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9. Obtain the client's informed consent to massage treatment. A: "Please review this informed consent document. It outlines the policies of this clinic, your rights as a client, the limits of massage treatment, and my credentials. Then, sign here to indicate you understand your treatment options and that you are requesting massage treatment from this clinic based on the work we do and what we can offer. If you have any questions, please ask." 11. Redirect a client who calls the therapist by a nickname that may have a sexual connotation (e.g., "sweetheart"). A: "(Client's name), I feel uncomfortable when you call me sweetheart because it's incongruent with my role as a professional therapist in our therapeutic relationship. I would prefer you call me April going forward. Thank you!" 12. Demonstrate effective language and behaviors to establish boundaries at the beginning of a massage session. A: Professional behaviors that establish boundaries include returning communication with a client promptly, wearing a uniform like scrubs and a name tag, wearing shoes during the session, asking clients to sign an informed consent document, treating clients in a friendly manner but not as a pal, etc. Professional language that establishes boundaries includes never using nicknames with the client, and always verbally sharing the treatment policies with the client, verbally sharing your qualifications, reminding clients to let you know if anything feels uncomfortable, giving clients a choice about what type of massage lubricant they would like used, giving clients a digital extra choice as to the music played during the session, etc. 13. Demonstrate effective language and behaviors to redirect or manage a client attempting to violate the therapist's boundaries in these situations: • A client keeps reaching out during the massage session to touch the therapist on the arm, leg, or hand. A: "(Client's name), please don't reach off the table to touch me when you want my attention. Simply say my name and I'll answer your questions or address your concerns if I can. I've obtained a massage license to have the legal right to touch you with your informed consent. When you reach out and touch me it makes me feel uncomfortable. It suggests intimacy and this session is for therapeutic massage. Please don't reach off the table to touch me again." • A client tells a therapist a story and becomes emotional, raising their voice and swearing excessively. A: "(Client's name), massage therapy is designed to support therapeutic relaxation. I understand that you're upset and venting, and that expressing feelings is appropriate in many situations. However, I feel that this isn't the place for this level of emotional expression and it's interfering with your ability to relax. I can refer you to an excellent counselor who can support your emotional process when our session concludes. For now, we need to return to the focus of our session, which is massage therapy for your low-back pain. Can you focus on taking some deep breaths and paying attention to the muscles of your lower back? Good. Thank you." • A client shares political views in opposition to the therapist's views. A: The best way to handle this situation is to remain silent or ask the client to focus on taking a deep breath while you provide a stroke down a body region. • A client shares her religious views in opposition to the therapist's views. A: Same as above. The client has the right to his or her views and you don't have to agree or disagree—just remain quiet and then redirect the client to the purpose of the session, which is massage. • A client states to a therapist, "I don't know what I would do without you. You are the only good thing in my world. I would be devastated without you!" A: This is a signal that transference is occurring and the therapist should redirect and reframe with words like, "I'm glad that massage is proving a useful tool to help you decrease your back pain. However, this isn't about me. This is about massage therapy and I encourage you to continue to obtain massage therapy, not just from me but from other therapists with other styles, too. Mix and match what you get and find out what really works for your back." Anne Williams ( is the director of education for Associated Bodywork & Massage Professionals (ABMP) and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012) and Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams & Wilkins, 2006). Karrie Osborn is senior editor at ABMP and collaborates with Williams on various education projects, including ABMP Exam Coach and ABMP Student Life.

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