Ethics, Boundaries, Rules and Regulations Part 1

On a unique occasion, a client appears depressed and mentions suicide as a possible option for dealing with life. Suggesting the client seek professional help is considered _______________.a. inappropriate b. beyond the scope of practice c. a personal preference d. a professional obligation

. d - One of the few times a massage therapist is allowed to break confidentiality is when he or she suspects a client to be in personal danger or harm. In this case, the massage therapist has a professional obligation to ensure the safety of the client.

When are massage therapists allowed to disclose confidential information about the client to third parties without the client's consent? a. When the massage therapist is placed in danger b. When required by law or court order c. When the massage therapist has suspicion of child abuse d. All of the above

d - In almost all situations, the massage therapist needs to retain a strict confidentiality of the client's information. However, there are certain exceptions, such as when the massage therapist feels in personal danger, when there are suspicions of a client abusing a child and whenever required by law.

Your last client of the day asks to treat you to a few drinks. What is the correct response? a. Suggest another time b. Say "yes" as long as it is not too expensive c. End your professional relationship with them d. Decline the invitation in order to keep the relationship professional

d - The concern with fraternizing with clients outside of the therapeutic environment is to avoid the possibility of creating a dual relationship.

Which of the following best describes a massage therapist who routinely drapes clients in an immodest and unprofessional manner? a. The massage therapist needs additional training. b. The massage therapist is participating in a dual relationship. c. The massage therapists scope of practice needs to be redefined. d. The massage therapist has broken a code of ethics

d - There are times when undraping sensitive areas for treatment is within the scope of practice of massage. However, a massage therapist who routinely drapes in an unprofessional manner is breaking a standard of conduct indicated in the massage code of ethics

When a client asks for personal information about their friend which happens to be a client, the correct response should be _______________. a. to discuss the details b. to end the conversation c. to tell them some but not all details d. to find a way to turn the focus back on them

d - When a client asks about the private matters of a common client/friend, they are trying to fill a gap that a massage therapist, as a professional, should not fill. The massage therapist may think the client making the request for information will respect the therapist for divulging privileged information but they will ultimately grow to distrust the therapist's adherence to client confidentiality. The best answer is one that puts the focus back on them.

Which of the following would be a possible concern for a new client? a. A detailed and thorough intake b. Low lighting in the treatment room c. Soft music played throughout the office d. Locked door for privacy

. d - A locked door can put the therapist at risk of being accused for entrapment of a client. If a door must be locked be sure to ask the client for permission

Having a discussion with a client about the positive and potentially negative effects of massage for a certain condition is an example of _______________. a. informed consent b. ethics c. framework d. personal boundaries

. a - Disclosing all of the details about a treatment to a client gives them the opportunity to decide how to proceed and is part of the process to obtain informed consent.

Choose the best example of transference out of the following: a. A client who is angry at the new charges proposed by a massage therapist b. A massage therapist who is extra friendly with a client who shares the same hobbies c. A massage therapist who receives extra gifts as a form of affection from a client d. A massage therapist asks a client to a therapeutic seminar

. c - A client that expresses feelings above and beyond the typical role as a client is seen as demonstrating transference. Being overly special can be seen as a red flag, especially in early stages of the therapeutic relationship

What do boundaries clarify? a. Our needs and desires b. Our need to protect ourselves c. Our need to protect our clients d. Our personal limits and expectations

d - Having clear boundaries will assist the massage therapist in knowing when a personal limit has been reached and what can be expected from the therapist and the client within a professional relationship.

Which of the following is a violation of client confidentiality? a. Asking a client about their home office b. Speaking with a client's doctor about their prescription c. Maintaining records in a safe location outside of the office d. Approaching a client in a public setting

d - Although it may seem cold and unfriendly, it is up to the client to approach the massage therapist if they wish in a public setting.

A massage therapist has posted a 24 hour cancellation policy in plain view and has made every client aware of the policy. A client that has missed an appointment and is now angry with the therapist for enforcing the policy is a sign of _______________. a. transference b. countertransference c. maintaining professional boundaries d. ethic justification

a - A client that projects an irrational emotion onto a therapist is considered transference. This is important to remember when it comes to standing ones ground with the policies that are set forth within a professional office.

