Chapter 38:

Client's Freedom of Choice


"acknowledge and respect the client's freedom of choice in the therapeutic session."

--NCBTMB Standards of Practice V (f)


"obtain voluntary and informed consent from the client prior to initiating the session"

--NCBTMB Standards of Practice I (i)


"respect the client's right to refuse the therapeutic session."

--NCBTMB Standards of Practice V (g)


One might think that signing up the client and getting their health information means they have put themselves in the therapist's hands. However, it is very important the therapist make it clear what the treatment will consist of and the cost. Without doing so the therapist runs the risk of the client balking half way through the treatment with "This isn't exactly what I was expecting" or the classic, "Now what is a Swedish massage?" and the therapist just happened to be doing Shiatsu. That is why it is very important that each client understands the type of treatment they will be getting and gives their consent. In fact, the client may say nothing and still go away thinking they did not consent to the type of treatment they received. A brief description of the therapy and then getting consent by following the description with something like "Is that alright with you?," is one way of getting consent.


One should never insist on a particular treatment if the client has reservations. The therapist will probably regret it later. The client may leave disgruntled and never return. Above all, it is unprofessional, rude, pushy and insensitive.


If the therapist is employed by someone else (such as a doctor or chiropractor) and finds the client already in the room, the process of informing the client and getting consent before the treatment begins still applies. It is a good idea for the therapist be introduced to the client by the doctor or chiropractor and told the therapist will be doing "x" procedure. Then the therapist can go into details of the type of therapy and get consent. "Is that OK with you?" can be asked to ensure the client's freedom of choice.


In the worst case, massaging a person without involving the person's permission would be assault. Assault is defined as "the crime or tort of threatening or attempting to inflict immediate offensive physical contact or bodily harm that one has the present ability to inflict and that puts the victim in fear of such harm or contact." Notice that assault does not require actual touching. Just the thought that one could be touched is enough. While it is unlikely this will happen, obtaining consent will eliminate this possibility or similar scenario.


Discussing details of the treatment will provide the opportunity for the client to exercise any choices desired. Making sure client knows what is going to occur (full consent) obviates any problems. Telling the client to let you know if something is uncomfortable is helpful.


The problem of freedom of choice may be particularly exacerbated where the therapist is male and the client is female. The therapist should take special pains to acknowledge the client's comfort level.


While the therapist may not want to repeatedly go through the process of informing the same client about the treatment or ask permission to treat each time, something must take place to comply with the standard.


The first time or two the client is treated, they would expect this formality. After a while it can be smoothed out a bit. Many therapists upon walking into the treatment room, say something to the client like "Are you ready for your massage?" Of course no one ever hears a "No" on that question. This is doubly good because it signals the client to let go of the high intensity of the outside world and shift into a different environment.


A new therapist may feel excited to demonstrate skills. But doing so with an unwilling victim may make the recipient feel trespassed upon. Putting one's hands on someone, especially in an incongruent setting, can create an awkward situation, even though the intent is benevolent. Professionalism has certain requirements.


Language may prevent or inhibit a client's exercising freedom of choice. America is becoming increasingly multicultural. In New York City, for example, more than 170 languages are spoken. If the therapist cannot communicate in the client's language, it is unlikely conventional consent can be achieved and the treatment may need to be postponed unless some alternatives are in place.


The point of this ethic is not to assume. The therapist's goal is to be aware and caring. Guessing what a client wants is less than this. Ethically, only when everyone understands and is in agreement is the treatment permissible.


Occasionally nothing can save the session. The client wants out. Sometimes a client has a preconceived idea about what the treatment is going to be like. Perhaps the client has had a previous treatment by a therapist who called it by the same name but performed the treatment entirely differently. Whatever the reason, it would be ethically wrong for the therapist to ignore any objections to treatment the client might raise, even after the treatment has been in progress. One size does not fit all in massage bodywork and the client may simply be uncomfortable; the nurturing environment in which massage should occur cannot be maintained in this setting.


Listening to the client may leave the possibility of return open if the reason for the termination is unrelated to the therapist. If the therapist is bullheaded and tries to continue the massage, the chances of the client returning are nil. The client may actually become angry.


Everyone has to be in charge of their own body and sensitivities. This Standard respects those rights.


The therapist should not assume the reason for the client's termination. The client may not be comfortable giving the true reason for leaving. The departure may be completely unrelated to the therapist or the therapist's performance. Once the client makes this assertion, the therapist should end any touching. The therapist might say, "Absolutely. No problem" and step away from the client. Any discussion should be later, after the client is off the table or massage chair and dressed to leave.


Oftentimes the client has to be somewhere. The client is not paying attention to the time while on the table. If the therapist is going over the time, it would be appropriate to mention this to the client. If the client should miss an important appointment elsewhere because the therapist did not warn of the overtime, client may resent having gone there in the first place. The missed appointment cancels out the feel good benefit of the treatment.


The refund policy of the clinic should be clearly posted so there is no question on this issue if a client requests termination of the session.


To next chapter

Chapters