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 relationship. It is best to avoid dual roles or 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 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 Case study 5 A female massage therapist has been working with a female client for six months and the client’s behavior has slowly become aggressive, demanding and critical of the treatment. The therapist focuses on the client’s shoulders and upper back muscles that are often tight but release during treatment. This is the problem areas identified by the client during development of the treatment plan. One day the therapist completed the upper shoulder work and started to move to the mid back. At that point the client turned and sat up, demanding that the therapist return to the shoulder area and shouted, “Do the work I told you to do and if you did it right the pain would not keep returning!” The therapist, wanting to please the client, said nothing and repeated the shoulder work. Nothing further was about the session by either party, and the therapist told herself that the client was having a bad day and kept the incident to herself.
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. 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. ● Use standard precautions to insure professional hygienic practices and maintain a level of personal hygiene appropriate for practitioners. Also applicable is Standard IV: Business Practices: ● Provide a physical setting that is safe and meets all applicable legal requirements for health and safety (NCBTMB, 2009). The following week, the therapist was uneasy and anxious as she approached the regular session with that client. Sure enough, when the client returned, she continued to bark instructions at the therapist. Again the therapist complied in order to assuage the client’s anger and to try and accommodate her demands. As the sessions continued the therapist grew more apprehensive and she began to doubt her competence as a therapist. The therapist reviewed the client’s chart and her treatment and believed that she had delivered the correct procedure using the appropriate method. She felt that she had lost her ability to provide effective services and faith in her ability as a massage therapist. After carefully reviewing the situation, conducting self awareness activities, reflecting on her feelings and the impact on her behavior and spending time on reflecting the therapist came to a realization. She had felt these feeling
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Book Code: MTX1325
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