identified vulnerable populations, are required to report whenever financial, physical, sexual or other types of abuse have been observed or are suspected, or when there is evidence of neglect. The line, “In many U.S. states,” indicates it is not federal law for the massage therapy professional and mandated reporter requirements are not uniform throughout the U.S. The term “vulnerable populations” will also vary among states, but will always include children, senior citizens and adults with mental and physical impairments that make them vulnerable to abuse. Adults who require assistance for daily living and functional skills, whether living at home or in an assisted living facility may also be included in this definition. In some cases, able-bodied adults may be included even if they are temporarily living in a rehabilitation facility to recover from illness or injury, are hospitalized, medicated, or otherwise incapacitated. In many states, reporting abuse is considered a breach of the confidentiality rule, although some states allow reporting abuse because it is viewed as criminal activity and must be reported to protect clients. Other states may include the massage and bodywork professional in the category of healthcare provider so they would be considered mandated reporters. Abuse counselors and agencies caution practitioners to be careful because reporting abuse may put the victim in danger of further abuse. When abuse is reported, it may cause the perpetrator to act out, feeling they have nothing to lose since they will likely face prosecution. One therapist interviewed but not identified in the article provided the following insight: In the very few incidents where a client has admitted to being battered, my first response to them was to ask, “Do you need help? I can get you in touch with someone who can help you.” I am not trained or qualified to provide any meaningful help, but I can get the phone number of a women’s shelter in less than five minutes! Oftentimes, though, they do not want our help or interference. In that situation, I have to accept their decision, sad though it may be. There is no black or white answer to this, so it is important to contact the state licensing or certification board and professional organization to know the proper procedure. If the state requires the therapist to be a mandated reporter, they must report the abuse to the appropriate authority within twenty four hours of observing the abuse or face legal and professional sanctions. Analysis Here, the client is seeking to engage in a dual relationship with the massage therapist; in this case, the client is proposing a business relationship that goes beyond the therapeutic relationship. It is best to avoid dual roles or multiple relationships, especially if it appears that the relationship might interfere with the therapeutic relationship. The possibility of a dual role or multiple relationships is not necessarily a violation of ethical boundaries; however, what is the potential impact of agreeing to accept this business opportunity with the client? Conversely, what consequences may follow from turning down the client’s business opportunity, regardless of the reason? Any dual role or relationship may impair objectivity or therapeutic effectiveness, or permit exploitation, or create an actual, apparent, or potential conflict of interest as noted in NCBTMB Standard IV: Business Practices.
The therapist has heard rumors that the client’s husband is involved in illegal activities and organized crime. The client begins to visit the massage clinic even when she does not have an appointment scheduled. Sometimes, she just reads the magazines and asks questions about massage. On appointment days, she arrives very early and lingers long after her session is over. She continues to increase the frequency of her appointments so that she receives two massages a week. The therapist senses that this is not a case of physical attraction and that the client she just wants someone to talk to. Analysis In this situation, it may be difficult for the therapist to avoid a breach of the client’s confidentiality, as she has not disclosed that she is either being physically or emotionally abused, regardless of appearances or hearsay. All information and matters relating to a client’s background, condition, and treatment are strictly confidential and should not be communicated to a third party without the client’s written consent or a court order. In this case, there is no method for obtaining a court order. If the therapist finds that he cannot in good conscience let the alleged abuse go undetected by the proper authorities, the therapist is left with one or both of the following options: either refer the client to a social worker, and/or terminate the therapeutic relationship. In giving the client a referral to a social worker, the therapist does not violate the client’s principle of autonomy, self-determination, which holds that individual persons have the right to make their own choices. If the client wants to seek support for abuse, she may do so of her own volition. In giving the client the referral, the therapist does not violate any professional boundaries, since he is remaining within his scope of practice. But the therapist may also choose to terminate the therapeutic relationship because the relationship with the client has become dysfunctional in terms of an effective therapeutic relationship. The obstacle for the therapist should be relayed to the client as early as possible so that the client is not surprised by any unexpected pronouncement that the therapeutic relationship will come to an end. Mandated reporting There is controversy surrounding whether or not a massage therapist is a mandated reporter. Massage Therapy World, published an article in 2016 on this topic and provided the following information: In many U.S. states and Australia, mandated reporters are professionals who, in the ordinary course of their work and because they have regular contact with children, disabled persons, senior citizens, or other Case study 3 A massage therapist working in a clinical setting has been treating a client, and during massage appointments, there was no indication of client dependency or physical attraction. The verbal and non-verbal feedback that the client provides during the session seems to facilitate the professional relationship. After the last appointment, though, the client began to discuss what appears to be a great business opportunity that he thinks the therapist might be very interested in. The client feels that this opportunity is so good that the therapist will probably want to share it with her friends, acquaintances, and other clients. He wants to meet with the therapist over lunch to describe the opportunity. He also wants the therapist to meet his spouse during lunch, since she is heavily involved in the business. The therapist does not know much about the client beyond the clinic, and has never spoken to him about anything but massage therapy and his treatment plan.
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Book Code: MPA0825
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