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Massage therapists, like most health care providers, understand that setting boundaries with their clients is a professional best practice.

And as the world grapples with the challenges presented by new technology and communication tools — electronic, omnipresent and offering more potential than ever for intrusion — massage therapists must address these new concerns as well. Some considerations:

• How much communication is too much?

• When does the convenience of email, texting or social media slip over the line and invade clients’ personal space?

• How should I communicate with clients in the very public forum of digital reviews?

The answers to these concerns all go back to boundary-setting and tools that must be used in a professional and legal manner in order to support the therapeutic relationship.

I urge massage professionals to establish time-tested limits and rules that apply to all client and stakeholder relationships.

Go Beyond Email

Texting and regular email are not sufficiently encrypted, so communicating with clients in those manners is a violation of HIPAA. There is a caveat to that, however. A client could check a box on a new-client form that says they are comfortable with some communication taking place over text and email. That communication could be about appointments, for example.

But really, the practitioner needs to find some encrypted system for client communication. We shouldn’t be using Gmail or Yahoo! to do those emails. We need to work with a practice-management system or a technology consultant to get set up with encrypted email so we can be HIPAA-protected and have the communications we need with clients.

Social Photos

If we use clinic photographs — or more specifically, photographs of clients in our clinic that we use for marketing purposes — we need to secure signed releases or, better yet, not use client faces in these photos.

Failing to do this makes clients uncomfortable when they are in photos and have not been properly asked. They are just going to feel yucky about it, and we don’t want to do that to our clients. Furthermore, failing to secure permission or failing to obscure the client’s face is a lawsuit waiting to happen.

Social Awareness

In the context of boundaries, there are a couple of aspects of social media that are important. One is the increased transparency we have as human beings on social media.

We have to think of social media as truly social and not as a personal or private experience. Twenty years ago, when the very first blogging sites became popular, we were all in the infancy period and sorting it out. Now we have to be thoughtful about how we present ourselves on social media, even on our personal pages.

Also, whatever you would not discuss with a client in the treatment room should not go on social media. That includes religion, politics and points of view in general. We have to be cautious. It’s challenging because today’s political environment is fraught with social concerns that I do think many people want to talk about freely. We just have to think very carefully about it before saying anything on social media and be aware that anything we do say is for public consumption.

You should be aware that everything you post on social media may and probably will be seen by your clients, even if you are choosing not to be connected as friends. You also need to be aware that everything on social media could be seen by a future employer.

What we post should be all about enhancing our standing in the professional realm and what we want our clients and other health care practitioners to see. If we use that as the standard, we should be OK.

Testimonials Best Practices

Testimonials are powerful for prospective clients to read. They help clients see the experience of working with a practitioner from another client’s perspective.

However, we need to be careful that the quantity of information included in the testimonial does not distinguish the client or, if it does, that that person is OK with us using that information for marketing purposes. Again, you should secure a signed release.

There also are many avenues for clients to provide ratings and comments voluntarily without being prompted by a clinician. I’m talking about reviews on Google, Facebook and Yelp.

These days, if you are going to run a massage therapy business — or really any kind of business — you need to be on top of your reviews any other form of public electronic feedback. If the feedback is negative, you need to respond within minutes if you can.

That can seem unreasonable for clinicians. We are not generally marketing people. Yet that is what it really takes. You can undo the damage from a negative comment quickly if you are swift about it.

For example, at my practice, I had a new client book an appointment with a therapist at the last minute. The therapist did not get the notification in time and was with another client when the new client showed up. All the new client knew was that she was being no-showed by the therapist, so she posted a bad rating, saying, “I scheduled an appointment and had terrible customer service.”

I got on it and responded within five minutes. I said, “I’m so sorry. We’d like to give you a free massage.” She called back, and we had a conversation. She got a free massage, changed her rating and said, “Mistakes happen. They couldn’t have been better to work with.”

The damage from bad reviews can be undone if you are quick in responding. If I had left her comment up for days, the client’s frustration would have festered, and it would have been difficult to change her mind.

If a massage therapist cannot be on top of all of their electronic communications, it’s worth hiring someone who can. Identify and hire a communications expert who can have their finger on the pulse of all of these various sources of information, and make sure they’re able to respond quickly.

Maintain Boundaries

Social media and other electronic tools can be fun, efficient — and increasingly something many of us are connected to during most of our free time.

The explosion in technology that has made communication so easy will continue to push the boundaries of professional interactions with massage clients. It’s all the more reason to develop an understanding and practice of setting and maintaining professional boundaries.

Michele Renee, DC, MAc, is a massage therapist and director of integrative care at Northwestern Health Sciences University in Bloomington, Minnesota. Watch Associate Editor Allison Payne interview Michele Renee here.