PD200 Flashcards

Question

key concepts (2)

Answer 1

boundaries & boundary-lessness dual relationships transference & countertransference

Answer 2

transaction not a casual interaction

Answer 3

0.5 meter = intimate space 1.2 meter = personal space 3 meter = social space

Answer 4

Clear communication Empathic yet firm Leaving no doubt as to where a boundary lies

Answer 5

Non disclosure of information places the client at risk Why might a patient be uncommunicative?

Answer 6

The client does not feel comfortable sharing the information The client does not think certain information is relevant The client forgets to disclose something specific

Answer 7

"might have difficulty reading"

Answer 8

1) verbally repeat questions on health form 2) reword questions 3) work conservatively/generally until it's possible to get more information

Answer 9

When therapists ignore their professional role, they may: Harm clients emotionally, psychologically, physically, financially. Promote transference. Ignore ethical responsibilities. Become vulnerable to clients who wish to promote personal contact.

Answer 10

When clients forget their roles, they may: Confuse therapeutic touch with intimacy. Assume that the therapist shares client feelings.

Answer 11

Inappropriate or suggestive comments Crude behavior Attempts to control through guilt or intimidation Offering advice outside of therapeutic role Ignoring client cues Exchanging treatments for personal favors Breaking confidentiality

Answer 12

Internal or external locus of control Family culture, schooling, religion, and personal experience with setting limits Attitudes towards: Intimacy, body image, and sexuality Authority and discipline

Answer 13

Permeable ------ Weak Ignores massage therapy transaction Does not challenge problematic behaviors Personal sharing compromises care

Answer 14

Rigid ------ Allows no personal information, attitudes or feelings to be shared Boundary is firm and cannot be penetrated No acknowledgement of potential for exceptions

Answer 15

Firm but flexible boundary ------ Allows personal information to be shared if it is: Ethical to do so In the client's best interest

Answer 16

Actively listen to client concerns while limiting advice-giving Stick to professional role and scope of practice

Answer 17

Represents a violation of client-centered care Poses significant risk to clients and therapists

Answer 18

Separate personal/professional environments Professional standard of hygiene Predictable schedule Availability limited to professional hours Clearly communicated fee structure Discounts and special relationships avoided

Answer 19

Occur when two people share more than one type of relationship Initial relationship foundational For example, Friends who later became clients will always be FRIENDS first.

Answer 20

Do not confuse the therapeutic hour with personal time with a friend.

Answer 21

Divided loyalties and conflicts of interest --- Therapeutic responsibilities versus personal relationships Unreasonable expectations for therapists --- Therapists must always respond therapeutically. Personal conversations may conflict with therapeutic response.

Answer 22

Conflict between professional role and personal relationship No objectivity Potential for misuse of confidential information

Answer 23

Dual relationships compromise objectivity. The nature of the first relationship defines the nature of the second.

Answer 24

Occurs when clients project feelings onto their therapist Stems from personal experiences

Answer 25

Pay attention to signs of transference. Transference is not about the therapist. Responsibility for managing it always rests with therapist.

Answer 26

Responsibility for managing it always rests with therapist.

Answer 27

Ignoring transference puts clients at risk. Client feelings may intensify. Client may feel permission to act out transference fantasies.

Answer 28

DO's Begin and end treatments on time. Establish and clarify boundaries. Limit personal disclosures. Respond empathically. Seek peer supervision.

Answer 29

DON'Ts Don't provide extra time. Don't meet the client socially. Don't indulge in dual relationships. Don't ignore signs of transference.

Answer 30

Occurs when: Therapists project feelings or associations onto clients Clients remind them of other relationships potential to ruin relationship

Answer 31

Countertransference causes communication and boundary challenges. Positive countertransference Feelings of love and attraction toward client Negative countertransference Feelings of discomfort, dislike, or even hatred toward client

Answer 32

Seek peer supervision to help: Clarify feelings and reactions. Create a strategy to address countertransference.

Answer 33

"I feel … (description of emotion) "when you … (specific description of behavior) "I would appreciate if [you, we] could do this differently by …" (request for a change in behavior)

Answer 34

Describe a therapist's limits to care Remind clients that massage therapy is a transaction Protect both clients and therapists Minimize transference and countertransference

Answer 35

a framework that predictably outlines what clients may expect. Hours of work Fees Location Ethical commitment to practice Clinical policies regarding: Confidentiality Privacy Cancellation fees

Answer 36

Business cards Your physical space The first telephone contact A website Word of mouth referrals – what kind of people are talking about you? Your fee structure, and how patients learn about it The music you play The length of your sessions; how you deal with lateness – your own, and that of your clients …

Answer 37

Having a business card shows you are serious about your business People expect professionals to have business cards Cards should be simple and eye catching “a graphic or other image used by a Registrant ...as a massage therapist should not suggest that some service is being provided other than massage therapy.” 78.3(1) “shall be dignified and in good taste.”78.3 (1)(b)

Answer 38

“Working out of an office rather than a home is generally more professional and will feel safer both to you and to your clients.” “You don’t want your office space to look like a bedroom with a massage table in it.” Practitioners need to avoid making their offices into displays of their personal beliefs-political, spiritual, or otherwise. “Clients love coming into a room that’s all set up for them.’

