Massage Therapy 6th Edition Salvo Test Bank

Chapter 02: The Therapeutic Relationship: Ethics, Boundaries, and Cultural

Competencies

Salvo: Massage Therapy, 6th Edition

MULTIPLE CHOICE

1. A good therapeutic relationship is one of the best predictors of which therapy-related factor?

a. Client compliance

b. Positive outcomes

c. Legal actions

d. Arbitration counsel

ANS: B

The efficacy of the therapeutic relationship can be substantiated scientifically. Research has

found repeatedly that a good therapeutic relationship is one of the best predictors of positive

outcomes in therapy.

2. Which term means adherence to a set of values and obligations, formally agreed-upon codes

of conduct, and reasonable expectations of clients, colleagues, and co-workers?

a. Therapeutic relationships

b. Professionalism

c. Conflicts of interest

d. Reciprocity

ANS: B

Professionalism is the adherence to a set of values and obligations, formally agreed-upon codes

of conduct, and reasonable expectations of clients, colleagues, and co-workers. Key values of

professionalism include acting in the client’s best interest and putting that interest

before your own, maintaining standards expected of other members of the profession, and

staying current with changes and discoveries in the field.

3. Which term means moral principles that govern behavior?

a. Autonomy

b. Laws

c. Empathy

d. Ethics

ANS: D

Ethics are moral principles that govern behavior.

4. Which aspect of ethics involves respecting the rights of competent individuals to make their

own decisions?

a. Autonomy

b. Veracity

c. Beneficence

d. Fidelity

ANS: A

Professionals have an obligation to uphold autonomy, which is respecting the rights of

competent individuals to make their own decisions.

Massage Therapy 6th Edition Salvo Test Bank

5. Which aspect of ethics obligates professionals to act in ways that benefit the wellbeing of

others?

a. Autonomy

b. Non-malfeasance

c. Beneficence

d. Fidelity

ANS: C

Beneficence obligates professionals to act in ways that benefit the wellbeing of others.

6. Which aspect of ethics requires that professionals remain loyal and dedicated to their clients,

and that professionals keep their promises and honor commitments?

a. Autonomy

b. Justice

c. Beneficence

d. Fidelity

ANS: D

The principle of fidelity requires that professionals remain loyal and dedicated to their clients,

and that professionals keep their promises and honor commitments.

7. Which principle involves protecting information from unauthorized access or release, loss,

theft, and from its modification?

a. Fidelity

b. Authenticity

c. Justice

d. Confidentiality

ANS: D

Confidentiality refers to the obligation of professionals or professional organizations to

safeguard entrusted information. The principle of confidentiality includes protecting

information from unauthorized access or release, loss, theft, and from its modification.

8. Under which circumstance can massage therapists legally breach confidentiality?

a. Records are requested by a client’s spouse

b. Records are subpoenaed by a court order

c. Transferring records from one massage therapist to another

d. Complying with verbal request for records by a client’s physician

ANS: B

If clients are involved in court proceedings and requests are made for client records, the

therapist may be legally required to release the record as the client/therapist relationship may

not be privileged under state law. If client records are subpoenaed, notify the client before

records are released and this action will allow the client to discuss the situation with his or her

attorney, which may lead the attorney to file a motion to quash or block the subpoena.

9. Which legislation requires professionals to report concerns of neglect or abuse to appropriate

state agencies?

a. Consumer protection

b. Mandatory reporting

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c. Malpractice regulation

d. Civil rights act

ANS: B

If therapists have reasons to suspect that children, elderly adults, or incapacitated adults are

being abused, neglected (including self-neglect), or exploited, they may be legally required to

make a report and provide relevant information to the appropriate state department. The legal

requirement is called mandatory reporting.

10. Which concept allows the application of professional knowledge and clinical expertise to help

clients achieve their treatment goals?

a. Dual relationship

b. Healing touch

c. Therapeutic relationship

d. Subjective rapport

ANS: C

The therapeutic relationship is the relationship between a therapist and a client that allows

therapists to apply their professional knowledge and clinical expertise to help clients achieve

their treatment goals. This relationship serves to protect the client’s dignity and provides a

framework for which ethical principles are applied.

