Therapeutic Relations Final Review
治疗关系最终审查
1. Review Standards of Practice (Draping standard, consent)
1. 审查实践标准（悬垂标准、同意）
2. CMTO Draping Standards:
2.CMTO 悬垂标准：
Ensure informed client properly about draping requirements with regards to assessment and treatment
确保客户正确了解有关评估和处理的悬垂要求
Explain clearly areas to be treated (Consent!!!)
明确说明需要治疗的部位（同意!!）
Explain about clothing to be removed as well as option to remain clothed and how to position themselves on the table
解释要脱掉的衣服以及保持穿着的选择以及如何将自己放在桌子上
Ensure client comfort when treatment is over clothing
确保客户在治疗结束时感到舒适
Provide opportunities to ask questions
提供提问的机会
Provide secure drape (Draping comes loose, massage therapist fixes draping)
提供牢固的悬垂感（悬垂松动，按摩治疗师修复悬垂感）
Verify client feels secure and comfortable
验证客户是否感到安全和舒适
Do not reach under drape
不要伸手到窗帘下
Ensure consent for bilateral undrape (lymphedema treatment)
确保同意双侧解开悬垂（淋巴水肿治疗）
Exceptions:
异常：
can uncover areas that aren’t sensitive for temperature regulation – leg, feet, arms or back.
可以发现对温度调节不敏感的区域 - 腿部、脚、手臂或背部。
Women in labour
分娩中的妇女
Child under 2
2 岁以下儿童
3. Therapist can share information when:
3.治疗师可以在以下情况下分享信息：
Circle of care = direct referral
护理圈 = 直接转诊
Client has given written consent (lawyer, insurance company, medical doctor etc.)
客户已给予书面同意（律师、保险公司、医生等）
Client is a danger to himself/herself (serious threat of suicide)
客户对自己有危险（严重的自杀威胁）
There is a concern about child abuse or neglect (the client is a child who is being abused, or the client talks about a child who is being abused, or the client is an abuser). Child abuse is reported to Children’s Aid Society. It is mandatory to report suspected child abuse.
担心虐待或忽视儿童（客户是被虐待的儿童，或者客户谈论被虐待的儿童，或者客户是虐待者）。虐待儿童的情况会向儿童援助协会报告。报告疑似虐待儿童是强制性的。
The client is a danger to someone else (serious threat of doing harm to another person)
客户对他人构成危险（严重威胁对他人造成伤害）
The client has suffered a gunshot wound
客户受了枪伤
4. What age can a child give consent?
4.孩子几岁可以表示同意？
Any age if they can understand the information and the consequences of the treatment or lack of treatment
任何年龄，如果他们能够理解治疗或缺乏治疗的信息和后果
How do you know if they understand? Ask to repeat in their own words
你怎么知道他们是否理解？要求用自己的话重复
5. Regulations in Ontario require that we have a fee schedule that applies to all our clients. This fee schedule must be posted in the office, outside of the treatment room and be easily visible, and brought to client’s attention at first appointment.
5.安大略省的法规要求我们有一个适用于所有客户的收费表。此收费表必须张贴在办公室、治疗室外，并易于查看，并在 第一次预约时引起客户的注意。
It is permissible to have special rates for certain groups (i.e., lower rate for seniors or student, or if your practice is at a health club, then a special rate for members.