Answer 39

“For clients’ confidentiality , you need to have a way that they can leave a message that only you can access.” (phone)

Answer 40

SOCAN – the Society of Composers, Authors and Music Publishers of Canada – is a not-for-profit organization that represents the Canadian performing rights of millions of Canadian and international music creators and publishers. SOCAN collects license fees from businesses that use music and distributes the money as royalties to those who create music. SOCAN operates in accordance with tariffs certified by the Copyright Board of Canada. In the case of a business such as a massage therapy clinic, the waiting room/reception area is considered public space and is therefore licensable and potentially subject to a yearly SOCAN fee, based on square footage. In a public area, music coming from a radio does not require a SOCAN music license, but streamed/online radio requires a licence. The exception to this is if you subscribe to a music supplier that already submits license fees to SOCAN. If you’re not sure if your music provider is licensed with SOCAN, you can contact SOCAN to inquire about your provider. Change rooms and treatment rooms are considered private space and therefore are not licensable. In a private area, any music can be played without a license from SOCAN.

Answer 41

Be careful about your tone (straight-forward, businesslike and confident, not apologetic nor punitive)

Answer 42

Lack of continuity of care Lack of charting Failure to remit required taxes (CRA – Treatment has value which is taxable) What happens if something goes wrong?

Answer 43

When you hire them for a commercial service, you create a situation where someone with whom you have a therapeutic relationship is now under contract to you in another context.

Answer 44

Is there a potential to create vulnerability for your patient? Are there risks in letting your patient into some aspect of your personal life? What happens if there are issues with the work done by the patient who is now your web developer or photographer? How will that change the therapeutic relationship? What happens if you are not satisfied with their work? Will it be awkward to discuss it with them? Or, provide them with a medically indicated treatment?

Answer 45

A yellow light: warning signs for boundary crossings Accepting personal gifts/money from a client (other than the regular fee for your services) that could be perceived as an unfair benefit or unfair advantage by other clients and staff.

Answer 46

If a registrant has decided not to accept a gratuity on the basis that doing so would violate CMTBC Bylaws, he should inform the patient of his reasons for declining the gift in a professional manner. Citing professional obligations and responsibilities may assist the patient in knowing that this is a professional requirement, not a personal rejection.

Answer 47

“An Rmt: 10. refrains from giving gifts to patients or receiving gifts( including tips) from patients, except where the RMT’s objectivity or ability to act in the patient’s best interest will not be compromised.”

Answer 48

Is the use of discount coupons in health care appropriate? The RMTBC believes that discount coupons in health care are not appropriate.

Answer 49

RMTBC guidelines do permit reduced fees on a patient-specific basis in order to enable access to those who are unable to benefit from our profession due to economic hardship or reduced income.

Answer 50

if the patient has no financial hardship, then discounting a treatment undermines the education and professionalism of RMTs in BC.

Answer 51

We encourage RMTs to separate themselves from non-registered body workers who commonly use this type of marketing.

Answer 52

Means the legislation, policies and procedures that apply to the practice of massage therapy in a jurisdiction(e.g. B.C.)including the governing statute, College/Board rules or bylaws, code of ethics and practice standard.

Answer 53

In B.C., it means that RMTs have ------ A unique combination of knowledge and skills; A commitment to duty above self-interest or personal gain; and Independence from external interference in the affairs of the profession (self-government).

Answer 54

Self regulation is a privilege delegated to a professional or occupational group by the Legislature only when it is clear that the public can best be served by regulating the profession or occupation.

Answer 55

With any self- regulating profession , there is an implied “social contract” between the profession and the public.

Answer 56

the profession agrees to regulate its members in the best interests of the public. In exchange, the public agrees to allow the profession to regulate itself instead of being regulated by the government.

Answer 57

The “social contract” is created when the government grants the profession self- regulating status through a legislative framework.

Answer 58

Massage therapy practice in British Columbia is regulated within a framework that starts with the Health Professions Act, but also includes regulations made under that Act, other provincial legislation applicable to health professionals, and CMTBC’s Bylaws, Code of Ethics, and Standards of Practice.

Answer 59

The Health Professions General Regulation provides further clarification of the Health Professions Act, including: The prescribed periods for disposing of complaints. The standard form Oath of Office for Board members. The reasons for refusing to disclose information contained in the register.

Answer 60

The Massage Therapists Regulation defines what constitutes massage therapy, as well as: Naming CMTBC as the regulatory college for massage therapy. Granting titles reserved for the exclusive use of registrants. Placing restrictions on the practice of massage therapy.

Answer 61

a) massage therapist b) registered massage therapist c) massage practitioner d) registered massage practitioner

Answer 62

a) prescribe administer drug/anaesthetic b) treat recent fracture of bone c) apply any form of medical electricity d) move a joint of the spine beyond the limits the body can voluntarily achieve using high velocity, low amplitude thrusts

Answer 63

CMTBC is one of 20 health regulatory colleges in BC governed by the Health Professions Act. The Act mandates the colleges to govern their registrants in the public interest. As outlined in section 16 (1) of the Act, it is the duty of a college: To serve and protect the public. To exercise its powers and discharge its responsibilities under all enactments in the public interest.

Answer 64

Set out rules for governance and administration of the College Define the requirements that RMTs must meet in areas such as registration renewal and quality assurance Set out entry-to-practice requirements for applicants for initial registration, and Establish fees.

Answer 65

The Code of Ethics outlines the expectations for ethical massage therapy practice.

Answer 66

CMTBC Standards of Practice define the minimum level of expected performance for RMTs. CMTBC is continuing to develop new standards of practice, each of which will be posted when it is ready for comment on the Proposed Standards of Practice page.

Answer 67

The HPOA came out of a very significant report conducted by an expert in the field of Health Regulation, Harry Cayton. The HPOA does important things: It takes a proactive approach to eliminating discrimination It improves governance of regulatory colleges by moving to a merit and competency-based appointment process. It creates a superintendent’s office to oversee the regulatory colleges. It allows for more transparency and accountability to the public. It is focused on keeping people safe.

