rule out contraindications or determine appropriate session adaptations. If I see signs of, or suspect, an undiagnosed condition that massage may be inappropriate for, I will refer that client to a physician or other qualified health-care professional and delay the massage session until approval from the physician has been granted. I understand the importance of ethical touch and therapeutic intent and will conduct sessions with the sole objective of benefitting the client.

  1. Commitment to Honest Representation of Qualifications

I will not work outside the commonly accepted scope of practice for massage therapists and bodywork professionals. I will adhere to my state's scope of practice guidelines (when applicable). I will only provide treatments and techniques for which I am fully trained and hold credible credentials. I will carefully evaluate the needs of each client and refer the client to another provider if the client requires work beyond my capabilities, or beyond the capacity of massage and bodywork. I will not use the trademarks and symbols associated with a particular system or group without authentic affiliation. I will acknowledge the limitations of massage and bodywork by refraining from exaggerating the benefits of massage therapy and related services throughout my marketing.

  1. Commitment to Uphold the Inherent Worth of All Individuals

I will demonstrate compassion, respect, and tolerance for others. I will seek to decrease discrimination, misunderstandings, and prejudice. I understand there are situations when it is appropriate to decline service to a client because it is in the best interests of a client's health, or for my personal safety, but I will not refuse service to any client based on disability, ethnicity, gender, marital status, physical build, or sexual orientation; religious, national, or political affiliation; social or economic status.

  1. Commitment to Respect Client Dignity and Basic Rights

I will demonstrate my respect for the dignity and rights of all individuals by providing a clean, comfortable, and safe environment for sessions, using appropriate and skilled draping procedures, giving clients recourse in the event of dissatisfaction with treatment, and upholding the integrity of the therapeutic relationship.

  1. Commitment to Informed Consent

I will recognize a client's right to determine what happens to his or her body. I understand that a client may suffer emotional and physical harm if a therapist fails to listen to the client and imposes his or her own beliefs on a situation. I will fully inform my clients of choices relating to their care, and disclose policies and limitations that may affect their care. I will not provide massage without obtaining a client's informed consent (or that of the guardian or advocate for the client) to the session plan.

  1. Commitment to Confidentiality

I will keep client communication and information confidential and will not share client information without the client's written consent, within the limits of the law. I will ensure every effort is made to respect a client's right to privacy and provide an environment where personal health-related details cannot be overheard or seen by others.

  1. Commitment to Personal and Professional Boundaries

I will refrain from and prevent behaviors that may be considered sexual in my massage practice and uphold the highest professional standards in order to desexualize massage. I will not date a client, engage in sexual intercourse with a client, or allow any level of sexual impropriety (behavior or language) from clients or myself. I understand that sexual impropriety may lead to sexual harassment charges, the loss of my massage credentials, lawsuits for personal damages, criminal charges, fines, attorney's fees, court costs, and jail time.

  1. Commitment to Honesty in Business

I will know and follow good business practices with regard to record keeping, regulation compliance, and tax law. I will set fair fees and practice honesty throughout my marketing materials. I will not accept gifts, compensation, or other benefits intended to influence a decision related to a client. If I use the Associated Bodywork & Massage Professionals logo, I promise to do so appropriately to establish my credibility and market my practice.

  1. Commitment to Professionalism

I will maintain clear and honest communication with clients and colleagues. I will not use recreational drugs or alcohol before or during massage sessions. I will project a professional image with respect to my behavior and personal appearance in keeping with the highest standards of the massage profession. I will not actively seek to take someone else's clients, disrespect a client or colleague, or willingly malign another therapist or other allied professional. I will actively strive to positively promote the massage and bodywork profession by committing to self-development and continually building my professional skills.

Reference: Associated Bodywork & Massage Professionals (2015). “ABMP Code of Ethics.” Web Accessed on June 20, 2020 from














NCBTMB Certificants shall act in a  manner that justifies public trust and confidence, enhances the reputation of the profession, and safeguards the interest of individual clients. Certificants will:


  1. Have a sincere commitment to provide the highest quality of care to those who seek their professional services;


  1. Represent their qualifications honestly, including education and professional affiliations, and provide only those services that they are qualified to perform;


  • Accurately inform clients, other health care practitioners, and the public of the scope and limitations of their discipline;


  1. Acknowledge the limitations of and contraindications for massage and bodywork and refer clients to appropriate health professionals;


