01.03.2004

Bodywork Within Boundaries

The issue of ethics in bodywork extends well beyond imposing a set of rules. As Hawaiian Lomilomi practitioner Oscar Naval explains, it involves taking responsibility for all aspects of our body from the physical to the spiritual and setting the boundary markers of relationship, mutual respect, communication and personal values.

The issue of ethics in bodywork extends wellbeyond imposing a set of rules. As Hawaiian Lomilomipractitioner Oscar Naval explains, it involves takingresponsibility for all aspects of our body from thephysical to the spiritual and setting the boundary markersof relationship, mutual respect, communication and personalvalues.

Body Workers must set high standards
What are the ethical boundaries of the professionalbody worker towards his or her clients? Ethics in bodyworkneed to encompass the three Rs: Respect, Relationship,and Responsibility. Body workers must maintain respectfor their client's interests, dignity, rights and needs.Respect also extends to honouring the client's process,being present, listening, and respecting their mental,physical and spiritual privacy. Another aspect of ethicaltreatment of clients is the quality of the practitioner'srelationship with their higher power, self, and others.At all times, the professional must maintain a therapist/clientrelationship with integrity, confidentiality, and diligencein practice and duties and provide the service for whichthey have trained. The final R, ethical responsibility,denotes accountability for the quality of care givento clients and maintenance of high standards in personaland professional arenas.

Take responsibility for your own therapy
As a client, you are responsible for your own life process- you have autonomy and self-determination. And youneed to take responsibility for what you wish to accomplishwhen you visit a therapist. When you come to a bodyworker you are consenting to certain physical and possiblymental, emotional, and spiritual processes. The professionalpractitioner has an obligation to be clear on the abilitiesand limitations of the services being offered, but youare ultimately responsible for your own wellbeing. Boththe client and the practitioner must consent to therelationship and services being rendered. Informed consentis a protection process for the consumer. It requiresthat the person understands what will occur and is participatingvoluntarily. Certain questions must be addressed suchas: What services are provided? What are the goals ofthis service? What behaviour is expected of the client?What are the practitioner's qualifications? What arethe financial considerations? How long will this take?What are the limits of confidentiality? True informedconsent allows you to evaluate the options availableand the risks involved in the particular therapy. Aboveall, client autonomy and self-determination are yourright.

The temple of our soul
Traditionally, when we think of the professional massagetherapist, we visualise a person trained in a backgroundof anatomy and physiology who manipulates the physicalbody in some mechanical fashion. But, the entire beingconsists of something greater than just the physicalbody. Western culture treats the body as a machine separatefrom emotions or spirit, and modern psychology is conventionallyviewed as a mental science. Modern society compartmentalisesour processes of learning and healing: physicians healthe body; psychologists the emotions, educators shapethe mind, ministers adhere to the spirit, and as humanswe have to will to accomplish our intentions. But theemotions, mind, will and spirit are all housed in thisphysical body, the temple of our soul. The emotional,mental, and spiritual bodies and will to move forwardare equally as important as the physical being. Humansare complex beings - you cannot separate out these partsof self but you can focus on one aspect alone. So, whatbody is your bodyworker working with? Your bodyworkprofessional should acknowledge the scope and limitationsof their therapy.