Answer 68

Massage Therapists will be amalgamated with Chiropractors, Naturopaths, Traditional Chinese Medicine, and Acupuncture HPOA received Royal Assent on November 24, 2022, and is to take place by June 28, 2024.

Answer 69

Keep in mind… Confidentiality Informed consent Framework – keep it consistent!

Answer 70

Personal Information Protection Act Freedom of Information and Protection of Privacy Act

Answer 71

Obtaining informed consent to treatment

Answer 72

When therapists establish informed consent, they fully disclose the purpose and benefits of a treatment approach. They discuss any potential problems that might arise, what parts of the body will be massaged and how the client will be draped. Therapists empower clients to state any concerns or ask any questions. Before proceeding with the treatment, the therapist explicitly asks the client for permission to begin.

Answer 73

Confidentiality: A commitment to keep private information from being shared with unauthorized individuals. Maintaining confidentiality means restricting access to client information to authorized individuals and keeping information secret from everyone else. In massage therapy, maintaining client confidentiality is a foundation of professional practice.

Answer 74

Obtaining consent is both a professional obligation, as well as a legal obligation under two BC statutes (the Health Care (Consent) and Care Facility (Admission) Act and Infants Act.

Answer 75

Section 9 of the College’s Code of Ethics requires RMTs to obtain informed consent for therapeutic services. Under section 8 of the Code of Ethics, RMTs must provide complete and accurate information to enable the patient to make an informed decision regarding the need for, and nature of, therapeutic services.

Answer 76

The CMTBC standard of practice on consent went into effect January 15, 2019. CMTBC’s Bylaws require RMTs to comply with the standard of practice on consent.

Answer 77

The Infants Act sets out different requirements for obtaining consent from an “infant” or minor (legally defined as an individual under the age of 19 years). While the Infants Act uses the term “infant” to describe all minors, it provides rules to determine who qualifies as “mature” minors and who are entitled to give consent to their own health care.

Answer 78

can, if ------ explained the nature, consequences the patient understands these benefits and risks efforts to determine that massage therapy ... best interest if one or more not met ... cannot consent

Answer 79

medical information must be kept confidential under the Personal Information Protection Act (PIPA)

Answer 80

“ In other words, there is not set age whereby infants can consent to their own medical treatment. Instead, registrants must use their own best judgement to determine when an infant is capable of providing consent.

Answer 81

Privacy Describes a client expectation: Being free from observation Client expects to undress in private Confidentiality Describes therapist action: Maintaining client information and records securely Ensuring that information may not be accessed without client consent

Answer 82

privacy = PATIENT EXPECTATION confidentiality = THERAPIST'S ACTION

Answer 83

informed about how their personal health information is used. obtain written authorization to share health information with third-party payers. have the right to refuse to share their personal information.

Answer 84

exploitation against bylaws/laws

Answer 85

This is a factual summary of all the information available regarding the patient’s history. It expressly does NOT contain any opinion from you with respect to the patients’ condition.

Answer 86

One is the long form for more complex cases. It includes a cover letter and then a report. The short form has the report within the body of a formal business letter.

Answer 87

The treatment programme consisted of a progressive approach to return the patient to normal activities and optimal function. Massage, ischemic pressure, contract relax, PNF, soft tissue manipulation, and cryotherapy were used to decrease spasm and pain. Active and passive joint mobilization techniques were used to improve and restore ROM. Cross fibre frictions were used to decrease fibrosis in left and right shoulders Progressive exercise programme was demonstrated to increase ROM and strengthen in cervical, scapular and thoracic regions Pendulum exercises for shoulders initially to increase ROM with progressive increase in intensity with light weights to strengthen shoulder muscles.

Answer 88

In complex cases it is even more important to send medical reports to the patient’s M.D. It is not our job to determine if a patient is malingering. When preparing a report ensure that the contents conform to legal evidentiary requirements. Opinions poorly written can result in embarrassing cross examination. It is extremely important to confine yourself to your area of expertise. (Experience, training and education).

Answer 89

It is appropriate to offer a prognosis, as long as it is couched in such terms as: “I have treated _______of patients over a __________ number of years exhibiting similar symptoms and have found that my patient’s symptoms and recovery are in line with their injury”. Never offer an opinion on how the law should apply. Your report should be objective and impartial.

Answer 90

deliberately deceiving HCP to receive more treatment/compensation Difference observed between what is claimed by client and what is observed by therapist. Ask questions, listen to gut instincts, and uncover ‘payoff’

Answer 91

It is not our job to determine if a patient is malingering.

Answer 92

Sometimes it is not a problem to socialize with clients if you remain aware of your roles and responsibilities.

Answer 93

some clients assume intimacy and friendship when none is offered. may become surprised/offended by contract negotiations --> cancellation fees, refusing off-schedule work

Answer 94

Remember that your professional hat is never off, even when you are not in the clinical environment. (When you see client outside work environment)

Answer 95

You are in a position of power with respect to your patients in the clinical setting and the power does not disappear when the setting changes. To refuse a client’s invitation, reassure them it is part of your professional policy not a personal rejection.

Answer 96

send to another practitioner

Answer 97

Do I have to refer a patient whose care I have terminated to another RMT? RMTs have an obligation to ensure continuity of care for their patients, even if the patient-therapist relationship is being terminated because of a conflict or an incompatibility. A patient with a medically-indicated need for massage therapy is entitled to be referred to another practitioner. If asked about the reason for the referral, you may state that the therapeutic relationship was terminated in accordance with the Code of Ethics

Answer 98

A registrant may terminate a therapeutic relationship when: Therapy is no longer indicated or wanted Another health care professional has assumed primary care responsibility, or Written notice of the intended termination had been provided to the patient.

