Articles

The Ethics of Touch, Part 3

An Excerpt By Ben Benjamin and Cherie Sohnen-Moe
Originally published in Massage & Bodywork magazine, August/September 2003. Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

The following is the third of three excerpts published in Massage & Bodywork from the newly released text The Ethics of Touch, by Ben Benjamin and Cherie Sohnen-Moe. (SMA Inc., Tucson, Ariz., 2003.)

Special Considerations in Cases of Trauma

On average, one of every five clients a practitioner sees has a history of trauma or abuse. Whether or not you are aware of it, in a large percentage of your sessions the client in your treatment room may be a survivor. Even the client might not know. To avoid ethical complications, every practitioner who uses touch needs basic knowledge about trauma and abuse survivors and a clear protocol for working with these particular clients.

Understanding Trauma and Abuse

Touch therapy can provide a valuable healing environment for the abuse survivor. Practitioners minimize the risks of retraumatization by being sensitive to the experience of the survivor and its effect on their work together. Psychologist Melissa Soalt eloquently describes the dilemma faced by the survivor as he enters therapy: "Being present in one's body is a double-edged sword for survivors: On the one hand, working through the body can stimulate the trauma and evoke confusing or frightening feelings; on the other hand, it is this very ability to be present and in one's body that ultimately allows one to feel more grounded and thus safer and more in control."1 Many responsibilities fall upon the practitioner. When a practitioner begins work with an abuse survivor, she may be the first person to touch the client's body since the abuse. The practitioner minimizes potential errors and creates a safe environment for the treatment process when she has awareness and understanding of the factors surrounding abuse and recovery. Sometimes, the client who is a survivor of abuse exhibits physical symptoms which indicate the presence of unresolved trauma. Examples of such symptoms include chronic fatigue, insomnia, chronic joint and muscle pain throughout the body and a weak immune system.2 Other reactions to the abuse experience include flashbacks and intense memories. It is useful for practitioners to understand the origins of these reactions, know how to recognize them and appreciate the contribution of the touch treatment to their resolution.

The Potential for Harm

Chris Smith, the founder of Trauma Touch Therapy and a survivor of abuse as a child, had some early experiences with bodywork that encouraged cathartic emotional releases. Although such releases may feel beneficial at first, Smith now believes that they ultimately increase rather than decrease the traumatization.3Smith is one of a large number of professionals who believe that bodywork undertaken in isolation from other therapies, or in a context that does not allow the client to integrate the experience, has more potential to harm than to heal. Below is an example of the negative effects of touch therapy when done without appropriate knowledge and training. A practitioner was approached by a client who wasn't in psychotherapy and wanted to address her abuse issues through bodywork. The practitioner had very limited training in working with survivors but wanted to assist the client in her healing process. In the course of their work together, the client began to have flashbacks during the treatments. The practitioner felt she should let the client fully experience these memories and would process what happened afterward. After several weeks of treatment, the client began to experience more uncontrollable, intense and disabling flashbacks on buses, in the supermarket and frequently upon entering the practitioner's office. The practitioner's lack of training in this area resulted in a damaging situation for the client and a lawsuit against the practitioner. In this case, the practitioner did not understand the significance of the flashbacks and how to deal with them. She did not realize the client needed psychotherapy and other support systems in place. She lacked outside supervision to guide her work when questions or difficulties arose. This harmful situation occurred because the practitioner did not understand that recovery from abuse proceeds in stages, and that her client was in a very early stage of this process. Therefore, the practitioner did not know what the

client needed to proceed safely with her recovery. This client was not psychologically ready to delve into her past. 4 The boundaries and support systems necessary for effective treatment were not adequately in place.