11. Which concept is the ability to accept another person’s beliefs despite own personal feelings?

a. Trust

b. Respect

c. Authenticity

d. Sympathy

ANS: B

Respect is the ability to accept another person’s beliefs despite your own personal feelings.

Respect in the therapeutic relationship is an acceptance of the client as a whole person.

Acceptance does not necessarily mean approval or agreement; it means acknowledging the

right of another person to have unique feelings, thoughts, and beliefs.

12. Which term does Rogers use to describe helping clients feel comfortable even if their feelings,

thoughts, and beliefs are different from the massage therapist’s?

a. Therapeutic accordance

b. Healing therapeutic space

c. Countertransference reversal

d. Unconditional positive regard

ANS: D

The goal of respect is to help clients feel comfortable even if these feelings, thoughts, and

beliefs are not the same as your own. Rogers called this unconditional positive regard. This

validation has the potential to be deeply healing for clients.

13. Which example demonstrates respect?

a. Self-disclosure of personal information to the client

b. Counseling a distressed client

c. Giving the client the massage he or she asked for

d. Draping the client improperly

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ANS: C

Therapists who are respectful take into account the client’s preferences, expectations,

predispositions, social and cultural values, and religious or spiritual beliefs when developing

the treatment plan without inserting their own agenda. For example, when clients request

relaxation massage, avoid turning the session it into a clinical massage as this action would be

disrespectful and invalidate the client’s preferences.

14. Which concept is the desire to understand what another person is experiencing without

mistaking it for own experience?

a. Empathy

b. Tolerance

c. Sympathy

d. Ambivalence

ANS: A

Empathy is the desire to understand what another person is experiencing without mistaking it

for your own experience. Empathy is educated compassion or intellectual understanding of

another person’s perspective and emotions.

15. Which nonverbal expression demonstrates empathy?

a. Avoiding eye contact

b. Avoiding mirroring the look on the client’s face

c. Determining what emotional affect the client has

d. Keeping arms crossed

ANS: C

Riess and Kraft-Todd identified seven essential nonverbal expressions of empathy which can

be used by professionals toempathy to their clients. Each uses a letter of the word empathy. E

is for eye contact; M is for muscles of facial expression; P is for posture; A stands

for affect; T is for tone of voice; H is for hearing the whole person; and Y stands for your

response. Affect is the term to describe expressed emotions. When listening to a client, try to

determine what he or she is feeling such as happiness, fear, apprehension, or sadness. Making

a nonverbal mental note of the client’s emotional state deepens our understanding of the

clients.

16. Which concept means confidence in and reliance upon others to act in accordance with

accepted social, ethical, or legal norms?

a. Trust

b. Respect

c. Validity

d. Congruence

ANS: A

Trust is confidence in and reliance upon others, whether individuals or organizations, to act in

accordance with accepted social, ethical, or legal norms.

17. Which statement describes cultural competency?

a. Ability of professionals to speak languages of more than one culture

b. Behaviors, attitudes, and policies that enable professionals to work effectively in

cross-cultural situations

c. Behaviors, attitudes, and policies that enable professionals to determine which

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culture is best

d. Ability of professionals to be tolerant of cross-cultural situations

ANS: B

Cultural competency is a set of behaviors, attitudes, and policies that enable professionals to

work effectively in cross-cultural situations.

18. Which aspect of cultural competency involves self-exploration and examination of one’s own

cultural and professional background and biases toward other cultures?

a. Desire

b. Knowledge

c. Encounter

d. Awareness

ANS: D

Cultural awareness is the process of conducting a self-exploration and examination of one’s

own cultural and professional background and biases toward other cultures, including the

existence of racism and other “-isms” in health care delivery.

19. Which aspect of cultural competency involves directly interacting and engaging with

individuals from culturally diverse backgrounds?

a. Skill

b. Knowledge

c. Encounter

d. Awareness

ANS: C

Cultural encounters indicate that the professional

directly interacts and engages with individuals from culturally diverse backgrounds.

These encounters have the potential to

modify existing beliefs about cultural groups and prevent possible stereotyping.

20. The therapeutic relationship is a professional one that exists to meet the needs of whom?

a. Client

b. Therapist

c. Client’s family

d. Massage regulatory board

ANS: A

The therapeutic relationship is a professional relationship that exists to meet the needs of

clients while providing them with safe, effective, and competent care.

