Update: 08/07/14. Subsequent to the post below, the therapist mentioned below was sentenced from 7-14 years in prison. A bit of investigative searching on your own will bring up the details of this case. The testimony was convincing enough to have this therapist, who was performing myofascial release, convicted of sexual assault on multiple female patients. What was most troubling was the wording, reported across multiple news sources, which must make one step back and re-assess our chosen modality, or at least how we approach it. Here is an excerpt:
“While they were lying prone on his massage table – sometimes with another person in the room – he would put his hands under their underwear or exercise clothing…”
I was taught, and continue to teach, a nearly identical hand placement as quoted above when it is indicated to perform a cross handed release/stretch on the sacrum, or if supine, across the lower region of the hip flexor (as it crossed the inguinal region). As MFR therapists, we may have done this a thousand times or more, all with nothing but positive effect on our clientele. I am posting this quote to reinforce the need for all of us to be crystal clear on our language, intent, and boundaries. While all accounts make it appear that this therapist grossly crossed a line of professional conduct, placing ourselves in a position where our motives and intent could be called into question should force all of us to revisit how we communicate with our patients. Myofascial release is a highly effective means of eliminating pain, but how we go about this may need addressing.
Myofascial release, as well as many types of manual therapy/massage, is traditionally performed on bare skin. Exceptions exist, for instance with most chair massage situation as well as in craniosacral therapy. The mindset in myofascial release was that skin-to-skin contact was necessary to assure a firm, non-slip contact with the skin/body of the patient. But, is it always necessary to have our hands directly on skin or can the same end result occur through clothing? I feel I can often be just as effective while working outside of clothing. It this worth trying, if for nothing but to avoid any type of confusion as to our motives and intents? Have you changed your treatment from how you were taught in any fashion, honoring your own boundaries? I have. I can perform a supine lumbosacral decompression without being on the skin of the sacrum and teach this as a viable option in my seminars. I no longer place my hand directly on the skin over the distal aspect of the iliopsoas region. Instead, I find the results are just as effective if I place one hand one the lower abdomen and the other on the upper thigh. Give it some thought; how can you modify your technique to minimize your liability and remain effective? How can you improve your verbal and non-verbal communication with your patients/clients to assure there is no ambiguity about what is being performed in the privacy of the treatment room? How can you minimize the chance of a court case like this happening to you?
___________________________________________________________________________________
There is a court case that just concluded in Pennsylvania, one in which I know not of the therapist’s true innocence or guilt. The therapist, who specializes in Myofascial Release, was convicted of groping female clients. He claims that he was simply performing the normal duties of a therapist and treating the areas of the body that a myofascial release therapist normally touches. The court saw it differently and convicted him and he is now facing time in jail.
This whole affair has made me reflect on the extreme care that I take every day to assure this does not happen to me. While many things are out of our control, as therapist’s our ability to communicate our needs and intentions in a clear and concise manner is crucial. We routinely touch areas of the body that may not be a big deal to us, but may indeed push a patient’s alarm button. I strive for open communication in my treatment room.
As myofascial release therapists, placing a hand on the bare sacrum or sternum is routine…for us. I have no issue with performing techniques that require handholds in these location such as these, even on a first visit, as long as my communication is clear and unambiguous.
“In order to provide proper traction to stretch the low back region, I would like to place my hand under your pelvis, directly on your sacrum. Are you clear with what I’m asking and are you OK with this?”
Sound awkward? It is much less awkward than a lawsuit.
I speak in these sorts of clear terms to my patients every day. If they show any sign of not understanding what I am asking or saying or seem at all ill-at-ease, I back off and figure out a workaround. I dress professionally, have proper lighting in my treatment room, speak to them clearly and unambiguously, and always get permission for what I am about to do. I clearly know and honor my professional boundaries as a physical therapist, knowing fully what I am and am not licensed to perform. If I am to work in an area that seems to make my patient uncomfortable, I ask them to sit up and I sit at a level lower than them and we discuss the issue at hand. Placing them in a lower (subordinate) position while you stand over them is not always the best approach.
Can this avoid every type of problem? No, but communicating your intentions clearly and gaining verbal permission goes a long way to assure you will work another day.
How do you present yourself to clients?
For Now,
Walt Fritz, PT
Foundations in Myofascial Release Seminars
Walt I also have worked on sensitive areas such as the breast, groin, sacrum, and tailbone. I ask my clients things like can I do? Are you okay with this? Some people are uncomfortable with this technique and I need your permission. My clients are always clear and educated as to why. I also ask do you feel safe? I then ask them to tell me I feel safe. I liked this Chiro who taught a class recently and always asked can I touch you before he did. He never assumed permission once. He had so much respect for the person he worked on. I am also very careful about my draping techniques. And never work under the covers. I have had discussions with clients and they have expressed feeling uncomfortable when a therapist is careless with draping. I like how you sit lower good way to give them power and permission to express concerns.
