Tuesday, May 19, 2009

The ethics of professional practice

Here I am going to discuss the therapeutic relationship between a massage therapist and their client. I will talk about client-centred care, infromed consent, confidentiality, scope of practise, professional boundries, power differentials, and over-all the dymanics surrounding the relationship between a massge therapist and their client.

Client-centred care is about meeting the clients needs within a safe practise, discussing a plan with the client to have those needs met and involving the client in any dicision-making process to implement a plan to reach their goals. When the massage therapist uses this approach the client feels safe and is then able to visualise a positive approach toward their massage.
Informed consent is for the safety of our client. Although our client has booked an appointment and has agreed to having a massage, we still need to inform our client of any areas we need to be massaging during the session. This is to help the client feel comfortable and more involved in the treatment plan. If the client is not comfortable with getting a particular area of their body massaged then the massage therapist needs to respect that and must not massage that area of the clients body. Informed consent involves the client and creates trust between the client and the massage therapist. Salvo states, "because clients are vulnerable trust, along with open communication, must form the basis of the therapeutic relationship." (Salvo, p 17)
Scope of practise An important part of our profession is to stay within our scope of practise and not to step outside or go beyond our role as a massage therapist. We need to inform our client of what we can do and where our limitations lie. We are not trained to go beyond our area of massage for example; physiotherapy and counselling are not part of our profession. Basically we must stay within our limits otherwise we are crossing the boundries of other professions and most of all we could harm our client. Salvo says, "therapists are required to know and practise only within the scope of practise outlined by the state in which they practise. We need to know what the limits of our skill and our physical abilities are; taking on a client whom we cannot serve well is unethical." (Salvo, p 24)
Confidentiality is key in massage therapy. Everything our client says to us is totally confidential unless it is something that would or could cause harm to another individual. Clients notes need to be kept in a safe place which is not visible to other clients. This is to protect the clients anonymity. Confidentiality is essential and builds trust between the massage therapist and the client. Salvo states, "Confidentiality concerns each client's right to and guarantee of privacy and safety within the therapeutic ralationship. This concept means that the client's name, details of his or her treatment, and information shared by the client during sesssions are not to be divulged to anyone." (Salvo, p 23)
Boundries Setting boundries is vital to maintaining healthy relationships in massage therapy. Not crossing those boundries is just as vital. Salvo states, " A boundry can be defined as a set of parameters indicating a border or limit. A boundry, with regard to relationships, marks or delineates the differences between client's and therapists." (Salvo, p 25).
Because our profession involves touch we need to respect our client's boundries. Communicating with our client's about boundries allows them the security and safety they deserve. Salvo also states, "By respecting the boundries of others, we instill a sense of dignity and respect to our client's, to our profession, and to ourselves." (Salvo, p 25)
Power differentials When a client approaches a massage therapist they are in need of some assistance from the massage therapist , therefore putting themselves in a vulnerable position. The massage therapist has knowledge and experience in this area which places the massage therapist in an authoritive role. This is power differentials and the massage therapist needs to respect this and treat the client with compassion, understanding and empathy. Salvo says, "Anytime a power differential exists in a relationship and the person who weilds the greater power does not recognize or respect the boundries of the other, client abuse and client neglect can occur." (Salvo, p 19).
Power differentials happen naturally between a massage therapist and their client, therefore the massage therapist can use this position of power to care for their client; encouraging them to be open to healing in this manner.
Relationships massage therapy involves relationships with other professionals and with client's. The relationship between a massage therapist and their client developes overtime. This involves clear communication and setting healthy boundries. The massage therapist should always avoid any conflicting issues and stay within the role of their profession in order for their relationship to stay healthy. Massage therapists also have relationships with other professionals. In this relationship we can refer our client's on to other professionals if the client's presenting issue is beyond our capabilities. We can also get referals from outside of our profession. Our client's care is our main focus.
Transference and Counter-tranference basically the aim of being a responsible massage therapist is to keep the relationship between you and client strictly professional. Salvo states, "When a client views the therapist as someone other than a health care provider, the result is transference. Conversely, the therapist may experience countertransference if he or she sees the client as something more than a client." (Salvo, p32)
Transference can occur at anytime especially if your client is needy and vulnerable. If this issue arises the massage therapist needs to take steps to reduce the transference from getting out of hand. Counter-transference is when a massage therapist brings along their personal issues expecting the client to fix it, or when a massage therapist crosses the client's boundries and begins to feel close to their client. Counter-transference can occur if the massage therapist is not maintaining strong boundries. Detachment is a healthy solution in either of these circumstances. A massage therapist can still care for their client and have detachment.

Here I have outlined the importance of maintaining healthy relationships between the massage therapist and their client. I have covered the scope of practise used in massage therapy, confidentiality, power differentials, boundries, informed consent and a few other important factors of massage therapy.

Salvo S. (2007), Massage Therapy. Principles and Practise. (3rd ed). Missouri, Saunders Elsevier

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