21. Which term means the spaces between the therapist’s power and the client’s vulnerability?

a. Professional boundaries

b. Professional resolutions

c. Ethics differentials

d. Interpersonal skills

ANS: A

Professional boundaries are the spaces between the therapist’s power and the client’s

vulnerability.

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22. What is the term for the imbalance of authority in the therapeutic relationship with clients in

the vulnerable position?

a. Power resurgence

b. Cultural competency

c. Power differential

d. Boundary distribution

ANS: C

Power comes from the therapist’s position and the access he or she has to client information.

In contrast, clients know (or should know) little about their therapists. These differences, also

called a power differential, create an imbalance of power in the therapeutic relationship with

clients in the vulnerable position.

23. What term means improper treatment of an individual due to carelessness or thoughtlessness?

a. Abuse

b. Neglect

c. Sympathy

d. Misperception

ANS: B

Neglect is improper treatment of an individual due to carelessness or thoughtlessness. Neglect

may occur from lack of professional knowledge or lack of boundaries.

24. What term means improper treatment that is intentional and deliberate?

a. Abuse

b. Neglect

c. Insensitivity

d. Misperception

ANS: A

Abuse is improper treatment that is intentional and deliberate. Abuse may occur when

therapists use clients for personal gain or gratification.

25. Which strategy establishes and maintains professional boundaries?

a. Develop and follow a treatment plan

b. Have more than one source of income

c. Put client needs ahead of self-care needs

d. Meet personal needs within the therapeutic relationship

ANS: A

Strategies for maintaining professional boundaries are (1) have clearly defined roles and

responsibilities including who can participate in the therapeutic relationship; (2) establish

clear boundaries between yourself and others; (3) develop and follow a treatment plan, (4)

recognize that different cultures and ethnic groups may have varying rules for interactions and

these rules must be factored into professional decisions and actions; (5) meet personal needs

outside the therapeutic relationship, (6) develop self-awareness regarding your responses to

the needs of others, and (7) follow a self-care plan.

26. What term describes a therapist’s revealing thoughts, feelings, and personal history to clients?

a. Self-disclosure

b. Confidentiality

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c. Empathy

d. Cultural competency

ANS: A

Revealing thoughts, feelings, and personal history to clients is called self-disclosure.

27. Which example demonstrates a physical boundary?

a. Starting and finishing a massage session on time

b. Sharing personal religious and political views with clients

c. Obtaining consent before working on the gluteal region

d. Intentionally evoking an emotional response from the client

ANS: C

Physical boundaries are the circumstances under which therapists physically touch clients; this

includes the who, when, where, how, and under what circumstances of professional touch.

Obtaining consent before working on the gluteal region is an example of a physical boundary

in the therapeutic relationship.

28. Which type of boundary helps an individual identify own feelings and keep them separate

from the feelings of others?

a. Physical

b. Biological

c. Emotional

d. Financial

ANS: C

Emotional boundaries involve the capacity to be aware of, to control, and to express one’s

emotions. It also involvesidentifying which emotions are yours and which ones are not

yours, and keeping these feelings separate.

29. Which response is appropriate for the massage therapist if a client has an emotional release

during the session?

a. End the client’s treatment immediately

b. Charge the client an additional fee

c. Assume the role of psychotherapist for the client

d. Bring the focus back to the client’s body

ANS: D

A massage therapist’s scope of practice does not allow for the intentional eliciting or

processing of emotions. When clients share their emotional concerns with their massage

therapists, therapist should act to bring the focus back to the body using questions such as,

“Where do you feel that in your body?” or “Can you tell me what you notice in your body as

you say that?”

30. Which term describes the unconscious transfer of emotions and resultant behaviors associated

with a significant person in the client’s life onto someone else such as the therapist?

a. Empathy

b. Transference

c. Countertransference

d. Fidelity

ANS: B

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Transference is the unconscious transfer or displacement of emotions and resultant behaviors

associated with a significant person in the client’s life onto someone else such as the therapist.

