● Calls the practitioner at home when explicitly stated otherwise. ● Brings a gift to every session. ● Solicits help in solving personal problems. ● Has difficulty maintaining physical boundaries (i.e., wants to hug or touch during every session). ● Asks for more time before and at the end of a session, and is disappointed when not appeased. ● Asks the therapist out on a date. ● Makes any comment or action that crosses the professional boundary of the relationship into a personal one (Riedell, 2005). In some cases, there are cultural or ethnic customs that influence a client’s behavior that may be misconstrued or misinterpreted by the therapist. Often small gifts from clients are a personal sign of appreciation, as may be the case for clients who cannot afford to tip (Riedell, 2005). The client’s customs may dictate that they offer food or drink to guests no matter what the occasion. Likewise they may hug or kiss as a standard form of greeting and Case study 7 A bodywork therapist is a member of a local church that offers a number of groups on a variety of topics. One group concerns self-improvement activities and encourages members to discuss areas of their lives that they would like to address. It deals with topics like handling stress on the job, positive parenting, conflict resolution, or strategies to improve communication skills. The members of these groups often divulge information that is personal in nature and reveal areas of weakness or uncertainty. It is not an official therapy group but the leader is certified as a spiritual counselor with a theology degree. One day a new member joined the group who was a client of the therapist. The therapist felt uneasy and somewhat uncomfortable about his participation in front of the client and declined to discuss personal information with the group in front of the client. The therapist feared that his role in the group, which sometimes included social activities, would constitute a dual relationship with the client, which would be a boundary violation if he continued as therapist for the client. Analysis A dual relationship is one where multiple roles exist or overlap between a therapist and a client and consists of both professional and social roles (Riedell, 2005). Examples of dual relationships could include clients who interact, in a variety of roles, with the therapist outside of practice. Client roles may include students, interns, friends, family, colleagues, supervisors, employees, business partners, teachers, subordinates, or healthcare professionals who interact with the therapist. The practitioner must understand the concept of dual relationships and know that they alone are responsible and accountable for dual relationship that may result in boundary relationships that may harm the client or disrupt effective therapeutic relationships. A power differential often exists between the therapist and client in both settings so the practitioner must access the effects of dual relationships to ensure clear relationship boundaries. Interacting with a client in any capacity outside of the treatment room may lead to a more personal relationship. The nature of the activity will dictate whether or not a relationship results in one that leads to a boundary crossing or violation. As the massage profession’s nature initiates a certain level of intimacy, each role within dual relationships and levels of intimacy determine a course of action (Riedell, 2005). For example if the activity is a ballroom dancing class, that may involve a level of intimacy that could lead to inappropriate feelings on the part of one or both parties. These feelings would change the nature of the therapeutic relationship if they were continued in the treatment room and could lead to inappropriate behaviors from either party if professional boundaries are not maintained or reset.
not to reciprocate or pull back would be a sign of rudeness or an offensive behavior by the therapist. The therapist should know as much as possible about the client’s culture in order to gage their intentions when the offer gifts, signs of affection or invitations to come to dinner or a social even outside of the massage venue. The therapist needs to carefully consider the words and actions of the client before deciding if they constitute a boundary violation or if the therapist needs to address a potential ethical conflict. When making decisions the therapist should consider if the client’s actions have the potential to cause harm to himself or herself, or the therapist, or interfere with the effectiveness of therapy. In this case, the therapist will have to determine if the intent of the hugs and baked goods were innocent gestures but if client comments began to cross a professional boundary, the practitioner needs to address the situation and reset boundaries. Review Standard V on Roles and Boundaries and Standard VI on Preventing Sexual Misconduct. Switching roles, or dual roles, in the therapeutic relationship can lead to confusion and the possibility of transference or counter transference, and both parties are often tempted to continue developing a personal relationship rather than maintaining a professional atmosphere (Riedell, 2005). If this occurs, it could result in emotional harm to the client and at best would interfere with objectivity and the focus on effective therapy to attain client healthcare goals. In this case study the therapist must determine why the client entered the group to be sure that their motivation was not just to be closer to the therapist. The therapist would also have to consider how their disclosure of personal information in front of the client might affect the therapeutic relationship. Would the disclosures in the group impact the respect of the client, would it lead to empathy, sympathy, of pity that might enhance or hurt the therapeutic relationship and under mind the confidence of the client in the therapist’s professional ability. Again the words, “do no harm,” must always be considered when determining the course of action with clients both in and out of the treatment setting. Massage therapists are not prohibited from all social contact in the code of ethics so they must make decisions based on self- assessment and the retention of clear boundaries to be sure all activities are legal and ethical. It is up to the therapist to evaluate the potential risks involved in fostering a dual relationship. When evaluating the risks, consider the following: ● What is the nature of the activity? ● Who initiated the activity? ● Is the activity beneficial to the client? ● What is the level of intimacy? ● Is there a potential for boundary crossing? ● What is the potential impact of the power differential? ● Who is accountable for what in the relationship? ● What is the relative maturity level? ● What are the consequences of participation and non- participation? ● What are the risks to the client, therapist, practice or profession? ● Would both parties be comfortable with public knowledge of the relationship? ● Does it best serve the client or the therapist? (Riedell, 2005) For example, the therapist has a car and a client who is an auto mechanic, which appears to be a mutually beneficial dual relationship at first. Before initiating this dual relationship, consider possible scenarios where the power differential may reverse: ● What if the mechanic does a poor job?
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Book Code: MLA1224
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