December 29, 2005
How Integrative Medicine Helps Fatigue |
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The secret to fulfilling the New Year’s resolutions of your clients is providing them the oomph to follow through. Western and complementary medicines have united to create Lipid Replacement Therapy, a scientifically proven method of increasing energy.
Renewed desire for improved health surges with the start of a new year. While resolutions encompass all aspects of health, improved energy levels is a predominant wish. Healthcare practitioners frequently see clients complaining of fatigue. Unless there is a detectable pathological illness associated with the fatigue, most allopathic medical doctors have little to offer these individuals. Alternatively, bodywork professionals typically rely on energy invigoration techniques, however, their effects are temporary.
An Integrated Solution
Integrative medicine borrows both from allopathic and complementary medical knowledge to offer state-of-the-art health solutions. When it comes to fatigue, integrative medicine successfully bridges the gap between healthcare systems. The approach to combating fatigue supplied by Lipid Replacement Therapy (LRT) is integrative medicine at its best. Components of LRT include:
• Western science chronicles the body’s energy manufacturing process on a cellular level.
• Breakdown of the energy production system is confirmed by contemporary research.
• Nutritional medicine provides a safe and proven method to repair the damaged structures responsible for energy production.
Lipid Replacement Therapy
Representing multiple medical perspectives, LRT is an effective, supplement-based, non-stimulant approach to naturally increase physical energy levels. LRT replaces phospholipids in cell membranes, resulting in improved function. Researchers Dr. Denham Harman and Dr. Bruce Ames have demonstrated that nutritional intervention can provide a healthier, more energetic life by supporting the health of energy-producing mitochondria. While many holistic healthcare practitioners have been schooled to examine how every system affects every other, looking at body dysfunction from a microscopic perspective is illuminating. Working backwards to understand energy’s abundance begins with the question, “What is energy and where does it come from?”
Basics of Energy Production
Although numerous factors can cause fatigue, solutions to increasing energy levels are restricted by the available metabolic energy supply. Remembering back to biology class, the human body’s principal energy molecule is adenosine triphosphate (ATP). ATP production occurs primarily in mitochondria, where an electrical chemical gradient is generated from the pumping of protons across its inner membrane (much like a battery). The charge builds, reaches a threshold and releases, providing the power to create ATP’s high-energy phosphate bond, the foundation of our body’s fuel.
The ability of the mitochondria to host the production of energy relies on the health of its membranes. The membrane’s lipid component allows it to remain fluid-like, ensuring an effective gradient for energy transfer. Oxidation by free radicals stiffens the membrane, making it less conductive, reducing energy levels. Spurred by age, disease, trauma and toxins, oxidative damage to the lipid membrane is considered to be the predominant cause of impaired mitochondrial function. Several clinical studies document the relationship between oxidation, membrane phospholipid loss, membrane damage and fatigue. Protecting cell membrane integrity is the key to enhancing cellular health, energy and metabolic efficiency.
Nutritional Medicine Protects and Heals the Membrane
Nutritional medicine is based on the premise that a healthy body requires the correct balance of foods, vitamins and nutrients. LRT is the actual replacement of damaged cellular lipids with healthy lipids. Essential for restoring membrane fluidity and function, LRT employs the following lipids to repair cell membranes:
• polyunsaturated phosphatidylcholine
• other polyunsaturated phosphatidyl lipids
• glycolipids
Clinical studies demonstrate a reversal of damage, restoration of cellular function and a return to normal energy levels when high concentrations of unoxidized, undamaged lipids are delivered to cells.
LRT requires several additional nutrients to be effective. Unfortunately, individuals whose weakened digestive systems pass nutrients quickly are unable to reap lipids’ benefits. In order to ensure lipids are utilized, nutritional medicine specifies the inclusion of essential fatty acids and probiotics (good bacteria) to nourish and balance the digestive tract, aiding nutrient absorption.
While lipids rebuild membranes, and fatty acids and probiotics ensure their delivery, antioxidants can stop the damage from occurring. The inclusion of antioxidants, found in amino acids, vitamins and minerals, adds another dimension of protection by preventing phospholipid oxidation and free radical production. LRT supplies nutritional supplementation with the appropriate balance of lipids, fatty acids, probiotics and antioxidants to support, protect and heal our microscopic, energy-supplying structures.