31. Which term describes the unconscious transfer or displacement of unresolved emotions by the

professional onto a client?

a. Sympathy

b. Transference

c. Countertransference

d. Fidelity

ANS: C

Countertransference is the unconscious transfer or displacement of unresolved emotions by

the professional onto a client. Countertransference may occur from unmet personal needs,

unresolved emotions, or internal conflicts that are brought into the therapeutic relationship

unknowingly.

32. Which example is a sign of countertransference?

a. Becoming angry when the client cancels an appointment

b. Shortening the session time if the client is late

c. Giving the client the office email address

d. Calling the client as a reminder for a massage session

ANS: A

Signs of countertransference can include becoming angry or depressed when a client cancels

an appointment.

33. What type of boundary encompasses beliefs, thoughts, and ideas while also safeguarding

self-esteem?

a. Physical

b. Intellectual

c. Time

d. Location

ANS: B

Intellectual boundaries encompass beliefs, thoughts, and ideas, as well as safeguard

self-esteem.

34. Which example demonstrates a time boundary?

a. Starting and finishing a massage session promptly

b. Sharing religious and political views with clients

c. Obtaining consent before working on the gluteal region

d. Intentionally evoking an emotional response from the client

ANS: A

Time boundaries include: (1) Being ready when clients arrive with music playing (if

appropriate) and clean linens on the massage table. (2) Beginning and ending the session on

time. (3) Focusing on the client during the session, and avoiding distracting activities such as

talking or texting on mobile devices or conversing with other clients in the waiting room.

35. Which example demonstrates a financial boundary?

a. Posting your fee schedule and accepted forms of payment

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b. Sharing personal religious and political views with clients

c. Obtaining consent before working on the gluteal region

d. Intentionally evoking an emotional response from the client

ANS: A

Financial boundaries involve issues of money and include fee schedules, payment

arrangements and procedures, and policies of non-payment.

36. Which example shows a common scenario involving a financial conflict of interest for

massage therapists?

a. Selling products to clients

b. Using more than one therapeutic modality

c. Being an independent contractor

d. Using a cell phone for business calls

ANS: A

One of the most common financial conflicts of interest for massage therapists is selling

products to clients. In these situations, therapists may be faced with choosing between the

client’s best interest and therapist’s financial interests when profits are received from product

sales.

37. Which type of boundary is necessary for emails, texting, and social media?

a. Intellectual

b. Financial

c. Digital

d. Emotional

ANS: C

Digital media including social media and electronic communications introduce a new

boundary for health care providers and this may create dual relationships, and issues with

confidentiality and privacy.

38. Which term is defined the existence of multiple roles a therapist and a client?

a. Dual relationships

b. Transference

c. Countertransference

d. Power differentials

ANS: A

Dual relationships are any situation where multiple roles exist between a therapist and a client.

Examples of dual relationships are when clients are also friends, family members, or business

associates.

39. What is the most common social dual relationship between therapists and their clients?

a. Friend

b. Family member

c. Business associate

d. Codependent

ANS: A

The most common social dual relationship is friendships.

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40. What characteristic differentiates friendships from therapeutic relationships?

a. Choice

b. Mutuality

c. Trust

d. Reciprocity

ANS: D

Friendships involve choice, mutuality (both parties voluntarily enter the relationship), trust,

pleasure (both parties enjoy the relationship), and reciprocity. Therapeutic relationships

involve choice, mutuality, trust, and pleasure, but not reciprocity.

41. According to the NCBTMB’s standards of practice, at least how much time should lapse

between discontinuing the client–therapist relationship and initiating a mutual romantic or

sexual relationship with a client?

a. 6 weeks

b. 6 months

c. 18 months

d. 24 months

ANS: B

The NCBTMB Standards of Practice (Standard VI.A) require discontinuation of the client–

therapist relationship for at least 6 months before initiating a romantic or sexual relationship

with that client.

42. Which action is part of the model for ethical decision making?

a. Blaming the person who started the problem

b. Imposing a preferred solution to a conflict

c. Agreeing to whatever another person wants

d. Identifying potential issues involved

ANS: D

A model for ethical decision making involves identifying the problem or dilemma, identifying

potential issues involved, reviewing relevant ethics codes, knowing applicable laws and

regulations, obtaining consultation, considering possible and probable courses of action,

enumerating consequences of various decisions, and deciding on what appears to be the best

course of action.

