"Make a habit of two things — to help, or at least to do no harm."
— Hippocrates, Epidemics, Book 1, Section XI

It's a common misconception that physicians who take the Hippocratic Oath swear to "do no harm." Actually, they don't; this phrase appears in the context of a different work by Hippocrates where he first instructs doctors to "help." Nevertheless, the words "do no harm" have the force of truth behind them that appeals to health care practitioners, as well as to clients and patients. Of course, individuals seeking health care hope not just to avoid harm, but also to receive help with their healing. We like to think that the people to whom we entrust the health of our bodies and minds share these two basic commitments: to do no harm and to do some good. Let me share with you my own point of view about what these ideals mean in our profession.

Do No Harm

All therapeutic situations involve a power differential, with the practitioner in a position of authority. Our clients accept a certain level of vulnerability because they believe that our therapeutic work is in their best interest. While we need clients' trust in order to help them, we must take care to avoid abusing that trust in any way. Here are a few basic principles that are important for all therapists to follow.

First, know your limits. Whenever we work with clients, we have a responsibility not to disrupt their well-being or increase whatever pain and suffering they are already experiencing. One way to help guarantee this is to always stay within your scope of practice. Know the limits of your training. Be honest with your clients about what you know and what you don't know, and don't practice techniques that you are not trained to apply. This principle is incorporated in the modern Hippocratic Oath: "I will not be ashamed to say 'I know not,' nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery."

Next, establish clear boundaries. There are many different types of boundaries involved in performing hands-on therapeutic work. Among the most important are sexual boundaries. Injunctions against sexual activity with clients go all the way back to Hippocrates' time, and are still critical for us today. Sexual involvement is just one way in which the boundaries between therapist and client may get blurred. A therapist who asks their lawyer client for legal advice while they are on the table is also crossing a boundary. As the person with greater authority in the therapeutic encounter, it's our responsibility to keep our relationships with clients safe, clear and healthy.

Be usre to maintain client confidentiality. Our ethical standards affect more than how we treat our clients; they also affect how we treat information about our clients. In the course of our work, we learn a great deal of personal information about people's lives and bodies, and sharing those details inappropriately is a serious violation of trust. For many health care professionals, a breach of patient confidentiality not only violates the Hippocratic Oath, but also breaks the law. The Health Insurance Portability and Accountability Act (HIPAA), passed in 1996, sets strict guidelines regulating the use, disclosure, and transfer of personal health information. Even if you're not required by law to be fully HIPAA-compliant (many of us who don't directly bill insurance companies are not), it's a good idea to familiarize yourself with these regulations (www.hhs.gov/ocr/privacy/). Regardless of our legal obligations, we all have an ethical duty to respect our clients' privacy.

Don't mistake your own needs for your clients' needs. If you haven't taken care of yourself first, you may impose what you need onto others without regard to their reality. A therapist's lack of self-awareness can translate into irrelevant or even inappropriate treatment. "Do no harm" requires us to have the food, sleep, human contact and care that allow us to provide for the client's needs, not our own.

Do Some Good

For most of us, practicing massage isn't just a way to make a living. We entered this field because we want to do some good in the world and help improve people's lives. We gain satisfaction from providing our clients with relaxation, comfort, greater freedom of movement and relief from pain. Staying connected to our impulse to help people can strengthen our motivation and deepen our level of fulfillment with our work. Here are just a few suggestions of ways to reinforce that commitment.

There are many, many people in the world who would benefit from your services, but who cannot easily access or afford them. Working with senior citizens, terminally ill patients, drug-addicted infants or people living in battered-person shelters could bring you a kind of satisfaction with your work that cannot compete with money. One businessman I know started a free health club for pregnant teens with a massage clinic where many therapists volunteer.

Within your practice, look for ways to make your work more accessible. For example, you might modify your policies to maintain a sliding scale for those who cannot afford your fees, while still charging a normal rate to most of your clients.

Consider taking on a client or two for free. For many years, in addition to having a sliding scale, I would offer my services to one client each year at no charge. Doing so reminded me that I was in this work because I loved it, not just because it made me money. I was surprised to find that many people felt they could not accept my offer of free services. Whenever I found somebody who could, however, they helped me cultivate the habit of doing some good for its own sake.

While doing no harm is essential for every massage therapist, not all of us are in a position to take these further, altruistic steps. We need to take care of our own needs before we can extend help to others. When I began practicing, the last thing on my mind was giving away my services for free. But as soon as I had enough for me, I got a lot of pleasure from helping people without financial benefit to myself. I strongly believe that our identities as successful entrepreneurs and as compassionate, socially conscious human beings are not only compatible, but mutually reinforcing. Once we have what we need, we can share the excess, and the satisfaction of sharing our gifts and talents can help to sustain us in our profession for the long term.