|Somatic practitioners are in a position
of power over clients. How that power is handled is the mark of
an ethical professional. Photo by EyeWire Images.
The following exercise helps clarify your core values. Take your
time. Ask yourself the following questions and write your responses.
When you finish this exercise, we recommend you discuss it with
a fellow student, friend or colleague. Engaging in a dialogue with
others is another way to more fully explore your own values.
• What values are most important to me?
• What are the character traits I deem essential?
• Who and what have been major influences in my values development?
• What are my attitudes and beliefs about wellness?
• What are my attitudes and beliefs about my profession?
• What are the most important personal characteristics for
someone in my field?
• What are the key professional characteristics for someone
in my field?
• What are the most meaningful attributes of an effective
practitioner in my field?
• How do my values affect my work with clients?
• Which of my personal values conflict with professional rules
• Which of my personal values
conflict with laws or regulations?
• How do my values enhance my
law holds bodyworkers to a higher standard or behavior than professionals
in other businesses who don't have such a marked power differential
over their clients.
Everybody Does It
When Johnny was 6 years old, he was with his father when they were
caught speeding. His father handed the officer a twenty dollar bill
with his driver's license. "It's OK, son," his father
said as they drove off. "Everybody does it."
When he was 8, he was present at a family council presided over
by Uncle George on the surest means to shave points off the income
tax return. "It's OK, kid," his uncle said. "Everybody
When he was 9, his mother took him to his first theater production.
The box office man couldn't find any seats until his mother discovered
an extra $5 in her purse. "It's OK, son," she said. "Everybody
When he was 12, he broke his glasses on the way to school. His Aunt
Francine persuaded the insurance company that they had been stolen
and they collected $75. "It's OK, kid," she said. "Everybody
When he was 15, he made right guard on the high school football
team. His coach showed him how to block and at the same time grab
the opposing end by the shirt so the official couldn't see it. "It's
OK, kid," the coach said. "Everybody does it."
When he was 16, he took his first summer job at the supermarket.
His assignment was to put the overripe strawberries on the bottom
of the boxes and the good ones on top where they would show. "It's
OK, kid," the manager said. "Everybody
When he was 18, Johnny and a neighbor applied for a college scholarship.
Johnny was a marginal student. His neighbor was in the upper three
percent of his class but he couldn't play right guard. Johnny got
the scholarship. "It's OK, son," his parents said. "Everybody
When he was 19, he was approached by an upperclassman who offered
the test answers for $50. "It's OK, kid," he said. "Everybody
Johnny was caught and sent home in disgrace. "How could you
do this to your mother and me?" his father said. "You
never learned anything like this at home." His aunt and uncle
were shocked. If there's one thing the adult world can't stand,
it's a kid who cheats...
From: The Power of Ethical Management, Peale and Blanchard3
The Ethics of Touch
following is the first of three excerpts that will be published in Massage
& Bodywork from the newly released book, The Ethics of
Touch, by Ben Benjamin and Cherie Sohnen-Moe. (SMA Inc., Tucson,
The topic of ethics can often be confusing, difficult and at times downright
baffling. Although debated by philosophers for millennia, agreeing upon
what is “good” and “bad” remains difficult.
So much depends on the situation. Not all ethical breaches are gross
violations of conduct; much unethical behavior is subtle. Furthermore,
being ethical is not limited simply to knowing and following ethical
codes, laws and regulations. Ethical behavior also involves striving
to bring the highest values into one’s work and aspiring to do
one’s best in all interactions: doing the right thing in the right
manner for the right reasons and with the right attitude. Tom Peters,
acclaimed author of In Search of Excellence,1
sums it up like this: “High ethical standards — business
or otherwise — are, above all, about treating people decently.
