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.
of both parties. Whether intentionally or unintentionally, the client’s transference (all the feelings experienced by the client, related to his or her past experiences and relationships, stirred up by or in the session) has tested the boundaries of the professional relationship leading to countertransference on part of the therapist (all the feelings experienced by the practitioner, related to his or her previous relationships and experiences, that are stirred up during the session, including the practitioner’s conscious and unconscious response to the client’s transference of emotions). Although transference and countertransference are generally neither negative nor positive, the risk of raising unrealistic expectations on the part of client or Reporting misconduct Many states require a “duty to report” by their licensees. If therapists believe they have first-hand knowledge of another practitioner acting unethically or illegally, they have a responsibility to report it. They should contact their state board, the certifying organization (NCBTMB, AMTA, etc.), or the Agency for Healthcare Administration (AHCA) Case study 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 said 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. 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, and reflecting on her feelings and the impact on her behavior, the therapist came to a realization. She had felt these feeling before when she was a teen and made to feel inadequate by her negative, authoritarian mother who was impossible to please. Reflection What is the term (or terms) used for the situation this therapist experienced? Analysis The therapist determined that the situation had devolved into one of transference and counter transference. Here are the relevant components: ● In relationships where a power differential is present, as between a healthcare practitioner and client,
to file a complaint. The AHCA is responsible for analyzing complaints and reports involving potential misconduct and initiating investigations. The boards and councils within statewide organizations determine probable cause and disciplinary action.
there exists a potential for transference and counter transference to surface. ● Transference occurs when a client unconsciously projects unresolved feelings, needs and issues onto a practitioner. ● In counter transference, the therapist unconsciously assigns unresolved feelings, thoughts, and perceptions about someone from their personal history onto the client. ● As a result, the therapist may lose objectivity and misinterpret a client’s actions, responses and needs. These misperceptions can lead to misunderstandings, poor judgment, and even negative feelings toward a client. ● Negative feelings often arise when a client displays similarities to a person in the therapist’s life toward whom ill will is harbored. ● Displaced positive feelings can arise when a client reminds the therapist of someone they feel favorably toward. ● Recognizing the signs of counter transference can prevent an awkward ethical dilemma up to and including litigation. The following behaviors are indicative of counter transference: ○ Unusually strong positive or negative feelings toward a client. ○ Predominance of impatience or anger if a client is not progressing. ○ Being argumentative with a client. ○ Over-emotional involvement in solving the client’s problems. ○ Making exceptions for a client’s inappropriate behavior. ○ Giving a client extra time and attention before and after a session. ○ Bending your professional and personal boundaries for a client. Steps to prevent or resolve counter transference issues include: ● Working on building trust and communication as a foundation. The therapist in this case stayed quiet too long. ● Working to become more self-aware and overcoming prejudices, preferences, judgments and personal issues, to establish clearer boundaries in the therapeutic relationship.
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Book Code: MFL1225B
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