• Ask the client near the end of the session if any particular area needs further attention. • Invite feedback and implement changes based on client comments. At the end of each session, therapists should discuss the clients’ treatment plan and health objectives. They should ask the clients to assess their progress or lack of progress toward treatment goals. Massage therapists should also answer any questions the client may have, and note the following information in the client’s record (Ashton, 2010): • If the client feels bruised, nauseated, or lightheaded • The length of the massage session • When the client should return for another session (session intervals/frequency) • Anything the client can do to accelerate progress toward treatment goals • Anything the client should do or not do between sessions • What results the client can expect, and when
when these clients are new to the experience and unfamiliar with a facility’s personnel and way of conducting business. Providing basic instructions and answers to common questions in a brief information sheet can put new clients at ease, especially when these clients are new to the experience and unfamiliar with a facility’s personnel and way of conducting business (Ashton, 2010). During the session, the therapist should inform the client when moving from one area to another, especially when the movement is to a particularly vulnerable area, such as the abdomen. Therapists should also do the following (Ashton, 2010): • Assess sensitivity and tolerance and inform the client as they progress to deeper movements. • Perform tapotement only with client permission, and after the individual is adequately informed about the process. • Take care not to startle a client in a relaxed state. • Inform the client regarding potential massage after- effects, such as tenderness or soreness, and the expected duration of such effects. Interpersonal dynamics exist in all relationships and are a normal and necessary part of a therapeutic relationship between client and practitioner. An important part of this dynamic is a power differential; the imbalance in authority or power that results from therapists’ greater expertise in the area of massage therapy. Massage therapists’ education, skills, experience in the field, and professional certification give them an authoritative advantage over their clients (Allen, 2019). Balance of power Ginn (2013) explains that the most common ethical dilemmas are often subtle and overlooked. Many ethical gray areas concern what Ginn calls the “power differential”, or the complex balance of power between client and therapist. The power differential is an imbalance in authority or power that results from the massage therapist’s greater expertise in massage therapy. “The key is to acknowledge the complexity,” says Ginn, “and understand one’s own history of power.” According to Ginn, massage therapists can create ethical dilemmas by overusing their power. Sometimes the overstepping of the use of power is obvious, as with inappropriate touch, for example. Other times, however, the overuse of power is more subtle, like being late for a client’s massage therapy appointment, or not listening to your clients concerns and questions carefully. In addition to overusing power, massage therapists can also underuse their power, for instance, massage therapists who do not have any established practice policies or who fail to directly establish boundaries when working with clients (Ginn, 2013). Not being able to quickly and properly address conflict is another way massage therapists underuse their power. Ginn (2013) notes that clients can over or underuse their own power, though she is quick to point out that massage therapists need to take more responsibility than their clients. She offers the following insights: • A healthy client-massage therapist relationship is not equal, but balanced. • In order to achieve a balanced relationship, massage therapists must learn to “teach your clients to be clients.” • Before beginning a massage therapy session with a new client, take time for introductions and explanations of practice procedures and policy.
Practitioners who recommend clients replenish fluids after a session may want to provide bottled water at their office. INTERPERSONAL DYNAMICS AND POWER IN THE THERAPEUTIC RELATIONSHIP
• Create guidelines for the session room and explain client and therapist roles, including the expectations and objectives of therapy. • Let clients know what their responsibilities are in the relationship, such as a policy to pay at the time of service, to arrive on time, and to speak up if something makes them uncomfortable. With any position of power comes the potential for abuse. Massage therapists, like many healthcare professionals, forge close relationships with people in their care. The combination of physical and social interaction between practitioner and client can trigger strong emotional responses in one or both parties, leading to small improprieties as well as egregious misconduct (Allen, 2019). Asking a client who is a lawyer for free legal advice, requesting a church donation, selling their daughter’s Girl Scout cookies at the office, mentioning personal details about a client, or repeating what was said during a session to a friend or spouse—all are subtle ways practitioners can take unfair advantage of their relationships with clients. Even when clients appear to welcome rather than resent such requests or behavior, they are never appropriate and do not belong in a professional environment. It is equally inappropriate for practitioners to accept favors, free merchandise and services, or confidential information (such as stock tips) from a client. These interactions can distort the therapeutic relationship and obscure its primary objective. It is not unusual for clients to unintentionally test professional boundaries, or for practitioners to unknowingly relax them. When practitioners and clients are motivated by countertransference and transference, respectively, they become more susceptible to inappropriate impulses that can lead to misconduct. Transference refers the redirection of all the feelings experienced by the client, related to his or her past experiences and relationships, stirred up by or in the session. Transference is neither negative nor positive but is “always a distortion; a projection of emotions from the past to current objects.” Countertransference refers to redirection of all the feelings experienced by the practitioner, related to his or her previous relationships and experiences, that are stirred up during the session, including the practitioner’s conscious and unconscious response to the client’s transference of emotions (Allen, 2019).
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Book Code: MMD0926
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