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MARYLAND Massage Therapy Continuing Education
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WHAT’S INSIDE
THIS COURSE MEETS YOUR ETHICS REQUIREMENT Chapter 1: Ethics in Massage Therapy (Mandatory)
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[3 CE hours] This course addresses a range of issues that should concern a professional massage therapist and introduces a number of concepts important to the ethical practice of massage therapy. Successful completion of the course equips massage therapists with the basic concepts and rationale for ethical decision-making in their practice, to help them navigate unknown ethical territory, identify questionable behavior, and identify “red flags” that signal potential conflict, as well as the steps involved in resolving these issues. Equally important, it will help therapists know when to seek professional guidance with a supervisor or mentor or turn to other appropriate resources for professional assistance. THIS COURSE MEETS YOUR COMMUNICABLE DISEASES (HIV/AIDS) REQUIREMENT Chapter 2: HIV/AIDS Update: Prevention, Transmission, and Treatment, 2nd Edition (Mandatory) [3 CE hours] The purpose of this course is to enhance healthcare providers’ knowledge of HIV/AIDS infection, including prevention, transmission, and treatment. An estimated 1.2 million people are living with HIV/AIDS infection in the U.S. CDC. HIV/AIDS infection is a persistent public health problem in the U.S. and worldwide. In 2018, an estimated 36,400 new HIV infections were diagnosed. HIV is disproportionately present in certain racial and ethnic minorities and in gay and bisexual men (HIV.gov, 2020b). It is imperative that all healthcare professionals work to prevent HIV transmission and facilitate treatment among those infected. This course provides nurses with information about HIV/AIDS incidence, prevalence, transmission, prevention, and treatments. THIS COURSE MEETS YOUR IMPLICIT BIAS REQUIREMENT Chapter 3: Understanding, Recognizing, and Mitigating Implicit Biases in Healthcare (Mandatory) [3 CE hours] Researchers have identified that unconscious biases affect clinicians’ perceptions of others, influencing decisions and actively contributing to health inequalities. Typically, implicit biases are negative and unintentionally lead to disparities in patient–provider interactions, treatment decisions, and overall access to care. The purpose of implementing implicit bias training is to emphasize to healthcare providers a modifiable risk known to play a role in the causation of health disparities. This interactive course incorporates several features to engage learners and promote active participation. Final Examination Answer Sheet
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©2026: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials. i MASSAGE CONTINUING EDUCATION Book Code: MMD0926
What are the requirements for license renewal? Licenses Expire CE Hours Required Frequently Asked Questions
Mandatory Subject
3 hours – Ethics or Jurisprudence 3 hours – Communicable Diseases (including HIV/AIDS) 2 hours – Diversity, Cultural Competency, or Implicit Bias
24 (12 hours are allowed through home study.)
Licenses expire on October 31, of every even-numbered year.
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Chapter 1: Ethics in Massage Therapy (Mandatory)
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HIV/AIDS Update: Prevention, Transmission, and Treatment, 2nd Edition (Mandatory) Understanding, Recognizing, and Mitigating Implicit Biases in Healthcare (Mandatory)
Chapter 2:
3 $55.00 MMD03HA
Chapter 3:
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Best Value - Save $115.00 - All 9 Hours
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How do I complete this course and receive my certificate of completion? See the following page for step-by-step instructions on how to complete and receive your certificate. Are you a Maryland board-approved provider? Colibri Healthcare, LLC is approved by the National Certification Board for Therapeutic Massage and Bodywork (Provider #450215-06). Are my hours reported to the Maryland board? The Maryland Board of Massage Therapy Examiners performs random audits at which time proof of continuing education is required. At the time of renewal, you may be audited for CEU compliance. It is the responsibility of each massage therapist and practitioner to keep accurate records of attendance of approved continuing education programs. Completion certificates must be maintained for at least four years and must be presented to the Board on demand. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau.
What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Massage-Therapy you will see our robust FAQ section that answers many of your questions. Simply click FAQs at the top of the page, email us at office@elitelearning.com, or call us toll-free at 866-344-0973, Monday - Friday 9:00 am - 6:00 pm and Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Disclosures Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
Licensing board contact information Maryland Department of Health | Board of Massage Therapy Examiners 201 W. Preston Street | Baltimore, MD 21201 Phone: (410) 767-6500 or (866) 888-1308 Website: https://health.maryland.gov/massage
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Book Code: MMD0926
MASSAGE CONTINUING EDUCATION
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MASSAGE CONTINUING EDUCATION
Book Code: MMD0926
Chapter 1: Ethics in Massage Therapy (Mandatory) 3 CE Hours
By: John Vinacci, LMT Course overview
or turn to other appropriate resources for professional assistance. This course fulfills two credits of mandatory coursework in ethics. In addition, it: Explains concepts important to ethical theory and practice in professional massage therapy and bodywork. Examines the value and function of ethical codes and professional standards of conduct. Emphasizes the delineation of boundaries that define the therapeutic relationship.
