● Inappropriate advertising : Using a provocative picture in advertising or presenting misleading qualifications. ● Dual relationships : Dating a client, providing therapy to a student, or hiring a client for personal work. ● Violation of laws : Practicing out of one’s home when not permitted by law, not reporting legal adjudication, or practicing with a suspended or expired license. ● Confidentiality : Name-dropping famous clients or telling a spouse details about his partner’s session. Harassment Harassment is a specific kind of misconduct or boundary violation in which an individual of equal or greater authority is inappropriately familiar with a student, co-worker, or junior employee. Harassment can be abusive remarks or behavior, belittling statements and actions, and discussion or commentary of an overly personal or offensive nature. Sexual harassment is abuse of power, typically exercised within the context of work, containing a sexual or gender-specific component. The Equal Employment Opportunity Commission defines sexual harassment as any unwelcome advance, request, verbal statement, or physical conduct of a sexual nature, including visual displays (United States Equal Employment Opportunity Commission, 2016). The examples of sexual harassment below occurred in the context of massage therapy and bodywork. Therapists have experienced the following: ● Propositioned to have sex with a manager, co-worker, or client. ● Repeatedly asked out on a date by a manager, co-worker, or client after the invitation was initially declined. ● Propositioned to have sex with a manager, co-worker, or client as a condition of employment or in order to receive promotions or other awards. ● Continually touched on the body by a manager, co-worker, or client after they were asked not to. ● Touched on or near the genitals, buttocks, or breasts by a manager, co-worker, or client. ● Instructed to massage a manager, co-worker, or client that the massage therapist declined to provide therapy for, due to sexual harassment, as a condition of employment or in order to receive promotions or other awards. ● Instructed to massage a manager, co-worker, or client in a specific manner so as to elicit a sexual response.
● Contraindications : Treating a client while sick or infectious or ignoring signs of conditions that preclude physical contact. ● Informed consent : Working on a minor without parental knowledge or treating an injury without permission. ● Practicing beyond scope of practice : Doing spinal adjustments, massage, or counseling without appropriate training. ● Sexual misconduct : Watching a client undress, hugging a client in a sexual manner, or inappropriate touching. ● Harassed, intimidated, or offended by the ongoing sexually explicit language of managers, co-workers, or clients that either references the massage therapist directly or is explicit in nature in the massage therapist’s vicinity, even if not directed towards the therapist. ● Asked to undrape genitals, buttocks, or breasts during a massage or to expose themselves to clients. ● Or patients who undrape themselves in a manner that is in violation of local and state laws. Sexual harassment, like sexual misconduct, is not defined by any specific sexual interaction between two individuals. Harassment may include the discussion of sexually explicit topics at a place of business, unnecessary or inappropriate references to specific body parts or functions, and visual depictions or notes of a provocative or offensive nature, such as posters or calendars featuring photos of nude or scantily clad models. Sexual harassment can occur between men and women, women and women, men and men, or any other combination of sexual or gender identity or orientation. Sexual harassment may feel humiliating or shameful, making the victim reluctant to report the incident. Of course, the best option is to prevent sexual harassment from ever escalating to the point that ethical concerns are raised. Practitioners can combat sexual harassment in any number of ways, and one of the easiest methods is to educate clients. As massage therapy becomes more readily accepted as a legitimate form of health care, massage professionals should be referred to as a ‘massage therapist’ and not a ‘masseuse’ (female), or ‘masseur’, (male), as these terms can carry sexual connotations. It requires little effort for practitioners to correct a client when they make this mistake in terminology, and it lets a client know that the massage therapist is a professional with ethical standards and boundaries.
IDENTIFYING ETHICAL DILEMMAS
Fitch (2015) categorizes ethical dilemmas into the following general categories: ● Thoughtlessness: Simple thoughtlessness can cause frustration for both clients and therapists. ● Expectations or assumption of special status. ● Challenges to professional role and personal beliefs. ● Boundary issues that compromise integrity. ● Manipulation, abuse, and predatory behavior. In any profession, ethical dilemmas will arise and this is especially true in the field of massage and bodywork where professionals work in close proximity to clients for extended periods of time. Massage therapy is a profession built on mutual trust, which is essential to building a strong therapist/client relationship to help clients achieve wellness goals. Ethical standards are the Practicing self-awareness Massage and bodywork therapists can avoid many ethical pitfalls by practicing self-awareness and reflection. Middleswarth advises practitioners to ask themselves some basic questions: “Am I stressed? Am I tired? Am I emotionally running empty? Do I have a supportive social network? “If we are needy in any way,” she warns, “we are particularly susceptible to stepping over boundaries.”
basis for building trust to create and maintaining a therapeutic environment. According to Middleswarth, by behaving ethically massage therapists are acting as responsible role models who help build public trust and establish a “standard of expectation for a professional therapeutic massage.” Ethical conduct also helps provide consistency in the professional behavior of massage therapists, thus maintaining the integrity of the profession, she adds. Ginn, believes ethical dilemmas are fairly common because of the nature of the massage therapy profession, “The relationship between client and practitioner can be complicated and confusing for both parties,” warns Ginn (Ginn, 2013). The complex nature of maintaining a professional relationship, Ginn explains, is compounded because of the intimacy inherent in massage therapy. Most education and training programs discuss the importance of self-awareness and self care in order to remain healthy and provide the optimal level of quality care to clients. Self awareness may involve better time management, accessing stress levels or fatigue, identifying demanding clients who add stress, leaving work issues at the office at the end of the day, assessing signs of physical or emotional overload that impacts wellness and effective or healthy functioning. Practicing self
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