Maintaining Spa Ethics
Heart of Bodywork

By Nina McIntosh

Originally published in Massage Bodywork magazine, April/May 2006. Copyright 2006. Associated Bodywork and Massage Professionals. All rights reserved.

In recent years, spas have become increasingly popular, creating broader employment opportunities for massage therapists. Working in a spa can be a good way to gain experience before starting out on your own or supplement income from your private practice. Therapists at all levels of experience have even found a comfortable niche in long-term spa jobs.

In a perfect world, working in a spa environment would present no special ethical challenges to the bodyworker. But the reality is, as in any industry, standards vary widely. Problems typically arise when therapists and spa management clash on values and viewpoint. Employers may not see massage therapy as a profession with a set of ethical standards, but as merely another luxury commodity, like a steam bath or manicure. Spa management may expect all employees, including massage therapists, not to question spa policies and business goals, while therapists see themselves as professionals who can -- and should -- exercise judgment in interactions with clients. This difference in attitudes can create frustration and conflict for the massage therapist when spa policies fail to provide safe boundaries for them and their clients.

While it's understandable for a employers to require loyalty and compliance, it's equally reasonable for employees to expect protection in carrying out their work and support in upholding appropriate standards. The following questions reveal common dilemmas of manual therapists who are trying to maintain their professional integrity in a spa environment.

Protecting the Client: Honoring Confidentiality
I've recently started working in a spa that employs five other massage therapists and am surprised at how much the other therapists gossip about their clients. In school, I was taught the importance of confidentiality, but there's little regard for it in this spa. Therapists chat casually with each other about their clients -- for instance, complaining about a demanding client, relating personal information shared during a session, or even making remarks about a client's body. The office manager is no help. Sometimes, she even joins in. Isn't this kind of talk unethical? Are the rules of ethics different for massage therapists who work in spas? Should I mention my concerns to my colleagues or talk to our manager about her collusion?

-- Susan R., Tucson, Ariz.

Violating a client's confidentiality is unethical no matter where you work. Nothing a client says or does in a session may be shared with others without the client's permission -- except, of course, for situations in which there is potential danger to the client or others.

That said, there are some telling differences between a spa massage and treatment in a private office. In a spa, total privacy may be impossible. Everyone -- including other clients, office personnel, and other therapists -- knows who your clients are, since they see them come and go from the therapy rooms. Also, the client-therapist relationship is often more casual. Spa clients may not be loyal to one therapist, and therapists may not feel as deeply connected to their clients as they would in private practice. You will have a more superficial relationship with a client who comes in for an occasional half-hour rubdown than with someone receiving long-term treatment for a back injury.

You may find it easier to be lax about confidentiality in these conditions; but aside from being unethical (and that's a pretty major aside), careless talk is a bad habit to get into. Gossiping about clients, even without using their names, can foster an uncaring attitude that won't serve you well in your career. In a spa, it can create a subtly unwelcoming atmosphere in a setting that's supposed to offer comfort and relaxation.

There are, of course, times when clients' needs, preferences, or medical conditions should be conveyed to other therapists or spa personnel. The spa's intake forms should require clients to grant or deny written permission for this kind of disclosure.

What to do when others are gossiping? You can start by not joining in. It's wiser to teach by example, rather than risk causing resentment by lecturing your colleagues. They're more likely to appreciate your caring and ethical attitude when they see that it leads to success with clients.

Our work as massage therapists can be stressful. It's perfectly appropriate -- and sometimes even advisable -- to vent after a frustrating day, but only within ethical boundaries. Complain to a teacher, mentor, or consultant who is also bound by confidentiality and who can offer supportive suggestions. In this way, you can use your difficult experiences to build your skills and understanding, rather than allowing them to undermine your practice.

