Module 2 - Creating a Therapeutic Relationship
5 Lessons
LESSON 1: The Therapeutic Relationship
Opening (5 minutes)
PPT-2 p.1Welcome to Module 2: Creating a Therapeutic Relationship
Pair Share
Ask learners to find a partner and share a little about their work history chronology.
After 2 minutes, ask partners to switch.
Call time after an additional 2 minutes.
Elicit any comments.
Return the graded Module 1 quizzes and Self-Evaluation Worksheets.
Remind learners to place both in their binder<
Our focus in Module 2 is helping you to develop successful and ethical therapeutic relationships with your clients.
PPT-2 p.2Lesson Objectives (Review objectives with students)
- Distinguish between the wellness model and the allopathic medical model.
- Identify therapist behaviors that are consistent with confidentiality of client identification, personal disclosure, files, and treatment information.
Let’s explore what goes into creating an effective therapeutic relationship…
The Therapeutic Relationship (25 minutes)
Reference text pp. 40-41
Defining the Therapeutic Relationship. What is a therapeutic relationship?
Look for: One that enhances the well-being of the client – and secondarily, the well-being of the practitioner – and does so ethically.
PPT-2 p.3Insights From the Experts
>Referring to slide, ask a volunteer to read the quote aloud<
Your relationship with your client is what will make or break your practice, much more than your knowledge of anatomy.- Nina McIntosh
>Invite comments before moving on<
HO 2-1Let’s take a look at what some other experienced practitioners have to say…
Divide students into small groups (4-6) – or simply ask learners to speak with their tablemates.
Remind groups to assign roles: facilitator, recorder and presenter.
Distribute one “quote slip” to each group.
After the facilitator in your group reads your group’s quote aloud (within the small group), I’d like each group to engage in a discussion, addressing the following questions:
What are his/her main points?
Do you agree with this practitioner’s perspective? Why or why not?
Is there anything you would add?
Is there anything that you would do differently?
What insights did you gain from this quote – and from your group’s discussion?
I’ll give you 5 minutes to discuss your quote within your group. Then, I’m going to ask that each presenter 1) read their group’s quote out loud to the full class and 2) share 2 insights that their group came up with – based on their discussion. If your quote has already been read out loud, then please just share your group’s insights.
>Allow each presenter to share their group’s quote and insights<
Invite others to add their thoughts, but also keep the mini-presentations moving along.
Wrap up this portion with some final thoughts.
Who’s responsible for the quality of the therapeutic relationship between the practitioner and client?
Look for: Although the client’s actions and attitudes play a large part in the quality of the therapeutic relationship, ultimately it is the responsibility of the practitioner.
How does massage work? As massage therapists, do we heal our clients?
Look for: Practitioners don’t fix or heal. Instead, they facilitate the client’s innate healing potential and empower the client’s ability to access his or her wisdom.
This is a crucial distinction. First, it reminds us of the limits of our scope of practice: We are not medical professionals who can fix broken bones or cure disease. To attempt to practice beyond our scope is not just unprofessional – it can harm the client and get us into trouble ethically and legally.
At the same time the differentiation helps us define the powerful contribution we do make to our clients – empowering them to tap into their own healing potential not just physically, but also mentally and spiritually.
>Ask a student to lead the class in a stretch<
The Wellness Model (20 minutes)
Reference text pp.40-41 and p.12 (6 Dimensions of Wellness Model)
As you discovered in your textbook reading, the medical model focuses primarily – but not exclusively – on the physical realm and on the removal and prevention of disease. The wellness model considers optimal health and well-being to be achieved through a balance between mind, body, and spirit.
Generally, the practice of massage occurs within the context of the wellness model – but it is not dogma. And you don’t need to choose between the two models. The most important thing is that you understand the client’s model of the world instead of imposing your model on to them.
In order to explore the multidimensional elements of well-being, we are now going to engage in a Wellness Wheel activity, applying the Six Dimensions of Well-Being, developed by the National Wellness Institute (shown on page 12).
Distribute Wellness Wheel worksheets and ask learners to take a few minutes to fill out their Wellness Wheel worksheet.
After completion, ask each to turn to a partner to share their results.
Any thoughts that anyone would like to share?
>Invite responses<
>Collect Wellness Wheel Worksheets<
We’ll actually be touching on this concept again when we get to Module #4: Practicing Self-Care.
Wrap Up (10 minutes)
>Go over homework<
Read pages 41-48. Begin with “Ethics” and stop at “Client Communication.”
