Standards of Practice


NCBTMB developed and adopted these Standards of Practice to provide Certificants 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 and Inappropriate Touch. These Standards of Practice were approved and ratified by the NCBTMB Certification Board, representatives of the Certificant population, and key stakeholders of the NCBTMB.

Revised: September 15, 2017

Copyright 2017: NCBTMB: National Certification Board for Therapeutic Massage & Bodywork, Inc. Standards of Practice. All rights reserved.


These Standards of Practice for the profession of therapeutic massage and bodywork are the guiding principles by which Certificants conduct their professional practice. These principles help to assure that all professional behaviors are conducted in an 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. These Standards of Practice are enforceable guidelines for professional conduct, and therefore, are stated in observable and measurable terms intended as minimum levels of practice to which Certificants are held accountable. Upon submission of the application for the Board Certification Examination, each applicant for certification must agree to uphold and abide by the NCBTMB Code of Ethics, Standards of Practice and applicable policies. Those Certificants who fail to comply with the Code of Ethics and these Standards of Practice shall be deemed to have engaged in professional misconduct which may result in sanctions, or other appropriate disciplinary actions, including the suspension or revocation of certification.

NCBTMB Certificants are obligated to report unethical behavior and violations of the Code of Ethics and these Standards of Practice they reasonably and in good faith believe have been performed by other NCBTMB Certificants.

These Standards of Practice reflect NCBTMB’s clear commitment that Certificants provide an optimal level of service and strive for excellence in their professional 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 are responsible for showing and maintaining professional compliance with these Standards of Practice.

NCBTMB requires Certificants to conduct themselves in a highly professional and dignified manner. NCBTMB will not consider and/or adjudicate complaints against Certificants 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 these Standards of Practice. These 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.



The Certificant 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 shall:

Standard I(a): adhere to the NCBTMB Code of Ethics, Standards of Practice, and Policies and Procedures;

Standard I(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 these Standards of Practice;

Standard I(c): treat each client with respect, dignity and worth;

Standard I(d): use professional verbal, nonverbal and written communications;

Standard I(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;

Standard I(f): use standard precautions to insure professional hygienic practices and maintain a level of personal hygiene appropriate for practitioners in the therapeutic setting;

Standard I(g): wear clothing that is clean, modest, and professional;

Standard I(h): obtain voluntary and informed consent from the client prior to initiating the session;

Standard I(i): if applicable, conduct an accurate needs assessment, develop a plan of care with the client, and update the plan as needed;

Standard I(j): use appropriate draping to protect the client’s physical and emotional privacy;

Standard I(k): be knowledgeable of his/her scope of practice and practice only within these limitations;

Standard I(l): refer to other professionals when in the best interest of the client and practitioner;

Standard I(m): seek other professional advice when needed;

Standard I (n): respect the traditions and practices of other professionals and foster collegial relationships;

Standard I(o): not falsely impugn the reputation of any colleague;

Standard I(p): use the initials BCTMB only to designate his/her professional ability and competency to practice therapeutic massage and bodywork;

Standard I(q): remain in good standing with NCBTMB;

Standard I(r): understand that the NCBTMB certificate may be displayed prominently in the Certificant’s principal place of practice;

Standard I(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;

Standard I(t): not duplicate the NCBTMB certificate for purposes other than verification of the practitioner’s credentials;

Standard I(u): immediately return the certificate to NCBTMB if certification is revoked; and

Standard I(v): inform NCBTMB of any changes or additions to information included in his/her application for NCBTMB certification or renewal within sixty (60) days of such changes or additions.


The Certificant 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 shall:

Standard II(a): obey all local, state, and federal laws;

Standard II(b): refrain from any behavior that results in illegal, discriminatory, or unethical actions;

Standard II(c): accept responsibility for his/her own actions;

Standard II(d): report to the proper massage therapy regulatory body within thirty (30) days of discovery of, any evidence, such as first-hand knowledge, indicating any unethical, incompetent or illegal act committed by other Certificants;

Standard II(e): maintain accurate and truthful records;

Standard II(f): report to NCBTMB, within thirty (30) days of discovery of, any evidence, such as first-hand knowledge, of violations of the NCBTMB Code of Ethics and these Standards of Practice by himself/herself or by other Certificants;

Standard II(g): report to NCBTMB, within thirty (30) days of discovery of, 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 himself/herself or by other Certificants;

Standard II(h): report to NCBTMB, within thirty (30) days of discovery of, any pending civil litigation and the resulting resolution related to the professional practice of the Certificant and the professional practice of other Certificants;

Standard II(i): report to NCBTMB, within thirty (30) days of discovery of, 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; and

Standard II(j): respect existing publishing rights and obey copyright and trademark laws, including, but not limited to, those that apply to NCBTMB’s copyright-protected examination.


