Ethics for the Massage Therapist
A Review for Texas Massage Therapists
3 CE Hours
By Stacey Potter, LMT, BS
Copyright © Stacey Potter 2011
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Learning Goals
Goal 1: The students will review the Code of Ethics for massage therapists licensed in the state of Texas.
Goal 2: The students will examine their ethics to fine-tune any areas of concern.
Texas Administrative Code
Title 25, Health Services, Part 1 Department of State of Health Services, Chapter 140 Health Professions, Regulation Subchapter H Massage Therapists, Division 2 Code of Ethics Rule 140.303 General Ethical Requirements.
(a)
A licensee shall not make deceptive, untrue, or fraudulent representations in the practice of massage therapy or employ trick or scheme in the practice of massage therapy, including, but not limited to, warranty of results of such services and false claims of proficiency in any field.
(b)
A licensee shall not use work area, equipment or clothing that is unclean or unsanitary.
(c)
A licensee shall not practice massage therapy fraudulently, with gross incompetence with gross negligence on a particular occasion or incompetence on more than one occasion.
(d)
A licensee shall bill clients or third parties for only those services actually rendered or agreed as to by mutual understanding at the beginning of services or as later modified by mutual agreement. A licensee must either honor an unexpired gift certified by that licensee or give a full refund.
(e)
For each client, a license shall keep accurate records of the dates of massage therapy services, types of massage therapy and billing information. Such records must be maintained for a minimum of two years.
(f)
A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.
(g)
On the written request of a client, a client’s guardian, or a client’s parent if the client is under the age of 17, a licensee shall provide a written explanation of the charges for massage therapy services previously made on a bill or statement of the client. This requirement applies even if the charges are paid by a third party.
(h)
A licensee shall not abuse alcohol or drugs in any manner, which detrimentally effects the provision of massage therapy instruction.
(i)
A licensee may not persistently or flagrantly overcharge or over treat a client.
(J)
A licensee shall not practice in an unlicensed massage establishment or massage school.
(k)
A licensee shall not allow an unlicensed person to engage in activity for which licensure is required.
(l)
A licensee shall not provide false information on material submitted to the department.
(m)
A licensee shall not interfere with a department investigation by the willful misrepresentation of the facts to the department or its authorized representative, by the use of threats, retaliation, or harassment against any person.
(n)
A licensee shall comply with any formal order issued by the department relating to the license
(o)
A license shall be subject to disciplinary action by the department if the licensee is issued a public letter of reprimand, is assessed a civil penalty by a court, or has an administrative penalty imposed by the attorney general’s office under the Texas Code of Criminal Procedure 56.31.
(p)
A licensee shall notify each client of the name, mailing address, and telephone number of the department for the purpose of directing complaints to the department by providing notification:
(1) on each written contract for services of a licensee; or
(2) on a sign prominently displayed in the primary place of business of each licensee; or
(3) on a bill for service provided by a licensee to a client or third party; or
(4) by another written and documented method.
(q)
A licensee shall keep his or her license file updated by notifying the department, in writing, of changes of names, address, telephone number and employment.
(r)
A license shall be subject to disciplinary action for failure to truthfully respond in a manner that fully discloses all information in an honest, materially responsive, and timely manner to a complaint filed with or by the department.
(s)
I licensee shall not make any false, misleading, deceptive, fraudulent, or exaggerated claim or statement about the licensee’s services, including, but not limited to:
(1) the effectiveness of services;
(2) the licensee’s qualifications, capabilities, background, training experience, education, certification or licensure, professional affiliations, fees, products, or publications; or
(3) the practice or field of massage therapy.
Comments for Rule 140.303 General Ethical Requirements.
