Massage Ethics 201

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This 6 CEU ethics course is a refresher for practitioners who need to review the six standards of the NCBTMB. There is an emphasis placed on Standard V: Roles and Boundaries.

Massage Ethics 201 Course Outline (6 CEUs):
  • Chapter One: What Are Ethics?

Before you can begin an assessment of your professional ethics, it is important to define what ethics actually are. Santa Clara University defines ethics as “well-founded standards of right and wrong that prescribe what humans ought to do.”i

  • Chapter Two: History of Ethics

Some of the first mentions of ethical behavior occur in the epic poems of Homer. Homer represents the ethics of ancient Greek society, where the biggest ethical concern was whether a man (and it was almost always concerned with a male) was performing according to his social station.ii Though Homer’s poems were not necessarily a historically accurate picture of literal Greek life, they did properly present the moral importance of fulfilling your role in society at the time.iii

  • Chapter Three: Ethics in Massage Therapy

The NCBTMB has a system of six Standards based on a code of ethics. The standards help ensure that certified massage therapists and bodywork practitioners offer the safest and most effective care in a professional manner.

  • Chapter Four: Standard One-Professionalism The Client and Coworkers

How a practitioner treats the client is the crux of professionalism. Standard One states that massage therapists are to “treat each client with respect, dignity and worth.”iv Also, Standard One states that massage therapists must “respect the traditions and practices of other professionals and foster collegial relationships,” a statement that outlines the basic element of an ethical working relationship with other massage therapists.

  • Chapter Five: Standard One-Professionalism Cleanliness and The Environment

Professionalism should be taken into consideration no matter where you are practicing, even if you are practicing in your own home, in a corporate office, or in the client’s home. Standard One states that the massage therapist must “use standard precautions to insure professional hygienic practices and maintain a level of personal hygiene appropriate for practitioners in the therapeutic setting.”v

  • Chapter Six: Standard One-Professionalism Your Certification and Compliance

The second basic tenant of the ethics of massage therapy (after providing high quality of care) is truthfully representing your qualifications. The NCBTMB Code of Ethics states that massage therapists must “represent their qualifications honestly, including education and professional affiliations, and provide only those services which they are qualified to perform.”vi

  • Chapter Seven: Standard Two-Legal and Ethical Requirements

Standard Two requires that massage therapists and professional bodywork practitioners follow all applicable laws regarding their profession, including local, state and federal.vii Specifically, the Standard states “the certificant or applicant for certification must comply with all the legal requirements in applicable jurisdictions regulating the profession of therapeutic massage and bodywork.”viii

  • Chapter Eight: Standard Three-Confidentiality Client Files and Conversations

The Standard for confidentiality is fairly straightforward. A massage therapist or bodywork professional must “respect the confidentiality of client information and safeguard all records.”ix This means that you should never disclose private information about a client unless it is asked for in writing.

  • Chapter Nine: Standard Three-Confidentiality Advertising, Exceptions and Other Concerns

Advertising is a complicated practice, but the restrictions are fairly straightforward. For example, the therapist should never sell or giveaway client information (such as an address) to advertisers.x In some states, the confidentiality guidelines extend to obtaining quotes or testimonials from clients for use in advertising or promotional materials. Massage therapists are prohibited from using any sort of information that may identify a client in their advertising or promotional material in these cases, including names, identification of various conditions, and the patients’ locations.

  • Chapter Ten: Standard Four-Business Practices Honesty and Advertising

The fourth standard is concerned with how you handle your business as a massage therapist. As a professional, you must “practice with honesty, integrity, and lawfulness in the business of therapeutic massage and bodywork.”xi

  • Chapter Eleven: Standard Four-Business Practices Financial Matters

Standard four requires you to keep the proper forms of liability insurance for your business.xii Insurance policies vary from company to company, with some offering policies that cover a variety of modalities and some that do not.

  • Chapter Twelve: Standard Four-Business Practices Progress Notes

Take proper progress notes on your clients after each session- and do the notes as soon as possible so you do not forget any details. This is called SOAP notes (Subjective Objective Assessment Plan), and is used to help you track your client’s progress over time.

  • Chapter Thirteen: Standard Five-Roles and Boundaries Personal Limitations and Influence

We will focus on standard five a bit more stringently than on the other standards. Ethical boundaries and the roles of client and therapist can be confusing, which makes it easier to commit violations of ethics inadvertently. This chapter in particular will cover personal limitations of clientele and influence that you have over the clientele and the ethical implications of this influence.

