CE INSTITUTE LLC BLOG

by Selena Belisle, Founder/Instructor, CE Institute LLC

Massage therapy and spa business primarily operates with in-person transactions, where you are face to face with the customer who pays you.  But, sometimes an individual or "representative" pays for a service prior to the appointment with a card in-hand. Unfortunately, in an extremely small majority of times, these massage therapy payments may be illegitimate.  The person has paid with a credit card number that is not there own, and will eventually be challenged and lost when its determined that someone's credit card was illegally used.

The largest scam massage therapists usually face is when someone contacts you stating they want to send a large group of people, or clients for regular appointments for large sums of income. The discussion will then turn to the person requesting your bank information, or asking you to make a payment to a driver or another individual to secure the work.  These are the types of financial scams that massage therapists and spa practitioners primarily face within our industry.  In our experience, we have never seen this type of "opportunity" turn into a legitimate massage therapy work experince.

The e-commerce website company Shopify, has provided new and up-to-date information about e-commerce fraud, including statistics, types of fraud and some identifying factors. While much of what Shopify has written and distributed (below) mostly relates to products and not services, it is great information that may help you avoid some of the the fraudulent trillion dollar business tactics. The following information is direct from Shopify, and edited in some places to show massage and spa industry issues:

In 2021 alone, approximately $20 billion in ecommerce losses were reported in the US due to online payment fraud. North American merchants have seen a 68% increase in fraud attempts throughout the COVID-19 pandemic. 

What is e-commerce fraud?

Ecommerce fraud happens when scammers intercept transactions happening on your online store. Also known as payment fraud, it’s a criminal act in which scammers hijack transactions and steal money from either the customer, the merchant, or both. 

With global ecommerce sales tipped to reach $5.55 trillion in 2022, there’s plenty of opportunity for scammers to hijack customer data and commit fraud. Let’s take a look at the seven types of ecommerce fraud you’re likely contending with an online store: 

Friendly fraud (does happen in the massage industry)

Friendly fraud happens when a customer pays for your massage service, and later files a chargeback with their bank. Shoppers illegitimately claim their they didn't receive the service or some other illegitimate execuse such as they canceled the appointment shortly after placing it. A complaint to their bank prompts an investigation, causing 2.9% of enterprise brands’ ecommerce orders to result in a chargeback.

Card testing fraud (also happens in the massage industry)

Card testing is a tactic fraudsters use to determine whether a stolen credit card works. Scammers often make a small, low-value purchase so the fraudulent transaction goes under the radar of the card holder. Once the card is verified to still work, they go on to make more expensive purchases using the stolen card. 

Card testing is the second most popular type of ecommerce fraud for all merchants. Not only is it frustrating for customers, but should most of your online payments be blocked due to card testing fraud, your business will be subject to extra fees and disputes. 

Refund abuse (not typical in the massage industry)

Refund abuse is a type of ecommerce fraud where customers return broken, damaged, or stolen items to a retailer in exchange for a refund. 

While many merchants have strict return policies that determine what qualifies for a refund, it’s still a costly problem. The National Retail Federation found that retailers lose $5.90 for every $100 in returned merchandise due to this type of fraud. It’s the type of online fraud that saw the biggest increase, with merchants reporting a 60% uplift in refund abuse last year. 

Online payment fraud (does happen in the massage industry)

Online payment fraud happens when scammers steal another person’s payment details and use them to make purchases. I was working in a spa where some young customers walked-in for several hundred dollars of massage and spa services, and then used a credit card that did not belong to them to pay for the services. We received a charge-back.  

Because the customers' spa services exceed $500, we asked for identification with the credit card and the person holding the card stated he did not have his license on him.  His friend who also received a massage appointment offered his identification so we accepted that, and provided this with the chargeback to the police. The police did nothing about it other than take a report and tell us other merchants in the area were subjected to the same fraud with the same group of customers. We were never paid.

Credit card fraud can also result when scammers create duplicate versions of your website and encourage customers to unknowingly purchase items through a fake website. Hijackers recoup their cash and store their credit card number for future scams. 

