love, sexual attraction, a need to rescue as well as avoidance, aggravation, frustration and anger. Many times a client's transference, when unrecognized, will generate countertransference on the part of the unaware therapist. This is nearly always a path to distress and possible disaster for the therapist. Transference and countertransference are natural, unconscious phenomena that occur in therapeutic relationships in which there is a power differential. If not recognized and effectively defused, the result has a negative impact on the relationship, possibly emotionally harming the client and potentially devastating the professional 's practice. Healthy professional boundaries are the best defense against transference and countertransference. When boundaries are challenged or when a professional is tempted to move beyond those boundaries, it is a warning sign to assess motivations and how one 13 is operating as a professional massage therapist. In a relationship in which there is a power differential, it is ultimately the responsibility of the person in the more powerful role to provide a safe, secure environment. The therapist is therefore responsible for recognizing and ensuring that transference and countertransference issues are not acted out in a way that is harmful to the client or the therapeutic relationship. In some circumstances, this requires ending the therapeutic relationship and referring the client to different practitioner. A dual relationship is any situation that combines the therapeutic relationship with a secondary relationship that extends beyond the massage therapist/client relationship. Dual relationships span a broad spectrum. An attraction, one for the other or mutual, results in a social or romantic relationship outside or beyond the therapeutic relationship. If the feelings or attractions come from the client, the massage therapist must clearly restate the professional boundaries and take responsibility to uphold them. If the feelings are on the part of the therapist, then you should seek out supervision to clarify the origin of the feelings and strengthen your boundaries, or refer the client to another practitioner. In the therapeutic relationship the power differential always makes it is the therapist's responsibility to always act ethically. The therapist can pose questions such as: how will the client-centered therapeutic relationship be affected? Will the dual relationship improve or enhance the client's well-being? Choices must be made that maintain and enhance the well-being of the client. The professional is ultimately responsible for maintaining boundaries even when the client initiates the activities. It is the practitioner's responsibility to inform the client of the possible positive and negative implications of pursuing the relationship. If there is a strong mutual attraction, both parties should openly discuss the ramifications and complexities before proceeding. It is important to carefully examine the motives of entering the nontherapeutic relationship. Mutual and equal consent is essential. Without good communication, feelings are hurt, which leads to all aspects of the relationship suffering. Before becoming involved or pursuing any social relationship, the therapist/client relationship should end. The therapist should seek supervision with peers or a supervisor to explore the source of the feelings. If the feelings persist and the client seeks the therapist outside of the therapeutic setting, the practitioner should use extreme caution before establishing any social relationship. It is usually a good idea to wait a period of time after the professional relationship is discontinued before continuing a personal or romantic relationship. Dual relationships are a normal part of human interaction but are nearly always detrimental to the therapeutic relationship. NCBTMB Approved Provider Standards of Practice 14 Background The purpose of the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) is to foster high standards of ethical and professional practice in the delivery of services and continuing education through a recognized credible Approved Provider program that assures the competency of educators of therapeutic massage and bodywork continuing education. These Approved Provider Standards of Practice ensure that Approved Providers and applicants for Approved Provider status are aware of, and committed to, upholding high standards of practice for the profession. Also, the Approved Provider Standards of Practice are meant to assist members of the profession, including consumers, other health care professionals, and state and municipal regulatory agencies or boards with understanding the duties and responsibilities of NCBTMB Approved Providers and applicants for Approved Provider status. The NCBTMB developed and adopted the Approved Provider Standards of Practice to provide Approved Providers and applicants for Approved Provider status with a clear statement of the expectations of professional conduct and level of practice afforded the profession in, among other things, the following areas: Professionalism, Legal and Ethical Requirements, Confidentiality, Business Practices, Roles and Boundaries, and Prevention of Sexual Misconduct. These Approved Provider Standards of Practice were approved and ratified by the NCBTMB Board of Directors, representatives of the Approved Provider