Article by Natalie Millan
Abstract
After a brief discussion of the task of a therapist, and what involves general public expectation, a professional framework is identified. This paper addresses how risk-management is relevant to the massage therapist within their clinical practice. An at-risk example within the daily work of the therapist is examined and leads to discussion centered on the client/therapist paradigm. It discusses boundary violation and the concept of boundaries relating to behaviour.
The author demonstrates how an ethical frame of reference is the key to assessing risks. The purpose of the paper is to show how the integrity of a massage therapist and their industry cannot afford to ignore risk-management education. The overall goal is to introduce concepts to help therapists work from a professional base as they move forward in a growing industry.
Massage therapy
Diana, an Indian woman aged thirty-five, is a marketing consultant and had been involved in a motor vehicle accident. She chose to visit a massage therapist for assistance with her lower back. The disabling pain had put a distressing halt to her dynamic life, including avid gym training and running.
Diana had spent eight months enduring consistent physiotherapy and slowly rebuilt her exercise lifestyle. She appreciated the first three appointments of remedial massage that helped her maintain her gains. Diana wanted to measure those gains out on her old running track that coming spring!
At the fourth appointment, the therapist briefly discussed how massage is turning into a maintenance treatment, which will use a broader approach. Diana understood this to mean the strokes would not be so painful. At one stage the therapist stopped massage, simply placing hands on Diana’s lower back; making her question what the therapist was doing. When the therapist explained that Reiki would help her, Diana requested ‘No Reiki – just massage’ to be performed so the therapist moved on to broader strokes. More on this later.
Boundaries and space
All therapists who treat human health must maintain boundaries. The massage therapist will be considered the professional in the public eye, as they are the client. It does not matter how interpersonal the role.
Boundaries are imperative when working within the intimate space of a client. Risk-management increases when a client’s private space, (physical, emotional and spiritual energies) have been entered into. The sacred space of human energy is to be treated with the utmost of care and respect as the therapist assists their healing process.
This very outlook is also the therapist’s ally if a client disrespects therapist space and the service they deliver through it. Trust and rapport are imperative for the client. Diligence and astuteness are imperative for the professional, equally for their personal safety.
So why didn’t Diana book a fifth appointment with the massage therapist?
At that fourth session, Diana drifted into a relaxed state; the therapist once again slowed down the massage component and simply rested hands on Diana’s shoulders. This ‘resting’ broke the continuity of rhythmic touch and Diana’s drift. In asking why this was being done, the therapist assured Diana that Reiki is what will help her. Rather than being professionally informed of this incorporated modality, Diana learnt of it haphazardly. First mistake.
When Diana did inadvertently learn of it, she specifically stated she didn’t want Reiki to be performed, because she had booked remedial massage. The therapist minimised this clear request. Second mistake.
To intrude on anyone’s personal space without permission and especially disregarding a client’s request, is rude and violating. Personal space includes spiritual energy to be the most sacred of all the energies. Diana lost complete trust in this therapist, hence no further bookings. Diana made no recommendations despite her opportunity to do so. Harsh?
Discussion
Importantly, the issue?was not Reiki as a modality. Many health workers, to include the author, are advocates for and are the recipients of energy based complementary therapies and their therapeutic benefits4.
It is held in high esteem that improving health and caring for others are a therapist’s underlying values. These values drive professionals to assist their clients quality of living. Having the opportunity to assist a client reach a strengthened pain free goal gives any professional in health their career satisfaction. The issue at hand is the intrusion on a client’s personal space without informed consent or permission.
Therefore the above example shows simple mistakes that demonstrate a therapist’s enthusiasm for her craft but lack of professionalism and respect for simple ethics. It is such acts of omission that open the door for boundaries to become clouded. The risk of stretching the boundary of consented modalities was loss of client and loss of recommendation. If the therapist in question plans to maintain a strong rapport and good reputation they must work from a professional based skill-set.
Risk-management
The aim of the previous example was to demonstrate how direct communication is part of a therapist’s professional framework that protects the client’s energy and their own. Extensive research is continually being updated surrounding risks in business, professional practice, public expectation and personal safety1.
This paper identifies one aspect of risk-management surrounding massage therapists to involve boundary recognition. The need for boundaries is not simply to align to governing ethical requirements; it is to reduce a therapist’s potential for at-risk situations.
Like ethics, the term boundary is still too broad when identifying therapist risk. Boundaries can range from a macro and basic practice-management to the micro interpersonal disciplines surrounding over-identifying with a client, personal and professional integrity. With risk-management therapists can further define and discuss boundaries using risk-context.
Risk-context
The discussed example showed the key problem related to risk-context was the therapist being too enthusiastic to use a technique she associated with. In any given treatment, if this keenness occurs (more than once in Diana’s case); the therapist is not working from an ethical frame of reference, that shouts the principle of competency. Likely, the therapist is working out of eagerness and personal opinion or influence. Enthusiasm can have a downside, that being; it can ignore the use of a client-centered care approach.
Simply stated, risk-context means that you don’t take up every opportunity that presents itself to you just because you can. For the professional working from an ethical frame of reference, it is a given when decision-making to ask yourself ‘what are the risks?’