This course addresses a range of issues that should concern a professional massage therapist and introduces a number of concepts important to the ethical practice of massage therapy. Successful completion of the course equips massage therapists with the basic concepts and rationale for ethical decision-making in their practice, to help them navigate unknown ethical territory, identify questionable behavior, and identify “red flags” that signal potential conflict, as well as the steps involved in resolving these issues. Equally important, it will help therapists know when to seek professional guidance with a supervisor or mentor Learning objectives After completing this course, the learner will be able to: Outline key principles of professional ethics in massage therapy. Define the concept of power dynamics. Introduction Ethics is a branch of philosophy that addresses systematic approaches to moral issues and dilemmas. It encompasses the rules or principles that govern right conduct and includes the study of morality (Dail, 2012). Professional massage and bodywork therapists are responsible for adhering to ethical principles and standards of conduct established by their professional, educational, and certification organizations. Establishing clear boundaries in professional relationships with clients is crucial for the safety of both the therapist and the client. These boundaries ensure that therapists operate within their scope of practice, which is defined by their education, training, and certification, in accordance with the code of ethics and professional standards. Ethical dilemmas may arise in the
Distinguish between transference and countertransference. Describe the nature of the fiduciary role. List four ways practitioners might work outside their scope of practice.
practice of massage therapy and bodywork, necessitating the development of sound ethical decision-making skills. Ethical practice also involves technical competence and knowledge specific to massage and bodywork. A professional therapist provides significant mental and physical health benefits to clients, drawing on competency gained through education, certification or licensure, and experience. Today, massage and bodywork practices are integrated into many multidisciplinary approaches to mental and physical health. Therefore, professional practitioners must understand various massage and bodywork modalities to effectively treat a wide range of mental and physical disorders.
THE NATIONAL INSTITUTE OF HEALTH ON BENEFITS OF MASSAGE
practicing on clients with certain health conditions (NCCIH, 2016): • In some cases, pregnant women should avoid massage therapy. Clients must consult with their health care provider before getting a massage if pregnant. Always consult the licensing agency or state regulations for additional guidance when working with pregnant clients. It might be prudent for the massage/bodywork professional to institute a standard release form to be signed and maintained in the client’s record in these cases. • People with some conditions such as bleeding disorders or low blood platelet counts should avoid having forceful and deep tissue massage. People who take anticoagulants, known as blood thinners , should also avoid these modalities. • Massage should not be done in any potentially weak area of the skin, such as wounds. Again, the massage professional should understand any regulations that govern their practice with these clients. • Deep or intense pressure should not be used over an area where the patient has a tumor or cancer, unless approved by the patient’s health care provider. Always
The use of integrative approaches to health and wellness has grown within healthcare settings across the United States, with more than 30 percent of adults and about 12 percent of children using health care approaches developed outside of mainstream Western or conventional medicine (NCCIH, 2016). The 2016 National Center for Complementary and Integrated Health (NCCIH), a division of the National Institute of Health (NIH), notes that scientific research on massage therapy and bodywork is in the preliminary stage, but significant evidence points toward beneficial effects of integrative healthcare in a variety of situations (NCCIH, 2016). These benefits include pain management for military personnel and veterans, relief of symptoms in cancer patients and survivors, programs to promote healthy behaviors, and symptoms associated with a number of medical conditions (NCCIH, 2016). Research evidence has documented positive short-term effects, and if clients continue massage and bodywork, care health benefits may continue (NCCIH, 2016). According to the NIH, Massage therapy appears to have few risks when performed by a trained massage therapist, though some precautions must be considered when
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• There is a risk of allergic reaction to body preparation products, including oils or aromatherapy materials. Any skin sensitivity, allergies or other conditions must be identified and discussed to identify any possibility of allergic reactions or sensitivities to products. • Though some soreness following deep tissue massage is common, pain during or after massage should not occur. Muscle weakness or pain after the massage should be reported by the client to their health provider. As the massage and bodywork professions continue to expand into integrated healthcare, they are gaining legitimacy for the therapeutic benefits they may provide to clients in areas of mental and physical health. Ethical practice goes beyond adherence to laws, standards, and guidelines and includes honesty with clients and colleagues, professional goals, continued education, and the obligation to always act in the client’s best interest. All state licensing authorities, certifying or accrediting agencies, and professional associations establish their own standards of conduct and ethical guidelines for their members. Massage and bodywork therapists need to refer directly to the organizations and academic or training institutions with which they are affiliated, as well as with state, local, and national associations to review ethical guidelines that apply specifically to their practice.