Answer 99

A registrant may immediately terminate the therapeutic relationship with any patient who sexualizes or attempts to sexualize the treatment or environment, or threatens the massage therapist or otherwise endangers the massage therapist. discriminatory

Answer 100

“Include no judgements, subjective comments , or opinions about the incident, only the facts.” The record should be dated and signed by the therapist and kept in the client’s file.” When a treatment turns ugly you are required to document the entire event from beginning to end in an incident report.

Answer 101

stigma and prejudice body image, weight, obesity eating disorders emotionally challenged patients patients directing the session tauma/PTSD

Answer 102

“A powerful discrediting and tainting social label that radically changes the way individuals view themselves as persons.”

Answer 103

essential foundation of therapeutic relationship This term means treating people and their ideas nonjudgmentally and with respect. "demonstrates I care -- not I care if you behave thus"

Answer 104

Abortion rights Attitudes toward money Cultural conflicts Homophobia Political or economic views Racism and cultural intolerance Religious beliefs Attitudes toward medically assisted death Sexism or misogynist views

Answer 105

“Working with people you don’t care for can seriously compromise the safety of the therapeutic environment. You may be inclined to be late, to be less than present, to tune them out, to short-change them on time, or to lack compassion. Practitioners cannot totally hide their personal feelings from clients. What client wants to be touched by uncaring hands??”

Answer 106

“RMTs have a responsibility to respect a client regardless of race, religion, ethnic origin, age, gender, sexual orientation, social or health status.”

Answer 107

“Some of the most blatant fat discrimination comes from medical professionals.” A 2018 report found that experiencing weight bias or stigma can be as harmful as the effects of obesity itself.

Answer 108

and then pictures of non-obese people, consistently rate the obese person as less attractive, less intelligent, lazy, weak-willed, gluttonous, and less likely to succeed.[1]

Answer 109

not within scope not area of expertise common facts that patient already knows

Answer 110

Recognize that eating disorders are potentially fatal diseases and treat them accordingly.

Answer 111

anorexia nervosa bulimia note amenorrhea as a result of anorexia nervosa

Answer 112

not our job/expertise refer to dietitian

Answer 113

guarding pulling away hypersensitivity holding breath

Answer 114

Self-regulation is an essential skill because it: Teaches self-soothing strategies. Encourages function. Lessens depression, anxiety, and insomnia.

Answer 115

Encourages deeper breathing Facilitates calm, rest, and relaxation Addresses pain Promotes flexibility

Answer 116

Distrust of authority figure Need to feel in control Discomfort with the gender of the clinician Fear of Judgement Conditioning to be passive Feeling unworthy of care Ambivalence about the body

Answer 117

ANXIETY DISORDER “brain weariness” in the American Civil war and “shell shock” in the First World War.

Answer 118

Soldiers and security personnel Victims of abuse, bullying, domestic violence Children The earlier in life a person is traumatized, the worse the effects

Answer 119

With PTSD, the person repeatedly experiences flashbacks to the traumatizing event. Emotional numbing or decreased involvement with the outside world occurs. increased sympathetic nervous system firing which contributes to headaches

Answer 120

It is considered acute if it lasts less than six months and chronic if it lasts for longer than six months. It is found that the condition lasts longer if the trauma is related to a human cause as opposed to a natural disaster such as a flood. Treatment includes relaxation strategies, especially breathing and visualization techniques, massage, counselling, including family therapy, and medication such as antidepressants.

Answer 121

Sexual, emotional or physical abuse is trauma that leaves profound and lasting effects on a person’s psychological , cognitive and emotional functioning.

Answer 122

Hypervigilance or Hyper arousal is a state of increased psychological tension marked by reduced pain tolerance, anxiety, exaggerated startle responses, insomnia, fatigue and accentuation of personality traits. Emotional Absence or Unresponsiveness avoiding or distancing strategies such as Dissociation Numbness or hypersensitivity Loss of personal connection

Answer 123

labile mood (marked fluctuation of mood) or mood swings. term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response.

Answer 124

When implicit memories surface, clients may protect awareness by: Detaching from self. Becoming unaware of surroundings. Disconnecting from the present. Becoming emotionally unresponsive. Becoming unable to remember significant aspects of trauma.

Answer 125

Victims have impression that: Choice may be ripped away at any time. No place feels completely safe. No person can be completely trusted. It's possible to deny, but not to forget. Life is fragile and can be gone in an instant.

Answer 126

Personal touch history encodes the trauma. They may not be able to take instructions. They may not believe therapist reassurances. They will likely feel triggered by: Confined spaces (e.g., treatment rooms). Close proximity to others (e.g., therapists).

Answer 127

Fear, trauma, and other emotions are processed in hypothalamus and amygdala. HYPOTHALAMUS AND AMYGDALA

Answer 128

Touch triggers somatic responses in traumatized clients. Reminding client of associated memories

Answer 129

Repeated trauma generates somatic responses that eventually become independent from trauma Client: Experiences a physical response to touch. Remains unaware of the cause of the response.

Answer 130

Actively kindling implicit memory equivalent to re-traumatizing client Clients unable to distinguish between "therapy" and "trauma"

Answer 131

Biological urge to seek safety when confronted with a frightening situation Observed throughout the natural world

Answer 132

Type of attachment system develops when children faced with stressful situation. Every person exhibits some form of attachment.

Answer 133

In order to avoid pain, clients may: "Forget" or avoid experience. Ignore bodily signals of distress. Give no sign they are in pain. Suppress pleasurable reactions. Deny trauma. Begin and abandon treatment.

