Therapeutic Relationship

Daiana Branco
Thursday September 25, 2014

Part 1: The importance of a Therapeutic Relationship

A therapeutic relationship is a relationship that is built between the Student
Massage Therapist (SMT) and the patient. I believe its important to build a therapeutic
relationship with your patients. For example, when your patient first comes into the clinic
it allows trust and confidence, both ways, between the SMT and their patient. May be shy
or very limited on what they want to share. Once the patient returns, with additional visits
overtime a relationship will start to be built, this will result in feeling more comfortable,
allowing the patient to be able to talk more openly which will result in the sharing of
more information or that they will start talking as well as feeling more comfortable. A
therapeutic relationship is different from other types of relationship because it requires
professionalism. For instance, even though our patients build trust and become more
comfortable with us as therapist, there is a point in the relationship where the therapist,
might be ask a question that goes against the Massage Therapy Act or RHPA therefore
causing a professional relationship to be broken. For example if a patient was to ask a
therapist to go out for drink the therapist would have to say no because that would be
going against the Massage Therapy Act but also not having that professionalism of just
talking to your patient about their treatment plan. Some strategies on how to create a
good therapeutic relationship include making sure that the therapist is listening to what is
being said by the patient. The therapist can do this by paraphrasing, therefore making
sure that the therapist understood everything correctly. Trust is very important aspect to
have in a therapeutic relationship. It allows for the building of confidentiality and privacy
from the patient to the therapist, as the patient is sharing personal or private information
that they expect you to not share with anyone else. Without trust there can never be a

good therapeutic relationship as the patient may start to feel uncomfortable, especially
when it comes to treatment or even asking questions. Another strategy to creating a good
therapeutic relationship would be treating everyone equally and not discriminating
against age, race, culture, gender, and sexual identity (Lewarne Andrew, 2012). Its
very important to treat everyone equal no matter what because people dont want to be
treated by a therapist who is being very discriminating. It makes the patient feel
uncomfortable and not wanting to be there and getting treated by someone who doesnt
care about them as a human being. Some issues that a SMT may come across while
trying to create a healthy therapeutic relationship with the patient could be as a result of
the therapist touching the patients body that is unclothed, can cause some culture,
gender, religion or even personal experience touch depending on how the patient
interprets the response of touch (Andrade & Clifford, 2008.pg83) This situation can
cause an issue as a result of a patients who has never received a massage or understand
how it works. They may not understand why they have to be undressed to get treated
instead of being treated while being dressed. For some people it might not bother them
but to others it will and therefore the therapist would have to accommodate towards their
needs. Our goal as a therapist is to make sure that the patient feels safe, comfortable, and
still able to continue with the treatment in which every way theyre comfortable in
(Andrade & Clifford, 2008.pg83). If I had this situation happen to me I would explain to
the patient that its perfectly fine if they want to be treated while being dressed just that it
will be al little harder for me to treat the specific muscle with the clothing in the way and
also I wouldnt be able to apply any lotion on. Another issue an SMT can come across
could be touch reminding the patient of a negative past experience (Andrade &

Clifford, 2008. Pg83). Touch can have a big impact on the patients life depending on
their personal past. For example being touched by a parent everyday such as giving
there child hugs and kisses compared to being touched once and not again for a while or
even being abused, all have different emotions and memory back to it (Andrade &
Clifford, 2008,pg 86). Whether the client has had a good emotion/ memory or a bad one.
When a patient has a bad memory from a bad childhood or adulthood its harder for the
patient to build trust with the SMT. This is because they think there can be harm done to
them like it was in there past. The way I would deal with this situation would be I would
tell the patient that they have the right to stop or modify the treatment and that Ill be
checking in on their comfort level. By doing this, the patient twill be aware hat you are
there to help them, care for them and not to harm them. Also they have the right to
modify the treatment and techniques to a way that helps them emotionally so touch
doesnt remind them of there past. Another way I would deal with this situation would be
talking to the patient while treating them. This would be helpful because it distracts them
from thinking to themself about anything negative, therefore this way they would be
more focus on the conversation we would be having instead of their past experience.
Part 2: Discuss Related to the Therapeutic Relationship
Listening would have to be one of the main keys ways to having a good
therapeutic relationship because it shows the patient that you care. For example if my
patient came in limping, I would ask him or her what happened and how it happened. Not
only does listening show that you cares it also shows the patient that they have someone
who they can come and talk to because they know you will listen to them regardless if
youre able to help them or not. Listening attentively just makes the patient feel better