How You Can Help
In addition to the short-term benefits of invigorating massage techniques, bodyworkers can offer a proven long-term solution to fatigued clients by suggesting or selling a nutritional supplement based on LRT. Incorporating this approach to membrane health can make the difference between clients dragging through the day as opposed to being vibrant and energetic. Integrative medicine’s LRT combines the wisdom of nutritional therapy with a comprehension of biochemistry to end fatigue, making achievement of your clients’ 2006 health goals possible.
Editor’s Note: For information about Lipid Replacement Therapy products, e-mail editors@natural-wellness.com.
References:
Agadjanyan, M., V. Vasilevko, Ghochikyan, et al. Nutritional supplement (NT Factor®) restores mitochondrial function and reduces moderately severe fatigue in aged subjects. J Chronic Fatigue Syndr. 2003; 11(4): in press.
Beckman, K., B. Ames, The Free Radical Theory Of Aging Matures. Physiol Rev. 1998; (78): 548-81.
Goldberg, Burton, L. Trivieri, Jr., Chronic Fatigue, Fibromyalgia and Lyme Disease. Celestial Arts, 2004: 324-51.
Harman, D., The Biological Clock: The Mitochondria. J Am Ger Soc. 1972; (2): 145-47.
Nicolson G.L., Lipid Replacement Therapy as an Adjunct for Chronic Fatigue, Anti-Aging and Restoration of Mitochondrial Function. JANA. 2003; 6(3): 22-28.
Nicolson G.L., Chronic Fatigue, Aging, Mitochondrial Function and Nutritional Supplements. Townsend Letter For Doctors 2003; July/August.
Posted by Nicole at 11:05 AM
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Sports Massage Adds a Performance Edge |
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Sports massage has evolved into a critical component of athletes’ training and recovery programs. This article clarifies the ‘when, what and why” of this specialized modality and how it can dramatically impact an athlete’s performance.
Serious athletes typically utilize sports massage therapy to recover from injuries and/or to maintain flexibility, strength and their performance edge.
Sports massage therapy, a recognized, valuable addition to other physical therapies and treatments, has become just as much a part of an athlete’s routine as diet and exercise. A sports massage therapist is the last person to touch many professional athletes prior to their competition. Athletes from all over the world, in every sport, have come to comprehend the advantage of a massage therapist with a thorough understanding of anatomy and kinesiology, the muscles used for a given sport and the wisdom to anticipate areas prone to injury.
Michael McGillicuddy, LMT, NCTMB, states in the May 2003 issue of Massage Today, “Sports massage is the specific application of massage techniques, hydrotherapy protocols, range of motion/flexibility protocol and strength-training principles utilized to achieve a specific goal when treating an athlete.” Keys to understanding these principles of sports massage, says McGillicuddy, are the “when, what and why” of sports massage; mainly timing, technique and intent.
Timing
Possibilities include:
• Pre-event massage
• Post-event massage
• Maintenance massage
• Rehabilitation massage
Technique
Technique refers to what applications will be used. Different techniques specific to sports massage include, but are not limited to, effleurage, friction, petrissage, vibration, shaking, compression, broadening, direct pressure, cross-fiber friction, range of motion, trigger point, counterstrain, reciprocal inhibition and proprioceptive neuromuscular facilitation (PNF) stretching.
Intent
The intention behind administering sports massage ranges from:
• Increasing blood flow
• Aiding recovery from exhaustion
• Increasing flexibility
• Improving strength and posture
Pre-event Massage
Pre-event massage typically occurs at the sports event, just prior to the athlete’s participation. Dr. James Mally, instructor of the Institute’s Sports Massage course, states that pre-event massage should take place prior to, but not replace a warm-up, approximately 20-30 minutes before the event. Pre-event massage focuses on the muscles that will be stressed most during competition. Depending on the sport, pre-event massage often uses friction to help warm the body, compression to increase blood flow to targeted muscles, and range of motion to prepare neural pathways and assist with joint mobility.
Pre-event massage routines and techniques depend upon the event the athlete is preparing to compete in. Examples include:
• Swimmers and runners require quick reaction time.
• Boxers need their muscles to remain loose.
• Gymnasts require flexibility.