As a licensed massage therapist we are held to a high standard of honesty and integrity. For example, one may not say they are reflexologies without proper training and skills. Ask, Do I know what I am doing? Can I do it well? There are standards of cleanliness we are required to maintain. Sheets must be clean for each client. The table needs to be sanitized before each client. Maintain a clean professional appearance. Any equipment used with a client needs to be cleaned and sanitized. Clients appreciate a clean therapy room. It is the best way to give the best first impression and it is the law. Incompetence is not having or showing the necessary skills to do something successfully. As a licensed therapist competency has been verified by skills and written tests. In order to stay licensed it is important to keep up the quality of services. As a therapist we need to give services for money. This includes honoring all gift certificates that haven’t expired. It is a requirement to keep accurate client records for two years. Before treating a minor who is under 17, a written consent from the guardians is needed. It is also important to have guardians consent before sending out any records. Massage therapists must not abuse drugs or alcohol. Massage therapists cannot overcharge for services. It is standard to get paid $40 to $80 per massage hour. It is also important to make sure everyone we work with and for is properly licensed for what services they offer. When dealing with the state department the massage therapist must be honest. When the state department gives an order it is important to comply. When a massage therapist has been charged with a crime, he/she must follow any orders issued by the state. Every client should be given the contact information for the state department. The massage therapist needs to keep their address and phone number up to date with the state department. Honesty with the state department is mandatory at all times. It is also important to be honest with the clients in regards to the services, the skills of the therapist.
Texas Administrative Code
Title 25, Health Services, Part 1 Department of State of Health Services, Chapter 140 Health Professions, Regulation Subchapter H Massage Therapists, Division 2 Code of Ethics Rule 140.304 Consultation Document
(a)
A licensee shall provide an initial consultation to each client(s) prior to the first massage therapy session and obtain the signature of the client on the consultation document. The consultation document shall include:
the type of massage therapy services or techniques the licensee anticipates using during the massage therapy session, including indications and contraindications;
the parts of the client’s body that will be massaged or the areas of the client’s body that will be avoided during the session, including indications and contraindications.
a statement that the licensee shall not engage in breast massage of female clients without the consent of the client.
a statement that draping will be used during the session, unless otherwise agreed to by the client and the licensee;
a statement that if uncomfortable for any reason, the client may ask the licensee to cease the massage and the licensee will end the massage session; and
the signature of both the client and the licensee.
(b)
If the client’s reason for seeking massage therapy changes at any time and any of the information subsection (a)(1)-(4) of this section is modified, the licensee must provide an updated consultation reflecting any changes and modifications to the techniques used or the parts of the client’s body to be massaged
Comments for Rule 140.304 Consultation Document
There are specific requirements for the documentation. The first form the client fills out is the initial consultation document. This document should contain the type of massage the client is receiving and any indications or contraindications. It should also have the parts of the body massaged and areas that will not be massaged. There is no massage of the breast without specific consent for this type of massage signed by the client. Draping is highly recommended. I wouldn’t do a massage without it. This document should also have a statement that if the client is uncomfortable for any reason at any time they may stop the massage. The initial consultation document needs to be signed by the client and the massage therapist. It is also important to update any changes to the documentation as they occur.
On the next page is an example of the document I use.
Client Information Form
Name_________________________________________ Birth Date ______________
Address___________________________________________________________
City_______________________________ State ___________________ Zip _________
Phone _(_____)_____________________
Present Employer______________________ Occupation________________________
PLEASE CHECK IF YOU HAVE EVER HAD:
_____Arthritis _____Bursitis _____Cancer _____Contacts _____Diabetes _____ Epilepsy _____Infection ______Heart Trouble
_____ High Blood _____Low Blood Pressure _____Migraine Headaches _____Phlebitis _____Varicose Veins _____Skin Disorder _____Tense Muscle
Are you currently pregnant?
Have you had any recent surgeries?
Have you had any trauma or injury?
CONTRAINDICATIONS (PLEASE LIST):
1.
2.
