resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth.
The Top Seven Website Mistakes Clinics Make
The majority of acupuncture clinics finally have a website for their business. Having a website is crucial for being found online through Google, Facebook and review sites like Yelp.
Connections Worth Making
"If most doctors are like me, [they are] isolated physically and professionally. I do not make the time to connect with other doctors and also a lot of doctors do not want to be connected for a lot of reasons. Dynamic Chiropractic keeps me grounded and connected.
The Conscious Evolution of Healing, Part 2
The idea of transmission is very important in the Chinese medical classics. According to author Claude Larre, the ancient Chinese were highly interested in the connection between things. Nothing was looked at as an isolated entity.
Put the Social Back Into Social Media
Social media is more than a passing fad, it is definitely here to stay. Social media apps and channels of distribution may evolve, but the concept of social media is now big business and a part of all our lives.
The Easy Way to Learn How to Document ICD-10
The 2015 Work Plan for the Office of the Inspector General (OIG) includes a focus on chiropractic services. This means chiropractors can expect to see more audits and reviews in the coming year because private payers pay attention to the OIG's focus as well.
It might have been a miserable start to the day in the heart of downtown San Diego. A heavy rain had soaked the large homeless population congregating near the intersection of Third Avenue and Ash Street as they waited for a free breakfast to be served at the First Lutheran Church on the corner.
We Get Letters & E-Mail
We Have Come a Long Way – But There's a Long Way to Go; Grounded and Connected.
Acupuncture and Homeopathy: Bioenergetic Brothers
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What's Triggering That Point?
An orthopedic friend recently saw a patient of mine. He felt an injection of a trigger point (TP) at the upper trapezius and surrounding areas was necessary, since that was the patient's area of chief complaint and there was a tender, radiating nodule.
Reflections: The Art of Teaching Asian Medicine
Over the past three decades, my global workshops have been translated into German, Swiss German, French, Romansch, Spanish, Lithuanian and Xhosa. Time to offer you new teachers a few tips!
Finding Balance in the Clinic
This past December, I celebrated 11 years in practice. I seriously don't know where the time went. I feel beyond blessed and grateful to be practicing our profound and beautiful medicine and to be helping guide my patients restore a state of optimal health.
Neuroscience: Where Western Medicine and Chinese Medicine Can Come Together
The recent advances in neuroscience are truly incredible. With this expansion of scientific knowledge, I would like to see even more research into the neuroscientific basic of acupuncture and Chinese Medicine.
Leg Length and Pelvic Fixations
A common component of low back pain is sacroiliac joint dysfunction. Signs of SIJ dysfunction can include fixation with reduced range of motion, and localized pain or joint laxity and inflammation.
Joint Supplements for Athletes (Part 1)
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Case Histories from Bali: Treating Balinese Chidren with TCB and Shonishin
When I moved to the island of Bali in 2005, I offered my services in Bumi Sehat, which means Healthy Mother Earth, a free birthing center for poor and disadvantaged local women located in Ubud.
Adjusting the Occiput on the Atlas
You may never see a particular set of patients in your office – the ones who are either afraid of neck adjustments or have had a bad experience. A vast majority of those who had a bad experience did not have a life-threatening vascular event.
Online Efforts That Convert Traffic Into Patients
Most chiropractors are using "dinner with the doc," "refer a friend," customer appreciation days, grand openings, health fairs, chamber of commerce meetings, and other networking events to get new patients.
Are You Really a Healthy Eater?
I always giggle a little bit (to myself) when someone comes into my office and informs me that they are a healthy eater. What exactly does that mean? Does that mean they eat sugar in moderation? And what's that, exactly?
It's Time to Create a Strong Acupuncture Footprint
Footprints in the sand. Footprints in the snow. Where do these footprints go? Some are big, some are small, but footprints are made by all.
September, 2010, Vol. 10, Issue 09
When a Client Crosses the Line
By Cherie Sohnen-Moe
The sexual assault allegations against Al Gore has elicited much commentary about clients crossing the line sexually. Regardless of the veracity of this particular claim, it is an important topic to explore in-depth.Some clients may "test the waters" about sexual services, while others blatantly cross the line. Massage practitioners must know how to appropriately deal with those situations.
A sexual boundary can be challenged physically, verbally or both. Many factors influence the impact this behavior has on a practitioner, such as the length of time the practitioner has been working, the practitioner's ability to manage boundaries, the practitioner's history of abuse, the setting in which the boundary challenge occurs, and the client's prominence.
Boundary Crossings vs Boundary Violations
Boundaries are contextual because they can change depending on the situation. Behavior that is deemed appropriate at one time may be highly offensive in another setting. A boundary crossing is a transgression that may or may not be experienced as harmful. Often it is a minute difference in degree that makes an action shift from being considered a boundary crossing to a violation. It is also relative: what is a mere boundary crossing to one person may be a major violation to another. A boundary violation is a harmful transgression of a boundary. Differentiating a boundary crossing from a violation needs to be done on a case-by-case basis taking into account the context and facts of the situation.