Answer 134

History provides context for understanding client reactions. Trauma and insecure attachment affect ability to feel safe and make choices. Empathy and choice support emotionally fragile clients. Clients who are at risk should be referred to appropriate healthcare professionals.

Answer 135

Has an Attention/socialization disorder Has Dementia and cognitive decline Has a disability Is always late, Misses appointments ,Late cancels. Has an erection/Asks for sexual services Reflect on beliefs, convictions and old learning patterns that interfere with our best intentions to self care Begin goal setting as an effective tool for self-assessment

Answer 136

Attention/socialization disorders Autism spectrum disorders (ASD) Traumatic brain injury (TBI) Dementia and cognitive decline Alzheimer's Disease (AD) Vascular Dementia Delirium

Answer 137

Don’t Pretend there is no communication challenge. Rush conversations Move quickly or suddenly. Express frustration with client capacity to understand. Rely on open questions. Expect clients to infer. Take offense if clients with Asperger or ASD criticize something about their experience in massage therapy. From their perspective, they are telling the truth, not trying to hurt or harm you.

Answer 138

Missed social cues. Focus on patterns instead of facial expressions. Interpret language literally. Cannot interpret nonverbal behavior. Often rely on visual information only. May include agitation, aggression, amnesia, lowered cognitive function, disorientation, and confusion.

Answer 139

Pay attention to behavior, patterns, and routines. State what is true. Describe what is expected precisely. Employ specific closed questions.

Answer 140

Behavior disturbances Anger or aggression Danger to self or others "Sundowning" or agitation as the sun sets Hallucinations

Answer 141

Dementia -Chronic confusion and cognitive decline -Short- term memory loss - Caused by cardiovascular deconditioning, medications, metabolic problems, nutritional deficiencies, brain tumors

Answer 142

short term memory

Answer 143

Sudden onset of acute confusion and change in cognition Result of infection, cancer, or change in medications Frequently associated with urinary tract or respiratory infections

Answer 144

Alert the healthcare team. Delirium as a result of infections or medication can be investigated and treated.

Answer 145

Adjust treatments according to client capacities. Maintain verbal ongoing consent throughout treatment. Employ plain language. Engage client in treatment decision making. Respect client choices.

Answer 146

Use clients as an opportunity to practice techniques. Correct or criticize. Ask questions unless necessary. Be surprised by client behaviors.

Answer 147

ask questions unless necessary***********************

Answer 148

Correct or criticize.

Answer 149

Speaking in a clear, slow, and deliberate manner enunciating each syllable helps when deaf individuals lip-read Taking blind clients by the arm to guide them may not be necessary or appreciated.******* may need the treatment room described in order to negotiate how to move around or get onto the table.

Answer 150

DO NOT SPEAK TO INTERPRETER OR CAREGIVER/COMPANION

Answer 151

take blind patient by arm unless requested

Answer 152

IS APPROPRIATE (?) left handshake also acceptable (?)

Answer 153

Place yourself at eye level by squatting down, leaning against a counter or taking a seat when speaking with a person who uses a wheelchair.

Answer 154

tap the person on the shoulder or wave your hand.

Answer 155

"1.Post a cancellation policy 2.Post treatment fees in place of practice. 3.You don’t have to be so rigid with this policy as to drive away clients. Find your balance. I usually give them one missed appointment." 4. Call your client to let them know they missed their appointment. 5. Is the client relatively new or has the client been loyal to you for awhile? 6. The reminder call

Answer 156

sexual stigma associated with massage.

Answer 157

discern the “intent” of the client’s erection. protect yourself without humiliating the client who may mean no harm. natural physiological response? client deliberately arousing himself?

Answer 158

"(Whenever the client or the practitioner is uncomfortable)" "Once a party is uncomfortable the session is not going to be truly beneficial because attention is diverted."

Answer 159

shows no signs of discomfort or embarrassment through verbal or nonverbal cues, and you are comfortable, it is not necessary to talk about it at the time. acts uncomfortable via nonverbal cues (body tension, flushed face), and although he has not been inappropriate in any way during the treatment (and even if you feel comfortable), then it is wise to talk to him to assuage his discomfort. has displayed other verbal or nonverbal behaviors during the session that seem to indicate sexual intent, then you are ethically obligated to talk with him immediately.

Answer 160

This is also the case for sexual arousal in women if she indicates sexual intent in verbal or nonverbal behaviors. There is no recipe for dealing with sexual arousal in a client. The therapist must determine, at that moment, the best way to handle the incident.

Answer 161

The antidote to the parasympathetic response is activation of the sympathetic response: change tempo to a quicker pace, increase pressure, and depth of touch. Move to a less risky area of body, such as the upper extremity or face and head.

Answer 162

Adjust the intent of the session to stimulate a more sympathetic output response by using stretching, compression, joint movement, and active participation by the guest. Stop working with your hands and use your forearms.

Answer 163

Practitioners must be prepared for sexual arousal from both sexes and all sexual orientations. Note: Sexual arousal does not mean sexual intent.

Answer 164

Work in a safe setting(Don’t work in an isolated office or schedule new clients late in the day or when no one is around.) Be careful about out calls. Choose your employers well.

Answer 165

Stop the massage Take your hands off the client’s body Address the situation Define your boundaries

Answer 166

avoid subjective words -- e.g. "creepy" or "disturbing" describe the action specifically and objectively use incident report if contacting the police becomes necessary

Answer 167

Identify different business models Define Vision and Mission statements Ethical dilemmas and treatment room conflicts

Answer 168

Your vision for the size or nature of your business The level of control you want The amount of structure you are willing to manage Your vulnerability to lawsuits The tax implications of different business structures Your expected profit or loss

Answer 169

…is a business owned by one person who is personally liable for all of the business transactions.

