Fundamentals Of Massage - Task 4

The Ethics of Professional Practice
By Suzanne Cunningham

Ethics - “The standards that govern the conduct of a person, especially a member of a profession” (Wiktionary, 2009). Massage therapists have a responsibility to themselves and their clients to set high ethical standards due to the unique relationship that exist between them. Just some of the ethical aspects to be considered will be outlined in this blog.

Client Centred Care
“In client-centered care, clients are [to be] considered first and foremost at every point in the planning, implementation, and evaluation… Clients are the experts on their own personal circumstances and wants” (Kols & Sherman, 1998). Therapists need to respect each client as an individual and tailor each session to be in the clients best interests. Clear communication will assist the therapist to obtain client information and informed consent prior to treatment.

Informed Consent
This is where a client gives permission for treatment based on a clear understanding of all the facts, and potential consequences of an action. The client must have the ability to reason the information they are given and must be provided with all the relevant details for consent to be given (Wikipedia 2009).

For massage, fully informed consent can be difficult due to the volume of information to be advised to the client. However, procedures and possible after-effects must be clearly communicated to and understood by the client prior to treatment. Minors or those who have some form of cognitive impairment should have a carer or legal guardian present to make informed consent decisions on their behalf. As part of the informed consent procedure, clinic policies, procedures and a scope of practice should be clearly available to the client.

Scope of Practice (SOP)
In order to have an honest SOP, Salvo (2007) advises that we need to understand our professional limits, and cautions that it is unethical to take on a client to whom we cannot provide adequate treatment (p. 24). Therapists who have a clearly defined SOP will be trained and have suitable experience to perform the specified treatments competently and professionally. Having an honest and clear SOP will promote therapeutic relationships with clients and professional relationships with other healthcare practitioners.

Relationships
Professionalism and trust are vital when developing both therapeutic and professional relationships.

This aspect has proved to be my personal challenge. It is easier to maintain professionalism when working with clients that I see only in the paid massage context. It is difficult to keep a professional distance when practicing on friends and family due to pre-existing relationships. In this situation, the balance of power is also altered (when compared to a paying client) as they are fulfilling my need to practice. This is an area in which I need to continue to develop to ensure I always maintain an acceptable level of professionalism in all massages.

If therapeutic relationships evolve into anything else, it is wise to refer the client to another therapist as they may be able to provide more objective treatment within professional boundaries.

Confidentiality
Many elements of client confidentiality are covered by the Privacy Act of 1993. Client records must be inaccessible to unauthorised persons. Only the client and persons explicitly authorised by the client are permitted to access them. Information in client records must also accurately reflect what has occurred during treatment. Inappropriate information should not be documented. For example, items such as work stress directly relating to a named third party should not be recorded. It is advisable to keep it generic and perhaps identify it as work related emotional stress.

Discussions about clients to third parties are also inappropriate. However, if it is an example of treatment techniques or results, providing the information supplied makes it impossible for the client to be identified in any way, this may be acceptable in some circumstances. This is an important rule in a city like Dunedin, where there are many surprising connections and relationships. If you happen to see a client outside the usual treatment environment, it is permissible to acknowledge them with eye contact and a smile, but the client must be the one to initiate any further contact. This respects their boundaries and privacy.

Boundaries
Boundaries clearly define roles and responsibilities in all relationships. By dressing in a professional manner (clean, tidy and appropriately), this sets an immediate boundary for the client. When this is backed by a warm but professional approach to the remainder of the massage process, the boundaries will remain clear and avoid any misunderstandings. According to Salvo (2007), “By having professional boundaries in place, we instil a sense of respect and dignity to our clients, to our profession and to ourselves” (p. 18). Occasionally, boundaries may shift and errors can occur like commenting on a clients appearance or the offering of psychological advice. However, continual monitoring of boundaries enables therapists to preserve the sanctity of the therapeutic relationship. Boundaries are vital to understanding and careful handling of the power differential that exist between a client and therapist.

Power Differentials
Clients place a large amount of trust in their therapist when removing clothing and allowing the therapist access to their body. They see therapists as the “professional” with superior knowledge and experience. By using the tools mentioned earlier in the blog, especially informed consent and boundaries, an ethical therapist will be able to maintain a successfully balanced relationship in a way in which there is no real or perceived abuse of power differentials. It is important for clients to understand that they have the right to stop treatment at any point if they feel this is not being handled appropriately.

Transference and Counter Transference
This is an interesting concept and also a frighteningly easy one to see how it can occur. Generally, we are raised in nurturing environments and taught to nurture others as best we can. However, when we are in a therapeutic relationship both client and therapist need to remain within professional boundaries.

If a client is displaying signs of transference (such as buying the therapist personal gifts, or inviting them to social occasions), this will need to be handled carefully to maintaining clear boundaries and if necessary, the client may need to be referred to another therapist.

On the flip side, there can be counter transference, which Salvo (2007) describes as the therapist bringing their unresolved issues or personal needs to the therapeutic relationship and having difficulty maintaining professionalism (p. 33). If a therapist displays these signs they need to carefully consider their behaviour and boundaries, and seek advice from their supervisor or counsellor. If this is not able to be resolved, the best course of action may be to end the therapeutic relationship to prevent it progressing and becoming unethical.

Conclusion
Understanding ethics in relation to professional massage practice has been an interesting learning experience. Many of these items at first seem like common sense which we all assume to have to some degree. However, as you delve deeper and make direct connections as to how they relate to a professional massage practice there are fundamental elements that are easily overlooked at first glance. Boundaries appear to be the strongest element that bonds all the others together. If as therapists we set high standards with the boundaries we put in place, everything else will hopefully reach the same standard. Individual attention to each step will still be required, but it is possible to have an outstanding ethical massage practice.



References

Kols, A and Sherman J (1998). Family planning programmes: Improving Quality, Population Reports, Series J, No 47. Retreived May 18, 2009 from http://www.infoforhealth.org/pr/j47/j47chap3.shtml

McQuillan, D, (2009). Fundamentals of Massage – Ethics. Retrieved May 18, 2009, from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html

Salvo, S (2007). Massage therapy principles and practice (3rd ed), St Louis, Saunders, Elsevier

Wikipedia. Retrieved May 18, 2009, from http://en.wikipedia.org/wiki/Informed_consent

Wiktionary, Retrieved May 18, 2009, from http://en.wiktionary.org/wiki/ethics