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I have a new male client and I'm trying to decide whether or not he's being inappropriate during his sessions. Normally it's a pretty straight yes or no with me, but this one has me wondering. 

From the get-go he mentioned having lower back issues, so we've always done a lot of lower body work. He then started claiming that his hip flexors and adductors were always really tight, so he requested a lot of inner thigh work.

This is all fine, but here's my issue - he continuously spreads his legs during the massage, to the point where they're almost falling off the table (most of the time one or both are no longer on the bolster). Sometimes I wonder if he's asleep, but other times I know that he's not b/c when I try to work on his IT bands, he works against me like he wants to keep his legs spread and does not want his legs to turn inward at all. He does this both when he's prone and supine, and it unnerves me.

He's never become aroused or said anything too inappropriate (the first time he came in he asked how my hands weren't always so tired and said he could "return the favor" should they ever hurt. I chalked it up to nervousness and it's not like that's super inappropriate). However, there is something about him in general that kind of creeps me out, which is probably why I'm being so indecisive about this one. Does anyone have experience with this? Is he being weird or is it just more comfortable for him? 

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Alyson,

I've had a patient or two say the same things to me about "returning the favor". Most also follow it up with knowing that they wouldn't do as good of a job with the massage as I can and do. I also get asked a lot about my hands hurting. I just simply respond to them that I don't just use my hands for the massage. I used forearm, elbow, etc. and the strength behind it all isn't coming from my hands, it's from using proper body mechanics. I work in a chiropractors office and we had to discharge a patient from massage because he was making inappropriate comments to our other therapist. She initially came to me since I've been here longer and it's just us two therapists so she felt more comfortable talking to me first to see if he ever spoke to me that way since I had been seeing him for many months prior to her starting to work here. I told her he never spoke to me in the manner he was talking to her and that she should tell the Dr. about it and let him make the final decision about course of action. It was initially decided that this patient wasn't allowed to schedule massages with her any more. The patient became upset and refused to schedule on my days since he specifically wanted her. When he was told he could no longer see her he quit coming to the clinic all together. Yes, it is upsetting that we lost a patient due to the situation but it is better for our therapist to know she will be protected when such incidences come up.

My advice to you is to talk to any other therapists who may have worked on that client before and see how he acted towards them. If he's never acted like that towards them then he may be just seeing what he can get away with with you or may be trying to get you to do something inappropriate with him. Just make it clear that your massages are kept professional and no inappropriate conduct will be tolerated. We do have the right as therapists to end a session if it starts to cross the line. I had a client who came in to our student clinic when I was still in school and he did something similar as to what your client is. I went to my instructor immediately and she spoke with him. He came back the next week and did the same with another student. He was no longer allowed to come in for massages. Maybe also reinforce when you are working on his IT band that him fighting against you is not helping with progress and you need him to relax and let you move his legs when you need to get to a certain area. I often have to tell my clients to just relax and let me be in control and if anything is uncomfortable (too much pressure, too tender) then to let me know.

I hope some of this helps and Good Luck!

Steph

I think your intuition is correct. He is acting weird. You don't need him as a client.  He knows that if your hands hurt, that you can get massage from your massage therapist friends or other people that you know.  I would hope, like Stephanie Garner, that you get support from the staff  and the people you work with( that's a very good work environment) .. If not.  I would be keeping an eye out for another place to work.

The best thing to do is remember that you are the therapist, it's your domain, and you are the one in charge of what happens in your space. Any time a client does something you aren't comfortable with, you need to address it immediately. If it has happened several times and you still haven't addressed it, it's your own fault that it has continued.

The next time you see this client, address it before the session starts. Do a thorough intake, then bring it up, saying something like, "I also want to address something I've noticed during recent sessions: While you are supine, you tend to spread your legs very wide, then keep them there even when I try to reposition them. This makes it much more difficult for me to help you. Starting today, I need you to let me reposition your legs so that I can do what is needed. If you experience discomfort from the position of your leg(s), you need to let me know verbally, IMMEDIATELY. Also, you have described discomfort in your hip flexors and inner thighs. Laying with your legs apart is pretty much guaranteed to aggravate that kind of pain, so today we will keep your legs much closer together until I move them as needed. Do you have any questions?"

If they give you any objections, evaluate them and discuss it further right away until the two of you are on the same page. If the client refuses to consent to your directives, suggest that they consider seeing another MT, as you are clearly not the person they wish to see. No matter what they say, do NOT let them push your boundaries further. Refuse to do the session, or simply skip the thighs and refuse to see them ever again.

My personal feeling, based on what you've stated so far, is that this person is a creep who has been gradually testing your boundaries. You could always just switch to the tactic of doing some deep, aggressive trigger point work for psoas and iliacus... watch his face and ask lots of clinical questions before, during, and after. Or you could keep him dressed and do positional release and Active Isolated Stretching (or some other stretching) for those areas. Or... well, pretty much anything OTHER THAN rubbing his thigh... which is a largely ineffectual method of treating groin/adductor pain anyway.

Don't be afraid to boot him out of your practice if he gets weirder or refuses to comply with your boundaries and treatment decisions.

I'm coming into my 12th year as a MT and about half my practice consist of men considering I specialize in sports and work with a lot of amature and pro fighters. I have NEVER had an situation, weird incident, or anyone say anything that was sexual in nature or made me feel uncomfortable. I believe it is my demeanor and my no bs approach. It really does work. Everyones comments and suggestions are great so far and you should try out what best works for you or what youre comfortable saying/doing. I make every new client sign my policy form and I go over the whole "if i interpret your behavior to be sexual in nature, I can and will terminate the session AND charge you full price" before begining our session. Something you may want to institute if you havent already.

As far is the ITB thing is concerned, I'd tell him straight up, "stop working against, drop your leg and try to relax the muscles." Maybe, try working the quads and some rocking and shaking through the sheet instead.  Also in prone position I like to bring the knee bent out and the ankle angled inward to expose the ITB, plus its easier body mechanics for me too.

 

Hope this helps.  

Your practice, your rules, your boundaries. He's playin wit ya becuz he can.

You have to set the tone for the session, as Qiana talks about.  I've been doing massage many years.  I used to get some men coming through like this guy. When I got clearer on how I wanted to work, I no longer got that type of client coming in.

You don't need to put up with it because maybe you think, you could use the work.

Try writing down what is your ideal practice and clients.

And always always listen to your intuition over your mind. It's there to serve your best interests.

I would agree with the other replies, I think this guy is walking the creep border. I would give him the benefit of the doubt and see how he acts when you set the rules "when you push against me with your leg you're fighting against me and making me work harder. If work harder I risk injuring myself and I don't think we both want that". If he persist you can just them "release" him from your care since his action might cause risk to you.

 

I think Jason Erickson gave you a great script for what to say. It's not accusing, so it won't cause him to get defensive with you.
I just wanted to say that I had a client like that when I first started. He spent a lot of money with me and I was broke so combine that with being brand new to the profession and I let him get away with way too much. He started out very strait laced and very gradually started pushing boundaries. I have found that people who push boundaries like that are very subtle and they know exactly what to say to make sure it could be interpreted several ways.
I think you should trust your gut. My gut has never steered me wrong.
And don't be too hard on yourself if you think you've been letting him get away with too much. We're all learning as we go along.

Listen to your gut.   If he makes you feel uncomfortable, it's because he is being weird.  Also, I agree with  Qiana Thompson about the positioning of the leg.  When in prone, I bed the knee out towards me, to work the IT band.  This really helps get the IT band with ease, and you're looking at it directly, when I've had to work it supine, it just is too rough on my body mechanics.

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