College of Massage Therapists of Ontario Glossary of Terms

College of Massage Therapists of Ontario

Code of

Ethics

Glossary of Terms

December 2019, revised February 2022

Code of Ethics - Glossary of Terms

College of Massage Therapists of Ontario

December 2019, revised February 2022 1

The purpose of this glossary of terms is to assist Massage Therapists in understanding and

applying the Code of Ethics.

This glossary explains some terms used in the Code of Ethics. In some instances, this glossary

provides basic definitions, while in other instances, more detailed information regarding key

concepts is offered to support Massage Therapists in applying the Code of Ethics in their clinical

practice.

Abuse

A violation of the power inherent the therapeutic relationship. Abuse occurs when a Massage

Therapist Massage Therapist utilizes the therapeutic relationship to meet their own personal

interests or needs. A Massage Therapist who abuses a client acts outside of professional

boundaries.

Abuse may be financial, physical, sexual and verbal, emotional or psychological:

• Financial abuse: financial abuse exploits the power differential between the Massage

Therapist and client and often results in a monetary or equivalent gain for the Massage

Therapist. Examples of financial abuse can include accepting gifts, borrowing money,

becoming a trustee of a client’s account, accessing a client’s bank account, seeking

financial benefits or other services.

• Physical abuse: an act which may cause pain or harm to another. Slapping, hitting,

pushing and use of force during a treatment are examples of behaviours that can be

viewed as physical abuse.

• Sexual abuse: the Health Professions Procedural Code, being Schedule 2 to the

Regulated Health Professions Act, 1991 (RHPA) defines sexual abuse as follows: “sexual

abuse” of a client by a registrant means (a) sexual intercourse or other forms of physical

sexual relations between the registrant and the client, (b) touching, of a sexual nature,

of the client by the registrant, or (c) behaviour or remarks of a sexual nature by the

registrant towards the client. “Sexual nature” does not include touching, behaviour or

remarks of a clinical nature appropriate to the service provided

As discussed in CMTO’s Standard of Practice: Prevention of Sexual Abuse

Code of Ethics - Glossary of Terms

College of Massage Therapists of Ontario

December 2019, revised February 2022 2

• Verbal, emotional or psychological abuse: language (including if used in online

communication) that can reasonably be seen to demean, humiliate or insult the client.

Verbal abuse may harm the client emotionally, culturally or spiritually. Given that

Massage Therapists work with clients of many cultures and beliefs, it is important to

recognize that personal remarks about a client’s appearance, behaviour, language,

beliefs, religious practices, etc. may be distressing.

Behaviours such as sarcasm, teasing, swearing or threatening are examples of

behaviours that may be considered verbal or emotional abuse. Psychological abuse

includes the destruction of a client’s self-esteem and/or sense of safety, often

associated with differences in power and control within the Massage Therapist/client

relationship. It includes threats of harm or abandonment, humiliation, deprivation of

contact, isolation and other psychologically abusive tactics and behaviours. A variety of

terms are used interchangeably with psychological abuse, including emotional abuse,

verbal abuse, mental cruelty and psychological aggression.

Accountability

Accountability is to be answerable for the practice of Massage Therapy and to act in a manner

consistent with a Massage Therapist’s professional responsibility, as outlined in the

Code of Ethics, Standards of Practice, legislation and other relevant documents.

Conflict of Interest

This occurs when a Massage Therapist’s personal or financial interest conflicts or appears to

conflict with the exercise of their professional judgment or duty to act in the best interest of

the client. A conflict of interest can be potential, real or perceived. If circumstances exist where

a reasonable person would conclude that the Massage Therapist’s professional judgment may

be compromised, then a conflict of interest exists.

Some examples of conflicts of interest

include:

• accepting a referral fee, or any other benefit, for the referral of a client to another

person or business; or

Please see CMTO’s Standard of Practice: Conflict of Interest and Conflict of Interest Guidelines for additional

information

Code of Ethics - Glossary of Terms

College of Massage Therapists of Ontario

December 2019, revised February 2022 3

• advising a client to purchase a particular healthcare product if the Massage Therapist or

a relative has a financial interest in that product (or the vendor of that product), unless

the Massage Therapist informs the client in advance about the nature of the financial

interest (in which case the registrant should also provide the client with information on

at least one other source for the product).

Consent

A client must provide voluntary and fully informed consent to all aspects of treatment and must

be capable of providing such consent.

