For massage therapists: Issues of Dual Relationships

Overview of massage therapy in Australia

Massage therapy has developed as the largest complementary medicine modality, with reported usage by the 20% of Australians in 2014 (Wardle, Barnett & Adams 2015). Attributing modulators such as comfort, contact, connection and caring were identified as the base of its success in the New Zealand study (Smith, Sullivan & Baxter 2009), and are the bases for argument about the Relationships Marketing (Vos & Brennan 2009).  Massage therapy is also gradually integrated into the healthcare system (Wardle, Barnett & Adams).  In this context, practitioners’ knowledge and attitude towards ethical standards, in particular, on dual relationships (DR) are the increased interest for the policy makers, researchers, professional bodies and therapists alike.  Though high quality massage studies are scarce (Hymel 2006), studies on the culture of massage, in terms of client experience (Ekerholt & Bergland 2006; Smith, Sullivan & Baxter) and therapeutic value from therapist-client interaction (Blackburn & Price 2006) aided to interpret equivocal aspects of DR.  However little is known about how massage therapists manage DR in their practice.  Answering the question will have significance in improving the practice quality, developing critical thinking skills, and self-care including the   prevention of burn out, a common syndrome for a healthcare worker with helpful nature (Fronek et al. 2009).

Dual Relationships:  are they potential causes for therapist burn-out?

Dual relationships in massage therapy can be ambiguous and most challenging.  DR involves blending professional and non-professional relationships between therapist and client including familial, social, financial, business, or close personal relationships including sexual and non-sexual misconducts (ACA 1995, p. 3).  Multiple relationships, therapist-client relationships, boundary setting, professional boundaries, worker-client relationships are other commonly used terms in place of DR.  Inherent harm and serious consequences including legal action and adverse psychological effects in both client and therapist are known (Fronek et al.  2009;  Weir 2007;  Reamer 2003;  Walsh 2000;  McIntosh 2011).  A conflict of interest arising from DR appears to be the culprit for impairing objectivity, practice competence and contextual judgment.  In particular, massage therapists and / or clients may face increased vulnerabilities in mobile practice or more commercial settings such as spa or shopping center massage where practice guidelines may not be implemented as clearly as in medical or larger organizations.

(References are available on request)

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