The Core of Trauma and Abuse

Before discussing how to work with clients who have been abused, it is important to understand what constitutes abuse and the complexity of its effects. Janet Yassen,5coordinator of Crisis Services at the Victims of Violence Program at Cambridge Hospital and co-founder of the Boston Rape Crisis Center, defines sexual abuse as "unwanted or inappropriate sexual contact, either verbal or physical, between two or more people, that is intended as an act of control, power, rage, violence and intimidation with sex as a weapon." Physical abuse is defined as the use of force or violence to cause pain or bodily harm which is used as an instrument of intimidation, coercion or control. Emotional abuse is the infliction of emotional harm by verbal intimidation or neglectful behavior to intimidate, demean or hurt another person. Mind control abuse can be defined as the act of undermining a person's free will through the control of behavior, information, thoughts and emotions. The trauma experience has a physiological effect even if the trauma is not physical in nature. The diaphragm and muscles of the chest contract restricting breathing; muscles at the base of the occiput and pelvis often contract; energy frequently withdraws to the center of the body, leaving the extremities cold; and there is an overall shrinking and contraction of the physical organization of the entire body.6Severe trauma may cause loss of muscle tone.7 Symptoms of the breach in psychic integrity from abuse include depression and anxiety.8 At its core, the intent of all abuse, whether sexual, emotional or physical, is the same: To dominate, humiliate and gain control of another person. It is a traumatic event, perpetrated by another person, that violates the basic bodily and psychic integrity of the victim.

Types of Sexual Abuse

Sexual abuse ranges from inappropriate seductive behavior and sexual touching to sexual intercourse. Sexual abuse includes rape, gang rape, date rape, partner or spouse rape and incest. Sexual abuse rarely occurs as an isolated event. Violations are often accompanied by other types of mental, physical and emotional torment. Emotional abuse such as put-downs, insults, demeaning comments and sudden irrational acts intended to instill fear are common. In the case of incest, this may also include the withdrawal of love and affection or threats to hurt other family members as a weapon of control.

Prevalence of Sexual Abuse

The statistics on sexual abuse are staggering and difficult for most people to fathom. The National Violence Against Women Survey found that in the United States, one of six women and one of 33 men has experienced an attempted or completed rape as a child or an adult; specifically, 18 percent of surveyed women and three percent of surveyed men said they experienced a completed or attempted rape at some time in their life. 9 Other research has found that approximately one in every five women and one in seven men have been sexually abused by the time they are 18 years old.10 To look at this another way, 18 to 20 percent of the U.S. population, or approximately 50 million people, have been sexually abused. If these numbers are hard to believe, reduce the total by half, or even two-thirds, and the tally is still a frightening number. It is difficult to determine whether sexual abuse has always been this prevalent and is only now being more accurately reported, or whether it has increased due to the dissolution of the family and other social factors. There have been several periods over the last hundred years during which sexual abuse has been exposed, discussed and acknowledged, but it has only been since the mid-1970s that the social and political context has provided an ongoing, welcoming atmosphere for research and wide acceptance. According to Judith Herman, author of Trauma and Recovery,11 the women's movement provided the political environment to support the ongoing research and recognition of the extensive existence of sexual abuse.

Types of Physical Abuse

Physical abuse of children is more common than imagined and shows itself in obvious forms such as violent beatings, corporal punishment, food deprivation or aggressive tickling that does not stop. Other types of physical abuse include spousal battery, the threat of violence as a means of control, and the use of physical torture as discipline of spouses and children. More women are injured by battering than are injured in car accidents, and it is estimated that each year millions of children directly witness acts of domestic abuse.12 Physical assaults and muggings are commonplace as well.

Types of Emotional Abuse

We define emotional abuse as the infliction of emotional harm by verbal intimidation or neglectful behavior. Direct verbal threats or attacks and taunting or belittling language used to intimidate, demean or hurt another are examples of emotional abuse. Emotional abuse occurs when a person, whether young or old, is regularly taunted, put down, shamed, berated, ostracized or humiliated. Emotional withholding and emotional neglect also constitute abuse. In children dependent on adults for their care, abuse may take the form of consistent lack of response to a child's emotional needs, the inability of the adult to express appropriate emotion to the child or neglect. Other forms of emotional abuse include when children are severely punished, dominated or forced to perform acts which go against their humanity. Usually victims experience strong feelings of fear, shame, rage or despair. If the feelings are overwhelming, victims may enter a depressed or dissociative state in which they are cut off from some or all of their emotions.

