A friend recently made me aware of a news article which I found fascinating. The scenario is a massage therapist who befriends one of her clients, ends the therapeutic relationship, begins dating the former client, falls in love and marries him - and then has a complaint filed by the new husband's ex-wife for violating a state statute banning sex for two years between massage therapists and ex-clients. The therapist claimed she was unaware of the statute. You might have seen this news article, as it has been discussed on various massage-related chat groups on the Internet; as usual, I am amused and delighted at the variety of feelings, opinions and expressions of dismay that have been shared.

At first read of the story (www.startribune.com/462/story/596791.html), I got caught up in the slant of a love story soured by heavy-handed regulation. After the second and third readings, however, I got into the complexities of the issue and the potential repercussions of similar circumstances for the rest of us. Yes, there is an issue raised about legitimate regulation, but there also are issues of good practice management, common sense in dating choices and social interactions, and the importance of being aware of boundaries.

If you are able to access the article, I think you'll agree that no one is contesting the illegality of the actions of the massage therapist, but rather discussing the mitigating circumstances and the advisability of the regulation in the first place.

The therapist was questioned by the state on small gifts exchanged between her and her client. The state indicated the gifts represented further "boundary issues," and contends that taking tips is unethical because of "transference," a process in which trust in the practitioner leads to increased reliance and vulnerability. I found this quite interesting. In my own practice, I don't encourage tipping (I suggest clients put the money toward coming in more often so we both benefit), but I honestly can say I never felt unethical accepting a gratuity if the client felt like providing one.

When trying to expand my understanding of the issues raised, I did a Web search of "sex with clients" and found that almost all of the hits involved attorneys having sex with clients! I was expecting a raft of information on psychologists and social workers and medical practitioners, but if Web articles are a measure of the size of a problem, lawyers are the front-runners. In actuality, many of the comments about this situation made distinctions between the various professionals in client relationships, but my thought is that it's the similarities that are more striking for purposes of this issue.

All of these professional relationships, including the lawyer/analyst/hypnotist/doctor/massage therapist-client relationship, involve people who come to the professional for help with a problem; most involve the transfer of confidential information to the professional; all involve to a greater or lesser degree the notion of transference; and all involve some degree of stress for the client or patient. Because the client invests the massage therapist with a great deal of power and authority, the massage therapist has a unique ability to influence the client and a corresponding responsibility to refrain from any action that would harm the client. The power imbalance and confidence given to the massage therapist as a professional might extend to confidence in the massage therapist as a person as well. It's this vulnerability of the client and corresponding power imbalance that necessitates a clear approach to the issue of professional-client sex. In my mind, the "cooling off" periods of time after breaking off a therapeutic relationship should not govern a therapist's private sexual relationships. It governs whom the therapist can see professionally. Therapists who wish to pursue a sexual relationship with a client can refer the client to another therapist or postpone the personal relationship until the professional relationship is completed. As further example of this, in the same state as the cited massage therapist, physicians and nurses not involved in psychotherapy have no specific time limits for relationships with former patients, but physicians must discuss ramifications and cease treatment. It would seem unnecessary that massage therapists would have stricter rules.

In the many blogs and chat groups picking up this story, some of the more clever comments that caught my eye are:

• "Who are we to impose a prohibition on falling in love?"
• "I sure hope this story has a 'happy ending.'"
• "First of all, Minnesota does not license massage therapists statewide. I think the state needs to be on one side of the fence or the other. Otherwise, ex-wives rule the ... state! Secondly, if the two-year rule 'protects consumers,' can I use that same two-year time frame in my advertising? 'My service will have power for two years!'"

And perhaps my favorite of all: "Unbelievable - they are married and this is her livelihood - Murderers can walk free on a technicality - Pedophiles can live in your neighborhood - Public Aid does not have enough money to help the elderly - but by all means let's pursue this terribly dangerous woman."

So, I have no answers here, but lots of rhetorical questions: Where should the line be drawn between ethics and regulation? Are there "circumstantial" ethics? How much discretion should there be in investigating/prosecuting complaints? My bottom line here is to remember the importance of good boundaries, and to make sure you know the applicable laws in your practice area. Professional association membership and a recurring study of professional ethics as continuing education can go a long way to avoiding needless legal complications.

That "tipping" issue still is bothering me - I may need to revisit it in a future editorial!

Thanks for listening.

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