therapist directly or is explicit in nature within the massage therapist’s vicinity but is not directed toward them). ● Asked to undrape the genitals, buttocks, or breasts during a massage or expose themselves to clients or patients who undrape themselves in a manner that is in violation of local and state laws. Sexual harassment, like sexual misconduct, is not defined by any specific sexual interaction between two individuals. Harassment may include the discussion of sexually explicit topics at a place of business, unnecessary or inappropriate references to specific body parts or functions, and visual depictions of a provocative or offensive nature, such as posters or calendars featuring photos of nude or scantily clad models. Sexual harassment can occur between men and women, women and women, men and men, or any other combination of sexual or gender identity. Sexual harassment may feel humiliating or shameful, making the victim reluctant to report the incident (U.S. EEOC, n.d.). Of course, the best option is to prevent sexual harassment from ever escalating to the point that ethical concerns are raised. Practitioners can combat sexual harassment in any number of ways; one of the easiest methods is to educate clients. As massage therapy becomes more readily accepted as a legitimate form of healthcare, today’s massage professional should be referred to as a “massage therapist” and not a “masseuse” (female) or “masseur” (male), as these terms carry with them sexual connotations. It requires little effort for practitioners to correct a client when they make this mistake in terminology, and it lets a client know that the massage therapist is a professional with ethical standards and boundaries. CASE STUDY A massage therapist and client have had a professional relationship for four months now. During this time, the client has received a massage once per month. There has not been any inappropriate activity during this time, and there has not been any nonprofessional contact outside of the massage sessions. Lately, however, the client has been scheduling weekly massages. Moreover, the appointments have been at the home of the client, and the conversations during a massage appointment have typically been personal in nature, often speaking freely. Although it is unspoken, both the client and the therapist believe they would make great partners socially. The client has been physically attracted to the therapist since their first appointment, and the therapist has become increasingly attracted to the client as well. The client is aware that the therapist is also getting over the recent dissolution of a long-term relationship and has few social outlets. During the massage, the client occasionally makes sounds that signify pleasure and possibly even sexual arousal. The therapist finds the feedback flattering and puts extra effort into making the massage an increasingly sensual experience for the client. Reflection Are there any issues regarding transference or countertransference in this scenario? Is the therapist abusing their power? Are any boundaries being ignored? Analysis This case potentially violates several areas of ethical concern. The first is an abuse of the power wielded by the massage therapist in the therapeutic relationship. Having forged a close relationship with the client, the therapist has allowed an emotional response to escalate into a physical one and let a small impropriety on the part of the client escalate into egregious misconduct on the part of both parties. Whether intentionally or unintentionally, the client’s transference (all the feelings experienced by the client,
related to his or her past experiences and relationships, stirred up by or in the session) has tested the boundaries of the professional relationship leading to countertransference on part of the therapist (all the feelings experienced by the practitioner, related to his or her previous relationships and experiences, that are stirred up during the session, including the practitioner’s conscious and unconscious response to the client’s transference of emotions). Although transference and countertransference are generally neither negative nor positive, the risk of raising unrealistic expectations on the part of client or practitioner in this situation is high. Ultimately, the therapist is responsible for maintaining the therapeutic relationship and, as such, is required to maintain boundaries that do not compromise professional judgment and objectivity. This case is also a clear example of an ethical violation of sexual misconduct, as the therapist intentionally seeks to gain the client’s approval in a manner that is not within the therapist’s scope of practice. In this situation, the therapist may want to consider how a potentially negative end to any personal relationship with this client may adversely affect the massage business in the future, both legally and in the court of public opinion. Reporting misconduct Many states require a “duty to report” by their licensees. If therapists believe they have first-hand knowledge of another practitioner acting unethically or illegally, they have a responsibility to report it. They should contact their state board, the certifying organization (NCBTMB, AMTA, etc.), or the Agency for Healthcare Administration (AHCA) to file a complaint. The AHCA is responsible for analyzing complaints and reports involving potential misconduct and initiating investigations. The boards and councils within statewide organizations determine probable cause and disciplinary action. CASE STUDY A female massage therapist has been working with a female client for six months, and the client’s behavior has slowly become aggressive, demanding, and critical of the treatment. The therapist focuses on the client’s shoulders and upper back muscles that are often tight but release during treatment. This is the problem areas identified by the client during development of the treatment plan. One day the therapist completed the upper shoulder work and started to move to the mid back. At that point the client turned and sat up, demanding that the therapist return to the shoulder area and shouted, “Do the work I told you to do, and if you did it right the pain would not keep returning!” The therapist, wanting to please the client, said nothing and repeated the shoulder work. Nothing further was said about the session by either party, and the therapist told herself that the client was having a bad day and kept the incident to herself. The following week, the therapist was uneasy and anxious as she approached the regular session with that client. Sure enough, when the client returned, she continued to bark instructions at the therapist. Again, the therapist complied in order to assuage the client’s anger and to try and accommodate her demands. As the sessions continued the therapist grew more apprehensive and she began to doubt her competence as a therapist. The therapist reviewed the client’s chart and her treatment and believed that she had delivered the correct procedure using the appropriate method. She felt that she had lost her ability to provide effective services and faith in her ability as a massage therapist. After carefully reviewing the situation, conducting self- awareness activities, and reflecting on her feelings and the impact on her behavior, the therapist came to a realization.
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