PD200 Flashcards
therapeutic vs non-therapeutic touch
.
power differential via
standing
clothed
active role
in position of authority in treatment room
client
lying prone/supine
without clothes
allowing therapist to touch them
passive role
client description vs what they actually feel
.
clues about what client feels
affect
nonverbal behaviour
body language
posture
tone of voice
breathing rate
tension in tissues
responses to question/touch
affect
how emotional state is expressed through facial expression, tone of voice, body language
Albert Mehrabian research about how speaker’s message is interpreted
7% verbal messages
38% paraverbal messages (tone/pitch of voice)
55% nonverbal messages (gestures, facial expression, stance, etc.)
differences in patients
“Some differences are due to patient illness, personality, socioeconomic class, or education, but the most profound differences may be cultural.”
danger in (incorrectly) considering cultural differences
“The danger in considering cultural differences is that of stereotyping people.”
GENERALIZATION VS STEREOTYPE
First, it is important to distinguish between stereotypes and generalizations.
They may appear similar, but they function differently.
A stereotype is an ending point, and no effort is then made to ascertain whether it is appropriate to apply it to the person in question.
A generalization, on the other hand, serves as a starting point.”
generalization
“A generalization is a statement about common trends within a group, but with the recognition that further information is needed to ascertain whether a generalization applies to a particular person.
Therefore, it is just a beginning.
Because differences always exist between individuals, stemming from a variety of factors, such as, in the case of immigrants, the length of time they have spent in [a country]and their degree of assimilation, even generalizations may be inaccurate when applied to specific persons.”
low context vs high context cultures
(LOW)
german, swiss, scandinavian
american, english, canadian
french, spanish, italian
mexican, greek, arab
japanese, chinese
(HIGH)
low context
specific
detailed
precise
poorer @ decoding UNSPOKEN MESSAGES
& body language
high context
less direct
emphasis on human relations
more sensitive to non-verbal elements
& to feelings of others
most cultures
Most cultures fall between the extremes on the spectrum and share characteristics of both high and low context traits to varying degrees.
how therapeutic touch is perceived?
The therapist touches the client in nurturing and compassionate ways that may remind the client of childhood or other times when caregivers kept them safe.”
Or not, as physical touch can provoke anxiety in survivors of childhood abuse.
INAPPROPRIATE TOUCH AS RMT
1) Hostile or aggressive touch
2) Erotic or sexual touch
3) Body areas of touch sensitivity
if anger b/w client/therapist, best not to touch?
If you are angry with a client, it is best not to touch them
Alternately, if a client is angry with you, do not touch until the energy changes
The perception of holding power over another underlies this type of touch
paying attention to intent of touch
Constant attention must be paid to the appropriate understanding and interpretation of the feelings generated during professional touch;
pleasurable touch must not evolve into or become misinterpreted as erotic touch
which body areas are more sensitive?
orifices
ventral surfaces (esp breasts)
inappropriateness of touch?
Touch –
when? the way? w/ what intent?
what is anxiety?
Feel on edge, fretful, distressed.
Be nervous, unsettled.
Feel faint, dizzy, nauseous, clammy, or sweaty.
Hold breath or experience heart palpitations.
define low moods
Appear unhappy, blue, despairing, and sad.
Seem fatigued or exhausted.
Lack of motivation to the point of incapacity
Feelings of worthlessness or being overwhelmed by life.
Experience disruptions in personal relationships.
how RMT help patients with anxiety or depression?
Improving mood.
Facilitating parasympathetic response and decreasing resting muscle tension.
Deepening breath and awareness of breathing patterns.
Teaching clients to stay focused in the present.
key concepts (2)
boundaries & boundary-lessness
dual relationships
transference & countertransference
MT is
transaction
not a casual interaction
intimate space boundary
0.5 meter = intimate space
1.2 meter = personal space
3 meter = social space
beware of illusion of intimacy b/w therapist/patient
.
clear communication
Clear communication
Empathic yet firm
Leaving no doubt as to where a boundary lies
client who is uncommunicative
Non disclosure of information places the client at risk
Why might a patient be uncommunicative?
why uncommunicative?
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
why might client not disclose info?
