Standard of Practice: Professional Boundaries, Draping, and Physical Privacy

Patient Outcome

The patient is treated with respect and dignity, knowing that Registered Massage Therapists/Massage Therapists (RMTs/MTs) maintain professional boundaries and do not subject patients to abuse of any kind. The patient is effectively covered by clothing and/or draping for their comfort and safety and to maintain appropriate boundaries and help prevent boundary crossings and boundary violations.

Registered Massage Therapist Outcome

The RMT/MT always maintains professional boundaries with patients to preserve the trust and respect of the therapeutic relationship and to prevent boundary crossing, boundary violation and abuse. The RMT/MT protects patient physical/personal privacy and safety and maintains appropriate boundaries by effectively using physical barriers.

Requirements

To maintain professional boundaries, the RMT/MT must:

1. Neither give nor receive gifts of significant value to/from patients.
2. Avoid treating family or friends (dual relationship), and not have personal relationships with patients where professional boundaries could be at risk of being violated.
3. Recognize that patient participation is never a justification for boundary crossings or violations.
4. Recognize the inherent power imbalance in the therapeutic relationship and take necessary actions to manage it as needed.
5. Ensure that all spoken remarks, body language and gestures towards patients are polite, professional and respectful at all times, and refrain from any behaviour that could increase the risk of boundary violation.
6. Address and document unintentional or accidental boundary crossings or violations immediately.
7. Allow patients to have another individual accompany them at an appointment if requested.
8. Not practise Massage Therapy under the influence of any substance (whether legal or illegal) that may impair their judgement.

Draping/clothing are important tools to distinguish areas of assessment and/or treatment. Secure effective visual and physical boundaries are essential to protecting the patient from boundary crossings and violations. The RMT/MT must:

9. Always drape the patient, unless the patient arrives for assessment and/or treatment in clothing suitable for their assessment and/or treatment and prefers to remain clothed.
10. Meaningfully engage the patient in a discussion about the options for draping and clothing for assessment and/or treatment, considering each patient’s unique needs, views, preferences and concerns (in line with a patient-centered approach) (see also the Standard of Practice: Patient-centred Care).
11. Explain to the patient how to best prepare for assessment and/or treatment, including how to position themselves.
12. Explain to the patient clearly what part of the body the RMT/MT intends to assess and/or treat, and determine the patient’s preference as to whether the touch will be directly on skin or through a cloth barrier (for example, a sheet or the patient’s clothing), and continuously monitor the patient for change in consent and comfort throughout assessment and/or treatment.
13. If assessing and/or treating sensitive areas, discuss with the patient how sensitive areas will be draped and/or clothed and how touch will occur (for example, over draping and/or clothing or on skin, and for bilateral exposure). Never expose sensitive areas without the patient’s informed consent (written or electronic) (see also the Standard of Practice: Consent and Standard of Practice: Prevention of and Zero Tolerance for Sexual Abuse).
14. Ensure the patient is protected from exposure of the genital area and the gluteal cleft. Never touch the patient’s genitals or anus. If treating a patient during childbirth, obtain explicit consent to have their genital area and gluteal cleft exposed for the purpose of Massage Therapy to other areas of their body.
15. Not reach underneath the draping and/or clothing without explicit consent:
    1. RMTs/MTs must not reach under draping and/or clothing in a way that could risk touching an area of the body for which the patient has not given consent to be touched.
    2. RMTs/MTs when requested by the patient shall discuss options to assess and/or treat under clothing, only when it is in the best interest of the patient and only with the patient’s explicit consent.
    3. Some patients may feel better protected during assessment and/or treatment by limiting exposure of some areas of their body or may present with accessibility needs. In these cases, the RMT/MT shall offer options for providing care in a way that does not require touch (for example, instructing patient to stretch) or assessing and/or treating on top of clothing with the patient’s consent.

If the patient remains clothed for assessment and/or treatment, the RMT/MT must:

16. Discuss options for maintaining patient physical/personal privacy if assessment and/or treatment occurs in non-private environment.
17. Adjust clothing only with the patient’s informed consent and in consideration of the patient’s unique needs, views, preferences, concerns, and health goals to protect the patient’s physical/personal privacy.

When patient draping is adjusted during assessment and/or treatment, the RMT/MT must:

18. Drape securely using material that provides an effective visual barrier to set clear physical boundaries that separate the areas being treated and/or assessed from the areas of the body where no touch is being applied.
19. Drape to prevent visual exposure of any areas of the patient’s body when they are not being treated and/or assessed (except for the shoulders, arms, hands, neck, face, and head). The RMT/MT must not uncover areas of the patient’s body when they are not being assessed and/or treated unless it is at the patient’s request and for the patient’s comfort (such as for temperature regulation), and the patient’s informed consent has been obtained. The RMT/MT must obtain the patient’s written or electronic consent prior to exposing any sensitive areas when they are being treated and/or assessed.

Bolded terms are found in the Glossary.