Answer 170

…provides many of the benefits of self-employment, without the large responsibility of running a business. Typically, one rents a room in a place of business such as a spa, clinic, physician’s office, or fitness centre. The therapist is responsible for appointments, fee schedule and other business parameters The therapist assumes liability as outlined by the contract negotiated with the owner of the clinic/centre/other.

Answer 171

…these forms of business ownership are more complicated to set up.

Answer 172

…two or more persons share ownership and all of the income, but also assume unlimited liability for the business.

Answer 173

…is a business arrangement with one or more owners who remain separate from the business.

Answer 174

ADVANTAGES: Direct control of decisions All profits are yours Work when and where you want No partner meetings Flexibility DISADVANTAGES: Responsible for all administrative details Lack of financial security No income balancing with partners No one else in office to handle emergencies No one to take your clientele when you are absent Isolation High overhead

Answer 175

Financial terms such as payment of expenses Sharing of profit and losses Capital contributions Administrative duties Payment of capital and income Length and timing of vacations Type of outside activities that partners may engage in Personal and professional goals

Answer 176

ADVANTAGES: Shared financial risk Continuity of cash flow when on vacation or sick Sharing of costs of any support staff Additional sources of capital and clients Division of labour Broader management base Ability to discuss cases with your partner Ability to provide your clients with different expertise. DISADVANTAGES: Hard to find suitable partners Conflicts Liability for partners actions Less freedom to choose clients Divided authority

Answer 177

A business arrangement with one or more owners who remain separate from the business. *Discuss with your accountant whether you should practice as a corporation.

Answer 178

The C.M.T. requires that you first get the consent of the College for the proposed name, and after the company is incorporated, apply to the C.M.T. for a corporate permit. A massage therapy corporation must include in its name the words “Massage Therapy Corporation”. Your corporate name must not be identical with that under which another corporation holds a valid permit.

Answer 179

ADVANTAGES Shareholders (owners) have limited liability. Under the Income Tax Act, tax advantages may be available. A corporation may pay taxes at a preferential rate, use tax deferral, income splitting, and perhaps utilize capital gains exemptions. Name of Corporation is fully and legally protected.

Answer 180

personal assets are off the table in event of lawsuit

Answer 181

DISADVANTAGES Complexity Most expensive Must supply financial statements and tax returns

Answer 182

Outlines what a company (individual) wants to be It focuses on tomorrow; It is inspirational; It provides clear decision making criteria; And it is timeless.

Answer 183

mission " --- Answers the question: What is my business? A Mission Statement is the beginning of personal and organizational leadership. It helps to Provide overall direction and Clarify our purpose and meaning. By referring to it - and internalizing its meaning -we are more likely go choose behaviours that serve our values, and reject behaviours that oppose them.

Answer 184

Outlines what the business is now. It focuses on today; It identifies the customer(s); It identifies the critical process(es); And it states the level of performance. mission = today vision = future

Answer 185

We set standards of professional practice for registered massage therapists to help RMTs deliver safe, ethical and effective care.

Answer 186

(Sole) Proprietorship Partnership Corporation/ company (Ltd or Inc.)

Answer 187

own business Your name and the business are seen as same Unlimited liability

Answer 188

Not separate legal entity (more like proprietorship) Make sure you have a written partnership agreement Combined income recorded in financial statements and split Unlimited liability

Answer 189

The company is seen as a separate legal entity Limited liability

Answer 190

Proprietorship, Partnership and Corporation ------ Essential to keep good records of revenue and expenses

Answer 191

Proprietorship: Not legally protected Partnership: Not legally protected Corporation: Fully and legally protected

Answer 192

Proprietorship: Report all income on a personal tax return Taxed at personal tax rates Partnership: Financial statement of whole partnership % would be taxed at personal rate Corporation: Can choose how much you pay yourself $100,000earned/ T4 $20.000/ Corp. keeps $80,000 profit taxed at corporate rate (which is less than personal rate)

Answer 193

Proprietorship: Must pay ~15-29% Partnership: Must pay ~ 15-29% Corporation: Tax free up to $1,000,000 once in lifetime

Answer 194

Proprietorship: Simplest Cheapest Tax return only Partnership: Financial statement and tax return Corporation : Complex Expensive Financial statements and tax returns for company Protected from debt

Answer 195

Ethical dilemmas Treatment room conflict Aggression and abuse Professional responses Apology and assertion

Answer 196

Doing what is morally right results in a bad outcome or bad effects Doing what is morally wrong results in good or at least better effects or outcome.

Answer 197

ETHICAL DILEMMA: Arises when we have a conflict of values, loyalties, obligations, in which a choice has both good and bad elements. Also harbor conflicting and hidden values, beliefs, and charged emotions.

Answer 198

ETHICAL ISSUE: A situation which raises a value or moral question about what is the right/good, wrong/bad course of action.

Answer 199

An ETHICAL DILEMMA in practice arises when the practitioner cannot proceed with a course of action that upholds all ethical principles or values.

Answer 200

Health Professions Act 32.2 (1) A registrant must report in writing to the registrar of an other person's college if the registrant, on reasonable and probable grounds, believes that the continued practice of a designated health profession by the other person might constitute a danger to the public.

Answer 201

“An ethical dilemma can be a conflict between at least two ethical principles, both of which could be readily applied to the decision making process and provide an equally good or, indeed, an equally bad outcome but one has to be selected. An ethical issue is not a dilemma if there is no conflict. In the practice of (health care) there are ethical issues that arise frequently but may seem like a dilemma but actually are not since there is general consensus in such a situation that one principle trumps the other.

