● When personal feelings are recognized, addressed and put aside, they do not interfere with the commitment to high quality healthcare. ● Awareness of counter transference marks the therapist’s return to professionalism. ● Moving beyond this barrier, the therapist can educate her client on the anatomical connections and therapeutic value of her work to release the shoulder tightness, which include connecting muscle groups, and provide strategies to address the cause such as better postures or adjusting computer height, angle, or reach. CASE STUDY The therapist, as part of an integrated health term, was hired to provide in-home treatment to a client after shoulder replacement surgery. The therapist noted, in the third month of a yearlong course of therapy, that the client wanted to begin and end the sessions by hugging the therapist. During the same time, the therapist noticed that the client began baking treats and offering beverages at the end of the session and encouraged the therapist to stay for longer social visits after the sessions ended. Gradually, the client began to ask more personal questions of the therapist and clearly expressed feelings that are inappropriate for a therapeutic relationship. When the therapist declined to reciprocate the feelings, and attempted to re-establish boundaries, the client became hurt and angry and threatened to ask for a new therapist. Reflection What are the appropriate steps the therapist should take to resolve this situation? Analysis In some cases, there are cultural or ethnic customs that influence a client’s behavior that may be misconstrued or misinterpreted by the therapist. Often small gifts from clients are a personal sign of appreciation, as may be the case for clients who cannot afford to tip. The client’s customs may dictate that they offer food or drink to guests no matter what the occasion. Likewise, they may hug or kiss as a standard form of greeting and not to reciprocate or pull back would be a sign of rudeness or an offensive behavior by the therapist. The therapist should know as much as possible about the client’s culture in order to gage their intentions when they offer gifts, signs of affection, or invitations to come to dinner or a social event outside of the massage venue. The therapist needs to carefully consider the words and actions of the client before deciding if they constitute a boundary violation, or if the therapist needs to address a potential ethical conflict. When making decisions, the therapist should consider if the client’s actions have the potential to cause harm to himself or herself, or the therapist, or interfere with the effectiveness of therapy. In this case, the therapist will have to determine if the intent of the hugs and baked goods were innocent gestures, but if client comments began to cross a professional boundary, the practitioner needs to address the situation and reset boundaries. Many insurance companies cover massage and bodywork therapy as these professions are gaining acceptance and value in the medical community as collaborative partners. This growth requires the massage and bodywork professional to increase their knowledge in the field of ethics including confidentiality and privacy issues included in the HIPAA Rules that govern the electronic sharing, maintenance and storage of protected client information.
She had felt these feeling before when she was a teen and made to feel inadequate by her negative, authoritarian mother who was impossible to please. Reflection What is the term (or terms) used for the situation this therapist experienced? Analysis The therapist determined that the situation had devolved into one of transference and counter transference. Here are the relevant components: ● In relationships where a power differential is present, as between a healthcare practitioner and client, there exists a potential for transference and counter transference to surface. ● Transference occurs when a client unconsciously projects unresolved feelings, needs and issues onto a practitioner. ● In counter transference, the therapist unconsciously assigns unresolved feelings, thoughts, and perceptions about someone from their personal history onto the client. ● As a result, the therapist may lose objectivity and misinterpret a client’s actions, responses and needs. These misperceptions can lead to misunderstandings, poor judgment, and even negative feelings toward a client. ● Negative feelings often arise when a client displays similarities to a person in the therapist’s life toward whom ill will is harbored. ● Displaced positive feelings can arise when a client reminds the therapist of someone they feel favorably toward. ● Recognizing the signs of counter transference can prevent an awkward ethical dilemma up to and including litigation. The following behaviors are indicative of counter transference: ○ Unusually strong positive or negative feelings toward a client. ○ Predominance of impatience or anger if a client is not progressing. ○ Being argumentative with a client. ○ Over-emotional involvement in solving the client’s problems. ○ Making exceptions for a client’s inappropriate behavior. ○ Giving a client extra time and attention before and after a session. ○ Bending your professional and personal boundaries for a client. Steps to prevent or resolve counter transference issues include: ● Working on building trust and communication as a foundation. The therapist in this case stayed quiet too long. ● Working to become more self-aware and overcoming prejudices, preferences, judgments and personal issues, to establish clearer boundaries in the therapeutic relationship. Conclusion As the popularity, integration, and acceptance of massage therapy and bodywork throughout the healthcare field continues to increase, so will the demand for professional practitioners who trained in a variety of techniques and are well versed in the area of ethical practice. Therapists will need to expand their practice to keep pace with the profession that has expanded to treat a wide variety of mental and physical conditions, and a more diverse client base.
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Book Code: MFL1227
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