  1. Provide treatment only where there is reasonable expectation that it will be advantageous to the client;


  1. Consistently maintain and improve professional knowledge and competence, striving for professional excellence through regular assessment of personal and professional strengths and weaknesses and through continued education training;


  • Conduct their business and professional activities with honesty and integrity, and respect the inherent worth of all persons;


  • Refuse to unjustly discriminate against clients and/or health professionals;


  1. Safeguard the confidentiality of the client’s identity and information in all conversations, advertisements, and any and all other matters unless disclosure of identifiable information is requested by the client in writing, is medically necessary or is required by law;


  1. Respect the client’s right to treatment with informed and voluntary consent. The certified practitioner will obtain and record the informed consent of the client, or client’s advocate, before providing treatment. This consent may be written or verbal;



  1. Respect the client’s right to refuse, modify or terminate treatment regardless of prior consent given;


  • Provide draping and treatment in a way that ensures the safety, comfort and privacy of the client;


  • Exercise the right to refuse to treat any person or part of the body for just and reasonable cause;


  • Refrain, under all circumstances, from participating in a sexual relationship or sexual conduct with the client, whether consensual or otherwise, from the beginning of the client/therapist relationship and for a minimum of six (6) months after the termination of the client therapist relationship, unless an ongoing current sexual relationship existed prior to the date the therapeutic relationship began;


  1. Avoid any interest, activity or influence which might be in conflict with the practitioner’s obligation to act in the best interests of the client or the profession;


  • Respect the client’s boundaries with regard to privacy, disclosure, exposure, emotional expression, beliefs and the client’s reasonable expectations of professional behavior. Practitioners will respect the client’s autonomy;


  • Refuse any gifts or benefits that are intended to influence a referral, decision or treatment, or that are purely for personal gain and not for the good of the client; and


  • Follow the NCBTMB Standards of Practice, this Code of Ethics, and all policies, procedures, guidelines, regulations, codes, and requirements promulgated by the National Certification Board for Therapeutic Massage & Bodywork,









NCBTMB (15 September 2017). “Code of Ethics.” Web. Accessed online on June 20, 2020 at










Department of Health

     You may feel that by joining a professional organization that you can be safe from reprimands. But not joining such groups will not keep you safe from public complaints against you. In the state of Florida, the public can file complaints against you by going to the following website:           

   At this website, you can download and file a form against a particular health care provider or establishment. Since all health care practitioners operating in the State of Florida are regulated by the Department of Health, claims filed against practitioners and establishments are handled through this organization.           

    This organization will follow up and investigate complaints and if the party is found guilty, then action may include license suspension or revocation, restrictions, fines, etc. Complaints may include unlicensed activity, poor quality of care, misdiagnosis of condition, inappropriate prescribing, sexual contact with patient, insurance fraud, misfiled prescription, substance abuse, advertising violation, excessive tests or treatments, and patient abandonment and/or neglect.           

     And although the public may want to file complaints against a lackluster practitioner, there are definitely areas where the state does not get involved in dealing with the public against their therapists. These areas include fee and/or billing disputes, personality conflicts, rudeness, missed appointments and bad attitude.           



  • To file a complaint/report, you must do so in a signed, written report.  For your convenience you may use this form providing dates and details about your complaint.
  • Use a separate complaint form for each practitioner you wish to file a complaint against.
  • Be specific and include copies of pertinent medical records, correspondence, contracts, and any other documents that will help support your complaint.
  • Medical records are needed to process your complaint.  Since a health care practitioner cannot disclose his or her patient names or records with authorization, the Authorization for Release of Patient Information form included on page 3 must be completed and signed.  Signatures must be witnessed or notarized.
  • The Department will notify you in writing of the status of your complaint throughout the process.  Please advise us of any address change.
  • If the allegations contained in your complaint/report are determined to be possible violations of applicable laws and rules, your complaint will be opened for investigation.
  • Please note that if your complaint is assigned for investigation, a copy of the complaint form will be provided to the health care practitioner pursuant to Florida law.
  • The Department may investigate an anonymous complaint if the complaint is in writing and is legally sufficient, if the alleged violation of law or rules is substantial, and if the department has reason to believe, after preliminary inquiry, that the violations alleged in the complaint are true.
  • If you are reporting Medicaid Fraud, you may be entitled to a reward through the Office of the Attorney General.  For information and to report Medicaid Fraud, please contact the Attorney General’s Fraud Hotline by calling 1-866-966-7226 or online at and clicking the “Report Fraud” button.