I so agree, Dorie. Draping is an entire new blog post, though not a major issue for me. My clients are dressed, with shorts and T-shirt, tank top, etc. Along those lines, I was taught in a method where bathing suits (generally 2 piece for women) were the norm. The reason for this was stated to be to allow better visual and palpatory “access” to the body. If you wish to start a session with the vast majority of people uncomfortable/awkward, ask them to appear before you in a 2 piece bathing suit!
I never work on naked or undraped bodies. I ALWAYS ask permission to touch (even long time clients). I make an agreement with every client that they are to tell me if they don’t like something and I promise I will stop immediately, no questions asked. After 30 years of practice, so far so good.
I try to cover as much as possible before the session with a signed informed consent. If plans change mid session I would incorporate communication such as you described…not in so many words though. ” i need to do this, are you ok with it?”
Written consent for each and every thing that we do is unrealistic. Verbal consent, without being a pain about it, is not unrealistic.
Great post Walt, unfortunately in so many cases (not sure about the one in Pennsylvania) the therapist is guilty until proven innocent instead of the other way around. The accused has the information made public about them which instantly tarnishes their image and business. Even if they are proven innocent in a court of law, the accusation still effects their reputation negatively. I will quite often give a patient their shirt and turn my back to them or step out while they put their shirt on instead of trying to any draping, I just find it a lot easier than trying to drape and have a possible mishap.
Wendy Rigby, a massage therapist from British Columbia, replied to this post on a Facebook thread and gave me permission to share it here:
“I’m certified by the Supreme Court of BC as an expert witness in Massage Therapy. As such, I’ve provided testimony in cases for both prosecution and defence. Your post is great, Walt. Another thing I would add is that judges and lawyers put a huge emphasis on what is written in the patient’s chart. Writing down what you’ve said to the patient indicates you are aware of boundary issues. If you’ve noted somewhere that you’ve received verbal approval for touching a “sensitive” area, it goes along way in your favour. What is written in the chart often is the tipping factor between conviction or release.”
Excellent advice.
Lots of *great* takeaways in this post!
My clients/athletes keep their cloths on for all of their sessions with me. That being said, I rent my space from a Podiatrist and the lights throughout the ceiling are pretty bright. For a few years now, I have been torn on getting a softer stand alone light, but didn’t want it to feel like a spa environment. This post made me think that I’m less likely to open myself up to problems with brighter lights. Prior to reading your post, I was not looking at my lighting from that angle.
I’m very comfortable with resting a hand on another area of the body as I do my work. And that level of comfort is so important to the clients overall experience and results!
I regularly work on the pyramidalis. And prior to addressing the muscle at its attachments, I show them a picture. Then, I explain why that muscle is so important to their overall function.
I’m going to share your post on all of my social channels.
Great thoughts, Rick. Any sort of education we can give patients reduces the confusion/liability. Thanks!
I also work with my clients fully clothed so there is never skin to skin touching. I’ve found that when I need to treat an area such as the origination of the adductor group, I will ask the client to put their hand over the groin or breast “to protect in case my fingers accidentally slide over the tight muscle.” It makes everyone comfortable with me being so close to a sensitive area.
This has worked for 25 years of treating both male and female clients, most of whom are athletes or people in chronic pain. They don’t think of me as a massage therapist, but as a muscular therapist because I never do a full body treatment, but focus on only the muscles involved with the current condition.
I hear you Julie. When I was at ESPN, I got used to working through the athlete’s clothing. In fact, I became so accustomed to palpating through the clothing that I have continued to address the attachments in the same way ever since.
Working through the clothing also saves a lot of time (and laundry).
Since I only do a Transverse/Circular Friction Massage at the point(s) at which the muscles attach to the bones, ligaments and tendons, I can easily manage to do the work through the client’s clothing.
Prior to booking an appointment, each client is notified in advance that they will be fully clothed throughout the entire session. At the same time that I’m taking them through the specifics of what to expect in the first session, I also ask them to wear comfortable clothing that will allow them to move freely.
I *don’t* have clients hold their hand over their breast or groin because I have found that reaching can impact how the muscle(s) responds to my work. Believe it or not, I very rarely use a bolster for the same reason.
That being said, prior to addressing the proximal attachments of the adductors or the distal attachments of the abdominals, I always have my male clients move their private parts to the side that I’m not working on. I also utilize side-lying whenever and wherever it makes sense.
Since I first read through this post, I have added a stand alone floor lamp that I only use with my regular clients. So far, that has worked out very well.
Thanks again for this phenomenal post Walt!
