medical interventions, including but not limited to hormones and or surgeries. Unlike transgender, transsexual is not an umbrella term. Many transgender people do not identify as transsexual and prefer the word transgender. It is best to ask which term a person prefers. If preferred, use as an adjective: transsexual woman or transsexual man. To create a practice that cares for all clients it must promote an atmosphere that is welcoming, accepting and comfortable regardless of orientation. LGBTQ individuals often experience workplace harassment or discrimination as well as being verbally harassed or disrespected in public includes restaurants, hotels, and even in massage businesses (Haines, 2016). In developing a practice that includes all clients there are important areas that must be avoided including: misgendering, misnaming, making body assumptions, and outing (Haines, 2016). Misgendering Misgendering someone is awkward at best, and potentially dangerous at worst. And it does not just happen to LGBTQ individuals. For example, a woman with facial hair or even just sporting a short hair cut or unisex clothing is enough to get labeled incorrectly. Misgendering on intake forms: In a massage environment, that labeling starts with intake forms. Male or female? For many people, this can feel like being asked if they are an orange or a parakeet and there is no correct answer. How do they respond? The way they look? The reproductive organs they have? What it says on their birth certificate? What it used to say on their birth certificate? A quick fix like an “other” option can go a long way or might consider doing away with the question altogether. Misgendering with pronouns: In English, pronouns for human beings are traditionally limited to only two sets: he/him/his, and she/her/hers. For whatever reason, we feel like gender is so important that it is an inherent part of our grammar, while age, career, and preferred style of massage are not. In some languages, nobody has gendered pronouns. In other languages everything from chairs to casseroles are assigned a gender. But in any language, being called something you are not would be offensive and hurtful (Haines, 2016). A massage therapist must address the issue of how to address clients appropriately: ● The therapist can ask the person what pronouns they prefer, would be awkward in the beginning, but avoids the worse case scenario of offending the individual. ● The question of pronoun choice can be explored on intake forms or online scheduling. This has the advantage of minimizing in-person awkwardness while communicating that the practice takes respecting people’s gender identities seriously. If a mistake is made, offer a sincere apology, rectify the situation and make sure all the staff is aware of the situation so that it will not happen again. Misnaming Names are intensely personal, and for this reason many individuals select a name that they feel more adequately reflects their gender identity or sexual orientation. This could be similar to their former name or not. It could be distinctly gendered or gender-neutral. It could be a nickname, an invented name or a family name, but regardless, it is the name the client wishes to be called, and so that is the name to use. Privacy and confidentiality The importance of confidentiality and privacy of client information is the ethical obligation of all massage and bodywork therapists. The ethical standards of confidentiality and privacy in professional practice dictate that practitioners
This might not be the same as the name on the ID or billing information, or on the insurance documents. This must not be considered a problem or addressed in any way that might make the client feel uncomfortable or draw attention from others. It does not matter one bit that Susanna’s bank account says George, any more than it matters that Katie’s says Kathleen. Again, these issues could be addressed on intake or online forms to address any fraud or identity protection, insurance or billing issues without confrontation. This holds true in the treatment room, at the reception desk, over the phone, and in emails. If multiple staff work in the practice, they must all be educated on the appropriate names and pronouns to use. In addition a staff meeting or in-service training should be provided to all staff on the issues addressed in this section (Haines, 2016). Making assumptions about the body Massage therapists are accustomed to asking questions about people’s bodies rather than making assumptions, which is how we avoid bruising the tough-looking client on blood thinners or injuring the dancer with a stress fracture. Similarly, making unwarranted assumptions about people’s bodies based on their gender presentation can be offensive as well as harmful. A few potential pitfalls: ● Assuming that, because someone does not have breasts, that they are comfortable with their chest undraped. ● Assuming that the therapist does not need to navigate around external genitalia, just because the client is a woman. ● Assuming that for example, due to a transgender client’s convincing gender presentation, they must have undergone surgery of various sorts. ● Assuming that techniques that are unsafe during pregnancy are okay, because you assume your client is a man (Haines, 2016). Transgender clients have all the physical issues that other clients have. Some may have a few more and the following are issues to consider: ● Beginning hormone therapy as an adult can lead to what is functionally a second puberty. Remember being a teen? Voice breaking, breasts aching, acne, mood swings, and inopportune sexual arousal? Imagine going through all that again at age 20 or 60. ● Surgery of any kind leaves marks on those who experience it. Scarring is an obvious example and tenderness or numbness, are other concerns. But also consider how someone’s posture changes after breast reduction or augmentation or their activity levels decrease while in recovery. Massage and bodywork practitioners may work in tandem with the client’s physical therapist or other members of their healthcare team. ● Just because it is the body the client wanted does not mean it is not different from the one they had before. It is not strange to feel uncomfortable, emotional, or nervous about this body being touched by a relative stranger. As in the case of all ethical issues, there are no absolute or universal experiences that are shared by any individual no matter what their gender identity or sexual orientation. In all cases the massage and body work therapist must avoid making assumptions and judgments about individuals and their bodies. There are plenty of individuals who undergo no radical changes to their bodies and others who choose partial or complete transformation. Increasingly, children and adolescents are being recognized and supported in their gender identities and sexual orientation. This also means that massage therapists who focus on pediatric populations are not exempt from the need to avoid assumptions about gender. protect the client’s identifying information, health status, billing, insurance or any other personal information that includes sexual orientation or gender identity. If individuals share private information with their massage or bodywork therapists it should
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