Answer 202

equally good or, indeed, an equally bad outcome but one has to be selected.

Answer 203

The main principles we use are: Autonomy (self-decision making) Beneficence (to do good to the patient) Nonmalificence (to do no harm) and Justice (to be fair to the patient and others).”

Answer 204

In the practice of (health care) there are ethical issues that arise frequently but may seem like a dilemma but actually are not since there is general consensus in such a situation that one principle trumps the other.

Answer 205

Stick to professional framework. Avoid making exceptions to rules. Notice feelings of needing to please clients. Beware of client games and manipulation. Use plain language to address conflict.

Answer 206

Therapists put clients at risk when they: Indulge in countertransference. Ignore boundaries and power differential. Manipulate clients. Abuse client trust.

Answer 207

Passive Passive aggressive Aggressive

Answer 208

ONGOING CONSENT*** Clients who... Say little Give no feedback May assume that the therapist knows more than they do May blame themselves for what occurs in the treatment room t Solution: deliberate and ongoing informed consent

Answer 209

Simply agree that a treatment is poor Do not reflect on the reasons why Give the impression that they don't care Solution: ask more questions instead of turning away

Answer 210

Apologies are essential when: Clients appear hurt by therapist actions. Therapist communication misleads or confuses clients.

Answer 211

Expression of regret "I'm sorry" Description of the offending behavior "I was wrong when I…" Willingness to make amends "How can I make it better?"

Answer 212

Passive-Aggressive responses to conflict occur when: A person feels angry or frustrated The person denies the anger or frustration He or she pretends or hides the angry feelings

Answer 213

Angry person controls another person by pretending not to be angry. At the same time demonstrates anger through: Sarcasm Stubbornness Procrastination Covert manipulation

Answer 214

May attempt to control therapists by: Appearing annoyed yet saying nothing Denying they are annoyed when asked Complaining about other issues that do not relate to the initial problem Challenging boundaries through manipulation

Answer 215

May give clients subtle cues of displeasure Show frustration by: Increasing pressure Massaging more aggressively Suddenly behaving coldly without explaining why Should seek therapy or peer supervision for help in eliminating passive aggression

Answer 216

Describe passive-aggressive behavior Use plain language Include example of evidence Employ "I" statements

Answer 217

The act of initiating or attacking another person with intent to dominate, hurt, or harm Explicit threat of consequences

Answer 218

If a client becomes aggressive, how will you get out of the treatment room? Plan an escape route long before you need it.

Answer 219

Refuse to continue treatment Speak clearly and with authority Avoid reciprocating with a teasing tone

Answer 220

Discharge the client Explain why discharge is necessary. Initiate discussion before final treatment. Give client opportunity to ask questions. Provide a referral if requested. Report criminal behavior to the authorities.

Answer 221

When it's essential to speak up, describe your position clearly. Describe situation. Explain why it is a problem. State assertion clearly.

Answer 222

Therapists who use their practice to exploit clients are called "predators". They have no empathy. They count on clients' inability of clients to speak up for themselves.

Answer 223

Most common in trust relationships Represents a gross abuse of power Violates client trust No thought given to safety, needs, or rights of client

Answer 224

When in doubt, always adhere to professional framework and role.

Answer 225

Individuals involved Relationship Approach Nature of Conflict Context Power Time Demands

Answer 226

Tendency of conflict to escalate and expand Tendency toward miscommunication and misunderstanding Guarded, defensive, rigid behaviour, manner and atmosphere Defensive posture and attack on differences Lack of focus on commonalities Coercion, close-mindedness, and resistance to change Low concern for relationship Strong desire to find resolution that meets own needs Use of power to gain advantage for self

Answer 227

Tendency toward de-escalation of conflict Willingness to listen and understand, desire to be listened to and understood Friendly and open behaviour, manner, and atmosphere Willingness to recognize and work with differences Motivation to build on commonalities Use of persuasiveness, awareness, and understanding used to achieve change Attention paid to improving relationship Desire to find resolution that works for both Use of power to benefit both parties

Answer 228

COMPETING/DIRECTING AVOIDING ACCOMODATING/HARMONIZING COMPROMISING COLLABORATING/COOPERATING

Answer 229

Shift from defending yourself to learning about the other person Shift your attitude from judgment to curiosity Shift the purpose of your disclosure from legislate (force own view) to educate (inform) Move from a “point of view” to a “viewpoint” (bigger picture)

Answer 230

Effective conflict resolvers integrate their internal drivers with the skills of the collaborative approach. Using listening skills will generally be ineffective in conveying interest if you are not genuinely interested. Changing one’s attitude is not always easy. Practising collaborative C.R. (conflict resolution?) Skills can change behaviours, which over time, in addition to better awareness and new experiences , can lead to a shift in attitude towards the other person.

Answer 231

AWARENESS READINESS UNDERSTANDING REFLECTION

Answer 232

boundaries = empathy

Answer 233

Some relationships ended or disrupted Risk of being hurt by openness Discomfort associated with confronting conflict High investment of energy to alter patterns of avoidance

Answer 234

advantage: Able to retain considerable control over own life as well as lives of others. Less vulnerable. Not easily taken advantage of. disadvantage: Alienated from people Often provokes counter-aggression Highly stressed.