  • Chapter Fourteen: Standard Five-Roles and Boundaries Transference

The third sub-point of standard five, transference, deals with the transfer of feelings for other authority figures to their relationship with their therapist. It is common in any healthcare or therapeutic practice where the client must place trust in the perceived authority of the therapist- this power differential is what allows the transference to form. Transference of feelings towards parents, spouses, or ex-romantic partners is especially common.xiii

  • Chapter Fifteen: Standard Five-Roles and Boundaries, Dual Relationships and Sexual Activity

The fourth and fifth sub-points of standard five, dual relationships and sexual activity, are important topics that can have serious ethical implications. For example, a massage therapist in Minnesota faced criminal charges (which were eventually dropped, but not after significant court costs for the defendant) for dating a client. That state requires therapists to wait at least two years before dating a former client, but the couple had only waited four months.xiv

  • Chapter Sixteen: Standard Five-Roles and Boundaries Client Rights and Alcohol/Drugs

Client right’s improve clientele’s freedom of choice in the therapeutic session. A client’s freedom of choice in the therapeutic session extends beyond letting them select the modality or therapeutic focus. The client should feel the freedom to express a desire to change the music, the dimness of the lighting, or to put out scented candles, if desired.

Also, ethical obligations implore the therapist to refrain from practicing under the influence of alcohol, drugs or any illegal substances. And terminating service to a client who is abusive or under the influence of alcohol or drugs.

  • Chapter Seventeen: Standard Six-Prevention of Sexual Misconduct

While other standards address sexual misconduct, and while common sense may make it obvious that it’s a bad idea, there are some details about this standard that may not be obvious. The standard states that massage therapist must “refrain from any behavior that sexualizes, or appears to sexualize, the client/therapist relationship. The certificant...recognizes the intimacy of the therapeutic relationship may activate practitioner and/or client needs and/or desires that weaken objectivity and may lead to sexualizing the therapeutic relationship.”xv

  • Chapter Eighteen: Other Concerns in the Office

There are other ethical concerns that are covered in this chapter that may have been unclear in other chapters. For example, you should not talk badly about other therapists with clients, especially with the motive of trying to steal the client. This is an obvious violation of the Code of Ethics, which prohibits you from acting in any way that is against the best interest of the client.xvi

  • Chapter Nineteen: Draping and Ethics

Draping properly is one of the best ways to make a client feel comfortable in what could be an otherwise uncomfortable situation. Always allow the client to undress to his or her level of comfort first, and then use the draping techniques you learned to maximize their comfort level.

  • Chapter Twenty: Ethics of Body Issues

Some clients may have certain emotional issues when it comes to their bodies. They may be sensitive to their weight, age, skin condition, skin color, markings, scars or various other physical things. Clients may also be sensitive to being touched in specific parts of their body, even in a non-sexual way, because of past abuse or former injuries.

  • Chapter Twenty-One: The Ethics of Controversial Issues and Gifts

The NCBTMB Code of Ethics states that massage therapists must “respect the client’s boundaries with regard to privacy, disclosure, exposure, emotional expression, beliefs and the client’s reasonable expectation of professional behavior.”xvii The NCBTMB Code of Ethics also states that a massage therapist must “refuse any gifts or benefits that are intended to influence a referral, decision or treatment, or that are purely for personal gain and not for the good of the client.”xviii




i Santa Clara University, “What is Ethics,”



ii Alasdair MacIntyre, A Short History of Ethics,” Psychology Press, 1998, page 4.



iii Ibid.



iv NCBTMB, “Standards of Practice,”



v Ibid.



vi NCBTMB, “Code of Ethics”



vii NCBTMB, “Standards of Practice”



viii Ibid.



ix Ibid.



x Mind-Body-Touch, “Confidentiality Agreement,”



xi NCBTMB, “Standards of Practice”



xii Nina McIntosh, Massage Therapy, “The Parlor Problem,”



xiii Ben Benjamin, Massage Today, “Transference,” March, 2004,



xiv Massage Therapy Fingertips, “Dual Relationship Dilemmas,” August 6, 2006,



xv NCBTMB, “Standards of Practice”



xvi NCBTMB, “Code of Ethics”



xvii Ibid.



xviii Ibid.




Continuing education units (CEUs) are provided via electronic download in PDF format. Review the course work at your own pace and then take the included test online. You can print your certificate immediately after passing each test! All coursework is NCBTMB approved (NCBTMB # 451897-12). NOTE: Each state has different requirements. Please be sure to check our state requirements page and contact your state to verify your requirements.