Each competitor will require a unique combination of techniques designed to maximize his/her performance. Pre-event massages are typically vigorous with the intention of imparting speed, power and endurance.
Pre-event massage effects include:
• Dilating blood vessels, which results in improved cellular nutrition to the muscles.
• Improving circulation to tendons and ligaments.
• Relaxing muscle antagonists, which results in greater muscle efficiency.
• Releasing trigger points that could negatively affect athletic performance.
• Increasing flexibility – best for gymnasts and athletes who require flexibility.
• Preventing and treating muscle spasms.
• Preparing the body’s nervous system for strenuous activity.
• Increasing heart rate, respiratory rate and body temperature.
Post-event Massage
Post-event massage is performed at the event site after competition. This work requires a great degree of skill and knowledge to assist the athlete in recovery. Reducing muscle soreness and/or cramping while reestablishing range of motion and blood flow can facilitate a faster return to training after an event. Post-event massage is given for 10-15 minutes following a cool-down period of about 15-20 minutes. Cuts, bruises, blisters, mild strains, sprains or muscle cramps must be treated prior to massage. If muscle cramps are due to dehydration, medical attention should be sought immediately.
Post-event massage might consist of compressive effleurage for calming the nervous system and pushing fluid, petrissage for easing muscle tension, compression for spreading muscle fibers and restoring blood flow, broadening strokes to lengthen tight muscles, and compressive effleurage as a finishing stroke to soothe the athlete. Stretching can relieve muscle tension and restore range of motion while reciprocal inhibition can relieve muscle cramps not due to dehydration. Athletes usually look forward to a post-event massage because the benefits are experienced immediately.
Maintenance Massage
Sports maintenance massage is performed when an athlete is not competing in an event. An effective maintenance program focuses on an athlete’s strength, flexibility, coordination, biomechanics, posture, stress patterns, scar tissue and existing injuries. It is important to determine if an injury is acute or chronic, as this will dictate the appropriate technique to use and prevent exacerbation of the injury.
A sports massage maintenance program designed to meet a specific athlete’s needs can add a significant edge to his/her performance. McGillicuddy advises a sports massage therapist to design a maintenance program based on information gathered from discussing the athlete’s existing goals and watching the athlete’s workouts or competitions. In addition, recording current or previous injuries, evaluating prior treatments and setting specific performance goals with the athlete contributes to designing an ideal maintenance program.
Rehabilitation Massage
Even with preventive maintenance, athletes’ muscles cramp, tear, bruise and ache. While rehabilitative sports massage should only be performed in conjunction with proper medical care, it can significantly speed healing and reduce discomfort.
Because rehabilitative sports massage techniques can temporarily increase pain and inflammation, massage on acute injuries is traditionally followed by cryotherapy. When assisting the proper formation of scar tissue, McGillicuddy suggests using effleurage, compression and cross-fiber friction, followed by ice treatment and movement. Additional techniques employed for rehabilitation include lymphatic and trigger point massage. In the acute stage of injury, lymphatic drainage massage can decrease swelling and accelerate the healing process. Trigger point or neuromuscular therapy can reduce spasms and pain in both the injured muscles, and those compensating for the injury.
An accomplished sports massage therapist applies the correct sports massage technique in every situation. Dr. Mally suggests beginning with the gentlest methods, then progressing toward those that are more active. Trial and error typically helps delineate what is most beneficial for the athlete. Learning about common sports injuries, mastering the principles of each technique and fully comprehending musculoskeletal anatomy and kinesiology all play a part in becoming a successful sports massage practitioner.
Recommended Study
Sports Massage
References:
Mally, Dr. James. Sports Massage, Abundant Health Resources, 2002.
McGillicuddy, Michael. Three Key Principles of Sports Massage, Massage Today, May, 2003.
McGillicuddy, Michael. The Art and Science of Pre-Event Massage, Massage Today, July, 2003.
McGillicuddy, Michael. The Art and Science of Post-Event Massage, Massage Today, September, 2003.
McGillicuddy, Michael. The Art and Science of Sports Maintenance Massage, Massage Today, December, 2003.
Posted by Nicole at 10:53 AM
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December 02, 2005
Ethically Navigating Difficult Bodywork Scenarios |
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All healthcare professionals encounter clients who challenge their professional and ethical boundaries. Analyzing examples of such encounters fosters practitioner preparedness and reduces the likelihood of being caught by surprise and without a plan of action.
