Massage Therapy Journal Fall 2025

40 • Massage Therapy Journal

AMTA Continuing Education

Informed Consent: Protecting Vulnerable Clients The keys to working safely with emotionally vulnerable clients are really no different than those for any other client. The principles are the same: • Provide a safe and supportive environment • Behave transparently and ethically to promote client trust • Negotiate informed consent thoroughly • Help the client to remain in the present • Focus on sensation rather than emotion or history • Collaborate with client health care teams 44,45 The simple act of engaging clients in a consent discussion ensures that they are able to choose who, when, where and for how long they receive massage. Negotiating informed consent with emotionally vulnerable clients requires considerable maturity, empathy and good communication skills, as well as an appreciation for the psychological implications of client history and context. Informed consent teaches clients that they can stop or leave a massage session at any time, or ask for more attention on one area or another. This autonomy is powerful medicine for individuals who have never experienced the right to choose what happened to them previously. Clients who learned at an early age to ignore their body signals regarding pain or pleasure may learn how to self-regulate by using the experience of massage therapy. 46,47 Trauma and the Attachment System The term “attachment” was first used by John Bowlby to describe the innate biological urge to seek safety when confronted with a fearful situation. 48 He observed that the urge to be soothed by a primary caregiver is not unique to humans but observed throughout the natural world. 49,50 Children are not born knowing how to comfort themselves. They learn it through being held, comforted, caressed, hugged, stroked, supported and encouraged by their primary caregivers and parents. 51,52,53 This is called self-soothing or “affect regulation,” and it is a learned behavior. 54

space and trust triggers, clients may decide they must disclose personal details at length because they think that is what the massage therapist wants. For those reasons, the process of massage therapy needs to be fully explained and clients need to be allowed space to openly discuss their desired outcomes before any touch therapy begins. Massage therapists must ask careful questions to help gauge whether clients are safe to receive massage therapy. At the same time, massage therapists need to understand their role so thoroughly that they do not step outside of their professional scope of practice. Massage therapists must discern how to best respond to clients who are susceptible

to depression, anxiety, hyper-transference or dissociation so they avoid triggering clients further. 41,42,43

The simple act of engaging clients in a consent discussion ensures that they are able to choose who, when, where and for how long they receive massage.

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