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Proposed Standards of Practice

CMTBC has developed a new standard of practice on professional boundaries. The proposed standard of practice outlines:

The CMTBC Board has approved the release of the proposed standard of practice to the profession and the public for an eight-week notice period, from April 16 to June 11, 2018. During the notice period, any RMT or member of the public may submit comments about the proposed standard of practice by email to standardsfeedback@cmtbc.ca.

The College will consider all comments received before submitting the standard of practice to the CMTBC Board for final approval in June 2018.

CMTBC Standards of Practice

Purpose

Practice standards define the minimum level of expected performance for registered massage therapists, and therefore define what constitutes safe, ethical, and competent delivery of care by RMTs.

RMTs are responsible for exercising their professional judgment to apply the standards to the situations that they face in practice.         

Boundaries

Definition

Boundaries define what constitutes a therapeutic relationship by clearly marking the differences between a therapeutic and non-therapeutic relationship. A therapeutic relationship between a patient and an RMT is based on trust, respect and the patient’s best interests. Professional boundaries specify the behaviours that are appropriate within the therapeutic relationship, and set clear behavioural expectations for RMTs.

The physical nature of massage therapy requires clear boundaries to ensure that the patient’s safety, comfort and dignity are upheld. Clear boundaries allow patients to know what to expect when they seek care from an RMT.

Requirements

An RMT:

  1. establishes and maintains professional boundaries with a patient before, during and at the termination of the therapeutic relationship, as required by the CMTBC Code of Ethics, by:
    1. providing patient-centred care at all times;
    2. demonstrating respect for the patient;
    3. establishing a professional rapport with the patient; and
    4. maintaining an appropriate level of professional objectivity;
  2. advises and redirects a patient if professional boundaries are crossed or unclear by:
    1. recognizing that it is always the responsibility of the RMT to establish and maintain professional boundaries;
    2. re-establishing professional boundaries with the patient;
    3. articulating the limits of the therapeutic relationship in a manner appropriate to the context; and
    4. using professional judgment to determine whether and when to terminate a therapeutic relationship in accordance with the CMTBC Code of Ethics;
  3. where there is a potential or actual boundary violation that cannot be adequately resolved, terminates the therapeutic relationship in accordance with the CMTBC Code of Ethics;
  4. recognizes and respects the obligations set out in the CMTBC Code of Ethics never to sexualize the treatment environment or the therapeutic relationship through words, touch, or any other form of explicit or implicit sexual conduct (which constitutes sexual misconduct), or to permit a patient to do so;
  5. does not enter into a close personal relationship with a patient;
  6. does not enter into a close personal relationship with a former patient except in accordance with the CMTBC Code of Ethics;
  7. avoids providing treatment to close friends or family members where possible, and, if such treatment is unavoidable:
    1. clearly communicates to the patient when the RMT is acting in a professional capacity; and
    2. maintains relationship boundaries when acting in a professional capacity;
  8. recognizes when he or she is in a dual relationship with a patient and:
    1. clearly communicates to the patient when the RMT is acting in a professional capacity as a registered massage therapist; and
    2. maintains relationship boundaries when acting in a professional capacity;
  9. recognizes transference and counter-transference and:
    1. continuously assesses the patient’s presentation and responds empathetically; and
    2. monitors his or her own communications and reactions to manage transference.
  10. refrains from giving gifts to patients or receiving gifts (including tips) from patients where this has the potential to compromise the RMT’s objectivity or ability to act in the patient’s best interests;
  11. recognizes the potential inequality within the therapeutic relationship and does not use the therapeutic relationship for inappropriate personal or financial gain;
  12. communicates verbally and non-verbally with patients in a manner that:
    1. meets patient needs;
    2. avoids professional jargon or overly technical language;
    3. is professional and respectful; and
    4. demonstrates unconditional positive regard.
  13. avoids disclosing personal information to the patient and only discloses limited personal information to the patient to the extent that it is part of the provision of patient-centred care;
  14. recognizes and is accepting of individual and cultural differences based on factors such as age, gender, religion, sexual orientation, ethnicity, cultural beliefs, ability, values or lifestyle;
  15. recognizes both cultural and individual differences in levels of comfort with touch and physical contact;
  16. regularly checks in with the patient regarding his or her level of comfort with physical contact and treatment delivery, and monitors the patient’s presentation for signs of discomfort (including non-verbal signs);
  17. employs touch only with therapeutic intent;
  18. does not initiate non-therapeutic touch or hugging with a patient and, before receiving non-therapeutic touch such as a hug, considers whether it would be appropriate, supportive and welcome;
  19. communicates the intent of therapeutic touch to the patient before and during treatment delivery near potentially sexualized areas of a patient’s body;
  20. obtains and documents the patient’s informed consent to treatment, both initial and ongoing;
  21. recognizes and takes steps to minimize the occurrence of unintentional or incidental physical contact with potentially sexualized areas of a patient’s body, including by:
    1. communicating treatment intentions clearly before and during treatment;
    2. obtaining informed consent to treatment;
    3. only undraping the area of the patient’s body where treatment is delivered; and
    4. using draping to delineate the treatment area or agreeing upon a way to delineate the treatment area with the patient if providing treatment over clothes;
  22. if unintentional or incidental physical contact with potentially sexualized areas of the patient’s body occurs, stops treatment, obtains patient consent before continuing, and documents the incident in the patient record;
  23. takes steps to prevent the occurrence of unintentional or incidental physical contact with the patient’s body by potentially sexualized areas of the RMT’s body.

Appendix: Defined Terms

Boundary violation: When the nature of the therapeutic relationship moves from professional to also being personal, such that harm can come to the patient, RMT or massage therapy profession.

Close personal relationship: A relationship with a person that is characterized by warmth and familiarity, and/or has elements of exclusivity, privacy or intimacy. 

Counter-transference: When the RMT reacts to transference by transferring his or her experiences or emotions onto the patient.

Dual relationships: When an RMT has a business or personal relationship with a patient outside of his or her practice.

Transference: When a patient projects feelings stemming from the patient’s own personal experiences or emotions onto the RMT.

Therapeutic relationship: The relationship between a health professional and a patient, which is potentially unequal. It is the responsibility of the health professional to recognize and manage this potential inequality in order to provide safe, effective and patient-centred care.

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