Navigating Ethics and Power in Massage Therapy
- Christina Aldan
- 2 days ago
- 7 min read
I just completed the AMTA Continuing Education course Ethics and the Power Differential, created by massage therapy educator Kathy Ginn, LMT. This course counts toward the NCBTMB Ethics requirement and it sharpened my awareness of what it means to ethically lead the client-practitioner therapeutic relationship.
If you’ve been on my table, you already know I take the emotional and physical safety of my clients seriously. What this course drove home for me is that the power differential means that clients also carry some of the responsibilities of the relationship.
Power in Massage Therapy
One of the first things the course established is that the power differential is inherent in the massage therapist–client relationship. It's not optional, it's built-in.
The moment a client walks into my studio, I’m the one with more knowledge, more experience, more training, and more control of the environment. I’m clothed, whereas they may be in some form of undress. I’m standing while they’re lying on a table. I know the territory where they’re navigating a new space. I’ve spent years studying human behavior, emotional intelligence, anatomy, fascia, and clinical reasoning and clients are depending on me to guide them through discomfort, pain patterns, and confusion.
That’s what I mean by inherent power. That is not equality, and "with great power comes great responsibility."
Believing “everyone is completely equal in this moment” might sound compassionate, but in reality it denies the truth that the massage therapist has the power to produce a desired effect or outcome. They have the power to influence change within the client. That’s literally the definition of power used in the course. So pretending a power differential doesn't exist isn’t ethical. It’s avoidant.
My job is to own that power without abusing it, underusing it, or making the client feel small because of it. My professional effectiveness depends on managing this dynamic with clarity, humility, and skill.
How I Manage the Power Differential in My Practice
Ethical development as a massage therapist means understanding and owning your power role. That idea resonates with me because as I learned from many years as an emotional resilience coach... the way I show up (verbally, physically, and energetically) will shape a client’s experience.
To keep the relationship safe, grounded, and effective, I:
1. Maintain clear, written practice policies
These policies outline expectations around things like professional boundaries, communication, fees, scheduling, scope of practice, and emotional safety. Having everything spelled out reduces confusion and builds trust. Clients read and sign these policies before we begin a session. If something needs renegotiating, such as a scheduling conflict, we discuss it openly and update our agreement.
2. Use informed consent as a foundational practice
Clients deserve to know my background, my scope, what I’m doing, why I’m doing it, and how the session may affect them. I use detailed intake forms, an informed consent form, and SOAP notes to support clarity and continuity.
What This Looks Like in Real Life
From my experience, I’ve had clients arrive with complicated emotional landscapes. They may feel vulnerable, hopeful, or carrying heavy stories. I’ve had clients tell me deeply personal things that require me to stay neutral, steady, and present. I’ve also had clients like a woman who came in after passing a kidney stone earlier that same morning. Her shoulders and upper trapezius had been clenched for two weeks from compensating for the pain. By working those areas and improving circulation, we gave her lower back and kidneys permission to relax. Before she left, I reminded her to drink at least a gallon of water to help flush out residual metabolites. That work helped her healing, but it required sensitive handling, strong boundaries, and clear communication (she had already spoken with and arranged an appointment with her doctor the next day. So there was no need to refer her out to a specialist).
My own experience receiving bodywork also shapes how I practice. I once worked with a therapist who made me feel like I was being disciplined or corrected. They were always judging me. It was awful. I never want a client to feel that way… like, ever. That experience directs my own approach for how I hold space for clients.
It’s why I read body language carefully. Why I notice breath, posture, micro-shifts in tone. Why I consider cultural competency. Why I walk into the room grounded, neutral, and present (a practice I deepened through my training with John Barnes at Therapy on the Rocks in Sedona. His “Healing Hands Seminar for Patients" taught me that psychological neutrality is not a suggestion; it’s an obligation. Clients require safety. They require warmth, empathy, and compassion, but also structure. If the relationship gets too casual, too friendly, or too blurred, ethics suffer. My job is to keep the roles clear and the container strong.
Creating a Collaborative, Safe, Empowering Space
This course reinforced that clients may raise you up or pull you down emotionally, and part of my responsibility is to maintain a steady center. Transference is real. Patterns from past relationships show up in our conversations and interactions. I’ve learned to navigate these dynamics with clarity and consistency. I've touched on this subject before (read about it here.)
Before a session, I take 15 minutes to talk with the client about their needs. I explain my scope of practice, why I’m choosing specific techniques, and how the work might affect them. I might ask something like, “Do you have any questions or concerns before you move to the table?”
