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Sexual Issues: Part 1
Protecting Your Client and Yourself

By Nina McIntosh

Originally published in Massage Bodywork magazine, April/May 2005.
Copyright 2005. Associated Bodywork and Massage Professionals. All rights reserved.


Sexual issues weren't discussed in much detail during my training. Although I think that I'm an ethical practitioner, I'm concerned I could unintentionally cross a line in some subtle way. I don't want to be misunderstood and falsely accused of violating a sexual boundary.
-- Fred S., New York, N.Y.


You're right to be concerned. Sexual violations are potentially the most damaging boundary problem, both to the client and to yourself. If you even cross a sexual boundary inadvertently during a bodywork session, it can be frightening and traumatizing to a client and potentially embarrassing to you. In the most extreme cases, being charged with sexual harassment, whether or not you are guilty, can be emotionally distressing and damage your reputation.


Defining Sexual Boundary Violations
We need to spell out what it means to violate a sexual boundary. Sexual boundary violations involve bringing a sexual element into the therapy session or into the client relationship. They can range from relatively minor, but still inappropriate behavior (flirting, making sexual innuendoes, or dressing seductively, for example) to more serious problems (asking a client for a date or socializing with a client in hopes of a romance developing) to the most serious violations (inappropriate touching, seducing clients, or taking sexual advantage of them during a session). Working close to a client's genitals or breasts can qualify as inappropriate touching if it's done without the client's consent or the consent is given during the session when the client is in an altered state.


Destructiveness of Sexual Violations
We have plenty of motivation for being careful about sexual boundaries, since violations can be harmful to both parties and to the profession as a whole. A client may be rightfully offended or shocked if a practitioner sexualizes the session in any way. Even what the practitioner considers "innocent" flirting can take on disproportionate dimensions for a client. Such behavior is also harmful to the practitioner's reputation. Rumors of sexual inappropriateness travel faster and have more staying power than any other kind of rumor. We have to think, too, of the reputation of the profession. Despite the growing legitimacy of the profession, too many people still associate massage with sexual activity. We should take care not to fuel that particular misconception.


Unhelpful Attitudes
Staying out of trouble depends, first, on your attitude. Some unhelpful attitudes about our relationships with clients can cause us to downplay the importance of providing a safe, nonsexual environment.

Problem Attitude No. 1. What's the big deal? We're both adults.

Some practitioners have the mistaken belief that, since they are both adults, the client and practitioner are equally responsible for what happens between them. This misconception can be used as license to act carelessly or irresponsibly. In order to see how harmful it can be to sexualize our professional relationships, we need to understand the special dynamics of those relationships.

Although our clients may be adults, the client-practitioner relationship is never equal, regardless of how much we might want it to be. A power imbalance is built into the relationship. Consider just the basics of the relationship: During a session, the client is in a vulnerable position -- usually unclothed and lying down -- while we are clothed and standing over them. We can touch them but they aren't supposed to touch us. Moreover, having come to us for help, our clients are more emotionally open to us than they would ordinarily be. Clients put their trust in us as experts who are supposed to be acting in their best interests.

Adding to that vulnerability is the fact that clients are usually in an altered state -- a relaxed state in which their unconscious is more available. Without consciously being aware of it, clients will usually give us more power than they would in a regular social setting. We then acquire heightened importance in their minds, becoming larger than life. Clients can come to see us, for instance, as a parent or authority figure, or they may idealize us. That can happen regardless of the client's age or status in the world. Their feelings arise from their unconscious and not the rational mind.

A successful businesswoman, who was usually assertive, received a massage from a female therapist at a spa. During the massage, the businesswoman felt the therapist was working too close to her genitals. She didn't think the therapist had a sexual intent, but it still made her very uncomfortable. In spite of her discomfort, she was uncharacteristically silent and didn't speak up. However, she never went back to that massage therapist.

Clients usually find it much more difficult to say no to us in our professional capacity than if they were relating to us on an equal footing. Consider, for instance, how even normally assertive clients often don't tell us if we're making them uncomfortable in smaller ways, such as when the pressure is hurting them or they feel the room is too cold or that we're talking too much. A client who likes her massage therapist might have a hard time speaking up if he were being sexually inappropriate or refusing him if he suggested a social date.

It's our responsibility as professionals to recognize clients' vulnerability and protect it -- not to take advantage of it. For the practitioner to bring any personal needs, especially sexual ones, into a session is a violation of that responsibility.

Problem Attitude No. 2. I'm safe from being accused of a sexual violation because I'm a heterosexual woman, a happily married man, a nice guy, etc.

