ABMP: Ethics, Boundaries, and Laws

The Therapeutic Relationship

Terminology

Armoring - The use of physical tension to support psychological defenses. When massage reduces tension, tissues soften, and armoring comes undone. As a result, people may come into full contact with their repressed or deflected feelings and experience an emotional release.

Client-centered session - A massage session in which the therapist commits to the client's overall well-being and benefit.

Countertransference - A redirection of feelings, in which a therapist tries to personalize an otherwise professional relationship with a client; opposite of transference.

Deflection - A psychological defense that involves ignoring or turning away from stimuli that trigger emotions in order to prevent recognition, or full awareness of, the material associated with the emotion. For example, a client might talk continually during a massage session to avoid paying too much attention to his or her feelings brought about by massage, etc.

Denial - A psychological defense that involves the outright refusal to acknowledge something that has occurred or is occurring. For example, a client might deny that a technique is painful or that feelings are arising during bodywork. A client might deny that a lifestyle choice is impeding healing from a soft-tissue injury, etc.

Dual relationship - A situation in which more than one relationship between therapist and client exists (e.g., the client is also a friend, etc.).

Emotional intelligence - The ability to observe one's own feelings and emotions and those of others, to differentiate among them, and utilize them to direct thoughts and behavior.

Emotional release - A rise of feelings within a client and the expression of those feelings through words or other forms of expression.

Emotional release process - Phases of a client's emotional expression, and the way in which the therapist manages his/her own reaction while maintaining a therapeutic environment.

Ethical professional touch - Skilled, purposeful, respectful touch that holds healing intent.

Power differential - The authority a massage therapist is granted by a client, based on the client's perception of the massage therapist as a knowledgeable and skilled health-care provider.

Practitioner responsibilities - The practitioner's duty during a session is to uphold ethical standards of behavior, not work outside the massage therapy scope of practice, and provide a nonjudgmental environment where clients feel safe. Practitioners should refer clients to other health-care professionals when client's needs exceed the limits of the massage therapy scope of practice.

Professional conduct - Positively representing the massage profession by maintaining standards of practice and demonstrating ethical behavior.

Projection - A psychological defense that involves the unconscious transfer of feelings, impulses, or thoughts to someone else. For example, a client might project an unrealistic expectation that one session of massage will solve years of cumulative stress, or a client might confer his/her power to heal from a condition onto a massage therapist, etc.

Psychological defenses - Mental processes that enable the mind to deal with conflicts it can't resolve. Every person learns some type of psychological defense from normal experiences of life. Common psychological defenses that occur during massage sessions include suppression, denial, projection, deflection, resistance, and armoring.

Rapport - The friendly bond between people based on mutual liking, trust, and a sense that they understand and share each other's concerns. In a therapeutic relationship, a practitioner builds rapport by treating clients warmly and respectfully while maintaining appropriate professional boundaries.

Resistance - A psychological defense that involves an unconscious opposition to the therapeutic process related to a client's feeling that change, even change perceived as desirable, is threatening. This psychological defense may show up as missed appointments, cancelled appointments, a seeming unwillingness to participate in self-care, and other behaviors.

Suppression - A psychological defense that involves the conscious pushing down of anxiety-producing ideas, urges, desires, feelings, or memories. For example, the client may recognize a tender feeling during a massage session, but tenses muscles and actively dismisses the feeling in order to avoid expressing or showing sadness during the massage.

Therapeutic intent - The intent to promote healing and overall benefit for the client.

Therapeutic relationship - A professional partnership between therapist and client where safe, structured touch helps the client achieve reasonable, well-defined goals.

Transference - A subconscious psychological phenomenon where the client places the therapist in a place of importance in his/her personal life, beyond professional boundaries.

Practice Quiz

1. The skill of recognizing, processing, and managing emotions in oneself and others is referred to as emotional:

A:Intelligence

B:Utilization

C:Integration

D:Maintenance

2. During his massage sessions, Jack talks and tells jokes constantly, even when Kathy, his practitioner, directs him to tune into his body and take deep breaths to release tension. This could be an example of the psychological defense of:

A:Rapport

B:Deflection

C:Projection

D:Transference

3. A psychological defense that involves the unconscious transfer of feelings, impulses, or thoughts to someone else:

A:Projection

B:Emotional release

C:Denial

D:Armoring

4. Sloppy draping, inattention to a client's comfort level, and the inability to meet a client's appropriate wants and needs are indicators of:

A:Psychological defenses

B:Informed consent

C:Sexual impropriety

D:Unethical, unprofessional touch

5. One indication of unethical, unprofessional touch is:

A:When the client feels angry or frustrated feelings toward the practitioner and leaves the clinic without paying for the session

B:When the practitioner is angry or frustrated with the client and can't drop it before providing massage

C:When the practitioner refers a client to another practitioner because he/she holds angry or frustrated feelings toward the client

D:When the client feels angry or frustrated feelings toward the therapist and won't allow the massage to proceed

6. "Armoring" describes the use of this to support mental coping mechanisms:

A:Projection

B:Physical tension

C:Transference

D:Deflection

7. A practitioner's responsibility during a session includes:

A: Giving the client helpful advice if he or she has life issues and needs life coaching

B: Creating a safe environment for clients and providing counseling if the client has an emotional release

C: Referring clients to other health-care professionals if they need medications, in addition to the "talk therapy" provided by the massage practitioner

D: Creating a safe environment for clients and referring them to other health-care professionals if their needs exceed the limits of the massage therapy scope of practice

8. Focusing on whatever is in the best interest of the client’s well-being is known as:

A:Confidentiality

B:Maintaining boundaries

C:Wellness care

D:Client-centered care

9. Jane encourages her client Rick to practice yoga 3 times per week and see her for a weekly massage session. She gets frustrated when he admits to vigorous weight lifting and only wants one massage per month. Which term best describes Jane’s reaction?

A:Boundary violation

B:Dual relationship

C:Transference

D:Countertransference

10. Tanya is a weekly massage client. Each time you ask her to communicate her needs and goals for the session and to report any stress or pain she is experiencing in her body, she dismisses your requests and says, "Just give me a good massage." This response begins to frustrate you and reminds you of other times in your life when people have not cooperated with you. As a result, you become edgy in your communication with her. Your feelings are an example of:

A:Transference

B:Denial

C:Countertransference

D:Deflection

11. A psychological defense that involves the outright refusal to acknowledge something that has occurred, or is occurring, is called:

A:Tearfulness

B:Countertransference

C:Denial

D:Softening of tissue

12. A psychological defense that involves the conscious pushing down of anxiety-producing ideas, urges, desires, feelings or memories is:

A:Rapport

B:Tearfulness

C:Projection

D:Suppression

13. When a client asks a practitioner numerous questions about his/her personal life and discloses very personal information during sessions, it is an example of:

A:Transference

B:Limitations of massage

C:Power differential

D:Countertransference

14. A client who insists that the pressure is comfortable, even though she is visibly grimacing and tensing her muscles, is exhibiting:

A:Projection

B:Deflection

C:Denial

D:Countertransference

15. When Jenny leaves the massage clinic to move on to a new career opportunity, her client becomes very upset. She insists that she can't recover from her sports injury without Jenny. This is an example of:

A:Denial

B:Armoring

C:Projection

D:Rapport

16. Client behaviors can sometimes lead practitioners to feel frustrated, angry, or hostile. These feelings toward a client become unethical when:

A:The practitioner is unable to release them in order to provide a professional massage, or fails to refer the client to someone else

B:The practitioner continues to see the client but drops his/her negative feelings and seeks advice from a supervisor

C:The practitioner refers the client to someone else and seeks advice from a supervisor

D:The practitioner leaves his/her massage job and moves to another clinic

17.

18.

19.

20.

21.

Practice Quiz Answer Key

1. A

2. B

3. A

4. D

5. B

6. B

7. D

8. D

9. D

10. C

11. C

12. D

13. A

14. C

15. C

16. A

17.

18.

19.

20.

21.

Code of Ethics

Terminology

Autonomy - Personal independence, self-sufficiency, self-government, and the capacity to make decisions and act on them.

Character traits - Inherent attributes that influence how a person responds in a given situation.

Client abuse - Any action by the practitioner that intentionally or unintentionally harms or injuries the client because of inappropriate, unethical, unprofessional, or incompetent behavior.

Client autonomy - The client's right to decide what happens to his or her own body based on the personal independence and self-government granted to people under the law. Children under the age of 18 have the same rights as adults, but are less able to assert these rights based on youth and inexperience. For this reason, minors must have a legal or appointed adult guardian present when they receive massage.

Client rights - The client's autonomy to make decisions about what happens to his/her body.

