and may include content that is counter to the practitioner’s professional image. Finally, when sending faxes that contain client information, always use a cover letter, be sure the fax number is correct and that it will be received by the appropriate staff to maintain confidentiality. Any massage or bodywork professional website, networking site or social media page should review their code of ethics, any state law and HIPAA rule that regulates technology within Investigating and ethical dilemmas The term ethics includes the study of moral decision-making (Dail, 2012). Ethical dilemmas are situations that violate the code of ethics and conduct standards of a profession. Ethical dilemmas also involve practitioner and client values, beliefs, experiences, emotions and level of trust and communication skills. The professional massage and body work professional must be cognizant of areas of practice that may lead to ethical dilemmas as well as concepts of power, professional responsibilities, effective communication, trust building, client autonomy and role in their care as a foundation to maintaining ethical practice. The competent and experienced practitioner will also be able to identify warning signs that issues are developing and address them with clients before they evolve into the level of an ethical dilemma. In a practice that is committed to ethical standards and conduct, dilemmas will often occur in subtly rather than resulting from gross negligence or malpractice such as inappropriate sexual conduct with clients. From the beginning, the practitioner must take the time to clearly establish their professional role and boundaries and maintain this level of standards-based conduct with each client interaction. They must be firm in communicating that they will not provide services that are illegal or unethical despite the requests of the client. This includes not using massage or bodywork modalities that are experimental, outside the scope of practice or the practitioner’s competence. Additionally, the practitioner must clarify the role of the client in truthfully disclosing medical information, communicating preferences, actively participating in their care decisions, maintaining boundaries and appropriate client conduct, following practice rules. Establishing and documenting these understandings in a therapist/ client agreement will set the foundation for effective and ethical practice and help to prevent misunderstandings or expectations that lead to ethical dilemmas in the future. As previously discussed, ethical dilemmas may occur even in the best of practices, despite the groundwork and agreements to prevent them. Ethical dilemmas can range from minor and easily solved dilemmas, to major dilemmas, resulting in ethical violations, lawsuits, and license or certificate revocation. Since Working through ethical dilemmas Once the dilemma is identified, the following strategies can be used to address them: ● Be sure to know all standards, ethics codes, state requirements, agency policy, and professional obligations and responsibilities prior to practice. When/if an issue arises, the therapist must review the elements of the situation against these to effectively address the conflict. The practitioner must know the standards of ethical conduct to make ethical decisions in practice. This is assuming that the practitioner acted in accordance with these criteria. ● The practitioner must be able to objectively and honestly observe and analyze the client behavior, as well as their own, to determine what contributed to the ethical issue. ● The practitioner must identify areas where boundary crossing may have occurred, determine the source, and take action to remediate the situation. ● The therapist must identify their triggers, and the client’s triggers, that may lead to ethical dilemmas.
and outside the state boundaries of the professional license or certification. In recent years, many systems have been compromised, hacked or cracked resulting in lost or stolen personal, medical and financial information. The practitioner can never be completely confident that they can protect the privacy rights of clients when using technology for communication. Practitioners must follow numerous safeguards and be extremely vigilant when using technology in their practice. these may occur in the private treatment room, the practitioner and client are the only witnesses and may both play a role in the progression of the ethical dilemma. The successful massage and bodywork specialist must prevent problems from escalating by preventing them through early identification of potential ethical issues and quickly addressing and resolving them with clients. What are the effects of ethical dilemmas on the relationship between the practitioner and client? 1. They damage the trust that is central to the relationship. 2. They interfere with open communication on both sides. 3. They may illicit fear, anxiety, stress, or depression in the client and therapist, which makes effective treatment impossible. 4. The client may leave the practice and seek legal recourse. 5. The therapist may refuse services and terminate the relationship. The negative end result is that the practice will be damaged and both the therapist and client will be hurt emotionally and psychologically if the situation is not successfully resolved. According to Fitch (2015) in an article for the AMTA: Usually, there are a number of warning signs that appear before a conflict erupts. If therapists ignore the warning signs, then the conflict may seem like a sudden crisis, dramatic and unexpected. If therapists pay close attention to client cues, then the conflict may offer an important opportunity to inform, change, or improve the client therapist relationship. If, on the other hand, therapists have no awareness of their client’s personal feelings about an issue, their decision making process will be flawed. Three principal responses to conflict occur in clinical disagreements which include passivity, passive aggression and aggression. The consequences are different depending on the client’s and therapist’s response, but all three circumstances have serious consequences. Remember that responsibility for treatment room communication lies with the therapist. Assessing personal risks and responding appropriately ensures that both clients and therapists remain safe within the professional massage and bodywork therapy environment. ● Though the roles and perceptions of the client and practitioner may not align, the responses of each may shed some light on the causation, time of origin or progression of the ethical issue. ● As soon as a warning sign of conflict appears, stop treatment and address the issue. One a problem develops effective treatment cannot be achieved and the conflict could escalate. ● It may take time to determine the root of the problem through careful investigation. This underscores the importance of accurate, contemporaneous documentation. ● Always speak truthfully and guard against appearing offensive or defensive ● Institute a decision making model and collaborate with appropriate resources. Contact legal counsel if indicated. ● When the issue is resolved, be sure to take steps to establish clear boundaries roles and expectations with the client
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