INTERPERSONAL DYNAMICS AND POWER IN THE THERAPEUTIC RELATIONSHIP Interpersonal dynamics exist in all relationships, and are a normal and necessary part of a therapeutic relationship between client and practitioner. An important part of this dynamic is a power differential, i.e., the imbalance in authority or power that results from therapists’ greater expertise in the area of massage therapy. Massage therapists’ education, skills, experience in the field, and professional certification give them an authoritative advantage over their clients (AMTA, 2014).
Balance of power Ginn (2013) explains that the most common ethical dilemmas are often subtle and overlooked. Many ethical gray areas concern what Ginn calls the power differential or the complex balance of power between client and therapist. The power differential is an imbalance in authority or power that results from the massage therapist’s greater expertise in massage therapy. “The key is to acknowledge the complexity,” says Ginn, “and understand one’s own history of power.” According to Ginn, massage therapists can create ethical dilemmas by overusing their power. Sometimes the overstepping of the use of power is obvious, as with inappropriate touch, for example. Other times, however, the overuse of power is more subtle, like being late for a client’s massage therapy appointment, or not listening to your clients concerns and questions carefully. In addition to overusing power, massage therapists can also underuse their power, for instance, massage therapists who do not have any established practice policies or who fail to directly establish boundaries when working with clients (Ginn, 2013). Not being able to quickly and properly address conflict is another way massage therapists underuse their power. Ginn (2013) notes that clients can over or underuse their own power, though she is quick to point out that massage therapists need to take more responsibility than their clients. She offers the following insights: ● A healthy client-massage therapist relationship is not equal, but balanced. ● In order to achieve a balanced relationship, massage therapists must learn to “teach your clients to be clients.” ● Before beginning a massage therapy session with a new client, take time for introductions and explanations of practice procedures and policy. ● Create guidelines for the session room and explain client and therapist roles including the expectations and objectives of therapy. ● Let clients know what their responsibilities are in the relationship, such as a policy to pay at the time of service, to arrive on time, and to speak up if something makes them uncomfortable, for example. Boundaries in the patient-practitioner relationship Boundaries define the limits of appropriate behavior within the scope of practice between professionals and clients and must be clearly communicated before a session begins. By establishing boundaries, a massage professional creates a respectful and protective space for the therapeutic relationship to occur that protects both the client and the therapist. A boundary violation occurs when a massage therapists’ behavior goes beyond appropriate professional limits as stated in the Code of Ethics and Standards of Practice from all professional organizations previously outlined in this course. The intimate nature of massage therapy presents the potential for boundary violations within the professional- client relationship. Remaining in the established professional boundaries may become difficult in prolonged or long-term relationships, but practitioners are responsible for retaining their professional boundaries with all clients at all times.
With any position of power comes the potential for abuse. Massage therapists, like many healthcare professionals, forge close relationships with people in their care. The combination of physical and social interaction between practitioner and client can trigger strong emotional responses in one or both parties, leading to small improprieties as well as egregious misconduct. Examples of subtle ways practitioners can take unfair advantage of their relationships with clients include: asking a client, who is a lawyer, for free legal advice; requesting a church donation; selling a child’s fundraising products at the office; mentioning personal details about a client; or repeating what was said during a session to a friend or spouse. Even when clients appear to welcome, rather than resent such requests or behavior, they are never appropriate and do not belong in a professional environment. It is equally inappropriate for practitioners to accept favors, free merchandise and services, or confidential information, such as stock tips, from a client. These interactions can distort the therapeutic relationship and obscure its primary objective. It is not unusual for clients to unintentionally test professional boundaries, or for practitioners to unknowingly disregard them. When practitioners and clients are motivated by counter transference and transference, respectively, they become more susceptible to inappropriate impulses that can lead to misconduct. Transference refers to the redirection of all the feelings experienced by the client, related to his or her past experiences and relationships, stirred up by or in the session. Counter transference may occur during a session when the practitioner’s unresolved feelings and issues are unconsciously transferred to the client (Bureau of Labor Statistics, 2016). Massage therapists should be aware that transference and counter transference could activate strong emotional reactions and/or feelings of sexual attraction, raising unrealistic expectations on the part of clients and practitioners. They should learn to identify emotional red flags of blurred professional/personal boundaries in their own behavior. Boundary issues are covered in a number of guidelines and regulations that govern appropriate professional behavior, including standards of conduct, codes of ethics, state and federal law, professional education and training programs, licensure and certification protocol. Clients must rely on the professional they consult for services to be trustworthy and competent in establishing and maintaining boundaries. When practitioners cross boundaries, they have not only lost their professional judgment and objectivity, but the trust of the client as well as the therapeutic relationship. Part of massage therapists’ responsibility in maintaining clearly defined boundaries is to protect the client. Inappropriate behavior tends to make people uncomfortable so the therapist must be observant to notice if a client is not responding positively to therapy, and make sure their behavior or comments are not the cause. Relieving stress and physical stiffness or pain should be a relaxing and
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