The following is a case study demonstrating how the Inquiries, Complaints and Reports Committee (ICRC) addressed a client’s complaint about the conduct of their Registered Massage Therapist/Massage Therapist (RMT/MT) during treatment.

Case Study Summary

The RMT/MT told the client to undress to their comfort level, suggesting that “underwear is probably the best.” The client felt uncomfortable because the draping was so thin that her underwear could be seen through it. The RMT/MT’s website stated he provided Swedish massage and used oil, but when the client arrived for treatment, the RMT/MT said they only perform Shiatsu massage, without oil. During the session, the client felt uncomfortable because registrant did not adequately explain the Shiatsu techniques being used. Additionally, the RMT/MT began treating the client’s abdomen without discussing this part of the treatment until moments before starting it. The client complained about the registrant’s conduct and care to CMTO, specifically concerns regarding their communications, draping practices, and failure to obtain informed consent.

In responding to the complaint, the RMT/MT:

• Did not offer an additional sheet because it was warm in the room. He felt that clients would normally raise concerns about draping if they had them.
• Stated they obtained verbal consent to treatment of the hips and gluteal muscles but acknowledged they did not discuss abdomen treatment until the end of the massage, just before beginning that part of the treatment.
• Asked the client: “In my general massage, I work over the hips and glutes. Is that okay?”, but did not obtain written consent to treat the client’s gluteal muscles.
• Said that if the client had concerns with the treatment provided, they should have expressed those concerns to the RMT/MT.

ICRC’s Perspective: Decision Process and Outcome

The ICRC reviewed the complaint and determined that the RMT/MT required remediation because they did not provide client-centred care. The ICRC’s written decision noted:

• An RMT/MT should be careful not to advise clients that “underwear is probably best.” It is important to provide client-centred care, which means that an RMT/MT should outline the options for draping and clothing and ensure it is clear that the level of undress is the client’s choice.
• At all times, an RMT/MT should ensure that “the client is effectively covered by clothing and/or draping for their comfort and safety.” A client should not have to ask for a sheet that provides an adequate visual barrier, this should be the default.
• There must always be a clinical indication to treat a client’s abdomen.
• An RMT/MT must obtain written consent to assess and treat sensitive areas, which includes the gluteal muscles.
• To provide client-centred care, an RMT/MT must consider, among other things, a client’s goals when creating a treatment plan and in the consent discussion. Clients can be unclear on what to expect, so an RMT/MT must communicate clearly prior to treatment, check-in during treatment, and observe clients for non-verbal cues of discomfort.

The ICRC ordered the RMT/MT to review relevant Standards of Practice and write a reflective paper to CMTO outlining how they will have consent discussions in the future.