A dual or multiple role relationship occurs when the professional, either at the same time or at different points in time, engages in two-role categories with a relative, friend, student, business partner, or instructor, in addition to the professional therapeutic relationship. While it is best to avoid dual relationships, it is not always possible or practical. In small towns, for example, it may be more difficult to avoid dual relationships because the practitioner will encounter clients in the community during normal, daily activities. There is a great range of opinions regarding the propriety of dual relationships in health professions. Some segments believe that all dual relationships have potential for negative outcomes, and are therefore ethical violations. Other organizations suggest that dual relationships are acceptable, if not exploitive or harmful to the client or if benefit them in some way. To ensure that these relationships do not cross the line into exploitation, therapists should follow recommended procedures including informed consent, open discussion, full disclosure, consultation, supervision, and examination of personal motivation, all of which should be documented and revisited during the course of the therapy. Some professionals consider it unethical to practice on friends, while others consider it acceptable to proceed as long as appropriate measures are taken to ensure there are no detrimental effects to the therapeutic or preexisting relationship. It is always best to avoid multiple relationships if there is a possibility that the relationship might interfere with the therapeutic relationship. But existence of a dual relationship is not always a boundary violation. There are clearly unethical dual relationships, known as prohibited dual relationships ; these impair objectivity and effectiveness, permit exploitation, create an actual, or potential conflict of interest or directly harm the client. If a complaint is filed, it will be the massage therapist’s responsibility to demonstrate that a client has not been exploited, coerced, or harmed intentionally or unintentionally Terminating a professional relationship If therapists feel it is appropriate, either because a specified course of treatment is concluding, or because they believe the relationship with the client has become dysfunctional, unproductive, or emotionally damaging, it may be necessary to terminate the professional relationship. While this can be a difficult and uncomfortable task, it should not be postponed out of a desire to avoid confrontation or discomfort. Terminating a potentially damaging relationship is an important professional obligation with specific responsibilities. Practitioners must assess the client’s potential for therapeutic benefits, and make a determination in the client’s best interests. Therapists must develop a plan for termination that is considerate of the client, understanding that the client may receive the news with emotion or distress. Informed consent provides a framework for termination because it specifies the need for an ongoing discussion between the client and practitioner regarding expected goals, progress reports and anticipated timeline for therapeutic benefits. Therapists should involve clients in the process so they are fully informed of treatment objectives, comfortable to ask questions, and understand the process of assessment as well as able to engage in the care plan. Therapists should discuss obstacles to client progress as they occur, so the client is not surprised by unexpected or abrupt changes in assessment results from one session to the next. Therapists should follow standard procedures for client assessment, and document relevant information about the client’s progress or lack of progress toward treatment goals after each session. Before terminating the client, therapists should: ● Consult appropriate information resources and supervising personnel. They can also contact a professional colleague or supervisor regarding the situation with the client, post a
in any way. Massage therapists should be vigilant to avoid any conduct that could impair objectivity or professional judgment, and/or conduct that has the potential for exploitation or harm to a client. Massage therapists should recognize and avoid the dangers of dual relationships when relating to clients in more than one context, whether professional, social, religious, educational, or commercial. Examples of prohibited dual relationships include: ● Accepting a former sexual partner as a client. ● Forming a sexual relationship with a current client or former client. ● Treating clients who are relatives or business partners. ● Bartering with clients for services. ● Treating students, supervisees, or trainees. ● Entering into financial or business contracts with clients other than standard payment for massage services. Other dual relationships develop when lending or borrowing money, meeting at inappropriate places or times, giving or receiving gifts, soliciting donations or political support, or hiring a client, as well as social contact that may be misconstrued by the client or others. Maintaining appropriate boundaries is an essential part of safe, effective, and ethical massage therapy practice. Therapists and clients, as consenting adults, may be equally capable of making decisions that result in boundary violations, but licensed professionals are bound by ethical standards to act responsibly with clients at all times. Appropriate behaviors reinforce professional boundaries. Massage therapists should try to maintain objectivity and apply the same structure and rules of conduct in each session with each client regardless of their requests. If therapists deviate from established structure or protocol, they should have a legitimate reason that is in the best interest of the client. If the therapist determines they have acted based on self-interest or emotions, they should seek support from a professional colleague or supervisor. question on a professional massage therapy website, or refer to their professional organizations. Therapists may be able to find an alternative to terminating the client, or a sensitive way to present the issue. If therapists appeal to any of these resources, they must maintain strict rules of confidentiality and privacy, ensuring that the client’s name or other identifying information is never revealed. ● Do a reality check. Therapists should make sure that they are “on the same page” as the client. Therapists should compare their understanding of a therapeutic relationship with the client’s, and discuss disparities in relationship perceptions, conflicts and desired objectives. This kind of clarification can help to determine the scope of the problem and whether it is the result of miscommunication or misinterpretation, i.e., something that can be remedied or requires termination. ● Be sure to allow time to work through a sound decision- making model and evaluate all relevant factors before making a decision. This should include confidential collaboration with other professionals. This step is also important if there is the potential for legal action after the termination. If it is necessary to terminate the client, therapists should ensure it is done when they have sufficient time to discuss the subject fully. Massage therapists should take the time to respond to any questions the client may have, and give the client sufficient time to react to the news, respond, and regain composure. Massage therapists should try to leave the client with positive feelings about themselves and the professional practice of massage therapy. In addition, therapists can provide referrals to other massage practitioners or healthcare professionals, as appropriate, within their scope of practice.
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Book Code: MTX1323
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