Retailers worldwide suffer from online payment fraud, though it’s most prevalent in Mexico, where merchants saw a 77% increase in online payment fraud last year. 

Account takeover fraud

Account takeover is a type of fraud that happens when scammers break into a your online account or website to use stored credit card numbers to make fraudulent purchases else where. 

Some 23% of brands experienced account takeover fraud last year, with scammers accessing customer accounts that use weak passwords, phishing emails, or malicious software on the device used to purchase. 

Promo, affiliate, or loyalty abuse

Ecommerce brands use promotion, affiliate, and loyalty programs to attract new customers and engage existing ones. But their popularity means promotions attract scammers who rinse your business of cash through fraud using tactics like:

• Affiliate fraud. Affiliate marketing gives customers who refer friends a percentage commission on their order. However, some affiliates bend the rules. They send spam traffic to the website or use stolen credit cards to get paid out—even though the customers they’ve referred aren't legitimate. 
• Loyalty fraud. Research suggests that $1 billion in rewards value is lost every year to fraud. It happens when customers join your loyalty program, earn points through stolen credit cards, and resell them for a percentage of their value on the dark web.
• Promotion fraud.Almost half of ecommerce businesses have experienced a rise in promo abuse since the start of the COVID-19 pandemic. It happens when scammers find loopholes in a retailer’s promotions to claim products for free. 

Triangulation fraud

Ecommerce businesses that sell through various sales channels often fall victim to triangulation fraud. It happens when:

Triangulation fraud is a serious problem for both ecommerce merchants and customers. Marketplace shoppers unknowingly have their credit card details stolen. Retailers also process fraudulent orders without recognizing the invisible middleman using stolen cards and netting the difference between the marketplace price and actual product price. 

• Fraudsters list your products for sale on marketplace such as eBay or Amazon
• Customers purchase the lower-than-RRP item from the scammer using their legitimate credit card
• The scammer uses a separate fraudulent credit card to buy the real product from your store using the customers’ shipping address
• The customer receives their order but their credit card information is compromised

Triangulation fraud is a serious problem for both ecommerce merchants and customers. Marketplace shoppers unknowingly have their credit card details stolen. Retailers also process fraudulent orders without recognizing the invisible middleman using stolen cards and netting the difference between the marketplace price and actual product price.

How to Identify Possible Fraud on Your Website:

Ecommerce fraud is an expensive problem, both in terms of lost revenue from intercepted online orders and customer loyalty. Shoppers are unlikely to return to your website if they were a victim of fraud the last time they purchased through it. 

Here are some red flags to spot possible fraudulent activities on your own website:

• Higher order volumes. Scammers using stolen credit cards often purchase high-ticket items since the cash they’re spending isn’t their own.
• Low value orders. “Be on the lookout for low value transactions, especially if they’re only around $1,” says Ben Hyman, CEO and co-founder of rug brand Revival. “Fraudsters will purchase low value products to see if their stolen card works.”
• Different credit cards. It’s a warning sign when one customer makes several purchases, each using a different credit card. Scammers often do this to test whether stolen credit card details work. 
• Repeated declined transactions. Fraudsters might not have the information they need to make purchases from a stolen card. If a payment declines repeatedly due to security code errors, for example, it’s unlikely to be an honest mistake from a genuine customer.
• Unusual IP locations. Look out for several orders from the same IP address, or suspicious orders from an IP address in a location that isn’t familiar. If most customers are in the US, for example, an attempted high-value order from an IP address in Indonesia is a warning sign of ecommerce fraud. 
• Different billing and shipping addresses. This is especially common with triangulation fraud, where fraudsters use stolen card details to ship items to legitimate customers. 
• PO box shipping addresses. While this type of shipping location is popular with businesses, PO boxes allow scammers to ship online orders to an anonymous location. Be wary of shipping too many orders to a single PO address. 

Here are some fraud prevention strategies to minimize the likelihood of fraud happening through your website. 

1. Manually Review Risky Orders

Ecommerce software exists to flag risky orders. Manually review orders that raise a red flag, reaching out to the customer for further information if you’re unsure whether it’s legitimate. 