For instance, just because a male client has an erection doesn't necessarily mean that he has any intention of sexual misconduct. Men experience erections even when they are not necessarily emotionally desirous of sex (e.g. when they need to urinate). Touch, itself, on any part of the body can stimulate a physiological response that results in a partial or complete erection. In a therapeutic setting spontaneous erections are often uncomfortable for practitioners and clients. The difficulty lies in that many practitioners (both men and women) are uncomfortable or fearful when a client has an erectile response during a session.
Both male and female practitioners often either ignore or overreact to an erectile response, becoming passive or aggressive with the client in discussing the condition. Each of these responses puts the practitioner in a vulnerable position. If a practitioner is verbally aggressive about the erection or hurts the client physically to quell the erection, the practitioner is abusing the client. Worse, many practitioners learn in school to discourage erections by "pressing hard on certain points." There are more respectful, clear and safe ways to deal with erections in men and arousal in women, which we will discuss.
With a sexually inappropriate client the number and intensity of behaviors usually escalate. What starts out as "innocent" boundary crossings can easily become violations. Clients might tell a sexual joke, ask overly personal questions, talk about their other massage experiences (with innuendos of sexual interactions), discuss their sexuality, or repeatedly expose themselves (accidentally removing the draping). One or two episodes may be an accident, poor boundaries, or a lapse in judgement. Or this could be a prelude to a boundary violation. While these actions may truly be innocuous, they should not be ignored, particularly when combined with other verbal or nonverbal requests or innuendos.
It may be helpful to distinguish the context surrounding the behavior. What were the client's verbal and physical cues? Did the client watch to see the practitioner's reaction? Are the behaviors increasing in frequency or intensity?
If a client (male or female) is obviously sexually aroused, and shows no signs of discomfort or embarrassment through verbal and nonverbal cues, it's usually not necessary to talk to the client about the arousal. Sometimes a simple action of moving to a different part of the body is all that's needed. However, if the practitioner feels uncomfortable or the client displays other verbal or nonverbal behaviors that could indicate sexual intent, ensure safety by obtaining sufficient information to discern the intent--whether it is merely a physiological response to touch or part of sexual desire. Identifying sexual arousal in a woman can be difficult, yet practitioners also need to keep good boundaries with their female clients. Documented cases exist where female clients have crossed the line.
Actions to Take
The first thing to do when a client crosses the line is to break physical contact. If possible make eye contact. Make sure the client is properly covered. Stand in a relaxed yet grounded manner and use a firm voice. Maintain safety. If the client's behavior feels intimidating do not stay too close to the table and position yourself so that you have easy access to your exit door. Leave immediately if the client actively threatens you.
Talk with the client. Describe the inappropriate behavior, ask the client for feedback (this helps to clarify the client's intent), and set (or reset) your boundaries and requirements. The steps taken totally depend on the client's responses. For example:
Practitioner: This is the second time that you've moved in such a way that caused the draping to improperly expose your body. Can you tell me about it?
Potential Client Responses:
Corresponding Practitioner Responses:
If the client agrees to your request, the session can continue. If not, the session should be terminated. Sometimes after going through all the above steps, a client's intent is still unclear. If that's the case, tell the client that you will continue this session but will stop if s/he behaves in any way that does not work for you.
Keep in mind that your safety is of primary importance. Sometimes the most appropriate action to take is to end the session immediately without going through the above steps. Store your belongings (including a cell phone) in an easily accessible place in case you need to make a hasty escape. If you feel threatened, leave the room and call the appropriate authorities. If you are in a spa or clinic, then go directly to the front desk. If you are in a private office, leave the building. If you are doing an outcall session, leave the premises--you can return later, accompanied by someone, for your equipment and supplies.
Document the Incident
Always document incidents of sexual boundary crossings and violations, even if the incident was resolved through conversation. Describe what happened, what you did to address the matter, and the client's response. This is for your protection just in case the client decides to lodge a complaint against you. This might seem bizarre, but consider that if a client is willing to cross sexual boundaries, who knows what else that person might do. There are cases where massage practitioners have been accused of sexual misconduct when in reality the client acted inappropriately. The practitioner refused to provide the requested sexual services and the rebuffed client complained to management that the practitioner made a sexual proposition.
Healthy boundaries are vital to managing sexual boundary crossings and violations. Sometimes strong boundaries can help prevent the "testing of the waters" from escalating into a sexual violation. Other times healthy boundaries include knowing when to leave.
One of the best ways to develop boundary skills in this area is to role-play scenarios. This is particularly important if you have a history of sexual abuse as practicing can help you avoid going into a dissociated state and "freezing."
Work through a variety of situations from the flirtatious client, to the client who makes questionable comments, to the client who asks inappropriate questions, to the sexually aroused client, to the client who is attempting sexual congress. If you are a student, this should be part of your training. If you are no longer a student, get together with colleagues and role-play. The more you practice dealing with these situations, the more adept you will be if they occur.
Next time, we will explore prevention techniques and ways to desexualize the touch experience.
Editor's note to readers: Tell us of your experiences in dealing with clients who have crossed the line. Let us know what happened, how you handled the situation and/or what you wish you would have done. Your letters and e-mails will be reviewed for possible publication in Massage Today print and online editions. If you would prefer to be left "anonymous," please indicate this in your letter. E-mail us at or mail to Massage Today, 5406 Bolsa Avenue, Huntington Beach CA 92649.
Click here for previous articles by Cherie Sohnen-Moe.
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