Episode 011: Why Consent is Crucial in Massage Therapy

In Folding Towels Podcast: Episode 11, we dive into one of the most important topics in massage therapy—consent. While the word might evoke memories of school permission slips, in the context of health care, consent is much more significant. It’s the cornerstone of a safe, respectful, and effective client-practitioner relationship. Without it, trust crumbles, outcomes suffer, and at worst, serious ethical or legal consequences arise.

In this episode, we explore how massage therapists can establish, maintain, and nurture client consent while ensuring that every treatment is a positive experience.

Informed vs. Implied Consent: Know the Difference

Massage therapy operates in a space where clear communication is essential. When it comes to consent, there are two primary forms: informed consent and implied consent. While both have their place, the focus must always be on ensuring clients feel comfortable, respected, and in control of their experience.

• Informed Consent: This is obtained by explaining the treatment, its purpose, possible side effects, and asking the client for permission to proceed. Importantly, clients are given the opportunity to opt-in or out at any point.“Informed consent is about educating our clients—what we’re doing, why, and how it might feel,” Jackie explains. “It gives them the choice to participate or not.”
• Implied Consent: This occurs when a client mentions specific concerns or asks for work in a particular area. For example, if a client says they have tight glutes, it’s reasonable to assume they want you to address that. However, implied consent can easily blur boundaries, making clear communication critical.

*“Even if a client mentions their glutes,” David says, “I’ll still gesture toward my own hip and ask if they want me to work on that area. One simple question turns implied consent into informed consent.”

The Dangers of Assumptions

It’s easy to get comfortable as a therapist, particularly if you’ve been practicing for a long time. However, assumptions can lead to serious breaches of trust—or worse.

David shares a story from his student clinic days where he was so focused on learning a new technique that he forgot to explain it to his client. Midway through the treatment, the client asked, “When is the massage going to start?” Lesson learned: Always communicate what you’re doing and why.

Assumptions can also be dangerous when it comes to sensitive areas or allergies. David recounts a story about a therapist who unknowingly applied a product containing shellfish to a client with a severe allergy. “Thankfully, it wasn’t life-threatening, but it could have been.” This underscores the importance of taking thorough health histories and knowing exactly what’s in the products you use.

Navigating Sensitive Areas: Ongoing Consent is Key

Certain areas of the body require extra care and communication. The belly, chest, and inner thighs are all regions where ongoing consent is essential—every single session.

*“Even if a client has given me permission to massage their belly at 36 weeks pregnant,” Jackie says, “I’ll still ask again at 38 weeks. Bodies change, and comfort levels shift.”

Therapists must also be mindful of clients with body dysmorphia, past trauma, or personal preferences. Just because a therapist believes an area needs work doesn’t give them the right to touch without permission. Consent is never a one-time deal—it’s an ongoing conversation.

The Positive Side of Consent: Empowerment and Trust

David recounts a positive experience where a massage therapist asked for his consent to try dry needling—a treatment he’d never experienced before. “I was hesitant,” he admits, “but the therapist reassured me that I could say no at any time, and that made all the difference.”

The result? He felt comfortable, empowered, and open to trying the treatment again.

Research shows that clients who feel empowered in their treatment have better outcomes. When a client trusts their therapist, they’re more likely to relax, communicate openly, and engage fully in their care.

The Gray Areas: When Things Go Wrong

Unfortunately, not all stories have positive outcomes. David recalls hearing about a therapist who routinely performed treatments without asking for permission, including using needles on clients without explanation or consent. “That crosses the line into assault,” he says, “and it’s simply not acceptable.”

As unregistered health professionals in Australia, massage therapists have a code of conduct they must follow. Breaching consent can result in complaints, investigations, and serious consequences.

Practical Steps for Building Trust Through Consent

1. Ask questions upfront. Have you had a massage before? What worked well for you? What didn’t?
2. Explain your treatment plan. Clearly outline what you’ll do and why, particularly if you’re using tools like cups, needles, or gua sha.
3. Always ask before touching sensitive areas. Never assume that what was okay last time will be okay again.
4. Respect refusals. If a client says no to a technique or area, listen to them. Their body, their rules.
5. Document everything. Make a note in your client’s file about the consent given, especially for sensitive areas or new treatments.

Communication Builds Connection

At its heart, consent is about more than just liability—it’s about building trust and creating a safe space for clients to heal. Whether it’s a first-time client who’s a little nervous or a regular who trusts you completely, clear, respectful communication makes all the difference.

As Jackie puts it, “When you take the time to ask good questions and listen, you’re not just delivering a massage—you’re creating an experience that builds trust and keeps clients coming back.”

Want to hear the full conversation? Check out Folding Towels Podcast: Episode 11 – The Importance of Consent in Massage Therapy for more insights and practical tips.