DUE DATE: Next class
Pay particular attention to both Code of Ethics (outlined on the top of p. 42) and the Performance Standards outlined on p. 43.
Let’s take a couple minutes right now. In your journal, write down some thoughts on how you are going to make sure that you will adhere to all of these ethics and standards. What are some practical ways to make sure these are enforced, especially if you are managing other massage therapists?
>Remind learners that in their group final project, they must demonstrate
that all of these Ethics and Performance Standards will be met<
In addition to this reading assignment, your homework is to ask 3 people for feedback on your communication skills. You’ll ask them to give you 10 to 15 minutes of their time to give you some feedback.
As you know, your skills as a communicator will be essential to your success as a massage therapist. Before you can decide what to improve, you first need a sense of how you’re doing right now. Then you can come up with a plan for increasing your communication skills.
This assignment requires you to be somewhat brave, but it can be enormously helpful. One person who did this with 2 friends discovered that when the friends shared a problem with him, he too often jumped right to figuring out the solution rather than letting them vent.
In his eagerness to help, he had the habit of cutting short the sharing of feelings, which made the friends feel not listened to. He was trying to solve the facts of the problem instead of just listening to the feelings. His friends explained that they could usually sort out the facts themselves, what they needed from him was some sympathy.
People had told him this before, he says, but he didn’t listen. It was only when he did the exercise – and heard the same feedback from 2 people in 2 days – that he actually heard. And he’s now a much better listener. It was easy to change once he knew.
You do not have to tell me or anyone what the people you interview say to you – unless of course you want to. You may uncover some bad news, but I’m sure you will hear good news as well.
The content of the interviews is private; the only thing you’ll turn in to me is a quick description of who you talked to – for instance, your spouse, a co-worker, and a cousin. However, please take time after each interview to write about your experience in your journal. For your own personal and professional growth, it’s critical that you actively reflect on what just took place – and what you learned.
Here are some guidelines. You don’t need to agree or disagree with what the person says – just listen. Don’t try to justify your skill or lack of it. Ask clarifying questions if you don’t understand what the person is saying.
You’ll thank them twice: First, in person at the end of the interview, and second, in a handwritten thank-you note that you’ll send within 48 hours after the interview.
You’ll have ____ [number] weeks in which to talk with 3 people. You’ll have an opportunity to share what you learned in Lesson 3, which meets on ______[date].
>Distribute Communication Skills Feedback handout<
DUE DATE: Module 2 – Lesson 3
This sheet gives you some ideas. Turn in the bottom part to me when we meet for Lesson 3, Module 2.
>Invite and answer questions before moving on<
LESSON 2: Ethics & Boundaries
Opening (5 minutes)
Collect Work History Chronology and “A Day in the Life of.”
PPT-2 p.4Lesson Objectives (Review learning objectives with students)
- Identify the commonalities among the ethical codes of all health care professions.
- Describe the process for establishing and maintaining professional boundaries and relationships with clients and peers in the workplace.
- Identify examples of boundary violations.
Creating a Safe Environment (10 minutes)
As massage therapists, we are responsible for creating a trusting and safe environment for our clients. This means upholding ethics and boundaries.
Pair Share.I’d like for you to take a moment to reflect back on past experiences you’ve had as a massage therapy client. When did you feel safe and at ease? What did the massage therapist do to help you to feel this way? Was there ever a time when you felt ill at ease? What did you think were the factors that contributed toward this feeling?
Direct learners to decide who will go first.
Call time after 3 minutes. Direct learners to switch roles.
Call time after another 3 minutes. Pull the full group back together and share thoughts and insights.
I want each of you to now think for a minute about and remember the best professional massage you’ve ever had. What made it so wonderful?
>Write the attributes of the best massages on the board<
Was the room ready for you when you arrived? Did the massage therapist keep you waiting? Did he or she seem distracted – or focused solely on you and the massage he or she was doing?
Did the practitioner chat a lot about his or her life? Or was the focus on you?
Tune the world out. Tune the client in.
Did you feel known to the practitioner? Recognized for who you were? As human beings, we all yearn to be recognized and remembered for who we are. Even if you only provide massage therapy once to a particular client, you have the opportunity to make a positive impact on that person’s life.
Massage can have a powerful impact on a client’s mental and emotional state. We know the physical impacts: deep relaxation, stress relief, improved muscle tone, etc. What are the mental and emotional impacts?
Look for: Feeling nurtured, feeling vulnerable, recalling past experiences (positive and negative).