Know what you want from bodywork
As a client, you need to come with a clear intentionof what you wish to accomplish. For example, I oftensee clients who are just 'stressed-out' and come withthe intention to relax. The scope of the traditionalmasseuse is the physical manipulation of soft tissueand/or connective tissue with the intention of relaxationand maintaining/improving health. But, what if you don'thave a clear intention? Sometimes you may be in an emotionallycharged state, or just confused. Be sure to communicateyour state of mind to your bodyworker who may now stepinto a counselling role to address the mental body aspart of your session. Everything that is said must bekept in strict confidence. But conscience, professionalliability, and local laws do require a limit to confidentiality.If a person confides to a professional therapist thatthey are about to do harm to themselves or others, thetherapist is obliged to report what was said in confidenceto crisis support or legal authorities. On the otherhand, some people just wish to chat when they have amassage. One of my clients said, "You are like a bartender,but without the alcohol." Sometimes this is all thesupport a person needs to guide them along their personalpath. Working with the physical body may arouse sexualenergies. Freud's libido and Reich's orgone theoriesconclude that human beings have strong responses connectedwith their sexual energy. This energy is the vital creativepower and a fundamental energy source of our being.All bodywork professionals must clearly state theirethical boundaries when it comes to sexuality and getthe client's permission for all procedures. Every clientcan self-determine the physical contact, the drapingof towels/sheets and extent of undress during theirbodywork session. As a male therapist, I constantlytell my clients (especially female) to undress to wherethey feel comfortable and I first ask their permissionbefore continuing with any procedure. Some clients havecome for more than just a relaxing massage. They havethe intention to heal emotional issues by working withthe body and emotions or trauma held in the body. StuartBlack, an international trainer and member of the InternationalCore Energetics (body-centred psychotherapy) Board ofDirectors, states: "The moment you (the massage therapist)ask someone how they are feeling emotionally you havegone beyond the scope of massage and become a psychotherapist."As a client, you have implied consent to proceed inpsychotherapy by answering how you are feeling emotionally.You need a clear boundary of how you wish your bodyworksession to proceed. The practitioner, in turn, mustbe aware of the client's emotional and mental statewhen they offer personal, emotional, or psychologicalinformation. The ethical principle of "non-maleficence"states that the procedure shall do no more harm andprevent harm from happening. The combination of thephysical, mental, and the emotional bodies in a sessioninvolve very, very powerful energies. Combining thoseenergies with sexual issues in a session may lead toeither a very powerful healing or a greater trauma tothe psyche. As a client, you need to be aware if yourtherapist has the training, experience, supervision,a crisis committee, and peer support of other professionalsin the medical and psychiatric community to ensure thosepowerful energies transform and heal. Shelley Towns,a Body Therapist in Albany and Fremantle, works withthe physical manipulation of the body but also the powerfulenergies of the mental, emotional and spiritual bodies.Many of her clients come specifically for body-centredpsychotherapy to heal various traumas to their bodiesand psyche. So how does she set the boundaries of asession? "After a short chat with a client I can sensewhether that person can go deeper into the physicalbody and confront their emotional and/or spiritual issuesas well. I always ask for (spiritual) guidance in knowingwhether to go deeper with this individual or just backoff. Some people just need a massage," explains Shelley.In her work she has a strong support community as wellas a crisis committee of professionals across Australiaand internationally. There is no clear-cut formula fora therapy session and the spiritual aspect of the client/therapistrelationship must be acknowledged.

Spirituality is part of your healing
The ethical principle of "beneficence" states that thetreatment should contribute to the client's overallwellbeing. Many therapists consider spiritual guidanceis essential in their own life as well as in helpingthem best serve their clients. The spiritually awarepractitioner's life includes meditation, prayer or aconnection with spirit in their personal and professionalroles. Different forms of bodywork require a surrenderingto God, spirit, or a higher power. In Hawaiian Lomilomimassage, for example, 'Pule' (prayer in Hawaiian) isrequired during the training and is an integral partof the massage. Clients need to be aware of their ownspiritual beliefs. For example, your practitioner maybe a devout Catholic and may openly use those symbolsand prayers. If you have a strong feeling about theuse of a specific religion or artefacts during treatmentthen you need to openly share that feeling because suppressingit will negatively effect your session. In all cases,spirituality is an aspect of your body whether you believein it or not. So God, Jesus Christ, Ala, Shiva, Gaia,a universal energy, higher power, or 'The Force' isan essential part of your body and your healing.

'Physician heal thyself!'
An essential part of the professional therapist's trainingis to experience their therapy. As a client if you intendto work with the mental, emotional or spiritual bodythen you need to know your therapist has worked on themselveswith their therapists. Shelley Towns agrees: "Only tothe degree that the therapist has travelled down thatsame road can the therapist lead someone else." Professionalbody workers must continue to question their own personaland spiritual growth. Among the Hawaiian people, forinstance, "Ho'oponopono" means 'to make right' withGod, yourself, and others. It is a daily practice totake responsibility for our own issues and to be vigilantin evaluating where we are in our personal growth. Whatflows from our own internal life force is what flowsout through our hands as practitioners. Professionalknowledge, too, is an ongoing need demanding that weread the latest literature and attend conventions, seminars,workshops, and retreats.

Seek out support
For both the client and professional practitioner, havinga strong 'family' structure is also very important.This doesn't just mean a biological family - it maymean your best friend who understands and doesn't judgeyour life process, an associate you can confide in,a crisis committee you can contact, or a discussiongroup. The combination of the physical, mental, emotional,and spiritual bodies and the will to deal with verypotent and vital energies requires a strong structureso that bodywork may augment your personal growth. Thesimplified definition of ethics is what is 'right.'But, what does that really mean? I believe it is theextent to which you take responsibility for your personaland professional life. In giving and receiving bodywork,it is the respectful relationship and open communicationbetween the client and the bodywork professional, requiringan understanding of the different aspects beyond thephysical body. Perhaps the guiding principle shouldsimply be: "Do unto others as you would have done untoyourself."

More information on ethics inbodywork can be found on the NCBTMB (National CertificationBoard for Therapeutic Massage and Bodywork) click here

The ethical principles and "Code of Ethics" used thisarticle are from the book 'Mosby's Fundamentals of TherapeuticMassage' by Sandy Fritz.

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