I, ___________________________________________, understand that the massage given is for stress reduction and increases circulation and is not to be used in place of medical treatment. It is recommended I see a physician for any medical problems that I may have regarding my state of health. I also certify that my medical history provided on this form is correct to the best of my knowledge.
Draping will be used during the session unless otherwise indicated above. There will be no breast massage of female clients unless agreed to by both the client and the therapist. Swedish massage is the only technique administered in this massage. If I am uncomfortable for any reason, I may request to end the massage session. The massage therapist may end the session, if sexually harassed.
Client Signature ____________________________________________ Date__________
Therapist Signature _________________________________________ Date __________
Texas Administrative Code
Title 25, Health Services, Part 1 Department of State of Health Services, Chapter 140 Health Professions, Regulation Subchapter H Massage Therapists, Division 2 Code of Ethics Rule 140.305 Sexual Misconduct
(a)
A licensee shall not engage in sexual contact during a session with a client. For the purposes of this section, sexual contact includes:
any touching of any part of the genitalia or anus;
any touching of the breasts of a female client, unless the touching is breast massage that is specifically authorized by the client through the signed consultation document referenced in 140.304 (a)(3) of this title (relating to Consultation Document;
any offer or agreement to engage in any activity described in paragraph (1) or (2) of this subsection;
kissing;
deviate sexual intercourse, sexual contact, sexual intercourse, indecent exposure, sexual assault, prostitution, and promotion of prostitution as described in Texas Penal Code, Chapters 21, 22, and 43, or any offer or agreement to engage in any such activities; or
any behavior, gesture, or expressions which may reasonably interpreted as inappropriately seductive or sexual;
inappropriate sexual comments about or to a client, including making sexual comments about a person’s body.
(b)
I licensee shall not allow any individual, including a student, licensee, employee, participant in a continuing education program, or one’s self to engage in sexual contact on the premises of any massage school, massage establishment, or the licensees own place of business.
(c )
A licensee shall not allow any individual, including a student, licensee, employee, or one’s self to practice massage therapy or provide other massage therapy in the nude, while partially nude, or in clothing designed to arouse or gratify the sexual desire of any individual.
(d)
A licensee shall not perform massage therapy, whether or not for compensation, at or for a sexually oriented business.
(e)
A licensee shall immediately discontinue the massage therapy session, activity or the professional relationship when a client initiates any verbal or physical contact with the licensee that is intended to arouse or gratify the sexual desire of either person.
Comments for Rule 140.305 Sexual Misconduct
During a session with a client there should me no sexual contact. Sexual contact is defined as touching any part of the genitalia, anus, or breasts. There should be no offer to engage in any sexual activity. There should be no kissing in a massage session. There should be no deviant sexual intercourse, sexual contact, sexual intercourse, indecent exposure, sexual assault or prostitution. A massage therapist needs to be careful not to seduce the client in any way. As a massage therapist we should make no comments about a client or a client’s body. There should be no sexual activity at a place of business for massage. Massage therapists cannot practice nude or partially nude, or in clothing designed to arouse or gratify another person. For example, we can’t wear lingerie to give a massage. No massage therapist should practice at a sexually orientated business. If the therapist feels that the boundary between client and therapist is sexual in any way, the massage should be ended immediately.
Texas Administrative Code
Title 25, Health Services, Part 1 Department of State of Health Services, Chapter 140 Health Professions, Regulation Subchapter H Massage Therapists, Division 2 Code of Ethics Rule 140.306 Advertising
(a)
A person, including and massage therapy instructor, a massage school, a massage therapist, or massage establishment, who is not licensed under the Act, shall not use the word “massage” on any sign display, or other form of advertising unless the person is expressly exempt from the license requirements of the Act. Under no circumstances may a sexually oriented business use the word “massage” or “bath” on any sign or other form of advertising.