If you’ve received a low-value order from an unusual IP location, conduct a manual review and reach out to the customer for further verification. Failing to hear back means there’s a strong chance that the order was made using a stolen credit card. 

Similarly, consult a customer’s purchase history to determine whether a risky transaction is ecommerce fraud. It’s likely not a cause for concern if a shopper who usually makes orders from the US makes one purchase from an IP address in Spain. But there’s a strong chance their account has been compromised if they’re making orders bigger than usual, using a different credit card, from a different location. 

Be vigilant when it comes to new customers. Take a closer look at orders from new customers, and be prepared to cancel or refund them if something looks suspicious.

2. Collect Proof of Delivery

Have your massage and spa clients fill out an intake form prior to the start of service, and detail notes collected about their appointment on the form. This will help show that the service was indeed provided after the fact. While you cannot show actual medical details to others because this would violate HIPAA, having the intake form in the office will help.

You can also provide surveys for your services after the treatment, and ask clients to fill these out to not only improve your practice, but to also show additional proof of receipt of services. Ask a client to mark the form n/a with their initials if they do not want to fill out the form after the fact - it may be hard for the client to say no to such a basic request after such a personal service.

3. Be PCI Compliant

All ecommerce businesses need to meet Payment Card Industry Data Security Standards if they’re processing online payments safely. These PCI compliance standards include:

• Changing the default password for software and systems
• Encrypting cardholder data across open, public networks
• Using antivirus software to prevent malware attacks
• Restricting which employees can access cardholder data
• Regularly testing online security systems 

“Having a firewall between your internet access and any system that stores credit card details is one way to ensure PCI compliance,” says Sina Will, co-founder of Foxbackdrop. “Therefore you must verify that you are adhering to the appropriate PCI requirements to avoid sanctions or penalties.”

4. Post Clear Policies on Your Massage or Spa Website

Post policies on your business website that explain how your business works. Aside from blanket terms and conditions, showcase clear policies on your website to crack down on ecommerce fraud. That includes: 

• Strong password policy. It’s easier for scammers to commit account takeover fraud if a customer’s login details are easy to crack. Alongside two-factor authentication, Stephen Light of mattress brand Nolah recommends a password policy because, “While some customers find password requirements tedious, it makes it much harder for any fraudsters to hack into our customers’ accounts if their passwords are complex.”
• Return policy. Build your case against customers requesting chargebacks or refunds with a solid return policy. Explain what qualifies for a return, the documentation needed, and how it’ll be processed (such as a cash refund, exchange, or store credit).
• Promotions and rewards policies. From limited order quantities to prohibiting the sale of reward points, this type of policy backs up any ecommerce fraud that goes against the terms and conditions of your promotion. 

5. Make Sure You Are Collecting ALL Credit Card Details to Verify Legimate Transactions

A telltale sign of ecommerce fraud is when a customer’s billing, shipping, or card details don’t line up correctly. Automatically identify orders that raise this red flag using verification software, such as:

• Card verification number (CVN). Scammers only need to see the front of a credit card to make fraudulent online purchases. Add the three or four digit PIN (CVN) as a required field on your ecommerce checkout as an added layer of security. It’s the most popular fraud detection feature used by more than half of merchants. 
• Address verification system (AVS). This verifies a customer’s billing address against the card they’re using. As Stephen Light, CEO and co-owner of Nolah says, “Many fraudsters will use multiple cards to make purchases to a single address, so an ASV can catch them out.” 

 6. Use IP Fraud Scoring Tools for Greater Protection

One person can commit several types of fraud using the same computer. Detect those serial fraudsters with IP scoring tools such as SEON or Scamalytics. Each detects an IP address that’s been linked to fraud in the past, using signals like:

• Their location (and whether it matches the country the card is registered in)
• Whether they’re using a VPN to disguise their true location 
• The type of internet service provider, such as a residential or public connection 

Orders placed from an IP with a high fraud score are highlighted, ready to manually review risky orders or automatically block them. 

