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March 2018: Treating a Friend’s Child

Question: I have practiced as an occupational therapist in paediatrics for about 10 years. My friend has asked me to assess and treat her child who was recently diagnosed with autism.

I have lots of experience working with children with autism and think I would be a great resource for my friend. Am I able to provide occupational therapy services to her child?

Answer: Occupational therapists are expected to avoid entering into therapeutic relationships with people with whom they have pre-existing personal relationships.

It may be challenging for the occupational therapist (OT) to maintain professional boundaries and preventing boundary violations may not be possible where the boundaries of a pre-existing personal relationship exceed that of a therapeutic relationship.

For example, if the OT and her friend already exchange texts and emails several times a week, how will the OT manage personal and professional communications? The personal relationship may influence the OT’s judgement and increase the risk of a boundary crossing or conflict of interest.

In the situation, the OT has intimate knowledge about her friend and the child and she has a vested interest as she knows this child personally. Possible risks include:

  • difficulty establishing clear expectations for occupational therapy service delivery; 
  • inability to remain neutral and impartial in recommendations for the child;
  • providing or expecting preferential treatment such as free occupational therapy service or recommending expensive equipment that would not normally be arranged for other clients;
  • feeling undue pressure to continue or increase services despite the child status;
  • difficulty separating personal interactions from professional interactions;
  • managing privacy and confidentiality of the health care information exchanged during therapy sessions;
  • managing potential disagreements about proposed interventions or dissatisfaction with service provided.

For these reasons, it would be more appropriate for the OT to clearly and sensitively explain, with reasons, why she is unable to treat her friend’s child. The OT could assist by providing her friend with names of community services or a list of occupational therapy providers in the area who treat children with autism.  

You can review the College's Standards for Professional Boundaries on our website.

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