I recently read “Blink” – sorry I’ve forgotten the Author’s name and have lent the book to someone. In it he describes how in ALL medical lawsuits there was an initial dislike of the practitioner involved. Generally patients found their tone to be condescending and felt their treatment and/or risks had not been properly explained to them. Practitioners with a good rapport with their clients were NEVER sued. Communication is the key
Thanks, Lucy. I’m not sure if I agree with everything you or the author stated, but I agree that communication is key. A good rapport is helpful, but in today’s health care environment, there are no guarantees that you will never be sued.
During the years I spent on our state board and participating in disciplinary hearings, I know in my heart that some of the accusations that were made, and male therapists lost their licenses, because of a failure to communicate with the client. My question to myself at these hearings was always “did this person have an intent to do something evil, or was this a lack of communication or mistake that could have happened to you or me?” It is sad to see someone who really did not intend to do anything wrong, but just failed to do it right by talking with the client, lose their license and their livelihood.
Hi all,
This is a good topic. I communicate clearly with my patients before I go on their sacrum or palpate their pubic tubercles, for example. I use anatomical models and anatomy books to explain how this palpation or hand placement is important for assessment and/or treatment. Because I do internal work, for these cases I require a signed consent and usually a doctor’s order to cover myself liability-wise.
I also wanted to address the subject of intent. It is the healthcare professional’s responsibility to be clear on their boundaries and be grounded and humble enough to listen to their client’s language, tone and body. If someone says, “Okay, you can work there”, but then flinches when you touch them near that area, the conversation needs to be continued in order to respect the patient. I find that patients are actually often much more sensitive to off body work, and this work requires the same sensitivity to the boundaries as the on body work.
Finally, I do believe that some practitioners do abuse their license to touch. I just wanted to bring this up because a person who has felt violated may be reading this blog and the replies. It is our responsibility to be clear with our patients and clients and to address them as equals, not projecting our agenda or ideas onto them
Thanks for the discussion, Walt!
It is our responsibility to be clear with our patients and clients and to address them as equals, not projecting our agenda or ideas onto them
So well said, thank you.
Thanks for bringing this to our attention Walt. I must say, though, that I’m not sure if the practitioner could have done anything to prevent this. After all, $1 Million or more in a civil liability case resulting from a criminal conviction is a pretty strong motivation for anyone to lie.
Additionally, as we all know, past traumas can, and often do, resurface during or immediately following MFR treatment. Depending on the emotional severity of this, it is entirely feasible that a female patient can have a past sexual assault triggered by treatment, then in the hours and days following the treatment, psychologically project the past trauma onto the therapy session. This creates the situation where a person is re-traumatized and has created a new story that they fully believe, no matter how incorrect it may be. Consequently, this patient cannot be caught in a lie and their testimony will absolutely be believed and used to convict the practitioner even when there is no other corroborating evidence of violation.
Given the percentage of women who have survived some sort of sexual assault in their lives, it is reasonable to assume that half or more of the female patients a male practitioner will see have a history of sexual assault. The potential for legal action in these cases is significant. This is especially true in cases where the patient underwent psychotherapy to “resolve” the trauma.
We all know that psycho (talk) therapy can only address that portion of the memory that resides in the higher brain. However, most of the traumatic event is recorded elsewhere in the body when the limbic brain shuts down the higher brain as the sympathetic nervous system is activated. Anyone who (naively, egotistically) believes that they have fully resolved past trauma through psychotherapy yet experiences a flood of related emotion following an MFR session is liable to directly associate the emerging emotions with the therapy session in an inappropriate manner. This Projective Identification is a real possibility that is impossible to prove in court without extensive psychological evaluation AND concrete evidence that supports such a condition while directly contradicting the patient’s testimony.
In this day of prosecutorial arrogance and ego, especially during election years, male practitioners are incredibly susceptible to legal action. Given the association, both past and present, of massage and sex, male MTs are in an especially vulnerable position. This is especially so given that most within the legal system are, well, in the system. As MFR therapists, we do not fully enjoy that luxury. We are on the outskirts, the fringe, of the accepted medical establishment that includes psychotherapy. As the psychotherapy industry in general still denies that emotions and memories can reside outside the brain, there’s not much chance for this legitimate argument to be taken seriously in court.
It is common for trauma survivors to develop extremely dysfunctional defense mechanisms for survival. These include a fragile sense of reality, a propensity for “bending” the truth and manipulation, and aggressively attacking those who refuse to consider them as victims and support their illusions. We are not psychotherapists; not trained to seek out and discover such conditions. Furthermore, we are compassionate human beings who want to help others heal and acknowledge their suffering. This can make it relatively easy for us to be sucked into a dangerous situation by jumping in with good intentions. (You know what they say about good intentions?)
So, all that being said, is there a way that we male MTs practicing/specializing in MFR can protect ourselves from such legal action beyond just communicating, building trust, and “not doing anything wrong?”