The Effects of Trauma

Traumas come with life. They create stresses which often encourage us to engage in self-exploration. Most people quickly overcome mini-traumas; other events take years to undo. Additionally, there is a category of traumatic events that goes far beyond the norm. Individuals who have gone through severe or repeated trauma may be in a kind of shock for the rest of their lives while others work through the trauma by themselves or with help from others. Throughout the ages, the brutality of rape and war have been consistently with us. Now the devastating aftermath these traumas create is beginning to be acknowledged.

The Benefits of Touch Therapy

As awareness of the prevalence of abuse has grown, an increasing number of survivors have sought various touch therapies to help them reconnect with and reclaim their bodies. Psychiatrists, psychologists, social workers and counselors are referring an increasing number of their clients for touch therapy. The practitioner who understands abuse and the healing process is prepared to respond in a helpful and knowledgeable way. Melissa Soalt, a psychotherapist and the founder of Model Mugging of Boston (a self-defense training program), has worked with many survivors and observes the following: - For survivors of abuse, bodywork can be a very powerful adjunct to psychotherapy. The trauma from abuse typically results in dissociative numbing or repressive mechanisms that leave survivors feeling "empty" or vacant on the inside. With reconnection and integration (or a move toward wholeness) as primary therapeutic goals, working through the body can be a valuable tool toward this end. Because the body is such a direct medium, bodywork facilitates this process of re-entry and one's ability to feel more present. - Bodywork can help survivors develop a friendly and compassionate relationship with their bodies. Sexual or physical abuse often leaves survivors feeling disgusted, shameful or even violent toward their body, as though their body betrayed or turned against them. - Bodywork helps survivors experience their bodies as a source of groundedness and eventually as a source of strength and even pleasure.13

Regaining Body Control and Rebuilding Boundaries

Somatic therapies can be helpful in rebuilding personal boundaries damaged by trauma and abuse. During their inclusion, the client reacquaints himself with his body through sensual awareness of how the body is organized and what sensations trigger trauma response. The process of learning about these boundaries and managing the bodywork session helps to integrate the sense of body control.14Eventually the client stays grounded in his body while talking about the experience, bringing a new level of healing through reorganizing negative body response to positive somatic memory.15 The client has the opportunity to construct new boundaries as the treatment progresses. For example, the client sets important boundaries by simply telling the practitioner where to touch and where not to touch. By being in charge of the session, the survivor gains another piece of control of his life associated with the body. Each experience of inviting, choosing and denying touch empowers the survivor.

Reintegrating Body Memories

In conjunction with psychotherapy, touch therapy assists the survivor in reaching hidden memories and integrating them into his present experience. Abusive traumas from the past cause the survivor to dissociate from the body, and this experience often recurs when the body is touched. Renegotiating somatic memory by replacing a negative physical response with a positive memory reintegrates the experience so that the client achieves a more balanced and positive state of body awareness. Therapeutic touch may trigger the recall of memories to be processed in psychotherapy.

As clients connect with their bodies in a more positive way, they experience improved body image and feel less shame. Practitioners may find that these clients take better care of their bodies as treatments continue.

Enhancing Psychotherapy Collaboration

Psychotherapists who recommend touch therapies for their clients see the bodywork practitioners as collaborators in the healing process. Many see touch as a valuable adjunct for some of their clients to reduce stress while others see it as a vital part of the task of reintegrating the body into the survivor's life. Psychotherapists and bodyworkers collaborate in different ways. A sequential mode is when the client has a bodywork session in the first hour and a psychotherapy session in the next hour. A combined mode entails the psychotherapist and the practitioner working simultaneously with a client in one room, as described by Robert Timms, Ph.D.16 (The combined mode, where psychotherapist and somatic practitioner work simultaneously, may present complex challenges, both rich in opportunity and possible difficulties.) Others work concurrently at separate locations, seeing a client weekly at their offices and communicating by phone as needed. Psychotherapists who regularly call upon touch therapists to support their treatment plan usually interview the practitioners before they refer their clients to them.