Regardless of gender or marital status, no one is immune from being misunderstood by a client. Although accusations of sexual boundary violations generally involve male practitioners and female clients, that isn't always the case. Moreover, seductive or reckless practitioners are not the only ones accused. We don't know what history or assumptions a client brings to the table that might make them especially concerned about sexual boundaries. Some clients, especially those who have been sexually abused in childhood, may be particularly sensitive to any hint of violation. Therefore, male therapists need not feel insulted if a female client is wary of them. They have to realize such wariness can't be taken personally, and they may have to work a little harder to earn the client's trust.


Keeping Safe Sexual Boundaries
Most practitioners who respect their clients' vulnerabilities do not run into trouble. While there's no way to ensure you will never be misunderstood or falsely accused of a sexual violation, there are ways you can minimize the risk.

Make sure clients have a voice. We've noted that clients often don't speak up when they're uncomfortable. This is especially true when the discomfort is around a sexual issue.

It can help clients voice their feelings if you demonstrate your interest in hearing how they feel and what they have to say. Let clients know you want to hear if they feel cold, want different pressure, or want you to stop at any time, even if they do not have a reason that seems rational and even if they feel they are being rude by doing so. You want to avoid the appearance of dominating a client.

Be aware of how you dress. Short shorts, tank tops, and cleavage are out of bounds in the office. Don't dress as though you're going on a date or to the beach. You can be comfortable and still look like a reliable professional. Basically, you want clean, neat, loose clothes that don't draw attention to your body.

Take care with the words you use. You need to be careful your language isn't even remotely suggestive or flirtatious. For instance, it's best not to tell clients, "Take off your clothes." That sounds like an order, and it also is too close to words that would be used in a sexual encounter. Instead, say something such as, "I'll leave the room so you can get ready for the session."

Choose your words carefully when you say anything about a client's body. Even, "Why do you criticize your body? You look great!" can sound overly personal or suggestive. You might sometimes want to respond to a client who seems to have a negative body image. When clients make unflattering comments about their bodies, you can say something general such as, "Gosh, women (or just people) are so hard on themselves about how they look." To avoid being heard as expressing sexual attraction, however, you're better off not making comments about how you think the client looks.

Always use draping. Draping is always a good idea. Most massage licensing laws require it. For deep work or emotional work, having the client wear underpants or briefs, in addition to draping, is a must. When in doubt, go for more cover, rather than less. It's respectful to the client's privacy and a way to protect yourself from misunderstandings.

Be sensitive to clients disrobing. Clients need to dress and undress in private, and they also need to know they do not have to undress at all if it makes them uncomfortable. Let them know they can wear a bathing suit or whatever else is suitable -- for instance, athletic shorts and a comfortable bra or tank top. If necessary, you can explain how it will limit your ability to work with them if they choose to leave clothes on, but always make sure they know it is their decision.

Don't initiate physical expressions of affection, however innocent. Though it may come from genuine caring, initiating hugs with clients isn't a good idea. Mandatory hugs can feel intrusive to some clients. The same is true, only more so, for kissing on the forehead or cheek. As the client is leaving the session, you can show through your body language that you are available for a hug if the client wants to initiate one (assuming you are), without forcing the issue. Giving clients the choice is another way to respect their boundaries.

Take care about unintentional touching during a session. When asked about uncomfortable experiences, clients often cite situations where some part of a practitioner's body other than hands touched them or the practitioner leaned against them. This is usually accidental on the part of the practitioner, but can be disturbing to the client.

You also don't want to prop yourself against clients as if they were furniture. Of course, if your technique requires you to touch clients with other parts of your body or to lean against them, you should explain the reasons and get the client's consent.

Avoid wearing sleeves that dangle or items that could brush against clients. In the open and receptive state induced by bodywork, clients shouldn't have to figure out what is touching them.

Seek out relevant workshops and supervision. The ability to be sensitive to sexual issues can often best be learned in workshops and through consultations that allow us to explore these issues more deeply. Look in your community and check your professional associations for appropriate workshops.

If you have a massage client who is actively working on sexual abuse issues in therapy, seek out a consultation -- either with the client's
psychotherapist (with the client's permission) or another mental health professional -- to help you navigate the best way to be helpful to that client.

***

Sexual boundaries can be confusing and subtle. It's always best to err on the side of being too careful. Doing so will protect you, and most important, make each session a positive one for your clients. Next issue, we'll talk about how acknowledging these boundaries can help protect the profession, as well as yourself.

Nina McIntosh has more than 20 years experience as a bodyworker and is a Rosen Method Bodywork intern. For more information on her book, The Educated Heart: Professional Guidelines for Massage Therapists, Bodyworkers and Movement Teachers, call toll-free 877/327-0600 or visit www.educatedheart.com.


Have tough questions about professional boundaries and ethics?

Send them to:
Nina McIntosh, MB
1271 Sugarbush Dr.,
Evergreen, CO 80439
or e-mail editor@abmp.com




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