“might have difficulty reading”
3 things therapist can do when they think client is giving incomplete or inaccurate information
1) verbally repeat questions on health form
2) reword questions
3) work conservatively/generally until it’s possible to get more information
what happens when therapist ignores their professional role?
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.
what happens when clients forget their roles?
When clients forget their roles, they may:
Confuse therapeutic touch with intimacy.
Assume that the therapist shares client feelings.
boundarylessness
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
note terms, internal/external locus of control – in the context of massage
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
types of boundaries permeable vs rigid
Permeable ——
Weak
Ignores massage therapy transaction
Does not challenge problematic behaviors
Personal sharing compromises care
types of boundaries permeable vs rigid (2)
Rigid ——
Allows no personal information, attitudes or feelings to be shared
Boundary is firm and cannot be penetrated
No acknowledgement of potential for exceptions
semi permeable boundary (3rd option, in b/w)
Firm but flexible boundary ——
Allows personal information to be shared if it is:
Ethical to do so
In the client’s best interest
power differential
Actively listen to client concerns while limiting advice-giving
Stick to professional role and scope of practice
what is the result of boundarylessness
Represents a violation of client-centered care
Poses significant risk to clients and therapists
components of a framework that supports boundaries
Separate personal/professional environments
Professional standard of hygiene
Predictable schedule
Availability limited to professional hours
Clearly communicated fee structure
Discounts and special relationships avoided
DUAL RELATIONSHIPS
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.
massage therapy during dual relationship
Do not confuse the therapeutic hour with personal time with a friend.
why do dual relationships put therapists in difficult position?
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.
confidential information risks
Conflict between professional role and personal relationship
No objectivity
Potential for misuse of confidential information
dual relationships and OBJECTIVITY
Dual relationships compromise objectivity.
The nature of the first relationship defines the nature of the second.
transference
Occurs when clients project feelings onto their therapist
Stems from personal experiences
responsibility for transference
Pay attention to signs of transference.
Transference is not about the therapist.
Responsibility for managing it always rests with therapist.
who is responsible for managing transference
Responsibility for managing it always rests with therapist.
risk of ignoring transference
Ignoring transference puts clients at risk.
Client feelings may intensify.
Client may feel permission to act out transference fantasies.
WHAT TO DO TO PREVENT TRANSFERENCE
DO’s
Begin and end treatments on time.
Establish and clarify boundaries.
Limit personal disclosures.
Respond empathically.
Seek peer supervision.
WHAT NOT TO DO (TO PREVENT TRANSFERENCE)
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.
counter-transference
Occurs when:
Therapists project feelings or associations onto clients
Clients remind them of other relationships
potential to ruin relationship
positive/negative counter-transference
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
countertransference & peer supervision
Seek peer supervision to help:
Clarify feelings and reactions.
Create a strategy to address countertransference.
“I” statements to address transference/
“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)
boundaries…
Describe a therapist’s limits to care
Remind clients that massage therapy is a transaction
Protect both clients and therapists
Minimize transference and countertransference
CLINIC FRAMEWORK
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
business framework
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
…
about business cards
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)
professional work space
“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.’
when receptionists present
“For clients’ confidentiality , you need to have a way that they can leave a message that only you can access.” (phone)
SOCAN & music in public spaces (lobbies)
Society of composers authors and music publishers of Canada
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.SOCANcollects license fees from businesses that use music and distributes the money as royalties to those who create music.SOCANoperates 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 yearlySOCAN fee, based on square footage. In a public area, music coming from a radio does not require a SOCANmusic 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 toSOCAN. If you’re not sure if your music provider is licensed withSOCAN, you can contactSOCANto 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 fromSOCAN.
talking to clients about money
Be careful about your tone (straight-forward, businesslike and confident, not apologetic nor punitive)
problem with bartering (services)
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?
risk of seeking professional services from a client
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.
seeking professional services from a client?
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?
risks of accepting gifts/gratuities from clients (Yellow light)
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.
sensitively declining gratuity/gifts
If a registrant has decided not to accept a gratuity on the basis that doing so would violateCMTBCBylaws, 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.
Boundaries – standards of practise (regarding gifts/tips)
“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.”
RMTBC & coupons
Is the use of discount coupons in health care appropriate?
The RMTBC believes that discount coupons in health care are not appropriate.
RMTBC & discounts
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.