Ted,
I believe that you have some valid points, which makes me call into question what you and I were taught when it comes to the treatment of emotional trauma as a part of a physical therapy or massage therapy plan of care.
“We all know that psycho (talk) therapy can only address that portion of the memory that resides in the higher brain. ”
I believe that I know where these thoughts originate and I strongly believe that whoever taught this to you represents a very small minority of thought. I must strongly disagree with your points here, as the cloudy veils that I was taught to look at traditional psychotherapy through are both wrong and dangerous. (I was actually told in a seminar that psychotherapist know nothing about emotions! Were you?) Empowering a physical therapist or massage therapist to believe that they are better equipped to handle a person’s past traumas is flat out wrong and beyond the scopes of our practice acts. Send an email to your state licensing board and ask if your license includes dealing with the full scope of emotional trauma. I can just about guarantee the answer will be a resounding NO. Just because we can elicit emotions on the table does not make it right for us to think we can adequately and safely deal with them. Dealing with emotions is best left to those who are trained and licensed to deal with them. I believe that you and I were both taught to be the renegade, to break free from conventional thought. Maybe it is time that we start acting like the renegade against perspectives such as what we were taught in our trainings? We have no place entering a session equipped with techniques that are intended to purposefully trigger an emotional reaction from our patients.
No disrespect intended, Ted, I just think that these issues need to brought to light. We do not know what happened in the treatment room of the Pennsylvania therapist mentioned in the lawsuit, but if past trauma was a part of the issue, the therapist should have referred this patient out to someone LICENSED and qualified to deal wtih this and not take it upon himself to work with it.
Thanks, Walt. I wholeheartedly agree that, as bodyworkers, we aren’t qualified or authorized to treat or help process emotions. I wasn’t suggesting that try in any way other than being compassionate and trying to empathize with the patient and assure them that they are safe and accepted. However, my explanation of trauma did not originate with my MFR training, but rather with specialty training in trauma I took prior to getting my massage license. It’s not just a “Renegade” thing.
My point was not whether or not we should try to intentionally “trigger” emotional release. Rather, I was merely expressing the very real concern that such a release can, and often does, happen during a bodywork session. When it does happen, the patient should have adequate support available (counselors, other therapists, etc.) to turn to immediately following the session so that the surfaced emotions are not distorted and either projected onto the bodywork session and practitioner or left alone to develop into some other psychological issue such as depression.
I may be the exception to those here or all of humanity for what I know, a magnet to dysfunctional behavior, but I have personally been the target of aggressive, abusive behavior by both men and women who were living in a constant “fight” mode and deemed me a threat for no good reason: Not fully agreeing with them, staying calm and grounded when they escalated, or not crossing a professional boundary. So for me, this is not a random fear.
Trauma can leave people incredibly raw and vulnerable. This can lead them to over-compensate by being hypersensitive and aggressive. In these cases, when an emotional release occurs, an impression can be formed and completely believed . . . even though it’s little more than an illusion–a dysfunctional manifestation of deactivated cognitive ability. Projective Identification in the case of a therapy session can absolutely ruin a career when there are no witnesses to defend the therapist.
Furthermore, while it’s nice to have something tangible to put one’s faith in, when a complaint of sexual inappropriateness is made and charges filed, a signed consent or waiver, no matter how well worded, is not going to protect a practitioner . . . or his license. A District Attorney will spin that as an intentional plan to create a protective shield for a sexual predator to hide behind. Unless you have a spare $Million laying around for legal defense, you’re going to jail and losing your license. Period.
So, I return to my question: Does anyone know of any other realistic practices that we male LMTs in private, solitary practice can put in place to protect us from a potential Projective Identification of past sexual trauma onto a therapy session that releases memories and emotions related to that trauma?
Ted,
I work in a town where for the longest time there was only myself and another therapist practicing as advanced MFR therapists ( this therapist no longer practices). Before I split with my teacher over control issues, I strongly believed in the power of unwinding and allowed it to happen as a natural part of the therapy. It happened on occasion. The other therapist in town had much different beliefs, thinking that it was the true way for all issues to be resolved. Essentially all of this therapists patients went through emotional unwindings. The frequency of emotional release in this other therapist’s patient was more a matter of her beliefs than it was about the needs of the patients, in my opinion. How strongly a therapist approaches this issue with the intention of having the unwinding occur can and does play a role in the resultant emotional responses. Just saying.
I have clients complete a body awareness chart each session . It allows them to exclude any area that may be treated in any typical session.
http://www.restoredbytouch.com/resources/Body+Awareness+Chart3.pdf Is an online version of the form. I include verbal instructions too bc they often think the chart invites them to direct me where I should work rather than charting their pain patterns and sensitivities.