A crush or loving interest from a client is a natural occurrence. a. True b. False

a - A crush or love interest is a natural occurrence, especially when a massage therapist is viewed as safe, comforting and a truly caring individual. However, acting on these natural feelings oversteps the boundaries and threatens the very ethos of the healing culture of massage therapy.

A massage therapist has the right to refuse to work on someone of the opposite sex. a. True b. False

a - A massage therapist has the right to refuse to work on members of the opposite sex, but the massage therapist must carry out the policy consistently where it does not change from person to person, otherwise the massage therapist may violate gender discrimination laws.

A client has asked a massage therapist to volunteer at a special event for the mentally disabled. The massage therapist would be the only massage therapist at the event. The therapist has over 10 years of experience and is well trained in massage. However, the massage therapist is uncomfortable working with people who have difficulties with communication. Which of the following is a valid explanation for declining the request in this situation? a. Inability to work with people who cannot communicate b. Lack of necessary training and skills c. Lack of additional support during the event d. Only works for money

a - Communication is a very important component of the client/therapist relationship. A therapist who prefers the feedback and open communication from a client is justified to decline work if the client cannot communicate with the massage therapist.

Boundaries are an integral aspect of the massage profession. Which of the following is a core value of boundaries? a. Establishing integrity b. Demanding respect c. Gaining acknowledgment from our peers d. Expecting loyalty from clients

a - Having concise and clear boundaries is the best way to eliminate confusion and gain trust from a client, and in doing so the massage therapist establishes integrity.

Which of the following determines the necessary certifications and educational requirements for licensure? a. State regulations b. AMTA guidelines c. HIPAA regulations d. Federal agency

a - Licensure is handled by state massage boards that determine the minimum educational requirements and certifications needed for qualification. A massage therapist who is interested in licensure in a state that regulates massage should first contact the state massage board for regulation requirements.

An internet marketer has contacted a massage professional and has offered money for client emails and contact information. Which law would this violate? a. OSHA b. State laws c. AMTA d. HIPAA

d - HIPAA, or the Health Insurance Portability Accountability Act, is a law passed in 1996 that, in part, regulates the use and disclosure of health care records and information

At the beginning, the needs of a particular client were very simple. Initially, the client requested general relaxation massage with occasional focus on deeper layers of muscle. However, just over six months ago, the client was diagnosed with diabetes. Since then the client's condition has progressed beyond the comfort and skill level of the massage therapist, though the therapist continues to offer treatment. What has occurred? a. The massage therapist is operating outside the scope of practice. b. A needy client has become unreasonably demanding. c. A power differential. d. A dual relationship has been created.

a - Sometimes a client can develop complex issues and it is important for a massage professional to "check in" with their own personal scope of practice to insure a healthy therapeutic relationship. In this case, the massage therapist should recommend another practitioner with special training to better assist the client.

Which of the following includes the educational and ethical standards of the massage profession? a. Scope of practice b. State laws c. HIPAA d. Personal boundaries

a - The scope of practice encompasses laws that govern the educational requirements as well as guidelines for conduct with regard to ethical standards.

Throughout the years, a massage therapist can learn a multitude of disciplines which can be used during treatments. A massage therapist who works with pregnant mothers, athletes and repetitive stress injuries is best described as using _______________. a. massage fundamentals b. integrated approaches c. structural integration d. applied kinesiology

b - A massage therapist who can use utilize a broad range of skills to treat various unrelated conditions is known to employ integrated approaches.

SOAP notes are medical records that cannot be used in a court of law. a. True b. False

b - All documents that are written about a client have the potential to be used as evidence in a court of law

A client who often jokes about going out on a date is _________________. a. breaking confidentiality b. testing boundaries c. exploring the therapeutic relationship d. just being kind

b - Any client who routinely requests to explore beyond the professional environment is testing the boundaries and professionalism of the therapist. Remember, the therapist is always at fault for allowing a breach of professional boundaries. The repercussions can lead to a hefty fine and/or loss of a massage license.