Ethics (15 minutes)
Reference text pp.41-43
For your homework, I asked you to pay special attention to both the Code of Ethics and Performance Standards that you are responsible for upholding as a massage therapist.
What is the difference between the two?
Look for: Whereas a code of ethics is geared more toward values, performance standards are geared more toward actions.
Let’s review each of these.
Ask volunteer(s) to read out loud Code of Ethics on top of p. 42.
Ask volunteer(s) to read out loud Performance Standards and Examples of each on p. 43.
It’s easy enough to read these aloud, but what matters most is how we actually internalize these guidelines. I also asked you to jot down ideas in your journal, as to how you will effectively uphold both. Would anyone like to share any thoughts?
>Invite comments<
The client’s trust that you’ll do only good things to them – and won’t hurt them – is key.
What sorts of mental and emotional responses have you had to massage? Did anything surprise you?
>Invite learners to share<
The intimacy of massage – the practitioner’s hands on one’s body – can be unsettling and confusing to some people. It brings up memories of other massages – good and bad. It can bring up memories of other kinds of touch, from one’s parents, lovers, or children.
Massage can bring up feelings of sadness from the losses in one’s life. The deep relaxation can lower one’s psychological shields and allow all sorts of thoughts and feelings to emerge – things that may have been long buried in order for the person to cope.
If the person receiving the massage has in the past been traumatized from physical or sexual abuse, the massage can feel nurturing and healing – or troubling.
Even after getting to know our clients, we can never fully know their past experiences – and what kinds of feelings massage therapy brings up for them. This is why it is so critical for us to establish and maintain clear boundaries. These are what will allow your client to feel safe.
>Ask a student to lead the class in a stretch<
Boundaries (25 minutes)
Reference text pp. 43-48
The massage therapist’s job is to respond with exquisite sensitivity and grace to whatever comes up for the client. Relying on his or her good will and professionalism, the massage therapist ensures that both parties, the practitioner and client, are at all times physically and psychologically safe.
What are ways that we can help our clients to feel physically safe?
Look for: appropriate draping and appropriate touch.
Psychological safety can be more difficult to pinpoint, but is just as important. What are some ways that we can help our clients to feel psychologically safe?
Invite comments and look for: maintaining confidentiality, listening whole heartedly, staying within boundaries when giving advice to clients, encouraging the client to voice how they are feeling.
An essential aspect of psychological safety for the client is the ability to say no at any time. Information, knowledge, and the right to refuse offer personal power to someone who is in a relaxed, vulnerable state. Don’t ever surprise the client.
Feeling safe largely boils down to maintaining boundaries.
What do we mean by “boundary”?
Look for: A boundary is a clear definition of what you will and will not do and what you will and will not accept from others.
Setting boundaries is your professional and ethical responsibility. You’re responsible to yourself, to your clients, to your colleagues – and to the profession of massage therapy itself.
How much of your personal life will you share with your clients? The client, just trying to be friendly, says, “Tell me about you! Are you married?” What will you say?
>Invite learners to share<
Will you share your marital status but not answer questions about where you live? How about your religion? Your finances? Your own ailments?
>Invite learners to share<
Keep in mind that not everyone agrees on all ethical issues – and what constitutes boundary violations. However, what’s most important to keep in mind is to always avoid turning to clients to meet your personal needs. This is one reason why practicing self-care is so essential. We’ll explore how you can effectively manage your self-care in Module 4.
Always remember that the therapeutic relationship is designed to primarily benefit the client – not you.
>Brainstorm graceful ways to deflect client questions and maintain professional boundaries<
>Brainstorm ways to define professional boundaries in and out of the workplace<
How do we define appropriate touch?
Look for: Appropriate touch is ethical (within boundaries of a professional relationship); consensual (the client has given permission); therapeutic (designed to help, not hurt); in the client’s best interests; and meets the client’s needs.
How do we define inappropriate touch?
Look for: Inappropriate touch is anything outside the boundaries of the professional relationship; nonconsensual (the client has not given permission); non-therapeutic (hurts instead of helps); against the client’s best interests; and anything sexual in nature.
Anything the client does not consent to is inappropriate touch.
>Discuss issues of sexuality in relation to maintaining professional boundaries in a therapeutic relationship<
Because of the closeness of contact between massage therapist and client, the feelings that come up may be confusing and disturbing for both. It’s important to differentiate between one’s thoughts and one’s actions (including what one says).
You are responsible for your behavior – what you do or do not do.
There are different kinds of boundary violations. The most obvious one is physical – unwanted, nonconsensual, or harmful.