Ethics of touch Book

5 step process in case management

-assessment -planning -implementation -coordination -evaluation

Procedures, techniques, and other regulations

-assessment vs diagnosis -education vs prescribing -technique restrictions -sexual enterprise

Feedback

-can be useful and constructive in our personal and professional lives -critical in proper functioning of all social systems -advantage: learn what is working/not working for clients, increased receptivity of clients

Permission to consult with the health care team

-inform client with whom info will be shared to providers -respect client's confidentiality -limit conversations to information pertinent to the client's condition and only in private

Types of mentoring

-informal --starts on its own --sharing hands-on techniques/business ideas -formal --assigned by a company, school, association

How to start and run a peer support group

-informal or formal -step 1: decide on format/frequency/goals (first few meetings) -

Interview potential supervisors

-initial contact by phone/email/video -formal interview or first session -questionnaires -face-to-face interview -prepare questions in advance

Externship

-learning programs offered by educational institutions to give students -short practical experiences in their field of study -shadow practitioners (observe/ask questions/live environment)

Common ethical issues

-legal considerations -financial considerations -marketing considerations

Greatest level of public protection/most restrictive

-licensure

Different types of coaches

-life coaches (achieve successful balance between personal/work lives) -career coaches (decide through careers) -business coaches (help start/grow business) -financial coaches (money issues) -leadership coaches (learn/practice skills to grow business by adding employees/lead/etc)

Sexual enterprise

-limiting hours of operation -physical restrictions -not allowing practitioners to work out of homes or do out-calls -annual fingerprinting -cross gender treatments illegal -from government regulations

Distinction between sex, touch, intimacy

-lines blurred with culture, behaviors, experiences, misuse of language

Step 2 resolution model: identify the potential issues involved

-list and describe the critical issues -evaluate the rights, responsibilities, and welfare of those affected by the decision -consider the basic moral principles of autonomy, beneficence, non-maleficence, and justice -ascertain the potential dangers to the practitioner, client and the profession

Ethical retailing

-list the types of products that are appropriate to sell in your practice -list the types of products that are inappropriate to sell in your practice -identify the types of products that you are not certain are appropriate to sell; describe your concerns about each of these items -what experiences have you had in purchasing products from a healthcare provider -describe how you can sell products without using "hard-sell" tactics or taking advantage of the power differential

The assertion sequence

-minimize misunderstandings in boundary discussions -after the face agreement discussions (include disclaimer if needed, if boundary was crossed after the 5 parts of stage 1)

Discuss tax collection requirements

-with the state and company you buy products for resale

The _____ movement provided the political environment to support the ongoing research and recognition of abuse

-women's

Appointments

-written, straightforward establishing clear boundaries -policy statement should include the length of initial and follow-up appointments, guidelines for scheduling changes, lateness, cancellations, and emergencies

The assertion sequence 4 stages

--stage 1: agreement discussion (what, why, consequences, obstacles, recap) --stage 2: follow-up (desirable behavior reinforcement, ongoing reminders, broken agreement discussion) --stage 3: confrontation meeting (explanation, solution generation, consequences, reflection, refocus, recap) --stage 4: termination (work with a supervisor if needed)

Prevalence of sexual abuse

-1/6 women and 1/33 men has experienced an attempted or completed rape as a child or an adult -18% of women and 3% men experienced rape or attempted rape -1/3 women women experienced abuse in childhood -more females than males -more perpetrators are men -1/5 clients will be a survivor of sexual abuse and many others victims

Coordination (step 4 in client management process)

-2+ providers involved in the treatment plan or otherwise providing ongoing health care needs of the client -good communication required for effective coordination of care

Key factor one in scope of practice: the law

-4 levels of gov: federal, state, county, local municipalities (city/town) -4 requirements: licensure, certification, registration, title protection

How mastermind groups work

-6-10 people -varied backgrounds/experience/areas expertise/professionals -meet on regular basis; brainstorm with each other/feedback/secret of success/goals/sharing -keeps track/accountable with goals -provide business leads and client referrals -any project/goal

No body in the ____ and ____

-C1 and C2

Health insurance portability and accountability act

-HIPPA -4th amendment (right of people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures shall not be violated) -1996

Scope of practice

-Hippocrates "do not harm" -4 key influencing factors: the law, educational training, competency, self-accountability -the where, when, how a professional may provide their service or function as a professional

Coaching

-International Coach Federation (ICF) (largest coaching/credentialing/support organization in the world -coaching: partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential -

Key factor 3: competency

-ability and proficiency -once the training hours are completed -pass a written exam -different per state

Barter exchanges

-National Association of Trade Exchange (NATE) or International Reciprocal Trade Association (IRTA) -more than occasional barter -International Trade Exchange (ITEX) -International Monetary Systems (IMS -selling goods and services to other members in exchange for trade dollars (valued at equivalent of cash dollars) -trade dollars are debited from the buyer's account and credited to the sellers account (then trade with other exchange members) -function like a bank -better if there are large enough member base in potential client pool

Employees

-National Labor Relations Board (NLRB): social media and labor relation issues --based on national labor relations act (nlra): face to face, phone meetings, online --right to discuss conditions of employment with fellow employees -keep social media policies general --establish roles/responsibilities/legal compliance/branding/purpose/values -consider have 2 social media policies: job/personal life -review NLRA guidelines

Communication with referring PCP

-PCP: doctor, nurse, chiropractor, acupuncturist, naturopath, physician --diagnose the client's problem, orchestrate treatment, refer to adjunctive therapist -practitioner provides referring PCP with clear, complete information so that she can give the client best possible treatment -disagreements with PCP not client

Sexual misconduct continuum

-Sexual misconduct: sexual intercourse, gestures or expressions that are seductive or sexually demeans to a client, failure to ensure a client's privacy, sexual comments about a client's body or clothing, etc --power differential -sexual harassment: in the workplace to staff of a lower level --quid pro quo (demand for sexual favors in exchange for job benefits) --hostile work environment (unwelcome acts or inappropriate displays that make job difficult

Almost all material are copyrighted the moment they are written

-a formal copyright notice isn't required -illegal to reproduce almost any new creative work (other than under fair use) without permission and copyright is still violated whether you charge money or not -facts and ideas can't by copyrighted, but their expression and format can -obtain permission to use the work and give proper credit

Declining potential new clients

-a full practice -inability to help -countertransference

Communication

-ability to send and receive information -effective verbal and written communication -lines of communication clearly defined and easily utilized -relevant documentation: professional, accurate, succinct, electronic, hipaa compliant

Denial (defense mechanism)

-active refusal to recognize or acknowledge the full implications of an undesirable reality -conscious mind

In a group setting, clinical supervision undertakes 4 functions:

-addressing the relationship issues that arise between clients and practitioners -functioning as a support group for the participants -serving as a forum for didactic instruction on important psychological concepts (projection/transference/countertransference) -training the participants in supervisory skills so that they feel confident continuing this helpful type of coaching by themselves at a later date without the supervisor

7 steps to conflict resolution

-adopt an attitude of resolution -listen carefully to each party's stories -allow a preliminary vision to arise with all parties -allow people to express their disappointment and then bring everyone into the current movement -agree (at least in principle) to create a new vision -design a new agreement -acknowledge resolution

Power differentials

-all therapeutic relationships -practitioners knowledge and status place her in a position of authority in relation to the client -negative impact on client's ability to communicate effectively

State licensing boards and professional organizations

-alone or in conjunction with the civil/criminal actions -one result: loss of licensure to practice or part of the organization --deprive the practitioner of a livelihood --prevent victimization of others by the same person -insurance usually pays then the rest is the practitioner

Evaluating the potential risks

-along a continuum -high risk=strong need or emotional component -between practitioners too -increase level of intimacy=potential harm -increase power differential=increase vulnerability of client (clouded judgement?) -who initiates the relationship (practitioner=power differential, client=either way) -the professional (not client) is always accountable -more mature=ethical (understands) -what are possible outcomes of the dual role -if bring negative consequences=not good -takes courage to decline the relationship if needed

Complex PTSD (CPTSD)

-alternate between opposing psychological hyper-awareness and numbness to balance; forgetting to fear -prolonged, repeated trauma -no guideposts for worthiness; violations of boundaries

Ethical guidelines in hospital and hospice settings

-always be careful to recognize the power differential in emotionally charged situations and refuse to exploit this for personal benefit -avoid the imposition of one's own cultural, ethnic, and religious beliefs and practices onto a patient or family and instead mx sensitivity to individual differences -mx clear boundaries to enhance professional and avoid personal involvement with patient and family members -always respect family privacy

Communications beyond the treatment room

-ambiguity (unclear message) -privacy (medical records/phone messages) -professionalism (image and credibility)

Legal considerations in group practices

-an association --one roof, share expenses, not share profits -a partnership --association shares profits/revenues -single legal entity --all expenses, profits, liabilities, allocated among the owners; partnership, corporation, limited liability company

Establishing appropriate intimacy

-appropriate is one way intimacy -already violated cultural taboo with any touching -need for safety: talks to get personal info from the other -self-care from others in work (i.e. supervisor?)

Most of the ethical problems around social media

-are due to ignorance rather than malice

Transverse foramen

-arteries run through them

Tips for creating a position w/in a hospital or hospice that supports a strong ethical framework

-ask to have access to patients medical history -ask to be given privileges to chart in the electronic medical record -offer to provide brief "in-service" trainings to clinicians in facility or unit -ask to be included in hospital wide notifications/trainings/updates -ask to be invited to grand rounds and other hospital gatherings that relate to care planning, etc -ask to be affiliated with a department in the hospital that relates to what you do -get connected with the employee health department/office to ensure that you have all immunizations and protections in place -establish a connection for professional supervision

C-1

-atlas

C-2

-axis

What are boundaries

-barriers -limits -borders -lines that separate people from environment and other people -clothing -elusive/personally discernible -define your personal space (area occupy which feel under your control) -protect emotions/thoughts/safety/emotionally -fluctuate (idiosyncratic: reflect likes, cultural background, history, etc/contextual: change on situation) -stressful/possible negative reactions/sensitive -sometimes unaware of it

Financial considerations

-barter is a taxable income (deductible); personal expenditures are considered draw/profit and not deductible; 1099-B form -equal bartering; check prices with other vendors; only ones you can fulfill

Touch

-basic human need -US is low-touch culture; from media and family (punishment) -discouraged to touch others in US starting from very young age -different in other countries -use food to satisfy need for comfort -begins in the womb -reduces stress in all ages (babies to older)

Social media ethics

-be aware of privacy settings; are they public or privately sent out? -careful what you are sharing online -subject to public notice at all times -brand/image under scrutiny at all times

Checklist for somatic therapy with trauma survivors

-be gentle but clear about boundaries -behave as a team and set goals together -allow the client to control the pace of the treatment -allot a time for closure at the end of each session -be present, inquire and never assume; do not hesitate to check with your client, asking about her experience -develop a referral list of psychotherapist and counselors; establish personal connections with these therapist before you refer them clients -develop the skills that allow to distinguish shock from trauma and to identify them when they're activated -receive bodywork or energy medicine treatment yourself to clear your own system of fatigue and repression, thereby preventing secondary traumatization and burn out -consider volunteering at the local safe house for survivors of domestic violence or joining the bodywork team at an AIDS service agency; volunteer training -cultivate a supervisory relationship and bring issues to your supervisor or peer supervision group

Tips for building rapport with clients (determines long term clients)

-be punctual -greet the client -smile -shake hands -mx good eye contact -give client your full attention -allow ample time for clients to talk and listen carefully to what they say -demonstrate genuine concern -speak with enthusiasm and conviction -use client's name frequently, be sure to pronounce it correctly -use language that the client can easily understand, avoiding unnecessary jargon and complex technical terms

Reconnection (stage 3 of recovery)

-begins to look into the future and imagine an intact self -recognizes but not possessed by it -more confidence to connect with the outside world

Implementation (step 3 in client management process)

-beings once the treatment plan has been formulated -facilitated by ongoing effective communication to assess progress and changing needs over time