Answer 235

advantage: Lowers stress by avoiding conflict Often seen as nice and giving Doesn’t have to take responsibility for expressing needs or resolving problems Can control others by refusal to acknowledge or resolve problems Others will tend to protect a passive person disadvantage: Life tends to be directed by others Relationships are less satisfying and/or intimate Generates feelings of resentment, anger and irritation from others Affection is repressed

Answer 236

Willing to confront conflict situations, with the goal of resolving them. Accepts feelings and expresses them without being disrespectful to the other person. Negotiates to solve problems in an environment of mutual respect. Operates from a belief system of personal rights and respects the rights of others. Acknowledges own statements as opinions and perspective; doesn’t claim ownership of the only truth. Takes responsibility for meeting own needs as much as possible. Takes responsibility for actions; apologizes when appropriate.

Answer 237

Approaches conflict as a power struggle and tries to control and overpower others. Discounts the feelings of others. Communicates using criticism, blame, defensiveness and pressure. Operates from a belief system of his or her own personal rights that are not balanced with rights of others. States opinions as facts and considers those who disagree as wrong or stupid. Expects others to meet his or her needs and sees others at fault if they do not. Doesn’t evaluate own actions as part of the problem; blames others for problems

Answer 238

Avoids dealing directly with conflict and tries to meet own needs indirectly( forgetting, arriving late, withdrawing) Holds back direct expression of feelings and instead expresses them indirectly (sarcasm, unkind joking) Operates from beliefs that direct expressions is threatening and fears conflict Meets own needs at expense of others

Answer 239

There are no direct advantages to this behaviour pattern disadvantages: Misleads others Seen as dysfunctional People don’t know what is going on Doesn’t provide people with accurate feedback to respond to Decreases chance for honest, satisfying or intimate relationships

Answer 240

Verbal and non-verbal cues Perceptions, feelings, values, beliefs, fears, concerns, assumptions, and expectations, with no regard to the conflict and the other person. The reactions of others Your own defensiveness, position taking , put -downs, “triggering” or other reactions that work against conflict resolution goals The existence of a more primary, underlying conflict behind a particular dispute. Values, beliefs, attitudes and what you believe you need in the situation The moment when tension is de-escalating and feelings of friendliness or warmth are developing.

Answer 241

Your awareness that a conflict exists, and that tension and other negative emotions are present, is usually necessary as a motivation to resolve conflict. Your orientation – you may need time to orient yourself away from a conflict or problem frame of mind, towards a resolution or goal frame of mind Emotional and psychological readiness. You may wish to wait until you have cooled down, talked to a support person, thought through your own perceptions and feelings, decided how you want to approach the conflict, gathered or examined information, or feel motivated to resolve the conflict Time or timing and setting

Answer 242

The process of seeking understanding includes adjustments such as the following: Being open and willing to acknowledge the other person’s experience, especially when it doesn’t match your version of the conflict Actively seeking out new information by being curious about the other person’s experience and underlying interests Allowing new information to influence your perceptions Being able to accept and work with differences between you and the other person Looking for and building on similarities or common ground between you and the other person Gaining new insight about you Withholding judgment and blame

Answer 243

Think about your role in the conflict Think about your goals in the conflict, and whether you met them Let go of residual bad feelings towards you or the other person Analyze how conflict unfolded and gain understanding about why it unfolded that way Think about any parts of the conflict that may not be resolved, or those that were missed entirely, but may still need to be addressed. Increase self-awareness about your undesirable conflict tendencies and resolve to act differently in the future.

Answer 244

Is the act of one person approaching another person for the purpose of beginning to resolve the conflict, or of making moves within the discussion to bring up new subjects or deeper levels of conflict When you are opening conflict resolution or responding to someone else’s initiative, be responsive to the other person’s reaction to your approach and to his or her readiness

Answer 245

Risk taking Communication style (collaborative ways of speaking and listening) Assertion Empathy Readiness/willingness of the other person

Answer 246

How you describe or identify the conflict aids in: Depersonalizing the conflict and eliminating blame Shifting from a past, negative view to a future-oriented view with many possible solutions

Answer 247

Personalized “You and the rest of the team have caused a lot of trouble with your restructuring plan” Negative, past focus “I don’t want to work as a team on this project” OR “I don’t want to work with you on this project”

Answer 248

“This restructuring process feels very threatening. I would like to get an agreement on how it will happen” Positive, future focus “I’d like to discuss our respective roles on the team before we start working on the next project” OR “I need a clear definition of each of our roles this time, because I experienced a lot of duplication the last time we worked together.”

Answer 249

Stating your own point of view with respect to what you want to resolve/decide Speaking for you (what you heard, how it impacted you) Inviting the other person to share their point of view Checking with each other for clarity Listening actively when the other person is speaking to ensure understanding Combining both parties’ issues or topics into an agenda Depersonalizing the conflict by stating issues in a way that does not assign blame or specify an outcome

Answer 250

(to learn what underlies the dispute and to understand the perspectives, needs, values and beliefs of both parties) The main goal of this phase is to give and receive information This phase involves questioning, listening, and asserting. Much of what is said may not be fully understood because it is based on assumptions and requires more discussion It is important to maintain an attitude of curiosity rather than judgment as you try to understand different points of view

Answer 251

The goal of this phase is to find mutually satisfying solutions to the conflict based on what is important to each party and what is important to both parties, and then choosing options that best satisfy all these requirements.

Answer 252

Inviting brainstorming – a mutual generation of options that meet the expressed needs of each party Evaluating the options and checking for fairness to ensure that the needs of both parties are met Choosing one or a combination of options that work for both parties Forming an action plan: who, what, when, where, how, and work out the details Evaluating the effectiveness of the solution Attending to the relationship aspects of the closing

Answer 253

Facilitative: -non-defensive listening -questions and probes -Empathic response, reframing, summarizing Assertive -’I’ messages, be objective and specific - Hard on the problem, soft on the people