Massage & Bodywork

March/April 2010

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ethics and etiquette BY TERRIE YARDLEY-NOHR MAINTAIN BOUNDARIES A frequent topic of conversation among massage therapists is the subject of boundaries and the many gray areas this word entails. Certain facets seem black and white, but there are areas that still prompt a variety of opinions. Massage therapists have unique challenges they must be aware of for the safety of the client and themselves alike. A boundary defines the difference between acceptable and unacceptable behavior. Most massage therapists believe they have a solid sense of their own boundaries and that it's crucial to have strong foundations. The challenges usually occur with clients they do not know or individuals who push their boundaries—knowingly or unknowingly. It is important to be aware of a client's concept of the boundaries in a variety of categories and how we can address related issues. When a boundary has been crossed, we may say someone has "crossed the line" or "gone too far." In many cases, a client crosses a boundary in a very innocent way. For example, a therapist may be working on a client's posterior neck when the client may ask the therapist if he or she could adjust the neck, anticipating the equivalent of a chiropractic adjustment. A client may not understand that this is beyond the scope of practice for a massage therapist. Simply educating the client can end that discussion. If the client knows that massage therapists aren't allowed to do neck adjustments and he or she still pushes to have this maneuver done, then he or she is crossing the line. Experienced therapists understand and know they will encounter challenges from time to time. They have learned ways to help clients better understand boundaries. New therapists may find it challenging to know and articulate what is acceptable and unacceptable in the field of massage. They know what they have learned in school, but that may not be sufficient for the challenges they encounter in the treatment room. Resources such as state laws, rules, regulations, or an association's code of ethics are good foundations for therapists. Confidence and a solid professional foundation go a long way when handling boundary issues. Most therapists know what behavior they expect from their clients, but how does a client know that the therapist has certain expectations when it comes to behavior on their table? We would like to think that common sense would prevail when it comes to boundaries, but it is many times the gray areas that turn into major issues. Most therapists cover topics such as draping, safe touch, and the type of work the client can expect before the session begins. Other therapists may distribute an orientation sheet to all new clients that gives a detailed description of what is expected, including a code of ethics, state rules and regulations, and the therapist's expectations for the sessions. It is important for each therapist to decide what information he or she feels is necessary to share and what feels like the best approach for each client. We ask a great deal of our clients. People you have never met before come to your office to receive massage. It is your responsibility to assure them that they can trust you. When we hear a story from a client about some of the unprofessional things she has experienced in the past, we shudder. It makes us angry to hear when a therapist has crossed the line and it hurts everyone in the profession. Clients come with a sense of what behavior feels safe to them, but that feeling can differ from the therapist's beliefs. It is important to explore the concerns a client may have. Is draping an issue? Communicating with a client and hearing the concerns he or she may unknowingly share is crucial. Helpful questions to ask clients during an intake interview include whether or not they've received a massage before and, if they have, what did they like best and like least about their previous sessions. For instance, if they mention they felt like they were not very well covered, you know draping is important to them. DIVISIONS OF BOUNDARIES There are five areas basic areas that a therapist should have a sense of when practicing massage. These are physical, social, emotional, sexual, and professional boundaries. PHYSICAL BOUNDARY This is the line a therapist or client must not cross. In some states, laws and regulations clearly define physical boundaries, but the bottom line is the boundary lies in a safe zone for both 104 massage & bodywork march/april 2010

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