            If you decide to file a report, you may choose your ‘Nature of Complaint’ from a written selection that includes items such as:

*Quality of Care

* Inappropriate prescribing

* Excessive testing or treatments

* Misdiagnosis of condition

* Sexual abuse

* Insurance fraud

* Advertising violation

* Substance abuse

* among others



Ethical Rules           

      Let’s take a look at some of the situations that may bring negative attention to you and to your business. You may be familiar with many ethical principles such as no discrimination, keeping records confidential, keeping a professional image, etc. but there are also ethical rules that are part of the code of ethics.  Ethical Rules include:

  • ·        Work within the scope of your practice
  • ·        Refrain from making sexual contact
  • ·        Refrain from making sexual and/or inappropriate jokes
  • ·        Truth in advertising
  • ·        Truth in marketing
  • ·        Do not make diagnoses
  • ·        Do not tell your client to stop taking their medications
  • ·        Do avoid conflict of interest But there are gray areas even were the rules are concerned. Some of these gray areas include: 
  •         ·        Accepting gifts from clients (does not include Holiday gift giving)
  •         ·        Referring clients to other health care practitioners for which you receive
  •         ·        Giving advice when not asked for
  •         ·        Offering solutions when not asked for
  •         ·        Offering advice that is out of the scope of practice (such as nutritional help)        



The Ethics of the Internet            

     With the invention of the Internet, and social networking in general, came the advent of a new opportunity to cross the client-therapist relationship. For massage therapists who have Facebook, Linkedin, and other social networking accounts, how do you handle clients who want to be your friend? Do you even have a standard policy for your clients? Should you?           

     If you are trying not to cross the boundaries of your client-therapist relationships then adding a client to your friend contact list on your social networking site can be construed as going out and having a cup of coffee with them, or maybe even a shopping trip with you. If this is something that you would not do with them, then don’t add them to your friend list. In fact, it would be highly advisable NOT to add ANY clients to your social networking. You are asking for problems done the line if you don’t have, and follow, a policy for Internet relationships.           

    Here is where problems can arise and cause conflicts. What if you had a very hard day and had a particular rough time with a client. So you go onto your Facebook account and blow off some steam about the session. You don’t mention names but your client realizes that you are talking about them. Not only have you violated confidentiality rules, but you have crossed the line in the client-therapist relationship (trust).            

    Even if your client doesn’t have a friend status with you, perhaps one of your clients friends notice that you are talking about that particular client and reports the information to the client. Either way, you lose. You have crossed the line and the client has legal recourse to file a complaint against you.           

    This new technology also includes texting. You can’t text your friends with snippets of information like ‘oh here comes that client’ or ‘here comes my hunk of a client’ or ‘here comes fatso’, etc. Anything you say is a breach of confidentiality.            

    And as for cell phones, they should be treated just like client files. Your cell phone should be turned OFF during all sessions (do not set on vibrate either). Cell phones should also be placed where clients can’t see or read, what is on it. Just like client files, cell phones should be out of public view.           

    If you haven’t decided how you are going to handle adding client’s to your friends list, then you should take some time to consider this now. Remember, you can’t add some and then refuse others. This will cause just as many problems in the long run as adding all of them.            It is a fine line that we cross every day when our clients become our friends. We risk the loss of professionalism in our sessions and in our meetings outside of the massage session. We can help keep our professionalism by keeping up our lines of what constitutes the massage session and the client-therapist session.              

   Realize that that by even acknowledging one of you clients when you are out shopping can become a breach of confidentiality if that particular client doesn’t want anyone else to know that they are coming to you.           


Gift Giving and Receiving

     Gift giving and receiving is another potential problem. I don’t go out for coffee, lunch, etc. with my clients. They are my clients, not my friends. I do not share personal information with my clients. Even though I will listen to my clients about their family and friends, I will not offer up any of my own personal information. For some clients, it is just a matter of being friendly when they ask what my holiday plans are, or if I am married. Try not to be rude, but firmly direct them back to the massage session. Sometimes I gently say, “This session is not about me, it is all about you” you then follow up with a question like, “how is the pressure?”            

     It may seem rude, but it is easier to keep a door closed than to try to close a door once it has been opened. If you are firm and stick by your policies (which I hope you have written down and posted by now), then you will be able to enjoy long, healthy and successful relationships with your clients.           