To me (as a person, business person and business owner) that means respect
for a person’s privacy, dignity, opinions and natural desire to
grow; and people’s respect for (and by) co-workers.”2
For somatic practitioners ethics can be especially complex as they encounter
ethical issues and dilemmas that do not always have simple, apparent
solutions. In many cases practitioners may inadvertently act unethically
because they have not considered the relevant issues. Expanding their
grasp of ethical principles helps practitioners understand the impact
of their behavior on clients and provides the knowledge and tools to
act appropriately. The overall purpose of ethics is to guide professional
practitioners so that clients’ welfare remains the first priority.
In essence, self-accountability is the cornerstone of ethics. It is
about who you are and what you do when no one’s watching you.
When you have a well-developed sense of self-accountability you are
honest with yourself, and you are answerable and fully responsible for
what you say and do at all times. You have the ability to look beyond
the immediate moment to consider all the consequences and know if you
are willing to accept them. You have personal ethics. As individuals
it is our capacity for self-accountability that keeps us functioning
ethically and responsibly.
Personal ethics is the precursor to professional ethics: you are not
likely to be more ethical in your professional life than you are in
your personal life. As the saying goes, “No matter where you go,
there you are.” In other words, you are most likely dishonest
in your business affairs if you are dishonest in your personal life.
Likewise, if you cannot keep the secret of a friend, your client’s
confidentiality is at risk.
Practical Application for Professionals
Forethought and understanding help practitioners avoid a myriad of problems
throughout their careers. Awareness of these potential issues and careful
consideration assist healthcare professionals to avoid thoughtless errors
in judgment. Below are a sampling of actions and behaviors generally
considered unethical by professional codes of ethics.
Practicing Beyond Scope of Practice: Doing spinal adjustments,
massage or counseling without appropriate training.
Misconduct: Watching a client undress or hugging a client in
a sexual way.
Misrepresentation of Educational Status: Calling yourself
a craniosacral therapist after taking a three-hour workshop.
Financial Impropriety: Charging a cash-paying client
a different fee than an insurance-paying client.
Exploiting the Power Differential: Asking a stock broker
for financial tips during a treatment.
Misleading Claims of Curative Abilities: Telling a
client you guarantee her pain will be gone in two sessions.
Accessibility: Refusing to adapt your office (or making
some reasonable accommodation) for those with physical challenges.
Bigotry: Refusing to work on someone due to race, religion,
size or sexual orientation.
Inappropriate Advertising: Using a provocative picture
in advertising; presenting misleading qualifications.
Dual Relationships: Dating a client.
Violation of Laws: Practicing out of your home when
it is not permitted by law.
Confidentiality: Name-dropping famous clients; telling
a spouse details about his partner’s session.
Contraindications: Treating a client when you are sick/infectious;
ignoring signs of conditions that preclude physical contact.
Informed Consent: Working on a minor without parental
knowledge; treating someone’s injury without permission.
A satisfying and balanced life occurs when your values are in synchrony
with the way you lead your life and run your business. Invest the time
in exploring your values. After all, they are the major conscious and
unconscious influences on the decisions you make throughout your life.
Many conflicts in one’s life, both professional and personal,
arise because there is a clash of values either within oneself or among
others. (See “Core Values Assessment,” page 70.)
To behave responsibly and ethically, every practitioner must intimately
understand a number of core psychological concepts. A lack of psychological
savvy is no longer a valid excuse for inappropriate behavior. These
basic concepts are essential for all practitioners to understand. Practitioners
must have a thorough understanding of the meaning of: the therapeutic
relationship; power differential; transference; countertransference;
projection; repression; and denial. These concepts create the bedrock
of ethical decision-making and responsible behavior in all professional
and (as a bonus) personal relationships.
The major elements in a therapeutic relationship are: there is a client-centered,
fiduciary relationship; the time together is structured; each person
has a clear role; the environment is safe; and there is a power differential.