document all medical conditions and discuss the safety and effectiveness of massage and bodywork with colleagues or supervisors. • The procedures for informed consent must include any medical diagnosis, massage and bodywork modalities to be used, and documentation must reflect any discussions and explanations conducted with clients. The informed consent section of this course will outline the important, specific, and ongoing components of informed consent that must be included in client records. Beyond the NIH advisory, there are other health conditions to consider before proceeding with massage and bodywork. The practitioner must communicate concerns with the client and obtain approval from other health professionals prior to initiating massage or bodywork if the client has experienced the following conditions (NC Massage School, 2016): • Bone damage, such as severe osteoporosis, may mean that massage is not indicated for the client. • Conditions such as deep vein thrombosis or blood clots may put clients at risk. Blood clots may become dislodged and travel to the heart or brain, causing heart attack or stroke. • An injury, especially one that affects the blood or bones, could be negatively impacted by massage and bodywork.
NATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE & BODYWORK (NCBTMB)
soreness/stiffness/spasms, injury rehabilitation, or overall wellness. • 92% of consumers believed that massage was effective in reducing pain and 93% believed it to be beneficial to health and wellness. • 45% of massage consumers got a massage for relaxation and/or stress relief in 2020. • The U.S. Bureau of Labor Statistics predicts an increase of 21% in Massage Therapist jobs between 2019 and 2029, with 34,400 jobs created during that time period (Bureau of Labor Statistics, 2019). Massage in health care More Americans are discussing massage with their doctors or health care providers (AMTA, 2021a): • In 2015, more than fifty-one million American adults, 16% of the population, had discussed massage therapy with their doctors or health care providers. • Of those who discussed massage with their doctor or health care provider, 69% of their doctors or health care providers referred them to a therapist, strongly recommended massage therapy, or encouraged them to get a massage. • While physicians in 2015 led the way in recommending massage, 49% of chiropractors and 43% of physical therapists also recommended massage therapy when their clients discussed it with them. • More referrals come from chiropractic offices than other sources, with 11% of survey respondents reporting receiving referrals at least once per week, and another 25% receiving referrals several times per month. • 55% of massage therapists received at least one referral every six months or less from a hospital or medical office in 2015. • Nearly two-thirds of adult Americans would like to see their insurance cover massage therapy. • The vast majority of massage therapists, 96 percent, believe massage therapy should be considered part of the health care field.
National board certification is voluntary and offered through NCBTMB to provide a credential beyond state licensure or certification for the massage therapy and bodywork profession (NCBTMB, 2020). It includes more education, hands-on experience, and a background check that conveys a higher level of mastery for the practitioner beyond state minimum requirements. The NCBTMB offers specialty certifications that align with the National Institute of Health 2016 Strategic Plan that addresses priorities for populations that may benefit from an integrated approach to health care. The objectives of the specialty certification programs are to: 1. Further elevate the standards of massage therapy. 2. Further include massage therapy’s role in integrative healthcare. 3. Provide therapists with access to high-quality, advanced programs for specific modalities and populations. 4. Ensure patients receive the best possible care. Statistics The following data, compiled by the American Massage Therapy Association (AMTA) from U.S. government statistics, consumer surveys, massage therapists, and recent clinical studies on the efficacy of massage, provides an overview of the current state of the massage profession. Released in 2021, these statistics highlight the public and medical acceptance of massage therapy's value and the growing consumer usage of massage therapy in the U.S. (American Massage Therapy Association, 2021). Understanding these statistics is crucial for practitioners to stay updated with the evolving profession, which necessitates an increase in their knowledge of ethical practice and their role in integrative healthcare. The primary reason people received massage was for health and wellness reasons as follows: • 63% of adult Americans who had a massage in the 12 months leading up to June of 2020 received it for medical or health reasons, such as pain management,
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State regulation of the profession • 44 states and the District of Columbia, Puerto Rico, and the US Virgin Islands regulate massage therapists through licensing requirements. • 46 states have practice law and regulation of some form. • In states that regulate massage therapy, massage therapists must meet the legal requirements to practice, which may include minimum hours of initial training and passing an exam.
