not appear harmful initially. Detecting boundary violations is complicated by the fact that transgressions are more often a process than an individual event or occurrence. Dual or multiple role relationships The boundaries set during a therapy session must apply to interactions with clients when they encounter them in the community. If the therapist resides in the same community, it is likely that they will have to interact with clients at establishments or events, like the grocery store, church, school, recreational facilities, or community functions. The practitioner must be aware of the importance of boundaries and the need to project professional and ethical conduct when in public. A dual relationship is an alliance in addition to the client/ therapist relationship, i.e. social, familial, business or any other relationship that is outside the therapeutic relationship. Dual or multiple relationships have been researched and included in the codes of ethics for counselors, social workers, psychologists, and mental health therapists for decades, and there is a wealth of information on the topic that applies to massage therapy and body work. A dual or multiple role relationship occurs when an individual either at the same time or different points in time engages in two role categories, for example, in addition to the professional therapeutic relationship, there is also another relationship, such as relative, friend, student, business partner, or instructor. While it is perhaps best to avoid dual relationships, it is not always possible or practical. In small towns, for example, it may be more difficult to avoid dual relationships (Institute for Therapeutic Massage, 2018) 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, therapists should follow recommended procedures including informed consent, open discussion, consultation, supervision, and examination of personal motivation, all of which should be documented (Institute for Therapeutic Massage, 2018). 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 that might impair objectivity or effectiveness, permit exploitation, or create an actual, apparent, or potential conflict of interest (Institute for Therapeutic Massage, 2018). It is the therapist’s responsibility, not the client’s, to maintain appropriate boundaries in the professional Case study A massage therapist working in a clinical setting has been treating a client who seems like a good person: fun, smart, and dedicated. During massage appointments, there has been no indication of either client dependency or physical attraction. The verbal and nonverbal feedback that the client provides during the session seems to facilitate the professional relationship. After the last appointment,
Boundary violations may be subtle or masked by the professional–patient relationship (Allen, 2019).
relationship. If a complaint is filed, it will be the massage therapist’s responsibility to demonstrate that a client has not been exploited or coerced, intentionally or unintentionally. Massage therapists should be especially vigilant regarding any conduct that could impair their objectivity and professional judgment in serving a client, and any conduct that carries the risk and/or the appearance of exploitation or potential harm to a client (Institute for Therapeutic Massage, 2018). Massage therapists should recognize and avoid the dangers of dual relationships when relating to clients in more than one context, whether professional, social, educational, or commercial. Dual relationships can occur simultaneously or consecutively. Generally prohibited dual relationships can include, but are not limited to: ● Accepting as a client anyone with whom a massage therapist has had a prior sexual relationship. ● Forming a sexual relationship with a current client or someone who has been a client. ● Treating clients to whom the massage therapist is 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 include extending the session, lending and/ or borrowing money, meeting at inappropriate places or times, giving or receiving gifts, soliciting donations, making inappropriate self-disclosure, socializing with clients, and using inappropriate 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 (Institute for Therapeutic Massage, 2018). Appropriate behaviors reinforce professional boundaries. Massage therapists should try to maintain the same structure and rules of conduct in each session and with each client. Therapists should examine the rationale and potential repercussions of any changes or exceptions they make for specific clients, even at the client’s request, before they implement them. Bending a rule may not always endanger the therapeutic process, but impropriety can be a “slippery slope.” If massage therapists uncharacteristically deviate from normal session structure or protocol, they should consider that their impulses may be motivated by self-interest. Or, if they are having strong emotional responses to a client, they should seek peer support or supervision (Institute for Therapeutic Massage, 2018).
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
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Book Code: MFL1225B
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