Whether or not you talk to the office manager is a judgment call you'll have to make, depending on your relationship and how open you feel that person might be to suggestions. An office manager's primary concern is the financial bottom line, so if you do decide to broach the subject, you could frame it in business terms. At one extreme, the spa could technically be sued for violating confidentiality. A more immediate concern is the atmosphere created by the casual gossip you describe. Clients may not actually hear it, but they will often pick up on the underlying negativity. Whether consciously or not, people will always end up choosing a spa that respects them and honors their privacy over one that doesn't.

Protecting the Therapist: Sexually Inappropriate Clients
The spa where I work won't back me up in dealing with a client who I think is being sexually inappropriate. As a female massage therapist, I've felt quite uncomfortable with a certain male client who enjoys flirting with me. He recently requested groin work, which is sometimes a legitimate need, but which can also signal that the client is looking for sexual stimulation. I didn't encourage his flirting, and although I did work briefly on his abdomen, I felt very uncomfortable. I have several regular male clients who I enjoy working with; however, this man makes me uneasy.

When I tried to discuss this client's behavior with the spa supervisor, she brushed me off. I told her I didn't want to work with him again, and I asked that if he made another appointment, she advise him flirting and sexualizing a massage aren't appropriate. If he didn't straighten up after that, I told her I thought the spa should ban him. The supervisor told me I was overreacting, and she wasn't willing to insult a client.

I need the money, but I'm not sure I want to keep working for this spa. Am I being hypersensitive? After all, this client hasn't actually tried to touch me or said anything overtly suggestive.

-- J.W., Colorado Springs, Colo.

Your supervisor should have taken your discomfort with this man seriously. If he makes another appointment, she should let him know that the spa doesn't offer sexually oriented massage and doesn't permit clients to sexualize the work of its therapists in any way, including flirting. (In fact, spa policy about such matters should be clearly communicated to every new client before he or she has a massage, which goes a long way toward preventing this kind of messy situation.) You might be overreacting, as your supervisor suggests, but the fact that you don't respond this way to all male clients is a good reason to trust your intuition in this case.

If you think your supervisor might be willing to listen, point out that allowing questionable sexual behavior isn't in her best interest. A spa that isn't clear about prohibitions attracts the wrong kind of clientele and will ultimately alienate respectable customers. It might even invite a visit from the vice squad. This is not to say that there's no room for flexibility. Sometimes, a client (male or female) may unintentionally become sexually aroused during a massage, or a client might mistakenly think the spa offers sexual services and then stop the inappropriate behavior after being informed otherwise.

The spa where you currently work obviously isn't concerned about protecting its employees or its own reputation, so I'm glad you're considering leaving. The potential harm isn't worth any amount of money. Being associated with such a place is demoralizing, and it can damage your professional reputation. The cost to your self-respect and your enthusiasm for your work will be much higher in the long run than anything this employer might pay you. For all these reasons, I urge you to start exploring other ways to generate income.

As always, prevention is the best cure. When considering employment at a spa, find out before you take the job if the establishment's values are compatible with your own. Make sure a policy prohibiting sexually inappropriate behavior is clearly stated on the intake form or posted in the reception area. Either in writing or verbally, clarification of such policies should be a routine part of every client's orientation.

The purpose of a job interview is for both parties to gather information. Ask your prospective spa employer about policies regarding clients' privacy and how they deal with sexually suggestive or assertive clients. Be sure to get clear responses to these and any other concerns you might have. Ask spa management to describe how they have resolved issues with inappropriate clients in the past. If possible, talk with a present or past employee. You might consider signing up for a massage with a therapist already working at the spa, both to get a sense of the environment and, if it seems appropriate, to ask the therapist how supported she feels there.

The Bottom Line
When considering a job at a spa, it's important to recognize you're relinquishing a significant degree of control over your practice. The employer will always end up calling the shots, so if your vision is at odds with that of spa management, you could be setting yourself up for a distressing situation.

By the same token, a spa that genuinely serves its clients will insist on high professional standards from all its employees. You don't have to compromise your values to make a living. Working in a spa can be a worthwhile career experience, but only if you take care to find the right fit for you.

Nina McIntosh combines more than 20 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

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