The Certificant shall respect the confidentiality of client information and safeguard all records.  In his/her professional role, the Certificant shall:

Standard III(a): protect the confidentiality of the client’s identity and information in all conversations, advertisements, and any and all other matters unless disclosure of identifiable  information is requested by the client in writing, is medically necessary, or is required by law;

Standard III(b): protect the interests of clients who are minors or clients who are unable to give voluntary and informed consent by obtaining prior written permission from a legal guardian;

Standard III(c): solicit only information that is relevant to the professional client/therapist relationship;

Standard III(d): securely retain client files for a minimum period of four (4) years from the termination of the therapeutic relationship; and

Standard III(e): dispose of client files in a secure manner.


The Certificant shall practice with honesty, integrity, and lawfulness in the business of therapeutic massage and bodywork. In his/her professional role the Certificant shall:

Standard IV(a): provide a physical setting that is safe and meets all applicable legal requirements for health and safety;

Standard IV(b): maintain adequate and customary liability insurance;

Standard IV(c): maintain adequate progress notes for each client session, if applicable;

Standard IV(d): accurately and truthfully inform the public of services provided;

Standard IV(e): honestly represent all professional qualifications and affiliations;

Standard IV(f): promote his/her business with integrity and avoid potential and actual conflicts of interest;

Standard IV(g): advertise in a manner that is honest, dignified, accurate and representative of services provided and remains consistent with the NCBTMB Code of Ethics and these Standards of Practice;

Standard IV(h): advertise in a manner that is not misleading to the public and shall never use sensational, sexual or provocative language and/or pictures to promote his/her business;

Standard IV(i): comply with all laws regarding sexual harassment;

Standard IV(j): not exploit the trust and dependency of others, including clients and employees/co-workers;

Standard IV(k): disclose a schedule of fees in advance of the session;

Standard IV(l): make financial arrangements in advance which are clearly understood by, and safeguard the best interests of, the client or consumer;

Standard IV(m): follow Generally Accepted Accounting Principles;

Standard IV(n): file all applicable municipal, state and federal taxes; and

Standard IV(o): maintain accurate financial records, contracts and legal obligations, appointment records, tax reports and receipts for the most recent three (3) fiscal years.


The Certificant 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 shall:

Standard V(a): recognize his/her personal limitations and practice only within these limitations;

Standard V(b): recognize his/her influential position with the client and not exploit the relationship for personal or other gain;

Standard V(c): recognize and limit the impact of transference and counter-transference between the client and the Certificant;

Standard V(d): avoid dual or multidimensional relationships that could impair professional judgment or result in exploitation of a client, student, employee, supervisee, mentee, trainee, or anyone else with whom a power differential exists;

Standard V(e): acknowledge and respect the client’s freedom of choice in the therapeutic session;

Standard V(f): respect the client’s right to refuse the therapeutic session or any part of the therapeutic session;

Standard V(g): 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);

Standard V(h): 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; and

Standard V(i): have the right to refuse and/or terminate the service to a client who exhibits language or behavior which the therapist deems as an immediate or potential risk to the safety of the: (i) client;( ii) Certificant; or (iii) therapeutic relationship.


