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Q: “I have a client who I think is developing an inappropriate attachment to me. She gave me an expensive Christmas gift, frequently leaves me voice messages and recently asked me to do something socially. How can I handle this?”

Different practitioners are comfortable with varying levels of closeness with their clients, so the first step is to define what “too close” means to you, according to Steve Eabry, a touch therapist who also practices polarity and Esalen massage in San Luis Obispo, California. Eabry, who has been practicing for more than 30 years, works primarily with women over 50 and pregnant women.

“If you feel uncomfortable that something is wrong, it probably is,” Eabry says. “You need to recognize that as early as possible and then do something about it.

“A very emotional situation can occur, but whether or not it is appropriate or ‘too close’ depends upon the intent of the practitioner and the expectations of the client. It’s when one person is not sure of the other’s intent or expectations, then you can get in trouble.”

Eabry says that a gift in itself is not inappropriate, but if it makes you feel uncomfortable, then it probably is inappropriate. “Sometimes a very emotional or expressive client who has been working with you may express thanks with a gift. That may not be inappropriate. How does it make you feel?

“First, assume no strange intent or expectation from the client,” Eabry continues. “Take it as a real expression [of gratitude] but that nothing further is intended. Give everyone the benefit of the doubt.

“At that point, you make a statement like, ‘We are going to a place that makes me uncomfortable,’ or ‘We’ve had a good relationship or good sessions, but you don’t need to give me a gift like this.’ Be very clear and very kind with the assumption that there is nothing strange about it. Most of the time, there probably isn’t. The client just is grateful and will recognize what he needs to do by your reaction.”

If the gift is inappropriate, it should be returned, not accepted, Eabry says. “If you accept it, the person has no real feedback that it was not appropriate and can assume it’s okay.” Eabry suggests even if a gift arrives by mail and you are not comfortable with it, to send it back quickly so the person is clear you are not accepting it.

But what if it happens again with the same client? Eabry says if the client doesn’t take the hint, you need to end the professional relationship “with kindness and with a referral elsewhere.”

Eabry says many uncomfortable situations can be avoided by taking some time up-front in the initial phone interview. “You need to develop a spiel that expresses what this relationship is, who it is you are and what you are here to do,” Eabry says.

When it comes to social invitations, Eabry repeats the importance of knowing your own boundaries. However, there may be times when you find yourself attracted to the client and that needs to be handled, too.

“There is certainly nothing wrong when both of you enjoy each other’s company and you go out socially and realize you want to get to know them better and see where it goes. But then the client/therapist relationship must be dissolved,” Eabry says. “You must refer the client elsewhere.”

Nina MacIntosh, author of The Educated Heart: Professional Guidelines for Massage Therapists, Bodyworkers and Movement Teachers (Decatur Bainbridge Press) has this to say: “First, I’m struck by the use of the phrase ‘inappropriate attachment,’ which has a hint of judgment. It’s not at all unusual for a client to develop a strong attachment or have a crush on us. For that one hour a week, we are touching them with care, focused on their welfare, and nurturing and compassionate. It’s normal for some of our clients to idealize us and to want more of that kind of attention. We have to remember that those feelings aren’t really about us – they’re about the role we take on in our work.

“We want to be respectful of a vulnerable client who has a crush and also be clear about our boundaries,” MacIntosh continues. “In this case, the massage therapist may not have been clear enough in the beginning, and so the client is, naturally, continuing to test. When the client gave the first expensive gift, the practitioner could have said, ‘I appreciate your generosity, but it’s not my policy to accept expensive gifts from clients.’ We can make it about policy and not about the client. In the same vein, when a client asks us to do something social, we can say, ‘I see how much the work we are doing together means to you, but my policy is not to socialize with clients.’ We can tell them that we’ve learned that socializing outside usually detracts from the special atmosphere of the therapy room and negatively affects the benefits the client receives – because it usually does.”

In addition, MacIntosh says, “The practitioner probably doesn’t want to respond by phone to voice messages, unless they’re related to business-changing an appointment, for instance. However, she or he could acknowledge the messages, without judgment, at the beginning of the next session, ‘I got your message about how much you liked the last session.’ Put the focus on the professional relationship. The messages and other such behavior will probably fade away once the client hears clear boundaries [set].'”

– Charlotte Michael Versagi, L.M.T., N.C.T.M.B., is a journalist and a massage therapist who specializes in manual lymph drainage and work with clients with cancer.

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