Learn how to support clients’ emotional healing without breaching scope of practice.

In personality tests (remember taking the Myers Briggs Type Indicator test back in high school?) the healer personality type is someone who embodies introversion, intuition, feeling and perception, and who feels a strong connection to other people.

This deeply felt connection orients healers toward providing comfort and rewards them emotionally when they see a positive outcome in a person who needs care.

Many new massage therapists are intrigued by the concept of healing clients—but seasoned massage therapists understand that they are not in fact healers, and that instead, clients’ bodies undertake the healing facilitated by massage.

Maintain Boundaries

Some massage therapists have a possible blind spot, however: Because they are guided by their feelings, they sometimes brush past professional boundaries in the hope of serving what they feel is a greater good.

This can happen, for example, when a massage therapist’s client has a breakthrough moment in a session and opens up emotionally to the therapist, exploring either a past trauma or a current dilemma. In those instances, the massage therapist can be tempted to act as a talk therapist by making comments or suggestions that are decidedly outside the massage therapist’s scope of practice.

By doing this, the massage therapist may end up doing more harm than good.

The question then is, how can a massage therapist make the most of the opportunities that arise for emotional healing without acting as an untrained talk therapist—and without breaching scope of practice?

To address this issue, MASSAGE Magazine spoke with David M. Lobenstine a massage therapist and continuing education teacher based in New York city; David Lauterstein, an author and co-founder of the Lauterstein-Conway Massage School in Austin, Texas; and Larry Cammarata, Ph.D., a licensed psychologist and instructor of qi gong and tai chi in Asheville, North Carolina.

Learn how to support clients’ emotional healing without breaching scope of practice.

The result is an overview of best practices that can help massage therapists find the ideal balance between facilitating emotional healing while working within scope of practice for massage therapists.

There are recognized codes outlining ethical boundaries in the massage industry, such as those published by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB).

Lobenstine explains the industry’s ethical standard in one takeaway point: “What we cannot do is fix somebody else. We can only facilitate a client’s own healing. That’s the crucial distinction.”

Like any healthcare professional, massage therapists must first be guided by the adage do no harm. This declaration is obvious on the surface, but the ramifications are far-reaching.

“There is a sort of caveat, or warning principle, that every massage therapist should know about, in terms of not harming—and to the degree that we are attached to our favorite theories and ways of operating with people, we may have some blind spots,” explained Cammarata. For example, he said, “I have concerns with people trying to do trauma work when they are not trained to do that.”

According to Lobenstine, massage therapists don’t have the training to give advice about, provide a diagnosis of, or create a specific plan of action for dealing with emotional issues.

“[We] have to be clear about our own boundaries, legally, in terms of our scope of practice, and also ethically, in terms of what we should and shouldn’t be providing for our clients,” he said. “I believe very strongly that we are not talk therapists and we shouldn’t be doing anything that a talk therapist would do.”

The Option of Referral

There will be cases when a client will want to explore past traumas and current dilemmas with a professional who is trained in that sort of work. In that case, you may make a referral to the appropriate type of health professional.

A general rule of thumb is to not push a referral when it isn’t being asked for, but rather to have the appropriate information ready if it is needed. As always, discretion and diplomacy should be observed.

“If someone really does want to talk, you can suggest that they see a talk therapist,” said Lobenstine. “But I wouldn’t do it during the situation, because that can be overwhelming. I would wait until after a session.”

He will tell the client, “If you would like a recommendation to talk to a therapist, I would be happy to provide you with that,” which leaves the conversation open and in the client’s control.

“You’re not judging them or forcing your view on them,” he explained. “You’re just giving them an option that they can take if they choose. We can’t be diagnosing them. Doing anything more than offering the option is going too far. It has to be their decision.”

But what should a massage therapist do when an emotional release happens during a session?

Create a Safe Distance

Learn how to support clients’ emotional healing without breaching scope of practice

Although scope-of-practice boundaries are very clear, a massage therapist can still support a client’s emotional healing.

Quite often this involves emotional release and a certain amount of vulnerability on the part of the client.

Sometimes you’re working and the [client] starts letting go from the inside out. By definition, that is a vulnerability, which isn’t a bad thing, as long as they’re in a healthy therapeutic situation,” Lauterstein said.

Some might say that creating a healthy therapeutic situation requires reducing the emotional distance between therapist and client. But literature on the topic suggests that creating a safe distance better serves this purpose.

According to Anne Katherine, author of Boundaries: Where You End and I Begin, “[p]rofessional distance between therapist and client gives the client safety. Friends give and take from each other. A client is safest if the therapist has no expectation of receiving from the client. Friends develop obligations. A client has no obligation to the therapist other than the financial one. The focus is on the client.”

By maintaining boundaries between massage therapist and client, the therapist reduces the client’s interpersonal anxiety and opens up a space for him to experience his own awareness, according to Katherine.

“Seeing the client in a strictly defined context gives them the widest opening into her own internal processes,” she wrote. “It reduces to a minimum the interpersonal anxiety that exists between any two people and therefore increases the intrapersonal awareness that leads the client into their own feelings.”