The Path Home

Touch therapy is a powerful adjunct in the recovery from abuse, and with this power comes the need for great responsibility on the part of the practitioner. The practitioner who provides ethical treatment for abuse survivors comes from a place of sensitivity, caring and the desire to help, as well as from one of detailed education, extensive training and ongoing supervision. Bodywork might be the first experience of pain relief or nurturing that survivors have on the physical level. It may be the path home. Ben Benjamin holds a doctorate in education and sports medicine. He is the founder and president of the Muscular Therapy Institute in Cambridge, Mass., and has been in private practice for 40 years. He can be contacted at bb@mtti.com. Cherie Sohnen-Moe is a business coach, international workshop leader and business owner since 1978. She was in private practice for many years as a massage practitioner and holistic health educator. She can be contacted at cherie@sohnen-moe.com. References 1. Soalt, Melissa. Personal interview, 1994. 2. Mines, Stephanie. Secrets: Healing Triumphs over Domestic Violence. Massage & Bodywork. 2001 Oct/Nov: 18. 3. Mowen, Karrie. Trauma Touch Therapy: An Interdisciplinary Approach to Trauma. Massage & Bodywork. 2001 Oct/Nov: 28-36. 4. Yassen, Janet. Personal interview, 1994. 5. Ibid., 1991. 6. Eckberg, Maryanna, Ph.D.,Victims of Cruelty: Somatic Psychotherapy in the Treatment of Posttraumatic Stress Disorder. Berkeley, CA: North Atlantic Books, 2000: 3. 7. Eckberg, 45. 8. Field, Tiffany. Touch. Cambridge, MA: A Bradford Book, MIT Press, 2001: 136. 9. Tjaden, Patricia and Thoennes, Nancy. Prevalence, Incidence and Consequences of Violence Against Women: Findings From the National Violence Against Women Survey. NCJ. Washington, D.C.: U.S. Department of Justice, Bureau of Justice Statistics, 1998 November: 172837. 10. Snyder, Howard N. Sexual Assault of Young Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics. NCJ. Washington, D.C.: U.S. Department of Justice, Bureau of Justice Statistics, 2000 July: 182990. 11. Herman, Judith. Trauma and Recovery. New York: Harper Collins Publishers: 1992. 6-32. 12. Herman, 6-32. 13. Soalt. 14. Eckberg, 41-48. 15. Ibid., 48-58. 16. Timms, Robert and Connors, Patrick. Embodying Healing. Brandon, VT: The Safer Society Press, 1992. 24. To order The Ethics of Touch call 800/786-4774 or visit www.sohnen-moe.com.

The Ethics of Touch

The following is the first of three excerpts that will be published in Massage & Bodywork from the newly released book, The Ethics of Touch, by Ben Benjamin and Cherie Sohnen-Moe. (SMA Inc., Tucson, Ariz., 2003.)

Ethical Principles The topic of ethics can often be confusing, difficult and at times downright baffling. Although debated by philosophers for millennia, agreeing upon what is good and bad remains difficult. So much depends on the situation. Not all ethical breaches are gross violations of conduct; much unethical behavior is subtle. Furthermore, being ethical is not limited simply to knowing and following ethical codes, laws and regulations. Ethical behavior also involves striving to bring the highest values into ones work and aspiring to do ones best in all interactions: doing the right thing in the right manner for the right reasons and with the right attitude. Tom Peters, acclaimed author of In Search of Excellence,1 sums it up like this: High ethical standards business or otherwise are, above all, about treating people decently. To me (as a person, business person and business owner) that means respect for a persons privacy, dignity, opinions and natural desire to grow; and peoples respect for (and by) co-workers.2 For somatic practitioners ethics can be especially complex as they encounter ethical issues and dilemmas that do not always have simple, apparent solutions. In many cases practitioners may inadvertently act unethically because they have not considered the relevant issues. Expanding their grasp of ethical principles helps practitioners understand the impact of their behavior on clients and provides the knowledge and tools to act appropriately. The overall purpose of ethics is to guide professional practitioners so that clients welfare remains the first priority. Self-Accountability In essence, self-accountability is the cornerstone of ethics. It is about who you are and what you do when no ones watching you. When you have a well-developed sense of self-accountability you are honest with yourself, and you are answerable and fully responsible for what you say and do at all times. You have the ability to look beyond the immediate moment to consider all the consequences and know if you are willing to accept them. You have personal ethics. As individuals it is our capacity for self-accountability that keeps us functioning ethically and responsibly. Personal ethics is the precursor to professional ethics: you are not likely to be more ethical in your professional life than you are in your personal life. As the saying goes, No matter where you go, there you are. In other words, you are most likely dishonest in your business affairs if you are dishonest in your personal life. Likewise, if you cannot keep the secret of a friend, your clients confidentiality is at risk. A Practical Application for Professionals Forethought and understanding help practitioners avoid a myriad of problems throughout their careers. Awareness of these potential issues and careful consideration assist healthcare professionals to avoid thoughtless errors in judgment. Below are a sampling of actions and behaviors generally considered unethical by professional codes of ethics. Practicing Beyond Scope of Practice: Doing spinal adjustments, massage or counseling without appropriate training. Sexual Misconduct: Watching a client undress or hugging a client in a sexual way. Misrepresentation of Educational Status: Calling yourself a craniosacral therapist after taking a three-hour workshop.