Values

-beliefs about what is intrinsically worthwhile or desirable -based upon beliefs and attitudes -desirable rather than right/correct -people don't necessarily agree on what is worthy -value structure may change many times over the course of life -intrinsic

The superior facets work as the ____ on C1 and C2

-body

Minimizing concerns in dual relationship

-both parties share clear understanding of complexities and risks -both parties allocate equal responsibility for the dual relationship -mutual and equal consent shared -seek supervision to ethically manage relationship -clear enforcement and understanding of school boundaries

Special boundary issues

-boundaries (clear and consistent)

Boundary crossings and violations

-boundary crossing (transgression that may/may not be experienced as harmful) -boundary violation (harmful transgression of a boundary) -terms mean different things to different people -inappropriate touch

Step 4 resolution model: evaluate potential courses of action

-brainstorm ideas (first options usually personal values) -enumerate the benefits, drawbacks, and possible outcomes of various decisions -consider the consequences of inaction -contemplate how you'll feel about yourself when all is done

Potential causes of nonverbal reactions

-breaking eye contact -collapsing chest -crossing arms/legs -gasping -grimacing -laughing at odd moments -looking down or away -sighing -squirming -tensing up -tilting one's head

A ____ with a clinical supervisor or group specialist is helpful to define and establish the contract and framework for successful peer support group supervision

-brief start up consultation

Exploring the possibilities

-call or visit your local hospitals and ask if they have practitioners on staff within your specific discipline -create a proposal for the appropriate hospital decision maker that describes the benefits of adding your discipline to their patient care

Key factor 2: educational training

-can be difficult to define a comprehensive knowledge base -personal issue -limits of your training regardless of the laws

Dating former clients

-can lead to legal liability -years mandated by state law before engaging in the relationship -client is most at risk; transference, countertransference, regressive experiences, increase vulnerability, -legal or ethical violations for practitioner -damage reputation of the organization -most straightforward risk=duration/consistency of professional relationship

Helpers in a helping profession

-can neglect themselves -leads to burnout/loss of clients/close business -needs to understand your clients needs come first -what motivates you? -be aware of your needs/keep focus on client -finances are a challenge: charging lower rates/being available to others/clients coming in more often than needed/resentful of income

Sliding fee scales

-can't pay?: let them go, reduce per-session cost by offering clients a prepaid package plan, or sliding fee scale -sliding fee scales: objective method for allowing certain people to pay a reduced fee for your services; awkward; tough to set up in advance; used w/target market in need; best with parameters

Review policies (written) with the client

-cancellation policy: standard for all clients -supervision policy: practitioners professional supervision and their function -code of ethics: give a copy; no social/intimate/sexual/or business relationships with clients -confidentiality policy: mx confidentiality (practitioner), won't ask for details of her history unless she provides voluntarily -collaborative nature of your work: work with psychotherapist/counselor, suggest it if client is not -delayed discovery of sexual abuse: until person settles into a supportive psychotherapy situation, keep list of referrals -level of therapy: which one? -informed consent: addendum to the confidentiality agreement, only you/therapist/supervisor (not by name) knows of situation -disrobing: comfort only, in private only

Reflecting

-capture essence of message in your own words -core meaning -rephrasing -face person, lean slightly, maintain eye contact, not head, briefly acknowledge, copy tone -alert for non-direct statements that don't represent the person's words

Boundary crossings/violations

-careless/uninvited words -sexual misconduct -excessively permeable boundaries -client reluctance to personal disclosure -inappropriate self-disclosure -tardiness -inappropriate use of social media

2 most common practices of concealing income from taxes

-cash payments/barter -exaggerating expenses

Barter

-cashless exchange of goods and services -face-to-face interaction to now a global transaction -simple, legal methods to conserve cash outlays -expanding client base -trade can be useful; clients may refer cash-paying clients

Transverse foramen only in the

-cervical spine C3-C7

Documentation of client sessions

-charting -important/vital -monitor client progress/outcome -condition/treatment only -accuracy -protected under law

Timely documentation

-charting done in timely fashion -during/immediately after a session

Physical and physiological effects of abuse

-chest contracts, cold extremities, contraction of entire body, loss of muscle tone -depression, anxiety

Types of physical abuse

-children: beatings, corporal punishment, food deprivation, aggressive tickling -spousal battery, threat of violence to control, use of physical torture as discipline -more women are injured by battering than in car accidents -assaults/muggings -leaves scars

Office space

-choose an appropriate office location -establish a professional space -set up a space that feels like an office when doing home or hotel visits

The client might have physical symptoms to show unresolved trauma:

-chronic fatigue -insomnia, chronic joint and muscle pain throughout the body -a weak immune system -flashbacks/intense memories

Ethical guidelines for multi-disciplinary practices

-clarify with group the professional image that desires to convey and determine; do you fit in -if joint marketing plan, ask an agreement be reached regarding payment incase someone leaves group -if sell projects, ask for clarity regarding ordering/profit sharing/impact of sales -understand existing dissolution agreement used in practice or insist for the agreement

Working with others requires

-clear and ethical plan that addresses common issues; including a common vision for the establishment and healthcare philosophies

Boundaries

-clear boundaries and effective communication -treat client as a person, not an object -admitting your mistakes -fostering appropriate self-disclosure -encouraging the client to speak up

Type of service

-clear definition of services, including benefits and limitations -areas of expertise, specialization, specific conditions your work addresses, target populations served, special equipment or products used, certain people you don't work with, and description of the referral network of related professionals that you utilize

Communicating boundaries

-client and practitioner boundaries -be proactive in addressing boundary issues initially and throughout sessions -be assertive in communication with language that communicates specifically and clearly (not passive language or aggressive language) -be consistent about your policies with everyone

Treatment done?

-client can function normally, or functional progress has plateaued -client has no significatn symptomatology, or clinic progress has plateaued -client demonstrates self-awareness by identifying situations that exacerbate his condition -client applies self-care techniques to limit exacerbations and to remedy exacerbations when they do occur --focus in on quality of life not a pain free life

Common issues for businesses using social media

-client confidentiality -labor relation issues -brand hijacking -miscommunication -spamming

Signs of transference

-client frequently asks you very personal questions -client calls you at home, though your policy does not -after 2 treatments, client is overly complimentary of your work -client keeps trying to bargain with you -client regularly requests times you don't work -client develops a crush on you -client seems overly attached -client gives you gifts -client invites you to social engagements; rejected you you say no -client asks you do more -client often mentions that you remind her of your spouse -client difficulty mx physical boundary/touching -client difficulty leaving/conversation -client gives you details of personal life/too intimate

Protocol for working with self-disclosed survivors

-client is referred by her psychotherapist as part of psychotherapy process -practitioner is contacted by a survivor who has heard about practitioner through a friend/or benefits of hands-on therapy -current client discloses his status of previous abuse

Boundary crossing signals

-clients pulls away when certain areas are touched -client changes communication style (overly quiet/talkative) -client avoids eye contact -client breathing changes: halts, shallow, increases -client/client significant other makes comments to the staff -client doesn't reschedule -client brings another to stay in the treatment room -client serves you with a compliant

Misuse of power and disempowerment of clients

-clients safety and wellbeing at risk -misuse of power in attempts to help: practitioner tries to override clients autonomy (self determination of client) b/c practitioner is worried about the clients behavior -misuse of power for personal gain (take advantage of clients physically, sexually, emotionally, financially, professionally) -disempowerment of clients (client is vulnerable position)

Handling referrals from outside providers

-clients usually come with an established diagnosis -referral may be formal or informal prescription sessions or treatments -you accept responsibility for care coordination related to the care you provide -timely documentation and communication of client progress to referring provider in writing is central -clients give informed consent for communication between providers

Medical clinics

-clinic is headed by a single practicing physician (pcp) instead of hospital leadership -clinics have limited hours instead of 24 hrs -clinics are outpatient basis -clinics manage patient's wellness care and supervise home treatment regimens for chronic conditions -clinics refer trauma to hospitals

Who helps practitioner define problems and questions

-clinical supervisor --helps practitioner explore internal workings and define appropriate boundaries; determine what actions to correct the situations --validate practitioners problem-solving skills; more effective and empowering resolution

Office ethics

-codes of conduct --conflict of interest (conflicts w/business interests) --compliance (adherence to laws/standards) --electronic resources (hardware, laptops, printers, etc) --insider trading (financial gains on non-public info) --intellectual property (who owns ideas/discoveries/improvements during the work) --professional misconduct (violation of professional code of ethics) --vendor relationships (value sources)

Ethical considerations for employees

-commitment (through action; quality work; long term) -loyalty (avoids associations that interfere w/company) -cooperation (w/laws/regulations/ethical) -obligation (accurate records/concerns to appropriate agency)

Referrals

-common ethical issues (keep secrets? change practitioners based on clients experiences?) -usually good to: say thank you, give them a free session, discount off future session, plant, etc); keeping it standard to all clients -ethical issue when practitioner receives financial remuneration for the referral; a kick back; referral fees

_____ is the primary way in which we build professional relationships; set, mx, negotiate boundaries; empower clients; resolve conflicts

-communication (transfer information from one person (group) to another

Legal issues principle aspects

-complying with local, states, and federal laws -mx appropriate insurance coverage -avoiding slander and libel -honoring copyright -negotiating and complying with contracts -minimizing civil lawsuits -hiring employees -independent contractors

Unethical tax practices

-concealing income -exaggerating expenses -not collecting for remitting sales tax -not filing appropriate tax forms

Electronic messages ineffective when

-concerned about privacy of your comments -trying resolve a conflict -frustrated/irritated/upset -express feelings about something -say things you won't say in person, including negative -ask questions or negotiate issues -giving bad news or other info that may upset (phone instead) -voice tone would provide you with additional key information (phone instead)

Difficult to talk to clients about sexuality/touching

-cultural experience tells them it is improper to talk about it -conversations only with sexual partner(s) or in an impersonal, clinical setting -if you did not have role models for open communication -if you were not respected or were violated

Checklist for somatic therapy with trauma survivors

-conduct a thorough intake interview -asses the recovery stage before consenting to work with a self-disclosed survivor -spend time connecting with the client -consider using subtle, gentle, non-invasive body therapy techniques -invest in education about trauma and shock, and understanding their somatic impact -always remember to ask permission to touch; wait if needed -remind a client that she can change her mind and revoke permission at any time in the session -establish a relational connection first; not touch mechanically -if a flashback occurs, bring the person back to the present immediately -keep regular contact with the client's psychotherapist; have clear, written permission from your client for these conversations

Ethical dilemmas

-conflict of duties/rights, something will be compromised -strong emotional component

Ethical guidelines for multi-disciplinary practices

-consider other professionals in the practice; values etc -how active a role you wish in running of the business and communicate preference to group -consider types of clients and how will your modality fit in -assess potential power and knowledge differentials between you and other group practitioners -before joining, examine benefits of contractor or employee status -clarify interaction levels with other members of group; invest desired time and energy -ask for a contract that outlines your financial obligations to the group; how profits are distributed -insist a code of conduct/policy/procedure manual be written/available/regularly updated

What assists practitioners in sorting out clinical and interpersonal dilemmas; protecting competent care of the client

-consultations

Marketing considerations in group practice

-cooperative marketing is one of the strongest benefits -what part of marketing is done jointly -develop a marketing plan -payment agreement to cover some that leave -create new client booking policy to fairly distribute new clients

Self-accountability

-cornerstone of ethics -doing right when no one is watching -personal ethic are precursor to professional ethics -make decisions that are congruent (consistent/alignment) w/ethical values in each situation -exploring how situation matches up w/own personal ethics is 1st step -take responsibility of person/professional ethics

Social media policy

-corporate contracts can build practice and leverage relationships -accounts set up by one person cannot be transferred to another -legal advice is important

Coaching is not

-counseling or therapy

Peer support group success tips

-create a regular date/time/location to keep things consistent -create a privacy policy and confidentiality policy -decide how formal or informal the group will be -decide on if discussions are limited to one area or what the goal of the group is -start each group with short introductions; decide how much time to take in the meeting -set goals for each meeting

