● Assuming that the therapist does not need to navigate around external genitalia, just because the client is a woman. ● Assuming that for example, due to a transgender client’s convincing gender presentation, they must have undergone surgery of various sorts. ● Assuming that techniques that are unsafe during pregnancy are okay, because you assume your client is a man (Haines, 2016). Transgender clients have all the physical issues that other clients have. Some may have a few more and the following are issues to consider: ● Beginning hormone therapy as an adult can lead to what is functionally a second puberty. Remember being a teen? Voice breaking, breasts aching, acne, mood swings, and inopportune sexual arousal? Imagine going through all that again at age 20 or 60. ● Surgery of any kind leaves marks on those who experience it. Scarring is an obvious example and tenderness or numbness, are other concerns. But also consider how someone’s posture changes after breast reduction or augmentation or their activity levels decrease while in recovery. Massage and bodywork practitioners may work in tandem with the client’s physical therapist or other members of their healthcare team. ● Just because it is the body the client wanted does not mean it is not different from the one they had before. It is not strange to feel uncomfortable, emotional, or nervous about this body being touched by a relative stranger. As in the case of all ethical issues, there are no absolute or universal experiences that are shared by any individual no matter what their gender identity or sexual orientation. In all cases the massage and body work therapist must avoid making assumptions and judgments about individuals and their bodies. There are plenty of individuals who undergo no radical changes to their bodies and others who choose partial or complete transformation. Increasingly, children and adolescents are being recognized and supported in their gender identities and sexual orientation. This also means that massage therapists who focus on pediatric populations are not exempt from the need to avoid assumptions about gender.
● The question of pronoun choice can be explored on intake forms or online scheduling. This has the advantage of minimizing in-person awkwardness while communicating that the practice takes respecting people’s gender identities seriously. If a mistake is made, offer a sincere apology, rectify the situation and make sure all the staff is aware of the situation so that it will not happen again. Misnaming Names are intensely personal, and for this reason many individuals select a name that they feel more adequately reflects their gender identity or sexual orientation. This could be similar to their former name or not. It could be distinctly gendered or gender-neutral. It could be a nickname, an invented name or a family name, but regardless, it is the name the client wishes to be called, and so that is the name to use. This might not be the same as the name on the ID or billing information, or on the insurance documents. This must not be considered a problem or addressed in any way that might make the client feel uncomfortable or draw attention from others. It does not matter one bit that Susanna’s bank account says George, any more than it matters that Katie’s says Kathleen. Again, these issues could be addressed on intake or online forms to address any fraud or identity protection, insurance or billing issues without confrontation. This holds true in the treatment room, at the reception desk, over the phone, and in emails. If multiple staff work in the practice, they must all be educated on the appropriate names and pronouns to use. In addition a staff meeting or in-service training should be provided to all staff on the issues addressed in this section (Haines, 2016). Making assumptions about the body Massage therapists are accustomed to asking questions about people’s bodies rather than making assumptions, which is how we avoid bruising the tough-looking client on blood thinners or injuring the dancer with a stress fracture. Similarly, making unwarranted assumptions about people’s bodies based on their gender presentation can be offensive as well as harmful. A few potential pitfalls: ● Assuming that, because someone does not have breasts, that they are comfortable with their chest undraped.
PRIVACY AND CONFIDENTIALITY
about the matter yet. Soon after, the Cordelia’s mother calls and asks if Dan has been behaving strangely lately. The client walks out after her session. Another client asks, “Is that a man or a woman? I can’t even tell.” The therapist regularly volunteers at an organization supporting the transgender community, which is how they first came into contact with a client named Lisa who receives services there as well as volunteering herself. The therapist chats briefly about mutual acquaintances and another practitioner asks “Oh, how do you two know each other outside of massage?” The therapist is a recent massage school graduate with a new practice in a small town, and one client is a trans man who recently moved from out of state. Another massage therapist in a public group on Facebook asks whether the therapist has any experience working with transgender clients.
The importance of confidentiality and privacy of client information is the ethical obligation of all massage and bodywork therapists. The ethical standards of confidentiality and privacy in professional practice dictate that practitioners protect the client’s identifying information, health status, billing, insurance or any other personal information that includes sexual orientation or gender identity. If individuals share private information with their massage or bodywork therapists it should never leave the treatment room but may be documented if it is relevant to the treatment plan and objectives of health care for the client. It takes the same thorough knowledge of ethical standards and guidelines, as well as good judgment and decision making, to work with all clients. Consider a few scenarios to determine the appropriate action (Haines, 2016): A 17-year-old client, known as Dan for the last year, confesses that they always wished to be born female, and asks to be called Cordelia while in private. They also mention that they have not spoken to their mother A final note on outing When it comes to sexual orientation, the idea of “coming out” is generally seen as a positive thing. It means that
someone was hiding their true reality, but is now living it openly. In the T part of the LGBT community, things may be
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Book Code: MPA0825
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