Scope of practice could likely be the most important aspect of your career. Your clients might have no idea what you are fully trained to do, and what you are not trained in. This is why it is up to you to maintain the highest level of professionalism and work only within your legal scope of practice.
There is an almost immediate level of trust that most clients place in us, and a relinquishing of power that comes with that trust. I can’t count the number of times a client came in and one of the first things she asked was, “Can you crack my neck?” Could I? Probably—but I always responded with the same answer: “I am not a chiropractor, and that’s not what I do.”
Fortunately, most situations like this are fairly black and white. According to Kara Schmitt and Benjamin Shimberg in Demystifying Occupational and Professional Regulation (Council on Licensure, Enforcement and Regulation, 1996), the process of evaluating a scope of practice is intended to:
- Ensure that the public is protected from unscrupulous, incompetent and unethical practitioners;
- Offer some assurance to the public that the regulated individual is competent to provide a certain service in a safe and effective manner;
- Provide a means by which individuals who fail to comply with the profession’s standards can be disciplined, including the revocation of their licenses.
I’m not trying to frighten any therapist away from doing the best work you can within the scope of what you were trained to do; however, you must be mindful of what your scope of practice is at all times when practicing.
Working within scope of practice isn’t just about what you do; it can also be about what you say to clients.
If you are not a licensed nutritional consultant or dietician and you talk to clients about food or supplements, you are working outside your scope of practice.
If you are not a licensed athletic trainer or exercise physiologist and you talk to clients about exercise or physical activity, you are working outside your scope of practice.
If you are not a licensed mental health care provider and you offer clients advice on their mental health, you are working outside your scope of practice.
If you ever need to remind yourself of your scope of practice, your first resource should be your state regulatory board for massage therapy.
If there is one in your state, then you know how to access the information—or you wouldn’t have a license to practice. If you are in one of the few states that does not regulate massage therapy, your best bet is to search one of the national associations’ websites, as it will have plenty of information about scope of practice for the massage therapy profession.
You should include a section in your intake form that outlines your scope of practice, so that there is no confusion on the client’s part. This is an example; various forms of this release text may be found online:
Please read carefully and sign where indicated: I understand that massage or bodywork may be contraindicated for certain medical conditions or symptoms. A referral from my physician or licensed health care provider may be necessary prior to service being provided
I further understand that massage or bodywork is provided for the purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during my appointment, I will inform the therapist so that the pressure or strokes may be adjusted accordingly.
I understand that massage or bodywork should not be perceived by me as a substitute for medical examination, diagnosis, or treatment and that I should consult a physician, chiropractor, or other qualified medical specialist for any mental or physical condition that I am aware of.
I have been informed that massage and bodywork therapists are not qualified to perform skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said during the session should be perceived as such.
Because massage or bodywork should not be performed under certain medical conditions, I attest that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical condition and agree that there shall be no liability on the therapist’s part should I neglect to do so.
I have plenty of training in several modalities. I am extremely confident in my abilities as a massage therapist. After 24 years as a therapist, I have seen and worked with just about every situation.
And yet I sometimes have to remind myself of my actual training and resist the temptation to recite anecdotal evidence or something I read in a journal as fact, even if I firmly believe it to be true on a personal level.
My experience with my own practice, as well as with other massage therapists, is that we want so earnestly to help, to nurture and aid in the client’s healing process. As pure and noble as our intentions may be, this is where the line can get blurry for us. It usually starts with the client looking at us and uttering that loaded question, “What do you think I should do about this?” This is the moment when you look at your massage certificate hanging on the wall, think about your training and give only the answer you are qualified to give
Working within scope of practice also applies to modalities within the massage and bodywork field. For example, attending a three-day reiki workshop does not make anyone a Level Three Reiki Master. (I don’t care what that bogus certificate says.)
I know it and you know it, but your client doesn’t know it. I have seen too many therapists exaggerate their level of training or credentials. By doing so, they are misrepresenting themselves and providing a disservice to their clients.
This is not to say you can’t refer a client to another practitioner whom you might feel is more or better qualified to answer client questions.
I will give you an example: I worked closely with a chiropractor who practiced not far from my center. In my practice, I dealt with insurance and worked primarily with auto accident cases. When a new client or even a longtime client would come to me after an auto accident and say she wanted massage to address her condition post-accident, my first question was, “Have you seen a physician since the accident?
If she had, I would ask her to get a letter of clearance from that physician to proceed with massage therapy as a form of treatment. If she had not, I would politely insist that she do so before I could proceed.
In many cases, I would refer the client to my chiropractor for, at the very least, an initial exam and X-rays to insure there were no hairline fractures or other issues where massage therapy would be contraindicated.
The point being, I did not assume that I could work on the client without knowing her actual physical condition. I would speak these words to the client: “I am not a chiropractor, radiologist or orthopedic physician. I could not possibly determine or diagnose this condition.” This was working within the scope of my practice.
Properly referring clients to a licensed medical professional will also create a great degree of respect from those professionals. I have had scores of new clients referred to me from physicians because I knew when and where to send clients for proper diagnosis and treatment.
Your career and reputation depend on you staying within your scope of practice—especially because if you don’t possess the required training in another area, then you simply aren’t competent to offer care or advice to clients in that area.
Secondly, working outside scope of practice opens you up to serious liability issues
Communicating your scope of practice to clients will gain a sense of confidence that you always have their best interest in mind. This will increase respect and reinforce their decision to place their trust in you.
Additionally, working within your scope of practice is essential to the overall well-being of the massage therapy field, as its members strive for professional acknowledgment and incorporation into the health care environment.
Stephen A. Kreger, L.M.T., is president of Island Software Company. He graduated from the Asten Center of Natural Therapeutics in 1992 and maintains his Texas license. From 1995 to 2012 he owned a day spa and wellness center in Richardson, Texas. He founded Island Software in 1999 to develop software for the massage therapy industry.