允许为某些群体提供特价（即，老年人或学生可享受更低价，或者如果您的诊所在健身俱乐部进行，则为会员提供特价。
All fees documented in client’s file
客户档案中记录的所有费用
Fees must be reasonable – fee based on time -60 minutes $100
费用必须合理 - 按时间收费 -60 分钟 100 美元
Can give lesser rate to any client but must note the fee and the reason in the clients file
可以向任何客户提供较低的费率，但必须在客户档案中注明费用和原因
Client given opportunity to ask questions about fee schedule
客户有机会询问有关费用表的问题
Rates determined by area. No CMTO standard on rate
费率由地区决定。没有 CMTO 标准费率
Must post a cancellation policy if you charge for missed appointments
如果您为错过的预约收费，则必须发布取消政策
6. CMTO policy on dating a client
6.CMTO 关于与客户约会的政策
Prefer never
宁愿从不
Wait one year after last treatment
最后一次治疗后等待 1 年
Sex with a client is sexual misconduct (sexual assault)
与客户发生性关系是不当性行为（性侵犯）
Cannot treat anyone who they have a sexual/romantic relationship with including spouse
不能治疗与他们有性/浪漫关系的任何人，包括配偶
7. When can we refuse to treat a client
7. 我们何时可以拒绝治疗客户
If there is a contraindication to treatment - Fever
如果有治疗禁忌症 - 发烧
If the needs of the client are beyond our skill, abilities or scope of practice
如果客户的需求超出了我们的技能、能力或执业范围
If a client is abusive (physically or verbally)
如果客户有虐待行为（身体或语言）
8. Discharging or discontinuing treatment with a client
8.出院或停止与客户的治疗
The goals of the plan have been met
该计划的目标已经实现
The client has developed a condition which is a CI
客户已经发展出一种状况，即 CI
We are decreasing our client numbers (our health, other commitments, or we’re moving)
我们正在减少您的客户数量（我们的健康、其他承诺或我们正在搬家）
9. Who can legally give consent
9.谁可以合法地给予同意
Anyone who can understand the information and the consequences of the treatment or lack of treatment
任何能够理解信息和治疗或缺乏治疗的后果的人
10. What areas of the body must the therapist get consent for..? ALL
10.治疗师必须获得身体哪些部位的同意..？ 都
Consent must be given before assessment (reassessment) and before treatment. It cannot be given once on the table for sensitive areas. The only change that can occur on the table is if the client requests you alter your technique, pressure, location or stop the treatment. In all other instances you can add all changes to the next treatment.
在评估（重新评估）和治疗之前必须获得同意。它不能在桌面上为敏感区域提供一次。桌子上唯一可能发生的变化是，如果客户要求您改变您的技术、压力、位置或停止治疗。在所有其他情况下，您可以将所有更改添加到下一个处理中。
What makes Consent Informed?
是什么让 Consent Informed 成立？
Massage you are proposing
您提议的按摩
Explain benefits, risks/side effects, alternatives to massage
解释按摩的好处、风险/副作用、替代方案
Empower client to stop at any time, techniques being used or area being treated
使客户能够随时停止，使用技术或处理区域
Consequences of not having treatment
不接受治疗的后果
Clothing to be removed and can leave on clothes
衣物应脱掉，可留在衣物上
Check in with client regarding comfort
与客户确认舒适度
Ask for any questions
询问任何问题
Ask for consent
征求同意
What makes consent voluntary:
什么使同意成为自愿的：
No pressure to have treatment or threatened in any way, no commitment to a number of treatments (financial abuse)
没有接受治疗的压力或以任何方式的威胁，没有承诺接受多次治疗（经济虐待）
Not voluntary if obtained by misrepresentation or fraud. “massage will cure OA (osteoarthritis)”
如果通过虚假陈述或欺诈获得，则不是自愿的。“按摩会治愈 OA（骨关节炎）”
Voluntary implies the client is mentally able to make the decision to have the massage and to be empowered
自愿意味着客户在精神上能够做出接受按摩和赋权的决定
Consent must be voluntary to be informed
同意必须是自愿的
Substitute decision maker would be – spouse, family member, power of attorney
替代决定 m将是 – 配偶、家庭成员、 授权书
11. CMTO Standards on Hygiene
11. CMTO 卫生标准
Wash hands and any skin surface that will/has come in contact with the client
洗手和任何将/已经与客户接触的皮肤表面
Ensure that soap and water or alcohol-based hand sanitizers used to clean skin surfaces by washing for a minimum of 10 seconds, including all surfaces
确保使用肥皂和水或含酒精的免洗手消毒液清洁皮肤表面至少 10 秒，包括所有表面
Before and after each client
每个客户之前和之后