Financial Impropriety: Charging a cash-paying client a different fee than an insurance-paying client. Exploiting the Power Differential: Asking a stock broker for financial tips during a treatment. Misleading Claims of Curative Abilities: Telling a client you guarantee her pain will be gone in two sessions. Accessibility: Refusing to adapt your office (or making some reasonable accommodation) for those with physical challenges. Bigotry: Refusing to work on someone due to race, religion, size or sexual orientation. Inappropriate Advertising: Using a provocative picture in advertising; presenting misleading qualifications. Dual Relationships: Dating a client. Violation of Laws: Practicing out of your home when it is not permitted by law. Confidentiality: Name-dropping famous clients; telling a spouse details about his partners session. Contraindications: Treating a client when you are sick/infectious; ignoring signs of conditions that preclude physical contact. Informed Consent: Working on a minor without parental knowledge; treating someones injury without permission. Values Clarification A satisfying and balanced life occurs when your values are in synchrony with the way you lead your life and run your business. Invest the time in exploring your values. After all, they are the major conscious and unconscious influences on the decisions you make throughout your life. Many conflicts in ones life, both professional and personal, arise because there is a clash of values either within oneself or among others. (See Core Values Assessment, page 70.) Core Psychological Concepts To behave responsibly and ethically, every practitioner must intimately understand a number of core psychological concepts. A lack of psychological savvy is no longer a valid excuse for inappropriate behavior. These basic concepts are essential for all practitioners to understand. Practitioners must have a thorough understanding of the meaning of: the therapeutic relationship; power differential; transference; countertransference; projection; repression; and denial. These concepts create the bedrock of ethical decision-making and responsible behavior in all professional and (as a bonus) personal relationships. The Therapeutic Relationship The major elements in a therapeutic relationship are: there is a client-centered, fiduciary relationship; the time together is structured; each person has a clear role; the environment is safe; and there is a power differential. Client-Centered The therapeutic relationship is a very special kind of relationship and is often referred to as clientcentered. Client-centered means that every action that the practitioner takes is in the service of the clients needs and not the practitioners needs. Trouble often begins when the practitioner takes an action just because she feels like it and not because it is therapeutically necessary. Client-centered also means that the client has a voice in the process and must agree to the course of treatment for it to proceed. In the client-centered relationship the client has the right to expect that the practitioner always acts in the clients best interest. When this occurs the client feels safe and attended. The client-centered relationship considers the client as a partner who shares decision-making power. In The Power of Touch, Phyllis K. Davis, Ph.D., describes a list of the characteristics of an effective healer that includes being motivated by the needs of the client.4 She emphasizes that creating a space for a supportive and nurturing environment begins with the practitioners commitment to personal and professional excellence. In this environment, overall health improves and enables everyone the practitioner touches to make a fuller connection with their lives. Fiduciary Relationship All healthcare practitioners have a fiduciary relationship with their clients. Fiduciary is a term