Added Bonus: The chart has been a useful tool to show clients their progress. People tend to forget about their pain history once the pain is gone. For example, a client mentioned she didn’t think she was making any progress. In looking at her charts, she could see the original 5 pain areas on her first chart and the 1 – 2 small areas remaining.
In addition to the chart, I explain my intention and the rational for the tx each time I work in an area that may give rise to concern or startle the client. Even with repeat female clients receiving repeat tx to the pecs, I give a verbal cue before starting tx.
I also request clients use their own hand to guard sensitive areas if I must work close but want to avoid any risk of inappropriate touch or drape slippage. For example, when I work serratus anterior with female client in side-lying and men who exhibit pain patterns that require release of inner thigh muscles.
Some therapists have a signed consent form when working pectorals muscles on women. I would if I were a male.
I heard another LMT describe how he was mortified when he tx from another LMT who made a draping error during the whole time she worked his leg. He never mentioned it to her! Studies show that only 5% of the general population will speak up about something of that nature at the time it happens.
Now, I also invite clients to tell me if the drape feels uncomfortable. I explain how I don’t always look down when I work, so if something shifts, I may not notice it.
Those are some specifics, but general demeanor goes a long way too. That includes what I say and how I dress. I wear scrubs during treatment. I conduct myself as professionally as possible so as to consciously build trust that their bodies and words are safe with me. If there were ever an accidental drape slippage clients oriented toward my general intent would be less likely to misinterpret.
That’s the office, but I’m also aware of how our conduct in personal situations impacts potential clients’ perceptions. Once when at a church picnic one of my table mates had just learned I’m a LMT. He commented about having met another attendee who’s a LMT. He directed my attention to her and said, “I wonder what kind of massages she gives!” His voice intonations and facial expressions indicated an assumption about sexual favors.
I found his attitude a bit disturbing, but when I followed his gaze, I saw what provoked him. Her summer dress was totally backless to below the sacrum. If she moved in certain ways, her breasts were exposed both from sides and front views.
It was difficult to defend her apparent lack of awareness about how her clothing could be interpreted so as to diminish her professionalism as an LMT. In talking with the women, she seemed very sweet and family oriented.
I make no judgment on her intent but, it was all too clear about the impact she was making on my other table mates. Our behavior communicates loudly on so many levels and so many situations both in and out of the office. Awareness and quality care is central to protecting our profession, our practice and our clients.
Thanks for reposting this here, Carole. There are behaviors we all can improve upon.
You are preaching to the choir over here. I work in Alabama, which is one of the worst places in the world for having the wrong idea about what massage is really about. So a male massage therapist is already playing against a stacked deck in my area. I have found the best way to combat this idea is with clear and open communication with my clients, regardless of gender. Don’t overwhelm them with a lot of technical BS, just explain in simple terms what I would like to see happen to their muscles, and how it can be done, then ask them if they are ok with it. It is such a simple concept, but one that a lot of therapists seem to forget in their zeal to actually get the work done. Several of my clients have told me that they recommend me over other therapists that they know simply because of that open line of communication that I establish. They feel more in control of the situation, and therefore, more comfortable.
I include this form with the client intake form and and they all read it and sign it before any work is done and answer any question they might have. Up to now I have not had any problems.
VILLASSAGE SOFT TISSUE THERAPY
200 Capri Isles Blvd. – Unit 1F Phone 941-223-6724 LMT FL# MA37108
Venice, FL 34292 E-mail dvillafana@verizon.net
PATIENT DISCLOSURE
To:_______________________
(Name of client)
Welcome to my practice. As you know, I am a practitioner of Soft Tissue Therapy which includes Myofascial Release, Soft Tissue Release, Craniosacral Therapy and Visceral Manipulation. I combine these modalities, which at times include Sports Massage, to custom treat you based on your needs.
I have been practicing Soft Tissue Therapy since 2002. My training and education is described below:
Completed 540 hours of Sports Massage at St. Croix Center for the Healing Arts in Hudson, WI- 2002
Graduated with a Certificate in Holistic Health Studies at the U. of St. Catherine in St. Paul, MN- 2002
Completed 1200 hours of Clinical working with athletes at the U. of St. Catherine – 2002
Completed the John Barnes program in Myofascial Release – 2008
Completed the 4 basic courses in Craniosacral Therapy by the Upledger Institute – 2010
Completed the 4 basic courses in Visceral Manipulation by the Barral Institute – 2012
I am certified by NCBTMB (National Certification Board for Therapeutic Massage & Bodywork) and a member of ABMP (Associated Bodywork and Massage Professionals).
I have been working for the last 10 years an average of 15 to 20 hours per week with people with soft tissue chronic pain following Florida law. I am requiring that you acknowledge receipt of the information provided in this form by signing it. You will receive a copy and I will keep the original in my records for at least 2 years.
