Massage Therapy: Common Patterns of Abuse and Recent Insights

We’ve handled a number of cases involving boundary crossing by massage therapists.

(One attribute of experience is the ability to recognize patterns before they're perceived by most people. Once you recognize a pattern, the next steps in the process are quicker and more sure-footed.)

Over time some common patterns and issues have emerged in these massage/abuse cases.

If I was Being Abused why Didn’t I Say “Stop” or Leave the Room?

This is one of the first questions victims ask themselves.

Sometimes it feels like anyone else in the same situation would have handled it differently. And if they would have responded differently, was what happened to me really over the line? Did I misinterpret what happened? Am I over-reacting?

But almost no one says stop. Or stands up, naked in front of the abuser, dons their clothes and leaves the room.

Most people assume that if a massage therapist touched them inappropriately, they would immediately say “stop” or leave. And, because they didn't, maybe their response doesn't match what happened. But human response to unexpected violation isn't what you would expect.

Researchers have studied and written a lot about why people don't say "stop," get up, and leave or punch the massage therapist in the nose.

• The freeze response. Most people know about “fight or flight." But the nervous system also has a “freeze” response. When someone experiences a sudden threat—especially one that is confusing rather than obviously violent—they may become temporarily unable to speak or act. It's an involuntary survival response, not a conscious choice.

• Shock and confusion. During a massage, the client expects to be touched. If the therapist crosses sexual boundaries, it may take several seconds—or much longer—for the client to realize that it wasn't an accident. That ambiguity can delay a response. And frequently, by the time the offense has been processed, the therapist has moved on to a different part of the body (or the massage has ended).

• Power Imbalance. Power imbalance helps frame, e.g., unwanted sexual advances in the workplace. It applies in a more subtle way in the context of massage. Many people who receive massages are pretty powerful in terms of career, financially, social standing, etc. But with massage all of that--along with the client's clothing--is left at the door. Clients submit to the massage therapist and turn over control. They're already in a headspace where they know that some uncomfortable things are going to happen, but that they're eventually going to feel better. They're prepared to suck it up, tough it out, and not say anything.

• Social Conditioning. People are taught to defer to experts and avoid confrontation. These norms can override more intuitive responses to conduct that crosses the line.

• Making a Bad Situation Worse. Sometimes it's a cost-benefit analysis. Does the patient resist and risk a full-on assault (or facing the embarrassment of being "wrong"), or ride it out and hope that by doing so they don't make a bad situation worse?

• Dissociation. Some people mentally detach from the experience during a traumatic event. They may feel numb, disconnected, or like it's not really happening. All of those things are barriers to stopping the unwanted conduct.

• Impact of Prior Trauma. A history of sexual abuse or other trauma makes freezing or dissociation more likely. (Studies suggest about 45 percent of women and 25 percent of men have experienced sexual abuse or sexual violence. (I suspect that there's some under-reporting and the numbers are actually higher.))

After boundaries have been crossed, people wonder why they didn't leave. What they sometimes fail to appreciate is that in the moment the brain is processing uncertainty, surprise, fear, and social expectations. All of that can produce very different behavior than what people might expect (of themselves or others).

All of this helps explain why sexual abuse is so common in this context. It's common because--regardless of whether the abuser understands all of the psycho-social complexities--he knows that most clients are not going to say "stop" or run from the massage room.

The biggest takeaway from all of this is the fact that someone did not say "stop" does not mean that nothing happened or that there was consent.

Abusers have a Playbook

Abusers demonstrate a remarkable lack of originality. What one client thinks only happened to them happens over, and over, and over.

Common tactics include:

• Building Trust and Legitimacy. They present themselves as highly experienced, caring, or uniquely skilled so the client is less likely to question them.

• Testing Boundaries Gradually. Rather than making an obvious move immediately, they may start with increasingly personal comments, unnecessary exposure, or touch that is close to intimate areas. This can make the client question whether anything inappropriate has actually happened.

• Creating Ambiguity. They may frame questionable contact as a therapeutic technique, making it difficult for the client to distinguish legitimate treatment from misconduct.

• Exploiting Opportunities. If a client appears confused, freezes, or doesn’t object immediately, opportunistic abusers sense a path forward without resistance.

• Discouraging Questions. Saying “this is standard,” “relax,” or “trust me,” reduces the likelihood that the client will resist or later report the conduct.

• Plausible Deniability. Contact is designed in a way that the abuser can claim later that it was either accidental and/or part of legitimate treatment.

• Wrapping Up Like Nothing Weird Happened. "Please leave me a five-star review." "Look forward to working with you again." "Did everything go okay?" These all imply that everything was normal and are a tricky way of gaslighting a client into thinking that their reaction must have been unreasonable or the product of ignorance.

Perpetrators do the same thing over and over because it works. There is usually a remarkably consistent pattern of behavior across multiple victims and encounters.

Abusers Don’t Necessarily Fit Stereotypes

Don't assume that a person’s stated sexual orientation predicts whether—or why—they might engage in boundary violations.

People who cross boundaries are often motivated by factors that extend beyond sexual attraction. The primary gratification for many abusers comes from violating boundaries or exercising power over someone in a vulnerable position. It's not solely about sexual gratification or, at least, direct sexual gratification.

One only needs to think of Jame Gumb in The Silence of the Lambs.



Jame is motivated to make a "woman suit" to satisfy his quest for female transformation.

Very much about gender. But the abuse isn't a source of direct sexual gratification.

Focus on the Employer and Washington Law Against Discrimination

Usually employers are liable for acts committed in furtherance of the employer’s business. Intentional sexual assaults are often viewed as outside the scope of employment because they serve the employee’s personal interests rather than the employer’s business.

In most cases the way to "get around" this rule is to allege that the employer was directly negligent.

These claims can be based on the employer's hiring, training, or supervising the employee. But to prevail, plaintiffs usually have to show that the employer knew or should have known the employee posed a risk.

In the massage context, all of these hurdles and work-arounds are removed.

The Washington Law Against Discrimination (WLAD) prohibits gender-based discrimination. And that includes sexual harassment in the context of public accommodation (like a spa or massage facility). Sexual harassment/abuse/assault is a form of gender based discrimination. As a result, employers are strictly liable for massage therapists who sexually harass/abuse/assault clients.

Not only can successful plaintiffs recover their actual damages, they can also recover their attorney fees and costs.

Do I Have a Claim?

If you think you have a claim, you probably have one.

It's one of those things like knowing whether you're awake or asleep. If you're not sure whether you're awake, you're probably asleep. If you're not sure whether the massage therapist crossed the line, they probably did.

By making a claim you not only get the compensation you deserve, you do a real service to other people who would otherwise be exposed to the line-crossing massage therapist.