Working successfully in groups

-create an ideal partnership or associate agreement -design a new client booking policy that fairly distributes new clients among all of practitioners -list potential reasons why you would be reluctant to refer clients to an associate -identify reasons why an associate might be reluctant to refer clients to you -designate options to counter any reluctances

Desexualizing the touch experience

-created/structured/sustained -tips --preparation, language, behavior --office space --treatment interactions --practice managment --marketing materials

Client policy statements

-creating boundaries that encourage trust, safety, comfort -define expectations for both -managing practice easier, circumvent awkward situations, conflict resolution, professionalism -points from other documents -increases chances for successful outcome of the services provided -letter, page -areas:type of service, training/experience, appointment policies, client/practitioner expectations, personal relationships, confidentiality, recourse policy -professional tone -periodically review -enforce it

Key components for effective case management

-critical thinking -communication -collaboration --with clear lines of communication, time, cooperation, shared values to suceed

Insurance coverage

-crucial -some areas require specific coverage -anyone can claim a lawsuit -litigation is expensive -ensure policy covers litigation and anything else you need covered -only if you uphold all state/local/federal legal requirements

Establishing a place of safety

-crucial first step in healing process -safe touch with dignity and respect in non-judgmental and non-sexual environment

Intentional practice

-cultivated by professional knowledge and behavior and by proper planning -understand the difference between unintentional and intentional practice -includes learning and practicing technical skills, understanding human nature in somatic relationships, establish boundaries, following procedures, self monitor

Sex

-culturally taboo -depends on intent, emotion, type of touch, area being touched -past: sexual abuse and incest -now: it is everywhere on media and homes -massage/sex is/used to be portrayed together -cultural values for providing group cohesion, group functionality, group security -problems when myths arise as values or facts

Educating

-decrease power differential -reveal choices client's wouldn't have had -clients take more active role in own healing -referring to others -auditory/kinesthetic/visual -theory of multiple intelligences (learning in different types independently from the other) -use as many methods as possible

Peer support groups

-decrease profession isolation -increase professional support and networking -normalize the stress and strain of professional life -offer multiple perspectives on any concern/problem -free of charge -intellectually stimulation/fun

Expiration dates on gift certificates

-depends on the state: strict regulations, no regulations -used wen they're in a promotions (no money exchanged), such as donating certificates to a charity -short expiration dates; practitioner receives the income sometimes without performing services; fraud -they are a contract with the purchaser for service/value -most people want one with long or no expiration date or revert to the purchaser if not used by expiration date

Identify appropriate marketing materials

-describe examples of marketing materials that you feel are in questionable taste -describe examples of marketing materials that you feel are blatant examples of unethical marketing -peruse a local directory for healthcare advertisements; find examples of different types of claims -weekend course for CE requirements to renew your license; how do you advertise your new skill?

Creating ethical barter transactions

-describe instances when a barter exchange worked well for both parties -describe instances when a. barter exchange did not work well for both parties -identify what types of barter exchanges could work for you -how can you ensure that your barter transactions are handled ethically

Define an ideal practice environment with case management

-describe your ideal practice environment involving case management -make a list of the potential care coordination issues in that setting -identify the case management issues that might arise when coordinating care among different providers, both within and outside the practice -brainstorm ways to overcome reluctance for associates in a group practice to incorporate case management

Step 3 resolution model : review your profession's code of ethics and relevant laws

-determine if this issue violates either the letter or the spirit of applicable laws, regulations, or professional codes (national/state/local level) -check if you policies or procedures address this issue

Further steps to prevent sexual harassment by supervisors/co-workers

-develop and post a policy against harassment -teach employees what constitutes harassment -improve morale and productivity -address complaints before they develop into litigation -establish an effective and confidential complaint process

Inviting input

-dialogues are more effective than monologues -reflecting -power differential -incorporate interactive speaking: speak-invite-reflect -informed consent discussion: what proposes to do in next session, why this is beneficial, how it might affect client

Group practices

-differ from medical clinics/hospitals in the services they offer and purpose of practice -holistic healthcare centers and wellness centers: several modalities offered -focus on identifying imbalances in the body and musculoskeletal injuries that the various modalities can address on educating and guiding clients about preventative measures they can practice at home

Guarentees

-different from promising a cure -reflects confidence -clearly defined

Business deductions

-difficult due to various tax codes -personal businesses/unnecessary travel expenses -need to work with tax accountant to reduce tax liability

Coaching responsibilities (by ICF)

-discover/clarify/align with what the clients want to achieve -encourage client self-discovery -elicit client-generated solutions and strategies -hold the client responsible and accountable --similar to an athletic coach

Strong emotions

-discuss this possibly prior to beginning work with a client -remain in your scope of practice -diffuse the situation and change the focus of the session -responsibility to bring closure to that interaction -common emotions (sadness, fear, anxiety, annoyance, anger)

Inappropriate questions about client's emotional responses

-do you know why you feel sad when I touched your leg -where you thinking of someone in particular when you began to feel anxious -do I remind you of someone in your family or your past -do you remember the first time this every happened to you

Civil lawsuits process

-filing a complaint in court: basic theories of legal duty and allegations of the practitioners liability and damage to the client -practitioner (through counsel) files an answer to the allegations/asserts defenses -discovery: prolonged period; information gathered on each side

Deciding when to consult with a supervisor

-does the care of client deviate from the usual professional standards of care for this client's problems? -are you aware of strong feelings about this client? -are there behavioral indicators of favored or disfavored treatment status? -are you confused or conflicted about the relationship aspects of this client's care? -Are you uncertain concerning the differentiation between professional and personal feelings, and where to construct the professional boundary? -Are you attracted to the client? -Is the client attracted to you?

Ethical product sales don'ts

-don't overuse products -don't make product claims that the manufacturer does not make -don't manipulate or coerce your clients

Personal relationships

-dual relationships (professional/personal) -discouraged

Technique restrictions

-each profession has certain prohibitions against treating certain parts of a client's body; such as breast tissue in US

Client/practitioner expectations

-ease anxiety for client/practitioner -include: procedural structure of a typical session, draping, communication guidelines, attitude, level of interaction outside of the actual treatment, illness, and etiquette expectations

Electronic messages be aware

-easy to lose control of information when communication via e-mail; no reply all unless u mean it -humor, joking, sarcasm often don't travel well over email, and other countries -any of these (particularly e-mails and texts) can be used as legal documentation

Empower the client by

-education -ideas/recommendations -allow client to make final decision

Cornerstone of success for case managment

-effective communication

Case management

-effective communication is foundation -preparation is key -update treatments plans in a timely manner -proper terminology -concise treatment plans with supporting information to gain cooperation -compromise for patient's best interest -keep all informed and educated within your scope of practice -process client-centered

4 facets of HIPAA

-electronic health transactions standards --when billing, use ICD and CPT codes -unique identifiers for providers, employers, health plans, and clients --each practitioner assigned a NPI -security of health information and electronic signature standards --uniform levels of protection of all health information is stored or transmitted electronically --electronic signature required -privacy and confidentiality --clients access --limits use and release --restricts purposes --requirements for research

Hospitals and other inpatient treatment centers

-employ or refer to allied wellness providers -clients have numerous conditions with multiple providers -dedicated case manager to a panel of patients -individual providers are responsible for accurate and timely documentation of their assessment and treatment plans for patients -familiarize yourself with the care team and case management procedures and be responsible for contributing within your scope of practice

Ethical guidelines for spa employees

-employees mx awareness of boundary issues and are diligent to avoiding dual relationships with management, peers, and clients -employees are familiar with hipaa requirements and confidentiality measure taken by the spa management to ensure client confidentiality -employees know and utilize the established means of communication to inform management of any ethical concerns that arise, and should be aware of their obligations, both legal and ethical -if sales are expected, employees base their sales pitches on honest evaluations of products/services that they feel support their modalities and client wellness -employees are willing to research and create ethical marketing techniques to increase the visibility of their modality within the spa setting

Sexuality

-encompasses biological, psychological, and cultural influences -influenced by genetics, upbringing, health status, cultural, social, religious -can chose when/how to express it -aspects: sexual orientation, gender identity, sexual behavior -can shift; wide range -making assumptions (not good/safe for clients/peers) -go beyond biases

Prepaid package plans

-encourages people to book sessions more frequently -infuse extra income into your bank account -saves clients money -keep it simple -rule of thumb: 3 months or 10 sessions

Step 5 of resolution model: obtain consultation

-engage in self-reflection -consider how members of your community and larger society might view these actions -determine the impact these actions could have on your profession -ask colleagues or supervisors for their reflections on the dilemma and what they might decide if they were you -justify a course of action based on sound reasoning which you can test in a consultation

Client prerequisites

-engaged in psychotherapy: confirm client is working with psychotherapist -appropriate stage of recovery: 3rd stage of recovery (reconnection) most helpful, 2nd stage of recovery sometimes helpful -consent to communicate: regularly, initially in writing, kept on file

Arousal in treatment setting

-ensure safety by obtaining sufficient information to discern the "intent" of the clients arousal (physiological or sexual desire) -verbalize the physical boundary of draping -gifts/praise to practitioner (avoid) -talks about sexual stuff (avoid) -addressed when the client/practitioner is uncomfortable -change what you are doing

Integrated complementary care in medical clinics

-environment where each patient has one chart for office with access to different specialty practitioners in the center -designated case manager; group meetings -business center set up determines employee or independent contractors

Single modality clinics

-environment with one type of major wellness care (massage clinic for example) -each practitioner agrees on the definition of case management or coordination and degree of interaction between practitioners -written/accessible policies

Survivor groups

-essential part of recovery and therapeutic process

Risks of dual relationships

-financial disagreements -expectations -misunderstandings -failure in business, school or personal level -deal directly with people's wellbeing; increase vulnerability -mindful observation on both parties is advised to prevent issues -practitioners should train on this issue

Marketing materials

-essential to a successful practice; can enhance individual practice -concerns: --exaggerated claims (be sure you can back your claims; verbal or written) --utilizing misleading ploys (multiple/unintended meanings, clearly state all parameters) --using questionable names and titles (inappropriate names/cute e-mails/website names) --displaying inappropriate images (should be professional/dignified/comfortable with business) --not following regulations (check city/county/state rules/regulations) --misrepresenting credentials (represent honest qualifications/competence/education/training/experience/affiliations)

Safety (stage 1 of recovery)

-establish physical and psychological safety -control the body and attend to basic physical needs -beginning to exercise initiative and take charge of recovery -takes little to lots of time

3 stages of recovery

-establish safety --touch therapy contraindicated -remembrance and mourning --touch therapy appropriate -reconnection --touch therapy appropriate

Fees structure

-ethical dilemmas when charge less for family/friends than regular customers and cash vs cc payments -consistency of rates charged is the key -balance: too little (something wrong with your service?) to too much (arrogant wit your service?) -approach financial activities with thoughtful considerations: different rates for different clients, price reductions, sliding scales, package deals, and credit -lapses in standards if charge different rates for different clients -be clear about price reductions

Ethical concerns of retailing

-ethical products are not hype or hard-sell tactics -it is easy access to high quality products to enrich wellbeing -educate client on the products -check your motives for selling the products -restrict conversations about product to before or after sessions -share enthusiasm about your products

Start showing professionalism by

-evaluating and meeting client expectations of personal etiquette and behavior -clean/neat office/dress appropriately: match expectations -lies in integrity: quality or state of being complete/unbroken condition/wholeness/honesty/sincerity

Unhelpful supervision

-evoke guilt/shame -pressure supervisee to agree with their own personal opinions or preferences -exploit the supervisee's vulnerability in any other way -evoke significant harm

Elements of unhelpful supervision (negative role)

-evoke intense negative feelings -burdened with disrespect -lack of honest self-disclosure -treat others as if they are not helpful --should seek other supervision if this happens

Ethical guidelines for specialty centers

-examine your reasons for associating with a specialty center -remember your commitment and loyalty to the center are keys to ethical practice -internal competition may arise; develop/discuss policies for this -decide how you can ethically make your services stand out from peers; specialize, extras

