Professional Boundaries (Standard)

Standard of Practice: Professional Boundaries
(see also Prevention of Sexual Abuse)

Bolded terms below are found in the Glossary.

Client Outcome

The client is treated with respect and dignity, knowing that RMTs maintain professional boundaries and does not subject them to abuse of any kind.

Registered Massage Therapist Outcome

The Registered Massage Therapist (RMT/MT) always maintains professional boundaries with clients to preserve the trust and respect of the therapeutic relationship and to prevent boundary crossing, boundary violation and abuse.

Requirements

The RMT must:

1. Never abuse a client; this includes, but is not limited to, verbal, physical, psychological, emotional, sexual or financial abuse.
2. Obtain the client’s informed consent (consent) prior to conducting an assessment, providing treatment or modifying a treatment plan. Consent must include a discussion with the client about the following six elements:
   • the nature of the treatment;
   • the expected benefits;
   • risks and side effects;
   • alternative courses of action;
   • likely consequences of not having treatment; and
   • the client’s right to ask questions about the information provided and that assessment or treatment will be stopped or modified at any time at their request.
3. Obtain the client’s written¹ informed consent prior to every assessment and/or treatment of sensitive areas including the upper inner thighs, chest wall muscles, and the breasts. Breasts must not be touched except when assessment and/or treatment of the breast is requested by the client for a clinically indicated reason (for example, surgical intervention or perinatal care). Written informed consent must also be obtained prior to assessing and/or treating the buttocks (gluteal muscles), but can be obtained once per treatment plan (then verbally prior to every treatment).
4. Disable all audio, video or photographic transmitting and recording functions of all devices in the room, unless:
   • the RMT obtains informed consent for the use of audio, video or photographic recording equipment; and
   • the recording functions are for assessment, treatment and/or educational purposes.
5. Neither give nor receive gifts of significant value with clients.
6. Avoid treating family or friends (dual relationship) and not enter into personal relationships with clients where professional boundaries could be at risk of being violated.
7. Recognize that client participation is never justification for boundary crossings or violations.
8. Recognize the inherent power imbalance in the therapeutic relationship and take necessary actions to manage it as needed.
9. Ensure that all spoken remarks, body language and gestures towards clients are polite, professional and respectful at all times, and refrain from any behaviour that could increase the risk of boundary violation.
10. Address unintentional or accidental boundary crossings or violations immediately and document them.
11. Allow clients to have another individual accompany them during assessment and/or treatment if desired.
12. Drape in accordance with the Standard of Practice: Draping and Physical Privacy.

Relevant Legislation and Regulation

• Professional misconduct in Section 26 of Ontario Regulation 544/94 under the Massage Therapy Act, 1991
• Professional misconduct in the Regulated Health Professions Act, 1991 (RHPA)

Related Career-Span Competencies (CSCs)