ETHICS OF MASSAGE

Touch comes with a special set of ethics, also known as the code of ethics. This policy should include the predetermined practices of a therapist considering client care, consent, confidentiality, boundaries and relationships. By maintaining a healthy, clear code of ethics it can prevent breaching of boundaries, confusion and unease, keep your client base and in addition sustain an ethical practice by allowing a stable frame work upon which the practice is set.


Client Centred Care:
Adopting a client-centred approach requires the therapist to tune into the client’s needs. This aspect of the therapy profession is essential in establishing and maintaining your massage practice. It is all very well executing the best massage of your career, however if it did not take into account the clients best interests and goals then it was not as effective for the client. Recognize that the client’s concerns and preferences are valid and important. Combined qualities of integrity, respectful behaviour, communication skills and being motivated to provide good care consistently determines the therapist’s professionalism for themselves and the practice.

Boundaries:
Boundaries are, by definition, something that specifies a border or a limit. Part of a massage therapist’s job is to identify, respect and honour the client’s personal borders which include physical and emotional boundaries. Understanding them is imperative in creating an ethical practice and forming professional relationships. The way a client is draped and the edge of the towelling becomes a physical limit. The client is aware of this and can feel comfortable knowing that the strokes will not continue past this border. Another example is a female client who decides not to remove her bra for the session. The bra has become her boundary; she has said it not with words but with her actions. These boundaries must be honoured as lack of respect takes a therapist into dangerous territory. A minor boundary crossing may result in the client feeling confused and uncomfortable. A severe violation may result in feelings of neglect or even abuse. Religious and cultural backgrounds, gender, families and personal boundaries are considerations a therapist must take into account for the client and generate a sense of professionalism that can promote assurance and trust from the client. To avoid potential ethical dilemmas increase the empathetic awareness, consider how the client could interpret the touch and notice mistakes when they occur. By talking to the client it shows that the therapist is aware of and values the personal boundaries of the client (Benjamin & Sohnen-Moe, 2004).

Power Differentials:
For the duration of the massage a therapist positions themselves within the client's personal space, often leaning over the client who may be unrobed and in a prone position. There is evidently more authority held on one side of the relationship, while the other is a more submissive and exposed role. This vulnerability must be taken into account and it is the duty of the therapist to help balance this power differentiation. Establishing a policy early on in the session that minimizes this apparent imbalance will ensure the client’s comfort, reduce the feeling of intimidation and develop a sense of trust for the massage therapist. However it is still important to keep the differentials. It is the practitioner who controls the situation and decides how the massage will progress. Nonetheless the client’s goals must always still be considered. (Beck, 2006)

Informed Consent:
Receiving consent from the client is very important for many valid reasons. Care must be taken not to injure the client or make a symptom worse. It is the responsibility of the therapist to get a medical history to rule out any contraindication and to know how to protect their client from harm. This legal document is also a means of informing the client of exactly what is going to occur in the massage session and for them to agree and accept the proposed treatment plan. This procedure should always be reviewed with the client before the session begins (Beck, 2006)

Confidentiality:
The relationship between the client and therapist is built on a foundation of trust and safety. To uphold the integrity of your ethics, the client’s written or verbal personal details should never be repeated outside the massage session. A client has entrusted the therapist with private information and they have an expectation that it will remain confidential. Details of the session must be accurate and only related to massage (Beck 2006). The practitioner must keep all clients details in a secure place when not in use. There are exceptions; although the client’s permission must be obtained before another can look at their personal details for example when referring the client to another health practitioner. With most ethical decisions there is usually a “what if” dilemma, in this case what if a client who was unable report or protect themselves was being abused? Fritz (2009) states that it is the duty of the professional to report the abuse to the relevant agency and if unsure then seek legal advice as to how to proceed.

Scope of Practice:
A client that has sought you out does so in believing that you have been trained competently in your field. Massage therapy is beneficial in relieve many conditions and injuries; however it’s not a one-cure-all treatment (Scheumann, 2006). By knowing the limitations of your massage skills and knowledge base and practicing within these parameters you can define your scope of practice. Communicate truthfully to the client when expressing your qualifications and also goals and outcomes of a massage. If the client’s needs are greater than what the therapist has been trained for, or they would benefit from another type of treatment then no attempt should be made to work beyond the therapist’s competence. Instead decline the request and refer them onto an appropriately trained health practitioner (Beck, 2006).

Transference and Counter-Transference:
Transference involves positive or negative misconceptions the client may have toward the massage therapist. Signs of this include the patient attempting to cross the boundaries of a professional therapeutic relationship by asking personal questions of the therapist, invitations to social activities or becoming more demanding of the therapists time. It may happen at an unconscious level and transference often tends to reduce the effectiveness of the massage session and the therapeutic relationship (Beck, 2006).
Counter-transference is similar to transference however from the therapist’s view point. Feelings of disappointment or guilt if a client does not respond to treatment, thinking about excessively or having strong emotional feelings toward a client are some of the signs of counter-transference. These feelings may be detrimental to the massage as it will influence the work done with the client (Beck, 2006).
In both situations, care must be exercised to deal with the issues in a professional manner to separate the ethical from the unethical behaviour. Refer back to your healthy boundaries, skilled support peers and your code of ethics when in doubt. In certain circumstances the therapeutic relationship may require to be terminated and a referral for the client to another health professional may be the best option.



To maintain an ethical practice and uphold the trust in the whole profession, a therapist must not violate their own code of ethics. Respect and honour the client’s confidentiality, boundaries, power differentials and transference. Stay true to your scope of practice and always put client’s requirements foremost as these collective qualities are the cornerstones of a successful massage practice.



References:

Beck, M. F. (2006). Theory and Practice of Therapeutic Massage (4th ed.). New York, United States of America: Thomson The balanced body Delmar Learning.

Fritz, S. (2009). Mosby’s fundamentals of therapeutic massage (4th ed.). St. Louis, United States of America: Mosby.

Benjamin, B. E., & Sohnen-Moe, C. (2004). The Ethics of Touch. Retrieved July 15th, 2009, from http://books.google.co.nz/books?id=qLFqSh3xo7kC&printsec=frontcover&dq=ethics+of+touch

Scheumann, D. W. (2006).The Balanced Body. Retrieved July 15th, 2009, from http://books.google.co.nz/books?id=7TGouoYckFwC&printsec=frontcover&dq=the+balanced+body