Flashback memory

-experience of reliving or re-experiencing a traumatic event as if its occurring or is imminent -concrete, distinct memories suddenly surface to the present -triggered by touch, emotion, sensation, experience, smell/short/long -state of altered consciousness/amnesia; minutes to hours -practitioner should bring client back to present ASAP

Benefits of touch therapy for survivors

-facilitates re-entry and ability to feel more present -develop friendly and compassionate relationship with their bodies -helps survivors experience their bodies as a source of grounded-ness and strength/pleasure -rebuild sense of trust and reconnects them to caring relationships

Ethical considerations for employers

-fairness and diversity (equal opportunity/advancement) -safety (safe environment physically, emotionally) -security (securing privacy/confidentiality of employees) -integrity (purpose/goals/mission/honest/fair/reviewed)

5 guidelines for navigating romantic relationships

-familiarize yourself with the relevant laws in your state and with the codes of ethics of your professional organizations -consider each of the complicating factors to make an informed judgment about client's vulnerability with you -consider your own level of involvement and vulnerability -wait before taking any steps toward a relationship (6-9 months) -get some counseling and supervision

Credit (treatments on credit)

-fee has to be billed to a third party (insurance agency, attorney, client's employer) --make client sign a statement "if a bill isn't paid within a specified time they are responsible for payment" -client forgot his checkbook -client has cash flow difficulties --make formal IOU

Impacts from ethical breaches

-feeling pressured -fatigue -confusion -betrayal -financial loss -feeling vulnerable -loss of work -social withdrawal -shame -depression -ptsd -dissociation/numbing -embarrassment -stress

Signs of countertransference

-feeling strong emotional charge, + or -, toward client -feeling irritable/angry w/client for not changing/improving/cooperating w/treatment plan -distorted thinking about client -distorted thinking about work in relation to client -pattern of feeling exhausted, exhilarated, depressed, uneasy -recurring themes to clients or desire to make friends -expectations of praise and resulting disappointment -feeling guilty when client experiences a painful rxn -frequent experiences of anger when crosses minor boundaries -undergoing secondary trauma upon hearing painful stories -helping clients outside of session

Repression (defense mechanism)

-feelings or memories that are too painful to bear are blocked from conscious awareness -refer to psychotherapist for traumatic memories

Honoring the power of touch

-feels good/strengthens responses to mental or physical stressors/lower bp, increase immune system activity, help body get rid of waste, more alert/calmer/capable to deal with challenges -recovering from accident/trauma -not always positive; mixed experiences -pay attention to verbal and nonverbal cues -variety and innovation in work

Adjunct complementary care in medical centers

-financial reasons -share overhead costs -separate practice in own clinics -don't promote inter-office referrals -independent contractors

Specialty centers

-focus on one type of modality -more visible in community and widely available -combines with national franchises or combine with smaller businesses -sessions at lower prices -high volume of clients -continuing education opportunities -provides supplies -new practitioners -peer support/supervision -clients develop loyalty to the center than individual practitioners

Setting parameters in mentoring

-for the relationship to work out best -time commitment (most challenging) -when/where/how often to meet -setting realistic goals -compatible philosophies/needs -adjust approaches to meet mentees needs

Slander and libel

-forms of defamation -be careful of what you say and do -stick to the facts -determine intent before saying anything -don't interfere with someone's right to contract (tortious interference with contractual relations) -report violations by other members -facts with caution

How to avoid malpractice lawsuits

-gather and complete an accurate medical history from each new client -obtain as much information as possible from the other members of the client's healthcare team -have the client sign an informed consent sheet and other hipaa paperwork -use common language when talking with clients -be courteous and professional -document every interaction (including phone calls) with a client -if a problem occurs during a session, immediately discuss it with the client (and family if needed), and on't have the client pay for further sessions -beware of high risk clients

Step 1 resolution model: identify the problem

-gather as much relevant info as possible -talk to the parties involved -clarify the nature of the problem: legal, values, moral, ethical, or a combination

Business ethics

-general finances -setting fees -tips -barter -gift certificates -taxes -product sales -referrals -marketing materials -social media -complying with local/state/federal laws -regulating bodies -insurance coverage -slander and libel -contracts -employment status -insurance reimbursement

Educating

-general information about a subject with the resource

Retrieve a client from a flashback

-gently break contact with your hands -make voice contact -make eye contact -cover the client with a blanket -follow client's instructions -encourage client to sit up -take time to talk about what happened

Supervision

-get your own needs met outside of client/practitioner relationship -help you stay focused on your values creating a stronger business framework -mx value based ethical practice, reduce burnout -boundary violations/professional misconduct -mx standards of profession by helping practitioners more aware -mx feelings with others and clients -help practitioners be more aware of when sessions become more about us than them. -help mx practitioners distance w/clients

What can help your career thrive and progress

-getting proper support to look at and deal with everyday occurrences

What is central in the management of professional boundaries

-identifying and understanding intense -sometimes objectionable -feelings in professional relationships

Gender and touch

-girls touched more often and less rough than boys -as boys reach puberty non-sexual touch decreases just as sexual experiences increase -men (sex/touch become synonymous) -fear/misunderstanding -cultural assumptions on heterosexual/homosexual/bisexual ideas -men massaged by man? or woman? -women not so concerned -men vs female practitioners: --men are not nurturing, know/fix/do things, traditional health care --women are nurturing, nurses/PT/massage, source of comfort and trust, not as competent

What is a professional

-gives high quality performance -is predictable and consistent -is self-motivated -is self reliant and takes responsibility -works well under pressure -is always willing to learn -understands her interconnectedness with humanity

Gift certificates

-good: --surge of income --easy way for clients to share your services with others --marketing tool to get new clients --goodwill promotion as presents or charities --growing in popularity

Registration: the law

-governmental tracking/record keeping -minimal consumer protection -no restrictions -non-practice related requirements

Peer support groups

-group of people in a similar career, who get together on a regular basis or a one-time situation to provide support in the form of sharing the struggles, challenges and successes that arise on a regular basis -leadership roles rotated among members or one leader organizes the group -hires a consultant to work on specific topics

Mentor skills, roles, responsibilities

-guide, teacher, motivator, coach, advisor, door-opening for mentee

HIPAA compliance

-health plans, healthcare clearinghouses, and healthcare providers who transmit any health information in electronic form in connection with a transaction -result in civil/criminal penalties

Purpose of case management

-help clients more effectively reach positive health outcomes -collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options, and services needed to meet a person's health needs -interdisciplinary, client-centered process that recognizes and addresses the unique needs and conditions of clients or patients on an individual basis

Increase profits, revenue and bookings

-help clients reduce stress and improve their health -increase frequency of clients booking sessions -clients shares with others plus uses the products at home -another avenue of supporting clients wellness

Emotional and body oriented therapies can

-help individuals reclaim themselves and their bodies

The main focus in coaching is

-help people set goals and accomplish them

Tips for successful business mentorship

-high level of expertise in the areas -mentee open to receiving feedback -time to commit to process -determine specific goals of relationship and set timeline for meeting them -create agreement of expectations for each party in the process -regularly check in with each other to see if the goals are met and relationship is mutually beneficial

Hospitals and hospice

-hipaa is stricter -more at stake in violations -more access to sensitive information -work as a team with others for patient care plan

Suggestions for visual promotional product

-hire a professional photographer to take pictures of you or your clients -use high quality artwork; royalty-free; reprint permission -avoid sensationalism -not provocative; from all angles -refrain from using "glamour" shots -not portray results that you cannot guarantee (i.e. wheelchair to running a marathon)

Unregulated professions

-holistic health coaches/nutrition consultants -check your states requirements/laws

Ethical guidelines in hospital and hospice settings

-honor the limitations of "delineation of privileges"; only work in areas that you can do in your scope and indicated by a patient's condition to be beneficial -use responsible, clear communication with patients and members of the care team regarding expectations around the results/effect of your work -stay up to date on changes in policy or procedure that affect patent safety and execution of care plans -understand what and how much to include in your notes in the medical record that detail the services provided to a patient

4 major symptoms of PTSD

-hyper-arousal -re-experiencing -negativity -avoidance

Diagnosis

-identification of the underlying cause, etiology, pathology, or nature of a set of signs or symptoms -info from assessment plus tests -limited to physicians and PCP's

Policy and procedure manuals

-identifies potential problems before they arise -creates values-based and orderly methods for their resolution -detailed, respectful, ethical -govern conduct of the business owners and staff

Planning your perfect support system

-identify the key elements of helpful support systems -create the detailed plan for developing your support system (supervisor, peer group, mentor, mastermind group, coach, online discussion forum, or other support)

6 step resolution model

-identify the problem -identify the potential issues involved -review your profession's code of ethics and relevant laws -evaluate potential courses of action -obtain consultation -determine the best course of action

Find your own mentor

-identify types of support you would like from a mentor -create a set of questions to ask when interviewing a potential mentor -list names of potential mentors -describe situations you might terminate using a particular mentor

Multi-disciplinary practices

-if a client wishes to continue working with you after a specific prescription expires, client first be released from the clinic before you see him on a private basis -remain client centered; client's condition and wishes

Complying with local, states, and federal laws

-ignorance is NOT a defense -values/morals conflict with laws -code of ethics:must abide by national, state, and local laws -be prepared to pay the consequences if break the law

Getting involved

-in the laws and regulation -helping shape and change the laws that govern them -call state office that issued your license -ask for person who answers specific questions about practice laws; professional board? -ask for a copy of applicable laws -no board? can you make one? -local senators/representatives -professional organization's local chapter for info on legislation

Types of sexual abuse

-inappropriate seductive behavior and sexual touching to sexual intercourse -includes: rape (gang, date, partner/spouse/incest)

Sharing article links, research data, and other information

-include URL

Major areas for friction in the workplace

-incompatible personalities -conflicting visions of the image of the business -the desired clientele -the optimal business operations -marketing -client care -finances

Training and experience

-increase client's sense of safety and confidence -education, organizational memberships, additional training, years of experience, specialty study, licensure status

Steps to avoid boundary crossings and violations

-increase empathy (what client is experiencing) -manage energy (boundaries, visualizations, meditations) -identify clients' behavioral cues (indirect verbal/non verbal behavior) -ask questions (identify when clients' boundaries may have been violated) -teach boundary identification and establishment (encourages clients to be aware of what feels right/wrong) -encourage clients to speak up (atmosphere of choice)

Appropriate coaching can

-increase productivity -time management skills -self-confidence -communication skills -team work -improve balance between work and personal life

Advantages of retailing

-increase profits -increase revenue -increase bookings -provide convenience -extend treatment benefits to home

Considerations for single modality clinics

-independent practitioner's agreement -employee agreement -partnership agreement -associates agreement -relevant policies and procedures -hiring attorney to draw up or review agreements and all sign -written agreements for cross-cover client care -all practitioners adhere to the spirit and specifics of that agreement

Mentoring

-individual, usually older and more experienced, who helps and guides another individual's career development -structured or informal one-on-one relationship that focuses on the needs of the mentee -foster care and supportive relationships that encourage individuals to develop to their fullest potential -includes learning/networking/sharing information and experiences

Managing transference/countertransference

-individuals more prone are children/adolescents, needy manner, referred by a mental health professional for bodywork to assist in processing of psychological issues -continued supervision helps -body holds patterns of physical tension, related emotions, thoughts, past experiences, beliefs

Principles

-individuals rules of behavior -principled people modify behavior so that each action arises from a deeply held sense of self -based on at least part of one's values and morals - may differ widely from one another to another

Emotional abuse

-infliction of emotional harm by verbal intimidation or neglectful behavior (direct verbal threats, attacks, taunting, belittling language) that intimidates, demeans, or hurts another person -sometimes on a regular basis -emotional withholding and emotional neglect -lack of appropriate emotion to a child's needs or neglect -severe punishment, domination, for forced performance acts against their humanity -strong feelings of fear, shame, rage, or despair -depressed or dissociative state cut off from emotions -emotional scarring and log lasting self-esteem issues

A good sex education

-info was developmentally appropriate for your age at the time -learning was ongoing throughout your childhood/all necessary facts -teaching was sensitive to your feelings and needs -model for decision making rather than a finite set of rules on behavior -you/your body were treated with respect