The Certificant shall refrain from any behavior that sexualizes, or appears to sexualize, the client/therapist relationship. The Certificant recognizes the intimacy of the therapeutic relationship may activate practitioner and/or client needs and/or desires that weaken boundaries which may lead to sexualizing the therapeutic relationship. In his/her professional role, the Certificant shall:

Standard VI(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 (6) months after the termination of the client/therapist relationship, unless an ongoing current sexual relationship existed prior to the date the therapeutic relationship began. In the case of a pre-existing ongoing sexual relationship, providing therapeutic massage and bodywork on such a person is discouraged, but may be done with informed consent which acknowledges the power differential in a therapeutic relationship and the complexities of dual relationships;

Standard VI(b): in the event the client initiates sexual behavior, interrupt therapy to clarify the purpose of the therapeutic session. Provided that the client’s initial sexual behavior ceases, the Certificant may, at his or her discretion, take action to terminate or continue the session. The Certificant shall terminate the session if the sexual conduct continues;

Standard VI(c): with the exception of a pre-existing ongoing sexual relationship, as set forth in Standard VI(a), recognize that sexual activity with clients, students, employees, supervisees, mentees, trainees, or anyone else with whom a power differential exists, is prohibited even if consensual;

Standard VI(d): not touch the genitalia;

Standard VI(e): only perform therapeutic treatments beyond the normal narrowing of the ear canal and normal narrowing of the nasal passages: (i) as indicated in the plan of care; (ii) after receiving informed voluntary written consent; and (iii) only if the Certificant is permitted to do so  under state law;

Standard VI(f): only perform therapeutic treatments in the oral cavity: (i) as indicated in the plan of care; (ii) after receiving informed voluntary written consent; and (iii) only if the Certificant is permitted to do so under state law;

Standard VI(g): only perform therapeutic treatments into the anal canal: i) as indicated in the plan of care; (ii) after receiving informed voluntary written consent; and (iii) only if the Certificant is expressly authorized to perform colonic irrigation under state law; and

Standard VI(h): only provide therapeutic breast massage: (i) as indicated in the plan of care; (ii) after receiving informed voluntary written consent; and (iii) only if the Certificant is permitted to do so under state law.


Boundary: A limit that separates one person from another. Its function is to protect the integrity of each person.

Certificant: NCBTMB Certificant or applicant for certification.

Client: An individual who receives the professional services of a Certificant, regardless of how or if those services are compensated. The term client may include a patient.

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.

Generally Accepted Accounting Principles: Rules, conventions, standards and procedures that are widely accepted among financial accountants and otherwise known as GAAP.

Genitalia:  Reproductive organs and structures. Genitalia include the penis, scrotum/testis, vulva (labia majora and minora, clitoris, vestibule), hymen and vagina.

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 and kept in a client file that indicate the date of the session, areas of complaint as stated by client, and observations made and actions taken by the practitioner.

Scope of Practice: The extent and limits necessary for safe and effective practice in the skills, procedures, actions and processes that Certificants with education and professional training are permitted to utilize within the context of their certification. Scope of practice is defined by the profession and limited, when applicable, by regulatory bodies.

Sexual Activity: Any verbal and/or nonverbal behavior for the purpose of soliciting, receiving or giving sexual gratification. Sexual activity may include, but is not limited to: (i) inappropriate touch; (ii) inappropriate hugs; (iii) body language; (iv) verbal dialogue about sexual preferences or fantasies; (v) verbal or physical flirtatious behavior; (vi) seductive or sexually demeaning gestures; (vii) sexual joking; (viii) failure to ensure client’s privacy in disrobing/dressing; (ix) filming the client without his or her permission; (x) therapist’s breast or pelvic area touching a client; (xi) kissing or other activity that is sexual in nature.

Sexual Harassment: Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when: (i) submission to such conduct is made either explicitly or implicitly as a term or condition of an individual’s employment; (ii) submission to, or rejection of, such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (iii) 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.

Sexual Misconduct: Unethical and illegal behavior involving sexualization of, or engagement in, sexualized contact with a client/student/mentee/employee/trainee during or after the professional relationship has ended. This is especially critical due to the power differential in which care providers may use or exploit the trust or influence derived from the professional relationship. Sexual misconduct includes a wide range of sexual activity. The behavior does not have to be coercive to be inappropriate.

Therapeutic Breast Massage: Manipulation of the non-muscular soft tissue structure of the breast up to and including the areola and nipple.

Therapeutic Relationship: The ongoing relationship between a therapist and a client established to support the client’s therapeutic goals. Characteristics of a healthy therapeutic relationship include personal awareness and insight, trust, respect, safety, authenticity, acceptance, empathy, collaborative agreement and the maintenance of personal and professional boundaries.

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.).

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