Monday, May 18, 2009

The Ethics of Professional Practice

The Ethics of Professional Practice

Fundamentals task4

What are ethics? My ethics are the rules or standards governing the conduct by which I live my life and make all my decisions as well as the rules or standards someone holds at their profession. A system of moral values that you hold and you try your hardest to stand by. In this essay I am going to discuss the ethics relevant to the professional practice of a massage therapist, discussing in more detail client centered care, informed consent, scope of practice, confidentiality, boundaries, therapeutic relationships, power differentials, transference and counter transference.

I’ve always been a strong believer of “do to others as you would have done to you”. So when it comes to client centered care, I always look back at this saying and think would I like to have this done to me.

Client Centered Care
Client centered care is when the massage therapist is focused on the client, provide the highest quality service as possible and their best interest as well as benefit the client. Accomplishing client goals by having a scope of practice, good code of ethics, standards of practice and also having educational requirements to be a massage therapist. The client needs to be fully aware of the terms of payment, scope of practice, your clinical procedure, recordings and intake forms and all the likely after effects of a massage. When a massage therapist has a good client centered approach to care, you will gain the clients trust and will make them feel safe and well attended too, and that’s when you will have clients coming back to you. They should also be shown respect, compassion and have clear, well informed communication between the client and the therapist. The therapist and the client work together to come up with a treatment plan for the client with their consent. When a therapist takes the focus off the client this is bad client centered care and should be kept away from as well as turning clients into friends or lovers, anything that is taking the focus off the client should be kept away from.

Informed consent
Getting informed consent from clients is a major thing in massage therapy as I have learnt very quickly. Making sure you have the clients consent before you get into the massage and double checking before you go to certain parts of the body. The client needs to be fully aware of what they are agreeing too and know what their rights are. Informed consents helps us as the massage therapist to know where they can and can’t go as some people don’t like certain parts of the body touched e.g. feet, head, gluteusmaximus…. Some religions are the same especially with heads. So getting informed consent covers the therapist and it makes the client feel reassured that the therapist isn’t going to go anywhere that they don’t want them to go, it goes back to client centered care, making the client feel as safe and secure as possible.

Scope of Practice
As a massage therapist our scope of practice is to offer reduced tension, pain and stress related conditions and aid in the rehabilitation of such things as injuries, strains and sprains. Anything other than this is not in a massage therapist’s scope of practice. We can refer onto people that can deal with different things but we can’t offer advice on things such as nutrition and/ or counseling. Massage therapists are asked to keep to the code of ethics set out by Massage New Zealand.

Confidentiality is a huge factor in massage, as everything that is said in the massage clinic/ session is to stay between the therapist and the client. All records and intake forms are to be kept in a locked cabinet, which can only be accessed by the therapist, the client or someone else that the client has given verbal consent too. Records can be asked for by a court of law so the information has to be legible and as accurate as known by the therapist. Only recording what the therapist is doing for the client, treatment wise and not putting down thoughts or feeling or any discussion that has happened throughout the session. Making sure the client knows about the rules that you hold with confidentiality and who can access their records, to make sure that the client feels secure and knows that anything they say is going to be kept between them and the therapist.

Boundaries are to be made between the client and the therapist and should not be breached unless it is in the client’s best interest and with the client’s consent at which they fully understand. Respecting client boundaries. Boundaries set limitations to the therapist to stop him/ her from getting into the clients personal space or making the client feel unsafe or on edge. Having boundaries makes it a safe environment for the client.

Power differentials
The therapist has a lot of power over the client as they have the knowledge. Where the client has very little knowledge, if any and may not fully understand and agree to things that they may not usually agree to and this is where the therapist should be fully explaining and asking questions on particular topics to make sure the client is fully aware of what is going on around them. The power differentials should not be used to the therapist’s advantage and should be fully talked about before the session to make sure the client feels as though they can say ‘no’.

Building beliefs, trusts and keeping the client happy and safe will help to build the therapeutic relationship. Being able to relax with the therapist. You should always keep your personal relationships, away from you work relationship and not bring them together. A professional relationship is built on open communication and the expectations of professionalism of the therapist. Being clean and tidy, having things ready and being as professional as expected.
Transference and counter-transference
When a client gets attached to their therapist it is called transference, this is when they start buying you gifts, wanting to socialize, becoming dependant on the therapist and doing things other than just coming to you for a massage. This is when the therapist needs to make sure that the boundaries are clear and known to the client and if things continue ether transferring the client to another therapist or making sure that there is regular supervision set in place.
Counter-transference is the needs of the therapist, where the therapist has attachments to clients, is wanting more than a therapeutic relationship, the feeling of not succeeding when the client and therapist didn’t get to what they wanted too. Dealing with counter-transference is to look at the needs of the therapist and think about their personal needs and think about how their client is related to these, as well as having regular supervision.

Salvo, S. (2007). Massage therapy - Principles and Practice (3rd edition). Missouri, USA: Saunders Elsevier.
Class Notes
Elluminate Thursday 14th May

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