Professional codes of ethics dictate appropriate behavior in the professional and therapeutic relationships of massage therapists. Actions and behaviors have a tremendous impact on therapists’ clientele. Beyond the limitations of the client/practitioner relationship, actions and behaviors have the potential to affect clients’ families, colleagues, employers and the community at large. In all of these relationships, a therapist must continually ask whose interests are being served, and whose may be harmed by one’s own thoughts and responses.
While a code of ethics offers guidance in navigating each relationship, the safety and well-being of the client remains the primary focus. Trust and open communication must form the basis of every therapeutic relationship. Establishing and maintaining respectful boundaries between practitioner and client promotes the trust necessary for a safe and viable partnership.
When it comes to the ethics of touch, physical boundaries between a client and practitioner are delicate issues. Whether conversing with a coworker or on line at the bank, people test physical boundaries each day based upon their levels of comfort and safety. As professionals whose work requires close physical contact, bodyworkers are generally more comfortable initiating physical contact and more relaxed about maintaining personal space. Those unfamiliar with massage come from a variety of backgrounds and experiences, and may require some time to adapt to massage’s high level of physical contact.
In addition to physical interaction, comfort and safety concerns can arise from emotional and sexual boundaries. Our touch can both communicate a message and elicit a response in either of these areas. Ralph Napolitano, author of the Institute for Integrative Healthcare Studies’ Ethics: Therapeutic Relationships course states, “In fact, what we communicate through touch is what the client will receive, regardless of the words we say.” For example, unresolved negative, judgmental or sexual feelings toward a client may be communicated through touch. This is where both the intention behind touch and clear communication of boundaries become crucial.
Before boundary issues arise, it is best to be prepared by considering possible scenarios and thoughtfully developing a plan of action. The following scenarios provide the opportunity to think about each situation and how you might best respond.
Scenario One
A female massage therapist has been regularly seeing a male client for four months. Over this time, he has become increasingly demanding and directive during the massage. After working his tight hamstrings and then moving up to work his lower back, during the course of a massage the client rises up from the headrest and states in a loud, demanding voice, “I need more work on those hamstrings!” In response, the therapist quietly obliges the client and returns to working on the hamstrings. During the following massage, the therapist feels timid and unsure of herself throughout the session, following every directive the client gave.
After reflecting on this situation, the therapist realized that this client reminded her of her perfectionist father, who was a demanding and authoritative figure throughout her childhood.
“As healthcare practitioners,” Napolitano states, “we must be conscious and avoid bringing our own personal and emotional baggage into the massage relationship.”
In relationships where a power differential is present, as between a healthcare practitioner and client, there exists a potential for transference and countertransference to surface. Transference occurs when a client unconsciously projects unresolved feelings, needs and issues onto a practitioner. In countertransference, the therapist unconsciously assigns unresolved feelings, thoughts, and perceptions about someone from their personal history onto the client. As a result, the therapist may lose objectivity and misinterpret a client’s actions, responses and needs. These misperceptions can lead to misunderstandings, poor judgment and even negative feelings toward a client.
Negative feelings often arise when a client displays similarities to a person in the therapist’s life toward whom ill will is harbored. On the other hand, displaced positive feelings can arise when a client reminds the therapist of someone they feel favorably toward. Recognizing the signs of countertransference can prevent an awkward ethical dilemma up to and including litigation. The following behaviors are indicative of countertransference:
• Unusually strong positive or negative feelings directed toward a client.
• Predominance of impatience or anger when a client is not progressing.
• Being argumentative with a client.
• Experiencing an overemotional reaction to or involvement in solving the client’s problems.
• Making exceptions for a client’s inappropriate behavior.
• Giving a client extra time and attention before and after a session.
• Bending our professional and personal boundaries to accommodate a client.
By becoming more self-aware and overcoming prejudices, preferences, judgments and personal issues, health professionals establish clearer boundaries in the therapeutic relationship. When personal feelings are recognized, addressed and put aside, they do not interfere with the commitment to high quality healthcare. Awareness of countertransference marks the therapist’s return to professionalism. Moving beyond this barrier, the therapist in Scenario One can educate her client on the anatomical connection and therapeutic value of working the lower back to release the hamstrings.