In summary, these are only a few methods that could help avoid fraudulent transactions. Learning about them is a great start to be able to identify and address them when they happen to hopefully prevent an fraudulent incident. Unfortunately, blocking 100% of fraudulent transactions is likely not possible. And while this is not a total exhaustive list of possible fraudulent exercises, it does provide many different examples where a practitioner could fall as a victim.

Fraud exists because it can be used in new and unthinkable situations so it would be extremely difficult to protect yourself from all fraud.  However, some fraud exists because it has been successfully applied in the past, such as asking a trustring massage therapist to share their bank account information for payment, or pay a driver in advance to drop off spa customers, etc.

We hope this information helps enlighten spa and massage industry staff to help avoid fraudulent transactions. Learning more about fraud is one way to help prevent it.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

#fraud #preventfraud #spa #spabusiness #massagebusiness #massagepayment #payments #website #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy

There is a website promoting free resources for massage therapists to share to help prevent illicit client solicitations within the industry.  The following information is available at there website which you can view by clicking: https://respectmassage.com/

The website states and we concur:  It would be weird to hang a sign on the front door of your practice saying, “We don’t give happy endings here.” Let Respect Massage do the talking for you. Allow our logo downloads and videos to open up a conversation with the public and your clients about the intentions of your practice.

They also encourage massage therapists to download and post their logo from their website with the following statement. 

Massage therapists that are members of Respect Massage hold themselves to the highest standards of an ethical, boundary-driven practice. Respect Massage members have a zero-tolerance policy for solicitations of any kind. Jokes, innuendo, and inappropriate requests are taken seriously and will result in the swift termination of the session. 

Respect Massage and the ABMP are third party agencies. Neither are affiliated with CE INSTITUTE LLC.  However, we always attempt to share valuable insights and information whenever possible, and this promotion may help save others from uncomfortable if not illegal business situations with unwanted solicitations.

The massage industry has been an unfortunate, vulnerable place for unwanted solicitations. Such practices often create an unsafe space for legitimate massage therapists to operate and work. It is past time to lend a voice and put a stop to unethical and illegal practices, so we hope all will spread this message!

If you are a victim of sexual assault, which in our opinion, includes unwanted solicitation of sexual acts, you can chat anonymously with a support specialist by visiting: https://hotline.rainn.org/online

Please also call 911 if you ever find yourself in danger or feel threatened in any way or by anyone. Safety is paramount for every individual, especially for those who unwillingly find themselves in dangerous or illegal situations. What's most important is to establish your safety first and foremost, and above all else.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

#respect #respectmassage #ethics #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #massageethics 

by Selena Belisle, Founder/Instructor, CE Institute LLC

Instilling trust amongst clients is paramount to providing a superior service. So how do you instill that trust with a new client who has another favorite therapist?

Establishing client confidence can regularly be achieved by applying commonly practiced opening rituals. Spending 60 seconds or more with something that feels familiar at the start of any session could deliver an incalculable benefit. Routine opening practices can help old clients quickly reconnect, and some might instantaneously relax when they recognize what they are receiving.

Similar opening rituals could also prove beneficial when couples book the same appointment in the same room. It could prove laborious for a partner to feel that they received lesser or greater treatment when at least some of their service was the same.

Unfortunately, a massage recipient could also attempt to invalidate a therapist’s work because it was not recognizable and did not match their previous treatments. New massage clients may additionally be confused when their session does not match what their friends or family have told them. Starting or finishing a treatment in a similar manner to what is commonly practiced could help avoid these adverse feelings.

There are many advantages to using familiar rituals beyond what we have published. And while it is perfectly acceptable to provide something different, there are a few commonalities that can be shared.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

In this article published by Massage Magazine, we examine common opening rituals plus a few closing practices in massage therapy and bodywork services.  To view the article on Massage Magazine's website, please click HERE.