• In states that do not regulate massage therapy, this task may fall to local municipalities. • Most states that license massage therapists require a passing grade on the Massage & Bodywork Licensing Exam (MBLEx), or one of two exams provided by the National Certification Board for Therapeutic Massage & Bodywork.
RESEARCH ON MASSAGE THERAPY
• In July 2015, 20% of women and 22% of men reported having a massage in the past 12 months. Massage use among male consumers was higher than that of female consumers, a change from previous consumer report findings. • Spas continue to be the most frequent sites for massages, with 41% of consumers having had a massage there in 2020 and 23% reporting that a spa was the location for their most recent massage. • The average consumer received 3.5 massages in the past year. Americans’ reasons for getting massages are changing (AMTA, 2021a) • Instead of seeking massage therapy solely for relaxation and pampering purposes, individuals are clearly turning to massage therapy to assist with medical conditions. • As few as 28% of individuals believe massage therapy is only a form of pampering, with 83% of consumers responding that massage therapy should be considered a form of healthcare. • Overall, 63% of consumers received a massage for health and wellness reasons, with pain relief, pain management, soreness, stiffness, spasms, relaxation, and stress reduction being the primary reasons that consumers sought out massage. Consumers are discussing specific medical conditions with their doctors (AMTA, 2021a) • 57% of respondents discussed pain relief or pain management with their doctor. • 47% discussed soreness/stiffness/spasms. • 43% discussed relaxation or stress reduction. • 36% discussed injury recovery or rehabilitation with their doctor. Health care providers recommending massage as a viable form of treatment for the conditions discussed above (AMTA, 2021a) Health care providers and doctors are more commonly viewing massage therapy as a legitimate option to address health concerns: • A total of 18% of consumers reported discussing massage therapy with their doctors. Of these consumers: • 25% were referred to a massage therapist. • 24% were strongly recommended to get a massage. Physicians were the most likely health care professionals to recommend massage to their patients (50%), followed by physical therapists (36%) and chiropractors (24%). NCBTMB Glossary of Terms (NCBTMB, 2017b) • Acceptable accounting procedures : Rules, conventions, standards, and procedures that are widely accepted among financial accountants. • Boundary : A boundary is a limit that separates one person from another. Its function is to protect the integrity of each person.
The therapeutic benefits of massage continue to be researched and studied. Recent research has shown the effectiveness of massage for the following conditions (AMTA, 2021a): • Cancer-related fatigue. • Low back pain. • Osteoarthritis of the knee. • Reducing post-operative pain. • Boosting the body’s immune system functioning. • Decreasing the symptoms of carpal tunnel syndrome. • Lowering blood pressure. • Reducing headache frequency.
• Easing alcohol withdrawal symptoms. • Decreasing pain in cancer patients. • Fibromyalgia relief. • Migraine relief. • Treating muscle stiffness or spasms. • Injury recovery or prevention. • Pregnancy and pre-natal topics. • Effects on general well-being. • PTSD symptom management.
• Autism in children. • Treating depression. Massage therapy for regular health maintenance (AMTA, 2021a) According to the 24th annual consumer survey sponsored by the American Massage Therapy Association, 75% of individuals surveyed claimed their primary reason for receiving a massage in the previous 12 months was health or wellness (49%) or stress related (26%). The reported medical reasons included massage for pain relief, muscle soreness, stiffness, or spasms. The consumer survey also included the following results: • 93% of individuals view massage as being beneficial to overall health and wellness. • 92% of consumers surveyed believe that massage can be effective in reducing pain; with an additional 25% stating that they have used massage therapy for pain relief. Frequency of massage (AMTA, 2021a) • According to the AMTA 2020 consumer survey, an average of 21% of consumers received at least one massage in the year prior. • As many as 38% of adults reported that they have had a professional massage in the past. Glossary of terms The major organizations that guide the massage therapy and bodywork professions have their own specific glossaries that reflect the unique practice of their members and the goals, ethics, and standards of the association. These often overlap, but the following terms that relate to this course are included.
