relationships can occur simultaneously or consecutively. Prohibited dual relationships can include, but are not limited to: ● Accepting as a client anyone with whom you have had a prior sexual relationship. ● Forming a sexual relationship with a current client or someone who has been your client. ● Treating clients to whom you are related by blood or legal ties. ● Bartering with clients for the provision of services. ● Entering into financial or business transactions with clients (other than the provision of massage services). Other situations that complicate the massage therapy relationship are: extending the session, lending and borrowing money, meeting at inappropriate places or times, giving or receiving gifts, soliciting donations, inappropriate self-disclosure, socialization with clients, and inappropriate use of language. Maintaining appropriate boundaries is an essential part of compassionate, effective, and ethical massage therapy practice. Although practitioners and clients may be similarly affected by these psychological processes and equally capable of showing poor judgment or acting irrationally, licensed practitioners are bound by their professional affiliation to act responsibly, even when the client does not. Appropriate behaviors reinforce professional boundaries. Try to maintain the same structure and rules of conduct in each session, with each client. Examine the rationale and potential repercussions of any changes or exceptions you make for specific clients, even at their request, before you implement them. Bending a rule may not always endanger the therapeutic process, but impropriety can be a “slippery slope.” If you uncharacteristically deviate from normal session structure or protocol, suspect your impulses may be motivated by self-interest, or are having strong emotional responses to a client, seek peer support or supervision. document relevant information about the client’s progress or lack of progress toward treatment goals. Before terminating the client, be sure to: ● Consult appropriate information resources and supervising personnel. Contact a professional colleague or supervisor about your situation with the client, post a question on a professional massage therapy website, or refer to professional organizations with which you are affiliated. You may be able to find an alternative to terminating the client, or a sensitive way to present the issue to him or her. If you appeal to any of these resources, be absolutely certain that you maintain strict rules of confidentiality and privacy, ensuring that the client’s name or other identifying information is never revealed. ● Do a reality check. Make sure you and the client are “on the same page” by comparing your understanding of a therapeutic relationship with theirs, and discussing disparities in the way you and the client perceive your relationship, including difficulties and desired objectives. This kind of clarification can help you determine the scope of the problem and whether it is the result of miscommunication or misinterpretation, something that can be remedied, or requires termination.If it is necessary to terminate the client, be sure it is done when you have sufficient time to discuss the subject fully. Take the time to respond to any questions the client may have, and give the client sufficient time to react to the news, respond to it, and regain composure. Do your
to avoid dual relationships, it is not always a possible or practical ideal. In small towns, for example, it may be more difficult to avoid dual relationships. There is a great range of opinion regarding the propriety of dual relationships. While some feel that not all dual relationships are negative, all have that potential. Some organizations suggest that dual relationships are acceptable, if not exploitive. To ensure that the relationships do not cross the line into exploitation, it is important to follow recommended procedures including informed consent, open discussion, consultation, supervision, and examination of personal motivation, all of which should be documented. Some professionals consider it unethical to work on friends, while others consider it acceptable to proceed as long as appropriate measures are taken to ensure there are no detrimental effects to the therapeutic or preexisting relationship. It is always best to avoid multiple relationships if it appears likely that the relationship might interfere with the therapeutic relationship. However, existence of a dual relationship is not necessarily a violation of boundaries. This is usually referred to as a “prohibited dual relationship.” This means a dual relationship which might impair objectivity or effectiveness, or permit exploitation, or create an actual, apparent or potential conflict of interest. It is your responsibility, not your client’s, to maintain appropriate boundaries in your professional relationship. If a complaint is filed, it will be your responsibility to demonstrate that a client has not been exploited or coerced, intentionally or unintentionally. Be especially vigilant regarding any conduct that could impair your objectivity and professional judgment in serving your client, and any conduct that carries the risk and/or the appearance of exploitation or potential harm to your client. Recognize and avoid the dangers of dual relationships when relating to clients in more than one context, whether professional, social, educational, or commercial. Dual Terminating a professional relationship If you feel it is appropriate, either because a specified, finite course of treatment with a client is concluding, or because you believe your relationship with the client has become dysfunctional, unproductive, or emotionally damaging, it may be necessary to terminate your professional relationship with the client. While this can be a difficult and uncomfortable task, it is important that it not be postponed out of a desire to avoid confrontation or discomfort. Terminating a potentially damaging relationship is an important professional obligation with specific responsibilities. Practitioners must be able to realistically assess their own limitations and/or their client’s potential for therapeutic benefits, and make a determination in their client’s best interests, without feelings of failure or guilt. They must develop a plan for termination that is considerate of the client, with attention to the possibility that it will be received with emotion or distress. Informed consent provides a framework for termination because it specifies the need for an ongoing discussion between the client and practitioner regarding the expected goals and anticipated time-line for therapeutic benefits. Involve your client in the process so he or she is aware of treatment objectives and can ask questions and make determinations about his or her progress toward them. Discuss obstacles to client progress as they come up, so your client is not surprised by an unexpected pronouncement or abrupt changes in your assessment of the client’s condition from one session to the next. Be sure to follow customary procedures for client assessment, and
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