The most important thing we can provide for a client is a container of safety within which to allow release of suffering, receipt of nourishing, and evolution of personal wholeness and freedom to occur.
Within the context of bodywork, therapists work, in a very intimate way, with clients who are in a variety of altered levels of consciousness. The extent to which we are able to convey to our client physical, psycho-emotional and ethical safety with consistent confidence, will largely influence the efficacy of the bodywork offered. Conversely, when a lack of ethical regard is conveyed, the greater the professional liability risk becomes.
The ways we manage the dynamics between openly facing our clients’ suffering and our own ability to provide compassionate guidance toward relief lay the groundwork for how we sustain our practice and maintain ethical fortitude.
Elements of the therapeutic relationship are paramount in bodywork. Ethics are about relationship: the ways we negotiate the polarities that arise between getting our own needs met while, at the same time, living among our communities with mutual respect and compassion for others. There are many levels of exchange happening within the client-therapist relationship in a professional massage therapy practice.
This is why there is such a vital and complex relationship between self-care and ethical practice. If the therapist is not getting her own needs met in her life, she is vulnerable to begin looking to her professional practice and client sessions to satisfy such primal needs as security, social intimacy and physical comfort.
This compromises the role of the therapist as the one ultimately responsible for the therapeutic container and the well-being of the client within the context of the session. Also, if we over-focus on giving to our clients without nourishing ourselves, we are in danger of exhaustion and burnout.
“Having started out to help others, we’re somehow getting wounded ourselves,” wrote Ram Dass in his book, How Can I Help? “What we had in mind was expressing compassion … [w]e’re tired of being with needy people, and embarrassed or guilty about feeling that way. As our heart begins to close down, joy and inspiration give way to apathy and resignation. Facing suffering is no small task. Nothing may be more important, in all this, than being gentle with ourselves. We see that to have compassion for others we must have compassion for ourselves.”
We generally do not make ethical mistakes when we are living our lives with balanced well-being. We are much more likely to stumble into ethical pitfalls when we are in states of fragile vulnerability. Following is an inventory of factors that can contribute to ethical vulnerability. If any—or several—of these sound familiar to you, you need to step back and take stock of how they may be influencing your practice.
- Burnout (exhaustion).
- Stress (lack of sleep, food or energy; excess of stimulants).
- Neediness, insecurity, low self-esteem.
- Unresolved personal history of abuse.
- Hunger for money or power.
- Period of managing a life crisis.
- Insufficient social/sexual/intimate contact.
- Lack of awareness of unexamined personal issues.
- Ignorance of ethical pitfalls.
- Underestimation of the power of altered states of consciousness.
- Unacknowledged longings for love and spiritual connection.
- Unprofessional presentation in dress or behavior.
- Lack of clarity regarding professional boundaries.
How do we nurture our own well-being, so that we maintain an ethical practice, so that our clients receive optimal care in an environment of ethical safety? There are both internal and community resources available. Inner personal well-being yields healthy relationships that contribute to professional standards of practice with integrity. A well-balanced lifestyle, where all aspects are routinely aligned and nourished, provides a steady foundation for professional performance.
The following actions should be at the top of your priorities:
- Right eating to maintain steady, calm and alert energy throughout the day. Drinking sufficient water to stay hydrated.
- Right amount of rest; not too much as to be groggy nor too little, leading to exhaustion.
- Regular doses of nature, silence, solitude.
- Regular and ample doses of time with friends and loved ones (new and old). The mind loves newness and learning. The heart thrives on the warmth.
- Sufficient physical comfort alone and with loved ones.
- Peer or professional support when work issues get you down.
- Daily joy and fun, even in random, small doses.
- Movement that softens the body and movement that strengthens the body.
- Cardio care that strengthens your heart and circulatory system.
One of the most important internal disciplines we can bring to keeping our massage work ethically strong is regular self-reflection with an attitude that is open, curious, non-judging and self-compassionate.
A simple four-step practice, stop-breathe-consider-choose can be a helpful method, intended to help find one’s way through ethical decision-making. By taking a moment to pause, center ourselves, and bring mindful consideration to a situation, we open to a range of responses available to us, rather than being swept up in an instinctive, emotional knee-jerk reaction. (Ram Dass coined a term, reperception, meaning re-framing a situation to allow for fresh ways of experiencing it.)
