Complete Your CE Test Online - Click Here inappropriate use of language. Maintaining appropriate boundaries is an essential part of compassionate, effective, and ethical massage therapy practice. Although practitioners and clients may be similarly affected by these psychological processes and equally capable of showing poor judgment or acting irrationally, licensed practitioners are bound by their professional affiliation to act responsibly, even when the client does not. Appropriate behaviors reinforce professional boundaries. Try to maintain the same structure and rules of conduct in each session, with each client. Examine the rationale and potential repercussions of any changes or exceptions you make for specific clients, even at their request, before you implement them. Bending a rule may not always endanger the therapeutic process, but impropriety can be a “slippery slope.” If you uncharacteristically deviate from normal session structure or protocol, suspect your impulses may be motivated by self-interest, or are having strong emotional responses to a client, seek peer support or supervision. Terminating a professional relationship If you feel it is appropriate, either because a specified, finite course of treatment with a client is concluding, or because you believe your relationship with the client has become dysfunctional, unproductive, or emotionally damaging, it may be necessary to terminate your professional relationship with the client. While this can be a difficult and uncomfortable task, it is important that it not be postponed out of a desire to avoid confrontation or discomfort. Terminating a potentially damaging relationship is an important professional obligation with specific responsibilities. Practitioners must be able to realistically assess their own limitations and/or their client’s potential for therapeutic benefits, and make a determination in their client’s best interests, without feelings of failure or guilt. They must develop a plan for termination that is considerate of the client, with attention to the possibility that it will be received with emotion or distress. Informed consent provides a framework for termination because it specifies the need for an ongoing discussion between the client and practitioner regarding the expected goals and anticipated time-line for therapeutic benefits. Involve your client in the process so he or she is aware of treatment objectives and can ask questions and make determinations about his or her progress toward them. Discuss obstacles to client progress as they come up, so your client is not surprised by an unexpected pronouncement or abrupt changes in your assessment of the client’s condition from one session to the next. Be sure to follow customary procedures for client assessment, and document relevant information about the client’s progress or lack of progress toward treatment goals. Before terminating the client, be sure to: ● ● Consult appropriate information resources and supervising personnel. Contact a professional colleague or supervisor about your situation with the client, post a question on a professional massage therapy website, or refer to professional organizations with which you are affiliated. You may be able to find an alternative to terminating the client, or a sensitive way to present the issue to him or her. If you appeal to any of these resources, be absolutely certain that you maintain strict rules of confidentiality and privacy, ensuring that the client’s name or other identifying information is never revealed. ● ● Do a reality check. Make sure you and the client are “on the same page” by comparing your understanding of a therapeutic relationship with theirs, and discussing disparities in the way you and the client perceive your relationship, including difficulties and desired objectives. This kind of clarification can help you determine the scope of the problem and whether it is the result of miscommunication or misinterpretation, something that can be remedied, or requires termination. If it is necessary to terminate the client, be sure it is done when you have sufficient time to discuss the subject fully. Take the time to respond to any questions the client may have, and give the client sufficient time to react to the news, respond to it, and regain composure. Do your best to leave the client with positive feelings about you and the practice of massage therapy. Provide referrals to other massage practitioners or health care professionals, as appropriate. Sexuality and massage Sexual misconduct, one of the most egregious examples of inappropriate behavior, refers to any sexual activity between the massage therapist and client. While women are less likely than men to be accused of sexual misconduct, they are not immune to such allegations. Some practitioners employ strategies of avoidance, ignoring the issue of sexuality entirely, either consciously or unconsciously, due to their own embarrassment or discomfort with the topic. While this approach may save you an awkward moment or two, an inability or refusal to address the subject when necessary (ignoring signs of sexual arousal, for example) may not only be inappropriate, but professionally irresponsible and a breach of ethical conduct. Strategies for client safety The emotional, financial, and legal consequences of professional misconduct for both the client and professional community are profound. Preventive policies should include an educational component explaining power dynamics in the therapeutic session, what constitutes appropriate and inappropriate conduct with individuals of the same and opposite genders, and strategies for speaking and acting in ways that delineate and reinforce appropriate boundaries. Ensuring your clients’ safety requires more than not being sexual toward them, or avoiding overt sexual behaviors with them. It means actively and consciously “desexualizing” the experience of massage; that is, making something with potential sexuality no longer sexual, or de-emphasizing that dimension. Desexualizing massage is a process of deconstructing the experience into its component parts, acknowledging human sexuality as a given, and accepting the practitioner and client as sexual beings. It’s natural for clients to feel some degree of anxiety or insecurity related to the process of disrobing and draping. Minimize anxiety or concern by stating and/or providing written information regarding disrobing. Before the client undresses, state that a draping procedure is required for purposes of modesty and physical comfort. Mention or have a written notice that explains draping; that it will cover all parts of the client’s body except the specific area receiving attention. Once you finish work in that area, you will recover it, and move to the next area. Tell clients to let you know if they have a question or concern, or are uncomfortable in any way. If you encounter a client who prefers not to be draped, explain that you are unable to proceed with the session until the client agrees to this customary procedure. Explain to clients what can and cannot be removed or left on without impeding your access to those parts of the body; reassure the client that it is not necessary to remove any more clothing than their personal comfort or modesty will allow. Request that clients do not begin undressing until you have left the room. Never allow the client to dress or undress in your presence. Inform your client before you begin what areas will be your focus and ask permission to proceed. Expose and work on only one area of the body at a time, and cover the exposed part before moving on to another area. Avoid ambiguity or the appearance of impropriety in your words and manner. Dress appropriately in a professional manner, avoiding any outfit that could be construed as revealing or provocative. Your demeanor should approximate that of other professional health care personnel. Use appropriate language; avoid cursing or indelicate comments. Use medical terminology when referring to physical conditions or parts of the body. Never discuss sexual topics with or in Massage.EliteCME.com Page 7