resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Conversation With Dr. Betty Edmond
This month's column is an exclusive interview with Betty Edmond MD, newly elected CEO/President of the AOMA Graduate School of Integrative Medicine in Austin, Texas.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols & treatment Timing
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
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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