thats applied to a professional in whom a client places his trust. The client is putting his wellbeing in the hands of the practitioner and theres an implicit contract that the practitioner places the clients interests above and before the practitioners. Protecting and maintaining the boundaries of professional relationships is the responsibility of the professional even if the client requests or instructs the professional to behave otherwise. When a professional deviates from standard practice, which is sometimes necessary and useful to individualize care for a particular client, the fiduciary principle and the client-centered approach remain as the guiding parameters of care. The practitioner/client relationship and the treatment choices must be continually monitored. Also, because somatic practitioners are in positions of power relative to their clients, the law holds them to a higher standard of behavior than in business relationships with a lower level of a power differential. Structure Other elements of the therapeutic relationship are that the time spent together is limited and structured. The client comes for a session each week, or some other time interval, for a specific type of treatment. Within a prescribed time frame certain expected activities occur. Each person has a clearly defined role in these interactions. The client comes for help and the practitioner is there to help the client. Safety The client has the right to expect that the emotional and physical environment is safe and does not include inappropriate personal comments or sexual advances. Power Differential It is difficult to understand the therapeutic relationship between client and practitioner without comprehending the dynamics of power in a therapeutic relationship. There is a natural power differential in many but not all relationships: between parent and child; between teacher and student; between employer and employee; and of course between healthcare practitioner and client. A parent, teacher, employer or healthcare practitioner has the more powerful position. They are the authority figures whose actions, by virtue of their role, directly affect the well-being of the other. The child, the student, the employee and the client are in the more vulnerable position. In theory, and in ethical practice, the power differential exists for the purpose of bringing benefit to these more vulnerable individuals: the childs well-being should be enhanced by the parents care; the employee should benefit from the employers management. The power differential is inherent in any therapeutic relationship. There is an implicit acknowledgment that the practitioner has more knowledge in this area than the client. In the healthcare field the power differential is amplified by the physical aspects of practice. The client takes a position usually lying or sitting in which he allows the practitioner access to his body. The practitioner positions herself within the clients physical space, often leaning over the client. Furthermore, in many professions the client is partially or fully unclothed. Although draping is used for privacy, the psychological effect of the unclothed client and the clothed practitioner increases the imbalance of power. Finally, as the practitioners hands make physical contact with the clients body, the clients physical safety is literally in the practitioners hands. The Practitioners Role The power differential in a relationship such as this requires consideration of two questions. The first seems obvious: How is the person with more power (in this case, the practitioner) handling that power? The person who holds the power in the relationship may be tempted to misuse that power. The practitioner could take advantage of clients physically, emotionally, financially or professionally. Resentment usually brews when a client is put in an awkward position. Consider the following examples: A practitioner is treating a client who happens to be a lawyer and asks, Since I have you here, could you just answer this quick little question I have about my divorce?

