Ethical considerations are covered under a code of ethics. These are standards that cover conduct of a person or member of a profession. Integrity of professions relies upon these.
Ethics are about the relationship between the massage therapist who is the professional and the client. They come into effect each time the therapist and client come together for massage therapy.
In massage therapy ethics cover the following:
As massage therapists we take responsibility for our clients comfort and safety and provide this by understanding their needs and rights. Legal requirements cover clients under the Privacy Act 1993, Consumer Guarantees Act 1993 and Health and Disability Consumers Act 1994.
The primary responsibility is for the health and safety of the client. Work must be carried out with due care and diligence (The health information network (n.d.).
We should serve the best interests of the client at all times, putting the client first and giving them the highest quality service. Focus on the best interests of the client and avoid any activity that takes the focus away. Therapeutic relationships with clear boundaries and good open communication will help to ensure that the client feels safe and attended too as we as build trust and respect. Involving the client in the decision making enables you to be aware of their goals and gain consent to the treatment discussed. This will ensure the massage is beneficial to the client.
Before any treatment takes place you need to obtain informed consent from the client. Your client needs to understand exactly what they are consenting too and what their rights are. Obtain feedback to reassure yourself that they understand. If working with a minor written consent from a parent may be appropriate.
You need to advise your client on the clinical procedure of your business such as the terms of payment - cash, cheque, eftpos, the cost of treatment, your scope of practise and your referral system to other professionals as well as the way in which you are going to proceed with the proposed treatment and the likely after effects of the treatment.
Scope of Practise
These are the parameters that you work within to provide massage treatment. It defines what services you can and cannot provide as a massage therapist (Salvo, 2007).
Training, experience, competency and qualifications will define your scope of practise. By understanding and working within your capabilities you are taking the safety of the client into account as well as feeling safe about what you are doing.
Client information is confidential. It is only to be used for the purpose it is provided. All information should be locked in a cabinet or if held on a computer accessibility is only with a password. Only record information about client treatment not the personal thoughts or feelings that are discussed. Records can be requested by a court of law so they need to be accurate and legible. Information is only released to a third party after receiving written consent from the client. Leaving messages on answer phones can be another breach of confidentiality. Who clears the messages?
As client trust increases they will open up and talk more about their thoughts and feelings. This stays between the therapist and client. When a client talks about their personal problems at one session then it should be the client that brings this up in future sessions not the therapist. Situations and emotions change and a client may regret what was discussed.
If you meet with a client socially ensure that confidentiality is respected. Eye contact and a smile will acknowledge the person but anything more should be initiated by the client.
“Professional boundaries create a healthy, professional distance between the client and the therapist. In fact the distance makes the therapeutic relationship a safe place for the client’s experience” (Salvo 2007, p 28).
Boundaries clarify roles, responsibility, expectations, and limitations as well as creating and preserving safety in relationships. Boundaries may be changed by use of effective communication to reduce misunderstandings.
The imbalance of power - i.e. the therapist is the professional and the client has a need, the client has come in for a treatment and the therapist has knowledge and skill to provide the treatment, the client lies down and the therapist stands over the client. These are not problems but would be if the power is misused by the therapist. In these situations the client cannot say no easily.
Situations should not be used to the advantage of the therapist such as when a client is in deep relaxation as the client may agree to something that they would not normally agree to.
These have to be therapeutic or personal but not both. Therapeutic relationships are unequal as a power differential has formed. Having both of these relationships with a client can make maintaining boundaries difficult also the therapist is responsible for any negative consequences of these relationships. Professional relationships need to be closed off before starting personal relationships.
Transference and Counter-transference
Transference occurs when client’s feelings for a person that was of importance in their life are transferred to the therapist. Warning signs can be that people may be dependent on you, they may give personal gifts, invitations to social events or have unrealistic expectations. To deal with this you need to maintain clear boundaries, have regular supervision and consider referral of clients to other therapists.
Counter-transference is when the therapist tries to meet their personal need through a client and can also occur when the therapist finds it hard to maintain boundaries. Warning signs are attachment to a client and the desire for more than a therapeutic relationship. To deal with this you need to know how your personal needs are related to your client’s relationship and undertake regular supervision.
To have a code of ethics is not enough. Therapists have to have their own ethics and morals to be able to uphold the professions code. These standards come from such things as our education, peer influences, life experiences as well as beliefs which have been embedded by our parents. They include such things as honesty, integrity, respect and loyalty. You need to have a caring attitude to be able to show understanding and empathy to the client as well as enjoying your job. This has to be genuine and cannot be taught, it needs to come from the heart of the therapist.
Salvo, S. (2007). Massage therapy - principles and practice (3rd ed). Missouri, USA: Saunders Elsevier.
The health information network (n.d.), A massage introduction, 5. Retrieved May 23, 2009. From http://www.nzhealth.net.nz/massage/ethics.shtml