[Fundamentals] Chpt 2 - Lecture

6 Professional Criteria's (Need to know)

• Specialized body of knowledge.
• Extensive training.
• Orientation towards others
• A commonly accepted code of ethics/practice.
• Legal recognition through certification of licensure.
• A professional association.

Certification vs. Licensure

• Certification:

• Voluntary credential
• Requires education and examination organization approval.

• Licensure:

• Government regulated, permits the practice of a profession.

Professional Tracks:

• Health and Wellness: Spa's (stress reduction, pampering services, cosmetics, and relaxation.)
• Medical, Clinical, and Rehabilitation: Working under the supervision of a licensed professional (i.e. A doctor, physical therapist, chiropractor)
• Sports and Fitness:  This can cover both wellness or medical. (based on issues related to the environments that supports exercise and sports performance.)

Educational Categories:

• Academic majors-Formal programs of study designed to impart knowledge and skills that represent the accumulated knowledge base in a subject area. (comprehensive and theoretical).
• Career majors-Formal programs of study designed to impart knowledge and skills that represent the relevant accumulated knowledge within the content of occupation-specific job requirements.(less theory, more application narrower focus than Academic majors.)

• Vocational career majors-consist of formal programs of study that impart the knowledge and skills required for semi skilled, skilled, technical, and paraprofessional occupations that typically require education below baccalaureate  level
• Nonvocational career majors-consist of formal programs of study that impart the knowledge and skills required for technical and professional occupations that typically require education at the baccalaureate level or higher.

 Therapeutic Massage(What, Where, and How):

• What - The scientific art and system of assessment, systematic, and manual application of a technique.
• Where - The superficial soft tissue of the skin, muscles, tendons, ligaments, and fascia as well.
• How - By means of hand, foot, knee, arm, elbow, and forearm.

Effects of Massage:

• Mechanical - Stimulation of a specific area in the body that with a specific technique that as a immediate result on at area such as Friction, rubbing out adhesions, increasing circulation, getting blood to the area.
• Reflexive - Stimulation to one area of the body that has a impact on a nearby organ or the whole body as a whole massage in general is reflexive.
• Both - Massage that includes both of the above techniques.

Approaches to Massage Therapy(Multiple Test Questions Must know):

• Asian - Asian Massage came from traditional Chinese medicine and concepts, and other Asian modalities. The effects of compressive manipulations and stretches that focus on specific areas of the body elicit responses of the nervous, circulatory, and muscular systems and affect the energetic flows in the clients body.(grounded in ancient concepts, stood the test of time.)
• Structural and Postural Integration - This technique focus's more on the connective and tissue structure to influence posture and biomechanics. The approach is systematic and effective. (grounded in the fundamentals of physiology and biomechanics. requires extensive training.)
• Neuromuscular - Created by many Doctors this technique is still taught by one of the originators today (Leon Chaitow) Many technqiues are similar to those performed in Rolfing, Asian methods, and Swedish massage and gymnastics. This technique is a nervous and reflexive method. Connective tissue is affected as well. The common threads running through all the styles are the basic concepts of activation of the toner receptor mechanism, reflex arc stimulation, positional receptors, and applications of stretching and lengthening.
• Manual Lymphatic Drainage - Created by Emil Vodder, this technique stimulates the flow of lymphatic fluid via mechanical and reflexive techniques. (sometimes called systemic massage)
• Energetic (Biofield) - based on ancient concepts of body energy patterns, this method uses near touch or light touch to initiate reflexive responses, often highly effective.
• Craniosacral and Myofascial - Created by William Sutherland and expanded upon by John Upledger, and John Barnes, Method focused on mechanical and reflexive connective tissue functions(tiny movement of the cranium and dura). Both light and deep touch are used depending on the method.
• Applied Kinesiology - Created by George Goodheart, this approach blends many techniques but works primarily with the reflexive mechanisms. A muscle testing technique is used to evaluate similiar to a biofeedback mechanism. Some of the techniques use Asian meridians and acupressure; others rely on osteopathic reflex mechanisms that seem to correspond with Chinese acupuncture points.
• Integrated Approaches - This includes; Infant massage, Sports massage, Animal/Equine massage, on-site or seated massage, prenatal massage, geriatric massage, massage for abuse survivors, Russian massage. This type of massage incorporates many different massages from many different cultures. Founders and teachers of Integrated massage include every massage professional that has developed a unique massage for a specific person.

Therapeutic Massage Tree:

• Although massage encompasses a wide diversity in its uses and applications, all forms of therapeutic massage methods stem from the same roots. (Body, Mind, Spirit.)