Code of ethics - A statement of a professional group's ethical principles.

Commitment to high-quality care - Serving the best interest of the client at all times, in all ways, to provide the best service possible.

Confidentiality - Agreeing not to share the client's information without the client's written consent, within the limits of the law.

Conflict of interest - A conflict between a person's private interests and his or her public obligations.

Desexualize massage - Avoiding any mention of sexuality during the massage, whether joking or in earnest.

Discrimination - When prejudicial or racial attitudes lead to behavior; discrimination is an act based on prejudice or racism.

Do no harm - Providing massage only when there is a reasonable assumption it will benefit the client.

Ethical decision-making model - A step-by-step method to work through ethical dilemmas.

Ethical dilemmas - When two or more principles are in conflict, and something of value is compromised regardless of the decision.

Ethical principles - Appropriate behavior defined for an individual or group.

Ethical violation - A breach of ethical principles resulting in inappropriate, offensive, or harmful behavior.

Ethics - A branch of philosophy exploring values, morals, principles, right and wrong, and responsibility.

Honest representation of qualifications - Honesty in advertising, promoting services ethically and in good taste, and practicing/advertising only techniques for which a person has been adequately trained or certified.

Honesty in business - Conducting business with integrity; avoiding any activity that conflicts with the best interest of the client or profession.

Incident report - A written document that is completed whenever an unusual event occurs that creates an unsafe environment or distress for a client, practitioner, or business owner. Situations that would warrant an incident report include a client making sexual advances during the massage session causing the practitioner to terminate the session; or a client, unhappy with a massage, who ends a session early and demands a refund. An incident report should include the date, time, and place the incident occurred, the name and title of the person filing the event, the contact details of involved individuals and witnesses, a detailed account of what happened, written witness accounts of what happened if appropriate, and how the matter was resolved (e.g., the client left the premises, or the client was given a full refund, etc.).

Informed consent - Receiving consent for treatment from the client after having fully disclosed policies and limitations that may affect the treatment.

Inherent worth of all people - Acknowledging the value of each individual and not discriminating against any person for any reason.

Kickback - Any type of compensation provided for referrals of clients.

Law - Rules that are recognized by a community as binding and enforceable by authority.

Limits of training - The extent to which a therapist is qualified to perform certain therapies based on his or her education and/or certification.

Practitioner responsibilities - The practitioner's duty during a session is to uphold ethical standards of behavior, not work outside the massage therapy scope of practice, and provide a nonjudgmental environment where clients feel safe. Practitioners should refer clients to other health-care professionals when the client's needs exceed the limits of the massage therapy scope of practice.

Prejudice - A pre-formed opinion (usually unfavorable) based on inadequate knowledge, irrational feelings, or inaccurate stereotypes. The belief that one's sex, socioeconomic class, or generation is superior are common prejudices.

Professional conduct - Positively representing the massage profession by maintaining standards of practice and demonstrating ethical behavior.

Professionalism - The competence, skill, good judgment, appropriate dress, and polite behavior that is expected from a person who is trained to do a job well.

Racism - The belief that one's ethnic stock is superior to or significantly different from another person's ethnic stock.

Referral - The act of directing a client toward another professional because it is reasonably assumed that person's services will benefit the client.

Respect dignity and rights of all - Treating all people fairly and equally regardless of difference in beliefs, behaviors, or characteristics; avoiding discriminatory thoughts or actions.

Rights - A moral or legal entitlement to obtain something, act in a certain way, or be treated with dignity and respect.

Sexual abuse - In a therapeutic relationship, the practitioner develops a power advantage over the client (power differential) and is considered a legal caregiver. For this reason, any sexual misconduct (regardless if the client consents), is considered sexual abuse. The practitioner is responsible and liable for sexual abuse, even if the client initiates sexual behavior. Sexual abuse is punishable by the law and may lead to severe fines or imprisonment.

Sexual harassment - Uninvited or unwelcome verbal or physical behavior of a sexual nature, especially by a person in an authority position (e.g., a practitioner with a client because of the power differential that exists in therapeutic relationships). Sexual harassment is punishable by the law and may lead to severe fines or imprisonment.

Sexual impropriety - A failure to observe professional standards or show due modesty in the massage environment. Examples of sexual impropriety include poor draping practices, telling sexual jokes, discussion of one's own sexuality within earshot of a client, gender-based comments or sexual sterotyping based on sexual orientation, requests of a date or the acceptance of a date, or emailing or calling clients for reasons unrelated to the massage session. Sexual impropriety can lead to sexual harrassment charges.