Boundaries are

-innate, developmental, and learned -influenced by experiences with the environment, family, teachers, neighbors, culture, and the world as a whole -culture at large and culture within the family -family influenced by cultural ethnicity, societal mores, social class, laws, educational experiences

Multidisciplinary group practices

-integrate therapies into individualized programs for clients to mx health or address common health problems -become knowledgeable about other modalities, establish professional connections, and experience a true team approach -mentoring, supervision, wellness centers with clear professional boundaries -submit for insurance reimbursement -skilled at charting client progress, mx billing records -operation and marketing challenges shared

Memory spectrum line

-integrated memory -unintegrated memory -flashback

Essential elements of helpful supervision (useful supervision)

-interpersonal climate of reasonable safety (warmth, respect, honesty, support); allows a trust-based relationship to develop -educational contract is as specific as possible and both parties communicate directly and clearly -foster personal and professional development of the individual practitioner are preferable

The discovery process

-interrogatories: written questions asked of either party; answered under oath -depositions: oral examination of a witness during which an attorney asks questions that the witness answers under oath -requests for production of documents: written requests by the attorney for either party addressed to the other party seeking the identification of documents that are relevant to the case -requests for medical or psychiatric examinations: examination by a neutral physician or psychiatric practitioner if the client claims in the lawsuit that she suffered medical or psychiatric injuries

Single modality clinic specific issues

-intra-office referrals -cross cover for established clients when the primary provider is not available -standards for mx and storing patient records -lines of communication for care coordination -switching providers within the clinic

Universal ethical principles

-justice (equal treatment for all) -honesty (upfront and truthful on communications) -reverence for life (respect, not harming physically, mentally, emotionally) -adherence to the law (know laws)

Practice management

-keep accurate records -inform your clients of their rights -treat all clients equally -effectively respond to inappropriate inquiries

3 levels of integrity

-keeping one's agreements -being true to one's principles -being true to oneself

An ethical practitioner (in term of taxes)

-keeps precise records -declares all income received -refrains from inflating expenses -accurately files governmental reports

Ethical guidelines in hospital and hospice settings

-know appropriate use of, and safeguarding of, protected medical information -know how, when, where, and with whom to discuss patient care specifics -be comfortable managing expectations and staying within scope when a recommendations from a physician or nurse isn't congruent with what you now to be the safe, best practices for your discipline -mx clear boundaries with regard to fielding patient questions; know what you should know, when to discuss with other members of the care team

Defining your scope

-law --review --discuss with others -training --activities/modalities within scope --how different from others -competency --identify/determine competency --factors to contribute to different scopes for colleagues -self-accountability --identify areas that fall in scope but might be questionable --determine areas/circumstances that are high risk --identify past actions or circumstances

Complications of power differentials

-leads to ethical complications

Benefits of dual relationships

-learn how to work within relationship complexities, and mx appropriate boundaries in the various roles, they can enjoy the benefits -trust from client to practitioner -increased compassion/understanding

Setting your fee structure

-list your fees -what circumstances would prompt you to offer a sliding fee scale? -what will you charge family members and friends for your service? -If your family or friend rate is different than your standard rate, describe why -what types of package plans could you offer? What are the benefits and disadvantages?

Boundary change agents

-location of service (professional environment) -interpersonal space (space boundary) -money (reinforces business nature) -appearance (dress to show trust/safety) -self-disclosure (describe training/experience to instill confidence in client) -language (most potent means to mx healthy boundaries) -touch (sensitive to physical boundaries, depth of touch) -time (limits on sessions)

Recognize flashbacks

-look at clients eyes; far away look, stare into space -curl in ball/cry/talk inherently -tight stiff body/shaking

Impacts from ethical breaches

-low self-esteem -physical pain and rehab -self-blame -difficulty trusting other professionals -sadness -touch avoidance -anger -loss of relationship -anxiety -grief -higher suicidal risk -derailed healing process -hyper-vigilance -self-doubt

Marketing materials

-maintain a professional image -choose an appropriate business name -set up separate business and personal email accounts -be careful with the links you include on your website

Ethical considerations in medical clinics

-major concerns: --possibility of needing to alter your style and scope of practice to suit the clinic's visions, policies, and procedures --hired as a independent contractor versus employee -be sure of the kind of clients are there, opportunities o use your favorite modalities, work at a pace a style for your -alter treatments in a clinic setting -freedom from administrative tasks -clients benefit from more time with you and equipment

Core values

-major conscious and unconscious influences on the decisions you make in your life -could be conflicting with others

The spa environment

-make a list of ethical dilemmas that may be unique to the spa environment -brainstorm ways for employees and employers to avoid or overcome those dilemmas

Ethical client education checklist

-make referrals to your published resources of clinical studies -state facts in a generic manner -make the "I" statements about "What I would do if I were you"

Malpractice insurance issues

-make sure it covers when an accident occurs, even if subsequently the practitioner no longer has coverage -some insurance companies will nullify a policy if the practitioner doesn't uphold all local, state, federal requirements -most policies don't cover sexual misconduct -some policies cover litigation costs but not damages awarded if the practitioner is found liable for sexual misconduct

Ethical product sales do's

-make sure the products you carry are appropriate and wanted -find products that meet clients goals and needs -know the products well -educate your client's on the proper use, benefits, and possible side-effects -restrict discussion of products to before or after the session -ask client for feedback -clearly label the cost of products

Charting income (taxes process)

-makes it difficult to hide income -duplicate books are illegal and very difficult -pocketing cash payments (no returns/charting/no receipts)

Ethical guidelines for spa management

-management does its best to design and decorate the spa environment in a way that doesn't elicit a confusing or sexual ambience -management clarifies the types and means of communication that are appropriate among practitioners, as well as between practitioners and clients, and between practitioners and management -management invests not just in modality training for its employees, but also in continued education in communication: interpersonal skills; hipaa and confidentiality regulations; and avoidance of sexual misconduct and harassment charges

Care coordination

-many forms -multidisciplinary -within your section or outside of your section/hospital -case care managers -conforms to professional standards of conduct in coordinating client care

Step 6 resolution model: determine the best course of action

-map out the best way to resolve the problem -consider who should know about the problem

Evaluation (step 5 in client management process)

-measures the quality and outcomes of treatment plans -ongoing process -client treated till her symptoms are completely resolved or reaches maximum improvement -once treatment goals are met, case management facilitates the transition to self-care or to alternate treatment modalities

Recognizing the family as a sex educator

-media ideas/stereotypes -family is most influential -sex repressive/sex obsessive/sex avoidant/sex expressive

How to get participants

-meet regularly -screen participants (team leader) -same people increases depth of sharing -online tools -professional associations/local schools good source

Unintegrated memory

-memory is so painful that parts of the memory are blocked with details missing -stir up unresolved feelings that are usually repressed -foggy memories -vague emotions/body memories -intrusion errors: info related to the theme of a certain memory but not part of original episode/event

Integrated memory

-memory that may have painful at one time but has been remembered, understood, accepted -copes with details of memory without being overwhelmed -tolerable

Difficulties in identifying boundary crossings

-mistakenly assume clients know how to identify when their boundaries are being crossed -mistakenly assume that when clients are aware that their boundaries have been intruded, they're then willing to talk about it -power dynamics of treatment relationship often make it difficult for clients to talk about their discomfort to a practitioner -practitioner should not rely on clients speaking up to ensure that boundary crossings and violations don't occur

Attitudes about money

-money is a medium of exchange for goods and services -can be uncomfortable to charge appropriate fees for services -income is often in direct proportion to one's self-esteem -know the difference between service and sacrifice -everything is relative, when it comes to money -balance is the key to all service; necessary to care for oneself in all aspects

Photocopy request information

-most authors/publishers give permission; unless it is part of a money-making venture -send a request to copy a copyrighted work to the permission department of the publisher of the work -copyright clearance center (for a fee) -requests include: --title, author, edition --exact material to be used, pg numbers/chapters --number of copies --use to be made of copied materials --form of distribution --whether the material is to be sold

Key factor 4: self accountability

-most decisive factor that keeps your functioning within your individual scope -no matter who is present -need to internalize the laws and guidelines that define the limits of your practice -creates and sustains your personal and professional ethics -keeps you functioning within your parameters of your scope

Why boundary crossings occur

-most practitioners act ethically/mx clear boundaries -subtle boundary crossings: --lack of understanding of boundaries --practitioners not aware of own boundaries --practitioners no understand/pay attention to client's barriers --practitioner may make incorrect assumptions about client's ability to communicate when crossed barriers --practitioner ignores therapeutic boundaries --assume client feels same they do --too close physically or emotionally --offer unwanted advice --unwanted hugs

Mentee

-motivated to learn/achieve goals -passionate/open to criticism -risk takers -benchmarks to measure the success of the mentoring relationship -apply knowledge as needed

The work environment of a spa

-mutual responsibility of employees and employer -need to practice transparency, honesty, integrity in communications with each other -most serious ethical concerns: inappropriate touch and sexual misconduct

Initial contact: phone interview

-name of client, name of referring person, -establish boundaries, structure, safety -brief description of initial session -let client know from the start that she is in charge -establish financial arrangements to minimize misunderstanding -client questions -background on self -repeat everything in 1st session=repetition

Contract checklist

-names/addresses of all parties involved -short description and mission statements -summarization of contracted party's desired role -classification of the business relationship -description of what each party is to provide -timetable -location of where work is to be performed -duration of the contract -payment method and schedule -fringe benefits -opportunities for financial increases -insurance coverage provided -insurance coverage required -guarantees -financial obligations of the contracted party -conditions for termination of the agreement -guidelines for transfer of the contract -who retains custody of the client -arbitration -who is responsible for contract breach legal fees -contract communication contact information -signature lines and date the contract is signed

Negativity (PTSD symptom)

-negative changes to beliefs and feelings that may come as a result of trauma -avoid relationships/world as dangerous place

Malpractice actions

-negligence -most common -establish 4 elements by a preponderance of evidence; by a jury --duty of care owed by the practitioner to the client --breach of that duty --causal relationship between the breach --damage to the client -measuring stick is the "standard of care"

The franchise phenomenon

-new/exciting business opportunity for employment and possibly own a business -good for new graduates

Communication barriers

-noise: interference with the transfer of information --ambiguity, contradiction, redundancy -the ambiguity of language: meaning of words in people's minds -reducing noise: stressful, shift awareness from what your saying to how your saying it

Transference

-normal, unconscious psychological phenomenon characterized by unconscious redirection of feelings from one person to another -clients unresolved needs, feelings and issues from childhood are transferred onto the helper -practitioners need clear boundaries and open communication

Mentoring

-not for financial gain -role models for other practitioners -same or closely related field -do not limit oneself

Receiving feedback

-notice whether you feel comfortable receiving it in the current situation -ask to postpone the discussion if you feel rushed, distracted or upset -ask for facts -small amounts of info at a time, paraphrase what she says -reflect her emotion as well -responses: tank the client/clarify facts/apologize/discuss possible solutions

Sexual feelings during treatment sessions

-observations: clients experience sexual feelings during treatments, practitioners have sexual feelings when giving treatment, confused/ashamed/embarrassed/behavior inappropriately -ethical behavior to be self-aware, recognize sexual feelings within yourself, steps to shift feelings, not act on feelings -practitioners responsibility to establish and maintain appropriate boundaries -relate to client as a client, not a person to take care of your needs

Preparation, language, behavior

-observe and know yourself -establish a pre-treatment thinking process -describe your techniques -maintain a professional appearance and demeanor -participate in ongoing supervision -commit to continued education

Sexual harassment prevention strategies

-obtain training to facilitate an understanding of the power of the roles -gain an understanding of the impact of one's own sexuality and the sexuality of those with whom one interacts professionally -learn appropriate ways of behaving around, and of communicating with, both genders -discover what behaviors are considered unacceptable -determine the types of situations that may lead to such transgressions -ascertain the effects of abuse and harassment -understand the potential legal and financial consequences of unacceptable behavior