Right of Refusal and Informed Consent

     There are other ways to be sure that you are hearing and understanding your client’s specific needs. Some of these ways is understanding informed consent. Informed consent is where your client will be able to make a decision based on adequate information that you have supplied to them.  Informed consent should include:

  • ·        What the goals and purpose of the session are
  • ·        What the cost of the selected treatment is
  • ·        What are the potential benefits of selected treatment
  • ·        What are the potential risks of the selected treatment
  • ·        What is the amount of time needed to complete selected treatment. 





Given complete information about their situation, clients may then choose either to accept, or deny, the massage session. Even if a client at first agrees with your assessment and treatment begins, the client can stop the session at any time (yes, even in the middle of the session). This is their right of refusal and you must respect it. If your client stops the session, or if even if you stop the session, there should be a refund policy in place at your establishment. If you do not have one, then please write up one now. Be sure that ALL of your policies are in writing and posted on your brochures, or hanging somewhere in your room. This will easily stop accusations of discrimination or other perceived complaints.  In order to prevent any misunderstanding in your practice, you might consider writing up an informed consent statement. This statement can be part of your client intake form but if it is, then you should be sure that your clients receive a copy of it so that they can read it at home and keep it for future reference. 


Your informed consent statement can include the following information:

  • Mission statement
  • Refund Policy
  • List of services that you offer with a definition of each
  • Treatment plans and goals
  • Potential risks and benefits of treatment
  • Boundaries
  • Ethics
  • Right of Refusal policy    




When we talk about boundaries, we sometimes think of it as a physical space. That if you stand too close, or touch inappropriately (sexual boundaries), you have crossed the boundaries of the client-therapist relationship. But boundaries are not just physical; they are also emotional and mental in nature. These boundaries may include the words that you speak, the gestures that you make, body language and the gaze of your eyes. They can be in the form of sexual joking, innuendo’s, and even perceived flirting. Keep yourself in check and if you are not sure whether you are being perceived correctly or not, ask a co-worker. You should also be keeping within your legal boundaries. Legal boundaries are what we call our ‘scope of practice’ and it is legally determined and defined by state law. This scope limits what services we can and cannot offer to the public at large, given our particular license to operate. As massage therapists, there are several things that we cannot do since they lie out of our scope of practice. Among these things are making diagnoses, offer counseling, give nutritional advice, use acupuncture needles, prescribe medications, read x-rays, and do spinal adjustments.                     



Ethics of selling products to your clients

Just about any business book or business article in a magazine will tell you of the importance to selling products to your client. But we walk a fine line between knowing what is wrong and right when we push our products (our beliefs) unto our customers.            Even though you believe in the products that you sell, and even if you believe that these products will be of benefit to your client’s, is it ethical to sell products to your clients?           


As a professional we are often put into a role of knowing what is best for the health and well-being of our client’s. We often make suggestions to our clients to help them on their path to healing. Our suggestions bear great weight with our clients as they want to trust our knowledge and experience in the world. Many of our clients will feel that we, as health care practitioners, know what succeeds and what will not.           


Some of the products that we sell many include neck and eye pillows, magnets, salts, Bach Flower essences and Aromatherapy essential oils. But before you make blanket recommendations to your clients, you must be aware that you must be honest and truthful in any and all claims that you make about the products. You will be held liable for any fraudulent claims that you make to your clients, especially if it causes them harm.            Clients put their faith and trust in you and expect that you will first do no harm. They look to you for help in pain reduction, to gain more flexibility and to improve the quality of their life. And you can help on so many levels.     



How to Practice ethics when selling products to your Clients

To practice ethical behavior while selling products in your office, you must be aware of how you may be coming across to your clients. You must decide if selling products (and making more money) is more important to you than the clients’ health and well-being? Check yourself during your communication with your client. Are you pushy? Are you saying words to your clients such as “If you want to feel better, then you will need to take these multivitamins every day?” or words like, “You can use lavender essential oil in a foot bath to treat athlete’s foot?” Be aware that you words carry weight with them and these sentences are outside of your scope of practice.               


Also be aware that if you sell products to your clients, then you may be held liable for any negative results from the client using the product. This is especially true if you client made a full disclosure to you on their health issues and erroneously suggested a product to them that was a contraindication to the medications that they are taking.           


If you have been specially trained in an area and have the credentials required by state law, then you can sell products to your clients that you feel would be of benefit to them. But even here, you must watch your claims and guarantees.           