Scope of Practice(what can we do):

• Knowledge base a practice parameters of a profession.
• Includes an assessment, treatment planning, and treatment through the manipulation of soft tissue, circulatory fluids, and energy fields of those effecting and benefiting all of the body's systems.
• (Relaxation, Stress Reduction, Enhancing over all Well-being. Improving posture, facilitating circulation, balancing energy, relieve pain and discomfort, repair and prevent injury, and rehabilitation.)
• Wellness - Spa, Massage franchise, Independent massage practice.
• Health care - Sports and fitness, Clinical, Medical, or Rehabilitation settings.
• Entry Level Massage:

•  Encompasses a range of massage services for wellness and pleasure practice.
•  Considered massage specialty which requires additional education and experience.
•  Career Development:

• Employee Pathway(Franchise) - Fast becoming the largest employer of massage therapists. Reliable pay, No hassles of owning your own business, good way to gain experience.
•  Independent Massage Practice - Complex due to varied structured options, career development, be very motivated, responsible for marketing and own taxes. 
• Independent Contractor - Establish contracts with a medical office, or spa offices.
• Massage Clinic - Your own franchise.

• Sports and Fitness - Covers a very broad spectrum of massage, from Wellness massage to Medical massage based on issues related to whatever the environment is that supports exercise and sports performance. 
• Entry Level Practice(Clinical, Medical, Rehabilitating, Wellness) - Popular as a primary avenue for massage practice. Growing Rapidly.
• 3 Realms of functioning.

• Normal - Seeking massage for Wellness, relaxation, no health care supervision is required.
• Dysfunctional, complex, athletic patterns - Person may be injured or have a history of illness. Requires usually over 1000 hours of practice in order to deal with more complex injuries. Supervision may be required pending on the functional level of the client(i.e. extent of the injury, how long ago it happened).

•  Illness and Trauma - Working with a healthcare professional (MD, PT, CPD) with a patient that had severe trauma or illness (I.e. Heart attack, or terminally ill) you need a medical release form in order to work with this patient, altering your techniques to fit the client's needs. You need medical supervision (medical script).

• Occupational Definitions and Scopes of Practice(Box 2-6):

•  Respect the scope of practice for other professionals. Refer your clients to someone who has more extensive training or knowledge in a medical field that you cannot assist with. (Refer if you do not know what is wrong with a client.)
• Acupuncture - Traditional Chinese concept medicine.
• Athletic Training - For performance. 
• Chiropractor - Joint Manipulation. 
• Cosmetology - External health and beauty of nails, skin and hair.(beautification)
• Dentistry - Teeth, Alveolar processes, gums, jaws, dependent tissues.
• Esthetics - clean and beautify the skin.
• Medicine - Diagnose disease, aliment, defect, complaint, or other physical or mental conditions.
• Naturopathy - Herbology, homeopathy, acupuncture, manipulation, hydrotherapy, massage, exercise, and psychological methods.
• Nursing - People who are experiencing changes in the normal health process or who require assistance in the maintenance of health and prevention of management of illness.
• Osteopathic Medicine - Musculoskeletal system with and other body systems
• Physical Therapy - Therapeutic exercises with or without devices, to prevent, correct or alleviate a physical or mental ability.
• Podiatric Medicine - is the examination, diagnosis, and treatment of abnormal nails and superficial excrescences on human feet.
• Psychology - Treatment of mental or emotional disorders, disabilities, and behavioral adjustment problems.

•  Personal Limits:

• Type and extent of personal education.
• Personal biases. 
• Life experiences.
• Personal interests.
• Physical limitation, size and endurance levels.

• Clients ability to adapt:

• Ability to adapt to certain internal and external stressors.

• Effective or Good Ability to Adapt.:

•  Good health function normally, able to conduct satisfying work, copes with stressors well, very flexible.
• Massage Goals - Maintain and enhance health and well-being.

• Ineffective or Moderate and Strained Ability to Adapt: 

•  Stressed or always chronically ill, functions with effort, beginning to break down or burnout needs intervention to cope with stressors.
• Massage Goals - (Via the book): Because massage temporarily takes the edge off of physical discomfort and reduces the strain of stress response, this allows people to perform better under stress, making it more tolerable. People tend to be less motivated to change if their stress or current circumstances seem tolerable. massage intervention may not be the best way to go about helping with person. Tassa said they may require intervention to cope with stressors (ie mental/psychological intervention) 

• Poor Ability or Inability to Adapt:

•  May be terminally ill or injured hope is lost, ability to function is lost and they require comprehensive intervention. 
• Massage Goals - Massage must be used carefully and supervised by a medical professional, and if massage is appropriate than it would be called palliative care(hospis for massage) this will not change or enhance the condition at all, it's pretty much to make the patient relax and reduce stress.

• Ethical Principles:

• Ethical principles help you in resolving ethical dilemmas and problem solving approaches.
• Respect - esteem and regard for clients, other professionals and yourself. 
• Client Autonomy - Self determination, give client the right to decide and the right to submit to sufficient information make a decision.
• Veracity - The right to be objective truth.
• Proportionality - The benefit must outweigh the burden on the treatment. 
• Nonmaleficence - Do no harm.
• Beneficence  - Treatment should contribute to the clients well-being.
• Confidentiality - respect for privacy and information.
• Justice - equality.  
• Standards of practice - Provides specific guidelines and the rules that form a concrete professional structure. Directs quality care and provides a means of measuring the quality of care.  

