Creating a Professional and Safe Practice

To behave responsibly and ethically, there are a number of core psychological concepts that every practitioner must understand intimately. A lack of psychological savvy is no longer a valid excuse for inappropriate behavior. These concepts are well-known and can be understood by everyone when they are clearly stated and taught using the appropriate information. In addition to the concept of boundaries, it is essential to have a thorough understanding of the meaning of the therapeutic relationship, power differential, transference, countertransference, projection, repression, and denial, for starters. These concepts create the bedrock of ethical decision-making and responsible behavior in all professional ( and even personal) relationships.

“The following material is from the book, The Ethics of Touch, by Cherie Sohnen-Moe and Ben Benjamin.” Cherie is well published with several textbooks that have been used in colleges as required reading  for more than 8 years.  She provides a tremendous amount of information available at www.TheEthicsOfTouch.com.

The Therapeutic Relationship

The major elements in a therapeutic relationship include the following: a client-centered, fiduciary relationship; structured time together; clearly defined roles for each person; a power differential; and a safe environment.

• Client-Centered: The therapeutic relationship is a special kind of relationship and is often referred to as client-centered, which means that every action a practitioner takes is in the service of the client's needs, not the practitioner's needs. Trouble often begins when the practitioner takes action because he or she feels like it, not because it is therapeutically necessary. It also means that the client has a voice in the process and must agree to the course of treatment. In the client-centered relationship, the client has the right to expect that the practitioner will always act in the client's best interest. When this happens, the client feels safe and attended to. The client-centered relationship views the client as a partner who shares decision-making power.
• Fiduciary Relationship: All health care practitioners have a fiduciary relationship with their clients. A fiduciary relationship refers to a relationship in which a client places his or her trust in the professional. When a client puts his or her well-being in the hands of the practitioner, there is an implicit contract that the practitioner places the client's interests above and before his or her own. Protecting and maintaining the boundaries of professional relationships is the responsibility of the professional even if the client requests or instructs the professional to behave otherwise. When a professional deviates from standard practice, which is sometimes necessary and useful in order to individualize care, the fiduciary principle and the client-centered approach remain the guiding parameters of care. The practitioner/client relationship and the treatment choices must be continually monitored. Additionally, because somatic practitioners are in positions of power relative to their clients, the law holds them to a higher standard of behavior than in business relationships with a lower power differential.
• Structured Time: Another element of the therapeutic relationship is that the time spent together is limited and structured. The client comes in for a session each week, or some other time interval, for a specific type of treatment. Within a prescribed time frame, certain expected activities occur. Each person has a clearly defined role in these interactions. The client is there for help, and the practitioner is there to help the client.
• Power Differential: The power differential is inherent in any therapeutic relationship. There is an implicit acknow-ledgment that the practitioner has more knowledge in this area than the client. I will explore this area further in next month's column.
• Safety: The final element in the therapeutic relationship is that the client has the right to expect that the emotional and physical environment is safe and doesn't include personal or sexual advances.

Ethics -  Professional Boundaries -  Projection and Transference

Pictures of my old office (a good example of how a treatment room should be set up)
notice there is a separate reception area to do general business, a changing area, the table is clean with freshly pressed sheets and there are extra towels to provide additional covering for modesty and warmth.