Is your massage business safe from potential misconduct allegations? Learn what the best protection is for clients’ safety, health and dignity.

This special three-part report on sexual misconduct—and preventing it in one’s spa, clinic, practice or school—is authored by educator and author Ben Benjamin, PhD. Benjamin has worked as an expert witness in cases involving sexual abuse, and co-authored the book The Ethics of Touch. He has taught courses in ethics, boundaries and communication for more than 30 years. This is Part One, “What I’ve Learned as an Expert Witness.”

There is no doubt that the vast majority of massage therapists and bodyworkers are ethical, hardworking professionals who would never engage in sexual misconduct of any kind.

Unfortunately, some individuals who enter our profession lack the integrity, psychological boundaries, or mental and emotional stability to practice ethically.

There are also some schools that behave unethically by accepting anyone who can afford their tuition, with little or no screening or monitoring processes to identify potential perpetrators.

It is a few predatory therapists who cause profound damage to clients, as well as the profession as a whole. Victims of these crimes often suffer lifelong consequences.

What I’ve Learned as an Expert Witness

Having worked in the massage industry for over 50 years and served as an expert witness on cases of sexual misconduct by massage therapists and bodyworkers for more than 13 years, I feel compelled to write this article.

Sexual violations are seldom written about directly and, unfortunately, are more common than most people realize.

Over the years as I’ve raised this topic with clients, students and friends, I’ve found that almost everybody has a story of inappropriate behavior in a therapeutic session—affecting either themselves or someone they know.

The large majority never reported these violations. (Since sexual abuse in general is significantly underreported, according to the US Department of Justice National Sex Offender Public Website, this isn’t surprising.)

In several cases I have worked on, after word got out that the therapist had been arrested, multiple individuals who had not spoken up earlier came forward with similar accusations.

As I see some massage therapy schools reduce the ethics, sexuality and communication content in their curricula, I fear that the incidence of these violations will only increase.

While the cases on which I have served as an expert witness all involved a spa or massage clinic, these violations also occur in private practice—they can occur in any type of massage business.

The best protection for clients’ safety, health and dignity is broad-based education of a massage business’ management, staff and clients about the warning signs and dangers of predatory therapists, along with reminders regarding appropriate and inappropriate touch.

This information is essential for both current and future clients, as well as for everyone who practices, teaches, or hires employees in hands-on modalities.

This article provides a direct and explicit discussion of sexual abuse by predatory massage therapists and bodyworkers, including details of actual cases, albeit with disguised identities of those involved.

I focus on scenarios involving male therapists and female clients, because the reports of abuse that I have encountered in my work as an expert witness have only involved male therapists and female clients.

However, recent studies indicate that sexual abuse of males in general—particularly when perpetrated by females—may be more prevalent than previously believed, according to author Hanna Rosin in her article, “When Men Are Raped,” published in April 2014.

All of the basic warning signs and guidelines outlined here apply equally to any therapeutic interaction, regardless of the genders of the client or the therapist.

Cultural Context

Certainly, sexual abuse and harassment are not unique to the massage therapy profession. However, the physical intimacy involved in hands-on bodywork heightens the level of vulnerability for a client.

Think about what happens in these therapeutic relationships.

A client makes an appointment with someone they’ve never met, enters a dimly lit, private room with this person, removes most, or all, of their clothing, and lies passively while being touched—usually skin to skin—for an hour or so. The client is highly vulnerable, both physically and psychologically.

Researchers estimate that approximately 1 in 6 boys and 1 in 4 girls experience sexual abuse before the age of 18—often in trusted environments such as homes, schools and places of worship, according to the American Psychological Association’s report, “Child Sexual Abuse: What Parents Should Know,” published in February 2014; and the National Child Traumatic Stress Network’s “Child Sexual Abuse Fact Sheet,” published in 2009.

This means that although they may never tell us directly, some of our clients are survivors of abuse, and are likely to be highly sensitive to any physical boundary crossing (even an accidental one).

They can be easily retraumatized. We must treat every individual with the care, respect and clearly defined boundaries we would offer to someone with a known history of sexual trauma. Guidelines for ethical practice must always err on the side of caution and client safety.