12. Use of PPE (personal protective equipment)
12.使用 PPE（个人防护设备）
If client or therapist with recognizable contagious condition that might be spread by contact or inhalation during massage treatment
如果客户或治疗师患有可识别的传染性疾病，这些疾病可能在按摩治疗期间通过接触或吸入传播
Intra-oral treatment
口服治疗
Therapist or client with non-intact skin or open or healing lesions
皮肤不完整或开放性或愈合性病变的治疗师或客户
Explain why you are using gloves, mask
解释您为什么使用手套、口罩
Allowing client to ask questions and answer their questions
允许客户提出问题并回答他们的问题
13. Treatment Room Standard
13. 护理室标准
Clean, organized and public health infection and control measures are observed at all times
始终遵守清洁、有组织和公共卫生的感染和控制措施
Good lighting to ensure client safety
良好的照明，确保客户安全
Free from potential hazards to injury – frayed cords in electrical outlets, trip hazards, clean up liquid spills from the floor
无潜在的伤害危险 - 电源插座中的电线磨损、绊倒危险、清理地板上溢出的液体
Respect clients’ needs related to allergies and sensitivities (scent, mold, dust free)
尊重客户对过敏和敏感的需求（气味、霉菌、无尘）
Adequately provides for client privacy and confidentiality for all aspects related to care (waiting room, payment, assessment, treatment, changing)
充分提供与护理相关的所有方面的客户隐私和保密性（候诊室、付款、评估、治疗、更衣）
No video or photographic devices or if used, only with permission and only for assessment, treatment and educational purposes
禁止使用视频或摄影设备 ，或者仅在获得许可的情况下使用，并且仅用于评估、治疗和教育目的
14. What is Transference – when a client unconsciously projects unresolved feelings, needs and issues (usually from childhood and related to a parent or other authority figure onto a therapist)
14.什么是 Transference – 当客户无意识地将未解决的感受、需求和问题（通常从童年开始，与 父母或其他权威人物有关）投射到治疗师身上时
Positive Transference – when a client has special affection and adoration towards the therapist
积极移情 – 当客户对治疗师有特殊的感情和崇拜时
Negative Transference – when a client mistrusts us without good reason, who expects us to hurt or criticize them
消极移情 – 当客户无缘无故地不信任我们时，谁期望我们伤害或批评他们
Countertransference: When the therapist projects unresolved feelings, needs or issues onto the client. These could be positive or negative.
反移情：当治疗师将未解决的感受、需求或问题投射到来访者身上时。这些可以是积极的或消极的。
15. Power Imbalance
15.功率不平衡
We as therapists are in a position of power
作为治疗师，我们处于权力地位
The client is undressed and lying down
客户脱掉衣服躺下
We are clothed and standing over/above them
我们穿着衣服，站在他们之上
We are touching the client
我们正在接触客户
The therapist is viewed/seen as the person with more knowledge
治疗师被视为/被视为拥有更多知识的人
We can influence the client’s health care with other HCP’s
我们可以与其他 HCP 一起影响客户的医疗保健
We have access to confidential information
我们有权访问机密信息
16. Why is it important for HCP to be non-judgmental?
16.为什么 HCP 不评判很重要？
To provide excellence in care
提供卓越的护理
Doesn’t’ make false assumptions/conclusions
不做出错误的假设/结论
To provide client respect
尊重客户
Non-judgmental Communication – don’t give opinions or advice unless asked for or unless absolutely relevant to the problem that the client is being treated for.
非评判性沟通 – 除非被要求或与客户正在治疗的问题绝对相关，否则不要提供意见或建议。
*avoid saying “should” or “if you would just”..
避免说“应该”或“如果你愿意”..
17. How do we set treatment goals?
17.我们如何设定治疗目标？
Therapist must stay in accordance with client’s needs.
治疗师必须根据客户的需求进行。
Ask client what their goals for treatment are
询问客户他们的治疗目标是什么
Assess findings
评估结果
Realistic expectations
切合实际的期望
Goals must reflect what is happening with client
目标必须反映客户正在发生的事情
18. Chart Storage
18.图表存储
Not accessed by unauthorized people
未经授权的人员无法访问
Keep files 10 years past the client’s last treatment with you, if it was a child, 10 years from the time they are 18(age 28)
将文件保存 10 年， 如果是孩子，则从客户 18 岁（28 岁）起 10 年
If a client returns after an extended absence which is less then 10 years you will retrieve the original file and continue with an updated health history.
