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N e w ! A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 63 Breaches in the Therapeutic Container We miss the mark when we breach our client's trust. This could be by not respecting their physical and emotional boundaries; by projecting our ideas of who they are or what they should be doing; by exploiting the unearned intimacy that is part and parcel of our work; by not being clear with our business policies; by not making appropriate referrals when the client would benefit from work that is outside our scope of practice; and by exhibiting prejudice or bigotry. Sexual misconduct is an extreme example of a breach in the therapeutic container and may lead to an insurance claim or legal action. Mostly, these breaches don't cause much of a stir. They are the types of failures that quietly make us untrustworthy. Therapists who gossip about their clients or talk about the content of their sessions are breaching the therapeutic container. We also miss the mark when we are inconsiderate of clients' time by running over or being prone to rescheduling at the last minute. Other examples are promoting our religious or political beliefs, minimizing client concerns, and giving advice. These types of failure (that quietly make us untrustworthy) cause clients to stop seeing us even when our hands-on work is excellent. They keep clients from recommending us to their friends and loved ones. They cause skilled therapists to have trouble filling their schedules, and many of these breaches aren't adequately addressed—or even mentioned—in our therapeutic trainings. This is why Kate Mackinnon and I spent a chapter exploring these types of issues in our book, Elements of a Successful Therapeutic Business (BookBaby, 2019). So, What Is to Be Done? We each have a personal responsibility to face our failures, to make amends where we can, and to make every effort not to make the same mistakes again. I have confidence that with humility and mindfulness we can all address the ways we miss the mark. The first step, of course, is to recognize and accept that every single one of us can and does cause a range of harms. We each will benefit from having an honest reckoning with ourselves, and also by asking those we trust where our blind spots are. Once we have some clarity about where and when we tend to miss the mark, it's time to take action to help ensure that we don't continue. We can improve our manual therapy skills with added training. We can take steps to make our equipment and space safe and welcoming. We can take ethics trainings and get supervision to review our cases. We can train ourselves to understand and address our implicit biases, the ways we judge people without even being aware of it. 4 I'd like to see us all strive to adopt a more humble and curious approach in our session work. For instance, if a client flinches, you can take the opportunity to check in right then and there: "I noticed you just tensed up. What happened?" Perhaps there's a way you can improve what you're doing, and you won't know without partnering with your client. Perhaps this is an opportunity for your client to really feel into their body and understand their response. 5 If we pretend not to notice a flinch, that's a breach. We then are training our clients that discomfort is a part of the process, and they should just take it. This can lead to clients losing connection to their felt sense. It's important we all learn to recognize the difference between someone being deeply relaxed on our tables and someone who has checked out and is no longer present in their body. Someone who isn't present with what's

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