Head rotates on the

-odontoid process; dens

Sources of ethical guidance

-official codes and regulations (laws, code of ethics, other policies) -laws (minimum standard necessary, shared ethical/moral principles, enforced by courts, state board) -professional code of ethics (inform ethical norms/behaviors, direction for challenging situations, encourage excellent service, protect clients, enforce desired professional behavior) -organizational policies/procedures (detailed guidance)

Referring out

-one of the greatest mistakes is believing you can do it all -awareness of your scope of practice, limits of training/knowledge, personal and professional limitations, your areas of weakness, blind spots is an asset -when in doubt, refer out -develop a network of professionals as resources for development of network -keep track of clients treatment and how they feel about the services rendered -don't refer out if you don't know their work

Financial considerations in group practice

-one person responsible for common expenses -all names on leases -clarify group budget -financial projections, written agreement on individual financial obligations, how revenues/expenses are split, who makes decisions (minor/major) and pays expenditures -incorporate product sales: choosing product line, who responsible overseeing sales, disbursing profits, action plan for product sales

Ideal client

-one that makes you feel inspired, rejuvenated, and passionate about what you do -same values as you -refer out to you -come regularly/less education needed -on time for sessions -respect fees and time

Preferred provider status

-only credentialed practitioners are permitted to bill under the preferred provider contract -insurance carriers contract with healthcare providers in an attempt to limit who provides healthcare services and how much the carrier pays for these services -discounts for using preferred providers -limited number of providers based on the number of insureds that reside in that area; quota met = network closed

Prescribing

-only licensed professional in that subject area

What can protect the practitioner against liigation

-open, direct communication with clients, consultation from colleagues, and documentation of the problem and subsequent treatment approach

Clinical supervision

-opportunity to discuss w/experienced staff to help a client while promoting increased self-observation and awareness -helps guide toward core issue -incase tolerance and understanding -nourishing, protective, creative endeavor that benefits all

Dispute resolution

-options: ignore it, attempt to resolve it yourself, submit to arbitration, engage in mediation, take it to court

Sexual abuse is often accompanied by

-other types of mental, physical, and emotional torment --putdowns, insults, demeaning comments, sudden irrational acts to install fear, withdrawal of love and affection, threats: as a weapon of control -can involve more than one perpetrator or victim

Dual relationship

-overlapping of professional and social roles and interactions between 2 people -naturally develop -common in small towns -loose standards 40 years ago; issues w/misconduct, sexual impropriety, treating family members -1990's: complementary healthcare evolved -personal to financial

Remembrance and mourning (stage 2 in recovery)

-painful/prolonged; relives the pains and horrors of trauma; grief and loss

Follow-up questions

-pains/injuries/medical conditions -medications and drugs: alcohol/smoking/drugs/meds -personal care: physically/mentally/diet -body awareness: where she carries tension or stress, ask and observe -previous bodywork: how was it? -open ended questions: history, additional info -flashbacks? abuse? -other questions from the client -give client the handout "feelings list": help if they feel it

Re-experiencing (PTSD symptom)

-past traumatic events recur as vivid memories interrupting the course of life in the present -flashbacks/nightmares

Breaking the silence

-past: kept silent -now: speaking out, increase in client complaints -widespread education

Employees

-paychecks -FICA -FUCA -pay state unemployment taxes -provide workers compensation -withhold state and federal taxes -deposit withheld taxes -file regular returns -send w-2 forms to employees annually -benefits -subject to the will and control of an employer -common law rules: legal right to method and results of service

Fees schedules insurance

-payer discrimination: charge insurance companies higher rates than clients who don't utilize insurance coverage for your services -be consistent -don't discriminate -same fee for the same service to everyone, regardless of type of payer -service most appropriate to the client

Finances

-payment solidifies professional contract -clarify distinction between personal time and work time -clear communication on fees -include: fee structure, sliding scale schedules, package plans, credit terms, insurance reimbursement, product guarantees and returns, bounced checks, gift certificates, and barter.

Cult mind control abuse

-people are subjected to an extreme form of abuse that involves creating an alternate identity which is programmed to depend on a person or totalistic system -creates dissociative disorder leading to trauma-related symptoms -control of behavior, information, thoughts, and emotions to undermine a person's free will -psychosomatic complaints; identity confusion, simplistic thinking, difficulty with decision-making, fear/panic disorders, sexual problems, sleeping and eating difficulties -cut off from family/friends -abandon education and career choices -cult jargon; aggressive, secretive, deceptive, evasive

Supervision is

-person or group of people who really listen to you and help you to feel heard -so that you can feel more confident and secure in finding out what is true for you -lead to consultation sessions for more specific help in ethical dilemmas, setting boundaries, and creating policies and procedures that support your business -provides a forum for reasons to help others and more service to others

Professionalism

-person who conforms to the standards of a profession -has or shows great skill -engages in a given activity as a source of livelihood -follows a learned profession -behaviors and qualities that mark an individual as reliable, competent, trustworthy, and polished professional person -stems from attitudes;; manifested through technical competency/communication skills/manage boundaries/respect/business practices -high standards

Boundary models

-personal boundaries (vulnerability) --permeable (info/feelings to flow easily in/out w/out barriers) --semi-permeable (flexible relationship w/outside world) --rigid (firm/distant, limits flow of info/feelings) -interactive boundaries --meeting at the boundary --boundary crossing or violation --distance from the boundary (no real contact)

Self-disclosure

-personal information that is exchanged between a practitioner and a client -could be indication of transference -sometimes too much info -practitioner can in the beginning: let client know about being safe and comfortable as possible, describe policies on confidentiality/lateness/cancellations/payment/other issues/invite questions or concerns/different comfort levels

Personal ethics and self accountability

-personal morals, values, and principles -sense of self-accountability

Intimacy

-personal/private/sex -physical intimacy entails affectionate and sexual touch -emotional intimacy refers to feelings of closeness, tolerance, and support -verbal intimacy involves disclosure of emotions, feelings, and opinions

Sexual response cycle

-phases: --excitement/arousal phase**during massage too --plateau phase --orgasmic phase --resolution -isolate physiological or anatomic functioning is key -sensory aspect; parasympathetic NS, limbic system

What are the different types of boundaries

-physical (arms length from body, 2-3 feet front/back and 1 foot on sides of body) -emotional (at the moment/situation, trust, intimacy) -intellectual (thoughts/feelings/beliefs) -sexual (subset of physical/emotional, express sexuality, relationship) -energetic (essential of who we are,

Online discussion forum

-place to get help -specific situations -ask questions/answer on sites -problems: statements taken out of context or take personally/exposing clients or yourself/ -make privacy settings optimal -protect client privacy and confidentiality at all times

Gratuities

-potential ethical issues: --problems inherent with transference; unethical? --clients aren't certain when or how much to give --clients can be concerned that the practitioner expects the same amount (or more) each time --clients worry that they won't receive the same level of service if they don't give a tip --gifts not good (especially consistently) --money is not the only way to express appreciation (thank you, will do)

Ethical concerns of retailing

-power differential between client and practitioner -educate clients on benefits of certain products and allow them opportunity to buy from you -long term clients = more exposure -our knowledge about body, products can support clients -some companies only sell to practitioners and not the general public -only sell products you know are reliable, suitable for use and natural extension of your business (such as hot/cold packs/ice pillow, etc)

Most common complaints clients make about healthcare professionals

-practitioner did not listen to client -client felt violated by the practitioner -most often from unwanted or insensitive touch or personal remarks made to the client

Client custody

-practitioner leaves the clinic setting or wants to see some clients at another location -need clear expectations/boundaries from employer -define how you'll deal with the future allocation of clients

Spas

-practitioner needs to understand employer expectations and understand the rationale behind the policies and procedures set by the employer -this protects the client and practitioner

Countertransference

-practitioner unconsciously transfers his unresolved needs, feelings, and issues onto a client; like someone from the past -results in less effective therapy, loss of clients, psychological harm to clients

Confidentiality

-practitioners guarantee to client that what occurs in the therapeutic setting remains private and protected -clients rights to privacy and safety -assumptions: --important/personal relationship exists between client and practitioner --trust is an essential element in this relationship

Nutritional supplements

-practitioners may be working beyond their scope of practice unless they are a nutritionist, herbologist, or extremely well versed in the subject -if there is a product that you really believe in and want to sell, educate yourself on the product (contents/applications/adverse rxns, contraindications) -results are not always proven/ reliable/ or right for everyone -discuss side effects and benefits to clients -proceed cautiously -team up with a nutritionist/take courses

Limits of ethical confidentiality

-practitioners obligations to the law -practitioners obligations to others -reasons to break it: --danger to client/other individuals --intention to commit a crime --abuse/neglect of another person

Downside of gift certificates

-prices increase by the time it is redeemed (can use interest bearing account or put dollar value instead of sessions) -lose money --you can put 1/2 of gift certificate revenue in a savings account and transfer the funds into checking account when certificate is redeemed -list ways to ethically sell gift certificates and manage those sales; develop a policy to handle unredeemed gift certificates

Psychotherapy

-primary therapeutic relationship for working through survivor issues

How boundaries develop (the family)

-privacy -physical contact -emotional connection and expression -sexual attitudes -sensitivity -intellectual expression -different ethnic norms

The hospital setting

-privately/publicly funded/nonprofit/for profit/etc -demand for wellness practitioners increasing -oversight of practitioners -brought in as a luxury instead of a need -slowly coming around and wellness is higher on the list for services -as part of a wellness program or work with a team for a patient

Client/practitioner expectation

-procedures (what is going to happen) -draping (your procedures) -communication guidelines (own style and expectations) -attitude (toward work and others) -interaction level outside of actual treatment (clarify with client their level of comfort; i.e. follow up calls etc) -illness (do not harm) -etiquette expectations (code of ethics that delineates expectations)

Assessment (step 1 in client management process)

-process of gathering client information to identify needs and potential barriers to meeting them -includes general health history, physical examination findings, phase of condition, and psychosocial issues

Planning (step 2 in client management process)

-process of setting up specific goals, objectives, and actions to meet identified needs -differ with clients -communicate effectively

The impact of family patterns in a therapeutic setting

-understand how sex education/clients background affects the ways they relate to others/clients -family patterns influences both practitioner and client to understand sexual dynamics in therapeutic relationship

Post flashback with client

-process why the flashback occurred: did you do anything to trigger the flashback, maybe have them dress before you ask questions -plan for client safety: ask for plans after massage, needs to be with others incase it comes back -adjust your schedule: longer only if you can and as needed -follow-up: suggest client talks with psychotherapist, practitioner talks to psychotherapist, call client later if they agree

Extend your treatment benefits (product sales)

-products they can use between sessions -use these items in your session to show clients how they work -sounds and scents triggers memories -therapeutic and pampering items

Check with _____ for most current standards of practice

-professional associations

Finding a mentor

-professional/trade organization -alma mater mentoring program -someone from work/professional circle you respect/admire

Standards of practice broad categories

-professionalism -competence -professional excellence -legal and ethical requirements -protecting the public and profession -responsibility to the client -confidentiality -business practices -professional relationships -roles -boundaries -prevention of sexual misconduct -professional conduct -educating the public -research -fees -accurate representation of Scope -professional appearance -continued education -courtesy -integrity

Projection (defense mechanism)

-project thought or feeling onto someone else, seeing it as the other person's issue

3 major purposes for HIPAA

-protect and enhance the rights of consumers by providing them access to their health information and controlling the inappropriate use of that information -improve the quality of health care in the US by restoring trust in the healthcare system among consumers, healthcare professionals, and the multitude of organizations and individuals committed to the delivery of care -improve the efficiency and effectiveness of healthcare delivery by creating a national framework for health privacy protection that builds on efforts by states, health systems, individual organizations and individuals

Working with minors

-protective nature -emotional/cognitive/social development into account -includes caretakers (know who is involved) -goals sharing -how to utilize touch in a healthy way at home -permission to touch -ask teenagers if they need a caretaker in the room -flexibility is key

Treatment interactions

-provide informed consent -allow privacy -always use proper draping techniques -use respectful communication -be mindful of body contact during the session -prevent straying strokes or movements