Sexual innuendo - An insinuation, oblique remark, hint, overtone, undertone, or allusive reference that suggests sexual interest or intent. For example, hanging "artistic" nude photographs in the massage clinic, calling a client by a sexual nickname such as "honey," making approving body comments such as, "You look great in those jeans," etc.

Standards of ethical practice - Professional guidelines based on ethical principles that describe the behaviors and language of ethical practice.

Stereotyping - When a person adopts an oversimplifed opinion or image of another group of people, often caused by prejudice.

Values - A collection of beliefs that indicates accepted standards for behavior of an individual or group.

Practice Quiz

1. How does confidentiality relate to a client's personal information such as address and phone number?

A:These can be shared with the practitioner's colleagues

B:A practitioner can share her client list with another practitioner if going on maternity leave

C:These should be kept confidential unless the client gives consent to share the information

D:These can be shared with similar providers that may benefit the client

2. In marketing materials, it is appropriate to:

A:List the lower introductory rate for massage as if it is the standard rate

B:List your services, fees, and credentials

C:Promise to eliminate low-back pain completely

D:Promise to reverse structural dysfunction completely

3. Stereotyping is:

A:The belief that one's ethnicity is superior to, or significantly different from, another person's ethnicity

B:The adoption of an oversimplified opinion or image of another group of people

C:When prejudicial or racial attitudes lead to negative behavior

D:A pre-formed opinion (usually unfavorable) based on inadequate knowledge or inaccurate stereotypes

4. These are made up of beliefs and opinions that hold emotional worth and guide people’s behavior.

A:Ethics

B:Judgments

C:Morals

D:Values

5. A massage practitioner in the local community is devoutly religious. He will only work on clients from his church. This practitioner is practicing:

A:Stereotyping

B:Discrimination

C:Racism

D:Sexism

6. A code of ethics states a professional organization’s ethical:

A:Beliefs

B:Opinions

C:Principles

D:Judgments

7. Claiming to be a neuromuscular specialist after taking a weekend workshop is a violation of which ethical principle?

A:Honest representation of qualifications

B:Nondiscrimination

C:Scope of practice

D:Confidentiality

8. Working within the practitioner’s scope of practice involves disclosing both the contraindications and _____ of massage or bodywork.

A:Fees

B:Time frame

C:Limitations

D:Confidentiality

9. How should Jeremy react to seeing his client Jill at a party?

A:Wait until she is alone and then approach her, asking if it is OK to acknowledge their connection

B:Wait until she greets him, and only discuss their connection if she mentions it

C:Greet her, introduce yourself to her friends, and chat politely for a few minutes

D:Leave the party in order to avoid having any social contact with her

10. This practice would not be considered a code of ethics violation:

A:Prescribing medication to a client

B:Diagnosing a client's condition

C:Offering discounts to special population groups (teachers, firefighters, etc.)

D:Misrepresenting one's professional credentials

11. The use of modest and skilled draping techniques demonstrates:

A:A practitioner's commitment to "do no harm"

B:A practitioner's commitment to represent his/her credentials honestly

C:A practitioner's respect for client confidentiality

D:A practitioner's respect for the dignity and basic rights of the client

12. A massage practitioner in the local community is fitness-oriented. She will only work with clients in good physical health. This practitioner is practicing:

A:Discrimination

B:Countertransference

C:Transference

D:The power differential

13. A practitioner sold his client's email contacts to a local marketing company for a $500 payment. This practitioner:

A:Acted ethically and in accordance with the standard of practice for confidentiality

B:Acted unethically by breaking with the standard of practice for "Do no harm"

C:Acted unethically by breaking with the standard of practice for confidentiality

D:Acted ethically and in accordance with the standard of practice for "Do no harm"

14. In the case of client misconduct, such as making a sexual advance, the practitioner should document this on a(n):

A:Incident report

B:Release of information

C:Police report

D:Confidentiality agreement

15. In which instance is it acceptable for a practitioner to break confidentiality?

A:To inform the client’s spouse of her condition

B:If there is clear and imminent danger to someone’s life

C:If a client is no longer actively receiving sessions

D:In discussing the client’s case with a close colleague

16. In regards to setting fees for a massage business, the best ethical practice is:

A:To set consistent fees for all clients

B:To give insurance companies a higher rate than cash-paying clients

C:To give family members a discounted rate

D:To use any payment scale you wish, so long as all fees are published in the informed consent documents