The therapeutic relationship is a very special kind of relationship
and is often referred to as client-centered. Client-centered means that
every action that the practitioner takes is in the service of the client’s
needs and not the practitioner’s needs. Trouble often begins when
the practitioner takes an action just because she feels like it and
not because it is therapeutically necessary. Client-centered also means
that the client has a voice in the process and must agree to the course
of treatment for it to proceed. In the client-centered relationship
the client has the right to expect that the practitioner always acts
in the client’s best interest. When this occurs the client feels
safe and attended. The client-centered relationship considers the client
as a partner who shares decision-making power. In The Power of Touch,
Phyllis K. Davis, Ph.D., describes a list of the characteristics of
an “effective healer” that includes being motivated by the
needs of the client.4 She emphasizes that creating
a space for a supportive and nurturing environment begins with the practitioner’s
commitment to personal and professional excellence. In this environment,
overall health improves and enables everyone the practitioner touches
to make a fuller connection with their lives.
All healthcare practitioners have a fiduciary relationship with their
clients. Fiduciary is a term that’s applied to a professional
in whom a client places his trust. The client is putting his well-being
in the hands of the practitioner and there’s an implicit contract
that the practitioner places the client’s interests above and
before the practitioner’s. 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 to individualize care for a particular
client, the fiduciary principle and the client-centered approach remain
as the guiding parameters of care. The practitioner/client relationship
and the treatment choices must be continually monitored. Also, 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 level of a power differential.
Other elements of the therapeutic relationship are that the time spent
together is limited and structured. The client comes 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
comes for help and the practitioner is there to help the client.
The client has the right to expect that the emotional and physical environment
is safe and does not include inappropriate personal comments or sexual
It is difficult to understand the therapeutic relationship between client
and practitioner without comprehending the dynamics of power in a therapeutic
relationship. There is a natural power differential in many but not
all relationships: between parent and child; between teacher and student;
between employer and employee; and of course between healthcare practitioner
and client. A parent, teacher, employer or healthcare practitioner has
the more powerful position. They are the authority figures whose actions,
by virtue of their role, directly affect the well-being of the other.
The child, the student, the employee and the client are in the more
vulnerable position. In theory, and in ethical practice, the power differential
exists for the purpose of bringing benefit to these more vulnerable
individuals: the child’s well-being should be enhanced by the
parent’s care; the employee should benefit from the employer’s
The power differential is inherent in any therapeutic relationship.
There is an implicit acknowledgment that the practitioner has more knowledge
in this area than the client. In the healthcare field the power differential
is amplified by the physical aspects of practice. The client takes a
position — usually lying or sitting — in which he allows
the practitioner access to his body. The practitioner positions herself
within the client’s physical space, often leaning over the client.
Furthermore, in many professions the client is partially or fully unclothed.
Although draping is used for privacy, the psychological effect of the
unclothed client and the clothed practitioner increases the imbalance
of power. Finally, as the practitioner’s hands make physical contact
with the client’s body, the client’s physical safety is
literally in the practitioner’s hands.
The power differential in a relationship such as this requires consideration
of two questions. The first seems obvious: How is the person with more
power (in this case, the practitioner) handling that power?
The person who holds the power in the relationship may be tempted to
misuse that power. The practitioner could take advantage of clients
physically, emotionally, financially or professionally. Resentment usually
brews when a client is put in an awkward position. Consider the following
• A practitioner is treating a client who happens to be a lawyer
and asks, “Since I have you here, could you just answer this quick
little question I have about my divorce?”
• A practitioner who is running in a charity race solicits sponsorship
during a session.
• During a session the client begins talking about an executive
whom the practitioner has wanted to meet and the practitioner asks for
a personal introduction.
To maintain an ethical practice, the person in power must regularly
say “no” to something she could easily get and must instead
choose to pay special attention
to the needs of the person with less power. The practitioner must consciously
decide to maintain the integrity of the client’s boundaries in
a situation where the client has significantly relaxed those boundaries.
Clients frequently test boundaries by offering things that may be inappropriate.
For instance a client suggests that he tells you about some exciting
new stock options while receiving a treatment or a client volunteers
to take your computer home to repair it because he sees you are having
trouble with it.
The second question is not so obvious: How is the person with less power
responding to the other’s use of power?