______________ are the physical and emotional space between a client and a therapist that helps maintain professionalism. a. Ethics b. Boundaries c. Frameworks d. Laws

b - Boundaries are integral to maintaining a healthy physical and emotional space within the therapeutic relationship

Extending a massage session without the clients consent and then charging them for the extra time violates which of the following? a. Legal boundaries b. Informed consent c. Framework d. OSHA regulations

b - Choosing not to disclose the details of a massage to capitalize on a client's ignorance is a violation of informed consent. A client must be informed at all times about any changes within the therapeutic environment that has a direct affect on them.

Which of the following ethical principles is being followed when a massage therapist is conscientious about keeping clients updated with informed consent? a. Healthcare services b. Client autonomy c. Professional maintenance d. Confidentiality

b - Client autonomy is when the practitioner keeps the client up to date about any possible changes or adjustments that can affect the client. This gives the client a chance to choose their course of action with the practitioner.

The federal and state laws that govern the massage profession are the _______________. a. professional boundaries b. legal boundaries c. HIPAA regulations d. OSHA regulations

b - Federal and state law form the legal boundaries of the massage profession.

As a self-employed sole proprietor or independent contractor, how often are you required to file form 1040ES with the IRS? a. Bi-monthly b. Quarterly c. Bi-yearly d. Yearly

b - Form 1040ES is required for estimated tax liability especially if you expect to owe at least $1,000.00 in tax for the year. You are required to make estimated tax payments to avoid federal penalties. The practice of paying your quarterly estimated tax reduces the burden of paying a large sum all at once

Which of the following best describes HIPAA? a. Therapeutic relationship b. Patient rights c. Office safety d. Credentialing

b - HIPAA or the Health Insurance Portability and Accountability Act, was established in 1996 to restrict access to individuals private medical records in an effort to protect patient/client rights.

Malpractice insurance is a requirement by Federal law. a. True b. False

b - Malpractice insurance is not required by Federal law. Regulations on massage vary from state to state. However, to adhere to sound business practices and for the protection of yourself and your clients, malpractice insurance is considered a necessity within the massage community

Which of the following best represents the purpose of OSHA? a. Ethics b. Safety c. Boundaries d. Professionalism

b - OSHA, or the Occupational Safety and Health Administration, is a federal agency created in 1970 to help prevent workplace injuries and illnesses by establishing and enforcing regulations on workplace safety.

A client calls a massage therapist to purchase a gift certificate for his wife who happens to be a regular client as well. The husband has a tendency to be chatty during his massage sessions. This occasion is no different than usual and he asks how his wife is doing with her massage therapy. Which of the following is the best response? a. End the conversation abruptly b. Suggest that the client talk to his wife directly c. Share some but not all information d. Go into detail about the client's wife

b - Speaking about a client to another client, a client's friend, or even the client's family member is a violation of confidentiality. However, we do not need to be rude to maintain our professionalism. Simply suggesting that your client speak to his wife is a perfectly acceptable response

Which of the following massage techniques should not be offered in a medical massage office? a. Feldenkrais b. Tantric c. Neuromuscular d. Hellerwork

b - Tantra is a Sanskrit word meaning expanding liberation and has a place amongst certain spiritual practices. However, tantric massage is often associated with massage that focuses on various levels of "sexual healing" and, therefore, an establishment seeking a tantric massage practitioner is outside the code of ethics of the massage profession.

_____________ is the knowledge base and practice parameters of the massage profession. a. Therapeutic relationship b. Scope of practice c. Code of ethics d. Informed consent

b - The knowledge base refers to education and special training/skills for providing care. The practice parameters refer to conduct and environment. These two combined explain the basic concept of the scope of practice.

A massage therapist has created a beautiful and comfortable space for treatment. They have posted their rates in clear view on the wall and created a well thought out intake form. They are extra careful to be aware of informed consent and client disclosure, as well as following all state and federal laws for running a massage practice. Which of the following best describes the guidance a massage therapist follows for establishing their practice. a. Confidentiality b. Framework c. Professional boundaries d. Personal boundaries

b - The question describes the fundamentals of framework. A framework is all encompassing within the massage field and includes the values and visions, conception, design and desires of a massage therapist as they apply to a business model. Developing a solid framework is essential to creating a healthy and successful practice.