RMTBC & discounts for no reason
if the patient has no financial hardship, then discounting a treatment undermines the education and professionalism of RMTs in BC.
separate from body workers
We encourage RMTs to separate themselves from non-registered body workers who commonly use this type of marketing.
Jurisprudence meaning
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.
self-governing profession
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).
privilege of self regulation
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.
social contract b/w profession & public
With any self- regulating profession , there is an implied “social contract” between the profession and the public.
social contract
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.
when social contract?
The “social contract” is created when the government grants the profession self- regulating status through a legislative framework.
Health profession’s act (BC*****)
Massage therapy practice in British Columbia is regulated within a framework that starts with theHealth 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.
Health Professions General Regulation (FURTHER CLARIFICATION)
TheHealth Professions General Regulationprovides further clarification of theHealth Professions Act, including:
The prescribed periods for disposing ofcomplaints.
The standard form Oath of Office for Board members.
The reasons for refusing to disclose information contained in theregister.
Massage Therapists Regulation (BC)
TheMassage Therapists Regulationdefines what constitutes massage therapy, as well as:
Naming CMTBC as the regulatory college for massagetherapy.
Granting titles reserved for the exclusive use ofregistrants.
Placing restrictions on the practice of massagetherapy.
3 titles reserved for use by RMTs
a) massage therapist
b) registered massage therapist
c) massage practitioner
d) registered massage practitioner
what may registrant not do (based on HPA Massage therapists regulation)
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
CMTBC one of
CMTBC is one of 20 health regulatory colleges in BC governed by theHealth Professions Act. The Act mandates the colleges to govern their registrants in the public interest. As outlined insection 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 publicinterest.
CMTBC bylaws do a number of things
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.
code of ethics
TheCode of Ethicsoutlines the expectations for ethical massage therapypractice.
standards of practice
CMTBCStandards of Practicedefine 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 theProposed Standards of Practicepage.
HEALTH PROFESSIONS AND OCCUPATIONS ACT
(reform of HPA – eventually replaces HPA)
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.
HPOA MT will be combined with
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.
keep in mind
Keep in mind…
Confidentiality
Informed consent
Framework – keep it consistent!
PIPA FIPPA
Personal Information Protection Act
Freedom of Information and Protection of Privacy Act
Health Care Consent and Care Facilities Admissions Act
Obtaining informed consent to treatment
when obtaining informed consent
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.
confidentiality
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.
obtaining consent
theHealth Care (Consent) and Care Facility (Admission) Act
Infants Act.
Obtaining consent is both a professional obligation, as well as a legal obligation under two BC statutes
(theHealth Care (Consent) and Care Facility (Admission) Act
andInfants Act.
consent
Code of ethics
Section 9 of the College’sCode of Ethicsrequires 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.
consent
CMTBC standards of practice (consent)
The CMTBCstandard of practice on consentwent into effect January 15, 2019.
CMTBC’s Bylawsrequire RMTs to comply with the standard of practice on consent.
infants act
TheInfants Actsets out different requirements for obtaining consent from an “infant” or minor (legally defined as an individual under the age of 19 years).
While theInfants Actuses 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.
mature minors & consent
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
infant’s medical information & PIPA
medical information must be kept confidential under thePersonal Information Protection Act(PIPA)
infant and age of consent to massage therapy
“ 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.
PRIVACY & CONFIDENTIALITY
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
privacy vs confidentiality
privacy = PATIENT EXPECTATION
confidentiality = THERAPIST’S ACTION
informed about how their personal health information is used.
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.
using private information for marketing or personal gains
exploitation
against bylaws/laws
MEDICAL LEGAL
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.
two types of medical legal reports
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.
example of treatment + techniques
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.
write reports within scope of practice and area of expertise – send reports to MD when necessary
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).
offering prognosis?
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.
MALINGERING
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’
is it our job to figure our if patient malingering or not?
It is not our job to determine if a patient is malingering.
socializing with clients
Sometimes it is not a problem to socialize with clients if you remain aware of your roles and responsibilities.
transference
some clients assume intimacy and friendship when none is offered.
may become surprised/offended by contract negotiations –> cancellation fees, refusing off-schedule work
is professional hat ever off outside work?
