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Regina Brand
by on September 21, 2018
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Therapeutic relationship refers to a working relationship developed between the patient or substitute decision maker and physical therapists. The main aim of the therapist is to sustain safe, effective and ethical therapeutic contact. Professional physical therapy undertaking constitutes establishing and maintaining suitable professional boundaries in relation to patient-based care. Clear understanding of the nature of a therapeutic relationship is essential to set up the appropriate boundaries. It should be noted that the quality run-through by a physiotherapist has proven to be complex and multi-faceted. It would entail applying the professional judgment, conducting ethically together with the relevant professional boundaries in such therapeutic relationship. It is important at this point to understand the difference between a personal and ethical relationship. Therapeutic relationship is different from personal relationship in the following ways. Firstly, it values patients’ interest before anything else, and the imbalance of power between the patient and physiotherapist. It suggests that through power difference, it is not possible to have a personal and therapeutic relationship simultaneously. A lot of academic writings highlighted this problem. I decided to share my opinion about the subject. This article aims at setting the appropriate therapeutic boundaries between a patient and a physiotherapist. In my view, therapeutic relationship constitutes various aspects such as respect, trust, power and personal closeness that are at all times present, and creates the basis for the physiotherapist-patient relationship. Under trust, patients expect that the physiotherapist has the skill, knowledge, and purpose to offer them the quality care. Physiotherapists are charged with the responsibility of not exploiting or harming the patient but rather ensuring a safe environment. It is in patient belief that the physiotherapist will carry his job to his best interest. In relation to respect, the physiotherapist is charged with the responsibility to respect and understand every individual. It is immaterial of the differences that may prevail such as color, place of origin, ethnic origin, sex, age, gender expression, ancestry, race and marital status. Physiotherapists are under a duty to act in respect to their patients. Additionally, personal closeness is an element of therapeutic relationship that includes the following aspects; witnessing emotional behaviors, physical closeness, varying extent of undress and full disclosure of personal information. The power arises from a number of factors such as the authority in health care, patient reliance on the service and unique knowledge the doctors possess. As a result, patients are careful not to compromise this relationship and thus, shy from challenging or questioning the care provider. It is for the physiotherapist to be conscious of the patient vulnerability and power imbalance and establishing an atmosphere that brings safety and easiness to the patients to be in a position to answer questions. In my setting of boundaries, the guidelines that will comply with are numeral. The setting of time limits for the start and finalizing of the session offers a structure for clients. Notably, knowing that there are individuals who might want to ignore such limits, it will be my responsibility to uphold such schedule. I will also have to define the place for a therapist. In most of the times, the office forms the customary place. However, there are times when other places are allowed. I will have to choose between visiting the patients at the hospital or go with them to court. Moreover, I will have to document all such visits carefully. I will also have to set financial boundaries. This is significant as it describes the association like business contracts. Though bartering is at times acceptable, I will most likely discourage this. My time, effort and energy will have to be compensated proportionately, although I may also consider reducing the price or providing on a pro bono scheme. Additionally, it is better to avoid favors. I will have to shun from accepting or giving favors like running errands, lunch, discounting services or any other thing which is outside the per-view of therapist relationship. I will also have to deploy sound judgment in relation to self-disclosure. It may be useful to the client; however I will have to determine its purpose and impact. I will also consider avoiding self-disclosure should I determine that it is exploiting to the client. Lastly, I will determine the degree of physical contact. Though it is not easy to establish definite rules against it, I will have to be cautious enough against any form of physical contact with the client like hugging, touching or any other. I will also have to deploy effective communication strategies coupled with interpersonal skills like discussing the boundaries of confidentiality, adopting a patient-based plan to plan of care and treatment goals, calling patient by their title or name, being vigilant and proactively looking into comments, behavior or attitude that may amount to be inappropriate. In my view, dual or multiple relationships are unacceptable. Such relationship implies to a situation where there exist multiple roles between the therapist and a client, for instance, where the client is a friend, student, employee or associate in business, or family friend to the therapist. There are numeral types of dual relationship like social, professional, business, treatment-professional, supervisory, sexual, institutional, communal and adoption. In my view dual relationship is always unfit. This is because as a member of any professional body one is under a duty to maintain the certain code of behavior as prescribed by the profession. Again, dual relationship is likely to compromise the relationship between the patient and physiotherapist that might cause harm on the patient. Therefore, client-therapist relationship is professionally, morally, ethically and legally bound to monitor and safeguard the boundaries. The violation of boundaries, results in the situations when the therapist takes advantage of the patient, due to the dynamic inherent within the therapy like dependency, intimacy, empathy and rapport. At any time a therapist places his needs beyond the wellbeing of the clients, then violation of boundaries occurs. Multiple relationships on the other hand, occurs whereby the psychologist has a professional role with a patient and again has another role with the very patient or in relationship with someone closely associated or related to the client. The doctor might also promise to enter a relationship with the clients or someone closely related to them in the future. This too impairs the objectivity, effectiveness or competence in carrying out the therapy or exploits and harms the client.
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