Standards of Practice
Revised October 2009 - Copyright 2007 National Certification Board for Therapeutic Massage & Bodywork
The purpose of the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) is to foster high standards of ethical and professional practice in the delivery of services through a recognized credible certification program that assures the competency of practitioners of therapeutic massage and bodywork.
These Standards of Practice ensure that certificants and applicants for certification are aware of, and committed to, upholding high standards of practice for the profession. Also, the Standards of Practice are meant to assist members of the general public, including consumers, other health care professionals, and state and municipal regulatory agencies or boards with understanding the duties and responsibilities of NCBTMB certificants and applicants for certification.
The NCBTMB developed and adopted the Standards of Practice to provide certificants and applicants for certification with a clear statement of the expectations of professional conduct and level of practice afforded the public in, among other things, the following areas: Professionalism, Legal and Ethical Requirements, Confidentiality, Business Practices, Roles and Boundaries, and Prevention of Sexual Misconduct. These Standards of Practice were approved and ratified by the NCBTMB Board of Directors, representatives of the certificant population and key stakeholders of the NCBTMB.
These 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. Through these Standards of Practice, NCBTMB seeks to establish and uphold high standards, traditions, and principles of the practices that constitute the profession of therapeutic massage and bodywork. The Standards are enforceable guidelines for professional conduct, and therefore, are stated in observable and measurable terms intended as minimum levels of practice to which certificants and applicants for certification are held accountable. Upon submission of the application for the National Certification Examinations, each applicant for certification must agree to uphold and abide by the NCBTMB Code of Ethics, Standards of Practice and applicable policies. Certificants or applicants’ for certification’s 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.
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 they reasonably and in good faith believe have been performed by other NCBTMB certificants and applicants for certification to NCBTMB.
These Standards of Practice reflect NCBTMB’s clear commitment that certificants and applicants for certification provide an optimal level of service and strive for excellence in their practice. This includes remaining in good standing with NCBTMB, committing to continued personal and professional growth through continuing education, and understanding and accepting that personal and professional actions reflect on the integrity of the therapeutic massage and bodywork profession and NCBTMB. Certificants and applicants for certification are responsible for showing and maintaining professional compliance with the Standards of Practice.
NCBTMB requires certificants and applicants for certification to conduct themselves in a highly professional and dignified manner. NCBTMB will not consider and/or adjudicate complaints against certificants and applicants for certification that are based solely on consumer related issues or are based on competitive marketplace issues.
As the therapeutic massage and bodywork profession evolves, so, too, will the Standards of Practice. The Standards of Practice are, therefore, a live and dynamic document and subject to revision in keeping with the changing demands and expectations of the therapeutic massage and bodywork profession.
Standards of Practice
Standard I: Professionalism
The certificant or applicant for certification must provide optimal levels of professional therapeutic massage and bodywork services and demonstrate excellence in practice by promoting healing and well-being through responsible, compassionate and respectful touch. In his/her professional role the certificant or applicant for certification shall:
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
e. provide an environment that is safe and comfortable for the client and which, at a minimum, meets all legal requirements for health and safety
f. use standard precautions to insure professional hygienic practices and maintain a level of personal hygiene appropriate for practitioners in the therapeutic setting
g. wear clothing that is clean, modest, and professional
h. obtain voluntary and informed consent from the client prior to initiating the session
i. if applicable, conduct an accurate needs assessment, develop a plan of care with the client, and update the plan as needed
j. use appropriate draping to protect the client's physical and emotional privacy
k. be knowledgeable of his/her scope of practice and practice only within these limitations
l. refer to other professionals when in the best interest of the client and practitioner
m. seek other professional advice when needed
n. respect the traditions and practices of other professionals and foster collegial relationships
o. not falsely impugn the reputation of any colleague
p. use the initials NCTMB only to designate his/her professional ability and competency to practice therapeutic massage and bodywork, or the initials NCTM only to designate his/her professional ability and competency to practice therapeutic massage
q. remain in good standing with NCBTMB
r. understand that the NCBTMB certificate may be displayed prominently in the certificant’s principal place of practice
s. use the NCBTMB logo and certification number on business cards, brochures, advertisements, and stationery only in a manner that is within established NCBTMB guidelines
t. not duplicate the NCBTMB certificate for purposes other than verification of the practitioner’s credentials
u. immediately return the certificate to NCBTMB if certification is revoked
v. inform NCBTMB of any changes or additions to information included in his/her application for NCBTMB certification or recertification
Standard II: Legal and Ethical Requirements
The certificant or applicant for certification must comply with all the legal requirements in applicable jurisdictions regulating the profession of therapeutic massage and bodywork. In his/her professional role the certificant or applicant for certification shall:
a. obey all applicable local, state, and federal laws
b. refrain from any behavior that results in illegal, discriminatory, or unethical actions
c. accept responsibility for his/her own actions
d. report to the proper authorities any alleged violations of the law by other certificants or applicants for certification
e. maintain accurate and truthful records
f. report to NCBTMB any criminal conviction of, or plea of guilty, nolo contendere, or no contest to, a crime in any jurisdiction (other than a minor traffic offense) by him/herself and by other certificants or applicants for certification
