Part of massage therapists’ responsibility in maintaining clearly defined boundaries is to protect the client. Inappropriate behavior tends to make people uncomfortable so the therapist must be observant to notice if a client is not responding positively to therapy, and make sure their behavior or comments are not the cause. Relieving stress and physical stiffness or pain should be a relaxing and comfortable experience. If a massage therapist’s behavior is appropriate, but a client appears anxious or uncomfortable, the therapist should discuss the situation with the client to remedy the problem and put the client at ease. A boundary violation occurs when professional behavior conflicts with the limits of ethical conduct. Boundary violations arise when the practitioner’s personal interest come before the professional’s primary obligation to the patient’s welfare in ways that harm the patient or the therapeutic relationship. Interactions between massage professional and clients are ethically problematic when they interfere with the plan of care, the therapeutic relationship, the professional’s relationships with colleagues or the ethics of the profession. Boundaries may be breached in ways that are inadvertent or unintentional in nature. The examples below are known as boundary crossings : ● Goodbye hugs initiated by a client at the completion of treatment. ● Physical gestures or expressions of reassurance at times of extreme stress, such as a pat on the shoulder or touch on the hand. ● Allowing a session to run overtime. ● Attempts to show concern or empathy, such as disclosing similar feelings or experiences. ● Sharing personal phone numbers, emails, or social media contacts. If boundary crossings are repeated, professional boundaries may be blurred, altering the professional therapeutic relationship and increasing the potential for boundary violations. Boundary violations erode the client’s right to safe and effective care and the practitioner’s obligation to protect their client from harm. Some examples include affectionate or inappropriate communication, inappropriate gesture or body language, self- disclosure of a personal nature by the practitioner, breaking confidentiality, conversations or behavior that falls outside of the scope of practice, and dual relationships outside of the therapeutic setting. The therapist is responsible for setting, communicating, and maintaining boundaries. In order to accomplish this, they must be observant, think critically, follow ethical standards of practice, develop effective communication with clients, apply decision making skills, and refrain from engaging in unhealthy practices such as recreational drugs or alcohol use that will interfere with professional judgment and behavior (Ginn, 2013). Codes of Ethics cannot cover every issue that will occur and ethical decisions involve complex variables and require thorough investigation, review of ethical standards and careful decision making. There are a number of areas within the practice of massage and bodywork that often lead to ethical conflicts which Personal boundaries and self-disclosure Self-disclosure is the process in which the practitioner reveals personal, rather than general or professional, information about themselves to the client. There are many types of self-disclosure, which may be deliberate, or accidental, initiated by either the client or the therapist, and they can be spoken or unspoken. An example of unspoken intentional self-disclosure is the manner in which therapists choose to decorate their workplace with a selection of a meaningful poster or picture, or a family photo. Some disclosure may be accidentally communicated through body language or tone of voice. Accidental self-disclosure also occurs in cases where a practitioner meets a client unexpectedly, such as when both are sitting in a lawyer’s office or medical lab. The therapists and client may feel uncomfortable in these setting
may build over time despite the practitioner’s best efforts to practice ethically. Maintaining proper boundaries between client and therapist is an area that often leads to ethical conflicts. “Boundary issues are common, and every client has different issues,” explains Jean Middleswarth, a licensed massage therapist and ethics instructor (Bond, 2014). “Know what the boundaries are so they can be respected.” According to Middleswarth, “If you find yourself thinking that something doesn’t feel quite right or that you spend too much time thinking about a particular client, you might be in danger of overstepping your bounds.” She provides the following example from her own practice: After becoming rather close friends with a client, Middleswarth noticed the line between client and friend started to blur, making maintaining a professional therapeutic relationship difficult. To rectify this problem, Middleswarth shored up the boundaries again by reinforcing the client-therapist relationship, talking to the client and agreeing to no longer discuss personal matters during massage therapy sessions. “If a client asks something too personal, ”Middleswarth says, “I won’t answer.” All practitioners must understand and control the boundaries in relationships with clients and establish and maintain an ethical therapist client relationship at all times. This is especially important if the therapist chooses to work with clients who are friends or family members. Establishing clear boundaries are critical to avoid compromising situations or conflicts of interest. Procedures, policies and standards must be followed in the same way with all clients with no exceptions. Middleswarth advises that any touch boundary issues must be addressed with the client before beginning a session: “Boundary issues should be addressed directly; tell [the clients] they should undress only to the level of their comfort. Even for clients you see regularly, you may want to remind them of this fact every now and again, as comfort levels may change from massage session to massage session. Ask, too, if there are any areas the client doesn’t want you to work on, and then check in with them during the session to make sure they’re comfortable. Their body will tell you when it’s not okay,” Middleswarth says (Bond, 2014). For example, a client who tenses up when you work on a certain area is probably a good indication that they are uncomfortable. Additionally, massage therapists need to know their scope of practice and be aware of their professional limitations. According to Middleswarth (Bond, 2014). This includes knowing when to terminate treatment and refer out. “When progress has stopped, but pain persists, it might be time to refer them to a different health care provider,” Middleswarth notes. “Recognizing and admitting when you are no longer able to help your client may be one of your toughest challenges professionally, but in order to practice ethically, you need to know when your clients need something other than massage therapy.” when faced with one another and may not want to disclose why they are there. It may be awkward, but the therapist will need to handle the situation in a way that is cordial, professional, and maintains boundaries for the privacy of both parties. In all interactions with clients the therapists should ask themselves two questions before self-disclosing: ● How will it benefit the client? ● How will it affect the professional therapeutic relationship and boundaries? Along with the primary obligation to do no harm to the client, therapists should also consider their own privacy. Self-disclosure is not always conscious or deliberate, and can be affected by fatigue, stress, haste or unchecked emotions. Words can
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Book Code: MLA1224
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