17. The standard of practice for the ethical principle "Do no harm" includes:

A:Maintaining client files in a confidential manner and not sharing client information with others

B:The honest representation of qualifications

C:The administration of a health history form and interview to rule out contraindications, and the proper referral of clients to other health-care providers when applicable

D:The use of modest and skilled draping techniques

18. A practitioner can discuss a client's condition and treatment goals with another health-care provider only if the practitioner has:

A:Written consent from the client

B:Genuine concern for the client's well-being

C:Reasonable cause

D:Lack of understanding about the client's condition

19. In which circumstance is it permissible to form a romantic relationship with a client?

A:The client receives only reflexology and not full- body massage

B:The client receives only one session per month

C:Six months has elapsed since termination of the professional relationship

D:Both parties consent to the romantic relationship

20.

21.

Practice Quiz Answer Key

1. C

2. B

3. B

4. D

5. B

6. C

7. A

8. C

9. B

10. C

11. D

12. A

13. C

14. A

15. B

16. A

17. C

18. A

19.

20.

21.

Professional Boundaries

Terminology

Boundaries - Conscious or subconscious imaginary lines that mark the limits of an individual's personal space or territory.

Boundary form - The aspect of life that a boundary relates to; i.e. physical, emotional, mental, etc.

Boundary type - The degree to which a boundary can be crossed; described as permeable, semipermeable, and impermeable.

Boundary violation - When one person disregards another's personal space in a way that makes the other person uncomfortable.

Client abuse - Any action by the practitioner that intentionally or unintentionally harms or injures the client because of inappropriate, unethical, unprofessional, or incompetent behavior.

Conflict of interest - A conflict between a person's private interests and his or her public obligations.

Dual relationship - A situation in which more than one relationship between therapist and client exists.

Embodiment - The subjective sensation of having and moving within a physical body.

Emotion - Subjective feelings that arise without conscious effort and connect a person to meaning in life.

Emotional boundary - The amount and the type of emotion a person feels comfortable sharing.

Emotional intelligence - The ability to observe one's own feelings and emotions and those of others, to differentiate among them, and utilize them to direct thoughts and behavior.

Emotional release - A rise of feelings within a client and the expression of those feelings through words or other forms of expression.

Emotional release process - Phases of a client's emotional expression, and the way in which the therapist manages his/her own reaction while maintaining a therapeutic environment.

Impermeable boundary - This boundary allows little to no information or energy to pass through; appropriate only in limited situations, such as when a client makes an overt sexual advance.

Informed consent - Receiving consent for treatment from the client after having fully disclosed policies and limitations that may affect the treatment.

Intimacy - A shared feeling of understanding, empathy, and closeness.

Mental boundary - The beliefs, values, and ideas a person feels comfortable sharing.

Permeable boundary - A boundary that allows information, feelings, thoughts, beliefs, and energy to flow freely in and out.

Personal space - The physical, mental, emotional, and spiritual space that people hold around themselves.

Physical boundary - The amount of space a person needs around his or her body in order to feel comfortable.

Power differential - The subconscious authority a therapist is granted by a client.

Semipermeable boundary - The appropriate boundary for a therapeutic relationship; allows for a balance of compassion between therapist and client while maintaining some separation and professionalism.

Sexual arousal response - A reaction of the parasympathetic nervous system that results in arousal of sexual organs.

Sexual boundary - To what degree and with whom a person is comfortable expressing themselves sexually.

Spiritual boundary - Subconscious beliefs, needs, and energy that a person radiates out into the world and absorbs from those around him/her.

Practice Quiz

1. Which of the following is a violation of physical boundaries?

A:Insisting that deeper pressure will be more therapeutic even when the client says it hurts

B:Constantly calling the client last minute to reschedule a session

C:Demanding that the client talk about her relationship with her mother

D:Discussing the client’s physical issues in a social setting

2. In the context of a dual relationship, it becomes difficult to maintain appropriate:

A:Progress notes

B:Countertransference

C:Boundaries

D:Transference

3. If a client has an emotional release during a session and the practitioner begins to act as a psychotherapist, giving advice or asking leading questions, this is a breach of:

A:Physical boundaries

B:Emotional boundaries

C:Confidentiality

D:Sexual boundaries

4. What is one practitioner behavior that can confuse the client’s sense of secure boundaries?

A:Telling a client she will have to wait a few weeks after surgery before receiving massage

B:Calling the client the day before a session to remind her of her appointment

C:Extending sessions by 15 minutes without discussing this with the client

D:Educating the client on lifestyle adaptations such as stretching and drinking more water

5. Which person presents the least risk when considering a dual relationship?

A:A distant acquaintance

B:A spouse

C:A family member

D:A close friend

6. When clients use sexual innuendo or sexual impropriety, such as telling jokes of a sexual nature or sharing with the practitioner that the client hasn't had sex in a long time, it is appropriate to:

A: Continue with the session and don't say anything but write them a letter the next day explaining that they are not welcome back at the massage clinic\

B: Terminate the session immediately and call emergency services\

C: Give them one warning that allows them to stop the inappropriate behavior and then terminate the session if the client does not stop the behavior that jeopardizes the therapeutic relationship

D: Terminate the session immediately and leave the room

7. When a practitioner sees a good friend as a massage client, and begins to discuss her relationship troubles during the massage, she is sacrificing this aspect of the massage:

A:Client-centered

B:Confidentiality

C:Non-discrimination

D:Physical boundaries

8. How can Suzy best enforce sound professional boundaries with her friend Becca, who always requests shoulder massages in social settings?

A:Say that she is enjoying her off time right now, but she would be happy to schedule an appointment next week

B:Tell Becca that it is rude and presumptive of her to expect massage in a social setting

C:Work on Becca’s shoulders for 10 minutes, then joke that she will have to pay if she wants her to continue

D:Excuse herself from the social setting, claiming she is tired

9. What is the best way to maintain professionalism around the issue of dating clients?

A:Avoid dating clients in all circumstances

B:Avoid making the romantic relationship public within the professional realm

C:Only date clients from private practice as opposed to clients from the clinic setting

D:Only date clients who come for infrequent or sporadic sessions

10. Working therapeutically with a distant acquaintance, as opposed to a close friend, makes it easier for the practitioner to create healthy:

A:Expectations

B:Friendships

C:Boundaries

D:Soft tissue

11. Sexual boundaries in a massage practice are established by:

A:Practicing the right degree of familiarity with clients by using anatomical terminology to impress upon clients the practitioner's expertise=

B:Practicing the right degree of familiarity with clients by calling clients by fun nicknames that keep sessions light=

C:Practicing the right degree of familiarity with clients by calling clients by their last names proceeded by Mr. or Ms.=

D:Practicing the right degree of familiarity with clients by being friendly but matter of fact

12. This type of boundary allows for a free exchange of energy, ideas, and thoughts between two people:

A:Permeable

B:Semipermeable

C:Quasi-permeable

D:Impermeable

13. In order to establish professional boundaries, the practitioner should:

A:Refrain from engaging in conversation

B:Talk extensively about technique during the massage

C:Avoid asking the client questions about his muscular pain

D:Practice conservative draping methods

14. A practitioner who refuses to work on a client because of race or sexual orientation is presenting which type of boundary?

A:Impermeable

B:Permeable

C:Multipermeable

D:Quasi-permeable

15. What can a practitioner do to ensure that a friendship with a client does not jeopardize the therapeutic relationship?

A:Agree to only see the client once a month for sessions

B:Decide that she will only interact with the client socially in a group

C:Agree to trade services as opposed to exchanging money

D:Create clear boundaries surrounding the dual relationship

16. When one person interferes with another's personal space, intentionally or unintentionally, this is referred to as a boundary:

A:Permeation

B:Violation

C:Exchange

D:Transference

17. If a practitioner happens to run into a client in a social setting, he should avoid:

A:Being noticed by the client

B:Discussing massage-related topics

C:Engaging in conversation

D:Acknowledging the client's greeting

18. Clients are alerted to client and practitioner behaviors that are considered unethical and that may lead to termination of the session during:

A:The range of motion assessment

B:The client confidentiality process

C:The informed consent process

D:The posture and gait analysis

19. Hugging a new client upon the first greeting may feel like a violation of this client boundary type:

A:Emotional

B:Physical

C:Spiritual

D:Mental

20.

21.

Practice Quiz Answer Key

1. A

2. C

3. B

4. C

5. A

6. C

7. A

8. A

9. A

10. C

11. D

12. A

13. D

14. A

15. D

16. B

17. B

18. C

19. B

20.

