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. ● Being argumentative with a client. ● Over-emotional involvement in solving the client’s problems. Case study 6 The therapist, as part of an integrated health term, was hired to provide treatment to client, after shoulder replacement surgery, in the client’s home. The therapist noted, in the third month of a year long course of therapy, that the client wanted to begin and end the sessions by hugging the therapist. During the same time, the therapist noticed that the client began baking treats and offering beverages at the end of the session and encouraged the therapist to stay for longer social visits after the sessions ended. Gradually, the client began to ask more personal questions of the therapist and clearly expressed feelings that are inappropriate for a therapeutic relationship. When the therapist declined to reciprocate the feelings, and attempted to re- establish boundaries, the client became hurt and angry and threatened to ask for a new therapist. Analysis ● The nature of massage and bodywork includes a high degree of intimacy and skin to skin contact in a private setting. ● As transference is an unconscious behavior, it is up to practitioners to recognize its signs and maintain professional boundaries. It is important to remain firm within established boundaries such as starting and ending sessions on time, proper draping and minimizing dual relationships. These steps reduce the likelihood transference has to destroy the therapeutic relationship (Riedell, 2005). ● Boundary crossing van begin slowly, seemingly innocent or harmless in the beginning. Transference and boundary crossing or violations can be recognized in a client who: ● Frequently asks about the therapist’s personal life. ● Calls the practitioner at home when explicitly stated otherwise. ● Brings a gift to every session. ● Solicits help in solving personal problems. Case study 7 A bodywork therapist is a member of a local church that offers a number of groups on a variety of topics. One group concerns self-improvement activities and encourages members to discuss areas of their lives that they would like to address. It deals with
● Making exceptions for a client’s inappropriate behavior. ● Giving a client extra time and attention before and after a session. ● Bending our professional and personal boundaries for a client (Riedell, 2005). Steps to prevent or resolve counter transference issues: ● Work on building trust and communication as a foundation. The therapist in this case stayed quiet too long. ● Work to become more self-aware and overcoming prejudices, preferences, judgments and personal issues, to establish clearer boundaries in the therapeutic relationship. ● When personal feelings are recognized, addressed and put aside, they do not interfere with the commitment to high quality healthcare. ● Awareness of counter transference marks the therapist’s return to professionalism. ● Moving beyond this barrier, the therapist can educate her client on the anatomical connections and therapeutic value of her work to release the shoulder tightness, which include connecting muscle groups, and provide strategies to address the cause such as better postures or adjusting computer height, angle or reach. Review the following Standard V: Roles and Boundaries: ● Recognize and limit the impact of transference and counter- transference between the client and the certificant. ● Have the right to refuse and/or terminate the service to a client who is abusive or under the influence of alcohol, drugs, or any illegal substance (NCBTMB, 2013). ● Has difficulty maintaining physical boundaries (i.e., wants to hug or touch during every session). ● Asks for more time before and at the end of a session, and is disappointed when not appeased. ● Asks the therapist out on a date. ● Makes any comment or action that crosses the professional boundary of the relationship into a personal one (Riedell, 2005). In some cases, there are cultural or ethnic customs that influence a client’s behavior that may be misconstrued or misinterpreted by the therapist. Often small gifts from clients are a personal sign of appreciation, as may be the case for clients who cannot afford to tip (Riedell, 2005). The client’s customs may dictate that they offer food or drink to guests no matter what the occasion. Likewise they may hug or kiss as a standard form of greeting and not to reciprocate or pull back would be a sign of rudeness or an offensive behavior by the therapist. The therapist should know as much as possible about the client’s culture in order to gage their intentions when the offer gifts, signs of affection or invitations to come to dinner or a social even outside of the massage venue. The therapist needs to carefully consider the words and actions of the client before deciding if they constitute a boundary violation or if the therapist needs to address a potential ethical conflict. When making decisions the therapist should consider if the client’s actions have the potential to cause harm to himself or herself, or the therapist, or interfere with the effectiveness of therapy. In this case, the therapist will have to determine if the intent of the hugs and baked goods were innocent gestures but if client comments began to cross a professional boundary, the practitioner needs to address the situation and reset boundaries. Review Standard V on Roles and Boundaries and Standard VI on Preventing Sexual Misconduct.
topics like handling stress on the job, positive parenting, conflict resolution, or strategies to improve communication skills.
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Book Code: MTX1323
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