Jon Kabat-Zinn, in his book, Coming to Our Senses, wrote, “The foundation for mindfulness practice, for all meditative inquiry and exploration, lies in ethics and morality, and above all, the motivation of nonharming.”
I would propose that the corollary is also true; that the foundation for ethical investigation and impeccability lie in some form of mindfulness practice. On one hand, you cannot know stillness and calm within if your worldly actions are clouding, agitating and destabilizing your mind. On the other hand, how can you find professional clarity and make ethically good decisions if you cannot master sufficient quietude to be able to perceive the deeper meanings, connections and ramifications of your and others’ actions?
In his book, A Guide for the Perplexed, E.F. Schumacher described how we arrive at the ethical beliefs we hold as mature adults. He identified three stages of ethical maturity:
Step one is learning from society and tradition to receive direction from family and community around us. Students arrive at massage school with a wide variety of values and ethical assumptions based on their life lessons thus far, for example. In the classroom, they learn from experienced educators with the framework of standards of practice provided by our professional massage community.
These guidelines represent the collective experience of many therapists, clients, educators and employers, and provide reliable and verifiable external direction about ethical standards.
Step two is internalizing the knowledge gained, sifting it, sorting it out, keeping the good and jettisoning the bad, individualizing and becoming self-directed.
Every new therapist grows through his own experiences with clients to become ethically self-directed: I make this choice, not only because that is what my professional organization tells me to, but because in my heart and mind I know it to be right.
Stop, breathe, consider, choose. We often learn healthy boundaries after having temporarily lost them. Experience helps us step into full engagement with our practice and become more confident, internally clear and trustworthy.
Step three is to develop regular and ongoing self-awareness and self-care practices to maintain sufficient self-love such that we can truly extend that loving kindness to our clients specifically and to the world in general, unconditionally and uncompromisingly. We live a life directed by consciousness of the highest good; disciplining our actions away from unwholesome, destructive choices and cultivating wholesome qualities that further well-being.
“Generosity, trustworthiness, kindness, empathy, compassion, gratitude, joy in the good fortune of others, inclusiveness, acceptance and equanimity are qualities of heart and mind that further the possibilities of well-being and alacrity within oneself, to say nothing of the beneficial effects they have in the world. They form the foundation for an ethical and moral life,” wrote Kabat-Zinn.
“Greediness, attempting to take for oneself what is not freely given on any and every level, being untrustworthy and dishonest, unethical and immoral, cruel and full of ill will, and driven by self-centeredness at the expense of others, by anger and hatred, and lost in confusion, agitation, and addiction are qualities of mind that make it difficult to lead a life of inward satisfaction, equanimity and peace, again to say nothing of the harmful effects they have in the world,” he added.
One last aspect of the relationship between self-care and ethics is more subtle and perhaps esoteric but no less vital to consider. As bodyworkers, we are always interfacing with our clients’ energetic blueprints and activity. One of the ways that we have super-human palpation skills is our ability and intention to deeply sense the patterns of contraction, imbalance and discomfort, and to guide the bodymind toward balance and freedom. This level of intimacy and vulnerability is the core of why it is so essential to have ethical impeccability, to create a respectful and safely therapeutic space for the client. There are three aspects of this:
First, we need to be clear mirrors for this work, so that we minimize distortion of what we palpate and sense. Second, we need to be as benevolently detached as possible, so as to not bring our personal agenda into the client’s process. Third, we need to keep our systems as smoothly aligned as possible so that as we work with our clients’ issues, we do not take them on as our own.
Whether you are a massage therapist, a student of massage, considering massage as a profession, or a receiver of healing touch, expect no less of yourself or of your therapist than impeccable, safe, respectful, compassionate, connected and professionally ethical practice.
As a practitioner, love yourself enough to ensure that you maintain practices of self-care and access the supports around you so that you can walk through your day-to-day, session-by-session practice with ethical confidence. This is the root that nourishes the power of healing touch to bring the blossom of peace into our world.
Linda Derick has been a massage therapist and educator for 30-plus years. She is director of the Connecticut Center for Massage Therapy. Her leadership weaves together academic studies in movement from Wesleyan University, contemplative education from Naropa University, and her evolving avocation as a certified yoga instructor, specializing in stand-up paddleboard yoga. She wrote “Is Your Clock Out of Control? 10 Strategies to Manage Time” for the June 2016 issue of MASSAGE Magazine.