Maintaining Ethical Boundaries Within a Session

Clear guidelines for therapeutic practice are essential to protect the public, practitioners, employers and the profession as a whole.

The sections that follow describe each part of a typical massage therapy session, including necessary precautions and areas where therapists with difficulty maintaining boundaries may run into trouble.

Disrobing

There is no rule that clients have to be nude to have a massage. If the client is perfectly comfortable being naked, that can be fine.

However, in massage business settings where there is not a longstanding therapist–client relationship, I recommend that therapists, and male therapists in particular, ask women to leave their underpants on so their genital region is covered—both to protect the client’s privacy and to avoid the risk of accidentally touching the genital region.

Therapists should always leave the room while a client disrobes and give specific directions about what to do. (Such as, “Disrobe to your level of comfort, lie face down/face up under the sheet.”)

If a practitioner pressures a client into getting naked for a therapy session, the client should consider that a warning sign and consider terminating the session. However, the client may mistakenly believe that getting fully nude is required and or at least expected from them.

It is both the massage therapy clinic’s, spa’s and practitioner’s responsibility to inform the client that they may undress to their level of comfort without any innuendo that it is better to be fully unclothed.

The clinic or spa should have procedures and safeguards in place to ensure that all practitioners follow these guidelines and can help educate clients by providing a written statement for them to read.

Draping

Some bodywork is done with the body fully clothed so no drape is used, but when clothing is removed, drapes must be used appropriately. Draping means that the areas of the body not being treated are completely and securely covered with a blanket, sheet, or towel.

Proper draping techniques are not difficult to teach, learn or perform, and should be taught in all massage schools.

Prior to hiring, a massage therapist should be evaluated on proper draping by a knowledgeable supervisor. If a client complains that they felt exposed in a session—that their sheet felt loose, or that they were concerned their breasts or genitals were going to be exposed—consider this a warning sign that a therapist may have acted inappropriately.

Many clients, especially new ones, are not clear about what constitutes appropriate draping. It is the practitioner’s responsibility to use proper draping to ensure that their clients feel secure, without fear of exposure.

It is the spa’s or clinic’s responsibility to ensure that their practitioners are appropriately draping their clients. In most sexual abuse cases I have worked on, the predatory therapist knew how to drape appropriately but chose not to with a particular client.

The genital regions should always be covered. (See Image 1.)

Image 1

In Image 2, you can see that the drape may be lowered to the base of the sacrum when the client is prone.

Image 2

The buttocks may be undraped only with explicit permission from the client, and usually only one side at a time. (See Image 3.)

Image 3

When putting the drape in place (as in Image 1), the therapist may lift each leg slightly to bring the drape securely under the thigh. While the client is disrobed, her legs should never be spread wide apart to secure the drape.

The primary fact to remember is that the drape is there to define the area of the body to be worked on. The therapist’s hands should never go under the drape.

Attention to Sensitive Regions of the Body

The Female Breasts

The female breasts should always be fully draped, not partially covered. When the client is supine, the drape generally covers the body up to the shoulders when the arms are under the drape and to the upper axila when the arms are on top of the drape. (See Images 4a and 4b.)

Sometimes the drape is lowered to right above the top breast line to work on the upper pectoral muscles, but only when the client gives permission. In some areas of the U.S., direct treatment of the breast is prohibited either by law or by professional ethical guidelines.

In other areas of the U.S., and in certain parts of Canada and Europe, breast massage is considered appropriate when indicated by a particular client condition and with specific consent.

For instance, massage can be useful for nursing mothers, especially when there is a clogged milk duct, or for women with painful post-mastectomy scars. In these cases, some universal guidelines are in place. The nipples should never be massaged, and no contact with the breast should occur when the client is lying face down.

Another potentially legitimate reason for working near the breast is the treatment of injuries to the intercostal muscles, which can benefit from various forms of hands-on therapy. The same can be true for the pectorals and other types of tissue damage in close proximity to the breast. (See Image 5.)