knowing that they were able to talk about the things that were possibly bothering them. A
good listener would be someone who is seating up straight, always having eye contact
with the other person, listening and responding back with care in a respectful manner,
paying attention to what is being said instead of being otherwise occupied. For example,
when someone is talking to me I tend to listen to what is being said and also making eye
contact with them. Usually when they are done talking Ill either tell them my opinion or
just agree with what was said. On the other hand a poor listener would be someone who
isnt paying attention to what is being said, talking over the other person, sitting all
slouched on a chair showing poor body behaviour such as slouchy on the chair showing
that they dont care what is being said. An example of this would be while a patient is
talking to you instead of listening to them you would be doing something else. For
instance talking to someone else or just over them and not allowing them to finish there
point because you feel what you have to say is more important then listening to what the
patient has to say. Having communication is very important to have. There are two
different types of communicating verbal and non-verbal. Verbal communication is when
the SMT asks the patient open-ended questions, which are questions that allow the
patient to answer the question in which ever direction they want to start from (Lewarne,
Andrew 2012). For example if the therapist asked the patient how did you hurt
yourself? he or she can start by saying I went snowboarding and this following
happened. From that point on the therapist can ask more question related to the topic to
try and get as much as information possible about the incident, such as who, what, where,
and when. Non-verbal communication is when the SMT is asking closed- ended
questions, which are usually questions that have a one word answer to (Lewarne,

Andrew 2012). For example if I asked my patient where on your lower back does it hurt,
he or she would either point to the place or just say over here, therefore making it a
closed ended question compared to an open- ended question of how did you hurt your
lower back. Good communication skills are done by always asking your patient openended questions because it helps the SMT get more information from the patient and also
allows the SMT to ask more questions about the incident. Also interacting with your
patient is very important because the SMT gets a better understanding on what happened
to the patient such as listening to them and rephrasing what was said. Asking your
patient if there comfortable while treating them, making sure you have consent before
doing any assessment or techniques. Providing better clarifications to the patient if they
dont understand what is being explaining to them or what youre going to do next.
Empathy is being able to understand and putting yourself in someone elses situation;
therefore making you feel what they feel. Empathy also plays a role in communication
because when the patient is explaining how there incident happen to them the SMT may
or may not have experience the same situation or similar situation therefore they know
how it feels like or can imagine how much pain they would feel just by how the patient is
explaining there incident. For example if the patient was telling me how they started to
yell randomly in a classroom because of a muscle spasm, I would definitely understand
why they yelled because Ive experience muscle spasm before and know that they are
very painful, therefore I understand exactly how the patient feels while having a muscle
spasm.

Scenario Discussion
After treating Jolanda I realized that I had shared some personal information
about her to a friend of mine. I didnt realize what I had done until Jolanda spoke to my
instructor what I had done and brought it to my attention, that what I did was breaking the
rule of patient confidentiality. The first thing I told Jolanda before starting the treatment
was that everything that was said was all kept confidence unless it was asked by law. Not
only did I break the patient confidentially rule, I also lost the trust that Jolanda had in me
because of one unprofessional mistake that I had done. Which can cause me to lose my
own clients because they might also think and believe that I could be talking about each
one of to my friend publicly as well just the same as I did to Jolanda. Jolanda wasnt also
being treated equally by me like everyone else was because I discriminated against her by
talking about her but also and also about her treatment. I would probably have to face
some consequences towards what I did since broke the rules in the Massage Therapy Act
and The Regulated Health Professions Act. I would try and fix the situation by
apologizing to Jolanda because what I did to her was rude and will probably make it hard
for her to trust anyone else because she might think they will also release information
about her to. She might also start to feel insecure and physically emotional knowing that
people know things about her that she didnt want anyone else knowing except me. I
would also tell her that what I did was truly wrong and I shouldnt have done what I did
because no one deserves that to happen to him or her. I would also ask Jolanda if there is
anything I can do to try and make her less upset. I think Jolanda wouldnt accept the
apologize because its hard to re-trust someone after someone has talked about you and
the treatment, especially since she trusted me and I let her down. What I would tell her is

that she should continue getting treated on the areas that are needed either by another
class or by one of my classmates because what I did shouldnt stop her from trusting
other who are reliable.

Reference
Andrade, C., & Clifford, P. (2008). Outcome-based massage: from evidence to practice
(2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Lewarne, 2012. Code of ethics, slide 6
Lewarne, 2012. Communication slide, 3-5