CAMLAW: Complementary and Alternative Medicine Law Blog

Energy Medicine and Ethics

Creating Right Relationships: A Practical Guide to Ethics in Energy Therapies offers a masterful discussion of legal and ethical issues (including a conversation about practitioner boundaries) regarding energy healing.

bookcovr.jpgThe book is available from Behavioral Health Consultants, PO Box 406, Cave Junction, OR 97523, and should be a staple in the "professional practice" course for any seminar or school teaching energy healing. It is also of enormous value to psychotherapists and other mental health professionals.

Here's just one of the gems from the book (pp. 101-105):

"Ideal clients for energetic interventions are people with the following characteristics:

* intact ego structure, good self-esteem and sense of personal identity
* clear intention to be helped
* willingness to receive energy work
* curiosity and interest in learning
* ability to help set and understand boundaries
* recognition of the sacred contract between healer and healee
* participation in mutual goal-setting
* willingness to give feedback and evaluate personal progress
* ability to recognize the resources of other practitioners, including their medical caregivers....

Client qualities that would cause us to be very cautious in selecting them for energy therapy ... are as follows:

* poor reality contact
* confusion about self-identity, low self-esteem ...
* confusion about touch, tendency to romanticize the caregiver ...
* having high dependency needs
* setting unrealistic expectations
* forming excessive attachment or transference ...
* objections to following referral suggestions....

We certainly operate under the ethical obligation to do no harm as we work for the best possible outcomes. We also operate under an established legal system that requires awareness of legal and regulatory issues involved in using innovative energy techniques with clients."

The forward I wrote for the book describes some of the contents and highly recommends the authors' labor:

The number of healers providing professional health care services is growing. Chiropractors, practitioners of acupuncture and traditional oriental medicine, massage therapists of various disciplines (ranging from Swedish massage to Shiatsu and naturopathic physicians) have licensure in many states, complementing the ranks of allied health professionals (such as nurses, social workers, and physical therapists) as non-physician providers of health care service.

Hospitals and other health care organizations increasingly are recognizing that conventional, biomedical care can usefully be conjoined with one or more complementary and alternative medical (CAM) therapies. Some CAM therapies have proven useful, such as acupuncture to manage chemotherapy-induced nausea, whereas others have been shown ineffective. such as Laetrile to cure cancer. The evidence regarding benefits and risks of specific CAM therapies continues to evolve. With funding support from the National Center for Complementary and Alternative Medicine (NCCAM) and other federal, state, and private institutions, the research community is actively investigating a variety of CAM therapies and their potential usefulness for various conditions.

Such emphasis on research is changing the health care landscape, offering institutions, healing professionals, and patients more information on which therapies are most useful for treating disease. At the same time, many dimensions of human health remain beyond the ken of clinical research alone.

Early on, medical historians and other commentators focused on a distinction between curing and healing. Curing disease was conceptualized as the exclusive province of biomedicine, with healing relegated to CAM therapies. This dichotomy followed the legal and regulatory distinction between medicine (which was defined largely in terms of diagnosing and treating disease), and the other health professions which had a defined, ancillary role.

But over time, it has become increasingly evident that these lines blur: good physicians ideally can and do, by their presence, help patients heal; and competent CAM practitioners can and do, within their legally authorized practice boundaries, help patients move toward ultimate cure. This statement is not to claim that any given CAM therapy either cures disease or is legally permitted to cure disease, but rather, to assert that the boundary between curing and healing can and does overlap and may be fuzzier than initially conceptualized.

In short, disease is a complex phenomenon; healing and curing occupy parallel yet intersecting worlds; and the notion of integrative medicine--integrating the best, most effective, most appropriate combination of biomedical and CAM therapies --is gaining currency among mainstream health care centers, including prestigious academic medical centers such as those at Johns Hopkins University and Columbia University.

Current research surrounding efficacy of energy therapies may be controversial, with clear proof often present only in the experience of many healers and their clients, and not in the objectively cognizable annals of biomedicine. The notion that some phenomena are beyond the current capacity of clinical research to validate does not make them completely speculative or hypothetical. On the contrary, the so-called frontiers of human experience frequently contain the richest components of our individual and collective paths.

Energy therapies often occupy that borderland between curing and healing; objectively validated and subjectively reportable results; tangible end-points and subtle awareness. Energy therapies even, I have argued, occupy the borderland between medicine and religion, since the "energy" in energy therapies will more likely be studied in a class on philosophy, psychology, religion, nursing, acupuncture, or oriental bodywork, than in a class on physics.

Indeed, there is some controversy as to whether energy therapies partake more of science (as in the teaching of Therapeutic Touch in secular settings such as nursing schools) or spirituality (as in some of the spiritual overtones of therapies such as Reiki). Proponents of one approach try to ground energy therapies in one science or another; while proponents of the other approach emphasize the spiritual dimension of using energy therapies. As a shamanistic practice, energy therapies purport to mediate worlds, bridging earth and sky, linking human and the spirit realms, and driving healing through portals of consciousness into the human energy field that is said to surround and interpenetrate the physical world.

Energy therapies not only occupy the borderland--or perhaps bridge--between disparate disciplines, they also operate across licensed and non-licensed professions. For example, licensed nurses often learn Therapeutic Touch through the nursing school curriculum; licensed massage therapists may learn Polarity Therapy in massage therapy school; licensed chiropractors may learn various non-contact or light contact, hands-on healing techniques in chiropractic school; and providers from various professions including physicians can learn Reiki in seminars and workshops outside the campus setting. In states which have statutes allowing non-licensed health care providers to practice (CA, MN, RI), those outside a licensed health care practice can offer energy therapies to clients provided they disclose their specific training and meet other specified criteria.