My method of treatment is Myofascial Release combined with any other modality as mentioned above.
If you ever have any concerns about the nature of your treatment, please feel free to discuss them with me. I recommend that you inform your medical doctor that you are receiving Soft Tissue Therapy.
RIGHT OF REFUSAL
I reserve the right to refuse service to anyone. This includes but is not limited to anyone who requests treatment or services that are outside my scope of practice. I will exercise this right if anyone arrives for treatment under the influence of alcohol or recreational drugs; I reserve the right to charge for the session time, whether or not services were rendered, if I so chose.
Acknowledgement and Consent to Receive Services
I fully understand the purpose of Soft Tissue Treatment is to balance the body and treat the dysfunction to minimize or eliminate the soft tissue pain. This is accomplished through direct soft tissue treatment to improve range of motion with minimum pain and reduction of fascia restrictions.
The soft tissue Therapist does not prescribe or diagnose illness, disease, or any other physical or mental disorder of the person. Nothing said or done by a soft tissue therapist should be misconstrued to be such. Medical diagnosis or treatment should be sought when such attention is needed.
I understand it is necessary for the Soft Tissue Therapist to touch my body in order to assist me in aligning my body and to treat the soft tissue pain. Treatment requires an initial visual assessment where the client will wear shorts or a 2 piece bathing suit (female). During treatment it is necessary to expose the area being treated.
I give David Villafana my permission and consent to do all those things necessary to help me aligning my body and reducing the pain, including, but not limited to touching my body. I give the Therapist full privilege and license to work on my body in such a way as to restore and establish alignment and reduce my pain.
I have read and understand the above disclosure about the Soft Tissue treatment offered by David Villafana and David Villafana’s training and education. I have discussed with David Villafana the nature of the services to be provided. I understand that David Villafana is not a licensed physician but does possess the required Florida License to practice the mixed modalities as listed above. I understand it is my responsibility to maintain a relationship for myself with a medical doctor. I have consented to use the services offered by David Villafana, and agree to be personally responsible for the fees of David Villafana in connection with the services provided to me.
Signed:________________________________________ _ Date:_______________________
(client/parent/conservator/guardian)
Indicate capacity to sign if other than client_____________________________________
http://www.Villassage.com
Regarding David Villafana’s client form: Intake forms are useless in lawsuits and are not recognized in courts due to mitigating or extraneous circumstances which require further hearing, judgement and action.
Huge resort spas and medical doctors know signing waivers is futile yet continue the printing of waivers and warnings to consumers in the hopes it will deter litigation. Generally the provider’s educational achievements are framed on the wall in the reception area and not posted for client/patient to acknowledge through signature.
Intake forms/sighed consents, etc., may be useless in court, as you say, but I do feel they have a place in setting a precedent of proper boundaries. If a therapist/client relationship is started in this way, fewer problems may result. Lawsuits can happen to even the most innocent, but we all do our best to avoid this.
I always make sure that even with regular massage therapy I let a new client know that it is ok to say what they are uncomfortable with. Especially if they have never had a massage before. With children, I require a parent be in the room for this very reason. It is way to easy to misunderstand some of what we do for someone who has no prior knowledge of massage or Myofascial Release!
PS Walt sorry I missed you last time you were on St Simon’s Island!
I currently have a Massage Therapist working alongside of me who recently underwent court battles and was convicted of gross sexual misconduct but appealed the matter and was cleared of all wrong doing.
I have allowed him to work with me because he was a student of mine and i feel he needs a second chance and some mentoring. What do you recomend he should do to regain his Integrity within the massage community?
Is regaining his integrity within the massage community the most important aspect? It seems that regaining his standing in the general community would be equally if not more important, as they are the ones who will come to see him. Just like newspaper retractions, aquittals do not go on the front page. Learning to be open, forthright, and squeaky clean would seem an appropriate starting point.
Melody, There are two options: one, if he stays in the area where the problem arouse he has an uphill battle because people will remember the incident and will forget that there are many ignorant people that make baseless judgements. He might become a community activist and and spent some time educating people and volunteering his time to help poor people; also, he might consider a form like the one I showed above.
The second option is to move to a new area and start all over again. This is the easy way out, but it will depend on his strength of character.
Melody, I believe you need to review some of the basic reporting and communication skills with the gentleman under your guidance. For example there are forms such as 1. Health history form the client fills out, 2. Clinical Assessment forms outlining what assessment was performed and why(of course asking permission if I can assess). 3. There are treatment forms outlining the areas you are going to treat and treated along with the techniques used. 4. He needs to go over the verbal description of the areas he is going to treat on the client and why following this with client consent…this includes informing the client of the type of lotion you plan on using(incase they have an alergy etc)… 5. when on the table, communicate as to where you plan on working next. …Most of my clients are post surgical mastectomy patients, hip/ knee replacements, low back and post surgery patients…no matter how many times you may see the same patient you must ask and make no assumptions from one treatment to the next…(this is fundamental treatment rules one learns in Massage school). If you need forms let me know…
Yes I think your right concerning this matter of being squeaky clean and upright within the community. Re-establishing his integrity and respect and being able to trust my own clients to his care and having him come to my events because he represents my company and my name as well. Are there any good books other than Educated Heart for me to recomend to him.