#massagepractices #healthcare #healthcarepractices #lmt #massage #massagetherapist  #bodywork #bodyworker #massagetherapy #openingrituals #rituals #openings #closings #closingpractices #openingmassage #closingmassage

by Selena Belisle, Founder/Instructor, CE Institute LLC

To maintain a professional and desirable massage therapy work environment, make sure your workspace is:

• Free of clutter
• Temperature controlled (to the client’s comfort)
• Installed with appropriate or adjustable lighting
• Dark enough for the client to relax with at least 40 watts of light during bodywork
• Light enough so the client can safely navigate in and out of the room, as well as dress, undress, find their personal belongings, etc.
• Properly installed with smoke detectors, carbon monoxide detectors, proper exit signs, fire extinguishers and any other safety equipment as needed and/or required by law
• Stocked with appropriate cleaning supplies and disinfectants
• Operating with an efficient scheduling process with proficient ability to process client cancellations, changes and payments
• Operating with appropriate security to keep client records and appointments confidential
• Installed with stable flooring, including any rugs secured to the floors and no uneven surfaces where clients could trip
• Easily accessible for the client. Ensure table height is appropriate so client can safely mount and dismount the table
• Provide a stepstool if the table is too high and nonadjustable

The massage therapy reception and work space should be equipped with appropriate chairs for sitting, waiting or changing, especially when serving a frail clientele. With geriatric or orthopedic leg post-op clients consider:

• Low setting couches may be trendy and sleek but would be difficult for a client to sit or rise
• Chairs without arms may pose the same problem
• Provide chairs and seating arrangements that create easy accessibility, especially for a client that may be in pain

Ensure the bathroom is clean and has:

• Toilet paper
• Hot & Cold Running Water
• Soap or Hand Cleanser
• Ability for client to dry their hand
• Paper towel
• Washable linens (to be used one time then laundered
• Air dryer

Always Perform Proper Hand Hygiene:

• Before eating
• Before and after having direct contact with a client (whether it be a massage, manicure, facial, haircut, waxing appt., etc.)
• After contact with blood, body fluids or excretions, mucous membranes, non-intact skin or any questionable exposure
• After contact with a sharp object that could have cut skin
• If hands could be moving from a contaminated-body site area to a clean-body site during client contact
• After glove removal
• After using a restroom
• Use additional care as needed

High Standards of Personal Hygiene and Professional Service Considerations Include:

Clean uncontaminated clothing.  Refrain from wearing clothes that have come in contact with a client – these should be changed to prevent “cross contamination” from client to client.

Use hand towels to separate the client’s body from bodyworker clothing.  If the bodyworker lays a prone ankle over their shoulder, then a hand towel should be placed over the bodyworker’s shoulder to prevent contact between the client’s naked ankle and the bodyworker’s clothing.

Refrain from wearing clothes that are dirty, have body odor, etc. 

Keep a “change of clothes” readily accessible so that appointments would not be cancelled due to soiled clothing OR that appointments are not performed with soiled clothing

Refrain from wearing clothing that provides excess nudity, i.e. bodyworker should wear comfortable, conservative clothing with a professional appearance.  The bodyworker industry does not want clients to “get the wrong idea” of the nature of therapeutic work because the bodyworker is dressed inappropriately or “suggestive” for the wrong type of service.

Refrain from wearing clothing that has holes, political statements, foul language, considered controversial or anything that could be upsetting to any client or coworker.

Use your best judgement.  Bodyworkers regularly earn more than the “average” hourly American wage.  Bodyworker’s should take pride in their appearance, and “look the part” of a professional.

Avoid Halitosis (bad breath)

Clients and coworkers do not appreciate foul odors, including bad breath.  In fact, a client may avoid communicating with a bodyworker who has bad breath.  Avoid eating foods that could cause undesirable odor such as onions, garlic and anything else that may be considered undesirable. Communication is critical to a safe or successful massage therapy session, so consider having the following available to avoid halitosis:

• Breath mints
• Mouth wash
• Oral sprays
• Toothbrush with toothpaste

Hot Towel Massage Therapy & Bodywork Practices

Hot towels are often used in bodywork service but are often improperly prepared.  Many times, bodyworkers will prepare hot towels by throwing a few towels in a sink and running hot water over them.  Sinks can harbor bacteria and as such – should not be used to prepare hot towels without cleaning the sink first. 

Hot towels can also be made with a clean bowl.  Simply put towels in a clean bowl and pour hot water over them. Excess water should be “rung” from the wet towels and be placed in a hot towel cabi to maintain heat until the bodyworker is ready to use them. 

