topics with or in front of the client, joke about sexual matters, make sexual or suggestive remarks, or use sexual innuendo. Several precautionary measures can help massage therapists to maintain a comfortable, safe, and professional environment: ● Massage therapists should avoid meeting new clients at unknown locations, at hotels, or in the client’s home, where personal safety may be at greater risk. If therapists meet a client on-site, they should set up the massage table in a neutral location, rather than a bedroom. ● Therapists can encourage relaxation through the client’s visual, auditory, and olfactory senses, but should keep the look and smell of the environment subdued and professional, avoiding creation of an overly perfumed, romantic, or sensual atmosphere. Therapists should also remember that a client might be allergic to certain odors, have strong negative reactions to certain smells, or associate a given odor with an unpleasant memory or incident. Music should also be soothing and subtle, and played only after therapists have asked the client about a preference for music or silence during the massage. ● Financial impropriety : Charging a cash-paying client a different fee than an insurance-paying client. ● Exploiting the power differential : Asking a stockbroker for financial tips during a treatment. ● Misleading claims of curative abilities : Guaranteeing a client that his/her pain will be gone in two sessions. ● Accessibility : Refusing to adapt the office, or make a reasonable accommodation for those with physical challenges. This is also illegal under the Americans with Disabilities Act. ● Bigotry : Refusing to work with someone due to race, religion, size, national origin, gender, or sexual orientation. ● Inappropriate advertising : Using a provocative picture in advertising or presenting misleading qualifications. ● Dual relationships : Dating a client, providing therapy to a student, or hiring a client for personal work. ● Violation of laws : Practicing out of one’s home when not permitted by law, not reporting legal adjudication, or practicing with a suspended or expired license. ● Confidentiality : Name-dropping famous clients or telling a spouse details about his partner’s session. ● Contraindications : Treating a client while sick or infectious or ignoring signs of conditions that preclude physical contact. ● Informed consent : Working on a minor without parental knowledge or treating an injury without permission. ● Practicing beyond scope of practice : Doing spinal adjustments, massage, or counseling without appropriate training. ● Sexual misconduct : Watching a client undress, hugging a client in a sexual manner, or inappropriate touching. The Equal Employment Opportunity Commission defines sexual harassment as any unwelcome advance, request, verbal statement, or physical conduct of a sexual nature, including visual displays (United States Equal Employment Opportunity Commission, 2016). The examples of sexual harassment below occurred in the context of massage therapy and bodywork. Therapists have experienced the following: ● Propositioned to have sex with a manager, co-worker, or client.
comfort or modesty will allow. In addition, therapists should request that clients wait to undress until after they have left the room. Therapists should never allow the client to dress or undress in their presence. ● Before they begin, therapists should inform the client of areas of focus and ask permission to proceed. Therapists should expose and work on only one area of the body at a time, and cover the exposed part before moving on to another area. ● Massage therapists should avoid ambiguity or the appearance of impropriety in their words and manner. For instance, therapists should dress in a professional manner, and avoid outfits that could be construed as revealing or provocative. The therapist’s demeanor should align with other professional healthcare personnel. ● In addition, massage therapists should use professional language and chose words carefully due the lack of personal space, and exposure of the body that can be intimidating, especially to new clients (Howard, 2011). When referring to physical conditions or parts of the body, therapists should use appropriate medical terminology. Therapists should never discuss sexual Misconduct Misconduct has been a persistent and troubling issue in healthcare and medical professions since modern medicine began. Written more than 2,000 years ago, the Hippocratic Oath is the basis for the principle of “do no harm” as it states, “I will keep them from harm and injustice” [Hasday,2013). It continues, “Come for the benefit of the sick, remaining free of all intentional injustice, of all mischief, and in particular of sexual relations with both female and male persons” (Hasday, 2013). In recent years, accusations of misconduct in the healthcare and personal service industries have become increasingly common, due in part to formal regulation of the profession, standardization of the complaint process, and greater awareness of the issue and client rights among the general public. Misconduct takes many different forms that vary in type and degree of severity. Misconduct can occur in every aspect of business practice, from organizational matters, to billing, to social interactions. Even in cases where inappropriate behaviors are the unintended result of poor record-keeping, lack of staff training, errors in judgment, or improper planning, they risk harm to the client and serious penalties for the practitioner. Victims of misconduct may face long term emotional and physical issues and allegations of misconduct. Even if allegations are proven false, they can damage the reputation of the therapist and the profession at large. Misconduct may take many forms. The following list provides some examples of misconduct based on violations of ethical guidelines and standards of practice: ● Misrepresentation of educational status : Identifying oneself as a craniosacral therapist after taking a two-hour course. ● Substance abuse : Practicing under the influence of alcohol, drugs, or any illegal substances. Harassment Harassment is a specific kind of misconduct or boundary violation in which an individual of equal or greater authority is inappropriately familiar with a student, co-worker, or junior employee. Harassment can be abusive remarks or behavior, belittling statements and actions, and discussion or commentary of an overly personal or offensive nature. Sexual harassment is abuse of power, typically exercised within the context of work, containing a sexual or gender- specific component.
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