The allegations and conviction point out the therapist was accused of groping female clients. What concerns me is that it was more than one female client.
I firmly believe in Intention. Where’s your head at? Not to be flip, but it better be in the game.
Well said.
Hi Rick. Good to hear that someone else is doing what I do, it makes life so much easier when people stay dressed. Like you, I tell people to wear comfortable clothes (no jeans). I’ve also found that this arrangement makes people look at me as a part of their medical team. Another benefit is that it actually makes their session 10 minutes longer because time isn’t taken away for undressing and dressing, and there is never anyone with ideas of sex.
My work is done with the patient clothed, with a preference for on-the-skin work when possible. I believe the type of work dictates whether one can work through clothing (Upledger style), shorts and tank top (my style), or completely disrobed. Considering the work one does as well as the clientele, I believe many could be just as productive with their clients clothed, rather than naked and draped, drastically reducing their chances of any issues.
I very rarely work on skin, even using a cloth if the person does come in with shorts on. I just find it easier since the my method I developed years ago doesn’t ever slide on the skin, it’s easier to have material between my hands and skin.
The neck is my only exception, and I still never slide in the skin. I haven’t bought oil in 15+ years, a great savings. I also only treat the muscles that have an impact on the specific condition I’m treating.I very rarely do a full body treatment, only if it’s warranted given the situation.
Walt-
I read the article in the Philadelphia Inquirer about the sentencing of this therapist. In the article it said that he was convicted of digital manipulation of vaginal regions. There are some problems with this therapist doing this kind of treatment. One, is that he is a massage therapist and internal treatment by a massage therapist is against the practice act for massage therapy licenses in PA. Two, even if he did it I wonder if he got written permission from the clients to perform this type of treatment. Three, for a male providing this kind of treatment with a female it is important to have another person in the room and for both the client and other person to have a clear idea of what is going to occur prior to starting and to dialogue with the client throughout the treatment as to what the therapist is going to do next.
Doing internal vaginal or rectal treatment is always a touchy subject because of how invasive it is. Doing external treatment in the genital area of either males or females also is very invasive. It is really important to have the trust of the person who you are working with and that they fully understand what you will be doing and where you will be touching them. If I am only using one hand I try to place my other hand somewhere on the client’s body that is a neutral zone, a hip or arm, so that the client knows where both hands are at all times.
Whenever I treat a man in the genital region, and I’m not directly accessing the testicles or penis, I ask the man to hold those structures out of the way and make sure that he is draped well. This is also important when doing rectal work with a man. Men are just as likely to have privacy issues as women are.
I also tell the client that I am going to have my hand(s) on the chest/breasts of a woman prior to doing so and that I will have my hand quite deep into the intergluteal cleft and not trying to be “fresh” when I do coccyx work externally. As Walt has mentioned I have begun working over clothing quite often when I do external work in the pelvic region that doesn’t necessarily require me to be skin on skin. Although skin on skin often is optimal it isn’t always necessary to get good results.
No matter what or where we are working on a person we need to remember to keep the client informed of what we are going to do prior to beginning treatment and throughout treatment. None of us wants to end up in the situation that the therapist in PA has found himself in.
Hello there:
I have been a massage therapist for 14+ years and always communicate clearly with each of my clients/patients. Our profession is of utmost importance to me and I respect and maintain my professional boundaries in all areas.. We, as massage therapists, have fought for years to gain respect as well as being recognized and accepted and valued of our profession and like PT, and dr’s and anyone in trust of a person’s health, should uphold all the protocols of being a professionalism. Communication is key as well as trust and reputation. There many more characteristics that make us all outstanding in our chosen field. I live in Ontario, Canada. We owe ourselves, our colleges, our professional associations, our clientele, our directors, etc and the community the right to safe, trustworthy and excellent care.
I think this whole discussion should be re-started in the interests of accuracy and not scaring the heck out of all male massage therapists. The early reports of this case now seem highly misleading. The article in the Philadelphia online newspaper stated that “Webb digitally penetrated the four women.” http://articles.philly.com/2014-07-30/news/52192640_1_massage-therapist-hogan That’s a different story, although I can understand that the details would be suppressed by the media for the sake of those who were assaulted.
