Features Research
Issue Of Ethics: Spring 2009

Grace’s Story must surely touch us with a resounding sadness. I believe that just like Grace, we too can and perhaps are asking ourselves why? Why did this have to happen? And, of course for the purposes of learning and growing as people and therapists what could have or should have been done differently? 

There is certainly no obvious or apparent answer to this question. Even the question itself appears to defy logic and common sense when we reflect on the situation. Here we have a woman clearly intelligent, articulate, sensitive, open and very receptive to massage therapy. Grace needs and wants massage therapy and sincerely believes that massage therapy can be of help to her. She seeks an appropriate practitioner, a licensed professional and trusting him to the point of self doubt “was it my fault?” encounters an experience that she, like anyone of us if the proverbial shoe was on the other foot, would be totally unprepared for. 

There is no doubt that what Grace experienced is unethical and inappropriate behaviour. We can literally count the breaches of ethics and professionalism in the story she recounts. Critical breaches that any licensed therapist knew or should have known constituted wrong and inappropriate behaviour on the part of a healthcare professional.

Informed Consent
First of all, Brian clearly fails to fulfill informed consent requirements. He has forgotten the most basic of basic rules, namely that consent is an ongoing dialogue between two people and as such he must check in continuously with the client and ensure that she is in fact providing her consent at all times.

Appropriate Patient Relations
Brian also knows that professional ethics requires that he abide by and work with appropriate patient relations skills. These too tell him that he must be checking in with the client and asking her clearly and repeatedly “how is the pressure for you” and of course listening to her responses or more tellingly her reaction. 

Brian should have known as a health care professional that he needed to listen to his client and that listening involves listening to both verbal and nonverbal cues. As most of us know body language is sometimes even more important and telling than verbal language. Grace tells us she cried and wiped her tears. Her body was clearly communicating to Brian in a very poignant and powerful way that she was not comfortable.

Patient Followup
We also know as healthcare professionals that we need to follow up with our clients, especially when a client makes it perfectly clear that follow up is necessary and highly desired. Grace had informed Brian that she had been hurt and harmed by the treatment he provided and is hoping that he will respond accordingly with genuine interest and concern for her. Following up isn’t an option in a situation such as this it’s a normal course of action and an expectation of a regulated health care professional.

Professional Accountability
Equally important is the fact that therapists need to take responsibility for their actions. The therapeutic relationship is clearly a power relationship and the person in the position of power, Brian the therapist, is the responsible and accountable agent. We can never blame our clients for our mistakes or failures.

In Grace’s case, Brian’s failure to listen and check in with her and to make sure that she truly is providing her informed consent to treatment.  Grace provides Brian with several opportunities to take responsibility and right the wrongs that occurred or at the very least, acknowledge that harm had been done and provide her with a sincere apology.

Instead Brian chooses to respond with insincerity and goes through the motions of doing the right thing, providing an apology in words but not intent because it is expected of him and not because he is sincerely contrite and ready to take responsibility for his actions.

We know this because the only thing Brian does hear is the word “violation” with its legalistic overtones and fears of consequences. He for the first time perhaps comes to realize that he may be held accountable by a third party for what he did and what he failed to do.

But, again, although he listens to Grace, he does not hear her. And Grace continues to try to communicate with Brian, still trying to reach Brian and have him care. But similarly to her earlier efforts this effort too fails and she knows this is the case when he fails to produce the draft of the article they are supposed to be writing together and in so doing proves to her again that he just doesn’t get it, that he isn’t really and truly sorry and that he hasn’t learned anything from this experience.

To Grace’s credit, she courageously decides to find some sort of healing and closure by choosing to do the right thing for others. In taking the time and energy to try and ensure this doesn’t happen to someone else by reporting this incident.

The right thing to do on her part though doesn’t change any of the wrong things that have been done or the harm that Grace has suffered by her therapist, who either forgot or choose to ignore two very important things.

1. Trust
The first, and most important of these, is that clients are vulnerable people. That our most important job as health care professionals at all times is to protect our client’s vulnerability. Whether reality or perception, Grace felt she was at Brian’s mercy. He was a professional, he was the one that knew what he was doing and she trusted him to know what appropriate and inappropriate pressure was. 

The key word here really is ‘trust.’ Grace trusted Brian because he was a licensed professional who she believed was there to serve and protect her best interests as a client. Trust is the reason why Grace allowed Brian to touch her in the first place and it is this trust that is wounded and possibly even lost.

2. Presence
The larger problem – and perhaps the heart of the matter – is that Brian didn’t ‘show up’ for the therapeutic relationship. Clearly his hands were present and his energy and sheer physical strength but he forgot to bring the rest of him to this experience and tried to treat a body instead of a person. 

People are not just their bodies and the success of the therapeutic relationship depends on the focused intent and presence of the practitioner. As we all know, knowledge and skill can only take us so far. The true vehicle or medium that supports healing is presence and a caring and integral intent. We need to be caring and present in order to heal people, instead of bodies.

To accomplish this goal we need to be able to listen.  Listen to what our clients say and even more importantly to what they don’t say. To what they need and to who they are. We need to be able to take responsibility for our actions whether these are mistakes or omissions. Our clients need to know and feel that we care and are sincere and that we will do everything in our power to protect their vulnerability. And, we need to remember that as massage therapists we are both health care providers and recipients of health care and that in protecting the vulnerability of our clients we are in fact protecting the most valuable asset we all possess, our common and shared human vulnerability.