Part 2: Keeping Clients Safe
How to Avoid Violating Client Boundaries
TASA ID: 4192
Cultivating sensitivity and trust is essential to keeping clients safe—especially as we are aware that many women and men have experienced physical or sexual trauma in their lives. According to the National Council on Behavioral Health, 70 percent of adults in the US have experienced some type of traumatic event. That’s equal to 223.4 million people, so it is highly likely you are working regularly with individuals who have experienced trauma.1
This article outlines some clear guidelines and boundaries that will help create a safe, comfortable environment for clients, not just those for which trauma is a factor. Safety is built on trust and trust takes time to establish. Yet, trust can also be lost in an instant. It is worth taking the necessary time and care to establish a therapeutic environment that feels both safe and respectful.
ASK WHAT THE CLIENT WANTS
As always, ask questions before you begin each session—even with regular and returning clients. For example:
• “Where would you like me to work today?”
• “Is there anywhere you would like me to focus on in today’s session?”
• “Is there anywhere you do not want me to work on today?”
Additionally, when checking in with regular clients, be sure to ask: “Is anything different since the last time I saw you?”
WHO’S IN CHARGE?
During your intake, let the client know they are ultimately the one in charge. At any point during the session, they inherently have the right to tell you to stop a particular technique, revisit an area where they would like more attention paid, or adjust the level of pressure. To reaffirm your commitment to their boundaries and increase their sense of safety and trust, remind the client they always have agency over their own body. Honoring this integral aspect of the client-therapist relationship requires that you let go of your ego or any false notions of control.
Most clients know what they like and what they want, and they will communicate it clearly when given the chance. But always use your common sense and avoid inappropriate touch that might cross a boundary or exacerbate an injury. Also, be mindful to not injure yourself or disregard your own boundaries.
PRESSURE LEVEL
As detailed in Part 1, be sure you know the type of session and the amount of pressure the client would like before you begin. Work gently as you start, and build in pressure based on the client’s expectations. If you find that a different pressure not initially requested might be more effective, always ask first before acting on impulse. Setting this intention reiterates that the client is in control of their own body and can accept or decline your suggestion. One method used to empower the client is a 1–5 pressure scale to communicate if you are using too much, too little, or just the right amount of pressure
PRIVACY BOUNDARIES
Always have the client change in private with the door closed or a curtain drawn. Do this even if the client says they don’t need privacy. Some clients will just walk in and start undressing without you saying anything. Stop them while you gather whatever information you need before the session starts; let them know you will leave the room, at which point they can change and get ready. This establishes a professional boundary. In the massage industry, the stock phrase “Undress to your level of comfort” is used frequently but doesn’t mean much to a person receiving massage or bodywork for the first time. Be sure to follow up this statement with examples like: “Some people choose to leave their underwear on, and others remove it, while some take off their socks and some leave them on. Do whatever is comfortable for you.” When you set or reassert a clear boundary, you again increase the client’s sense of safety and comfort. It’s especially important to have this conversation with a first-time client because it normalizes their choice with regard to disrobing. Some people feel it’s expected to remove all their clothing. If they don’t, some clients feel it will impact the session, or they will be viewed negatively. With all the sexual and physical trauma people (especially women) experience in our society, safety and trust can only be facilitated when the client is free to make choices without judgment.
CHECK IN FREQUENTLY
Due to the inherent power differential, many clients have difficulty speaking up during a session when their expectations are not being met, they feel disappointed, or they don’t like what’s happening in the session. A client may fall silent or, worse, choose not to return without explanation. In creating an atmosphere of ease and safety, remind clients that an open dialogue is welcome. Begin to cultivate this awareness during your intake by saying to the client: “Feel free to let me know at any point if you don’t like something or feel uncomfortable. If you notice an internal dialogue that questions what’s happening in the session, it’s time to say something. Remember, it’s your session, not mine, and I’m happy to listen and change what I’m doing.” A client’s comfort level in communicating openly with a therapist will vary based on their familial, social, cultural, and religious history.
DRAPE SECURELY
Secure draping is an important part of establishing safety. Sloppy or loose draping only makes the client feel uncomfortable and may create unnecessary issues for the therapist. As the client is naked (or almost naked) on your table, they have to feel confident the drape will not slip, fall off, or be compromised in any way. Their confidence level rises if the drape is positioned professionally, which means it is secured in the right place and only exposes the area on which you are currently working. Never work under the drape; this violates the implicit, agreed-upon boundary.
WORKING SENSITIVE AREAS
Explicit permission is necessary before working on body regions that may be sensitive areas for your clients. Use the following tips for handling these delicate areas, while also maintaining client trust.
BUTTOCKS
Permission from your client before engaging in work on the buttock region is necessary, especially the middle and lower buttock. Most spas have restrictions on working in this area, and some do not permit therapists to work on the gluteus muscles at all. Others have therapists work only on the superior part of the buttock or on top of the drape. Conversely, many therapists who have an independent, private practice do work on the buttock area. There are important ligaments that are located at the medial and superior border of the gluteus muscles and others that are deep to the gluteus muscles. The gluteal cleft is the groove between the buttocks that runs from just below the sacrum and coccyx to the perineum. If you work with clients who experience low-back and hip pain, working on the buttock can be an important area to treat, if done appropriately. Remember to always undrape the buttock one side at a time, and keep the gluteal cleft covered. Never place your fingers into the gluteal cleft.
INNER UPPER THIGH
The inner upper thigh is a very personal and sensitive area. It is often associated with touching only in an intimate, sexual relationship. Therefore, I discourage working the inner upper thigh unless you work 3–4 inches below the groin.
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