The inside of a warm most environment can be a bacterial breeding ground, so if a hot towel cabi is used, be sure to routinely clean/sanitize the inside.  This includes leaving the inside of the cabi door open when not in use.  Anaerobic bacteria (bacteria that cannot live in the presence of oxygen) will not be able to continue to grow in the present of oxygen with the door open.

Finger nails Must be Short and Clean

If the whites of the fingernail beds are showing, then make sure underneath the nail is cleaned prior to working on each client with a nail brush or other appropriate cleaning method

Some bodyworkers can perform bodywork with medium to long fingernails however this is not advised under normal bodywork circumstances.  That’s because of multiple factors including:

• Bacteria, virus and other undesirable agents can linger underneath the nail in this hard-to-reach area
• When working on clients with poor circulation, such as a diabetic geriatric client, a small cut to the skin (by a fingernail that’s too long), could create detrimental effects. A client in this medical condition generally has poor wound healing – and if the skin cut becomes infected, it’s possible the client could lose their limb or life with a systemic infection, all from a simple fingernail cut to the skin by a bodyworker.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#client #clientrelations #workenvironment #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #halitosis #hygiene #relax

by Selena Belisle, Founder/Instructor, CE Institute LLC

Professional massage experts agree that all therapists should refrain, under all circumstances, from initiating or engaging in any sexual conduct, sexual activities, or sexualizing behavior involving a client, even if the client attempts to sexualize the relationship.

I Met My Soulmate Situation

What experts “disagree” about is the “meeting of a soulmate” situation when working with a massage client.

As our culture works longer hours, a good deal of relationships start at work. So, this poses the question – what is someone supposed to do when two consenting adults would like to start a personal relationship above and beyond a practitioner/client relationship? What is someone supposed to do when they feel they have met their “soulmate” at work – and are in a forbidden practitioner/client relationship?

Apply the Following for Ethical Considerations

Some massage experts agree that it is okay to terminate the practitioner/client relationship to start a personal relationship. Ways to address this could include:

• Determine the “end-date” of the practitioner/client relationship to start a personal relationship. A specific date creates a clear defining moment of when the relationship changed for both parties, and with each other’s consent.
• Draw up a written contract that clearly states the practitioner/client relationship has been terminated for purposes of to start a personal relationship. Include details such as there is no payment exchange for massage or bodywork services in the new personal relationship.
• Consult a licensed attorney or whomever seems most appropriate for the situation when needed.  This includes whether or not the therapist should inform colleagues or superiors of this decision to change the client relationship status.

What to Do When You Are a Massage Therapist Employee
Informing an employer that you wish to start a personal or sexual relationship with a client would likely result in a reasonable loss of employment.  Also, not informing an employer could also result in a loss of employment if they found out.  It's almost a no win situation.

Every individual situation is different, and each individual must weigh their own pros, cons and ethical obligations to make their own decision to determine if changing a professional relationship with a client to a personal one is worth it.

Personal Experience

As a previous large employer of massage therapists, sometimes employing more than 40 at one-time, I've seen several instances where massage therapists have dated each other from work, which sometimes caused friction at work and was not a great idea for the staff as a team.

I also experienced one therapist tell me very professionally that she was mutually interested in dating one of her regular weekly clients, and they wanted to continue their massage sessions so this would not affect me.  My response was I was okay if they wanted to start dating, but that would mean it would be the end of his clientship at our massage establishment, which they both accepted.  We would no longer be able to service his massage appointments at our business to establish a clear line that the professional relationship has ended and a personal relationship has begun.

It is Never a Good Idea to Pursue a Personal Relationship with a Client

How you chose or navigate your own personal choices or interests with clients is a personal decision that each therapist must make for themselves.  What is important to remember is your professional and ethical obligations to the client, including how a power differential might have influenced the interest or start of the personal relationship.  It is NEVER a good idea for a health care provider to start dating their client.  However this has happened with proper and professional discretion amongst a few therapists, with successful navigation when ethics and clear communications were applied.