如果客户在长时间缺勤（少于 10 年）后返回，您将检索原始文件并继续更新运行状况历史记录。
19. Only give out referral “Thank you’s” if you have the client’s permission to ensure confidentiality for the new client
19.只有在您获得客户许可以确保 新客户的机密性时，才推荐“Thank you's”
20. Missed appointment fee – only charge what is posted in your policy and can only charge if there is a posted policy.
20.错过预约费 – 仅收取保单中公布的费用，并且只有在有公布的保单时才能收取费用。
21. Late arrivals – do what you can for treatment but don’t go over original treatment time (i.e., if they arrive 15 minutes late for a 30-minute appointment they will receive a 15-minute appointment)
21.迟到者 – 尽您所能进行治疗，但不要超过原来的治疗时间（即，如果他们在 30 分钟的预约中迟到 15 分钟，他们将获得 15 分钟的预约）
22. If there are CI’s to treatment refuse to treat that day
22. 如果有 CI 要治疗，当天拒绝治疗
23. Closing practice – give notice to all clients ASAP with directions on how they can access their files
23.成交实践 – 尽快通知所有客户，并指导他们如何访问他们的文件
24. Listening – is not passive, it means mental activity is required to listen
24.倾听 – 不是被动的，这意味着需要进行心理活动来倾听
25. Vocation – that you see your occupation as your life’s work, or your mission in life.
25.职业 – 您将自己的职业视为毕生的工作或人生使命。
26. Vision – is the “big picture” of massage therapy for yourself and the profession
26.愿景 – 是按摩疗法对您自己和行业的“大局”
27. Dual Relationships – client is a friend, family member, coworker, client and therapist barter. Any situation that combines the therapeutic relationship with a secondary relationship that extends beyond your practice is called a dual relationship.
27.双重关系 – 客户是朋友、家人、同事、客户和治疗师的易货交易者。任何将治疗关系与超出您的实践的次要关系相结合的情况都称为双重关系。
Enhanced potential for client abuse
增加客户滥用的可能性
Blurred boundaries
模糊的界限
Conflict of interest
利益冲突
Becoming friends with a client creates a Dual Relationship.
与客户成为朋友会创建双重关系。
28. Code of Ethics is our morals and principles of the profession. Standards of Practice are our rules and guidelines.
28.道德准则是我们职业的道德和原则。 实践标准是我们的规则和指导方针。
29. A Boundary is defined as “the limits that allow for safe connection based on the client’s needs”. In any therapeutic relationship there is an unwritten contract between the professional and the client which defines appropriate behaviour. Boundaries can also be described as personal comfort zones that help a person maintain a sense of comfort and safety. They can be professional, personal, physical, emotional, intellectual and sexual.
29.边界被定义为“允许根据客户需求进行安全连接的限制”。在任何治疗关系中，专业人士和客户之间都有一份不成文的合同，它定义了适当的行为。 界限也可以被描述为帮助一个人保持舒适感和安全感的舒适区。它们可以是专业的、个人的、身体的、情感的、智力的和性的。
30. prior to a client arriving for their first appointment they need to know:
30. 客户在第一次就诊之前，需要了解：
- if the filling in of the health history is a part of their appointment, if the assessment is part of the appointment and if so, how much time is allotted to it
- 如果填写健康史是他们预约的一部分，如果评估是预约的一部分，如果是，分配给它的时间
- the fee schedule and cancelation policy if you have one
- 费用表和取消政策（如果有）
31. Confidentiality must be considered at all times. Ensure you don’t disclose information accidentally through phone calls and giving out information without proper authorization, being overheard talking to a client or about a client, conversation with one spouse about the other spouse etc.
31.必须始终考虑保密性。确保您不会在未经适当授权的情况下通过电话和提供信息意外泄露信息，不会偷听到与客户交谈或谈论客户，不会与配偶一方谈论另一方配偶等。
32. Review conflict of interest and what it means, understand examples – we cannot profit from our clients when it’s not in our clients best interest
32.审查利益冲突及其含义，了解示例 – 如果不符合客户的最佳利益，我们就无法从客户那里获利
33. Review PTSD and emotional release. Understand the influence of this on treatment.
33.回顾 PTSD 和情绪释放。了解这对治疗的影响。
34. Selling of gift certificates must have clear understanding of who will honor the certificate if the therapist leaves the clinic. When a gift certificate is purchased, include the description of the service as “Gift Certificate” and the dollar amount paid on the receipt. When the gift certificate is redeemed, a receipt for the dollar amount of the gift certificate is not issued. If the recipient wishes to receive a receipt, then the dollar amount listed must be “gift certificate redeemed” with no dollar amount given.
34.礼券的销售必须清楚地了解如果治疗师离开诊所，谁将兑现礼券。购买礼品券时，请在收据上注明服务描述“礼品券”和支付的美元金额。兑换礼品券时，不会开具礼品券美元金额的收据。如果接收人希望收到收据，则列出的美元金额必须是“礼券兑换”，没有给出美元金额。