(b)
A licensee shall not use advertising that is false, misleading, or deceptive or that is not readily subject to verification, false, misleading, or deceptive advertising that is not readily subject to verification includes advertising that:
makes a material misrepresentation of fact or omits a fact necessary to make the statement as a whole not materially misleading;
makes a representation likely to create an unjustified expectation about the results of health care service or procedure;
compares health care professional’s services with another health care professional’s service unless the comparison can be fully substantiated;
contains a testimonial;
causes confusion or misunderstanding as to the credentials, education, or licensure of a health care professional;
advertises or represents that the benefits of a health care insurance deductibles or copayments may be waived or are not applicable to health care services to be provided if the deductibles or copayments are required;
advertises that the benefits of health benefit plan will be accepted as full payment when deductibles or copayments are required;
makes representation that is designed to take advantage of the fears or emotions of a particularly susceptible type of client; or
advertises or represents in the use of professional name, title, or professional identification that is expressly or commonly reserved to or used by another profession or professional.
(c)
When an assumed name is used a person’s practice as a massage therapist, the full legal name of the massage therapist or license number of the massage therapist must be listed in each advertisement and each time the business name or assumed name appears in writing. The license number of a massage establishment must be listed in conjunction with the assumed or legal name of the massage establishment. An assumed name used by a massage therapist must not be false, misleading, or deceptive.
(d)
A massage school shall not make false, misleading, or deceptive statements concerning the activities or programs of another massage school.
(e)
A massage school shall not maintain, advertise, solicit for or conduct any course of instruction intended to qualify a person for licensure as a massage therapist without first obtaining licensure from the department.
(f)
Advertisements by a massage therapy educational program seeking prospective students must clearly indicate that a training is being offered, and shall not, either by actual statement, omission, or intimidation, imply that prospective employees are being sought.
(g)
Advertisements seeking prospective students must include full and correct name and license number of the massage therapy educational program and massage school.
(h)
No statement or representation shall be made to prospective or enrolled students that employment will be guaranteed upon completion of any program or that falsely represents opportunities for employment.
(i)
No statement shall be made by a massage therapy educational program or massage school that it has been accredited unless the accreditation is granted from a nationally recognized accrediting agency or organization. The name of the accrediting agency or organization must be used in any accreditation statement.
(j)
No massage therapy educational program shall advertise as an employment agency under the same name or confusingly similar name or at the same location as the educational program. No representative shall solicit students for a program through an employment agency.
(k)
A massage therapy school shall not use endorsements, commendations, or recommendations by students in favor of massage therapy educational program except with the consent of the student and without any offer of financial or other material compensation. Endorsements shall bear the legal or professional name of the student. An endorsement of a school by a student in compliance with this subsection is not a testimonial as references in subsection (b)(4) of this section.
Comments for Rule 140.306 Advertising
Unless a person is licensed as a massage therapist, the word “massage” cannot be used in any advertising. As a therapist advertising may not be false, misleading, or deceptive. If a claim is made it must be verifiable. Every part of advertising must be honest. A therapist may not overinflate credentials or skills. There should be no advertising that states that no deductibles will be charged to a client. As a therapist we can’t take advantage of the fears and emotions of our potential clients in advertising. All advertising needs to contain the therapists legal name, massage number, and business name.
A massage school must be honest about their competition. A massage school may not take on students unless the license of the massage school is valid. Massage schools may not tell students they are seeking them for employment. When a massage school is advertising it needs to use the full name and license number of the massage school within its advertising. Massage schools may not guarantee employment to the students. A massage school can only advertise accreditation if they are accredited. A massage school may not pay students for testimonials.
The link to the Texas Administrative Code is:
Summary:
Ethics is a way of trying legislate honesty and integrity. It is in a massage therapist best interest to stay far away from any practice or appearance of dishonesty. As a therapist we need to ask the questions: Could someone think I am doing something unethical in this situation? If the answer is in the affirmative then we need to fix this situation. We have worked too hard to get this career to loose it to false accusations. If we maintain a professional relationship with our clients, then we will have no problem with ethics.