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. ○ Making exceptions for a client’s inappropriate behavior. ○ Giving a client extra time and attention before and after a session. ○ Bending your professional and personal boundaries for a client. Steps to prevent or resolve counter transference issues include: • Working on building trust and communication as a foundation. The therapist in this case stayed quiet too long. • Working 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.
The certificant is required to properly respond and comply with the NCBTMB peer review process prior to the committee making a final determination. NCBTMB reserves the right to take additional action against the Certificant if additional information related to the complaint becomes available. During the suspension period, the certificant may not: 1. Advertise using their credential or any NCBTMB logo. 2. Use their certificate in any other way to promote their practice. 3. In any way make themselves out to be certified by NCBTMB. Probation: A certificant has been placed on probation for a definite period of time and may be subject to meeting certain requirements before the probation is lifted. During the probationary period, the certificant may continue to: 1. Advertise using their credential or any NCBTMB logo. 2. Use their certificate in any other way to promote their practice. 3. In any way make themselves out to be certified by NCBTMB. CASE STUDY A female massage therapist has been working with a female client for six months, and the client’s behavior has slowly become aggressive, demanding, and critical of the treatment. The therapist focuses on the client’s shoulders and upper back muscles that are often tight but release during treatment. This is the problem areas identified by the client during development of the treatment plan. One day the therapist completed the upper shoulder work and started to move to the mid back. At that point the client turned and sat up, demanding that the therapist return to the shoulder area and shouted, “Do the work I told you to do, and if you did it right the pain would not keep returning!” The therapist, wanting to please the client, said nothing and repeated the shoulder work. Nothing further was said about the session by either party, and the therapist told herself that the client was having a bad day and kept the incident to herself. The following week, the therapist was uneasy and anxious as she approached the regular session with that client. Sure enough, when the client returned, she continued to bark instructions at the therapist. Again, the therapist complied in order to assuage the client’s anger and to try and accommodate her demands. As the sessions continued the therapist grew more apprehensive and she began to doubt her competence as a therapist. The therapist reviewed the client’s chart and her treatment and believed that she had delivered the correct procedure using the appropriate method. She felt that she had lost her ability to provide effective services and faith in her ability as a massage therapist. After carefully reviewing the situation, conducting self- awareness activities, and reflecting on her feelings and the impact on her behavior, the therapist came to a realization. She had felt these feeling before when she was a teen and made to feel inadequate by her negative, authoritarian mother who was impossible to please. Reflection: What is the term (or terms) used for the situation this therapist experienced?
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Book Code: MMD0926
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