rules. Establishing and documenting these understandings in a therapist/ client agreement will set the foundation for effective and ethical practice and help to prevent misunderstandings or expectations that lead to ethical dilemmas in the future. As previously discussed, ethical dilemmas may occur even in the best of practices, despite the groundwork and agreements to prevent them. Ethical dilemmas can range from minor and easily solved dilemmas, to major dilemmas, resulting in ethical violations, lawsuits, and license or certificate revocation. Since these may occur in the private treatment room, the practitioner and client are the only witnesses and may both play a role in the progression of the ethical dilemma. The successful massage and bodywork specialist must prevent problems from escalating by preventing them through early identification of potential ethical issues and quickly addressing and resolving them with clients. What are the effects of ethical dilemmas on the relationship between the practitioner and client? 1. They damage the trust that is central to the relationship. 2. They interfere with open communication on both sides. 3. They may illicit fear, anxiety, stress, or depression in the client and therapist, which makes effective treatment impossible. 4. The client may leave the practice and seek legal recourse. 5. The therapist may refuse services and terminate the relationship. Working through ethical dilemmas Once the dilemma is identified, the following strategies can be used to address them: ● Be sure to know all standards, ethics codes, state requirements, agency policy, and professional obligations and responsibilities prior to practice. When/if an issue arises, the therapist must review the elements of the situation against these to effectively address the conflict. The practitioner must know the standards of ethical conduct to make ethical decisions in practice. This is assuming that the practitioner acted in accordance with these criteria. ● The practitioner must be able to objectively and honestly observe and analyze the client behavior, as well as their own, to determine what contributed to the ethical issue. ● The practitioner must identify areas where boundary crossing may have occurred, determine the source, and take action to remediate the situation. ● The therapist must identify their triggers, and the client’s triggers, that may lead to ethical dilemmas. ● Though the roles and perceptions of the client and practitioner may not align, the responses of each may shed some light on the causation, time of origin or progression of the ethical issue. ● As soon as a warning sign of conflict appears, stop treatment and address the issue. One a problem develops effective treatment cannot be achieved and the conflict could escalate. ● It may take time to determine the root of the problem through careful investigation. This underscores the importance of accurate, contemporaneous documentation. ● Always speak truthfully and guard against appearing offensive or defensive ● Institute a decision making model and collaborate with appropriate resources. Contact legal counsel if indicated.
The negative end result is that the practice will be damaged and both the therapist and client will be hurt emotionally and psychologically if the situation is not successfully resolved. According to Fitch (2015) in an article for the AMTA: Usually, there are a number of warning signs that appear before a conflict erupts. If therapists ignore the warning signs, then the conflict may seem like a sudden crisis, dramatic and unexpected. If therapists pay close attention to client cues, then the conflict may offer an important opportunity to inform, change, or improve the client therapist relationship. If, on the other hand, therapists have no awareness of their client’s personal feelings about an issue, their decision making process will be flawed. Three principal responses to conflict occur in clinical disagreements which include passivity, passive aggression and aggression. The consequences are different depending on the client’s and therapist’s response, but all three circumstances have serious consequences. Remember that responsibility for treatment room communication lies with the therapist. Assessing personal risks and responding appropriately ensures that both clients and therapists remain safe within the professional massage and bodywork therapy environment. ● When the issue is resolved, be sure to take steps to establish clear boundaries roles and expectations with the client ● The practitioner must reflect on personal attitudes, values, and beliefs that influence behavior and ethical decision making. ● The practitioner should understand that personal morals, bias, and professional principles are intertwined. They must learn to separate personal values, beliefs and feelings from professional ethical standards when reaching an ethical decision. Separating personal beliefs and values from professionally ethical choices clarifies decisions. Over time, experience will help the practitioner to feel more confident and capable to identify the early warning signs of ethical conflict to communicate with the client, stop inappropriate actions and solve the issue before it becomes an ethical dilemma. Fitch (2015) concludes: ● When therapists have a strong internalized code of ethics, they are able to maintain a clear sense of purpose, professional role, and internal sense of power regardless of the circumstances. ● These therapists use inappropriate behavior as an opportunity to instruct the client and clarify what is acceptable. ● Therapists must learn how to “practice professionally, independent of personal beliefs.” ● Therapists must differentiate between personal and professional beliefs and explain how the client’s behavior must change. ● Regardless of how a client behaves, the answer always lies in choosing the professional role over personal impulses. ● A professional response, delivered empathically, can usually address whatever issues arise from client behaviors.
DECISION-MAKING MODELS FOR CLIENT CARE
There are many decision making models that have been used successfully in medical and clinical setting to assist clients in building autonomy in the therapeutic process. Supporting patients in this way correlates with standards of professional conduct as well as ethical guidelines. Most decision-making models involve collaboration with other colleagues or authorities in the profession to provide additional information for decision making within professional practice.
The nature of this type of process precludes a collaborative relationship between client and practitioner. A shared decision making process with the client is a way to build the therapeutic relationship from the beginning, set a tone of collaboration, build client autonomy, and help balance the power differential in the relationship.
EliteLearning.com/Massage-Therapists
Book Code: MTX1323
Page 52
Powered by FlippingBook