Soulmates are supposed to be a once in a lifetime person.  Any massage therapist who is regularly dating their clients, regardless of professionally terminating the client relationship, would likely be seen as a sexual predator or someone who is abusing their power differential in the client relationship.  While some may understand that someone has met a soulmate at work, dating multiple people from work would not be appropriate and is extremely ill-advised. In fact, it could be deemed unethical by a licensing board and result with a suspension, training requirements, fines, loss of licensure and become extremely damaging to your public image, nevermind a client who may have felt taken advantage of in the power differential. A therapist also risks personal lawsuit or criminal action if a client claims a sexual relationship started during licensed healthcare services.

Also, even just one inappropriate sexual engagement with a client at work or outside of the establishment would be considered highly unethical, if not illegal.  A once in a lifetime exception, if there ever was one, would only apply when the professional client relationship is mutually terminated to consent to a new personal relationship that would strictly occur outside of the workplace to establish and maintain clear boundaries.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#client #clientrelations #ethics #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #sexualrelationship 

by Selena Belisle, Founder/Instructor, CE Institute LLC

Address a Client's Massage Therapy Goal

Ascertain your massage client’s goals and address them during bodywork. Notify the client if any of their goals or medical conditions are unreasonable or contraindicated prior to starting service.

Set reasonable client expectations with a bodywork treatment plan, such as expected number of appointments to achieve client’s goals.  Explain to the client that there are no guarantees made with the treatment plan. A treatment plan is a set of goals that you wish to mutually achieve.

Do not continue to work on client if their bodywork goals are not being reasonably satisfied, or if the client’s medical condition deteriorates. Refer the client to a medical professional for greater medical evaluation if or when a (reasonable) client goals cannot be met and the client continues with a health issue or pain.  it is vital to immediately refer the client to a medical professional if their health deteriorates at anytime during the plan.

A Massage Therapy Treatment Plans Can Consist of Any of the Following:

• A signed treatment plan (by therapist and client) can show informed consent or agreement as to the mutual plan and goals
• Document appointments with proper record keeping.  This includes notating each appointment’s progress upon completion if anything was observed.
• Include any notes that seem relevant to the massage therapy treatment plan i.e. the client would like reduced pain; however, after the last appointment the client felt so good that they played 36 rounds of golf in one day – and their 36 golf rounds created extreme pain for the client on the following day. Client states they are now back to the original amount of pain they had prior to massage appointment(s).
• Using a SOAP note charting system can be helpful.
• Providing a well-formulated/documented bodywork treatment plan is a good ethical practice where the client can provide INFORMED CONSENT of the treatment plan, and the bodyworker can responsibly track the client’s progress!

Formulating a Treatment Plan When Massage Goals are Not Met
Set a reasonable number of massage therapy sessions to achieve client’s goals or improvement.  Educate the client that bodywork may not be able to achieve any reasonable goals - results are not guaranteed.  You can also notify your client that unfortunately the only way to ascertain progress is by the massage application itself.  And that the client should continue to see another medical professional to achieve their goals (i.e. physical therapist, etc.) if their goals were not met with the massage treatment plan.

Inform the client of the health benefits of bodywork, and allow the client to choose if they wish to continue with their bodywork sessions when/if you are not achieving their bodywork goals.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#soapnote #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #LMTsoapnote #recordkeeping #massagerecordkeeping

Massage therapists and bodyworkers are provided an extreme amount of “power" over their clients in order to provide service.  As such it's vital to earn and retain trust in the power differential of a therapeutic massage client relationship. 

Massage and bodywork clients are often:

• Naked
• Vulnerable
• Required to disclose personal details and medical information about oneself
• Sometimes required to leave a credit card number up front to secure an appointment

It is Our Ethical Duty as Bodyworkers to Protect Our Clients

Clients are often in an altered state of mind which can be rendered from our bodywork. Our clients and work require integrity and consciousness for safe and effective application, especially due to the nature of the requirements to provide bodywork.

What is Ethics?