Remember that your professional hat is never off, even when you are not in the clinical environment.
(When you see client outside work environment)
running into patient outside work
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.
large/densely muscled individuals
send to another practitioner
patient referral
Do I have to refer a patient whose care I have terminated to anotherRMT?
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 theCode of Ethics
when terminate?
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.
may immediately terminate if
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
incident report
“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.
consider
stigma and prejudice
body image, weight, obesity
eating disorders
emotionally challenged patients
patients directing the session
tauma/PTSD
stigma is
“A powerful discrediting and tainting social label that radically changes the way individuals view themselves as persons.”
are beliefs acquired/learned
yes
UNCONDITIONAL POSITIVE REGARD
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”
personal beliefs and challenges to professional role
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
working with people you don’t care for can put therapeutic relationship in risk
“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??”
RESPECT
“RMTs have a responsibility to respect a client regardless of race, religion, ethnic origin, age, gender, sexual orientation, social or health status.”
be cautious about overweight clients
“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.
social studies of obese people
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]
don’t tell patient to lose weight
don’t tell them to exercise more
don’t tell them to eat better
not within scope
not area of expertise
common facts that patient already knows
eating disorders
Recognize that eating disorders are potentially fatal diseases and treat them accordingly.
note eating disorders
anorexia nervosa
bulimia
note amenorrhea as a result of anorexia nervosa
conversations about weight, calories, diet?
not our job/expertise
refer to dietitian
notice these things during touch
guarding
pulling away
hypersensitivity
holding breath
self-regulating & self-soothing
Self-regulation is an essential skill because it:
Teaches self-soothing strategies.
Encourages function.
Lessens depression, anxiety, and insomnia.
massage therapy – self soothing/regulation
Encourages deeper breathing
Facilitates calm, rest, and relaxation
Addresses pain
Promotes flexibility
trauma in clinic room shows as
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
PTSD
ANXIETY DISORDER
“brain weariness” in the American Civil war
and “shell shock” in the First World War.
PTSD victims
Soldiers and security personnel
Victims of abuse, bullying, domestic violence
Children
The earlier in life a person is traumatized, the worse the effects
PTSD in patients?
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
duration of PTSD
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.
type of trauma (PTSD)
Sexual, emotional or physical abuse is trauma that leaves profound and lasting effects on a person’s psychological , cognitive and emotional functioning.
hypervigilance / hyperarousal (symptom of PTSD)
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
affect of emotional disregulation
labile mood (marked fluctuation of mood) or mood swings.
term used in the mental health community to refer to anemotionalresponse that is poorly modulated, and does not fall within the conventionally accepted range of emotive response.
dissociation
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.
how victims feel?
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.
how affect massage?
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).
where fear processed in brain?
Fear, trauma, and other emotions are processed in hypothalamus and amygdala.
HYPOTHALAMUS AND AMYGDALA
how touch trigger fear?
Touch triggers somatic responses in traumatized clients.
Reminding client of associated memories
KINDLING
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.
massage, somatic responses, kindling
Actively kindling implicit memory equivalent to re-traumatizing client
Clients unable to distinguish between “therapy” and “trauma”
attachment
Biological urge to seek safety when confronted with a frightening situation
Observed throughout the natural world
are children born knowing how to comfort themselves?
no
stressful situations, attachment, and children
Type of attachment system develops when children faced with stressful situation.
Every person exhibits some form of attachment.
what do clients do to avoid pain?
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.
Client’s personal history of trauma & MT
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.
clients who have
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
client with communication challenges
Attention/socialization disorders
Autism spectrum disorders (ASD)
Traumatic brain injury (TBI)
Dementia and cognitive decline
Alzheimer’s Disease (AD)
Vascular Dementia
Delirium
with clients with communication challenged (E.g. ASD) – DO NOT …
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.
attention disorders and communication skills
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.
how to aid comprehension with socially challenged clients
Pay attention to behavior, patterns, and routines.
State what is true.
Describe what is expected precisely.
Employ specific closed questions.
cognitive challenges may result in
Behavior disturbances
Anger or aggression
Danger to self or others
“Sundowning” or agitation as the sun sets
Hallucinations
dementia
Dementia
-Chronic confusion and cognitive decline
-Short- term memory loss
- Caused by cardiovascular deconditioning,
medications, metabolic problems, nutritional deficiencies, brain tumors
dementia type of memory loss
short term memory
Delirium
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
If you notice a sudden change in client cognition:
Alert the healthcare team.
