Ethics is not something meant to be learned once and then relied upon only in the direst of situations. Truth is, as massage therapists and bodyworkers, you face ethical challenges every day in your practice—not letting a late client impact your next appointment, referring out to other health-care providers when a client's needs exceed your capabilities, not letting boundaries get fuzzy. And your ethical "talents" continue to improve with each circumstance.
There is always room to grow your ethics knowledge, no matter what stage of your career you are in. Because of the nature of the work you do, it's important to be on a lifelong ethical journey.
In this second installment of "What's Your Ethics IQ?," it's time to test your understanding of boundaries and relationships in the treatment room. Take a look at the questions below. Answer what you can, research what you can't (answers at the end). We've given you a head start on a few. Good luck!
Because of the nature of the work you do, it's important to be on a lifelong ethical journey.
List three therapist behaviors that demonstrate a lack of attention to sexual innuendo.
Answer: Making complimentary comments about a client's body or accepting client compliments about the face, body, or hair; having nude artwork anywhere in the massage practice; and making sexual jokes or allowing clients to make sexual jokes.
List two instances where referral to another health-care provider demonstrates ethical practice.
Answer: When the massage therapist does not believe massage can benefit the client, or the client needs treatment beyond the ability of massage to benefit the condition.
Watch for the third and final installment of "What's Your Ethics IQ?" in the next issue!
Quiz Answers below:
1. Define the phrase conflict of interest as it relates to a therapeutic relationship.
A. A conflict between a person's private interests and their public obligations. In a therapeutic relationship, the therapist has an obligation to provide the best possible care to the client. If therapists find themselves in a situation where they may benefit from influencing a client in a certain way, it is a conflict of interest and they should avoid the situation or step down from the therapist role.
2. Define the term kickback.
A. A kickback in massage is any money, fee, commission, credit, gift gratuity, thing of value, or compensation of any kind provided for referral of clients. If a chiropractor sends a massage therapist a thank-you card containing $20 for every client the therapist sends the chiropractor, the therapist is accepting a kickback. This violates ethical standards.
4. List four therapist behaviors that demonstrate sexual impropriety that can lead to sexual harassment or sexual assault.
A. Any immodest behavior, behavior that encourages immodesty in clients, draping loosely or not using a drape, using nicknames of a sexual or romantic nature with clients or allowing clients to use a nickname for the therapist, telling or allowing sexual jokes, requests for a date or accepting a request for a date, etc.
5. Define the term sexual abuse as it relates to a therapeutic relationship.
A. Because the therapist has a power advantage over a client, any sexual misconduct, whether or not the client consents, is considered sexual abuse.
6. List two possible outcomes of sexual abuse allegations by clients.
A. Jail time, payment of damages, loss of massage credentials and the ability to work, etc.
7. List three pieces of information you would find in an informed consent document.
A. (1) A written description of massage, its scope, its limits, its benefits, indications, contraindications, and risks. (2) A written description of the business policies of the clinic or massage business, including fee schedules, returned check policy, late arrival or no-show policy, policy on draping, and expectations of therapist and client conduct. (3) And a written description of the rights of the client, including the right to terminate the session at any time, confidentiality, and the limits of confidentiality.
8. Define the term referral.
A. When a therapist suggests that a client seek treatment from another massage therapist with more skills, or another health-care practitioner, for treatment outside the massage scope of practice.
10. Define the term boundaries.
A. Conscious and subconscious imaginary lines that mark the limits of an individual's personal space or territory.
11. Explain the meaning of personal space.
A. The physical, emotional, mental, and spiritual space people "hold" around themselves.
12. Give one example of when to use each of these types of boundaries: permeable, semipermeable, impermeable.
A. Use a permeable boundary with close friends and family, a semipermeable boundary with most clients, and an impermeable boundary with a client who is crossing therapist boundaries.
13. Describe these types of boundaries: physical, emotional, mental, spiritual, sexual.
A. Physical: boundaries we set around whom we share our bodies with (e.g., allow to hug us).
Emotional: boundaries we set around whom we share our feelings with.
Mental: boundaries we set around whom we share our thinking and ideas with.
Spiritual: boundaries around whom we share our ideas of grace, spirit, life after death, and other beliefs with.
Sexual: boundaries we set around whom we share our sexuality with.
14. Define the term boundary violation (or boundary crossing).
A. When one person disregards another's boundary.
15. Give one example of a way a therapist might cross each of these client boundaries: physical, emotional, mental, spiritual, sexual.
A. Physical: a therapist might cross a client's physical boundary by hugging the client without having enough history with the client to warrant that level of physical intimacy.
Emotional: a therapist might cross a client's emotional boundary by sharing a personal story and becoming emotional so that the client must now comfort the therapist.
Mental: a therapist crosses this boundary when they share political beliefs, opinions, and other ideas or thinking with the client—anything that causes the session to become therapist-focused and not client-focused.
Spiritual: when therapists share religious or spiritual beliefs with the client. A therapist might cross a client's spiritual boundary by sharing personal views of religion or by practicing energetic bodywork on the client without informed consent.
Sexual: a therapist violates a sexual boundary by joking in a sexual way with the client, complimenting the client on their looks and hair, or any form of sexual impropriety.
16. Explain one client behavior that might violate a therapist's boundary during a massage session.
A. The client calls the therapist by a nickname with a sexual connotation, "Honey," or asks the therapist on a date.
17. List two methods that help clients establish healthy boundaries during a massage session.
A. Ask the client for specific feedback. Ask the client which body areas he or they do not want massaged.
18. Recall three therapist behaviors that establish the boundaries of a therapeutic relationship during a massage session.
A. An informed consent process, wearing a uniform with a name tag, and verbally reviewing clinic policies with the client.
19. Explain the phrase dual relationship.
A. A situation in which more than one relationship with a client is present.
20. List one type of dual relationship that is prohibited in the massage profession.
A. A sexual relationship with a client is always prohibited.
21. Identify ways to obtain external guidance on issues related to therapeutic relationships.
A. Enlist the help of supervisors, confer with mentors, talk issues through with peer groups.
Sometimes, it’s not about the context of a conversation with a client but about how you ask the questions when speaking and listening to clients.
Don’t be envious of others’ success. Focus on creating your own.
Gossiping with or about clients is always unethical. But there are limited scenarios where it is legally OK to violate confidentiality.
When we use the term emotional release, we create an agenda where none should exist.
