be inadvertently spoken, accidently overheard, said in haste without proper evaluation, or simply be emotionally charged. Practitioners must be aware of their personal privacy boundaries, know when they may be crossed and be aware of personal behavior triggers that may lead to boundary crossings. When in doubt, stop, think, and do not self-disclose (AMTA, 2015b). It is best for therapists to withhold emotional responses or judgments, both negative and positive. Therapists must monitor their own feelings without imposing these on clients. If therapists are distracted or affected by a strong emotion or feeling, they must be able to be objective and flexible enough to adapt to the situation, and not let it interfere with service delivery during the session. After the session, it is important to address the conflict with a professional colleague or supervisor, or to identify the antecedent, i.e., cause of the emotional conflict, and plan strategies to handle emotions or stressful situations in the future (AMTA, 2015b). Dual/multiple role relationships The boundaries set during a therapy session must apply to interactions with clients when they encounter them in the community. If the therapist resides in the same community, it is likely that they will have to interact with clients at establishments or events, like the grocery store, church, school, recreational facilities, or community functions. The practitioner must be aware of the importance of boundaries and the need to project professional and ethical conduct when in public. A dual relationship is an alliance in addition to the client/ therapist relationship, i.e., social, familial, business or any other relationship that is outside the therapeutic relationship (Bureau of Labor Statistics, 2016). Dual or multiple relationships have been researched and included in the codes of ethics for counselors, social workers, psychologists and mental health therapists for decades and there is a wealth of information on the topic that applies to massage therapy and body work. A dual or multiple role relationship occurs when the professional, either at the same time or at different points in time, engages in two-role categories with a relative, friend, student, business partner, or instructor, in addition to the professional therapeutic relationship. While it is best to avoid dual relationships, it is not always possible or practical. In small towns, for example, it may be more difficult to avoid dual relationships because the practitioner will encounter clients in the community during normal, daily activities. There is a great range of opinions regarding the propriety of dual relationships in health professions. Some segments believe that all dual relationships have potential for negative outcomes, and are therefore ethical violations. Other organizations suggest that dual relationships are acceptable, if not exploitive or harmful to the client or if benefit them in some way. To ensure that these relationships do not cross the line into exploitation, therapists should follow recommended procedures including informed consent, open discussion, full disclosure, consultation, supervision, and examination of personal motivation, all of which should be documented and revisited during the course of the therapy. Some professionals consider it unethical to practice on friends, while others consider it acceptable to proceed as long as appropriate measures are taken to ensure there are no detrimental effects to the therapeutic or preexisting relationship. It is always best to avoid multiple relationships if there is a possibility that the relationship might interfere with the therapeutic relationship. But existence of a dual relationship Terminating a professional relationship If therapists feel it is appropriate, either because a specified course of treatment is concluding, or because they believe the relationship with the client has become dysfunctional, unproductive, or emotionally damaging, it may be necessary to terminate the professional relationship. While this can be a
As with other boundary crossing, self-disclosure should be client-focused and based on the welfare of the client. Different clients and practitioners have different personal boundaries so appropriate boundaries must reflect the client’s comfort zone while maintaining ethical boundaries and professional standards of conduct. Personal and professional boundaries exist for the benefit of both the practitioner and the client. Changing or moving boundaries result in confusion for both parties, compromises trust in the therapeutic relationship, and put the safety of the client and therapist at risk. Boundary crossings may occur as a subtle process, rather than a distinct event and may not appear to have negative repercussions initially. Boundary violations may build slowly during repeated sessions, leading to a number of harmful consequences for clients. is not always a boundary violation. There are clearly unethical dual relationships, known as prohibited dual relationships ; these impair objectivity and effectiveness, permit exploitation, create an actual, or potential conflict of interest or directly harm the client. If a complaint is filed, it will be the massage therapist’s responsibility to demonstrate that a client has not been exploited, coerced, or harmed intentionally or unintentionally in any way. Massage therapists should be vigilant to avoid any conduct that could impair objectivity or professional judgment, and/or conduct that has the potential for exploitation or harm to a client. Massage therapists should recognize and avoid the dangers of dual relationships when relating to clients in more than one context, whether professional, social, religious, educational, or commercial. Examples of prohibited dual relationships include: ● Accepting a former sexual partner as a client. ● Forming a sexual relationship with a current client or former client. ● Treating clients who are relatives or business partners. ● Bartering with clients for services. ● Treating students, supervisees, or trainees. ● Entering into financial or business contracts with clients other than standard payment for massage services. Other dual relationships develop when lending or borrowing money, meeting at inappropriate places or times, giving or receiving gifts, soliciting donations or political support, or hiring a client, as well as social contact that may be misconstrued by the client or others. Maintaining appropriate boundaries is an essential part of safe, effective, and ethical massage therapy practice. Therapists and clients, as consenting adults, may be equally capable of making decisions that result in boundary violations, but licensed professionals are bound by ethical standards to act responsibly with clients at all times. Appropriate behaviors reinforce professional boundaries. Massage therapists should try to maintain objectivity and apply the same structure and rules of conduct in each session with each client regardless of their requests. If therapists deviate from established structure or protocol, they should have a legitimate reason that is in the best interest of the client. If the therapist determines they have acted based on self-interest or emotions, they should seek support from a professional colleague or supervisor. difficult and uncomfortable task, it should not be postponed out of a desire to avoid confrontation or discomfort. Terminating a potentially damaging relationship is an important professional obligation with specific responsibilities. Practitioners must assess the client’s potential for therapeutic benefits, and
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