Policy, Practice, & Principles

If you've ever found yourself wondering, "Wait—is this against the rules, or just frowned upon?"—you're not alone. In massage therapy, navigating the difference between employer policy, scope of practice, and professional ethics is part of the job.

These boundaries don’t always overlap, and understanding where each one begins and ends is key to safe, legal, and ethical practice. Yet, these terms are often misunderstood or used interchangeably, leading to confusion that can have serious consequences.

Let’s break them down and look at how they show up in real-life scenarios.

1. Policy: The Employer's Rules

Policy refers to what your workplace allows or prohibits. These can include dress codes, attendance expectations, or rules about dual relationships. Policies are internal rules that may be stricter (or more conservative) than your state laws or professional ethics. Employers create policies to align with their business model, client base, or liability concerns.

Policies can be stricter than laws or ethical codes, but they cannot legally permit what the law prohibits.

Example: No Work on Glutes or Abdomen You work at a franchise spa where the policy is clear: No massage on the gluteal region or abdomen. Even if clients request it, you’re told to avoid these areas.

However, working on the glutes or abdomen is absolutely within the legal scope of practice in most states and can be an ethical, beneficial part of therapeutic treatment. The restriction is an employer policy, not a legal or ethical limit. This isn't about the law or ethics, it's about workplace compliance.

🧭 Always follow your workplace’s policies—even when you know something is within your scope and training. Violating policy could cost you your job, even if you’re technically “right.” You may consider gently encouraging your employer to reconsider their policy.

2. Scope of Practice: Legal Boundaries

Scope of practice is determined by state law or regulation and defines what you are legally allowed to do as a massage therapist- based on licensure, training, and continuing education. Violating scope of practice can lead to legal action, fines, or loss of your license.This varies from state to state, and it's your responsibility to know your limits.

Example: Cupping Therapy in Arkansas Here in Arkansas, the law requires massage therapists complete 6 hours of approved continuing education (CE) in Cupping Therapy before offering it to the public. Your clinic has cupping listed on its menu of services, client's are asking for it, and your manager may encourage you to offer it—but you haven’t taken a CE course yet.

🚫 That’s a violation of your legal scope of practice.Even if your employer and client is okay with it, you are still legally responsible for knowing your state’s laws.

3. Ethics: The Profession’s Moral Code

Ethics are the moral principles and professional guidelines massage therapists agree to follow, usually outlined by professional organizations like the American Massage Therapy Association (AMTA), Associated Bodywork & Massage Professionals (ABMP), and the National Certification Board of Therapeutic Massage & Bodywork (NCBTMB). Some state laws may even have a Code Of Ethics.

Example: A client asks you to stay late or extend their session at the end of your shift. Let’s say your last client of the day says: “Could you go an extra 30 minutes? I’ll pay you for the time—I just really need it today.”

There’s probably no law against this. Your employer might even allow it (or not have a specific policy). And the client is offering to pay. So on paper, it may look fine.

But ethically, it can be a problem.

Why it’s an ethical issue:

• Informed boundaries: Part of ethical practice is protecting your own physical, mental, and emotional well-being. Working overtime without proper rest or preparation can lead to burnout or diminished quality of care.

• Therapeutic consistency: Suddenly adjusting session length can disrupt the structure and expectations that make a massage feel safe and professional. It also can be perceived as favoritism which can lead to conflicts with other clients.

• Power dynamics: Clients may not realize they’re asking you to choose between being kind and being healthy. If you say “yes” to avoid disappointing them, that’s not true consent—it’s pressure.

🧭 Ethics are there to protect the client and the therapist—even when the client is the one asking for more.

When They Intersect: One Action, Three Violations

Some actions break all three boundaries—and sexual misconduct is a powerful (and painful) example.

Example: Inappropriate Touch or Comments A therapist touches a client’s genitals, breasts, or buttocks without clear, prior consent—or makes sexually suggestive comments during a session.

This is a violation of:

1. Policy: Almost all employers have strict sexual harassment and misconduct policies.

2. Scope of Practice: No state allows sexual contact as part of massage. Even if the client requests sexual favors.

3. Ethics: This violates every core ethical principle, from client autonomy to do-no-harm.

🛑 ⚖️ 🛑 Sexual misconduct can lead to termination of employment, disciplinary action on your license, criminal charges, and causing lasting trauma to a client.

This is why clear boundaries, consent, and professional conduct are at the heart of massage therapy education and regulation.

Why It Matters

Understanding and respecting each of these domains is essential not just for staying out of trouble, but for building trust with clients and helping massage therapy continue to grow as a respected healthcare profession.

When in doubt, ask yourself:

• Is this allowed by my employer? (Policy)

• Am I legally permitted to do this in my state? (Scope of Practice)

• Does this align with my profession’s ethics? (Ethics)

If the answer to any of these is “no,” then it's worth reconsidering your actions—or seeking guidance. Just because something is legal doesn’t mean it’s ethical or complies with workplace policy. Just because something is ethical doesn’t mean it’s allowed at your job or covered in your scope of practice. And just because your employer may be neutral on any action - it doesn't mean it's legal or ethical to do. Whenever you make a decision, be sure you're being intentional and aware of the potential consequences.

Massage therapists work in a unique intersection of health, wellness, and personal care. This gives us powerful opportunities—but also serious responsibilities. Our profession thrives when we respect its boundaries. Not just because it keeps us out of trouble, but because it keeps our clients safe and our work respected. This isn't about red tape- it's about practicing with purpose.

Knowing the difference between policy, scope, and ethics (and where they overlap) is what makes you not just a massage therapist, but a professional.

Peace and Healing,

Kirby Clark Ellis, MTI, BCTMB