21.

Laws and Regulations

Terminology

Background check - Required for licensure by some states; includes a review of the applicant's legal history and having fingerprints on file.

Board of massage - A board that supervises the safe and legal practice of massage.

CPR/FA Training - Cardiopulmonary resuscitation (CPR) and/or first aid (FA) training.

Certificate of completion - A document proving completion of an educational program.

Chiropractic adjustment - Purposefully realigning a person's bones as would be carried out by a doctor of chiropractic medicine.

Consumer complaint - Consumers can file complaints against a massage therapist through the state board of massage website.

Continuing education - Further education in advanced or specific topics in massage or health.

Diagnose - Naming a client's signs and symptoms as a specific disease or condition through interviewing, physical examination, or testing, as would be carried out by a medical doctor. This practice is outside the scope for massage therapy.

Disciplinary actions - Any punishing action taken by a regulatory board against a massage therapist.

Education requirements - The amount and type of education that qualifies a person to practice massage, after having sat for the required examination(s).

Exemptions to the law - The permission not to do something that others are required to do.

Grandfathering provision - Allows people who practiced massage under an old system to integrate into the new system.

HIPAA - The Health Insurance Portability and Accountability Act standardized health-care record keeping and outlined guidelines for patient privacy.

HIV/AIDS training - Guidelines established for treating clients with HIV/AIDS; required in some states.

Jurisprudence exam - An exam, usually open-book, that tests knowledge of state laws, ethics, and continuing education requirements for massage practitioners.

Law - A rule that is recognized by a community as binding and enforceable by authority.

Liability insurance - Insurance that protects a practitioner in the case of client injury from the massage, or a "slip and fall"-type accident.

Licensing - Mandatory requirement for practice in most states. Allows qualifying therapists to use a protected title and list their credentials after their names in advertising material.

Limits to scope of practice - Actions or techniques that are not permissible for a licensed massage therapist to perform in professional practice.

Maintenance of credentials - Each state has different requirements for what is required for a therapist to maintain credentials, including continuing education.

Massage & Bodywork Licensing Examination (MBLEx) - A massage licensing exam developed by the Federation of State Massage Therapy Boards on behalf of member boards.

Massage credentials - Certification, license, registration, or any other designation noting that a person is qualified to practice massage therapy.

Mental health counseling - Giving advice or professional input regarding a client's personal life or emotions (this practice is out of scope for massage therapy).

Practical examination - An examination in which the applicant must demonstrate massage techniques in front of a panel to prove competency and overall professionalism.

Prescribe - Directing a client to follow a specific course of treatment, particularly related to using a specific medication at set times and a certain dosage (this is outside the massage therapy scope of practice).

Public protection - When a state board lists disciplinary actions against a massage therapist on their website to ensure public safety.

Registration - Designation that carries similar legal stature to licensure; identifies therapists who have completed requirements necessary for professional practice.

Regulation - Directives that give official guidance about how laws should be followed.

Revocation/suspension of credentials - Legal action permanently or temporarily taking away a person's credentials and thus their ability to practice massage.

Scope of practice - Defines the methods and techniques a professional can use in practice.

Standards of ethical practice - Professional guidelines based on ethical principles that describe the behaviors and language of ethical practice.

State-approved massage exam - An exam approved by the state board of massage or department of education that tests students on entry-level massage concepts.

Practice Quiz

1. What is the most common designation conferred upon a professional massage practitioner?

A:CMT

B:LMP

C:RMT

D:LMT

2. What are professional guidelines based on ethical principles?

A:Standards of practice

B:Moral codes

C:Legal requirements

D:Regulations

3. Requirements to practice massage and bodywork vary according to:

A:Age of applicant

B:State of residence

C:Gender of applicant

D:Work environment

4. This term is used to designate legal massage credentials, depending on the state:

A:Certified

B:Associated

C:Nationally certified

D:Approved

5. This term is used to designate legal massage credentials, depending on the state:

A:Accredited

B:Licensed

C:Approved

D:Nationally certified

6. While working on the mid-back, a client's spine adjusts with an audible pop. The client asks the practitioner if he just adjusted her back. How should he respond?

A:"Yes, I could tell that T-7 needed to shift to the right. Do you want me to adjust your neck?"

B:"It is never my intention to cause a spinal adjustment, but this will often happen naturally as your muscles let go."