Scenario Two
A therapist has been giving treatments to a home-bound client receiving workmen’s compensation, twice a week for 6 months. During the last month, the client begins every visit with a warm hug and a small, inexpensive gift (i.e., a candle, incense) for the therapist. During the session, the client plays music she knows the therapist likes. Further, following the massage, the client invites the therapist to stay and talk while having tea.
The therapist is noticing the boundaries of this therapeutic relationship are being breached.
Transference is the displacement or transfer of feelings, thoughts and behaviors related to a significant person onto someone else, such as the therapist. Individuals seeking help with unresolved needs, feelings and childhood issues are often attracted to a compassionate, helpful and knowledgeable caregiver, and can unconsciously transfer expectations of resolution onto that caregiver. Since vulnerability can stimulate transference, it is the responsibility of the therapist to be aware of this possibility, how it affects the client, and how the therapist’s behavior may affect transference.
A massage session can magnify transference because:
• There is a striking similarity between the practitioner/client relationship and a parent/child relationship.
• The client is in an altered state of consciousness.
• Bodywork involves a high level of intimacy.
As transference is mostly an unconscious behavior, it is up to practitioners to recognize its signs and maintain professional boundaries. It is important to remain firm within established boundaries such as starting and ending sessions on time, proper draping and minimizing dual relationships. These steps reduce the likelihood transference has to destroy the therapeutic relationship.
Transference can be recognized in a client who:
• Frequently asks about the therapist’s personal life.
• Calls the practitioner at home when explicitly stated otherwise.
• Brings a gift to every session.
• Solicits help in solving personal problems.
• Has difficulty maintaining physical boundaries (i.e., wants to hug or touch during every interaction).
• Asks for more time before and at the end of a session, and is disappointed when not appeased.
• Asks the therapist out on a date.
It is also possible to misinterpret a client’s behavior and subsequently, react negatively due to preconceived notions or fears. Often small gifts from clients are a personal sign of appreciation, as may be the case for clients who cannot afford to tip. Weighing the client’s intention for giving gifts, hugs or invitations to stay after the massage will dictate a practitioner’s ethical plan of action. Whatever the decision, the goal is to create clear and comfortable boundaries between the therapist and his/her clients. As Napolitano asks, “Will the action I choose enhance the therapeutic relationship, or hinder it?”
Scenario Three
A massage therapist attends group therapy for personal development. An opening in the group is unexpectedly filled by one of the therapist’s clients. Although a member of the group for years, now the therapist feels uncomfortable about disclosing personal information with the group in the presence of the client.
A dual relationship is one where multiple roles exist or overlap between a therapist and a client. Consisting of both professional and social roles, examples of dual relationships are when a client is also a student, friend, family member, employee, business associate, teacher or healthcare provider to the therapist. In the healthcare field, it is the practitioner’s responsibility to be informed and accountable for dual relationship repercussions. The power differential that exists within a therapeutic relationship demands practitioners gauge the nature of dual relationships in order to establish and maintain clear relationship boundaries.
Seeing a client at a monthly association meeting or at the gym may initiate a minimal level of intimacy. However, a client who joins a therapist’s gym, church or association to be closer to the therapist may be seeking a deeper level of intimacy. As the massage profession’s nature initiates a certain level of intimacy, each role within dual relationships and levels of intimacy determine a course of action.
Switching roles in the therapeutic relationship can lead to confusion and the possibility of transference or countertransference. Although not a massage therapist during group therapy, the client may transfer their pre-existing respect onto your personal opinions shared in the group. Self-disclosure to a client outside of the professional relationship will impact the atmosphere when bodywork sessions resume. Both parties are often tempted to treat sessions as a time to continue developing a personal relationship rather than maintaining a professional atmosphere. Under these circumstances, boundaries crumble, session length considerations decrease and focus on the client during the session diminishes.
A therapist must ask why they would self-disclose in the presence of a client. If it may benefit the client in some way, such disclosure may be valuable. Timing, method of delivery and the amount of information revealed, will aid in preventing dual relationship dilemmas.
If a massage therapist is lonely and in need of social interaction, it may be tempting to reciprocate the adoration and respect received from clients. Since massage therapists are not precluded from social contact after treatment sessions by their code of ethics, this is a personal decision based on self-assessment and the retention of clear boundaries.