. Which of the following is an example of a massage therapist working as an independent contractor? a. A massage therapist has a regular schedule that is filled by an office manager. b. A massage therapist has direct access to clients and control over scheduling. c. A massage therapist receives income from an office and not the client. d. A massage therapist is expected to work a set schedule.

b - There is conflict within the massage professional surrounding the parameters of working as an employee and working as an independent contractor. It is important to know your local laws regarding this issue. Typically, an independent contractor will have control over the details of the work, like having direct access to clients and control over scheduling, and will not be controlled by an employer.

A regular client who has been going thru a divorce has begun to share emotional details about their experience. They are staying later after their treatment and now routinely show up late for their appointment. They state they are having a difficult time and really need a friend. What can be said about the relationship between the client and therapist? a. The client is still learning how to be responsible. b. Everything is okay. The client will eventually recover. c. The client is testing the boundaries of the therapeutic relationship. d. The client is experiencing a tough time and is allowed special treatment.

c - A client who routinely presses the structure of the practice, like in this case, is testing the boundaries on what is acceptable. Regardless of a client's situation, it is the therapist's responsibility to set appropriate boundaries to ensure all participants feel safe and comfortable within the therapeutic environment.

If you are self-employed as a sole proprietor or independent contractor, which of the following forms must you file for business income and expenses with the IRS? a. Schedule A b. Schedule B c. Schedule C d. Schedule D

c - An individual person, working as a sole proprietor or as an independent contractor, must file the Schedule C for all related business income and expenses to calculate the net profit or loss of the business. Net profit or loss is then carried to IRS Form 1040.

A 16 year old has come to your office for a massage. What is your next step? a. Fill out the intake form b. Make sure they can afford the treatment c. Request a parental release d. Ask them for referrals

c - Before providing a massage to a minor, the massage therapist needs to obtain a parental release. Any person under the age of 18 is considered a minor.

What is the primary reason for keeping all records safe and protected? a. To insure you are paid from insurance b. To protect against being sued c. Client confidentiality d. Personal reasons

c - Client confidentiality is an aspect of professional ethics and should be adhered to out of respect for the client. Also, not protecting a client's information is a violation of HIPAA.

There are moments when a massage therapist needs to disclose personal information about themselves to clients. Which of the following is considered an appropriate disclosure? a. Relationship difficulties b. Sharing information about a mutual friend c. Coming down with a cold d. Business concerns and financial woes

c - Coming down with a cold directly affects the client within the therapeutic environment. The other three choices are irrelevant to a client.

A client with cancer is in a disagreement with a doctor's orders to avoid massage for the next two months. The client has made a special request for massage and is willing to take all responsibility for any adverse effects that may arise due to the massage. Choose the best protocol to proceed. a. Massage as normal using both light and deep pressure. b. Massage as normal using only lighter massage techniques ie, Swedish. c. Massage using only MLD. d. No massage. Follow the orders of the medical doctor.

d - A strict order to not treat by a medical doctor should always be honored, especially in the case of a medical condition that can be adversely affected by massage. If the client insists on massage, then the massage therapist should recommend that the client obtain a second opinion and an authorization letter or prescription from another doctor.

Over the past year, the relations between a massage therapist and a client has grown friendly. There are times when both parties talk during the massage session and sometimes things are shared that are beyond the regular scope of practice. Lately, the client, who openly talks about his financial success in business, has been having difficulties with the construction workers who are building the client's dream home. The massage therapist, who lives in an apartment, has recently become irritated by the client's personal problems and is having a difficult time performing her duties as a massage therapist. Which of the following best describes the relationship? a. A dual relationship b. Transference c. Countertransference d. Indifference

c - Countertransference is when a practitioner projects feelings or emotions onto a client. In this case, the massage practitioner is most likely jealous of the client's fortunes and has lost the ability to be a compassionate professional towards them. If this were a dual relationship, the two parties would be engaging each other outside of the treatment office

