At my ethics class in Sarasota last week, the scenario came up about a client requesting to have a massage without a drape. Immediately, other class participants yelled out various comments about draping requirements. Some were wrong, others were on par for being at a class in the massage community. Here are few…
“You will lose your license. It is in Chapter 480!”
“For 25 years my policy is to have all clients stay completely clothed. I have had no problems.”
“My first job was at a nudist colony! No need to drape when a naked person walks up to you.”
“It is fine! As long as you have written consent!”
So what do the Laws and Rules actually say about draping? Here is how I explain things in my Florida Laws and Rules Update course.
Florida Massage Establishment Draping Requirements
Draping is first discussed in the Rules for licensed massage establishments, 64B7-26.003(3)(e), F.A.C.
Establishments must:
Maintain a sufficient supply of clean drapes for the purpose of draping each client while the client is being massaged, and launder before reuse all materials furnished for the personal use of the client, such as drapes, towels, and linens. As used herein “drapes” means towels, gowns, or sheets.
Easy enough! Keep enough drapes (“drape” is defined elsewhere) in the massage establishment for all clients. However, that doesn’t really help us with the question about the draping during a massage.
More Florida Administrative Code on Draping
The answer to this question is found again in the rules of the board, or Florida Administrative Code, under Misconduct and Negligence. That can’t be good.
64B7-30.001 Misconduct and Negligence in the Practice of Massage Therapy.
The following acts shall constitute the failure to practice massage therapy with that level of care, skill, and treatment which is recognized by a reasonably prudent similar massage therapist as being acceptable under similar conditions and circumstances:
(4) Failure to explain expected draping techniques to a client. As used in this rule, draping means towels, gowns, sheets or clothing.
(5) Failure to appropriately drape a client. Appropriate draping of a client shall include draping of the buttocks and genitalia of all clients, and breasts of female clients, unless the client gives specific informed consent to be undraped.
I am going to highlight a few important words used in Rule that we should discuss. Remember, I am not a lawyer and this is not legal advice. You should always check the current laws and rules and Florida. If you have any questions on how they pertain to you, contact a lawyer.
Appropriate Draping
Appropriate draping of a client shall include draping of the buttocks and genitalia of all clients, and breasts of female clients…
This is how the board defines “appropriate draping” for Florida massage therapists. These are the guidelines I personally use. I have never heard of anyone appearing before the board for misconduct for using appropriate draping and good client communication.
Now, let’s review that last part of that sentence in this Rule.
unless the client gives specific informed consent to be undraped.
The Client
How would this make you feel?
Massage Therapist: “You know, I find it better if the massage session is undraped. Is it okay if we do not use a drape this session?”
A statement like this may make a client feel pressured into an uncomfortable situation and leaves the practitioner open to misconduct allegations. While it may be permitted to have an undraped massage, we all should review the definition of “power differential”. Clients deserve to feel safe and unpressured in the massage room.
Informed Consent
The client must provide “specific informed consent to be undraped”. I did not see anything that specified whether consent should be written or verbal.
There is one more thing the Rules say.
Explain Expected Draping Techniques
64B7-30.001 Misconduct and Negligence in the Practice of Massage Therapy.
(4) Failure to explain expected draping techniques to a client.
Why is that? Here are my thoughts.
If I went in for a massage and the therapist failed to explain that a rolled-up washcloth will be the only thing covering my backside, I would take issue with that. Poor client-therapist communication is where therapists often run into problems with misconduct.
Communication about the session, including draping, prior to the massage is imperative.
Communicating Draping With Clients
Your draping policies should be part of your website, your intake, and pre-session consultation.
Example scenario:
A new client says they have had a massage before. You skip the explanation about draping and come back in to find they are face down on top of the top sheet without a drape.
You failed, not the client. Explaining draping techniques to every client is your professional responsibility.
Direct Your Attention to the Massage Therapist Standing in Front of You
Our instructor the other night likened it to a flight attendant giving safety instructions before take-off. We should use hand signals and be super-specific.
Massage Therapist:
I will leave the room here shortly.
When I do, you can get undressed to your comfort level. This means you can take off all of your clothes, can leave on your underwear, or stay completely dressed.
I use sheet draping techniques during every massage. This means only the part of your body I am massaging will be undraped. For instance, when we work on your back, I uncover your back down to here (pointing to my sacrum). When I am done, I cover that part and move onto the next area.
After you are undressed to your comfort level, lie face down underneath the top sheet here (lift the top sheet for them to see the top and bottom sheet).
I will go wash my hands and come back and knock to see if you are ready. When you indicate that you are ready, I will enter the room and we will begin the session.
Any questions or concerns before I go?
Keep Explaining and Checking In
When you make a drape and tuck, ask the client – “Does that feel okay or does it need to be adjusted?”
Clear communications and boundaries will benefit your practice for years to come.
Back to Boundaries
A drape sets a boundary, a physical boundary, which is important in a professional massage. The Rules state a drape as “towels, gowns, sheets, or clothing” (64B7-30.001(4), F.A.C.). Like everything else, we are left with grey areas that are open to interpretation. Is a washcloth a drape? Are underwear and swimsuits drapes?
What are draping options?
- Gowns
- Sheets
- Towels
- OR clothing
Codes of Ethics
Now that we have talked about what Florida says about draping, it is time for another reminder. Most likely, you have other people you might have to answer to, other than the board, as a massage professional. There are codes of ethics and standards of practice you promise to follow when you sign your check or request insurance coverage.