When looking for insurance, look for a policy that offers product liability. It is always better to be safe than sorry. When I am asked about claims being made by the many product manufacturers in the world, I would honestly say to the client, “I don’t know enough about the product to help you decide whether it will be good for you or not.” If you want to go a step further, I would suggest that the client ask his or her primary care physician first. Lastly, I would enter this conversation into my S.O.A.P. notes in case any further discussion about it happens down the road. It has already happened in my business that a client came to me a month after taking something over the counter and blaming it on me. I pulled the chart out and read the notes from the session where I had successes they seek guidance from their doctor first (which of course they had not done). Seeing it in writing and reading it back to them jogged their memory. It is hard to argue with the written word so that is why I am sure to write ALL of the experiences and conversations of the session down in the clients’ charts. You just never know when you will need to remember something again. Make it a habit. It only takes a few extra minutes out of your day and save you headaches in the future.            


Even if you think that it is up to the client whether they purchase products from you or not, this is not true. Because of their trust and faith in you and your knowledge, clients can be easily persuaded to purchase products from you. They may also feel obligated to purchase these from you, even if they don’t want to. In this case, since the clients wants to please you, this is called transference.         





Transference and Countertransference

Transference is the act of transferring emotions and reactions by the client unto the therapist. Countertransference is the act of transferring emotions and reactions from the therapist on to the client. Transference and Countertransference can be either a positive or negative thing. If during the massage session the client gets a whiff of a scented candle that you are burning and it brings back pleasant memories, than the client will have a more positive transference. On the other hand, if the client experiences a specific way that you massaged their head in a negative way, then this will cause a negative transference.     



Some Signs of Transference by the Client

There are some signs of transference that you can be on the lookout for and they include:

  • ·        The client may tense up
  • ·        The client may begin to cry
  • ·        The client may begin to laugh
  • ·        The client may begin to relax
  • ·        The client’s voice may getter softer, or gentler
  • ·        The client’s voice may get louder, or huskier
  • ·        The client may begin to fidget, or become nervous
  • ·        The client may pull away from your touch
  • ·        The client may begin to breathe more rapidly
  • ·        The client may begin to sweat, or shake (as with fear)
  • ·        The client makes a fist
  • ·        The client quickly becomes silent
  • ·        The client moves their head from side to side
  • ·        The client frequently brings you gifts
  • ·        The client asks you out for a date
  • ·        The client calls you at home
  • ·        The client asks you for advice about their personal issues
  • ·        The client asks you for extra time in the session
  • ·        The client asks you about your personal life   


 If you experience any of these signs with your client, then try not to take it too personally. Your client is in a place of vulnerability and it may be hard for them to cope with their feelings undressed on a table. You might want to reassure your client that you are providing a safe and secure environment and that you there to focus on their particular needs. Be sure to communicate with, and receive feedback from, your client throughout the session.     


Transference often occurs when the client’s needs are not being met outside of the therapeutic session. These needs could be anything from having a human touch, to having someone taking care of their needs. When the therapist takes on this special and significant role in the client’s life, then transference may happen and may end up making the session uncomfortable or unhealthy for both the client and the therapist.     


If you see that your client will not make a move without your approval, then you will have to either to have a talk with your client about your boundaries, or find your client another therapist.           


If this transferences turns into a crush, or causes sexual innuendos, then the therapist must realize the early signs of transference occurring and reduce the chances of it becoming full blown-right from the start. Allowing things to progress without stopping them is almost the same as encouraging the behavior to continue.      




On the other side of the coin is Countertransference. In Countertransference, it is the massage therapist who reacts positively or negatively to the client. Perhaps a client comes in to your room and she reminds you of an old critical aunt that you despised growing up or perhaps even one that abused you as a child. Your reaction to this client will be quite different than if a person walked in to the room and they reminded you of a dearly loved aunt who you miss. Just like in transference, Countertransference can signal that the therapists’ has unresolved feelings in their own life and is looking to the client to fulfill one of their needs. Maybe the therapist wants to feel important in someone’s life and sees the client-therapist role as an opportunity to feel important and needed in the client’s life.In a massage relationship, the therapist must maintain strict boundaries between their personal and professional life. The massage session must be about the client and what their specific goals and needs are-not the therapist.   It is very easy to determine if you have Countertransference with your clients by answering the following questions. If you find yourself answering yes to these questions, then it would be best for you to re-evaluate your massage sessions:

  1. Are you are happy to see your client? Were you looking forward to seeing them?       
  2. Are you full of dread at seeing your client? Wishing and hoping that they would cancel their session or find another therapist?
  3. Are you happy and inspired while working on your client?
  4. Do you feel drained and uninspired while you are working on your client?
  5. Are you sad when the session ends or are watching the clock because you can’t wait until it is all over?
  6. Are you happy to hear about your client’s day or do you try to ‘tune out’ of their ramblings?
  7. Do you greet your client with enthusiasm and an uplifted voice or do you greet them with dread and abruptness.
  8. Do you find that you spend more time with the clients that you client before and after a session? Or do you meet and greet all of your clients and allow the same amount of time for each?
  9. Are you attracted to your clien
  10. Do you become overly emotional if you client cancels a session?
  11. Do you give one client additional time but not another?
  12. Do you find yourself arguing with a client?
  13. Do you find yourself becoming impatient with a client?
  14. Do you find yourself having romantic fantasies about a client?
  15.  Do you find excuses for your client’s inappropriate behavior?
  16. Do you find yourself becoming involved in your client’s life? 



It is important to keep proper perspective and to keep you emotions in check as it is easy to affect the outcome of the massage session. If you find that there are some clients that you simply can’t work on, then it would be best to refer them to another practitioner. That would be the ethical thing to do. If we can’t give our clients our undivided attention and focus, then we should allow them to find another practitioner to create a healthy client-therapist relationship with.         


Basic Terms and their Definitions 

  • Boundaries-Line between what is, and is not, acceptable behavior. 
  • Code of Ethics-Document stating standards of conduct of individual or group Countertransference-Therapist attributes the thoughts and feelings that they are having for another person on to the client. 
  • Ethics-Standards of behavior from an individual or group 
  • Morals-The beliefs of what is good and bad (right or wrong) of an individual or group 
  • Professional boundaries-What is, and is not, acceptable professional behavior 
  • Professional Ethics-Standard of expected professional behavior from an individual or group. 
  • Scope of Practice-Set of activities that a professional is, or is not, allowed to perform. This set of activities is defined by the professional’s training, laws and regulations. 
  • Transference-Client attributes the thoughts and feelings that they are having for another person on to the therapist.  









 Final Test

NAME______________________________ DATE________________


TELEPHONE NUMBER_______________________________________



Test Questions Please circle the correct answer for each of the following questions.


You must earn an 80% or higher in order to successfully complete this course and  receive your 2 ce’s.’’


  • 1.      The purpose of ethics in massage therapy is:  a. to get paid for the work that you do  b. to get a massage license  c. to know how to give a good massage  d. to protect the client-therapist relationship
  • 2.      The word ethics mean:  a. it’s the law to pay me for the work that I do  b. it’s a rule that we all have to live by  c. it’s a license to practice in the State of Florida  d. it’s basic principles of right and wrong
  • 3.      The word principle means:  a set of moral standards  b. rules of conduct  c. a basic truth  d. all of the above
  • 4.      The Code of Ethics offers the massage therapist the following:  a. clear cut guidelines on how to act professionally  b. a formal dress code  c. a formal education  d. a professional document to hang in their office
  • 5.      Some ethical rule may include which of the following sentences:  a. give a good massage  b. work within the scope of your practice  c. ask your client out on a date  d. diagnose your client’s condition if their physician can’t
  • 6.      A good therapist will:  a. refrain from making inappropriate joke  b. not tell their clients to stop taking their medications  c. advertise truthfully and honestly  d. all of the above
  • 7.      A good therapist will not:  a. be on time for appoints  b. accept gifts from clients  c. return phone calls  d. reschedule appointments if ill  
  • 8.      Transference is the act of:  a. transferring emotions by the client to the therapist.  b. transferring of money to your bank account.  c. transferring emotions by the therapist to your client.  d. transferring negative reactions back and forth in a session.
  • 9.      Countertransference is the act of:  a. transferring emotions by the client to the therapist.  b. transferring of money to your bank account.  c. transferring emotions by the therapist to your client.  d. transferring negative reactions back and forth in a session.
  • 10.  A set of activities that is defined by the professional’s training, law and regulations as to what a therapists can, and cannot do in a session is called:  a. code of ethics  b. scope of practice  c. professional ethics  d. professional boundaries 


Cost: $10 for Medical Errors-2 ce's.