Let’s put risk-context another way
If a therapist has just completed a post-graduate in a specific technique, chances are they will use that technique at every opportunity. Here we join risk-context with ethics by addressing behaviour. A blind-spot can occur for the therapist when they do not assess the risks and the appropriateness of using their professional skills. If boundaries are ignored, it is considered an unethical behaviour. The professional is to be mindful that risks lead to consequences that lead to negligence.
If blind-spots are occurring in a clinical practice, they show how the involved therapist has found that although reading about principles in ethics is simple, the difficulty lies in their application. Realistically speaking, most therapists in private practice are on their own when dealing with their risks. However, the constructs of isolation, competition, multicultural society, cultural and technical diversity give reasons for massage therapists to work with the commonality of a professional ethical framework6.
The practice of effective risk-management is not a professional instinct; it is a learnt skill that involves respect toward professional power. Even when competency in technical skill is evident, competency in client-based care involves discipline when administering this professional power. Addressing risk-context shows the therapist how the professional weights their personal enthusiasm toward modalities, techniques and opinions with professional appropriateness2.7.
Until now ethics has been stereotyped as boring and authorative, seen to only serve the governing body and/or legal business requirements. Therapist disinterest in ethics is potentially due to the lack of education on how ethics can benefit them. Notably the ability to educate correct and useful strains of ethics has also contributed to therapist complacency, which has been found throughout the helping professions3.
Currently, massage therapists are intuiting a greater need for sound education in ethics, to assist their growing practices and risk-management strategies.
General public expectation
One explanation for the growth of the massage therapist’s practice is their ability to work within complementary therapy and conventional medicine. Many forums have been structured to discuss how to integrate the two disciplines which many massage therapists have attended. Recently one municipality held a forum for the public. It was run by a business networking group. Their forum was on conventional versus complementary treatment and public opinion.
The outcome observed was a strong demand for trusted therapists to be available from local doctors. Albeit one networking group, it typified public expectations strongly calling for well-being integration with an emphasis on whom they can trust.
It showed how the general public hold greater reliance on complementary therapies and use trusted recommendations. This forum also brought to light that currently, the key modality conventional medicine will refer to is massage therapy, making therapists (with a sound and trusted reputation) the high contender for referral from General practitioners.
The downside to increased public demand is generally, therapists do not know how to address the difficult at-risk situations that may occur in their practice5. Yet with greater public expectations on massage therapists, there is greater risk for therapist burnout. This reinforces how an ethical therapist must seek out education that shows how to reduce burnout by monitoring major and minor risks. Such strategies will show that the key to risk-management is regular clinical appraisal and self-reflection.
Looking toward the future
Massage therapists are seeing the results of public education with increased clientele. The public have become educated in personal health and are more scrutinizing in the therapists they will trust. Our younger generations are being taught about well-being within their educational systems, potentially increasing the demand on complementary therapies further.
With the generations to come, both public and professional, the therapist who survives will have built a trusted reputation. They will have overcome a stereotypical mind-set towards ethics3. The modern massage therapist will embrace a professional and ethical framework that shows veracity and integrity toward their profession, toward other professionals, to the public and importantly toward themselves.
To conclude
As therapists we all are vehicles to assist clients in regaining their health, well-being and quality of life. Modality and specialty practised by the therapist notwithstanding. The commonality lies in capturing an opportunity to care for another person and to support them. Such an opportunity is a privilege and a responsibility all professionals providing a health service are to take very seriously. This same seriousness applies when intimately working with clients. Your professional base stems from a solid ethical frame of reference that reduces at-risk concerns, regardless of public expectations and client types. n
References:
- Australian and New Zealand Risk Management Key Steps. www.riskmanagement.com.au sighted 20/6/2008.
- Brody, H. (1992). The healers power. New Haven. Yale University Press.
- Corey, G., Schneider-Corey, M. and Callanan, P. (2007). Issues and Ethics in the helping Professions. 7th ed. Belmont, C.A. Thomson Brooks/Cole.
- Crellin, J., and Ania F. (2002). Professionalism and Ethics in Complementary and Alternative Medicine. Binghamton, NY. The Haworth Integrative Healing Press, an imprint of The Haworth Press, Inc.
- Egan, G. (2002). The Skilled Helper. A problem-management and opportunity-development approach to helping. 7th ed. Brooks/Cole.
- McBride, N., and Tunnelcliffe, M. (2002). Risky Practices. A Counsellor’s guide to risk management in private practice. Palmyra. W.A. Bayside Books.
- Peterson, M.R. (1992). The Professional’s struggle with power. At Personal Risk. New York. W.W. Norton and Company. pp50-71.
Natalie Millan is an advocate for healthy esteem and is the author of Professional Esteem a practical guide to ethics and risk-management; the new series release for 2008. Her second book Professional Esteem – ethical energy is currently in print. Natalie is an educator in communications and ethics and has 20 years experience as a massage therapist. She volunteers her services for the committee of the A.A.M.T and is currently developing workshops for therapists on risk-management. View Natalie’s profile at www.healthyesteem.com.au.