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• Sexual activity : Any verbal and/or nonverbal behavior for the purpose of soliciting, receiving, or giving sexual gratification. • Sexual harassment : Sexual harassment consists of unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when: (1) submission to such conduct is made, either explicitly or implicitly, a term or condition of an individual’s employment; (2) submission to, or rejection of, such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (3) such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment. • Scope of practice : The minimum standards necessary for safe and effective practice, and the parameters of practice determined by a certificant’s professional training and education, and, when applicable, regulatory bodies. • Therapeutic breast massage : Manipulation of the non- muscular soft tissue structure of the breast, up to and including the areola and nipple. • Transference : The displacement or transfer of feelings, thoughts, and behaviors originally related to a significant person, such as a parent, onto someone else, such as a massage therapist, doctor, psychotherapist, teacher, or spiritual advisor.
• Competency : Study and development of a particular professional knowledge base, and skills associated with and applied in practice within that knowledge base. • Counter-transference : A practitioner’s unresolved feelings and issues that are unconsciously transferred to the client. • Dignity : The quality or state of being worthy, honored, or esteemed. • Dual relationships : An alliance in addition to the client/ therapist relationship, such as social, familial, business or any other relationship that is outside the therapeutic relationship. • Genitalia, female : Labia major, labia minor, clitoris, and vaginal orifice. • Genitalia, male : Testes, penis, and scrotum. • Impugn : To assail by words or arguments, oppose, or attack as false. • Integrity : Honesty. Firm adherence to a code of values. • Multidimensional relationships : Overlapping relationships, in which the therapist and client share an alliance in addition to the therapeutic relationship. • Progress notes : Notes written by a practitioner certified by NCBTMB, and kept in a separate client file that indicates the date of the session, areas of complaint as stated by client, and observations made and actions taken by the practitioner.
PRINCIPLES OF PROFESSIONAL ETHICS
to ensure quality and integrity in the profession (Thiroux & Krasemann, 2014). This course is based on the standards of ethical behavior embodied in the American Massage Therapy Association (AMTA), the Associated Bodywork and Massage Professionals (ABMP), and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) Codes of Ethics. • Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues. • Demonstrate professional excellence through regular self-assessment of strengths, limitations, and effectiveness by continued education and training. • Acknowledge the confidential nature of the professional relationship with clients and respect each client’s right to privacy within the constraints of the law. • Project a professional image and uphold the highest standards of professionalism. • Accept responsibility to do no harm to the physical, mental, and emotional well-being of self, clients, and associates. The AMTA provides the following ethical rules to ensure that massage therapists/ practitioners shall (AMTA, 2021b): • Conduct all business and professional activities within their scope of practice and all applicable legal and regulatory requirements. • Refrain from engaging in any sexual conduct or sexual activities involving their clients in the course of a massage therapy session.
Ethics refers to the principles of morally right or good conduct, specifically when two or more people are involved. Professional ethics in massage therapy is the application of guiding principles of right conduct to the study, practice, and business of massage therapy. Unlike personal morals, which are flexible and open to debate, professional ethical codes are formally defined, mandatory standards of conduct established by and for members of professional associations The AMTA Code of Ethics This code of ethics is a summary statement of the standards of conduct that define ethical behavior for the massage therapist. Adherence to the Code is a prerequisite for admission to and continued membership in the American Massage Therapy Association (AMTA, 2021b). Principles of ethics form the first part of the code of ethics. They are the model standards of exemplary professional conduct for all members of the association. These principles should not be regarded as limitations or restrictions, but as goals of which members should constantly strive to achieve. The second part of the code is Rules of Ethics. Rules of Ethics are mandatory, and direct specific, minimally acceptable professional conduct for all members of the association. These rules are enforceable for all association members, and any members who violate this Code shall be subject to disciplinary action (AMTA, 2021b). The AMTA provides the following ethical principles to ensure that massage therapists/practitioners shall (AMTA, 2021b): • Demonstrate commitment to provide the highest quality massage therapy to those who seek their professional service. The ABMP Code of Ethics The AMTA and ABMP organizations share similar fundamental principles, but it is important to review both to expand the professional knowledge of ethics. Members
of the ABMP pledge commitment to the highest principles of the massage and bodywork profession as outlined below (ABMP, 2016):