It is up to the therapist to evaluate the potential risks involved in fostering a dual relationship. When evaluating the risks, consider the following:
• What is the level of intimacy?
• What is the potential impact of the power differential?
• Who is accountable for what in the relationship?
• What is the relative maturity level?
• What are the consequences of non-participation?
In all practitioner/client relationships, the power differential favors the practitioner, who must use that power to best serve their client’s needs. For example, a massage therapist has a car in need of repair and an auto mechanic as a client. This may appear to be a mutually beneficial dual relationship at first. However, before initiating this dual relationship, consider possible scenarios where the power differential may reverse:
• What if the mechanic does a poor job?
• What if the mechanic never shows up on time and causes the therapist to miss appointments?
• How might this situation spill over into the treatment room?
• After the car was supposedly fixed, would it be tempting to give a below standard treatment if your automobile problem resurfaced?
Professional ethics require accountability, guide us to do no harm and dictates we help our clients to the best of our ability. Nina McIntosh, author of The Educated Heart, suggests asking yourself the following questions to determine if any action taken is ethical:
• Does the action keep the focus on safety and well-being of the client?
• Are you being respectful of the power imbalance and/or the transference effect? Or are you using this power imbalance to your own benefit?
• Does the action create a dual relationship and make the therapeutic boundaries less clear?
• Does the action remain within the original contract with our client – or are we exceeding either our area of expertise or the client’s informed consent?
• Does the action create a safer environment for the client or detract from it?
• Could the action lead to future problems in the therapeutic relationship?
Massage and bodywork professionals have a license to touch. The type of touch used either establishes a sense of safety and reassurance, or it can make clients feel uneasy, apprehensive and uncomfortable. Establishing appropriate boundaries in regard to the nature and type of touch used and communicating these to clients early in the relationship can avoid potential misunderstandings.
Recommended Study
Ethics: Therapeutic Relationships
Posted by Nicole at 09:44 AM
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A Common Male Physiological Response to Massage |
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It happens and it is normal, yet no one wants to talk about the primary reason men avoid therapeutic massage. Learn how to assess a client’s intentions and professionally address this situation.
It is very common for men to get an erection during a non-sexual, therapeutic, full body massage. While an erection can be indicative of being physiologically aroused, it does not necessarily indicate the presence of emotional or sexual desire. Touch administered to any part of the body can activate the parasympathetic nervous system, which can result in a partial or complete erection. Professional assessment can help a therapist decipher a physiological response to touch from inappropriate sexual intentions.
While physical arousal can occur with both male and female clients, a woman’s arousal is typically less visible. Fear of an erection, or a massage practitioner’s response to it, prohibits some men from seeking a much needed therapeutic massage. For those devoid of inappropriate intentions, education about normal body function can ease this fear and invite a new level of comfort with somatic-based therapies.
If there is any discomfort on the part of either the client or the practitioner when an erection occurs, it must be addressed.
• Discomfort on the part of the client or the therapist will divert the focus of the therapy, resulting in decreased effectiveness.
• If a man shows no signs of embarrassment or discomfort due to his erection, and the therapist is comfortable, then addressing it is not necessary.
• If the therapist notices any client discomfort, such as body tension or facial flushing, then it would best serve the client to talk about it.
• Because the antidote to a parasympathetic response is activation of the sympathetic nervous system, changing the technique being used can quell a spontaneous erection.
• The sympathetic nervous system can be activated by increasing massage pace and pressure. Note: This increase should be moderate, as it is not intended to alarm or cause pain to the client.
Based on fundamental communication skills, Ben E. Benjamin, Ph.D. and Cherie Sohnen-Moe describe “The Intervention Model” in The Ethics of Touch. When a client’s intent is unclear, The Intervention Model contains eight steps to guide a practitioner’s assessment and subsequent action in response to ethical dilemmas. Dependant upon the details of the situation being addressed, it may be necessary to consecutively progress from step one to step eight, stop after step one or two, follow the steps in a different order or skip inapplicable steps. The following outline of The Intervention Model has been slightly modified for approaching a client with an erection when the client’s intent is not understood.
Step One: Stop the treatment using assertive behavior.
• Addressing the client with body language congruent with verbal communication demonstrates assertive behavior.