Informed consent includes the client understanding all the following:

1. The nature of the treatment;

2. The expected benefits;

3. Risks and side effects;

4. Alternative courses of action;

5. Likely consequences of not having treatment; and

6. The client’s right to ask questions about the information provided and that assessment

or treatment will be stopped or modified at any time at their request.

Consent for treating sensitive areas, as defined in the Standard of Practice: Consent, must be

obtained in writing.

Dignity

Dignity is the quality of being worthy of respect and esteem as human beings.

Dual Relationship

This occurs when a Massage Therapist has some other type of relationship with a client in

addition to the professional therapeutic relationship. The multiple relationships can become

blurred or merged, making it difficult for the Massage Therapist to maintain clear boundaries

and clinical objectivity, despite best intentions. A Massage Therapist may only have a dual

relationship in exceptional circumstances (see list below). A dual relationship is never

permissible with a person with whom the Massage Therapist is in a sexual or romantic

relationship, including their spouse, as this is considered sexual abuse under the Regulated

Health Professions Act, 1991.

Code of Ethics - Glossary of Terms

College of Massage Therapists of Ontario

December 2019, revised February 2022 4

Exceptional circumstances may include:

• there is no other similar or viable healthcare professional available (for example, in

small or remote communities);

• there is a demonstrated financial hardship on the part of the client;

• the client’s level of distrust and/or discomfort is such that it would be impossible for

them to seek services from a healthcare professional whom they do not know; or

• there exists a real barrier to the client accessing other healthcare services.

Examples of dual relationships include, but are not limited to:

• personal friendships with clients;

• bartering for goods or services with clients;

• treating family members; or

• romantic or sexual relationships with clients (which is sexual abuse under the RHPA).

Fair and Equitable Access to Care

Massage Therapists must treat clients in a non-discriminatory manner and give the same

opportunity to receive Massage Therapy. This includes applying policies and practices in a way

that respects individuals’ unique needs.

Honesty

Honesty is being sincere and truthful, and refraining from any kind of deceit in the practice of

Massage Therapy.

Integrity

Integrity is the quality of being sincere, honest and trustworthy in making choices and decisions

consistent with a Massage Therapist's professional values.

Professional Judgement

Professional judgement is the ability to competently interpret and apply ethical, legal, and

professional requirements to the unique circumstances of practice.

Professional Misconduct

Professional misconduct is conduct that does not meet the minimum expectations of integrity,

client-centered care and professionalism, as well as other legal and ethical standards.

Code of Ethics - Glossary of Terms

College of Massage Therapists of Ontario

December 2019, revised February 2022 5

Professional Responsibility

Professional responsibility includes the duties that Massage Therapists exercise to their clients

as regulated healthcare professionals in line with their professional role and commitment.

Regulated Health Professions Act, 1991 (RHPA)

In Ontario, regulated health professions are governed under the Regulated Health Professions

Act, 1991 (RHPA) and individual health profession Acts (Massage Therapy Act, 1991).

Scope of Practice

Massage Therapists may only practise within the Scope of Practice of Massage Therapy in

Ontario, defined in the Massage Therapy Act, 1991 as: “the practice of massage therapy is the

assessment of the soft tissue and joints of the body and the treatment and prevention of

physical dysfunction and pain of the soft tissues and joints by manipulation to develop,

maintain, rehabilitate or augment physical function, or relieve pain”.

Therapeutic Relationship

The professional relationship a Massage Therapist has with their clients. It should be designed

to promote, support, and advance the health and best interest of the client and be grounded in

trust, respect and the appropriate use of knowledge and power.

Therapeutic Touch

Therapeutic touch is physical contact between a Massage Therapist and client for clinical

indications within the Scope of Practice of Massage Therapy, and with the intention to facilitate

their health and well-being.

Transference and Counter-Transference

Transference

Transference refers to redirection of a client’s feelings for another person who is significant

to them to the Massage Therapist. Transference can obstruct the goal of the therapeutic

relationship.

Counter-Transference

Counter-transference refers to redirection of a Massage Therapist’s feelings towards the

client, or when the Massage Therapist uses a client to meet personal psychological needs.

Counter-transference can change the focus or content of the therapeutic relationship, as the

Massage Therapist’s needs and/or unresolved issues become part of the therapeutic

experience and impede the Massage Therapist’s ability to be fully present for the client.

Code of Ethics - Glossary of Terms

College of Massage Therapists of Ontario

December 2019, revised February 2022 6

Transparency

Transparency is the quality of being open and honest.