Furthermore, engaging in any business besides massage therapy with this client may lead to other conflicts, such as the lending and borrowing of money, gift giving, soliciting donations, and the unsolicited marketing of massage to other business partners. Maintaining proper boundaries Case study 4 A massage therapist works at a spa where he believes the employer’s standards for cleanliness do not meet professional standards. The employer does not require oil or lotion containers to be cleaned as they are filled or at the end of the work day, does not require massage room surfaces to be cleaned on a daily basis, does not send dirty linens to a laundry service to be sanitized, and only requires hot stones be sprayed with a disinfectant between clients. Analysis The answer to this problem may lie in each state’s particular regulations or the regulations suggested by each state’s massage licensing board, although it should be noted that the suggestions for cleanliness advanced by a massage therapy board may not have legal precedence. Where the law is applicable, sheets, towels, table surfaces, and other relevant items or materials must be cleaned according to all legal health and safety requirements. Where the law is lacking in comparison to a code of ethics or standards of practice, therapists may have to protect themselves and their clients from potential safety hazards. In establishments where hot stones are used, for example, the standard of practice is such that hot stones should be scrubbed with hot water and soap between clients, and the water in the hot stone caddy exchanged for clean water before the next client receives a hot stone massage. One reason for this Case study 5 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 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, reflecting on her feelings and the impact on her behavior and spending time on reflecting the therapist came to a realization. She had felt these feeling before when she was a teen and made to feel inadequate
is critical to the effective and ethical practice of massage therapy. It should be noted that in this case the therapist acted appropriately and had not done anything to encourage the client’s potential boundary crossing.
is that an undetected pathogen from one client may be transferred to the hot stones during a hot stone massage and possibly transferred to the next client who receives a hot stone massage if the same stones and water are used. It would be a clear violation of a therapist’s obligation to protect the client from harm to allow unsanitary conditions to continue, regardless of the employer’s standards of cleanliness. Ethically speaking, the therapist should consider educating the employer about the fundamentals principles of infection prevention as outlined by the Centers for Disease Control and Prevention (CDC) and review state and local health regulations that may apply. Review NCBTMB Standard I: Professionalism that includes: ● Provide an environment that is safe and comfortable for the client that meets all legal requirements for health and safety. ● Use standard precautions to insure professional hygienic practices and maintain a level of personal hygiene appropriate for practitioners. Also applicable is Standard IV: Business Practices: ● Provide a physical setting that is safe and meets all applicable legal requirements for health and safety (NCBTMB, 2009). by her negative, authoritarian mother who was impossible to please. 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.
EliteLearning.com/Massage-Therapy
Book Code: MPA0825
Page 38
Powered by FlippingBook