• Informed Consent: 

• Protection process for your clients.
• Requires that the client understands what will occur, that they participate voluntarily and that they can be competent to give consent .
• Guardians must provide consent for minors unable to do so. (under 18 needs parents consent)
• Discussions leading to consent and clarify ethical gray areas, Ask open ended questions that require a detailed response from your client. (How does that make you feel, is it dull or sharp, does it radiate to another area or is it stationary.)
• Consent could be both verbal or written. 
• In all cases the Therapist is responsible for obtaining informed consent. 

• Test Question:  

•  Which one of  these 4 is not able to give informed consent?

• Pregnant lady in her 3rd trimester, exhausted moody and emotional.
• An 84 year old widow with 5 speeding tickets.
• A guy with a car accident and he can communicate only through his computerized keyboard.
• Severely depressed woman on medication and her husband wants to cheer her up.  (No she can not.) 

•  Client needs to know the following before giving proper consent:

• Goals of the Therapeutic program.
• The service you are providing.
• Behavior expected of the client.
• The Risks and Benefits.
• Practitioner's qualifications.
• Financial considerations.
• Length of Therapy.
• Confidentiality Limitations.
• Levels of mandatory reporting practices.

Intake Procedures: 

• Needs assessment, based on medical history and physical assessment.
• Use this assessment to devise a initial treatment plan.
• Initial Treatment Plan:

• States the goals, duration of the session, how many sessions needed, costs, and chosen intervention.
• Establishes objective progress measurements for identifying what goals have been reached. 

• Give client written policy statement information such as a brochure, indicating the following:

• Type of Service
• Training and experience.
• Appointment policies
• Expectations
• Fees(Be specific)
• Statements of sexual appropriateness
• Recourse policy

• Confidentiality:

• Respect for your clients private information.
• A clients information is private and it belongs to the client (HIPAA: Health Insurance Portability and Accountability Act.)
• You can not discuss a clients information with anyone but the client without written consent.

• Boundaries:

• Test Question (possibly 2) on Right of Refusal. KNOW THIS.

• Right of Refusal:
• Professional -  This is a right that both the practitioner and the client have. You have the right to refer or deny the client service, if a just and reasonable cause exists.(Done through disclosure, as long as you acknowledge and inform the client of the situation that interferes with the professional relationship.)  
• Client - The same right goes to the client, if they do not feel you are doing good enough, or your a smoker, or your a female/male, and they are a male/female and do not wish to be massaged by the opposite sex they can deny you. (if this does happen you can either not charge or reduce their rate.)    

• Personal Boundaries: 

• Define yours by honestly looking at your feels, fears, frustrations, prejudices, biases, personal, and moral value systems.   
• Your personal boundaries are within an arms length of someone's space.  
• You need to be invited into your clients space, so you do not invade them.  
• Provide guidelines for professional boundaries. (Physical or emotional space in the therapeutic relationship.)

• Client's Boundaries:

• First you must find out what their boundaries are. (some people who have had an abusive past may not be able to define their own personal boundaries because they've never been given the opportunity.)
• Keep an eye on your patients facial expressions and body language as well when you are determining your clients boundaries. 
• If this is their first massage, you need to be more aware of their boundaries.

• Defuses feelings of sexual arousal:

• Recognizing your arousal and interrupting what your doing.
• Be aware of your own psychological state.
• Adjust the intent of the session to stimulate a more sympathetic outcome.(change the lighting, music, use a different stroke, conversation, and position.)
• You have be able to educate your client, explaining the feelings in a professional manner using clinical terminology. (para-sympathetic reaction to your touch may stimulate the client.)

• Transference: (Will be on test possibly 4 times.)

•  Client's personalization of the professional relationship. [Could be in the form of them demanding more time after the session. providing more massage. They can give you personal gifts. May express anger and blame you for not being able to aid you with their condition. Also have unrealistic expectations. or want to be your friend.]

• Counter-Transference:

• Professionals inability to separate the therapeutic relationship from personal feelings. [I.e. You get angry because your client isn't reaching the goals you set for them.  Unable to say no, "client wants you to spend more time on an area, you are unable to say no."]
• Also this could be practicing techniques that only you like to give or receive. [I.E. you enjoy deep tissue massage, that means everyone you massage is getting deep tissue massage. Or you don't like your feet touched therefore you aren't going to touch anyone's feet.]
•  Not counter-transference - If you are grieving from the loss of your best friend it is not count-transference.

• Dual(or multiple) rolls:

• When the scopes of practice overlap, and you are a Massage therapist Esthetician and cosmetologist, you can tell a client and use things that would benefit their condition. [I.E you can use ahoba oil on their scalp to relieve dandruff or relieving the scalp.]

• Appropriate body language

• When you initiate your client sessions begin with a handshake, then invite that person into your space, you also wait for them to welcome you into their space. Cultural challenges may exist. 

• Reciprocity 

• The right of exchange of privileges between governing bodies. [find what other laws and regulations are in the states you want to practice in.]

• Self-Reflection

• Dealing with suspected ethical or illegal behavior, self-reflect before initiating a consultation of actions, motives should be based on genuine concern for the fellow professional client and the good of the profession not on the personal values of moral beliefs.
• Talk with someone involved in the community in which you want to get involved in.