If vaginal penetration is what the jury found as fact, then the convictions and sentence seem justified. There was no consent for any treatment, and probably no training for it, that involved vaginal penetration, which is usually specifically prohibited in the massage therapy regulations and ethical standards (as opposed to some physical therapists who are trained and permitted to do related work).
Without that important fact, the penetration, the 7-14 year sentence would seem excessive. However, no amount of “explanation” or “awareness” or “sensitivity” or “communication” or “permission” or “draping” would make it okay for a licensed massage therapist doing myofascial release or massage to digitally penetrate four massage clients. That is far beyond the massage scope of practice and certainly sounds like an aggravated criminal sexual assault due to the nature of the professional relationship of trust.
Earon,
While I respect your opinion, my intent was not to scare the “heck out of” anyone, but to attempt to re-frame how we interact with our clients, specifically with myofascial release. If one reads through all accounts of the testimony, the convicted therapist’s reports of what he had done sound nearly identical to what MFR therapists do on a daily basis. I in no means mean to imply the therapist is not guilty, based solely on this fact. If the actual facts were as the jury found, then he grossly crossed a line. I wrote this post to make therapists aware that what we view as normal operating procedure may indeed be mistaken for misconduct on the part of the public. While proper communication may lessen or eliminate this as a problem, I am advocating therapists to revisit whether skin-on-skin contact is necessary in sensitive areas, as many of us were taught.
Earon, It’s not just men. I have a client that was asked by a female massage practitioner if she would like to have “vaginal massage,” and when my client declined, this practitioner persisted. My client did suffer some subsequent fear issues, and shared this with me during a shiatsu massage. I don’t have clients disrobe (although I’ve heard some shiatsu practitioners do…?), so she felt safe. I talked with her during the massage reassuring her that the other practitioners actions were completely wrong and that she could press charges, or whatever she felt she needed to do. She came to a point where she was able to feel safe and empowered again and has come back on several occasions. So I think Walt is correct and the whole issue of what is acceptable and the way to handle it will need to be further examined as massage continues to become mainstream. Plus, I am a firm believer that not only should we all be given a written exam, but before any licenses are issued we should all be given a hands on massage! Even if a practitioner does not display this type of behavior, there are clues in a persons massage style that could be valuable in curtailing these problems.
Walt, It occurs to me that the practitioners mentioned above may have NOT indicated their intent or discussed or informed the client properly. I humbly site one of my own situations where, as a shiatsu practitioner, I occasionally use a specific point. Pericardium 1 is a point that lies directly on the lateral side of the areola. On men of course, this is not a problem but with a woman there is a chance that my thumb will land on the wrong place, and that could be disastrous. I always explain where and why, and then ask permission. And sometimes I even ask help in locating the area. In my own experience receiving massage, I have encountered a few practitioners that have a kind of arrogance or perhaps entitlement attitude that, since they are practitioners, I should trust them and let them touch me where ever they want. This always ends up being awkward for me, even though I’ve been a practitioner for 16 years. I always feel a bit violated when their hand winds up somewhere delicate, or even somewhere painful without proper notification! Perhaps our schools could emphasize the need to explain to the client what we want to do and why it will help so that client feels safer. Just a thought! Thanks!
Great points, Paula. I too have encountered this arrogance in therapist who have treated me. It needs to change at many levels, both in early training (school) as well as in continuing education.
Although I never felt like your intent was to scare your audience, it is good to know that the massage therapist is serving time because of actual digital penetration on four separate occasions.
Since I have been working through the clothing for years, this post hasn’t changed how I approach the human chain. But, it did serve as a reminder to pay attention to my emotional intelligence (EQ).
This is partly due to the fact that we never really know the *entire* history of the person that’s on our table. So to be on the safe side, I think it’s a good idea to tread lightly until we establish rapport and trust with out clients/patients.
Over the last year, I have been much more selective with who I work on. Although I can’t know for sure if it will help me to avoid situations like the one we’re talking about here, I do feel like it can’t hurt.
As an instructor, I feel like the majority of the massage therapy schools can improve on so many levels.
It takes so many hours of practice for most students to feel confident with touch. And for the most part, I don’t think it’s a stretch to say that their confidence doesn’t take hold until they have logged a considerable amount of hours after graduation. Because of that, I’m much more comfortable with a pyramidalis muscle being addressed in a CE class.
But even then, a seasoned professional can have a very good understanding as to the *why* and the *how* behind the need to address the pyramidalis, and then, still not be completely comfortable.
And then there is the client’s conscious (and unconscious!) response to the lack of confidence in the practitioner’s touch to consider as well.
In the end, there is a lot to think about.
with *our clients/patients
Thanks Walt. I agree and practice in a similar way. Clarity is the best policy!
[…] speak at length to this topic in a blog post (here). During any of my Foundations in Myofascial Release Seminars, I ask therapists to practice wording […]