Tuesday, May 19, 2009

The Ethics of Professional Practice

The Ethical considerations that are relevant to professional practice as a massage therapist include

Client-Centred Care
As Hippocrates said “To help, or at least do no harm” (David McQuillian, Elluminate, 2009) As a therapist we need to make sure the clients best interests are foremost at all times. We need to make sure we respect who they are, treat them with compassion and involve them in all aspects of the treatment so that they have a clear understanding of what is happening, make sure they know that their goals are being meet and that we both have a clear understanding about boundaries and how to communicate to each other about all aspects of treatment.

Informed consent
As a massage therapist we must always obtain informed consent from our clients. This starts at the first contact we have with the client, where they need to be aware of costs, services that are provided, our intake procedure and any referral services (if necessary). During the intake procedure they need to be informed about clinical procedures, our record taking, likely after effects of massage, therapist qualifications, benefits & contraindications of massage, are they comfortable with areas on the body to massaged e.g. feet, glutes, head etc. Throughout the treatment the use of the pressure is a verbal form of consent that makes sure they are in a comfortable condition.

Scope of Practice
As therapists we need to inform our clients of our scope of practice. We need to inform them of our training, experience in the industry, qualifications and competency. If the client asks for something that is outside our scope of practice, we should refer them onto the appropriate qualified professional than can help them. It is not ethical to work outside of our Scope of Practice as we could end up doing more harm than good.

Clients need to know that the relationship that forms between us will be kept in strictest confidence. They need to feel confident that access to their records is only by rights of other healthcare professionals or via written consent from them. Clients also need to feel secure in the knowledge that any discussions between client and therapist are confidential (with some exceptions). As a health care professional we must not recognise a client in public unless they greet us first. Some clients might not wish others to know they are using our services.

It is important to outline boundaries right from the start. Boundaries include personal space, emotional distance, terms of service and our personal autonomy in a given situation. We need to use these boundaries to clarify our roles, responsibilities, expectations, limitations, and create and preserve safety in relationships. Boundaries are negotiated and maintained through good communication

Power Differentials
As a therapist we have to be very aware of the “power” we have over our clients. This is not only when advising treatment, but while treatment is being received. Our clients believe in us because we are trained, and thus they look at us as teachers. They can take everything we say as gospel and this is where we have to be careful not to be too suggestive. Also when the client is on the table, we have to be careful not to stand over the client as they are vulnerable, and during the treatment, the client maybe so relaxed that anything we suggest will be agreed with as they may not be fully aware of what is being asked. We must maintain a professional persona at all times and never misguide our clients.

As a therapist we have to be aware that we either have a therapeutic or personal relationship with someone, but not both as it typically does not work. It is very hard to maintain boundaries and keep professional if you are involved with someone as their therapist and partner. If a personal relationship does arise, you need to close off the therapeutic relationship first as to not cross any boundaries.

Transference and Counter-transference
These work both ways, either the clients form an attachment for the therapist or vice versa. Several signs include becoming dependant on one another, invitations to personal events, personal gifts etc. One of the signs of Transference of a client is their unrealistic expectations of the therapist and their dependence on them. On the other hand when the therapist forms the counter-transference they have a need to fix people. We have to make sure we set clear boundaries for both the client and therapist, and if these signs start becoming more frequent, we should seek regular supervision when the client is present. At its worst we should consider referring the client to someone else

Class Notes
David McQuillian, Elluminate, 2009

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