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1.REFUSAL OF TREATMENT
When is it appropriate to discontinue working with a client?
When the parameters of the therapeutic relationship have changed for the negative.
When the therapeutic relationship is damaged and beyond repair.
When it is no longer beneficial to either one of the two parties involved.
When there is the threat of physical harm or abuse.
When your client feels the need to test your boundaries e.g. keeping appointments, punctuality, seeking or giving inappropriate personal disclosure.
When the client inappropriately fulfills some social or emotional need of yours or theirs.
When they need work beyond your training or scope of practice.
When you feel in your gut that it isn't appropriate to continue working with them.
When you feel in your heart that it isn't appropriate to continue working with them.
When you know intellectually/ in your mind that it isn't appropriate to continue working with them.
When they have an unrealistic view of you or your work.
How do you approach discontinuing with a client/treatment?
If they test your boundaries, make them aware of it and inform them that if it continues the therapeutic relationship will be terminated.
In the case of immediate threat or abuse, their violating the therapeutic relationship or continually testing your boundaries after warning: inform them the therapeutic relationship is terminated and don't book them for any further sessions. If they've paid in advance return their money. Make it final, no need for further discussion.
If the parameters change for the negative or you are violating the therapeutic relationship or boundaries, seek supervision or mentoring and see what your supervisor/ mentor recommends. Act on it. If you feel it is particularly serious, delay your client's sessions until you have had supervision or have more clarity around the situation.
If it is training, scope of practice, minor boundary violations (i.e. their punctuality), the gut/ heart/ mind feeling or their unrealistic thinking/ expectations, explain that you feel your work isn't benefitting them or is inappropriate for them or that you simply can no longer work with them, but give them referrals to several other practitioners who you feel may be more appropriate to their situation. Explain it to them, terminate the relationship responsibly so that they don't feel "dumped" or left hanging.
An AMT Ethics wiki contribution,2008.
You too can contribute to the wiki: http://www.amt-ltd.org.au/wiki/
2.DRAPING
The most basic rule or guideline for draping is that it should always be done with the comfort, modesty and dignity of the client foremost in the practitioners mind. It should be done in such a way that:
1) The therapist has access to the relevant, targeted body part to be treated.
2) The client is comfortable with the draping procedure.
If their comfort means they wish to remain fully clothed, then so be it.
3) No more of the body is uncovered than is required.
4) Draping procedures and their rationale should be explained prior to the commencement of the session, and consent or permission sought.
5) If the draping is to be changed during the session, ensure permission has been granted for the new draping position before doing it. There should always be a therapeutic rationale for any change of draping.
The above applies to all passive massage. In more active bodywork or if movement therapy is involved, ensure that your client is wearing appropriately modest clothing that, while allowing you as the practitioner access or the ability to visually observe, THE CLIENT FEELS COMFORTABLE IN WEARING WITHOUT THEIR DIGNITY BEING IMPINGED.
An AMT Ethics wiki contribution,2008.
You too can contribute to the wiki: http://www.amt-ltd.org.au/wiki/
3. EXCEPTIONS TO CONFIDENTIALITY
Circumstances in which client confidentality can be breached:
1) Self harm: if there is a possibility the client may harm themself.
2) If there is the real possibility of specific harm to a specific other.
3) If there is current child abuse or the danger of abuse to children.
4) As required by a court order.
5) If the client is a minor or is of diminished mental capacity: disclosure can be made to the responsible parent, guardian or carer of the client. Due respect should still be shown for the clients privacy.
An AMT Ethics wiki contribution,2008.
You too can contribute to the wiki: http://www.amt-ltd.org.au/wiki/
4. ADVERTISING:
Therapists must not advertise or otherwise promote their services in a manner that:
is false, misleading or deceptive, or
is likely to mislead or deceive, or
creates, or is likely to create, an unjustified expectation of beneficial treatment.
creates, or is likely to create, false hope (e.g. massage cures cancer or other serious illnesses or the blatant, massage rids toxins).
Therapists should not advertise or promote services or modalities which they are not certified or qualified to perform. They should not advertise or promote services that are outside their scope of practice.
An AMT Ethics wiki contribution,2008.
You too can contribute to the wiki: http://www.amt-ltd.org.au/wiki/
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Hello Glimmer
I've probably treated somewhere in the vicinity of 40 -50 clients, more AS than autistic. A a percentage of my practice? I'm unsure, it is small but significant. Thanks for stopping by and commenting.
Colin.