The answer to this second question may be difficult to determine because
of the explicit power dynamics in professional helping relationships.
It is the practitioner’s responsibility to be aware of how the
power differential may be affecting the client’s ability to raise
Consider this: The increased perception of the power differential in
a hands-on session puts the client in a highly vulnerable position.
The client feels less free to defend against intrusions or to question
unexpected behavior by the practitioner. The client may feel uncomfortable
about raising concerns, complaining about the treatment process or making
requests. The client may find it difficult to say “no” or
to question the practitioner’s behavior, even if the client feels
uncomfortable or mistreated. The client may even refrain from communicating
anything that could possibly be construed as negative for fear of reprisal
An active business woman has received massage twice monthly from
the same massage therapist for over two years. She recently began having
sharp pains in the big toe of her right foot. On one occasion, she mentioned
the pain to the practitioner at the beginning of the session in hopes
that the therapist would spend some time vigorously working the area.
As the massage proceeded, the practitioner moved through the foot area
Disappointed, the client debated about asking the massage therapist
to go back to the toe area. She couldn’t understand why it was
so difficult to ask. After some thought she realized she felt vulnerable
lying naked on the table having someone standing over her, touching
her body (even though she was covered by a sheet). And asking someone
to do something to her (especially on a big toe) might seem silly. She
might be imposing, or maybe the practitioner would become upset since
it was close to the end of the session. She did not want to appear needy
Finally, the client muttered in a very unsure, childlike tone, “Um,
ah, do you think, I mean, would it be OK, could you, um, work on that
toe that hurts?” The practitioner’s response? “Sure!”
In this case, even though the client and practitioner had worked together
for a couple of years, the client became hesitant to make a request
out of a sense of vulnerability, a fear of appearing foolish and concerns
over possibly upsetting the practitioner. The psychological effects
of the power differential in this case remained unperceived until a
need arose requiring the client to make a request. And even after recognizing
the effects, the client still asked as a child would for something she
is not quite sure she should have.
Because of this psychological dimension, a growing trend in the healthcare
world is to encourage clients to take an active role in the decision-making
process of their healthcare. This is the way most somatic practitioners
interact with their clients. Getting clients to take responsibility
is not always easy. Unfortunately, it is difficult to reprogram a lifetime
of “the doctor knows best.” Realize that even though you
may be doing your best to foster an atmosphere of equality, the power
differential always exists on some level in a therapeutic relationship.
Ethics is an exciting, vital field of study for all professionals. Life
is more fulfilling and satisfying if we live with honor and integrity
in all our relationships and business dealings. Clarifying your values
and understanding core psychological concepts is the first phase in
developing a solid ethical foundation. The next steps include: expanding
your abilities to resolve ethical dilemmas; learning to better manage
boundaries; enhancing communication skills; improving your practice
management capabilities; setting up a support system; and learning to
effectively work with special populations. Running an ethical practice
takes a life-long commitment to self-evaluation and exploration. We
are delighted to join you on this journey.
1 Peters, T.J. and Waterman, R.H. In Search of Excellence.
New York: Harper & Row; 1982.
2 Peters, T.J. Ethics is an everyday, lifetime endeavor. The Arizona
Daily Star. 1989 Sept 26.
3 Peale, N.V. and Blanchard, K. The Power of Ethical Management.
New York: William Morrow and Company, Inc.; 1988. 30-31.
4 Davis, P.K. The Power of Touch. Carlsbad, Calif.: Hay House,
Ben Benjamin holds a doctorate in education and sports
medicine. He is the founder and president of the Muscular Therapy Institute
in Cambridge, Mass., and has been in private practice for 40 years.
He can be contacted at email@example.com.
Cherie Sohnen-Moe is a business coach, international workshop leader
and business owner since 1978. She was in private practice for many
years as a massage practitioner and holistic health educator. She can
be contacted at firstname.lastname@example.org.
To order The Ethics of
Touch, call 800/786-4774 or visit www.sohnen-moe.com.
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