Ann Blair Kennedy, LMT, BCTMB, DrPH, Executive Editor/Editor-in-Chief, IJTMB
University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
Discussions of professionalism and conflict within practice are an important area of enquiry as massage therapy practice continues to be recognized within the health care realm. The scientific literature has paid little attention to these massage therapy professional and ethical dilemmas. Herein, we explore one such area of conflict between a client and therapist in regard to communication and complaints. An interview was conducted to gain further insight to the situation and is structured based upon the following interview guide: description of the instance, how the therapist handled this situation, reflection on how the therapist’s actions contributed to the situation, brief discussion of how other professions handled these types of situations, and reflection on what could have been done differently.
As massage therapy practice continues to develop and be recognized within the health care realm, discussions of professionalism and conflict within practice are an important area of enquiry. To date, scant attention has been paid within the scientific literature to exploring either ethical dilemmas or professionalism within massage therapy practice. This, then, yields a gap that the IJTMB can potentially help fill. With this in mind, approximately one year ago I received an interesting email from a massage therapy colleague. They had recently experienced a troubling situation with a potential client who filed a formal complaint against them and their practice. The complaints were not criminal in nature, but initially appeared to be a disagreement about the information collected on the intake form and problems with communication.
Understanding that this is a situation that may come up unexpectedly for practicing massage therapists, as well as wanting to reflect upon the situation, this colleague asked how the IJTMB might be a vehicle for sharing this lonely and isolating experience. The caveat was that this colleague wanted to remain anonymous. Exploring the possible options with the editorial team, we determined that an interview published as an editorial could address the need to stay anonymous, while providing gracious insight and reflection about this experience which could befit those who are in practice. With the goal to explore and gain further insight into this situation, this editorial is organized into seven distinct sections based upon the questions that were sent to my colleague.
I am a massage therapist and I love what I do. I love helping people, and meeting the diverse and amazing people that come through my clinic doors. I have over 20 years of clinical experience. I believe, like many in the massage profession, that massage has many dimensions/constructs, that massage can affect more than just muscles such as psychological, neurological, and hormonal components, and that there are non-hands-on aspects of treatment such as the therapeutic relationship.(1) Additionally, I am a therapist who has a client-centered treatment ethos and a very strong ethos on professionalism, safety, and providing the best care possible. I do this by keeping up to date with evidence-based data on massage and improving aspects of myself to be the best therapist I can be. I would like to share with you my experience of having a formal complaint made against me.
The circumstances that led to the complaint being made against me are fairly simple. The complainant completed an intake form online for a massage treatment and did not believe the data that was being collected on the intake form was necessary for the service I was providing. The complainant contacted me via email to voice their concerns and to request an explanation for why data was being collected. The complainant and I did not meet, nor did not they receive any treatment from me, and we had little opportunity to form a therapeutic relationship.
My initial response to the complainant’s concerns was to reply to the email with the aim of conveying that I had heard their concerns, stating that the data being collected was necessary for the service I was providing, and that I was undertaking a review of the intake form based on their feedback. The complainant was not happy with my response to the email nor with the explanation I provided, and this led to a series of emails between the complainant and me. I applied the following strategy when responding to the complainant’s emails: a) I did not reply to the emails straight away; b) I took time to read and re-read their email; and c) I tried to provide a considered response after taking their point of view into account.
It became clear that the message I wished to convey to the complaint was not being received in the way I intended. While maintaining confidentiality, I sought advice from a professional psychological organization as to how I could better respond and communicate to the complainant. The complainant continued to be unsatisfied with my response to their original concerns and, moreover, took umbrage at my responses to their emails and, increasingly, at me personally. At this point, I was considering suggesting to the complainant the option of getting a mediator in to help bridge the communication breakdown, but the complainant indicated that they were going to make a formal complaint. I contacted my professional massage organization and my insurance company and was told to cease all communication with the complainant immediately, which I did.
