THE ETHICS OF PROFESSIONAL PRACTICE

Massage is a client focussed therapy and as such a massage therapist needs to 'acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudical manner with clients' (Massage NZ Code of Ethics, nd). There are many ethical considerations when dealing with clients as discussed below. Following these guidelines will help to build a trust relationship with clients and will benefit both them and the practitioner's reputation and practice.

Client centered care
The massage therapist needs to always have the client's best interest at heart. Rapport has to be established with the client at the very first meeting. This is the start of a trust relationship where the focus is on meeting the client's needs. The therapist needs to gain essential information from the client in order to ascertain whether the client's needs can be met and/or if the expectations of the client are realistic. Before formulating a treatment plan, the client's beliefs have to be taken into account, e.g. the client may not be comfortable with some areas of the body being worked on or may have cultural and/or religious beliefs that need to be considered. It is also important to gain information on the client's health to ascertain that there are no contraidications for massage. The ultimate goal of the therapist needs always to be to give the client the best value for their time and money and to do them no harm.

If the client experience an emotional release during the treatment, it has to be handled with empathy and compassion without going beyond the ethical boundaries. The “otherness' of the client always needs to be respected, especially if the client is not of the same culture or gender as the therapist. Having an open mind will help the therapist to remain sensitive to the client's needs.

Informed consent
Before starting a massage, the therapist has to explain the proposed treatment plan to the client and give the client enough time to ask questions. Once the client understands and agrees to what the session is going to entail, informed consent needs to be obtained before proceeding with the massage. According to Salvo (2007), this will demonstrate 'client participation in the therapeutic relationship.'

Scope of Practice
The massage therapist needs to be very clear about her/his own qualifications, training and experience and always work within his/her 'scope of practice'. Salvo (2007) defines the term scope of practice as “the profession's working parameters” which sets 'professional boundaries and limitations.” A relaxation massage therapist, can not offer therapeutic massage to a client or prescribe any medications, as this would be outside their scope of practice. If a client's treatment needs are outside the therapist's scope of practice, the client needs to be referred to another health professional.

Confidentiality
Confidentiality needs to be maintained at all times. The client's details cannot be discussed with any other person without prior consent by the client or unless required by law. Client files need to be kept in a locked cabinet and not left lying around where anyone else can see it.

Boundaries
The massage therapist has to maintain a professional relationship with the client at all times, e..g by conduct, dress and the treatment offered. The client's personal space and privacy has to be considered by maintaining adequate draping and not making any personal comments about their bodies. This helps to keep client/ therapist roles clear so that the client will feel safe and therapist and have confidence in them. It is imperative for a massage therapist to be self-aware and to think clearly at all times. This includes not using drugs, alcohol or other substances that impairs the normal thinking and judgement process (Salvo, 2007).

Power Differentials
The massage therapist needs to be conscious of the client's vulnerability and possible feelings of not being 'in control' as they lie on the massage table. There is a power difference in the fact that the therapist has the specialist knowledge and is giving the treatment, but the client needs to be able to decide what they wish the treatment to achieve. It is essential to build rapport with the client from the start so that they will trust that you will not abuse your power but will give them the best possible treatment.

Relationships
The therapist needs to maintain a professional relationship with the client, irrespective of whether the client is a friend or family. A counsellor can advise the massage therapist on strategies that will help to maintain professional boundaries with clients that are related or a friend. Small talk should ideally be kept to a minimum and, while in the session, the therapist needs to keep the conversation on the reason for the consultation.

If a therapist should want become involved in an intimate relationship with a client, the client needs to be referred to another therapist as this would be a violation of professional boundaries.

Transference and Counter-transference
A client may become emotionally attached to the therapist and may start calling the therapist just to talk to them, sgive them gifts, stay longer after a treatment to talk or even making suggestions of social contact and a romantic relationship. This is called transference. The therapist needs to discuss such issues with a counsellor or mentor and then make an appropriate decision to either refer the client on to another therapist or set clear boundaries with the client.

It could also happen that the therapist develops an attachment to a client due to the personal needs of the therapist, e.g. for acceptance or friendship. This could give rise to the therapist giving the client longer sessions and wanting to spend more time, with them, which could develop in an unhealthy client/therapist balance. The therapist could want positive feedback from the client to boost their selfesteem. This can make the client feel obliged to be positive about the outcome of each session. This is a breach of ethical practice and the therapist needs to seek professional guidance if they become aware of this happening.

Conclusion and Reflection
It is imperative that a massage therapist maintains an ethical approach to his/her profession and adhere to standards and boundaries as set in their Code of Practice. Confidentiality and respect for clients' rights need to be an integral part of their treatment plans, whilst keeping within their scope of practice. This will ensure a healthy and balanced relationship with clients and contribute to developing and maintaining an exciting career.

I have become aware of both strengths and weaknesses with regard to ethical considerations in my practice. I have found it relatively easy to treat friends and family without crossing the professional boundaries, by creating a professional environment and keeping to the purpose of the visit. I am aware of the need of confidentiality and also how essential it is that the client can trust me with their details.

What I need to watch out for, is not to overstep my scope of practice and be tempted to do therapeutic massage before I have the knowledge and qualifications to do so. I also find that with my friends (not with other clients) that I do not watch the time closely and tend to give them more time. I need to set the boundaries clearly in this regard. I also feel that I need to concentrate more on the client's goals for the session and then to check that they are happy with the outcomes. I can also improve on my client record keeping by recording more detailed information on the treatment plan and goals set.

I would like to adhere to ethical standards in my practice as I realise it would help ensure that I meet the needs of my clients and enjoy my work.

Reference List
Salvo, S. (2007) Massage therapy: principles and practice (3rd Ed). Saunders: Mosby.

Massage New Zealand Code of Ethics. Retrieve on 13/08/09 from http://massagenewzealand.org.nz/about-us/code-of-ethics/

Notes from Elluminate lecture Felicity Molloy. 6/7/09