Image 5

Intercostal massage is appropriate only when performed by a therapist who is trained in working with these particular types of injuries, following the specific request of a client seeking help for this issue.

Typically, that would occur in a private massage therapy practice or a chiropractor’s office, but not in a spa setting. Therapists in spa environments usually don’t have the required training, and spas usually don’t offer this type of service.

Warning Sign: Touching the Breasts in the Prone Position

When a client is lying face down on the table, there is no legitimate reason for the therapist to make contact with her breasts.

Often, when a woman lies prone, the sides of her breasts extend a few inches out to the side, so it takes conscious awareness and care to avoid touching them.

When working on the client’s back, a therapist may knowingly (with malicious intent) or unknowingly (because of poor training) bring their hands close to the treatment table and run them over the sides of the breasts.

This is never acceptable.

When the therapist’s hands move down from the top of the client’s shoulders and return to the low back, they should be on the edges of the back, but never low enough to touch the sides of the breasts. (See Images 6 and 6a.)

If the therapist makes contact with the sides of the breast, the client may feel confused about what happened. In many of the abuse cases I see, the victim reports wondering whether the touch was accidental or intentional, or even something she just imagined.

The Upper Inner Thighs

It is also essential to maintain good physical boundaries during massage of the thigh. In most people, the upper inner thigh is a very private, sexually sensitive area. The drape should always cover the upper three to four inches of the inner thigh, whether the client is lying on the back (supine) or face down (prone).

In most massage therapy sessions, the therapist should never make contact with the very upper inner thigh. (See Image 7.)

Image 7

Careless technique is no excuse for the fingers to move under the drape near the genital region. This will make clients uncomfortable and should never happen.

The only exceptions to these guidelines occur when the client specifically requests therapeutic work on an injury in this region.

For example, a client may seek treatment for a strained upper adductor muscle-tendon unit from a therapist who is trained in working with those particular injuries.

Even in these cases, the genital area should always remain covered and never be grazed or touched. The drape is secured at the very top of the thigh at the lateral aspect of the pubic bone, delineating a boundary that must never be crossed.

Image 8

The Lower Abdomen

Some massage techniques include work on the abdomen. Abdominal massage can be very therapeutic for certain conditions, including constipation and injuries to various abdominal muscles. However, the abdomen—especially the lower abdomen—is a very sensual area of the body for most of the population.

From my experience as an expert witness, I am aware that lower abdominal massage is often a precursor to a predator therapist moving his hands increasingly lower and in a sexualized way.

As a general rule, the therapist’s hands should remain at least two inches above the client’s pubic bone. (Depending on the client’s build, this boundary will lie roughly two to three inches below the navel.)

There may be some exceptions to this guideline, always with client consent, such as treatment of Caesarean section scars or similar surgical scars by a qualified therapist trained in scar tissue work.

If the therapist has a good therapeutic reason to perform abdominal massage, he should explain that and receive the client’s permission before the treatment begins.

Accidental Touch

The genital region should never be touched in a massage or bodywork session under any circumstance, even by accident. Any touching of one’s genital region during a massage, even by accident, is never acceptable. Even if a client is unable to respond in the moment to clearly tell the therapist to stop, this in no way means the behavior is acceptable.

Sometimes legitimate accidents do occur. One real example, cited in a book I co-authored with Cherie Sohnen-Moe, The Ethics of Touch (Sohnen-Moe Associates, 2013), occurred when a chiropractor found himself in an unfortunate situation that was quickly and easily dealt with through honest and direct communication:

A male chiropractor was beginning to work on a prone female client who was wearing a gown opened in the back. He placed one of his hands on her lower legs and the other hand on her upper back. 

All of a sudden, with a cry of shock, the client said, “Doctor, what’s going on?”

The chiropractor looked down and saw that his tie had fallen between the client’s thighs. In an even and professional voice, he said, “I’m sorry; my tie slipped and is touching you. Let me keep my hands where they are while you turn your head to see for yourself.”

The client saw that the chiropractor was telling the truth; because of his clear and honest communication, she relaxed and continued the treatment.