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1. Commitment to high-quality care . ○ Serve the best interests of your clients at all times and provide the highest quality of bodywork and service possible. ○ Recognize that the obligation for building and maintaining an effective, healthy, and safe therapeutic relationship with your clients is your responsibility. 2. Commitment to do no harm. ○ Conduct a thorough health history intake process for each client and evaluate the health history to rule out contraindications or determine appropriate session adaptations. If signs or suspicions of an undiagnosed condition are detected that might make massage inappropriate, refer that client to a physician or other qualified health-care professional, and delay the massage session until approval from the physician has been granted. ○ Understand the importance of ethical touch and therapeutic intent, and conduct sessions with the sole objective of benefitting the client. 3. Commitment to honest representation of qualifications. ○ Never work outside the commonly accepted scope of practice for massage therapists and bodywork professionals. ○ Adhere to the state’s scope of practice guidelines and only provide treatments and techniques based on your training and credentials. ○ Evaluate the needs of each client and refer the client to another provider if the client requires work beyond your therapeutic capabilities, or beyond the capacity of massage and bodywork. ○ Do not use the trademarks and symbols associated with a particular system or group without authentic affiliation. ○ Acknowledge the limitations of massage and bodywork by refraining from exaggerating the benefits of massage therapy and related services in marketing materials. 4. Commitment to uphold the inherent worth of all individuals. ○ Demonstrate compassion, respect, and tolerance for others. ○ Seek to decrease discrimination, misunderstandings, and prejudice. ○ Understand there are situations when it is appropriate to decline service to a client due to the best interests of a client’s health, or for personal safety, but do not refuse service to any client based on: disability; ethnicity; gender; marital status; physical build; sexual orientation; religious, national, or political affiliation; or social or economic status. 5. Commitment to respect client dignity and basic rights. ○ Demonstrate respect for the dignity and rights of all individuals by providing a clean, comfortable, and safe environment for sessions, using appropriate and skilled draping procedures. Give clients recourse in the event of dissatisfaction with treatment, and uphold the integrity of the therapeutic relationship. ○ Be truthful in advertising and marketing, and refrain from misrepresenting your services, charges for services, credentials, training, experience, ability or results.
○ Refrain from using AMTA membership, including the AMTA name, logo, or other intellectual property, or your membership position, in any way that is unauthorized, improper or misleading. ○ Refrain from engaging in any activity that would violate confidentiality commitments and/or proprietary rights of AMTA or any other person or organization. 6. Commitment to informed consent. ○ Recognize a client’s right to determine what happens to his or her body. ○ Understand that a client may suffer emotional and physical harm if a therapist fails to listen to the client and imposes his or her own beliefs in a situation. ○ Inform clients of choices relating to their care, and disclose policies and limitations that may affect their care. ○ Do not provide massage without obtaining a client’s informed consent, or that of the guardian or advocate for the client. 7. Commitment to confidentiality. ○ Keep client communication and information confidential and do not share client information without the client’s written consent, within the limits of the law. ○ Ensure every effort is made to respect a client’s right to privacy, and provide an environment where personal health-related details cannot be overheard or seen by others. 8. Commitment to personal and professional boundaries. ○ Refrain from and prevent behaviors that may be considered sexual in massage practice, and uphold the highest professional standards in order to desexualize massage. ○ Do not “date” a client, engage in sexual intercourse with a client, or allow any level of sexual impropriety, i.e. behavior or language, from yourself or from clients. ○ Understand that sexual impropriety may lead to sexual harassment charges, the loss of credentials, lawsuits for personal damages, criminal charges, fines, attorney fees, court costs, and jail time. 9. Commitment to honesty in business. ○ Know and follow good business practices in regards to record keeping, regulation compliance, and tax law. ○ Set fair fees and practice honesty in marketing materials. ○ Do not accept gifts, compensation, or other benefits intended to influence a decision related to a client. ○ Use the ABMP logo appropriately to establish credibility and market a practice. 10.Commitment to professionalism. ○ Maintain clear and honest communication with clients and colleagues. ○ Do not use recreational drugs or alcohol before or during massage sessions. ○ Project a professional image with respect to behavior and personal appearance in keeping with the highest standards of the massage profession. ○ Do not actively seek to take another colleague’s clients, disrespect a client or colleague, or malign another therapist or other allied professional. ○ Actively strive to positively promote the massage and bodywork profession by committing to self- development and continually building professional skills.
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The NCBTMB Code of Ethics This NCBTMB board certification credentials are available for the massage therapy and bodywork profession. It requires achievement beyond entry-level licensure, including completing more education, hands-on experience, and a background check (NCBTMB, 2017a). Board Certification through the NCBTMB seeks to align the massage therapy and bodywork profession with other allied health and medical professions, enhancing the value and credibility of these professions. Many health care facilities and spas now require board certification to apply for positions (NCBTMB, 2017a). National board certification, unlike state requirements that vary, is based on a uniform set of standards and code of ethics. Certificants throughout the profession represent and benefit from a consistent level of quality evidenced by their national board certification. The NCBTMB Code of Ethics was last updated in 2017, and reflects principles and standards as listed below (NCBTMB, 2017a). NCBTMB Certificants shall act in a manner that justifies public trust and confidence, enhances the reputation of the profession, and safeguards the interest of individual clients. Certificants will: I.
