Issue link: https://www.massageandbodyworkdigital.com/i/68178
QUESTIONS ABOUT PROFESSIONAL BOUNDARIES AND ETHICS? CONTACT NINA MCINTOSH AT WWW.EDUCATEDHEART.COM. This situation brings up the question of when we can make exceptions to the rules of confidentiality. THE EMERGENCY An elderly woman has been your client for several months. You've noticed lately that she seems more forgetful and confused. Although her daughter brings her to the sessions, you know the client lives alone. You are concerned for her safety; however, you don't want to ask the client for permission to talk with her daughter for fear it will upset her. The next time the daughter brings her mother in, you speak with her privately while her mother is getting ready for the session and tell her your concerns. Was it ethical for you to do so? Clearly, you were acting in what you think are the best interests of the client. But putting aside good intentions for the moment, this situation brings up the question of when we can make exceptions to the rules of confidentiality. Circumstances in which we can legally breach confidentiality— and, in fact, are often obligated to—are those in which there is clear and imminent danger to the client or others, there is suspicion of abuse or neglect of a child or incapacitated person, or there is a medical emergency. The question here is whether the danger to the client is imminent, that is, whether it's just about to happen. I would think we could make a good case for calling the danger here imminent, as you have noticed that the client's mental confusion is constantly compromising her safety, raising the fear that she could harm herself at any time. However, you would be taking a risk. Most likely, the daughter will be grateful for your good intentions. Your observations may be just the reinforcement the daughter needs to take steps to make her mother's life more secure. However, she could also be annoyed by what she views as butting in. Or she may, on the other hand, begin to see you as the authority in this situation and start to lean on you for advice about how to deal with her mother. Asking the client for permission to talk with her daughter about your concerns would also be a risk because she could say no. As is often the case with boundaries, the question of talking with the daughter without the mother's approval could have been avoided by laying the groundwork during the intake process. This dilemma is a good reminder to obtain written permission during every client's intake process to contact a specific relative or friend in case of emergency. (There should also be written permission to contact relevant physicians, counselors, and so forth.) Again, calling this situation an emergency may be stretching it a bit, but best to err on the side of the safety of the client. Although there is no specific emergency in this case, the increasing likelihood that one could occur without timely intervention on the mother's behalf qualifies this situation as one needing action. Having emergency numbers and names of close relatives can also keep you out of the position of taking on too much responsibility for an elderly or fragile client. Performing such tasks as taking a client to the doctor regularly or acting as a surrogate daughter or son can put you in the precarious position of taking on too much responsibility without legal authority. None of the specific situations discussed here would be likely to result in ethics charges against you. However, considering the delicate nature of our relationships with our clients, such stories remind us that we need to give careful thought to how best to honor our clients' privacy and confidentiality. years of experience as a bodyworker with her previous years as a psychiatric social worker. She is the author of The Educated Heart: Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers (Lippincott Williams & Wilkins, 2005). To learn more about professional boundaries and ethics, visit www. educatedheart.com. Nina McIntosh combines more than 20 To learn more about illustrator Mari Gayatri Stein, visit www.gypsydogpress.com. connect with your colleagues on massageprofessionals.com 119