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Responsible Touch With Survivors Of Abuse

What defines us as health care professionals is the promise that we make to society to serve the well-being and best interests of our patients. Why does society require this of us and not service providers such as retailers?


September 17, 2009
By Cidalia Paiva PHD

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What defines us as health care professionals is the promise that we make to society to serve the well-being and best interests of our patients. Why does society require this of us and not service providers such as retailers?

The answer to this question lies in the fact that patients are vulnerable persons. That is, people who, by virtue of their pain or discomfort, lack of knowledge or even simply the inability to perform these services for themselves, are vulnerable.

Given that our health and well-being are the most valuable things we possess, this vulnerability becomes even more obvious and pronounced when we seek health care services.

The patient entrusts the therapist with his or her vulnerability and in so doing, places the therapist in a position of power.

This is perhaps most poignantly true in the case of treating survivors of sexual abuse. The effects of sexual abuse are devastating because a basic trust has been violated. Someone, usually a significant person the patient trusted, betrayed their trust and now we as health care professionals are asking them to trust us.

The question then arises, how can we gain, keep and maintain the trust of the survivor of sexual abuse?

I think we need to begin with the recognition and acknowledgment that it is a privilege to facilitate their health care needs. They are providing us with a special opportunity despite their earlier betrayal, to demonstrate to them that as health care providers, and as human beings in positions of trust, we can be there for them, we can be trustworthy. We can begin the process of creating and building trust by bringing our full and abiding presence and intentionality to the therapeutic experience.

This means scrutinizing our motivations. Are we treating this person because we feel sorry for him or her, because we need to prove that we are benevolent and kind, or that we can work with survivors of sexual abuse? Have we made sure that our needs for connection, relationship and intimacy are met elsewhere in our lives and do not interfere with the therapeutic relationship?

Having done this “clearing” work, we are now ready to guide our client through the therapeutic experience. We can initiate the therapeutic session by clearly informing the patient that he or she is in control, and that he or she will make the decisions regarding his or her treatment care.

For survivors of sexual abuse, disrobing and draping are very important aspects of the care we provide. Request consent at each step of the process and confirm consent before proceeding. Remember to work at the patient’s speed. Ask the client to guide you in telling you where to work, how deep to go, etc.

Also, clearly inform him or her that he or she can end the treatment at any time. If you sense discomfort, stop; ask for consent to continue, and give your patient enough time to feel comfortable continuing.

Generally speaking, appropriate self-disclosure about your training and your work, outlining the
expectations of therapist and patient, providing a regular and structured environment and maintaining good personal boundaries will also support your efforts to provide a safe environment for the patient.

No matter how effective a clinician you are, what will serve you best in treating survivors of sexual abuse will be your presence, the fact that for those 60 precious minutes you are there exclusively with them and that they know and feel in this committed presence, that you respect, honour and cherish them. The courage and hope that brought them to you is the very human part of all of our healing journeys.


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