C:"Yes, I can often tell where your bones are out of alignment and, with firm pressure, I can get them to move."

D:"No, why? Was that painful? I'm so sorry, I didn't mean to work that deeply."

7. When does the scope of practice for massage indicate the necessity of collaboration with a primary care provider?

A:Any time the practitioner is performing therapeutic massage

B:When working with terminally ill or hospitalized clients

C:Any time the practitioner is performing wellness massage

D:If the client is undergoing athletic training

8. Which of the following represents a practitioner violating his scope of practice?

A:An athletic trainer uses sports massage for her athletes

B:A nurse uses circulatory massage for her bedridden patients

C:A massage practitioner offers spinal adjustments to clients

D:A reiki master does not obtain a massage license

9. The techniques, actions, and methods permitted to a practitioner under law describes the practitioner's:

A:Educational requirements

B:Scope of practice

C:Moral guidelines

D:Legal restrictions

10. States that license massage practitioners typically designate this group to supervise the profession in that state:

A:Focus group

B:Police department

C:Board of physicians

D:Board of massage

11. When a client vents about her struggles with managing her symptoms of depression and the many medications she takes, the appropriate response from the practitioner is:

A:Compassionate listening

B:To end the session, telling the client she cannot help her with these issues

C:A suggestion to quit taking her medications and manage her symptoms with nutrition

D:A recommendation to begin a regular yoga or meditation practice

12. The most common number of hours of education required for state licensure to practice massage is:

A:750

B:1000

C:100

D:500

13. In this type of exam, applicants perform massage in front of a panel to demonstrate competency in technique, sanitation, communication, and professionalism:

A:Practical

B:Jurisprudence

C:Licensure

D:Open-book

14. In most programs, a basic "wellness" massage education would NOT prepare a practitioner to work with:

A:Athletes

B:Tension headaches

C:Hospice clients

D:Muscle sprains

15. Which of the following is NOT within the scope of practice for a massage practitioner?

A:Recommending increased water intake and heat packs

B:Offering counseling or psychological evaluation

C:Suggesting an ergonomic desk setup at work

D:Providing self-care exercises and stretches

16. In a state that regulates massage, if a practitioner observes ethical violations on the part of a coworker, this should be reported to the:

A:Violating practitioner's clients

B:State government

C:Board of massage or regulatory agency

D:Massage schools in the state

17. When people who have been practicing massage for a number of years under an older system are allowed to integrate into the new system, this is referred to as:

A:Maintenance of credentials

B:Reciprocity

C:Transference of credit

D:Grandfathering

18. Along with allowing a person to practice massage, licensure also allows:

A: A qualifying person to use a protected title and train clients in weight lifting techniques to help them build muscular strength

B: A qualifying person to suggest the intake of nutritional supplements to improve muscular health

C: A qualifying person to use a protected title and list their massage credentials after their name

D: A qualifying person to prescribe over-the-counter pain medications and the use of hot packs to clients

19. The professional practitioner has an ethical obligation to:

A:Meet the state’s requirements for continuing education

B:Offer discounts or packages to make services affordable

C:Serve any client no matter their physical condition

D:Trade services with fellow practitioners to build a referral base

20. A practitioner completing a continuing education course from a recognized provider, such as the Rolf Institute of Structural Integration, will receive a:

A:Accreditation certificate

B:License

C:Certificate of completion

D:Registration certificate

21. This type of exam, usually open-book, tests knowledge of state laws, ethics, and continuing education requirements for massage practitioners:

A:Jurisprudence

B:Practical

C:Regulatory

D:State-approved

22. Which of the following is an example of a modality that is often excluded from the law and requirements of a massage practitioner?

A:Neuromuscular reintegration

B:Deep work

C:Trigger-point work

D:Reflexology

23. When is a license required to practice massage therapy?

A:A license is always required

B:If the practitioner is performing therapeutic massage

C:In a medical environment such as a hospital

D:If it is mandated by state or local government

24. Use of which tool is permitted within the scope of practice for a massage practitioner?

A:T-bars

B:Ultrasound machine

C:Acupuncture needles

D:Electrical stimulation machine

Practice Quiz Answer Key

1. D

2. A

3. B

4. A

5. B

6. B

7. B

8. C

9. B

10. D

11. A

12. D

13. A

14. C

15. B

16. C

17. D

18. C

19. A

20. C

21. A

22. D

23. D

24. A