Ethics: Professional Boundaries

• Identify ways for health professionals to create a safe and consistent therapeutic environment.
• Minimize problems related to client transference.
• Recognize "red flags" that can often indicate an ethical decision point.
• Identify ways you can help yourself feel good about receiving money.
• Define transference, countertransference, confidentiality, and dual relationship.
• Address ethical issues and challenges presented by the Internet and social media.

"One sign that clients have promoted us to an elevated status is that they rarely express their unhappiness with something we're doing, and they often agree to something they don't really want to do. They may tell us, for instance, that they are fine lying in a position that is actually making their neck hurt. They often don't speak up when we make them uncomfortable, such as when we've set the room temperature too hot, we're talking too much, or even when they think we've crossed sexual boundaries. If we make them too uncomfortable, they simply don't come back, sometimes without being conscious of the reason. Or they might remain as clients but become what we call "difficult" clients.

The sense of powerlessness that usually goes with being a client is especially noticeable when the client is also a peer. I hear many stories from even seasoned practitioners who have had trouble speaking up when getting work on themselves. You would think that, as professionals, we would have no trouble asserting ourselves, but because of the power of the transference, because of what happens when we are on the table, we may be as speechless as anyone else. If we feel powerless to question our colleagues, how must our clients feel?" (The Educated Heart: Professional Boundaries for Massage Therapists and Bodyworkers by Laura Allen, 2017, p. 76-77)

Which of the following is an example of transference?

1. A client easily expresses unhappiness with something the practitioner is doing
2. A client is assertive about their readiness to release pain
3. A client agrees to something they don't really want to do
4. A client speaks up when the room temperature is too hot