Case studies: Ethical issues in practice Case study 1
both parties. The therapist has crossed the boundary of self-disclosure since the client knows of the dissolution of a relationship and engages in personal conversations during therapy. Whether intentionally or unintentionally, the client’s transference has tested the boundaries of the professional relationship, leading to counter transference on part of the therapist. Although transference and counter transference can generally be neither negative nor positive, the risk of raising unrealistic expectations on the part of client or practitioner in this situation is high. Ultimately, the therapist is responsible for maintaining the therapeutic relationship and as such, is required to maintain boundaries that do not compromise professional judgment and objectivity. This case is also a clear example of an ethical violation of sexual misconduct, as the therapist intentionally seeks to gain the client’s approval in a manner that is not within the therapist’s scope of practice. In this situation, the therapist may want to consider how a potentially negative end to any personal relationship with this client may adversely affect the massage business in the future, both legally and in the court of public opinion. The therapist should seek assistance from colleagues, supervisors, and possibly legal counsel, to end this relationship and resolve conflicts that will result. In addition to violating NCBTMB Standard VI to prevent sexual misconduct, the basis of Standard II, Legal and Ethical Practice states that the professional will: ● Refrain from any behavior that results in illegal, discriminatory, or unethical actions. ● Accept responsibility for his/her own actions (NCBTMB, 2009). written consent or a court order. In this case, there is no method for obtaining a court order. If the therapist finds that he cannot in good conscience let the alleged abuse go undetected by the proper authorities, the therapist is left with one or both of the following options: either refer the client to a social worker, and/or terminate the therapeutic relationship. In giving the client a referral to a social worker, the therapist does not violate the client’s principle of autonomy, self-determination, which holds that individual persons have the right to make their own choices. If the client wants to seek support for abuse, she may do so of her own volition. In giving the client the referral, the therapist does not violate any professional boundaries, since he is remaining within his scope of practice. But the therapist may also choose to terminate the therapeutic relationship because the relationship with the client has become dysfunctional in terms of an effective therapeutic relationship. The obstacle for the therapist should be relayed to the client as early as possible so that the client is not surprised by any unexpected pronouncement that the therapeutic relationship will come to an end. Mandated reporting There is controversy surrounding whether or not a massage therapist is a mandated reporter. Massage Therapy World, published an article in 2016 on this topic and provided the following information: In many U.S. states and Australia, mandated reporters are professionals who, in the ordinary course of their work and because they have regular contact with children, disabled persons, senior citizens, or other identified vulnerable populations, are required to report whenever financial, physical, sexual or other types of abuse have been observed or are suspected, or when there is evidence of neglect.
A massage therapist and client have had a professional relationship for five months. During this time, the client has received a massage once per month. There has not been any inappropriate activity during this time, and there has not been any non-professional contact outside of the massage sessions. Lately, however, the client has been scheduling weekly massages. Moreover, the appointments have been at the home of the client, and the conversations during a massage appointment have typically been personal in nature, often speaking freely. Although it is unspoken, both the client and the therapist believe they would make great partners socially. The client has been physically attracted to the therapist since their first appointment, and the therapist has become increasingly attracted to the client as well. The client is aware that the therapist is also “getting over” the recent dissolution of a long-term relationship and has few social outlets. During the massage, the client occasionally makes sounds that signify pleasure and possibly even sexual arousal. The therapist finds the feedback flattering and puts extra effort into making the massage an increasingly sensual experience for the client. Analysis This case potentially violates several areas of ethical concern. The first is an abuse of the power wielded by the massage therapist in the therapeutic relationship. Having forged a close relationship with the client, the therapist has allowed an emotional response to escalate into a physical one, and allowed a small impropriety on the part of the client to escalate into misconduct on the part of Case study 2 A massage therapist has a private massage therapy practice in a small town. The therapist works at a clinic located in the center of town where five therapists share office space. One of the therapist’s clients is an unemployed housewife. Her initial intake form notes that she rarely leaves the house, and that she arrived late because she got lost on the way to the clinic. Since then, she has been a punctual client for several months. Recently, though, she has been arriving to her appointments with bruises on her back and shoulders. Today, she arrived early with a bruise over her eye, which was covered with make-up. When asked about the bruises, the client said that she “fell down.” Although the client has not mentioned anything personal to the therapist, he gets the sense that she is being physically and verbally abused. The therapist has heard rumors that the client’s husband is involved in illegal activities and organized crime. The client begins to visit the massage clinic even when she does not have an appointment scheduled. Sometimes, she just reads the magazines and asks questions about massage. On appointment days, she arrives very early and lingers long after her session is over. She continues to increase the frequency of her appointments so that she receives two massages a week. The therapist senses that this is not a case of physical attraction and that the client she just wants someone to talk to. Analysis In this situation, it may be difficult for the therapist to avoid a breach of the client’s confidentiality, as she has not disclosed that she is either being physically or emotionally abused, regardless of appearances or hearsay. All information and matters relating to a client’s background, condition, and treatment are strictly confidential and should not be communicated to a third party without the client’s
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