Version F

You have treated Huan now for 4 weeks and she is starting to feel more comfortable with
treatment and is opening up to you about school and playing tennis. You know from previous
treatments that Huan practices quite a bit and also has to maintain her GPA at school. Today,
while treating her lower leg you notice some increased tension and ask if she has been
practicing more than usual. Huan immediately starts crying and tells you that the stress of
school and playing tennis competitively is wearing her out. She is starting to wonder if it is worth
continuing in her program or if she should return back home but her family is pressuring her to
continue and remain dedicated. As she discusses this Huan keeps asking you for your opinion.
How would you respond in this situation?
Demonstrators: Liana and Meshawna
Therapist: Liana
Patient: Meshawna (Huan)
REFLECTIVE FRAMEWORK FOR SOLVING ETHICAL DILEMMAS
1.

Identify the problem (What happened? How did it occur?)

Huan is asking your (the therapist) personal opinion about personal matters (i.e. school,
family, tennis). She starts to cry and says that she is overwhelmed and stressed.
2. Describe all feelings, attitudes, values, morals and beliefs that arise as a
result of this problem. Place concerns in their appropriate column
Professional
Keeping the therapeutic relationship
professional to not jeopardize the
relationship (avoid dual relationship)
giving personal opinion about
personal issues can get the therapist
in trouble with CMTO out of scope
of practice, referral would be an
option for Huan (i.e. counselling,
group therapy)
3.

Personal
Empathy towards her situation and
understanding where she is coming from
especially when she is facing a lot of
stresses in her life

Reflect on dissonant parts

Conflicting parts to the scenario:

Huan is able to open up to you more and she is more comfortable with you. If
you close off your opinion, Huan may feel like she cant open up to you and
feel embarrassed for asking anything its like taking 2 steps forward, and

then 4 steps back

4. Describe the ethical dilemma in one sentence (Include a description of the
issue, personal values and conflicting principles
eg. ________________ behavior conflicts with my ______________
Huans emotional breakdown and behaviour conflicts with my professional morals and
opinions.
5. Review professional resources that can assist in decision making (eg. Code
of ethic, standards of practice, position statements, CMTO website,
professional colleague)

6. Determine appropriate solution.

Explain to Huan that you care about her situation, but explain to her that you are not
inclined to give your opinion on this matter because it is out of our scope of practice. Just
be honest with her and tell her to keep the therapeutic relationship professional. Because
she is crying, we can give her a moment to gather herself and calm herself down. We
would ask her if she would like to speak to someone who would help her in a way that we
cant (i.e. counsellor, group therapy), then ask if shes okay with proceeding with
treatment.
7. Create an I statement that addresses the ethical dilemma and removes
judgment and blame.

Treatment Demonstration
Identify 3 impairments:
(1) Pain in extension from the behind the knee
(2) Postural malalignment
(3) Impaired muscle integrity/tension to hamstrings and TFL
Identify 3 outcomes:
(1) Decrease pain in extension from the behind the knee muscle
stripping to the hamstrings (technique standard: standard 10 - myo-fascial trigger
points)

(2) Normalize postural alignment and increase postural awareness

myofascial technique to the right hip via gluteals and TFL (technique standard 9:
apply deep fascial technique)
(3) Increased muscle extensibility to hamstrings and TFL specific
compression to the hamstrings and TFL (technique standard: standard 10 - myofascial trigger points)
Outline of Demonstration
Demonstrators: Jenn and Fern
Body: Liana
(1) Hygiene - wipe down the table, stool, lotion bottle before and after use
to ensure health and safety regulations for the patient and therapist (stop the
flow of bacteria); wash hands after you prepare the table and after you are
done treatment Standard of Practice 3 (Fern)
(2) Demonstration of actual technique for each outcome
(a) Muscle Stripping to hamstrings (prone) - Jenn
(i)
Warm-up muscles using superficial stroking,
shaking, then effleurage (warm up gluteals and TFL with heat)
(ii)
Demonstrate technique
(iii)
End with heat hydrotherapy
(b) Myofascial Technique to right hip via gluteals (prone) and TFL
(sidelying) - Jenn
(i)
Assess the fascia through touch/palpation
(ii)
Warm-up muscles using shaking and rocking
(maybe)
(iii)
Demonstrate technique
(iv)
End with heat hydrotherapy
(c) Specific Compression to TFL (sidelying) and hamstrings (prone) Fern
(i)
Warm-up with superficial stroking, superficial
effleurage, wringing
(ii)
Demonstrate technique
(iii)
End with superficial effleurage and a stretch to the
TFL/hamstrings
***For each technique:
Optimal positioning, pillowing and draping
Principle of massage, either or/and:
Superficial-deep-superficial
Proximal-distal-proximal
General-specific-general
Periphery-centre-periphery
Standards of practice
Pre- & post-techniques/protocols (if applicable)
Proper application of techniques

Body mechanics
Verbal descriptions regarding application of techniques
Rationales for choosing these techniques
Communication with patient
Patient feedback
Patient boundaries