43. Which step of the model for ethical decision making involves seeking advice from mentors,

teachers, peers, or other trusted professionals?

a. Identify the problem or dilemma

b. Obtain consultation

c. Identify potential issues involved

d. Consider possible and probable courses of action

ANS: B

Prejudices, biases, personal needs, or emotional investments can impair objectivity. Therefore,

it is prudent to seek advice from mentors, teachers, peers, or other trusted professionals. If

there is a legal question, seek legal counsel. After full evaluation of the problem, request

feedback to ascertain that you have considered all applicable factors including ethical, legal,

clinical considerations.

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44. Which term can be defined as sexual interaction between someone in an authoritative role and

a subordinate?

a. Interest

b. Activity

c. Misconduct

d. Assault

ANS: C

Sexual misconduct encompasses a wide range of sexual behaviors and includes sexual

harassment, nonconsensual sexual contact, and any sexual activity between someone in an

authoritative role and a subordinate.

45. Which type of sexual misconduct consists of unwelcome verbal hostility, threats, jokes, and

circulation of unwelcome graphic material?

a. Harassment

b. Exacerbation

c. Activity

d. Risk

ANS: A

Sexual harassment includes, but is not limited to (1) unwelcome verbal, written, or physical

conduct that denigrates or shows hostility or aversion toward an individual (or that of an

individual’s relatives, friends, or associates); (2) unwelcome threats, derogatory comments,

jokes, innuendos, insults, slurs, epithets, negative stereotyping, and other similar conduct; or

(3) placement, dissemination, or circulation of any unwelcome written or graphic material (in

hard copy or electronic form) that denigrates or shows hostility or aversion toward an

individual or group.

46. Which example demonstrates a way a massage therapist can decrease the risk of sexual

misconduct?

a. Avoiding terms of endearment, such as “honey” or “sweetie”

b. Dressing for work as though going on a date to increase tips

c. Wearing tight or revealing clothing to perform the session

d. Using the words “release” or “happy ending” in advertisements

ANS: A

Avoiding terms of endearment, such as “honey” or “sweetie” is one way to reduce the risk of

sexual misconduct.

47. Which procedure is an appropriate way of dealing with a client’s erection?

a. Ask questions about the client’s parents

b. Apply pressure to the client’s abdomen

c. Tell the client that erections are unimpressive

d. Turn down the thermostat to lower the client’s body temperature

ANS: A

When your client has an erection, you can ask questions to distract the client from whatever

thoughts, feelings, or sensations led to the erection. For example, you might say, “Tell me

about your mother” or ask “What type of work did your father do when you were a child?”

Even if you do not know his parents, you can ask. Or you can ask him to roll over and

continue the massage.

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48. Which activity is an indication the client is sexualizing the massage?

a. Snoring or drooling during part of the session

b. Requesting additional draping, such as a blanket

c. Wearing undergarments under the drape

d. Moving the pelvis repetitively

ANS: D

The client is likely sexualizing the massage if he or she exhibits certain behaviors. Behavior

ranges from subtle to overt, and may include noises such as moaning, repetitive movements of

the pelvis, touching his or her pelvis or penis, or removing some or all of the drape.

Inappropriate behavior may also include sexually suggestive comments, questions, or jokes.

The client may also touch you, even in a seemingly casual or accidental way.

49. Which action by the massage therapist is appropriate when terminating a massage while in

session?

a. Answering any of the client’s questions while in the room

b. Leaving the massage room without notifying the client

c. Removing hands from the client and stepping toward the door

d. Waiting in the massage room for the client to get dressed

ANS: C

Removing hands from the client and stepping toward the door is an appropriate way to

terminate a massage while in session if the client is behaving inappropriately.

50. Which action is required of massage therapists who know first hand about sexual misconduct

by another therapist?

a. Letting the therapist know the exact nature of the allegations

b. Informing the therapist’s supervisor of the allegation

c. Filing a report with the state licensing board

d. Keeping information confidential until contacted by the authorities

ANS: C

In many states, there is “duty to report” sexual misconduct by other therapists. If we have

firsthand knowledge (i.e., witnessed it ourselves or it was disclosed by the offending

therapist), we are required to file a report with the state licensing board. If we fail to do so, we

are in violation of the law.