• Tips to remain assertive include making eye contact, standing with relaxed, yet grounded posture and using a firm voice.
• Shrinking or speaking quietly portrays passivity, while yelling or touching inappropriately displays aggression. Avoid both.
• By adjusting the drape to make sure the client is properly covered, the therapist non-verbally confirms professional boundaries. Additionally, if touch has contributed to a sexually aroused state, adjusting the drape physically stops the cause of stimulation.
• At this point, maintaining safety is crucial. If the therapist feels intimidated, positioning him/herself with easy access to an exit can allow for safety should the client become actively threatening.
Step Two: Describe the behavior.
When encountered with an erection, stating the obvious can be difficult, but clarifies the client’s intent. By describing a behavior, the client knows the therapist is paying attention without passing judgment. Examples of this type of communication are:
• “I notice you’re tightening your muscle and grimacing when I pass over this area.”
• “I am aware that you made a comment about my appearance, then made a sexual joke and now you have an erection.”
Step Three: Clarify the client’s intent.
After stating the obvious, directly asking the client what they are experiencing can reveal the meaning behind the erection. Examples include:
• “Can you tell me what’s happening?”
• “What are you experiencing?”
Dependant upon the client’s comfort level and their intent, a client’s response may or may not be straightforward. It is important to resist providing an answer for the client, so wait for a clear response. Clarification of the client’s intent allows for the practitioner to render an accurate assessment.
Step Four: Educate the client.
During a somatic-based therapy, some recipients experience unexpected emotional and physiological responses. When aware of a client’s concerns, the therapist can share information to educate the client. Examples of educative statements for a client experiencing an unintentional erection are:
• “Sometimes clients become aroused as a physiological response to touch. It is a normal body response.”
• “It’s natural for some men to have a physical response to massage.”
• “I noticed you had an erection during the last massage. I want you to know that erections are usually just a physiological response to touch and it’s not unusual for clients to have them.”
Step Five: Re-state your intent.
Safety is re-established by a therapist clarifying the therapeutic contract of the session. Examples of re-instating therapeutic intent are:
• “It is never my intent to create sexual arousal during a session. If it happens and I’m confident your intent isn’t sexually inappropriate, then I’m comfortable in continuing the session if you are.”
• “I want to make it clear that this is a non-sexual massage. I will end the session if you are looking for something else.”
Step Six: Continue or discontinue the session as appropriate.
A client with sexual intent or displaying inappropriate behavior necessitates immediate termination of a session.
• If sexual intent is determined right away, there is no need to employ the previous steps.
• If a client’s intent remains unclear, establishing conditions may be necessary.
• An example of establishing conditions is “I will continue with this session, but will stop if your behavior causes me to feel uncomfortable in any way.”
Step Seven: Refer client to other professionals as appropriate.
This step is typically taken after the completion of a session.
• In your opinion, if your client could benefit by professional help from a psychotherapist, counselor or other medical practitioner, provide referral information to the client when he is fully dressed and alert.
Step Eight: Document the situation.
After the client leaves, document the occurrence and obtain supervision or peer support as necessary.
• Difficult communication with a client can evoke ethical questions and safety concerns. Seeking supervision indicates a commitment to ethics and professionalism.
• A neutral party can provide a reality check or needed emotional support.
• Unless you fear for your own or someone else’s safety, client confidentiality must be honored.
• When documenting the situation, be sure to include all the facts, including your own actions. This is vital should a client ever lodge a complaint.
Encountering the male physiological response to parasympathetic arousal is a frequent occurrence in the massage profession. Professionally managing human interaction surrounding this type of arousal requires preparedness, maturity and education. Determining the intention behind a man’s erection serves to maintain professionalism, ensures therapist safety and reduces client embarrassment. Meanwhile, communication regarding client behavior, therapeutic intent and the physiological normalcy of erections allows a therapist to preserve ethical boundaries while maintaining respect for the client.
Resources:
Benjamin, Ben E., Ph.D., and Cherie Sohnen-Moe. The Ethics of Touch. Tucson: Sohnen-Moe Associates, 2003.
McIntosh, Nina. The Educated Heart Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers. 2nd ed. New York: Lippincott Williams & Wilkins, 2005.
Posted by Nicole at 09:34 AM
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