AMTA, ABMP, and other liability insurance companies have guidelines for ethical standards. Some of these standards include requirements for draping. Make sure you are aware of your responsibilities for your chosen insurance carrier.
AMTA Standards of Practice
3. Professional Relationships with Clients
3.1 The Practitioner relates to the client in a manner consistent with accepted standards and ethics.
ABMP Code of Ethics
5. Commitment to Respect Client Dignity and Basic Rights
I will demonstrate my respect for the dignity and rights of all individuals by providing a clean, comfortable, and safe environment for sessions, using appropriate and skilled draping procedures, giving clients recourse in the event of dissatisfaction with treatment, and upholding the integrity of the therapeutic relationship.
FSMTA Code of Ethics
Describe their massage therapy treatment and their intended draping procedures to each client/patient.
FSMTB
The MBLEx content outline section under GUIDELINES FOR PROFESSIONAL PRACTICE includes the subtopic on draping (F. Draping – Safe and Appropriate Communication).
NCBTMB Standards of Practice
Standard I(j): use appropriate draping to protect the client’s physical and emotional privacy;
Red Flags!
What if a potential client calls and asks about draping? Is this always a “red flag”?
Ask more questions about their goals or intentions. Not all people that call about draping are sexual predators. State your policy and let them know you are not the massage therapist for them. In the case that the potential client continues to throw up red flags, no need to send them anywhere else. Hang up the phone.
There are a few reasons why our draping expectations might not line up.
Cultural Differences
Massage therapists in other countries often forgo the use of precise draping we use here in the states. My neighbor tells the story of a tropical vacation and being handed something that resembled a shower cap for a drape, and a robe that was much too small for his couples massage.
If your clientele includes typical Florida tourism, or the thousands that move here from Europe to retire, prepare to have some European clients that are unfamiliar with our standard draping protocol. They may be used to paper-like disposable underwear and undraped breasts, which are not uncommon practices in their countries.
Modalities
Your modality may be traditionally performed with minimal draping. Some forms include Chavutti, Lomilomi, or Esalen. If your clients are unfamiliar with the draping used in these modalities, make sure you fully explain the differences to them.
True Aversion
Yes, there are people with real sensory processing disorders. This may include a true aversion to clothing. Also, there are people who run too hot or feel claustrophobic under heating pads, blankets, or sheets. How do you handle these requests?
Ask what you can do to make them more comfortable. Suggestions include:
- Turning the air down
- Opening a window
- Turning on a fan
- Keeping the feet and legs uncovered
- Suggesting a swimsuit
Your Draping Policy
Now that we have covered laws and ethics, it is time for you to work on your draping policy. If you work for a salon, spa, or otherwise -ask what is their policy on draping. If the company doesn’t have one, suggest they make one.
Prepare for these requests and questions.
My policy is to drape all clients. Drapes can be underwear, swimsuits, bath towels, or sheets. Also, I can turn the air down, open a window, or put a fan on you during the massage to keep you comfortable.
Get Back to Work
Finally, for our profession to advance in credibility with the public and medical community, it is important that we work towards the highest standards of professionalism.
Whatever you choose to do in your practice, do it with the utmost respect for the client-therapist relationship.
Excellent explanation & commentary – very thorough.
Are disposable linens permitted?
I am not aware that they are prohibited anywhere.
As someone who has basically survived excessive pain for years thanks to massage and other “alternative” medicine practices, I have seen numerous changes to massage and draping regulations – much of this coming to be due to actions of an unscrupulous group of individuals who ignorantly construe the techniques employed on a therapeutic massage with that of sex / sexual foreplay. A sad commentary to both our rebellious and yet puritanical values here in the U.S.
As someone who has had deep musculoskeletal issues for years it was nice to avoid all the encumbrances I’ve experienced with “scared senseless” therapists who either cover me with so many layers, or tuck so tightly it negates all the (legitimate) reasons I’ve there to address. It was beneficial to be able to establish a comfortable working relationship with a therapist and not have it be a national crisis if my glutes / gluteal cleft, or God forbid my genitals, were exposed for a brief moment or even long enough to be worked out with the necessary attention (glutes, hip flexors, abductors, etc. – NOT my genitals). Back in the days when I was limited in disposable income and insurance covering massage was not even a consideration, every minute wasted was treatment lost in both my mind and for several of my therapists.
There was never anything “sexual” about it – it was a body in need of healing and the therapist’s hands transferred that healing. Truth be told, I get uncomfortable every time I have to have certain parts of my anatomy examined by my physician(s), and they are deemed acceptable viewers of our bodies on various states of undress up to completely naked – not mention handling, probing, etc. are most intimate of areas! So, the last thing I want is for my therapist, who is is there to relax my tension and put me at ease, is to be rubbing around on my most personal of areas.
Nowadays, because I’m American and having grown up on our puritanical culture am expected to “fall in line” with those who with whom I’m judged, being labeled a pervert, deviant, or worst of all “a sexual predator”! Really?!? Maybe it’s good these rules are in place, because if they weren’t, I’d say all the puritans hypocrites* who preach and regulate morality, to kiss my hairy white ass, and it would be there for them to see it!
* I’ve seen the hypocrisy first hand of those who hold up their solid “moral fiber” of spending their disposable income at the local “gentleman’s” club on Friday or Saturday nights! I suppose they were purging themselves of their sins before walking into church Sunday morning – especially for the church leader who was there (regularly).
I guess I’ll just cross my fingers that there is that brave therapist out there who knows they can trust me and I them. Until then, it will be my legs that stay crossed.