Massage Therapy and Informed Verbal Consent

What is Informed (Verbal) Consent, and why is it necessary for a massage therapy assessment or treatment?

Ignorance is NOT bliss in the massage therapy profession.

I remember my first few weeks of massage therapy school – making new friends, touching people I didn’t know, and the overwhelming amount of information involved, not the least of which was trying to wrap my head around informed verbal consent.(also known as informed consent) I was more “fortunate” than most of my peers, because I had actually had an awful first experience with massage therapy which, as a student and later a therapist, instilled in me the need to advise my clients of what to expect during treatment.

I swear that the massage therapist who treated me for my very first treatment could have been the poster child for what NOT to do to a new client. He didn’t tell me what to expect, he used pressure so deep I wanted to cry, and he talked about how much he hated his ex girlfriend. Wow, did I ever feel vulnerable, and had I known I could discontinue the treatment I would have. With a first experience like that it’s amazing that I ever went to another massage therapist, let alone became one.

So basically, the definition of informed (verbal) consent is: obtaining client agreement to the impending treatment based on full disclosure by the therapist as to what the client should expect before, during and after the treatment. The client consents on the treatment with full knowledge of what’s going on.

Why is Informed Verbal Consent so important?

There are a few purposes to obtaining informed verbal consent, not the least of which is that the client has a right to know what is going to happen – this is not rocket science. Would you buy a car or a house without knowing the specifications? Probably not. And certainly where a client’s health is concerned, he or she must be presented with sufficient information to make an informed decision concerning the treatment, and then give you permission to do it. Informed consent is about empowering the client through knowledge and trust. This knowledge and empowerment protects the best interests of the client. After all, it shouldn’t take too much imagination to remember how it feels to be lying in a very vulnerable position, mostly undressed, in a closed off room with just you and a complete stranger.

Informed consent helps establish trust between the therapist and the client – which is the foundation of a productive therapeutic relationship. When you say to expect XYZ and the client receives XYZ, then he or she knows you are a person of your word. If a client feels pain during treatment, and you stop whatever you’re doing when you are asked, the client understands that you are there to look out for her best interest.

Informed verbal consent protects the therapist, too. When therapists take the time to advise a client on the various points of informed consent, he or she is ensuring that whatever happens will not alarm, scare or cause undue pain to a client. A therapist should document that he or she received permission to continue with the treatment for each treatment – a simple IVC next to the treatment date should suffice. And therapists should remember that any time any new area or body part is worked on, or different treatment modality is used, consent must be obtained from the client.

What should be included in basic Informed Verbal Consent?

1) The nature of the treatment – tell the client what body parts you’ll be working on, as well as how much pressure you’ll be using. I like to explain to my clients how the will be undraped (uncovered) and that the only part of the body that will be uncovered is the part that I am working on.

I also tell clients to undress to their comfort levels, though it is more effective if I work directly on the skin. If my new client looks unsure, I usually tell him he can leave their underwear on, and I will leave the room so he can undress and get on the table in privacy. I also make sure before I do leave the room that my client doesn’t need any assistance with either.

2) The benefits of treatment – If your client comes in for a relaxation treatment, then a benefit should be that she will be more relaxed and may sleep better. If a person comes in specifically for treatment of an injury, then the benefit of treatment should be the same as the treatment goals – i.e. decreased pain, increased mobility etc.

3) What are the risks and side effects of the treatment? A risk is generally more long term in nature, whereas a side effect is more immediate. For example, a side effect is that a client may be a little “woozy” when he or she gets off of the table, but a risk of a more vigourous treatment is that your client may be a little sore the next day.

4) Advise your client of alternatives to treatment. This is described in the context of massage therapy – for example, if a client presents with scar tissue, you can advise your client that you will be performing Frictions (aka friction massage therapy). In the event that this is too much for your client to tolerate, you should advise that an alternative is to do petrissage and deep kneading to the area.

5) What are the consequences of not having treatment? If a client doesn’t have treatment, then he or she can expect to NOT achieve the goals and aims of treatment and not improve. So, if a client presents with limited range of motion of the right shoulder, and opts out of treatment designed to increase the ROM, then a consequence of not getting the treatment would be no improvement of shoulder range of motion.

6) The client ALWAYS has the right to stop or modify the treatment. Period.

Sometimes clients look a little confused when I say this, so I tell them “if anything makes you uncomfortable in any way, please let me know and I’ll stop what I’m doing. If you feel that you have had enough of the treatment, then we can finish.”

7) Ask the client if she understands what you have told her AND if she has any questions. This presents her with the opportunity to speak up if she is unsure about anything.

8 ) Ask the client if you have her permission to proceed with the treatment as you have described it. This might seem obvious, but you don’t ever want to get caught on a technicality. This gives her the ability to “Yes” or “No” the treatment, enabling you to carry on with confidence.

This is basic informed consent that every therapist should use when treating a new client.

For those candidates preparing for the College of Massage Therapists’ of Ontario (CMTO) certification exams (i.e. the MCQ and OSCE exam), informed consent is a little more involved. (OSCE = Objectively Structured Clinical Evaluation).

Though informed verbal consent (aka informed consent) may seem tedious, once you establish your own way of doing it, it should become second nature to you. And remember, it serves both you and your clients, and builds the therapeutic relationship on a foundation of trust.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
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