A massage therapist has worked with a particular client for over a year now. In the last couple of massages, the therapist has noticed a shift in the way the client responds to the treatment but is not able to discern anything specific. What could the massage therapist do to help the situation with the client? a. Talk with the client about intimacy issues. b. Be sure to adjust body language towards the client. c. Refer to a peer for support. d. Sign up for a continuing education class to deal with the client.

c - Discussing the issue with a peer is the best step towards gaining an unbiased view of the situation. The other choices signal that the therapist has made an assumption about the dynamics surrounding the client's behavior.

The dynamics between a client and a massage professional are complex, which creates an immediate _______________. a. friendship b. relationship c. power imbalance d. power equality

c - Power imbalances occur naturally when one person is perceived as being an authority over another in a certain situation. This is why the dynamics between a client and a professional of all backgrounds has the capability of becoming emotionally unbalanced if left unchecked.

A massage therapist that conducts a regular self-assessment of strengths and weaknesses, respects the privacy of client information and upholds the standards of professionalism is adhering to _______________. a. legal boundaries b. informed consent c. the massage code of ethics d. personal boundaries

c - The massage code of ethics is a standard of conduct that defines ethical behavior for a massage therapist. The question lists principles of the massage code of ethics.

There are two main roles between a therapist and a client. The first role is as a massage therapist and the second role is as ___________________. a. an instructor b. a counselor c. a professional d. a confidan

c - The second role, as a professional, is as important as the first role. One can be the greatest massage therapist in the world, but if the massage therapist does not abide by the guidelines, ethics and laws set forth for the profession, then the therapist can do more harm than good to those who seek their help.

A therapist may legally engage in sexual relations with a client if they: a. Obtain written permission from a lawyer b. Officially end the client/therapist relationship within a week before intercourse occurs c. Maintained a sexual relationship prior to developing a client/therapist relationship d. A therapist should never engage a client in intercourse

c - There are laws, rules and regulations against developing a sexual relationship with a client. If a sexual relationship existed prior to the client/therapist relationship, then continued sexual interaction is allowable. A typically safe amount of time to wait is 6 months after the client/therapist relationship has been dissolved (documented and signed by both parties) before pursuing a romantic interaction. However, the best path to preserving your career and avoiding a possible investigation is to never engage a client or previous client in any relations outside of a therapeutic environment.

Which of the following is the local laws that control the physical location of an office? a. Building codes b. Licensing c. Zoning d. Business registry

c - Zoning ordinances and regulations are local laws that govern how a property can be used. Always check with the local municipality before making any major changes to a home or office.

. A client has requested to receive visceral manipulation from a massage practitioner who has no experience or training in visceral manipulation but has a general understanding of the technique. The client has received visceral manipulation from other massage therapists and insists that he can teach the practitioner to provide the treatment. The client is not affiliated with any aspect of healthcare. Choose the best option to proceed. a. Massage the client but avoid any attempt to provide visceral manipulation. b. Massage the client while attempting to provide visceral manipulation. c. Massage the client while learning from the client's experience of visceral manipulation. d. Refer the client to a practitioner who is trained in visceral manipulation

d - A massage practitioner should never work outside of his or her scope of practice. There are many therapists with varying degrees of training and expertise. The best option is to refer the client to another therapist or medical practitioner with the proper training to better assist the client's needs

. A potential client calls to make an appointment for a massage. You notice that they are slurring their words and having difficulty speaking in complete sentences. They claim they were in an auto accident yesterday but declined medical attention. They awoke this morning feeling very sore and achy as well as having a pounding headache. They insist they need a massage. What is the appropriate plan of action for the massage therapist? a. Book the appointment immediately b. Book them within next week c. Refer to another therapist d. Immediately refer them to a doctor

d - A person who has been in an auto accident could have any number of injuries including shock. For the safety of the client and your protection as a therapist, the best recommendation is to refer the client for a medical evaluation before any treatment is considered