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Clarity, Please

Last blog I talked about how you can make sure, first and foremost, that the person who claims to be an RMT is in fact an RMT in Ontario. Today, I want to go over possibly the most important part of meeting your RMT for the first time, and that is how the intake process happens. Over on my social media I posted a video about this same subject focusing on clinical policies, which you can check out at (fb link). Over here, I'm going to talk about the intake process itself.

Hi nice to meet you, come on in!

We have specific standards to guide our work as RMTs to ensure we are providing the most appropriate care for the presenting problem in a safe and secure environment. During your first appointment and even follow ups, there is a sort of flow, or pattern for how the treatment should go and how you should feel when your therapist says, "ok I'm going to step out and let you get set. I'll be back in a moment."

The massage therapy appointment should follow a basic step-by-step process. There is some sort of information gathering, a discussion about what will happen during your appointment, execution of said plans, and then some post treatment follow up.

For new patients, paperwork is always, at LEAST, a health history form where your personal health history is recorded and you indicate some of the details that brought you in for care. Some RMTs may also present you with some policies that outline their clinical boundaries such as fee schedules, cancellation and no show policies, and expectations for safe work environments for you, your therapist and staff on site; these can include scent-free policies, suspicion of intoxication policies and sexual misconduct policies.

The interview is how the therapist gains more details about the presenting complaint, and a bit of a snap-shot of “a day in the life.” This information helps us understand not only the problem you are coming in with, but how it might be influencing varied areas of your life, and vice versa. The interview process can include or precede an assessment. The assessment allows us to rule out red flags which require we send you to a different professional (often your family doctor and sometimes urgent care or emergency), understand yellow flags such as possible mood disorders or difficulties in ones personal life (ie. The sandwich generation), and try to find the roots of the problem so we can address it. After the assessment, the RMT will discuss your treatment plan. This is when the RMT will inform you of exactly what they intend to do about the issues you present with; they will describe what body areas will and won't be touched, how those body areas will and won't be touched, instructions for getting on and off the table, what to do about clothing, and how to communicate to your therapist what you are experiencing during the massage such as pain or changes in symptoms. This is also when you are given opportunity to tweak the plan such as limiting access to parts you don't want touched, choosing to keep articles of clothing on or not, and how prepared you are for discomfort during the massage – and you are welcome to say flat out NO. If everyone is in agreement with the plan, the therapist will step out and allow you to get ready, prepare themselves, and re-enter to begin the agreed upon treatment.

Even if you have seen your RMT before, the follow up and subsequent appointments will likely follow the same outline with a bit of discussion first (how did you feel after? Change in symptoms? How was your flight home from vacation?), maybe some re-assessment to check on progress, and a check in for what exactly will be done that day. Deviations from the original treatment plan can happen and, as needed, notations are made to acknowledge these changes.

In my practice I am a stickler for consent, enough so that this is actually the second time on my blog that I am discussing it. The long of the short of it is, you are the boss of your body. If a client indicates to me that a certain body area has become off limits, or a new complaint comes up that involves treating a body area that we haven't before, a discussion happens so they know what exactly is going to happen and they make their mark on my treatment notes to indicate that, yes indeed, Jen took care to gather my consent for these changes in the plan.

Following these protocols are not JUST a matter of ticking off boxes to cover our own butts. This IS what sets health care apart from a nice treat at the aestheticians. Taking the time to ensure that we are clear about what you are coming in for, what limits there are for the giving and receiving of care, and that you fully understand how the treatment is going to occur and that you are 100% on board with it demonstrates that we respect you and ourselves. It is THIS respect that you want to receive from your therapist. When people respect us and our bodily autonomy, we can begin to place trust in them, and the relationship we are building. Our health care providers should be putting the work in to earn our trust and having a clear, direct discussion about boundaries is probably the best way to start that process.

Communication break downs

A lot of RMTs in Ontario could stand to take a step back and examine how they conduct their intake process and... beef things up a little bit (or a lot). Among my colleagues, it is known. Not only does it reflect poorly on the profession to guide a new patient into the treatment room, barely ask them what they are here for and then leave them to it with no instruction or clarity on boundaries, but it actually creates a relationship that feels uncontained, and this lack of containment does NOT inspire a sense of safety and security at all. Instead, it feels unstable. The purpose of boundaries in the therapeutic alliance is to keep everyone safe but also to communicate what exactly the relationship is. Not knowing leaves all kinds of room for misunderstandings and bad behaviour.

As regulated health care professionals, RMTs are expected to lead the more awkward conversations. It is our responsibility to establish the rules of conduct that we will hold ourselves and our patients to. Truthfully, this is difficult. Without risking too much of getting out of my lane, culturally we have some skewed ideas about boundaries and consent. We may even find ourselves thinking so-and-so was rude when in fact, so-and-so was well-boundaried. A lot of us have a hard time saying no, that's not for me. In the health care setting, while it is important to be able to advocate for yourself, ideally, in a picture perfect world, you wouldn't have to because your health care providers are already centering their work on your unique needs. They are leading the way through the relationship, erecting and navigating boundaries at every step to show you exactly where you stand and what you should be expecting from them.

And this prevents sexual It is not a secret that health care providers, including RMTs, can end up in the news media because of really terrible behaviour. It is entirely possible that some are just very good manipulators and the scope of this blog can't possibly begin to help a person spot a master manipulator, but there are also plenty of not-so-newsworthy instances of RMTs just being really sloppy with boundaries and this can result in ... well sexual assault. So, looking for the signals above, following the step-by-step process, listening to you, centering their care plans on your unique needs and circumstances and making all the boundaries CRYSTAL CLEAR are great things to look for. Taking your consent to heart, making the time for it all and beginning treatment when YOU indicate that you are ready and feel safe doing so communicates a profound respect for your integrity as a person, and the integrity of the therapist too. And anything less than that? Well, IMO? You deserve the best. Full. Stop.

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