 A practitioner who is running in a charity race solicits sponsorship during a session. During a session the client begins talking about an executive whom the practitioner has wanted to meet and the practitioner asks for a personal introduction. To maintain an ethical practice, the person in power must regularly say no to something she could easily get and must instead choose to pay special attention to the needs of the person with less power. The practitioner must consciously decide to maintain the integrity of the clients boundaries in a situation where the client has significantly relaxed those boundaries. Clients frequently test boundaries by offering things that may be inappropriate. For instance a client suggests that he tells you about some exciting new stock options while receiving a treatment or a client volunteers to take your computer home to repair it because he sees you are having trouble with it. The Clients Role The second question is not so obvious: How is the person with less power responding to the others use of power? The answer to this second question may be difficult to determine because of the explicit power dynamics in professional helping relationships. It is the practitioners responsibility to be aware of how the power differential may be affecting the clients ability to raise concerns. Consider this: The increased perception of the power differential in a hands-on session puts the client in a highly vulnerable position. The client feels less free to defend against intrusions or to question unexpected behavior by the practitioner. The client may feel uncomfortable about raising concerns, complaining about the treatment process or making requests. The client may find it difficult to say no or to question the practitioners behavior, even if the client feels uncomfortable or mistreated. The client may even refrain from communicating anything that could possibly be construed as negative for fear of reprisal or loss. An active business woman has received massage twice monthly from the same massage therapist for over two years. She recently began having sharp pains in the big toe of her right foot. On one occasion, she mentioned the pain to the practitioner at the beginning of the session in hopes that the therapist would spend some time vigorously working the area. As the massage proceeded, the practitioner moved through the foot area rather quickly. Disappointed, the client debated about asking the massage therapist to go back to the toe area. She couldnt understand why it was so difficult to ask. After some thought she realized she felt vulnerable lying naked on the table having someone standing over her, touching her body (even though she was covered by a sheet). And asking someone to do something to her (especially on a big toe) might seem silly. She might be imposing, or maybe the practitioner would become upset since it was close to the end of the session. She did not want to appear needy or self-centered. Finally, the client muttered in a very unsure, childlike tone, Um, ah, do you think, I mean, would it be OK, could you, um, work on that toe that hurts? The practitioners response? Sure! In this case, even though the client and practitioner had worked together for a couple of years, the client became hesitant to make a request out of a sense of vulnerability, a fear of appearing foolish and concerns over possibly upsetting the practitioner. The psychological effects of the power differential in this case remained unperceived until a need arose requiring the client to make a request. And even after recognizing the effects, the client still asked as a child would for something she is not quite sure she should have. Because of this psychological dimension, a growing trend in the healthcare world is to encourage clients to take an active role in the decision-making process of their healthcare. This is the way most somatic practitioners interact with their clients. Getting clients to take responsibility is not

always easy. Unfortunately, it is difficult to reprogram a lifetime of the doctor knows best. Realize that even though you may be doing your best to foster an atmosphere of equality, the power differential always exists on some level in a therapeutic relationship. Just the Beginning... Ethics is an exciting, vital field of study for all professionals. Life is more fulfilling and satisfying if we live with honor and integrity in all our relationships and business dealings. Clarifying your values and understanding core psychological concepts is the first phase in developing a solid ethical foundation. The next steps include: expanding your abilities to resolve ethical dilemmas; learning to better manage boundaries; enhancing communication skills; improving your practice management capabilities; setting up a support system; and learning to effectively work with special populations. Running an ethical practice takes a life-long commitment to self-evaluation and exploration. We are delighted to join you on this journey.
References 1 Peters, T.J. and Waterman, R.H. In Search of Excellence. New York: Harper & Row; 1982. 2 Peters, T.J. Ethics is an everyday, lifetime endeavor. The Arizona Daily Star. 1989 Sept 26. 3 Peale, N.V. and Blanchard, K. The Power of Ethical Management. New York: William Morrow and Company, Inc.; 1988. 30-31. 4 Davis, P.K. The Power of Touch. Carlsbad, Calif.: Hay House, Inc.; 1999.173-174.

Ben Benjamin holds a doctorate in education and sports medicine. He is the founder and president of the Muscular Therapy Institute in Cambridge, Mass., and has been in private practice for 40 years. He can be contacted at ben@mtti.com. Cherie Sohnen-Moe is a business coach, international workshop leader and business owner since 1978. She was in private practice for many years as a massage practitioner and holistic health educator. She can be contacted at cherie@sohnen-moe.com. To order The Ethics of Touch, call 800/786-4774 or visit www.sohnen-moe.com.

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ower of Touch Touch is one of the most basic human needs, documented for thousands of years. It occurs in every culture. Touch also affects animals. Equine massage (for horses), canine massage (for dogs), and feline massage (for cats) have been popular for years. Though the animal is on the receiving end, studies have also shown that petting animals lowers stress, high blood pressure, and depression in humans. Doctors have taken notice of these studies and have even prescribed pets as part of the healing process. Programs involving pets in hospices and retirement homes are also becoming popular. Touch can be used as a method for: Communication, Learning, Comfort, Building self-esteem, Expediting the bodys healing potential. Scientific research proves that deprivation of touch can cause significant obstacles for healthy personal development and immune function in the body. Touch is essential for our survival, if used ethically. Starting in the womb through our adult lives we use touch to communicate, evaluate, and navigate through life. When used appropriately, touch can yield incredibly positive results in the body.