VIII. Refuse to unjustly discriminate against clients and/or health professionals; IX. Safeguard the confidentiality of the client’s identity
and information in all conversations, advertisements, and any and all other matters, unless disclosure of identifiable information is requested by the client in writing, is medically necessary, or is required by law; Respect the client’s right to treatment with informed and voluntary consent. The certified practitioner will obtain and record the informed consent of the client, or client’s advocate, before providing treatment. This consent may be written or verbal;
X.
XI. Respect the client’s right to refuse, modify or terminate treatment regardless of prior consent given; XII. Provide draping and treatment in a way that ensures the safety, comfort and privacy of the client; XIII. Exercise the right to refuse to treat any person or part of the body for just and reasonable cause; XIV. Refrain, under all circumstances, from participating in a sexual relationship or sexual conduct with the client, whether consensual or otherwise, from the beginning of the client/therapist relationship and for a minimum of six (6) months after the termination of the client therapist relationship, unless an ongoing current sexual relationship existed prior to the date the therapeutic relationship began; XV. Avoid any interest, activity or influence which might be in conflict with the practitioner’s obligation to act in the best interests of the client or the profession; XVI. Respect the client’s boundaries with regard to privacy, disclosure, exposure, emotional expression, beliefs, and the client’s reasonable expectations of professional behavior. Practitioners will respect the client’s autonomy; XVII. Refuse any gifts or benefits that are intended to influence a referral, decision or treatment, or that are purely for personal gain and not for the good of the client; and XVIII. Follow the NCBTMB Standards of Practice, this Code of Ethics, and all policies, procedures, guidelines, regulations, codes, and requirements promulgated by the National Certification Board for Therapeutic Massage & Bodywork, Inc.
Have a sincere commitment to provide the highest quality of care to those who seek their professional services; Represent their qualifications honestly, including education and professional affiliations, and provide only those services that they are qualified to perform; Accurately inform clients, other health care practitioners, and the public of the scope and limitations of their discipline; Acknowledge the limitations of and contraindications for massage and bodywork, and refer clients to appropriate health professionals; Provide treatment only where there is reasonable expectation that it will be advantageous to the client;
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VI. Consistently maintain and improve professional knowledge and competence, striving for professional excellence through regular assessment of personal and professional strengths and weaknesses and through continued education training; VII. Conduct their business and professional activities with honesty and integrity, and respect the inherent worth of all persons; Ethics codes cannot possibly cover every situation that may arise during practice. Standards of practice, sometimes referred to as rules or standards of conduct, offer more specific guidelines for everyday practice that reflect the ethical principles outlined in the code. All major professional organizations develop and promote standards of practice for ethical conduct. Standards of Practice for AMTA The AMTA provides the following information on standards of practice that complements its code of ethics (AMTA, 2021d). These standards of practice were developed to assist the professional massage therapist to (AMTA, 2021d): • Provide safe, consistent care. • Determine the quality of care provided. • Provide a common base to develop a practice. • Support/preserve the basic rights of the client and professional massage therapist. • Assist the public in understanding what to expect from a professional massage therapist.
STANDARDS OF PRACTICE
Standards of practice establish the expectations of professional conduct in regard to the law, confidentiality, business practices, roles and boundaries, and prevention of misconduct. Standards of practice and codes of ethics for massage therapists cover three areas of conduct: • Conduct in relation to performing a massage. • Conduct in business dealings. • Conduct when interacting with clients in both a professional setting as well as in the public. The document allows the professional massage therapist to evaluate and adapt performance in his or her massage/ bodywork practice. The professional massage therapist can evaluate the quality of his/her practice by utilizing these Standards of Practice in conjunction with the AMTA Code of Ethics and Bylaws and Policies, as well as precedents set by the AMTA Grievance, Standards and Bylaws Committees (AMTA, 2021d). Below is a summary, but complete details can be found on the AMTA website: 1. Conduct of the professional massage therapist or practitioner, hereinafter referred to as “Practitioner.”