The complainant did go on to make a formal complaint with my professional massage association/accreditation body.
In this situation, I was much more focused on trying to put the complainant’s needs at the forefront of my responses than getting my own needs met. I tried to acknowledge that I had heard their complaint and that I was looking into the area of the complaint; I tried to be sympathetic to their situation in my communications. The complainant continued to be unsatisfied with my response to their original concerns and then began adding other complaints. I experienced the complainant’s ongoing communication as becoming more aggressive and hostile, and I found that I was trying to find the balance of responding, trying to address their concerns, but also not providing more fodder for more complaints. In trying to find that balance, I feel that my attention and focus for that situation was divided over many areas and, thus, I was not able to put the majority of my focus on working out how I was not meeting the complaint’s needs and what I could do to repair the breakdown in communication.
I would handle the situation in a very similar way as I did, but with a couple of important changes. I felt that, in my attempt to try and address the complainant’s needs and understand where they were coming from, I neglected to set some professional boundaries, especially around how I experienced the communication when I felt it becoming more aggressive and hostile. If the same conflict arose again, I would respectfully set some boundaries around the writing style, language used, and also the content. I found dealing only via email to be impersonal, and I feel that contributed to the communication breakdown from my end and I would change that in a future conflict. While I think it is important to acknowledge and try to accommodate the complainant’s boundaries, if I feel they are hindering the situation then I would stop engaging in that form of communication and try, if possible, to find another form of communication that would meet both of our needs. The experience of dealing with the complainant was highly stressful, and that level of stress did impact my capacity to take myself out of the situation and try and look at it objectively without emotion. If the same conflict arose again, I would choose to create some space by stating that it is important to me to respond to their complaint in a way that matches my values of empathy, kindness, and professionalism. I would reiterate to the complainant that their complaint is important but, at the moment, I am unable to give the matter the focus and attention that it deserves, and that I will get back to them in a timely manner when I am able to provide the attentiveness to respond in a way that matches my values.
Research shows that individuals in the health professions who have a complaint made against them experience feelings of anxiety, stress, isolation, and shame.(3,4) I experienced all of those emotions during my complaint journey, and it made me realize how little complaints are talked about in the massage industry. There is very little spoken about the effect of a complaint on a therapist’s mental health or ways in which therapists can be supported during the complaint process. There was also very little information around on how a complaint can affect a therapist’s confidence, self-esteem, and professional identity. As this is an area that is not talked about much, it can lead to feelings of isolation and shame, as therapists are unaware of other therapists’ experiences. I am proud of how I managed my stress during this difficult time. I feel that the management of my stress and feelings was very self-driven. When I look back, what I really wanted was another therapist with whom to share my journey—ideally, in the form of a mentor who had experienced having a complaint made about them, and was able to share their experiences and self-care tools.
While the complaint process is highly stressful, it provides an opportunity for growth both personally and professionally if the therapist has the right support. I would love to see professional associations and or boards look at implementing a complaint mentorship program as an option for their members to utilize when a formal complaint is made against them.
1 Kennedy AB, Cambron JA, Sharpe PA, Travillian RS, Saunders RP. Clarifying definitions for the massage therapy profession: the Results of the Best Practices Symposium. Int J Ther Massage Bodyw. 2016;9(3):15–26.
2 Fitch P. Fundamentals of ethical decision-making: origins of massage treatment room conflict. Massage Ther J. 2015;(Fall). Accessed April 7, 2021. https://www.amtamassage.org/publications/massage-therapy-journal/ethical-decision-making/
3 Bourne T, Wynants L, Peters M, Van Audenhove C, Timmerman D, Van Calster B, et al. The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey. BMJ Open. 2015;5(1):e006687.
4 Haysom G. The impact of complaints on doctors. Aust Fam Physician. 2016;45(4):242–244.
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INTERNATIONAL JOURNAL OF THERAPEUTIC MASSAGE AND BODYWORK, VOLUME 14, NUMBER 3, September 2021