Delirium as a result of infections or medication can be investigated and treated.
cognitive challenges – DO’s
Adjust treatments according to client capacities.
Maintain verbal ongoing consent throughout treatment.
Employ plain language.
Engage client in treatment decision making.
Respect client choices.
cognitive challenges – DON’T
Use clients as an opportunity to practice techniques.
Correct or criticize.
Ask questions unless necessary.
Be surprised by client behaviors.
DO NOT**
ask questions unless necessary*******
DO** NOT**
Correct or criticize.
Blind clients
Deaf or hearing impaired clients
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.
SPEAK DIRECTLY TO PERSON WITH DISABILITY
DO NOT SPEAK TO INTERPRETER OR CAREGIVER/COMPANION
DO NOT
take blind patient by arm unless requested
hand-shaking with people with artificial limbs or limited hand use?
IS APPROPRIATE (?)
left handshake also acceptable (?)
GO TO EYE LEVEL WITH SOMEONE SITTING DOWN OR IN A WHEELCHAIR
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.
HOW TO GET SOMEONE’S ATTENTION WHO IS DEAF
tap the person on the shoulder or wave your hand.
missed/late appointments by patient/client
“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.”
- Call your client to let them know they missed their appointment.
- Is the client relatively new or has the client been loyal to you for awhile?
- The reminder call
sexual stigma and massage
sexual stigma associated with massage.
What to do if a client has an erection…
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?
“When do practitioners need to talk to their client about erections or arousal?”
“(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.”
partial/full erection?
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.
sexual arousal in women
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.
possible way to respond?
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.
possible responses (2)
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.
sexual arousal vs sexual intent
Practitioners must be prepared for sexual arousal from both sexes and all sexual orientations.
Note: Sexual arousal does not mean sexual intent.
client requesting sexual services – do/don’t
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.
If a client makes an inappropriate sexual suggestion during a session?
Stop the massage
Take your hands off the client’s body
Address the situation
Define your boundaries
incident reports
avoid subjective words – e.g. “creepy” or “disturbing”
describe the action specifically and objectively
use incident report if contacting the police becomes necessary
business practises
models of business
Identify different business models
Define Vision and Mission statements
Ethical dilemmas and treatment room conflicts
what to consider for business model
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
SOLE PROPRIETORSHIP
…is a business owned by one person who is personally liable for all of the business transactions.
INDEPENDENT CONTRACTOR
…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.
PARTNERSHIPS AND CORPORATIONS
…these forms of business ownership are more complicated to set up.
PARTNERSHIP
…two or more persons share ownership and all of the income, but also assume unlimited liability for the business.
CORPORATION
…is a business arrangement with one or more owners who remain separate from the business.
SOLE PROPRIETORSHIP …
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
essential to get written partnership agreement
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
advantages disadvantages (partnership)
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
CORPORATION …
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.
name of corporation?
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.
advantages/disadvantages of corporation
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.
limited liability?
personal assets are off the table in event of lawsuit
disadvantages of corporation
DISADVANTAGES
Complexity
Most expensive
Must supply financial statements and tax returns
vision statements
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.
MISSION STATEMENT vs Vision “
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.
mission vs vision statement
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
CMTBC mission statement
We set standards of professional practice for registered massage therapists to help RMTs deliver safe, ethical and effective care.
3 models of business = ?
(Sole) Proprietorship
Partnership
Corporation/ company (Ltd or Inc.)
LEGAL PROPRIETORSHIP
own business
Your name and the business are seen as same
Unlimited liability
PARTNERSHIP
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
Company/ Corporation
The company is seen as a separate legal entity
Limited liability
Accounting
Proprietorship, Partnership and Corporation ——
Essential to keep good records of revenue and expenses
legal protection (personal assets?)
Proprietorship:
Not legally protected
Partnership:
Not legally protected
Corporation:
Fully and legally protected
INCOME TAX?
