Tuesday, May 19, 2009

Ethical Considerations

“Most licensed health care professions have a code of ethics that members of these professions are expected to follow when working within their scope of practise.”(Salvo, 2007)

Client Centred Care
“When the therapist has a client-centred approach to care, the client feels safe and well attended.” (Salvo, 2007) As massage therapists we have an ethical responsibility to incorporate into our practice; respect, compassion, safety, be responsible for our client and their needs, and build a relationship based on trust. Taking a client-centred approach benefits the client and helps them to trust the therapist in forming a therapeutic relationship. At all times the focus is on the client and their needs. Effective communication with the client is essential for building trust and respect.

Informed consent
Obtaining informed consent prior to performing any massage on a client is a vital ethical consideration. This ensures safety for the client and the therapist. Communicating with the client is the best way of informing them about the information they need to know before they give consent to the massage. The client needs to be informed about the therapists; qualifications, payments types available and price of massage, record taking before the massage, contraindications, confidentiality and scope of practise. It is also crucial that the client is informed about your treatment plan, benefits and effects of massage and the feedback system. Client forms, handouts and pamphlets’ are an easy way to notify any relevant information the client may need.

It is essential for a therapists to respects their client confidence. All client records and personal information needs to be kept confidential and in a safe place (Locked filing cabinet). Client records can be accessed by the client or other health care professionals if needed. No information can be given out to family members or other members of the public without the consent of the client. The Privacy Act 1993 states “ensure that personal information which the organisation holds is kept secure against loss or unauthorised use, modification or disclosure.”(Privacy Commissioner, 2009) Out of work the therapist cannot discuss any of their clients with their family or friends and if the therapist sees a client out of work it is best to wait for them to approach you first. Maintaining client confidentiality is an ethical responsibility and requirement of the therapist.

Scope of practise
“Therapists are required to know and practise only services stated in their scope of practise outlined in the state in which they practise.” (Salvo, 2007) It is important that a therapist only performs massage techniques in which they are qualified to do. At the end of this term we will have a Certificate in Relaxation Massage and it is crucial that we only perform relaxation massage. It is in the best interest of the client as we are ethically bound by the hipocratic oath to not want to cause any harm to them. We need to know our limitations, work within our scope of practice and can refer clients to other therapists that have different training or qualifications when needed.

Boundaries/ Power differentials
A therapist must have boundaries between themselves and their clients. Important boundaries to establish for a therapeutic relationship between client and therapist are; personal space, emotional distance and not building a relationship with a client that will be more than just professional. Establishing boundaries and respecting them helps to build trust and a feeling of safety and is an ethical consideration and responsibility for the therapist to maintain. Boundaries may not be crossed and communication is needed to prevent this from happening. There also needs to be boundaries put in place to prevent the client from feeling vulnerable or inferior to the therapist. As massage therapists we have the skills and qualifications but we do not want to show a difference in power because of this. From our experiences and knowledge we are able to stop a massage at any time if we feel uncomfortable with our client or if they cross any boundaries.

Transference and Counter-transference
Transference can occur if a client sees the therapists as a friend, family member or lover and not as the professional they are. As some clients are very vulnerable they can feel comfort, care and a sense of safety from the massage. This can result in feelings for the massage therapists. Clients may want to spend time with therapists outside of work or may even start sending you gifts to show their feelings for you. As therapists we cannot change the way our clients feel but we can try reducing transference from occurring. Counter-transference can occur “when the therapist has trouble maintaining his or her professional distance and detachment from a client.”(Salvo, 2007) A therapist can feel overly responsible for the needs of the client and can lose all the boundaries by having unnecessary feelings towards a client. Warning signs such as attachment to client and the desire for more than a therapeutic relationship can go unnoticed. It is important for therapists to put their personal needs and desires aside when at work so that they can be professional and run a smoother practise.

“In order to meet the trust placed in it by the public as a whole, the professional must have care for the setting in which the profession is practiced: the human setting of massage, the ethical setting, and the overall political setting. This involves the professional voluntarily accepting a code ethics that goes beyond that required of ordinary citizens by law.” (The Health Network, 2009) Client centred care, confidentiality, communication, scope of practise, informed consent, boundaries and power differentials need to be considered when building a professional and successful practise. Ethics are important when it comes to understanding and building therapeutic relationships with clients.


Class notes

Salvo.S.G. (2007). Massage Therapy: Principles and Practice (3rd ed.). Missouri, Saunders.

The Health Network. (2009).Massage Ethics. Retrieved May 18, 2009,
from http://www.nzhealth.net.nz/massage/ethics.shtml

Privacy Commissioner. (2009). Privacy Principle Five. Retrieved May 16,2009,
from http://www.privacy.org.nz/privacy-principle-five/

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