Features Practice Technique
An Issue of Ethics: Winter 2003

When a registered massage therapist and a patient come together in the context of a therapeutic service, the therapist and patient enter into a therapeutic relationship. What distinguishes the therapeutic relationship from other relationships the therapist may be involved in is the very special purpose and goal of the therapeutic relationship.

The purpose and goal of the therapeutic relationship is to serve the needs and best interests of our patients. Patients are not usually experts in massage therapy; they do not possess the knowledge, clinical skill or ability to treat themselves.

Moreover, and more importantly our patients are often vulnerable people. That is to say persons who by virtue of their pain, discomfort, infirmity, disability, age (especially children and elderly persons) or other relevant and associated psycho-social factors are rendered vulnerable.

As health care professionals, we must ensure that the therapeutic relationship respects and honours our patients’ vulnerability and fulfills their healthcare needs.

How can we do this? We make ourselves available to treat our patients by ensuring that our relationships with our patients are indeed therapeutic relationships, relationships whose primary goal and function is to facilitate the health and well being of our patients.

This can be very difficult to do. Despite our best intentions and good will, at times what we bring to the therapeutic relationship is often less than a clear and concentrated focus on the patient’s needs or simply a conscious presence.
It is critical for massage therapists as health care professionals to look at what they bring to the therapeutic relationship. Therapeutic progress can be blocked when therapists use their clients, perhaps unconsciously, to fulfill their own needs. That is a need to be a caretaker to others, to shore up weak self esteem and feel capable and powerful.

For many of us, all too comfortable with care-taking roles as elder siblings, mothers or mentors, the therapeutic experience can become one more place to take our familiar life role and play it out day after day.

The caretaker role can be a very tempting departure from the true purpose of the therapeutic relationship. After all, many of us will have received our validation, recognition and acceptance by caretaking and certainly many of our clients will find us immensely appealing as caretakers. Most of us enjoy the experience of being taken care of.

Finding mother in the therapeutic setting for some individuals may be more powerful than the clinical experience itself. At some deep level, we all want to be taken care of. We all want to drop our vulnerability, worries and concerns in the hands of a responsible loving other who will hold us in a place of love and kindness in much the same way we wish our parents had. The therapeutic relationship can also suffer when therapists have a strong need for approval and acceptance; when he or she feels the need to win the acceptance, admiration and respect of the client.

For some of us, lingering unresolved low self-esteem may find us desperately seeking confirmation and affirmation from our clients. If the therapist is unaware of his or her needs, he or she can depart from the purpose of the therapeutic relationship and in effect, abuse his or her power within the therapeutic experience. An awareness that we have needs, and that they may show up in the therapeutic experience, is instrumental in helping us centre ourselves, clear our intentionality and focus on working on the client’s needs and best interests instead of our own.

As human beings, therapists have needs and these needs, too, must be met to bring each one of us to the fullness of our lives and being.

However, this work does not belong in the therapeutic relationship, and should not get in the way of the goal, which is to meet the needs of the client.

Being aware of our needs helps us to centre our presence in the therapeutic relationship by recognizing what does and does not belong in this experience and clearing the way to be there, all there, for the client. Healing is facilitated when the therapist brings his or her full, clear intentionality and good will to the therapeutic experience.

A client will sense almost intuitively when we are there for us instead of them. They test the tepid waters of healing, week after week, to find out where we are and why we are there in order to determine if it is safe for them to come forward, and entrust us with their vulnerability. There is an interesting story I would like to share with you, here.

A therapist conveyed to me once that she was treating a woman for a soft tissue injury who suffered from a schizophrenic mental condition. One day, in order to take a vacation, she turned this patient over to her locum replacement who was a young woman who did not feel comfortable working with people with mental health conditions and consequently could not bring her sincere intentionality to the therapeutic experience.

The patient, upon her therapist’s return to the office, expressed her dissatisfaction with the treatment the other therapist provided, stating to her that the “treatment did not work.” Her locum replacement was a highly skilled clinician. She possessed the knowledge and skill to do the job, but she did not and could not bring her full being to this experience, and the patient, recognizing this, was unavailable to be healed.

As a therapist, it is a good idea to develop a reflective awareness of our intentionality and our presence. We need to constantly ask ourselves, “Am I here today? Am I here for the client? If not, how can I refocus my intentionality and return to the therapeutic intent?” Again, as human beings in the therapeutic experience, we will err, breach boundaries, and be less than what we want to be for our clients and ourselves.

When this happens, we need to be able to move into a reflective place and compassionately assess what
happened and why. How can we do it differently next time?

These are the times when ex-teachers, mentors and friends can be especially valuable resources for us. Sometimes, just talking to another therapist and sharing your experience with him or her can help relieve the frustration of being alone in this experience and not knowing how to deal with it.

The experiences of others can shed light for us, which our own experiences cannot. Especially older or more experienced therapists who have had the opportunity to reflect on their errors and have moved on
to a place we wish we could be.

We must always keep in mind that simply because we should not use the therapeutic experience to meet our needs, does not mean that we do not have needs, or that we should ignore or deny them.

What it does mean is that we need to find an appropriate way to meet these needs, which though very real and valid, are not part of the therapeutic relationship.

Understanding our motives and taking our responsibility seriously in the therapeutic relationship can fulfill the true goal and purpose of the therapeutic relationship and help us keep our promise to society and to our patients.