investigation, review of ethical standards and careful decision making. There are a number of areas within the practice of massage and bodywork that often lead to ethical conflicts which may build over time despite the practitioner’s best efforts to practice ethically. Maintaining proper boundaries between client and therapist is an area that often leads to ethical conflicts. “Boundary issues are common, and every client has different issues,” explains Jean Middleswarth, a licensed massage therapist and ethics instructor (Bond, 2014). “Know what the boundaries are so they can be respected.” According to Middleswarth, “If you find yourself thinking that something doesn’t feel quite right or that you spend too much time thinking about a particular client, you might be in danger of overstepping your bounds.” She provides the following example from her own practice: After becoming rather close friends with a client, Middleswarth noticed the line between client and friend started to blur, making maintaining a professional therapeutic relationship difficult. To rectify this problem, Middleswarth shored up the boundaries again by reinforcing the client-therapist relationship, talking to the client and agreeing to no longer discuss personal matters during massage therapy sessions. “If a client asks something too personal, ”Middleswarth says, “I won’t answer.” All practitioners must understand and control the boundaries in relationships with clients and establish and maintain an ethical therapist client relationship at all times. This is especially important if the therapist chooses to work with clients who are Personal boundaries and self-disclosure Self-disclosure is the process in which the practitioner reveals personal, rather than general or professional, information about themselves to the client. There are many types of self-disclosure, which may be deliberate, or accidental, initiated by either the client or the therapist, and they can be spoken or unspoken. An example of unspoken intentional self-disclosure is the manner in which therapists choose to decorate their workplace with a selection of a meaningful poster or picture, or a family photo. Some disclosure may be accidentally communicated through body language or tone of voice. Accidental self-disclosure also occurs in cases where a practitioner meets a client unexpectedly, such as when both are sitting in a lawyer’s office or medical lab. The therapists and client may feel uncomfortable in these setting when faced with one another and may not want to disclose why they are there. It may be awkward, but the therapist will need to handle the situation in a way that is cordial, professional, and maintains boundaries for the privacy of both parties. In all interactions with clients the therapists should ask themselves two questions before self-disclosing: ● How will it benefit the client? ● How will it affect the professional therapeutic relationship and boundaries? Along with the primary obligation to do no harm to the client, therapists should also consider their own privacy. Self-disclosure is not always conscious or deliberate, and can be affected by fatigue, stress, haste or unchecked emotions. Words can be inadvertently spoken, accidently overheard, said in haste without proper evaluation, or simply be emotionally charged. Practitioners must be aware of their personal privacy boundaries, Dual/multiple role relationships The boundaries set during a therapy session must apply to interactions with clients when they encounter them in the community. If the therapist resides in the same community, it is likely that they will have to interact with clients at establishments or events, like the grocery store, church, school, recreational facilities, or community functions. The practitioner must be aware of the importance of boundaries and the need to project professional and ethical conduct when in public.
friends or family members. Establishing clear boundaries are critical to avoid compromising situations or conflicts of interest. Procedures, policies and standards must be followed in the same way with all clients with no exceptions. Middleswarth advises that any touch boundary issues must be addressed with the client before beginning a session: “Boundary issues should be addressed directly; tell [the clients] they should undress only to the level of their comfort. Even for clients you see regularly, you may want to remind them of this fact every now and again, as comfort levels may change from massage session to massage session. Ask, too, if there are any areas the client doesn’t want you to work on, and then check in with them during the session to make sure they’re comfortable. Their body will tell you when it’s not okay,” Middleswarth says (Bond, 2014). For example, a client who tenses up when you work on a certain area is probably a good indication that they are uncomfortable. Additionally, massage therapists need to know their scope of practice and be aware of their professional limitations. According to Middleswarth (Bond, 2014). This includes knowing when to terminate treatment and refer out. “When progress has stopped, but pain persists, it might be time to refer them to a different health care provider,” Middleswarth notes. “Recognizing and admitting when you are no longer able to help your client may be one of your toughest challenges professionally, but in order to practice ethically, you need to know when your clients need something other than massage therapy.” know when they may be crossed and be aware of personal behavior triggers that may lead to boundary crossings. When in doubt, stop, think, and do not self-disclose (AMTA, 2015b). It is best for therapists to withhold emotional responses or judgments, both negative and positive. Therapists must monitor their own feelings without imposing these on clients. If therapists are distracted or affected by a strong emotion or feeling, they must be able to be objective and flexible enough to adapt to the situation, and not let it interfere with service delivery during the session. After the session, it is important to address the conflict with a professional colleague or supervisor, or to identify the antecedent, i.e., cause of the emotional conflict, and plan strategies to handle emotions or stressful situations in the future (AMTA, 2015b). As with other boundary crossing, self-disclosure should be client-focused and based on the welfare of the client. Different clients and practitioners have different personal boundaries so appropriate boundaries must reflect the client’s comfort zone while maintaining ethical boundaries and professional standards of conduct. Personal and professional boundaries exist for the benefit of both the practitioner and the client. Changing or moving boundaries result in confusion for both parties, compromises trust in the therapeutic relationship, and put the safety of the client and therapist at risk. Boundary crossings may occur as a subtle process, rather than a distinct event and may not appear to have negative repercussions initially. Boundary violations may build slowly during repeated sessions, leading to a number of harmful consequences for clients. A dual relationship is an alliance in addition to the client/ therapist relationship, i.e., social, familial, business or any other relationship that is outside the therapeutic relationship (Bureau of Labor Statistics, 2016). Dual or multiple relationships have been researched and included in the codes of ethics for counselors, social workers, psychologists and mental health therapists for decades and there is a wealth of information on the topic that applies to massage therapy and body work.
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Book Code: MTX1323
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