The obstacle for the therapist should be relayed to the client as early as possible so that the client is not surprised by any unexpected pronouncement that the therapeutic relationship will come to an end. Mandated reporting There is controversy surrounding whether or not a massage therapist is a mandated reporter. Massage Therapy World, published an article in 2016 on this topic and provided the following information: In many U.S. states and Australia, mandated reporters are professionals who, in the ordinary course of their work and because they have regular contact with children, disabled persons, senior citizens, or other identified vulnerable populations, are required to report whenever financial, physical, sexual or other types of abuse have been observed or are suspected, or when there is evidence of neglect. The line, “In many U.S. states,” indicates it is not federal law for the massage therapy professional and mandated reporter requirements are not uniform throughout the U.S. The term “vulnerable populations” will also vary among states, but will always include children, senior citizens and adults with mental and physical impairments that make them vulnerable to abuse. Adults who require assistance for daily living and functional skills, whether living at home or in an assisted living facility may also be included in this definition. In some cases, able-bodied adults may be included even if they are temporarily living in a rehabilitation facility to recover from illness or injury, are hospitalized, medicated, or otherwise incapacitated. Case study 3 A massage therapist working in a clinical setting has been treating a client, and during massage appointments, there was no indication of client dependency or physical attraction. The verbal and non-verbal feedback that the client provides during the session seems to facilitate the professional relationship. After the last appointment, though, the client began to discuss what appears to be a great business opportunity that he thinks the therapist might be very interested in. The client feels that this opportunity is so good that the therapist will probably want to share it with her friends, acquaintances, and other clients. He wants to meet with the therapist over lunch to describe the opportunity. He also wants the therapist to meet his spouse during lunch, since she is heavily involved in the business. The therapist does not know much about the client beyond the clinic, and has never spoken to him about anything but massage therapy and his treatment plan. Analysis Here, the client is seeking to engage in a dual relationship with the massage therapist; in this case, the client is proposing a business relationship that goes beyond the therapeutic Case study 4 A massage therapist works at a spa where he believes the employer’s standards for cleanliness do not meet professional standards. The employer does not require oil or lotion containers to be cleaned as they are filled or at the end of the work day, does not require massage room surfaces to be cleaned on a daily basis, does not send dirty linens to a laundry service to be sanitized, and only requires hot stones be sprayed with a disinfectant between clients. Analysis The answer to this problem may lie in each state’s particular regulations or the regulations suggested by each state’s massage licensing board, although it should be noted that the suggestions for cleanliness advanced by a massage therapy board may not have legal precedence. Where the law is applicable, sheets, towels, table surfaces, and other relevant items or materials must be cleaned according to all legal health and safety requirements. Where the law is lacking in comparison to a code of ethics or standards of practice, therapists may have to protect themselves and their clients from potential
In many states, reporting abuse is considered a breach of the confidentiality rule, although some states allow reporting abuse because it is viewed as criminal activity and must be reported to protect clients. Other states may include the massage and bodywork professional in the category of healthcare provider so they would be considered mandated reporters. Abuse counselors and agencies caution practitioners to be careful because reporting abuse may put the victim in danger of further abuse. When abuse is reported, it may cause the perpetrator to act out, feeling they have nothing to lose since they will likely face prosecution. One therapist interviewed but not identified in the article provided the following insight: In the very few incidents where a client has admitted to being battered, my first response to them was to ask, “Do you need help? I can get you in touch with someone who can help you.” I am not trained or qualified to provide any meaningful help, but I can get the phone number of a women’s shelter in less than five minutes! Oftentimes, though, they do not want our help or interference. In that situation, I have to accept their decision, sad though it may be. There is no black or white answer to this, so it is important to contact the state licensing or certification board and professional organization to know the proper procedure. If the state requires the therapist to be a mandated reporter, they must report the abuse to the appropriate authority within twenty four hours of observing the abuse or face legal and professional sanctions. relationship. It is best to avoid dual roles or multiple relationships, especially if it appears that the relationship might interfere with the therapeutic relationship. The possibility of a dual role or multiple relationships is not necessarily a violation of ethical boundaries; however, what is the potential impact of agreeing to accept this business opportunity with the client? Conversely, what consequences may follow from turning down the client’s business opportunity, regardless of the reason? Any dual role or relationship may impair objectivity or therapeutic effectiveness, or permit exploitation, or create an actual, apparent, or potential conflict of interest as noted in NCBTMB Standard IV: Business Practices. Furthermore, engaging in any business besides massage therapy with this client may lead to other conflicts, such as the lending and borrowing of money, gift giving, soliciting donations, and the unsolicited marketing of massage to other business partners. Maintaining proper boundaries is critical to the effective and ethical practice of massage therapy. It should be noted that in this case the therapist acted appropriately and had not done anything to encourage the client’s potential boundary crossing. safety hazards. In establishments where hot stones are used, for example, the standard of practice is such that hot stones should be scrubbed with hot water and soap between clients, and the water in the hot stone caddy exchanged for clean water before the next client receives a hot stone massage. One reason for this is that an undetected pathogen from one client may be transferred to the hot stones during a hot stone massage and possibly transferred to the next client who receives a hot stone massage if the same stones and water are used. It would be a clear violation of a therapist’s obligation to protect the client from harm to allow unsanitary conditions to continue, regardless of the employer’s standards of cleanliness. Ethically speaking, the therapist should consider educating the employer about the fundamentals principles of infection prevention as outlined by the Centers for Disease Control and Prevention (CDC) and review state and local health regulations that may apply. Review NCBTMB Standard I: Professionalism that includes: ● Provide an environment that is safe and comfortable for the client that meets all legal requirements for health and safety.
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Book Code: MLA1224
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