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4.3. The Practitioner’s communication with other professionals regarding clients is in compliance with accepted standards and ethics. 4.4. A Practitioner possessing knowledge that another practitioner: (1) committed a criminal act that reflects adversely on the Practitioner’s competence in massage therapy, trustworthiness or fitness to practice massage therapy in other respects; (2) engaged in an act or practice that significantly undermines the massage therapy profession; or (3) engaged in conduct that creates a risk of serious harm for the physical or emotional well-being of a recipient of massage therapy, shall report such knowledge to the appropriate AMTA committee if such information is not protected or restricted by any confidentiality law(s). 5.1. Client records. 5.1.1. The Practitioner establishes and maintains appropriate client records. 5.2. Financial records. 5.2.1. The Practitioner establishes and maintains client financial accounts that follow accepted accounting practices. 6. Marketing. 6.1. Marketing consists of, but is not limited to, advertising, public relations, promotion and publicity. 6.2. The Practitioner markets his/her practice in an accurate, truthful and ethical manner. 7. Legal Practice. 7.1. American Massage Therapy Association members 5. Records. practice or collaborate with all others practicing professional massage/ bodywork in a manner that is in compliance with national, state, or local municipal law(s) pertaining to the practice of professional massage/bodywork. 8. Research. 8.1. The Practitioner engaged in study and/or research is guided by the conventions and ethics of scholarly inquiry. 8.2. The Practitioner doing research avoids financial or political relationships that may limit objectivity or create conflict of interest. • NCBTMB certificants and applicants for certification are obligated to report unethical behavior and violations of the Code of Ethics and/or the Standards of Practice. The NCBTMB Standards of Practice, last updated in 2017, are summarized below (NCBTMB, 2017b): Standard I: Professionalism. The certificant or applicant for certification must provide optimal levels of professional therapeutic massage and bodywork services, as well as demonstrate excellence in practice by promoting healing and well-being via responsible, compassionate and respectful touch, and shall do as follows: a. Adhere to the NCBTMB Code of Ethics, Standards of Practice, policies, and procedures. b. Comply with the peer review process conducted by the NCBTMB Ethics and Standards Committee regarding any alleged violations of the NCBTMB Code of Ethics and Standards of Practice. c. Treat each client with respect, dignity and worth. d. Use professional verbal, nonverbal, and written communications.
1.1. AMTA members must meet and maintain appropriate membership requirements.
1.2. Individual members who engage in professional massage/ bodywork shall adhere to standards of professional conduct, including the Code of Ethics. 1.3. The Practitioner follows consistent standards in all settings. 1.4. The Practitioner seeks professional supervision/ consultation consistent with promoting and maintaining appropriate application of skills and knowledge. 2. Sanitation, hygiene, and safety. 2.1. Practitioner provides an environment consistent with accepted standards of sanitation, hygiene, safety and universal precautions. 2.2. Pathophysiology (contraindications). 2.2.1. The Practitioner maintains current knowledge and skills of pathophysiology and the appropriate application of massage/ bodywork. 2.2.2. The Practitioner monitors feedback from the client throughout a session. 2.2.3. The Practitioner makes appropriate referrals to other reputable healthcare providers. 3. Professional relationships with clients. 3.1. The Practitioner relates to the client in a manner consistent with accepted standards and ethics. 3.2. The Practitioner maintains appropriate professional standards of confidentiality. 3.3. The Practitioner relates to the client in a manner that respects the integrity of the client and practitioner. 3.4. The Practitioner ensures that representations of his/ her professional services, policies, and procedures are accurately communicated to the client prior to the initial application of massage/bodywork. 3.5. The Practitioner elicits participation and feedback from the client. 4. Professional relationships with other professionals. 4.1. The Practitioner relates to other reputable professionals with appropriate respect and within the parameters of accepted ethical standards. 4.2. The Practitioner’s referrals to other professionals are only made in the interest of the client. NCBTMB Standards of Practice Preamble Key concepts are as follows (NCBTMB, 2017b): • Standards of Practice for the profession of therapeutic massage and bodywork are the guiding principles by which certificants and applicants for certification conduct their day-to-day responsibilities within their scope of practice. • These principles help to assure that all professional behaviors are conducted in the most ethical, compassionate, and responsible manner. • The Standards are enforceable guidelines for professional conduct, and therefore, are stated in observable and measurable terms intended as minimum levels of practice. • Each applicant for certification must agree to uphold and abide by the NCBTMB Code of Ethics, Standards of Practice and applicable policies. • Failure to comply with the Code of Ethics and the Standards of Practice as provided herein constitutes professional misconduct and may result in sanctions, or other appropriate disciplinary actions, including the suspension or revocation of certification.
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Book Code: MMD0926
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