In the case of honest error, as this example illustrates, the therapist immediately stops, apologizes and provides a direct, straightforward explanation of what has happened.

If anything sexually inappropriate occurs more than once by a practitioner, it is likely to be intentional sexual misconduct, and the practitioner should no longer see clients.

It is not only the practitioner’s but also the spa’s or clinic‘s responsibility to ensure that clients are protected from any inappropriate sexual contact.

Placement of the Client’s Hands

Another type of sexual violation can occur when the client is lying prone (face down) with her hands on the table and her palms facing up toward the ceiling. (See Image 9.)

Image 9

This positioning requires male and female therapists to be very careful. I know of multiple incidents where a therapist’s penis and testicles have ended up in the hand of a client—some by accident and others on purpose.

When I owned a school, this happened to a young male massage student by accident—just once, for a moment—but it was still profoundly disturbing to the client. He was totally unaware that it had happened until the client reported the incident to his supervisor.

In a special meeting facilitated by the school, he apologized profusely to the client.

I am also aware of multiple cases where this scenario happened repeatedly and was the prelude to other sexually inappropriate acts. Most of these therapists went to jail for this sexual abuse, but their clients still have to live with the impact of these violations.

Massage treatment tables can be quite wide, and the therapist often must lean over the table to do their work, especially when treating the opposite side of the client’s back.

I, therefore, suggest that in order to prevent accidental contact with the therapist’s genitals, male or female, a client who is lying prone keeps her arms on an armrest beneath the face cradle or drops them over the side of the table, rather than at her sides on the table.

If she prefers them at her sides on the table, they can be placed way under her hips and returned to the table during work on the lower legs, arms, head and neck. (See Image 10.)

Image 10

Light Touch

I’m now going to describe a type of potentially problematic behavior that is subtler than the ones discussed so far: light touch

About 40 years ago, in the early years of owning a massage school, I began encountering students whose male clients at the practice clinic repeatedly got erections.

The students were disturbed that this kept happening—they had no sexual intent—and they reached out for help, as I mentioned in The Ethics of Touch.

I was called in by the clinic supervisor to figure out what was going on with these particular students.

The common denominator, we discovered, was light touch. Many massage techniques have two parts: the primary movement, where the greatest pressure is applied, and then the firm but lighter drag back to the starting position.

Each of these students was working too lightly, especially on the return part of the technique. The issue was not just a matter of pressure—it’s OK to use a small amount of force—but the particular quality of the contact.

This type of touch felt like a light grazing or brushing against the skin, causing a sensation verging on tickling (See Image 11.)

Image 11

Even without sexual intent, this type of touch can feel sexual to a client. Once this faulty aspect of the students’ technique was recognized, they received more explicit training and their technique was corrected. None had any further issues with client sexual arousal.

With good training, massage therapy students learn the difference between therapeutic touch and light, potentially sexual touch, and therefore avoid these issues altogether.

However, a therapist with sexual intent uses light touch deliberately—often with the palms lifted off the body or with the fingertips barely grazing the skin. This light touch may linger for some time. Many of us can sense that something is off when we experience touch that is more sexual than therapeutic, even if we can’t pinpoint exactly what’s going on.

Guidelines

In “Protect Your Massage Business From Misconduct Allegations [Part Two: Guidelines for Schools, Spas and Therapists],” I will go over guidelines to help a massage business screen out inappropriate candidates, train students in ethical touch and communication, and detect warning signs that a student or staff member may be acting inappropriately.

“Protect Your Massage Business From Misconduct Allegations [Part Two: Guidelines for Schools, Spas and Therapists]” will be published on massagemag.com on Jan. 18.

About the Author

Since 2004, Ben Benjamin, PhD, has worked as an expert witness in cases involving sexual abuse by massage therapists and bodyworkers. He has authored many articles on professional ethics and co-authored The Ethics of Touch with Cherie Sohnen-Moe (Sohnen-Moe Associates, 2013). Benjamin has taught courses in ethics, boundaries and communication to somatic therapists for more than 30 years. He may be contacted at drben@benbenjamin.com.

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