Unfortunately, some people misuse massage by doing mass-produced assembly line massage or sensual/sexual massage. This could be due to a lack of proper education or just for their own selfish motives. Unethical people giving these types of massage accomplish devastating results by: Showing disrespect for the entire massage and bodywork trade, Increasing the negative stereotypes of massage, Hurting the reputation of professional certified massage therapists with proper education who legally practice massage. Physiology of Touch The human body is covered by approximately 18 square feet of skin, making it the largest sensory organ. Unlike other sensory organs, the skin remains in a constant state of readiness. The sensory nervous system sends a constant flow of information to the brain. Through the skin and the sensory nervous system we can detect information such as change in pressure, temperature, pain, and pleasure. For the blind and deaf this function is critical for survival. Scientific studies have proven that the skin, muscles, and fascia (connective tissue in the body) can even store remnants of emotional or physical issues from the past or the present. Dr. Tiffany Field, PhD at the University of Miami, is one of the foremost experts in the world in myofascial therapy and emotional release. Dr. Field's research on the benefits of massage on the human body have concluded that any physical and/or emotional distress, whether from car accidents, divorce, moving to a new home, or past/current relationship issues for example, will be stored in the fascia for years. During a massage-therapy session some clients will have what is called an emotional release. The clients emotional release comes from this fascial memory and can manifest unexplainably in tears or less commonly in laughter and other emotions. California state-approved massage-therapy schools teach students about fascia and emotional release and how to prepare ethically to help the client. A Local Perspective As a massage therapist and California state-approved massage instructor for more than 20 years, Ive experienced quite a cross-section of massage-therapy issues. In my opinion, all massage-therapy appointments fall into two main categorieswellness and therapeutic massage. The main approach of wellness massage is for preventative maintenance. Massage increases circulation for many physiological benefits. These physiological benefits are not necessarily focused on specific muscular conditions or complaints. For example, I have worked on some clients for stress/tension, immune system issues, injury prevention, and so on. The therapeutic massage-therapy approach always requires a higher level of education and advanced massage-therapy techniques. Common issues I have treated with therapeutic massage therapy are allergy and sinus headaches, bursitis, tennis and golfer's elbow, thoracic outlet syndrome (numbing and tingling down the arm), frozen shoulder, rotator cuff, carpal tunnel, sciatica, patellar/ meniscus (knee) complications, shin splints, and so on. Code of Ethics Most massage therapists follow a code of ethics belonging to one of two massage-therapy organizations.

The largest, most popular, and reputable organization is Associated Massage and Bodywork Professionals, ABMP (www.abmp.com). The other common organization is American Massage Therapy Association, AMTA (www.amtamassage.org). The code of ethics in general contains the following important points: 1.Commitment to provide the highest-quality bodywork to the client, 2.No discrimination/prejudice toward the client or colleagues, 3.Demonstration of professional excellence within the confines of previous education and training, 4.Respect for the client's right to privacy, 5.Conduct of bodywork within the scope of all city, county, state, and federal laws, 6.No tolerance for intimate, sensual/sexual relationship with any massage client. 7.Also, the massage therapist does no harm physically or emotionally to the client and does not let his or her own emotions affect clients or coworkers. 8.And massage therapists understand that they are not to diagnose client issues, prescribe medications or drugs, and they are not to manipulate the skeleton of the client in any way (no chiropractic). The best approach when seeking a professional massage is to first and foremost look for a certified massage therapist who received his or her education from a state-approved or accredited massage school. The therapist should have 250 hours of basic massage-therapy certification and some regular continuing education. The massage therapist should also be able to provide references and give a price in advance. A few local massage businesses have been known to verbally increase their prices even during the massage! Ask what method of payment the therapist accepts as some therapists are independent contractors. Check out the office. Look for cleanliness and ask if the massage therapist is a member of a professional organization and if she or he has insurance coverage to practice massage specifically. You also have the right to ask where the therapist received an education. Finally, make sure you report any massage therapist who you feel is practicing unethically to the police department or a local state-approved school. I hope and pray that your future massage experience is professional, healthy, and ethical.