Defense mechanisms

-psychological strategies of relating to the world around us that we develop unconsciously to protect us from fear, pain, shame, anxiety, and other emotionally painful experiences -can limit our ability to respond to future challenges in an appropriate way -projection; repression; denial

Prerequisites for working with survivors

-psychological understanding of clients trauma and their boundaries -issues/motivations: understand own issues and motivations and needs -ethical dimensions: code of ethics, boundaries, relationship with clients, respect for clients confidentiality, admitting mistakes, honesty -secondary traumatization: fear/outrage/despair of survivor/helpless/vicarious traumatization/counter transference -supervision/support: setting up support systems for yourself; transference/counter-transference; work with supervisor/psychotherapist

Enhancing psychotherapy collaboration

-psychotherapist helps the client integrate her emotional and cognitive insights -bodyworker helps the client increase her self-awareness and gain access to emotions and less conscious memories through direct touch -sequential mode: bodywork session then psychotherapy session -combined mode: bodywork/psychotherapy sessions together

How to find a supervisor

-psychotherapy disciplines are good sources (psychiatrists, nurses, social workers, psychologists, and counselors) -personal recommendations -state/national organization to obtain names

Fair use factors for copyrighting

-purpose and character of the use: includes commercial nature or non-profit educational purposes -nature of the copyrighted work -amount and substantiality of the copied portion in relation to the copyrighted work as a whole -the effect of the use upon the potential market for, or value of, the copyrighted work

Electronic message can be effect/efficient when

-purpose of message is clearly stated -making a request for specific actions (clearly spelled out) -passing along facts/links -making appointments (minimal back-n-forth negotiation) -written copy for later reference

Peer groups meet on a regular schedule; like_____

-quarterly or bi-annually -individually as needed as well

There can be negative effects of touch therapy when done without appropriate knowledge and training:

-recovery from abuse proceeds in stages -understand the significance of flashbacks and how to deal with them -lack of boundaries and support systems necessary for effective treatment -lack outside supervision to guide therapy -works too deeply or inadvertently violates boundaries -understand abuse issues and process of recovery to structure treatment -need gentle and enduring patience to go slow -need well-informed care

Ethically sharing content

-reference/credit the source of the content -get people to share/repost/etc -directly from the source

Accepting payments for _____ clouds the ability and puts practitioners ethics in a compromising position

-referrals --creates conflict of interest --illegal --called rebating

The hospice setting

-referred to if medical profession believes the patient's disease will lead to death w/in 6 months -all ages -provide comfort measures and daily care int he patient's home setting or if needed inpatient hospice or institution for 24 hour care -follow patients weekly or bimonthly basis -better record than hospitals of integrating complementary therapies into their patient care routines -part time basis -independent contractors -flexible scheduling essential -know contraindications for massage -need clear directive from medical staff -knowledge of medical terminology -emotionally demanding

5 types of interactions essential to manage effectively

-reflecting -inviting input -responding to body language -educating -asserting and maintaining balance

Recourse

-refund -not charge -discuss with client -lack of communication -mediator

You are required to collect and remit sales tax on product sales

-regardless of volume

Product sales

-reluctant b/c: seem unprofessional/cross boundaries -natural extension of somatic therapies, skin care, and personal training -follow guidelines, keep good boundaries, treat people with respect/fairness, remain client-centered -as long as no pushy sales process and is relevant to needs -educate clients instead of sell to clients

Memory

-remembered past experience that may/may not be painful -continuum of consciousness -images, sounds, thoughts, emotions, sensations within the body

Licensure: the law

-required by the law to practice -high consumer protection -code of ethics and professional conduct requirements -educational and exam requirements

Pre-treatment mutual interview

-restate what was discussed on the telephone -1/2 session conversation

Peer support group advantages

-rests with individual group members and clarity of peer group contact -agree on time/location/frequency of meetings -defined/affirmed organization structure and goals -interpersonal atmosphere of reasonable safety (respect, warmth, honesty, collaborative openness) is critical

Social media policies

-review before you join -have account management features; mx control of site -create of statement of how you want your social media identity to be handled -create your own social media policy for your practice (support/protect/empower high quality engagement) -creates ethical guidelines

Develop social media policy

-review guidelines for social media websites -create overall social media mission statement for how you want your social media handled for both business and personal -establish social media policies for your personal and business accounts -review the NLRA to familiarize yourself with acceptable language for social media policy

Take the client history

-review history and client's situation -strengths in creating strategies for his survival -is bodywork good at this time? -"I hereby give permission to (practitioners name) and my psychotherapist (name) to exchange relevant information to help me in my healing process"-client signs and dates -add "please feel free to add additional comments below that might be helpful in our working together"

Analyze your profession's standards of practice

-review your state/province/national Standards of Practice -identify the following: --items that you highly value --statements that are vague --standards that you don't agree with --additions you would like to include

Informed consent

-right to know about and fully participate in their own care -provides the foundation and framework of an ethical and safe experience

Contracts

-roles/expectations -avoid problems, predetermined method for resolving conflicts, keeps you focused on the goals -some written form (letter, memo, full blown contract): what is contracted, terms of the exchange, parties signatures, dates -verbal contracts are also legal and binding -clarifying and mx ethical behavior

The practitioner minimizes potential errors and creates a ____ environment for the treatment process when she has ___ and ___ of the factors surrounding abuse and recovery

-safe -awareness -understanding

It is useful for practitioners to:

-understand the origins of reactions -know how to recognize them -appreciate the contribution of the touch treatment to their resolution -recommend other medical consultations when appropriate

Touch precautions for PTSD flashbacks

-safest areas to touch are: hands, arms, feet, legs below knees, scalp, forehead, middle/lower neck, shoulders, upper back, mid-back -caution areas: sub-occipital muscles at back of head, buttocks, front and back of thighs -avoid: inside the mouth, front of neck, throat, abdomen, upper to inner thigh, woman's chest, breast tissue, front of pelvis, genitalia -body positions/regions: depending on trauma and client -check with client before you start massage and techniques; modify pressures as needed

The taxation area that many practitioners choose to ignore is

-sales tax

Make it convenient (product sales)

-saves clients another trip to a different store/online for same or similar products

How boundaries develop (the culture at large)

-schools -media -religion and religious groups -voluntary social groups

Ethical clinical practice for all somatic practitioner include:

-self-awareness -self-monitoring -ongoing review of challenging or difficult cases

Physical environment

-sense of safety/comfort -neutral/soft colors -plants to look less sterol -look professional if at home -less clutter -covered windows -sheet for client -separate bathroom -draw curtains -sound proof room -quiet music -literature in waiting room -policy statements in binder for clients to read -less scents

Practitioners minimize the risks of re-traumatization by being _____ to the ___ of the survivor and its effect on their work together.

-sensitive -experience

Multi-disciplinary practices

-serve a variety of clients/patients -similar issues to single specialty clinics -important to be clear on the definition and practice of case management -clear lines of communication between disciplines -lead provider clearly identified -specific routes of communication established to communicate ongoing assessment and progress

Giving feedback

-set a goal (correcting misinformation, helping client perform more effectively, informing on certain behaviors on them and you) -select your facts (guide decisions, clients use the info as they like, back up opinions with facts) -deliver the feedback (ask permission to give feedback, state your goal, solicit questions, explain the situation, check for understanding, ask for a response, discuss possible solutions)

Coaches helps clients

-set goals -follow through on commitments -evaluate measurable outcomes related to personal or professional successes

Transition to bodywork (ask first if they want to continue)

-set goals together (long/short term) -empower the client (invite client to make suggestions) -create emotional safety (ask how client wants you to react w/issues)

Setting up a support group

-set up guidelines for developing/running your ideal peer support group -brainstorm topics for discussion in peer support group -develop a series of questions you would ask a participant in a peer support group who is presenting an idea -identify any areas or issues that you might be reluctant to discuss in a support group environment -list the advantages and disadvantages of peer support groups over clinical supervision

Post-traumatic Stress Disorder

-severe/repeated trauma; shock -rape/war/sexual/emotional/physical abuse/trauma -impacts and symptoms of trauma

Clear boundaries around ___ , ____, and ____ create the foundation for safety and trust, which is the basis for healing in all therapeutic relationships

-sex, touch, intimacy

High risk client characteristics

-sexually provocative client -professional plaintiff client -client with unrealistic expectations -client who idolizes the practitioner

1st session preliminaries

-shake hands only if client extends hand -give something to read of client has to wait -pre-treatment mutual interview -review policies -take client history -follow-up questions

How mastermind groups work

-shared responsibilities by all members -led by person with more experience willing to take on leadership role -host sets agenda, coordinates schedules, handles logistics/facilitates meeting -in person or online

Mentoring benefits

-sharpen communication skills -increase self-confidence -develop professional skills -manage ethical concerns -give/receive objective feedback -improve overall success -increase career satisfaction -have an ally -cultivate lasting friendships -develop leadership skills -be a role model -give back to the community

Internships

-short lived

Legal issues

-shows respect for the community, the field, clients welfare, and practitioner's own values

Treatment is warranted

-until the condition is corrected or maximum improvement is made -with appropriate instruction for follow-up self-care, and prevention of future occurrences

Sexual misconduct and sexual harassment

-similar meanings -person taking advantage over another person -lack of awareness of what kinds of behavior are offensive or harmful -know states stance -females usually the victim, males usually the perpetrators -blatant disregard of ethics, boundaries, and genuine care for client -sociopaths prey on others to satisfy own needs; reason has no effect on them -ignorance is another root; so is weakness

Ethical care coordination in specific environments

-single-modality clinics -multi-discipline practices -hospitals and other inpatient treatment centers

Range of dual relationships

-socializing -group affiliation -friendship -social media -dating -sex -family -financial arrangements (bartering, exchange of healthcare, employment) -students

Rebuilding boundaries

-somatic therapies helpful -client reacquaints himself with his body through sensual awareness of how the body is organized and what sensations trigger trauma response -integrates sense of body control -experience of inviting, choosing, and denying touch empowers the survivor -in conjunction with a psychotherapist

Dismissing a client

-sometimes best to review treatment goals b4 dismissing client -discomfort; unsafe; sexual advances -transference and countertransference -lack of results -completion (benchmarking)

Ethical guidelines for spa employees

-spa employees know the goals, mission, and standards of the spa; understand what actions on their part support those standards; and express their loyalty to the business through such supportive actions -employees insist on the correct classification of their relationship with the spa; independent contractor or employee so they meet IRS requirements -employees clearly communicate with management concerning treatments they're willing to do and additional training needed -employees are willing to conform to the corporate image to represent business success and unity to clients -employees know the scope of practice parameters and contraindications to treatment, and mx professional standards at all times

Ethical guidelines for spa management

-spa management is responsible for creating clear, written codes of conduct and policy and procedure manuals, and for ensuring that employees receive training that reviews these expectation -management formulates employee contract that clearly spell out all aspects of financial agreements, methods of compensation, and benefits -management ensures that front desk and other support staff are educated regarding the types of treatments offered, that they understand the ethical principles behind the scope of practice considerations, and that they're aware of basic contraindications to the treatment offered by the spa

Incest

-specific kind of abuse -sexual abuse of a person by a family member who is related by blood or marriage -include trusted individuals with regular access to a child or care giving responsibilities

Morals

-standards of right/wrong -shared assessment, undertaken by a group of people -usually based on cultural or religious standards -actions can be judged as moral in one culture and immoral in another

Time management

-start and end on time (clear boundaries) -cancellations (clear policy)

Steps to a productive supervision meeting (avoiding gripes)

-start with round robin sharing for 1 min per person; no solutions -group picks a case presenter -assign roles (moderator/scribe/consultants) -case presentation (details w/out clients info) -moderator/consultant asks case presenter to formulate a key question for the group -case presenter makes a request -consultants share ideas based on request from case presenter -conclusion; case presenter states which ideas were helpful, reports which suggestions were valuable, gratitude to the group

Avoidance (PTSD symptom)

-state of avoiding situations, people, or thought processes that trigger memories of the trauma -avoid anything that makes you uncomfortable -involuntary avoidance when intense pain of event is so severe (numb to pain) -attachment/emotion-less - dissociation