g. report to NCBTMB any pending litigation and resulting resolution related to the certificant or applicant for certification’s professional practice and the professional practice of other certificants or applicants for certification
h. report to NCBTMB any pending complaints in any state or local government or quasi-government board or agency against his/her professional conduct or competence, or that of another certificant, and the resulting resolution of such complaint
i. respect existing publishing rights and copyright laws, including, but not limited to, those that apply to NCBTMB’s copyright-protected examinations
Standard III: Confidentiality
The certificant or applicant for certification shall respect the confidentiality of client information and safeguard all records. In his/her professional role the certificant or applicant for certification shall:
a. protect the confidentiality of the client’s identity in conversations, all advertisements, and any and all other matters unless disclosure of identifiable information is requested by the client in writing, is medically necessary, is required by law or for purposes of public protection
b. protect the interests of clients who are minors or clients who are unable to give voluntary and informed consent by securing permission from an appropriate third party or guardian
c. solicit only information that is relevant to the professional client/therapist relationship
d. share pertinent information about the client with third parties when required by law or for purposes of public protection
e. maintain the client files for a minimum period of four years
f. store and dispose of client files in a secure manner
Standard IV: Business Practices
The certificant or applicant for certification shall practice with honesty, integrity, and lawfulness in the business of therapeutic massage and bodywork. In his/her professional role the certificant or applicant for certification shall:
a. provide a physical setting that is safe and meets all applicable legal requirements for health and safety
b. maintain adequate and customary liability insurance
c. maintain adequate progress notes for each client session, if applicable
d. accurately and truthfully inform the public of services provided
e. honestly represent all professional qualifications and affiliations
f. promote his/her business with integrity and avoid potential and actual conflicts of interest
g. advertise in a manner that is honest, dignified, accurate and representative of services that can be delivered and remains consistent with the NCBTMB Code of Ethics and Standards of Practice
h. advertise in a manner that is not misleading to the public and shall not use sensational, sexual or provocative language and/or pictures to promote business
i. comply with all laws regarding sexual harassment
j. not exploit the trust and dependency of others, including clients and employees/co-workers
k. display/discuss a schedule of fees in advance of the session that is clearly understood by the client or potential client
l. make financial arrangements in advance that are clearly understood by and safeguard the best interests of the client or consumer
m. follow acceptable accounting practices
n. file all applicable municipal, state and federal taxes
o. maintain accurate financial records, contracts and legal obligations, appointment records, tax reports and receipts for at least four years
Standard V: Roles and Boundaries
The certificant or applicant for certification shall adhere to ethical boundaries and perform the professional roles designed to protect both the client and the practitioner, and safeguard the therapeutic value of the relationship. In his/her professional role the certificant or applicant for certification shall:
a. recognize his/her personal limitations and practice only within these limitations
b. recognize his/her influential position with the client and not exploit the relationship for personal or other gain
c. recognize and limit the impact of transference and counter-transference between the client and the certificant
d. avoid dual or multidimensional relationships that could impair professional judgment or result in exploitation of the client or employees and/or coworkers
e. not engage in any sexual activity with a client
f. acknowledge and respect the client's freedom of choice in the therapeutic session
g. respect the client’s right to refuse the therapeutic session or any part of the therapeutic session
h. refrain from practicing under the influence of alcohol, drugs, or any illegal substances (with the exception of a prescribed dosage of prescription medication which does not impair the certificant)
i. have the right to refuse and/or terminate the service to a client who is abusive or under the influence of alcohol, drugs, or any illegal substance
Standard VI: Prevention of Sexual Misconduct
The certificant or applicant for certification shall refrain from any behavior that sexualizes, or appears to sexualize, the client/therapist relationship. The certificant or applicant for certification recognizes the intimacy of the therapeutic relationship may activate practitioner and/or client needs and/or desires that weaken objectivity and may lead to sexualizing the therapeutic relationship. In his/her professional role the certificant or applicant for certification shall:
a. refrain 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 months after the termination of the client/therapist relationship unless a pre-existing relationship exists between a certificant or applicant for certification and client prior to the certificant or applicant for certification applying to be certified by NCBTMB
b. in the event that the client initiates sexual behavior, clarify the purpose of the therapeutic session, and, if such conduct does not cease, terminate or refuse the session
c. recognize that sexual activity with clients, students, employees, supervisors, or trainees is prohibited even if consensual
d. not touch the genitalia
e. only perform therapeutic treatments beyond the normal narrowing of the ear canal and normal narrowing of the nasal passages as indicated in the plan of care and only after receiving informed voluntary written consent
f. only perform therapeutic treatments in the oropharynx as indicated in the plan of care and only after receiving informed voluntary consent
g. only perform therapeutic treatments into the anal canal as indicated in the plan of care and only after receiving informed voluntary written consent
h. only provide therapeutic breast massage as indicated in the plan of care and only after receiving informed voluntary written consent from the client
Glossary of Terms
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.
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 which 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 majora, labia minora, 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.
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 the 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 (or doctor, psychotherapist, teacher, spiritual advisor, etc.).