Ethics is:  A set of moral principles

Ethics is: Rules of behavior

Ethics is: A branch of philosophy dealing with what is right and wrong

Ethics is: The morale principles influencing and governing conduct

Here are Some Important Massage-Related Vocabulary Words and Phrases for Massage Therapy Practice

What are Morals?  Standards and beliefs about what is acceptable or not acceptable.

What is Informed Consent? A full explanation of treatment is provided to a client that includes detailed information including service details and any possible benefits or risks, so that the client can make an INFORMED decision whether they would like this treatment, or not.

What is Scope? The range of elements of an expression over which an operator has control.

Accurately Represent Services When Advertising Massage 
Do not make claims such as “nursing care” or other abilities that are beyond the practitioner’s training, licensing or certification or scope of practice.

Massage Therapist Training to Provide the Best Available Services

Seek out legitimate training. Do not seek-out or support educational opportunities that are falsified (i.e. a CE Provider issues a Certificate for 12 LIVE CE Hours of training after only 6 Hours of attendance, etc.)

Continue training in respective field. Information, application, new contraindications, massage philosophies and even science can change over the years. Take responsibility to learn the newest information so that clients can receive the best service possible.

Professional Massage Groups, Agencies and Boards

Different agencies (i.e NCBTMB, AMTA, ABMP, FSMTA, etc.) have different Codes of Ethics.  It’s up to each individual practitioner to review all Codes of Ethics with each agency that they belong, and ensure that their practice is in-line with the agency’s ethics requirements.

To learn more about massage therapy practice including ethics and medical errors prevention, please click HERE to find a class and register for training with us.

#lmtethics #massageindustry #ethics  #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #massageethics 

SOAP note charting is an easy, popular and effective way to keep records, including for the practice of massage.  SOAP is an acronym for:

• Subjective
• Objective
• Assessment
• Plan

A SOAP note provides a narrative of the client's issues.  The massage therapist records how they will address the client's issues with massage therapy application with a well formulated plan after assessment.

The following is a SOAP note example for massage therapy record keeping purposes.  In this SOAP note example, we will review how to record a client's massage therapy treatment to address a client's pain:

Subjective: here are some examples of questions for a client who seeks pain relief.  A massage therapists can ask as little or many of these questions as they wish - the more information, the better directed a practitioner will be to addressing a client's needs:

Onset:  When did their pain start?

Location:  Where is their pain?

Duration:  How long is the pain a problem?

Alleviating Factors:  Is there anything that relieves the pain?

Aggravating Factors: What makes the pain worse?

Chronology:  Better or worse since onset?  Is pain variable, constant, etc.?

Quality:  Is the pain sharp, stabbing, dull, etc.?

Additional Symptoms:  Is there any numbness, tingling, loss of coordination?

Treatment: What else has been done to address the pain? 

Temporal Pattern:  Is the pain every morning, all day, etc.?

Severity (think VAS which readers can learn more about in our school blog):  A scale of 1-10 can be used with 1 being almost no pain and 10 being intolerable, then the client can choose their # for the pain that they experience throughout the day, or when pressure is applied during the massage.

Objective: the bodyworker will document objective, repeatable, and traceable facts about the client’s status.  This includes:

• Client’s personal statistics
  • Age
  • Height
  • Weight
• Palpable tissue changes (softer, more pliable, etc.)
• Range of motion increases/decreases (use goniometer)
• Observed abnormalities
• Bruises
• Anything medically remarkable that would be relevant to the:
  • Client’s health
  • Bodywork contraindications

Assessment:  the bodyworker’s collective assessment of the client’s body (and goals) from the subjective and objective information.

Plan: describes what the bodyworker will perform for the client.  This can include the “Treatment Plan” as described earlier in this course, including:

• Number of minimum appointments needed to achieve goals
• Length of appointments needed to achieve goals
• Costs of Individual Appointments as recommended in the treatment plan
• Areas to be worked on (on the client’s body)
• Modalities to use in different areas of the client’s body
• Physical Address of Where Bodywork Will Occur
• Set Goals – the goals the client wants to achieve through bodywork
• Consent or Agreement

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#soapnote #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #LMTsoapnote #recordkeeping #massagerecordkeeping