Hyper-arousal (PTSD symptom)

-state of constant alertness to danger experienced by the survivor of trauma -extreme irritation or alarm/poor sleep

Civil lawsuits

-statutes of limitations: specified time limit which a suit may not be filed, regardless of the claim -discovery rule: suspends the running of the statue of limitations until the victim discovers or should have discovered the injury and its cause; victims of boundary violations

Mastermind groups

-strengthen your support system and widen your circle of professional acquaintances -like having a volunteer board of directors that gives you guidance, support and shares proven success strategies -coined by napoleon hill's book "think and grow rich"

Challenging topics of conversation

-strong emotions -boundaries -feedback -managing negative feelings

The hands-on treatment

-structure (clear/established routine, goals) -pace and predictability of touch (slowly before moving to different body parts and tell client what you are doing) -voice quality (gentle, genuine, concerned and present) -language (warm, professional) -being present (most important) -continuous communications (prevent disassociation, checking in) -closure (tell client you are close to finishing, re-drape/adjust clothing, leave time to talk to client) -feelings (feeling list handout, talk with client)

Sequential relationships

-students graduate are hired by their schools -classmates meet after graduation and form business partnerships -former student joins the faculty and becomes a colleague -former employee and employer marry -when one set of roles completely ends before a different set of roles begins

Sexual abuse

-unwanted or inappropriate sexual contact, either verbal or physical, between 2+ people, that is intended as an act of control, power, rage, violence, and intimidation with sex a a weapon

The therapeutic relationship

-study of ethics=study of right/wrong conduct/behave, depends on the context -key elements: --client centered (contract that puts client's interest above your own; do not harm/do positive good) --safety (physically, emotionally) --privacy, clear structure (HIPAA, limited/structured contact; time/activity/roles) --power differential (practitioners role, base of knowledge, clients awareness, physical aspects: age/economic status/gender/education/etc)

Hostile work environment proves

-subjectively, the individual had to regard the behavior as sexual harassment -another reasonable person would also regard this incident or behavior as sexual harassment

Consequences of unintentional practitioner

-sued -damaging reputation -losing clients -losing your job -losing your license

What creates a setting for self-care, support and nuturance

-supervision

Support systems

-supervision -peer groups -mentoring -mastermind groups -apprenticeships -coaching -online discussion forums

Who assists practitioners to identify and manage feelings around boundary dilemmas

-supervisors

Ethics

-system of moral principles and appropriate conduct -uphold the dignity of the profession -be client centered -adhere to prevailing laws -stay committed to quality -respect each client -remain service-oriented -work w/in scope of practice

Assessment

-systematic method or approach to gathering information about a client's condition and symptoms -subjective (written or verbal from client) or objective (directly observed from client) information

Critical thinking

-systematic process for gathering, synthesizing, prioritizing, analyzing and evaluating information -reliable, accurate information on client's case gathered and shared with relevant providers who contribute within their scope of practice

Internships, externships, apprenticeships

-systems of training practitioners in a structured competency-based set of skills -teach in a live setting -additional support post training programs -hands-on/apply therapy and skills in real-life situations -effective

Managing your negative feelings

-take a break from the interaction -tell them that you are upset and need time to think about the issue more -plan another time to continue talking (20 min for NS to calm down) -clarify feels and goals during the break -ask a trusted friend/supervisor to coach you through this process

Addressing touch with clients

-talk to client as part of 1st appointment; expectations -modify behaviors as needed

Actions that minimize confidentiality problems

-tell client up front on the limits to the confidentiality of your work -may discuss work with supervisor -break it under extreme circumstances (discuss with client b4 hand)

Responding to body language

-tell person what you've observed and ask him to share what is going on -direct observations often tied into a context -third person statements -explanations of choices or alternatives -expressions of openness to the client's input

Treatment

-test findings by discontinuing care for a predetermined length of time -most clients who reach maximum improvement for their conditions would benefit from wellness care

Mind control abuse

-the act of undermining a person's free will through the control of behavior, information, thoughts, and emotions.

Most anterior part of the spine

-the body --takes weight

Mastermind groups

-the coordination of knowledge and effort in a spirit of harmony between 2 or more people for the attainment of a definite purpose -serve as a confidential sounding board; listen to business concerns/ideas are shared/analyzed/honed -strength is that members committed to supporting each other -fosters amazing creativity and results

Emotional abuse

-the infliction of emotional harm by verbal intimidation or neglectful behavior to intimidate, demean, or hurt another person

The major factors courts and enforcement agencies consider in determining liability are

-the nature of the conduct -the frequency and openness of the conduct -whether it could easily have been avoided by the victims

Evaluate dual relationship risks

-what is the intimacy level -what is the impact of the power differential -to what extent does mutual and equal consent exist -who is accountable for what in the relationship -what is the relative maturity level -will the therapeutic nature of the relationship be enhanced, hindered, or unaffected -what are the consequences of non-participation

Physical abuse

-the use of force or violence to cause pain or bodily harm which is used as an instrument of intimidation, coercion or control

Ethical considerations in hospitals and hospices

-the way a practitioner is integrated into a hospital/hospice setting is important --volunteer with no access to patient care history/plan could cause issues --need to stay within own scope of practice

Complicating factors in dual relationship

-therapist has become a key figure in the client's life -therapist talks to the client about the client's personal life, relationships, and psychological struggles -significant emotional involvement or dependency -therapist breaks own rules with a client -prior relationships/clients history -follow guidelines for psychotherapists: 2 years waiting period

Boundary-setting support

-threatening/dangerous clients (consultation with mental health professional/supervisor) -requests for special concessions (deviations from usual practice) -needy clients (emotional personal dilemmas into professional relationship) -personal or sexual advances (confuse sexual contact with caretaking)

Core of any abuse

-to dominate, humiliate, and gain control of another person -a traumatic event perpetrated by another person that violates the basic physical and psychic integrity of the victim

_____ therapy can provide a valuable healing environment for the abuse survivor

-touch

Dynamics of touch

-touch can change the way the body functions -touch can make the body systems work better -aggressive behaviors decreased with massage/touch -parasympathetic NS: relaxing/pleasurable/lowers bp/ increase digestion/slows breathing -sympathetic NS: soothing/welcome/anxiety-provoking/upsetting/ threatening -generally a positive experience -unconscious reactions to touch (analytical process)

Experiencing the pleasure of non-sexual touch

-touch that is neutral or pleasurable provides building blocks for a changed experience of the body -after safety has been established through repeated positive physical contact -expanded sense of self and a trust in life experiences

Reintegrating body memories

-touch therapy assists survivor in reaching hidden memories and integrating them into his present experience -abuse traumas can cause dissociation from the body -replacing negative physical response with a positive memory reintegrates the experience for balanced/positive state of positive experience -improve body image and less shame

Direct barter

-trade proposals; equal value -common in health care -gift certificates or vouchers -all parties feel good about the trade -based on time rather than money -problems: --inequitable trades, trading for goods/services you don't really need --problems eliminated by a membership

Clinical supervision roles

-train students -continuing education for all wellness professionals -one-on-one or peer supervision group (witnessing others learning) -doing the same kind of work -various disciplines with different views broaden the base of learning/creating an additional support system -feel less isolated and alone -provide support

Contact you State Department of Revenue to apply for the

-transaction privilege tax license --usually fill out form monthly for the 1st year then reduced if volume is low

Types of emotional abuse

-trauma extent goes beyond individual's ability to effectively cope; psychological wellbeing harm of another

Bartering tips

-treat barter as a cash -issue gift certificates or scrip to keep track of trades -carefully evaluate barter prices -realistically assess your barter commitments -set good boundaries -join a barter exchange

Sex and touch therapy

-ultimate ethical challenge to acknowledge the role of inherent sexuality in a milieu where sex is absolutely inappropriate -desexualize the experience -cultural beliefs/personal experiences -location and atmosphere of a session holds cues -sexual innuendos, provocative jokes, aggression from clients -high level of intimacy in therapeutic setting -consider reactive behaviors

Collaboration

-ultimate goal of case management -working together w/a specific client communicate periodically about client's treatment and progress -clear who is responsible for the case management process -empower clients by educating clients on their and inviting them to make key decisions

The at-risk practitioner

-under major stress -insufficient knowledge -poor organization -inappropriate boundaries -working beyond scope -insufficient documentation -not following policies and procedures -lack of contingency plans

Standards of practice

-underlying principles of a given filed, the expectations of professional conduct, and the quality of care provided to clients -elaborate upon the items in a code of ethics -overlaps

Sexual harassment

-unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature --submission to such conduct is made a term or condition of an individual's employment, either implicitly or explicitly --submission to or rejection of such conduct is used as a basis for employment decisions affecting such individual --such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, offensive, or hostile work environment. -physical contact, touching, hugging, stroking, inappropriate greetings, sexually explicit language, reference to body parts, displaying explicit materials

Personalize your scope

-update your resume -define your personal strengths -review local licensing laws -retire old techniques and modalities -network with other professionals -represent yourself honestly -be attentive to high risk areas

The well-informed client

-use client agreement form to eliminate any misunderstandings of services -know why client is seeking your services/goals -explain procedures and invite input -don't assume client knows your treatment process -verbally inform client when you're moving to more vulnerable areas -verbally inform client when you are leaning against the table or climb on the table -inform client when work deepens and check if tolerable -get permission to vary the treatment plan -several minutes before-inform client session is ending soon -no surprises for client -expectations for post treatment (i.e. soreness, etc) -cover all bases -if semi-sleep client, gently transition between strokes

Sharing photos on social media

-use royalty free photo sites -review terms of use section on sites -give credit to the page of the original post -ask for permission and their guidelines -geotagging on phone (remove to use the photo)

The intervention model

-use when verbal/nonverbal communication from a client is unclear or when practitioners feel their boundaries are being violated -steps --stop the treatment using assertive behavior --describe the behavior(s) --clarify the clients intent --educate the client --re-state your intent --continue/discontinue the session as appropriate --refer client to other professionals as appropriate --document the situation

Informal group

-usually gets to talk and see what transpires -no leader/goal -end up being venting sessions -reduce isolation and build connections with others in the same field

Apprentices

-usually paid with increasing salary -flexible arrangements to accommodate the individual's learning needs

Peer group disadvantages

-varying commitment -inconsistency of attendance of members

Employers liability

-vicarious liability: --doctrine of respondent superior holds an employer liable for the acts of an employee -direct liability: --employers own negligence in hiring, retaining, or supervising employees

Supervision and peer groups can

-vital part of starting/running an ethical practice -help deal with daily challenges -personal/professional needs met -build a framework that supports your values (through boundaries); through policies/procedures -appreciation and validation met -builds a vision of ideal clients values

Certification: the law

-voluntary, non-governmental -high consumer protection -code of ethics and professional conduct requirements -educational and exam requirements

Title protections: the law

-voluntary, only required to use title -no consumer protection -no restrictions -minimal requirements

Boundaries

-warm blanket -nurtures business and helps it grow

Processing your thoughts and feelings

-what is the quality of the feeling I'm having -do i treat this client differently in session than other clients -is this attraction so strong that i want to pursue a relationship

Codes of conduct

-written/openly available/regularly reviewed -wide spectrum -address applicable state and federal laws, established business/professional ethical standards -refer practitioners to multiple regulatory and policy documents that the members of the business are expected to follow -complex: highly regulated businesses, national/international presence -adopt one from a professional association

Noisy communication behaviors

-yes-but (contradictory message) -mind-read (act on assumptions) -negative-prediction (bad outcome assuming) -leading question (pressure other person) -complaint (hopeless passive outlook) -attack (venting anger/irritation)

Taxes

-your belief system is the context for all financial dealings -taxation is fraught with emotional charge -many people resent money they pay in taxes (or how it is spent) and use the anger to justify shady business practices

Independent contractors

Advantages -file form 1099-misc annually (if you pay contractor $600 or more) -not required to withhold income tax/ss tax -less risky/easier to terminate -reduced liability Disadvantages -paying a higher price for their services -not having control over their work in terms of timeliness and quality -professionalism is not the same -less likely to build the business