Listen with Your Hands

Learn how to support clients’ emotional healing without breaching scope of practice

Keeping in mind the distinction between fixing the client and facilitating the client’s healing, Lobenstine said, “I definitely do not believe that we should be serving as a talk therapist—in other words, we shouldn’t be telling [a client] what breaking up with their boyfriend means or how to go ahead with their lives.”

However, Lobenstine said, emotional support can be offered by the massage therapist in way that does not breach professional boundaries—by simply being present for clients—by putting your hands on the client as he cries, or by letting the client know that you are there and that you are listening.

“You are literally listening to the client with your hands,” he said, “and I think that that is an example of how we can facilitate the client’s own healing, without trying to force anything or fix the client. There is a lot we can do.”

Regarding the importance of listening, Lobenstine said that sometimes a person doesn’t need advice; instead, he or she just needs to speak while another person is receptive, engaging in active or empathetic listening.

“You’re not doing anything, but you’re making it clear to the client that you’re hearing what they’re saying,” said Lobenstine. “I think that’s the clear extent of what we as massage therapists should be doing.”

What is Your Intention?

Learn how to support clients’ emotional healing without breaching scope of practice

Lauterstein agreed that it is not appropriate nor professional for a massage therapist to respond to an emotional release with any sort of advice for the client.

“This is to say that if you approach a person with a lot of care and they start to have a feeling, that’s not a problem,” he said.

“At that point, it’s appropriate for the therapist to be caring and to play the role of a caring observer, making sure the [client] is okay with [his or her emotional release], but in no way should they be diagnosing or prescribing what the person ought to do psychologically.”

While acknowledging the reality of emotions in the therapist-client dynamic, Lauterstein was clear about the need to keep the client on safe ground.

“If a person starts having an [emotional release], that’s fine. If it starts becoming upsetting to them, in my opinion that’s the time for the therapist to say, ‘Easy does it, feelings are natural, just breathe regularly and know that I’m here to be present.’”

When a massage therapist acts as a talk therapist, his words may have unintended consequences, added Cammarata.

“Regardless of profession, our words are so powerful. Our words can implant suggestions into our clients, especially in the realm of trauma,” he said. “[We have to] be sensitive to the power of words and not make quick interpretations that can then take on a life of their own.”

Lobenstine echoed this sentiment: “We should not be offering advice. We should not be telling people what to do with their lives, except for maybe telling them how to sit at their desks, but not whether they should marry their fiancé or not.

“That’s the clear line—listening but not offering advice,” he added. “Advice should be limited to the realm of the somatic.”



Learn how to support clients’ emotional healing without breaching scope of practice

Situations will arise when a client becomes emotionally agitated and begins to vent feelings, sometimes with a lot of energy. What should the massage therapist do in those situations?

According to Lobenstine, redirecting the client so that she is in her body and not lost in emotions can be helpful.

“I sometimes try to stop the conversation before it gets too emotional. Nothing that [the client] can vent about or complain about is going to change their lives,” he said. “Instead, they’ll have wasted that 10 minutes of the session because they are not going to be in their bodies.”

The tricky part is redirecting the client without making her feel badly about opening up emotionally.

“You don’t want them to feel bad if they’re opening up to you, by suddenly shutting the conversation down. You don’t want to give advice, but you also don’t want to say ‘I don’t want to talk about that with you,’” Lobenstine said.

“The one thing I use for all of my sessions, but which is particularly applicable with emotionally charged sessions, is to return the client’s attention to their own breathing,” he added.

Lobenstine said the massage therapist may acknowledge what the client is saying, then suggest that the client take a minute to focus on her breathing. He tells his clients to allow their body to inhale however feels best, and then pay attention to the exhale.

“’[When] you breathe out, imagine your body sinking down into the table,’” he tells his emotionally activated clients.

You’re not telling the person exactly how to breathe, he said; instead, you are adjusting her focus so that the client is not stuck in her head.

“They’re becoming more aware of their body, so what happens is that by focusing on their exhalation—rather than just saying ‘Take a deep breath!’ which can get them worked up—you’re giving them a means to calm down,” Lobenstine explained

Although it may seem counterintuitive, redirecting the client away from venting their emotions can help facilitate their emotional healing. Why? Because, Lobenstine said, you are giving the client something to do and supporting his self-engagement.

“What I find is that once a client starts to become aware of their breath, they actually don’t want to talk as much, because they’re much more in their body, and they want to really experience the massage.”

He added that this makes the massage therapist’s job more manageable and in alignment with scope of practice for massage therapists, while also providing a useful therapeutic experience for the client—because he or she is engaging with their body.

And that somatic engagement is what being a massage therapist is all about: Facilitating the client’s own healing process, rather than trying to fix anything at all.

Learn how to support clients’ emotional healing without breaching scope of practice.

About the Author

Phillip Weber is a San Diego-based writer and co-founder of The English Adept (theenglishadept.com), a language-learning website where he blogs frequently. He writes news and features for MASSAGE Magazine, including “Male Body Image: Massage Addresses Muscular and Emotional Tension” (June 2017, in print), “Massage Brings Peace to Torture Survivors’ Bodies & Minds” and “Massage Therapy Improves Quality of life for Frail Children.