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)
CAPITAL GAINS
(When you sell your business)
Proprietorship:
Must pay ~15-29%
Partnership:
Must pay ~ 15-29%
Corporation:
Tax free up to $1,000,000 once in lifetime
summary of business models
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
next key concepts
Ethical dilemmas
Treatment room conflict
Aggression and abuse
Professional responses
Apology and assertion
ETHICAL DILEMMA???
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.
ethical dilemmas (?)
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.
ethical issues (?)
ETHICAL ISSUE:
A situation which raises a value or moral question about
what is the right/good, wrong/bad course of action.
when ethical dilemma?
An ETHICAL DILEMMA in practice arises when the practitioner cannot proceed with a course of action that upholds all ethical principles or values.
HPA requirement to report
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.
ethical issue vs dilemma
“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.
ethical dilemma can provide equally ____
equally good or, indeed, an equally bad outcome but one has to be selected.
main principles for ethical issues (?)
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).”
WHAT HAPPENS WHEN ONE PRINCIPLE OVERPOWERS OTHERS?
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.
when conflict arising from client behaviour – what to do?
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.
when does therapist put client at risk?
Therapists put clients at risk when they:
Indulge in countertransference.
Ignore boundaries and power differential.
Manipulate clients.
Abuse client trust.
response types to conflict
Passive
Passive aggressive
Aggressive
what to do with clients who are passive?
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
therapists who are passive?
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
ASK MORE QUESTIONS INSTEAD OF BEING PASSIVE
.
when to apologize
Apologies are essential when:
Clients appear hurt by therapist actions.
Therapist communication misleads or confuses clients.
basic components of apology
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?”
passive-aggressive response
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
features of passive agression
Angry person controls another person by pretending not to be angry.
At the same time demonstrates anger through:
Sarcasm
Stubbornness
Procrastination
Covert manipulation
passive-aggressive patient?
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
passive aggressive therapist?
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
challenging passive aggression
Describe passive-aggressive behavior
Use plain language
Include example of evidence
Employ “I” statements
aggression?
The act of initiating or attacking another person with intent to dominate, hurt, or harm
Explicit threat of consequences
precaution/measures to take
If a client becomes aggressive, how will you get out of the treatment room?
Plan an escape route long before you need it.
what to do when patient is aggressive?
Refuse to continue treatment
Speak clearly and with authority
Avoid reciprocating with a teasing tone
If Aggressive Behavior Persists
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.
assertion
When it’s essential to speak up, describe your position clearly.
Describe situation.
Explain why it is a problem.
State assertion clearly.
predators
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.
predatory behaviour
Most common in trust relationships
Represents a gross abuse of power
Violates client trust
No thought given to safety, needs, or rights of client
when in doubt
When in doubt, always adhere to professional framework and role.
factors to consider (conflict)
Individuals involved
Relationship
Approach
Nature of Conflict
Context
Power
Time Demands
see destructive vs constructive conflicts
.
see adversarial vs cooperative responses
.
adversarial approach
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
cooperative approach to conflict
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
5 conflict styles
COMPETING/DIRECTING
AVOIDING
ACCOMODATING/HARMONIZING
COMPROMISING
COLLABORATING/COOPERATING
newapproach
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)
INTERNAL ELEMENTS “inner work”
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.
internal shifts via
AWARENESS
READINESS
UNDERSTANDING
REFLECTION
boundaries?
boundaries = empathy
assertiveness advantage vs disadvantage
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
aggressive tactic advantage vs disadvantage
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.
passive advantage disadvantage
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
assertive
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.
aggressive
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
passive aggressive
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
passive aggressive advantages disadvantages
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
THE INTERNAL ELEMENTS:
awareness
readiness
understanding
reflection
.
AWARENESS
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.
READINESS
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
UNDERSTANDING
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
REFLECTION
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.
THE EXTERNAL ELEMENTS:
opening
identifying
exploring
closing
.
OPENING
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
opening involves …
Risk taking
Communication style (collaborative ways of speaking and listening)
Assertion
Empathy
Readiness/willingness of the other person
IDENTIFYING
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
PERSONALIZED vs DEPERSONALIZED conflict identification
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”
DEPERSONALIZED conflict IDENTIFICATION
“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.”
IDENTIFICATION involves …
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
EXPLORING
(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
CLOSING
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.
Closing involves
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
communication strategies
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
Hard on the problem, soft on the people
.