Clients decide what clothing they want to remove or leave on. They tell me which areas to avoid. They guide pressure levels (not everyone loves firm pressure). This client-therapist collaboration strengthens their sense of agency while keeping me firmly in the professional role.
After the session, we spend another 15 minutes checking in. I ask how they’re feeling and whether anything needs clarification. This isn’t just small talk, it’s part of healthy power-sharing and helps prevent misunderstandings. It also ensures that even if a client arrives late, they still get their full table time without feeling rushed. I learned long ago that if you hurry, you miss essential signals. And the tiny cues that, when go unnoticed, can change the whole trajectory of a session.
The Responsibilities I Uphold as the Professional
Everything I do, from how I speak to how I move to how I manage my own personal life, shapes the therapeutic container. Excessive self-disclosure gives away my power, so I keep personal details light and backgrounded. My unmet personal needs are a non-issue inside the massage studio. They are handled outside the session room. I only work within my scope of practice, referring out to my network of doctors, chiropractors, acupuncturists, mental health professionals, and functional medicine practitioners whenever needed.
The way I offer expertise matters too. I don’t use “should” or “ought to.” Instead, I say things like, “What does your doctor/trainer/therapist recommend…?” "One thing I've noticed that has helped people is..." Clients deserve gentle invitations, not lectures. They deserve specificity that relates to their needs, not ego that relates to my needs.
How I Support Clients Through Safe, Ethical Power
How do I incorporate these values into my practice? Here are the five core qualities I intentionally cultivate in my practice:
Trust
I explain what I’m doing before I do it so nothing ever feels mysterious or sudden.
I ask for feedback during sessions (“How does this pressure feel?” “Do you want more or less pressure here?”) so clients know their voice actively shapes the work.
I follow through consistently. I use the same professionalism, same presence, every time you walk in. Reliability builds trust.
Safety
I invite clients to choose what clothing stays on, which areas we avoid, and how the pressure feels. Consent isn’t a formality, it’s an ongoing conversation and can be revoked at any time.
I watch for emotional comfort as much as physical comfort because we store tension and stress in the nervous system.
I avoid rushing. A calm, grounded pace helps your body settle so deeper work is possible. We go "slow and low."
Accountability
I maintain detailed SOAP notes so I can track client progress and make adjustments based on what actually works for you.
I communicate boundaries clearly on my website, on forms, during conversations. Clients are informed of session times, fees, my rescheduling policy, and my cancellation policy.
If something is outside my scope, I refer you out to a trusted professional instead of guessing or overreaching outside of my scope of practice. I am not a doctor. Not a trainer. Not a therapist. Not a nutritionist. I'm a bodyworker.
Respect
I practice active listening without interrupting, correcting, or assuming. No one knows your body better than you do. Your body’s story belongs to you.
I keep personal disclosures minimal so the focus stays where it belongs: on your healing, not my life.
I honor your limits. If your body says “no,” I pivot immediately without questioning so there is no pressure to push outside of your edge.
Clarity
I explain techniques in everyday language (“Here’s why this might help your shoulder” “Here’s what fascia does” "This is the benefit of making the 'ah' sound on the exhale") so you’re never left decoding jargon.
I review your goals at the start of each appointment and discuss what we did at the end of your session so you always know what’s happening and why. As well, it's another opportunity for you to ask questions and give me feedback.
I made practice policies easy to read and easy to understand so expectations are smooth on both sides.
Why My Own Self-Discipline Matters to Your Healing
The course also highlighted the essential role of self-care and self-discipline for practitioners. My presence is sharper when I’m rested, nourished, learning, and grounded. I take that commitment seriously.
I prioritize sleep now (though it took me years to get there). I carve out time for play, friendship, travel, and reading just for pleasure (there were many years where I only read for learning and business). I stretch, exercise, and manage my diet. I stay connected with my own health professionals. And because I’m a lifelong learner, I consume the work of teachers like Thomas Hübl, Pema Chödrön, Alan Watts, James Baldwin, and Jane Goodall.
All of this strengthens my sense of self. It's the foundation I need to effectively hold space in a healing environment for others.
Clients come to me for healing. My self-discipline ensures I can stay focused, attuned, and present for every single one of them. At the end of the day, knowledge, self-care, and the development that I gain from self-discipline improves my attention and caring presence, making me a more effective therapist for my clients.
If you'd like to learn more about the practices of how I manage my massage business and my life, you can follow me on social media on Instagram, LinkedIn, or TikTok. I'm @luckygirliegirl everywhere on the interwebs.
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