Any individual wishing to practice one or more energy therapies would be prudent to understand legal and regulatory issues such as licensure and scope of practice within the home state. Such knowledge is important both to help manage the risk of civil liability, e.g., malpractice, as well as criminal liability for practicing outside one's scope of practice and engaging in the unlicensed practice of one or more professions.

In addition, legal and ethical issues often coincide. For example, the obligation of informed consent has both legal and ethical dimensions. This obligation requires a health care provider to disclose and discuss the material risks and benefits of any procedure or course of treatment as well as reasonable alternatives with the patient or client.

But even more broadly, in the ethical domain, boundaries are sometimes observed more in the breach during practices involving energy therapies. On one level, energy therapies share the same ground as other health and mental health professions in terms of the propensity for boundary violations. Caregiver and client meet in a unique space: one in which the client offers vulnerability and receives wisdom, knowledge and nurturing. The therapeutic relationship is deep and exhilarating; prior limits, it feels, can be transcended in the healing space of understanding and empathy between therapist and client. This very freedom allows space for abuse for those who are unwary. Humans who have not fully done their own psychological and spiritual work, it seems, can be tempted to turn the grace of a sacred encounter into an unwelcome and profane violation; the safety of therapeutic intimacy, into terrifying invasion.

While energy therapies share this potential danger zone, boundaries are perhaps even more easily penetrated in energy therapies than in psychotherapy, because the work can move quickly through deep emotional layers and, in the experience of many healers and clients, even further, to spiritual layers that may have been previously hidden. From the personal to the transpersonal, energy therapies aim to remove the grit of the psyche and clean the soul as well as the mind and body. As freeing and blissful as that sounds, the shadow side lurks equally powerfully.

The main title of this book expresses its purpose: "Creating Right Relationships." Ultimately, the ethics of practice is about creating a right relationship between healer and client. That relationship is mysterious, sacred, and professional--it cannot be abused. The healer has too much responsibility, and the client has too much to lose. As Chapter 1 notes: the "intention of caring" requires "careful interactions with others to ensure that our transactions are of the highest integrity and in keeping with our values." The subject of ethics is thus for the practitioner as well as the client--preserving and protecting the integrity of the healing work. The subtitle of the book, "A Practical Guide to Ethics in Energy Therapies," expresses the aim of illuminating the arenas of temptation and guiding the practitioner toward ethical practice.

The authors are uniquely qualified to write this book. Dorothea Hover-Kramer is both a licensed clinical psychologist and a nurse, and co-founder of the Association for Comprehensive Energy Psychology. Her dual training serves the task of grounding a set of therapies that sometimes seem esoteric in the ethical principles applicable to mainstream health care professions. Midge Murphy is an attorney with years of experience in the corporate world. She also studied energy medicine with Carolyn Myss, and thus brings a lawyer's eye to experiential immersion in energy therapies.

The book frames its ethical propositions in terms of concepts familiar to health care providers such as psychologists and practitioners of energy therapies, integrating clinical psychology and spirituality. For example, an early chapter notes that the healer's self-actualization is one of the goals of paying attention to ethics. The same chapter also describes the effect of a healer's unresolved negativity both in terms of the psychological concept of the Shadow, and in terms of the Buddhist notion of "right, mindful relationship," and the Hindu concept of remaining aligned in the shushumna (the "central energetic line" that, according to this tradition, supports flow of healing energy).

Creating Right Relationships also moves into a discussion of relevant ethical, legal, and regulatory concerns for practitioners of energy therapies. The authors do not limit themselves to dry discussion of principles. Rather, they illustrate their points through lively examples of situations that come up in practice. Practicing without appropriate training, inappropriate advertising, violating confidentiality, making misleading claims, exploiting the power differential, and other behaviors all serve to illustrate some of the pitfalls practitioners must learn to confront and avoid. The book summarizes and applies core legal issues, such as malpractice, informed consent, and battery.

In addition to illustrating potential sources of ethical and legal trouble, the authors offer suggestions for introducing energy therapies in ways that positively manifest respect for clients and maintain healthy boundaries. Creating Right Relationships also offers pointers for deciding when not to offer energy therapies to clients--for example, when clients have poor reality contact or high dependency needs. Also, the book points out many fallacies that healers need to hear to correct distortions that frequently accompany access to higher states of consciousness. For instance, the book marks as a danger zone the inappropriate use of intuitive powers to direct a client's choices. The Case Examples posit many situations that will no doubt resonate with the reader's shadow side--situations such as the aptly named "Drama Triangle," and the "Dual Relationship: 'You Owe Me.'"

Make no mistake: energy therapies still occupy a legal gray zone for many professions and in many states. Reading a book is no substitute for legal advice or opinion, and it can be important to consult an attorney for legal advice regarding the offering of energy therapies within a particular practice setting. At the same time, Creating Right Relationships breaks new ground in illuminating the complex legal, ethical, psychological, and spiritual danger zones inherent in the practice of energy therapies. Ideally, this book will help readers study both the danger zones and the pathways to correct behaviors that lead to healthy boundaries as well as higher-order healing on all levels.

Michael H. Cohen
Nassau, Bahamas
September 2005

Principal, Law Offices of Michael H. Cohen
Visiting Professor, College of the Bahamas
Assistant Clinical Professor of Medicine, Harvard Medical School
He is the author of Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives (Baltimore: Johns Hopkins University Press, 1998); Beyond Complementary Medicine: Legal and Ethical Perspectives on Health Care and Human Evolution (Ann Arbor: University of Michigan Press, 2000); and Future Medicine: Ethical Dilemmas, Regulatory Challenges, and Therapeutic Pathways to Health and Healing in Human Transformation (Ann Arbor: University of Michigan Press; 2003).

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