Confusion. Ethics. All that jazz. (Part 2)
This is the second half of a two-part series on massage therapy ethics and why they confuse the crap out of me. Missed Part 1? Check it out here: Confusion. Ethics. All that jazz.
Confusion #2: Dual Relationships
From before I was born until he retired when I was around 20, my family had the same physician. Dr. White was as much a fixture in our lives as anybody else in town. We ran into him at the local Italian restaurant sometimes. He would chide my mother about her smoking, and talk distance running with my dad. Since my mother was an administrator at the local hospital, they knew each other professionally as well. Nobody ever thought it was weird that he’d seen her in her underwear. He was the doctor. He saw everybody that way.
What is wrong with this picture?
No, really. In a non-rhetorical way: what? Because I sure can’t find anything. Wasn’t Dr. White able to serve us BETTER as our physician because he saw us socially? Didn’t we trust him more because we knew his character as a human being and not just as another white coat with a prescription slip? This whole “if you ever have a thought that you actually LIKE your clients and might want to spend some time talking about something other than their trigger points, you need THERAPY to cure you of this nasty personal shortcoming” idea just doesn’t gel with me. I didn’t get into massage therapy so I could view my clients as bodies that spit out money when you work on them for an hour.
What is ethics for, anyway?
- Is it to cover our butts in case we aren’t virtuous enough as individuals? Or in case of a lawsuit?
- Is it to provide a one-size-fits-all plan for behavior?
- Is it to keep us neurotic about making a potential mistake that reflects on our character as a human being in addition to the quality of our practice?
I’d like to think that ethics is about helping us to think about the affects of our actions in a broader sense than might come naturally. If that’s the case, we need to do some serious reworking of the tools we’re using now.
Useful: Let’s brainstorm some of the possible repercussions (positive and negative) of socially-focused conversations with clients from the client’s perspective.
Unuseful: OMG countertransference is teh EVIL!!!!!!!1111
Okay, I’ve never actually heard anyone use “OMG” and “countertransference” in the same sentence together. But you get the idea. And if you’ve been in school for more than a WEEK you’ve probably encountered the attitude.
I’m still hashing this stuff out in my head, for now. I just wish ethics were something we could figure out together, rather than something to listen to in a state-mandated 8 hour workshop before you’re allowed to graduate. As it is, I’d rather go back and read Aristotle again and have good conversations about developing phronesis than sit through another “Grandma gave me cookies in exchange for a massage and I’m not licensed yet. Can I take them? Nope. Moving on …”
Any thoughts? Share in the confuzzlement!. (Or present your brilliant answer that causes everything to become completely lucid in the course of a single, elegantly-crafted sentence. I’m all in favor of those, if you’ve got one.)
6 Responses on Confusion. Ethics. All that jazz. (Part 2)
Yep, I hear ya. I, literally, have been in school for two weeks, and we’ve only briefly touched on the “Grandma gave me cookies for a massage and I’m not licensed yet” ethical dilemma. Our education director keeps bringing up the point that we’re not allowed to diagnose anything, and that we have to stay within our scope of practice (kind of like what you touched on in Part 1).
So, when I mentioned in a forum post that I could help others with their body mechanics, I paused and asked, “Is this something within my scope of practice?” Probably not. But am I going to get caught and then slapped by the Ethics & Professionalism Police for it?
We’ll be getting more into these dilemmas later in the year, I think. For now, I feel like I have to worry about toeing the line.
Unrelated: Hi! I found your blog through the bodyworkonline forums, and I love it!
– BethanyBob
I’ve been doing massage for 20 years now and I watched the no dual relationship theory develop, it wasn’t always around, at least not at the school I attended. It seemed that the massage profession was developing ethical boundaries and took some guidance from psychotherapists. I don’t really think there is the same kind of overlap, it may be wise for a therapist to not see clients socially, but massage therapy is different. Helping a client with a headache and then going to a movie together a few days later isn’t an ethical lapse as far as I’m concerned.
And for your part one, there’s nothing wrong with giving advice about areas you have knowledge in. I however notice that clients, friends and family members see me as having more expertise that I do and will ask me for advice and opinions that I am not remotely qualified to answer. But I do listen and then encourage them to see the appropriate person who can give them the help they need.
@BethanyBob. It’s a REAL shame if massage school is dis-encouraging students from even entertaining the possibility of ‘helping people with their body mechanics’ As a soft tissue worker, you do already! And to not offer common sense education to help people maintain that help would seem unethical to me! Diagnosis is not something that I’ve ever felt moved toward. That seems obviously medical. But to offer people intelligent reasoning around the causes of their plight…? There’s ‘scope of practice’ and then there’s being an intelligent, observational and willing-to-help-another-suffering-human kind of guy. No-one can regulate that.
The subject in hand… I have social relationships with a couple of my clients. As a therapist, I gave them a hard time for their postural shortcomings, and I’m sure nowadays that they sit further back into their chair when I walk into their house!
I don’t think that ethical training needs to be employed to tell us whether or not it’s OK to have social, non-sexual relationships with our clients. That’s just a matter of personal choice. These social relationships always carry consequences, and we just have to work out if we’re ready for those. Ethical instruction should certainly be offered to help bring into consciousness the level of intimacy between therapist and client. I mean, either you want that client as a mating partner or you don’t. If you don’t, then step back, if you do then step forward after the session and ask for a date. I’ve never dated any of my clients apart from one, who is now my wife. I’ve certainly fancied a few, but that I kept to myself. So, I did fancy them, but I didn’t want to mate with them so it wasn’t complicated.
As for the issue of over-treatment as a way of raking in more cash from vulnerable clients? If I’m a crook, I know that already. A few lectures on ethics isn’t going to change me. Learning through consequence helps both me and my clients to wake up a bit!
If we didn’t teach ethics, people would simply make choices and learn from consequences. It’d be a lot more simple and impact-ful!
@BethanyBob: Hi! Congrats on having started out your schooling! It’s a pretty exciting time. At about two weeks in we’d talked mostly about compensation, draping, and privacy (with relation to personal medical information). People on forums seem to run the gamut as far as their views of ethics go, but I can just about guarantee there’s always SOMEBODY who will think what you’re doing is a bad idea.
That’s the nature of the internet. If you’re prepared to justify yourself, I say go ahead and post.
@Jennifer:
I wonder why massage therapy has been so much more paranoid (proactive?) than other medical fields when it comes to the dual relationship thing. Maybe it’s a symptom of the struggle to overcome the whole prostitution stigma? It would be kind of interesting to look at how this attitude has developed over the years … and see where it’s going.
@Phil:
“If I’m a crook, I know that already. A few lectures on ethics isn’t going to change me. Learning through consequence helps both me and my clients to wake up a bit!”
Good point.
In theory, ethics trainings can help people to learn through OTHER people’s consequences and not have to live through quite so many firsthand, which is nice. And knowing the legalities at hand is important, even if ethics training won’t necessarily change the behavior of a loophole-seeking individual.
I think developing the habit of talking through our choices, either internally or with others, is something that definitely needs to be fostered in schools. (Heck, in elementary schools, not just massage therapy schools!) And I see a little bit of that happening. But if it remains the secondary consequence of ethics training, then it will also remain the secondary internal process (after wondering whether you’re about to get caught).
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