# Standard for Professional Boundaries and the Prevention of Sexual Abuse, 2023

Occupational therapists are fully responsible for establishing and maintaining professional relationships with clients, colleagues, students, and all others they encounter in their practice setting. Breaching clinical, financial, intimate, or social boundaries with clients demonstrates a lapse in professional judgement and jeopardizes clients’ emotional and personal safety.

The most serious boundary violation is when relationships with clients become intimate, romantic, or sexual. This is sexual abuse. When referring to sexual abuse, both the Health Professions Procedural Code (s. 1 [6]) and the Regulated Health Professions Act, 1991 (RHPA; Regulation 260/18) use the term “patient” to refer to anyone who receives services from an occupational therapist, even if the services are provided at no cost or are not documented. The Health Professions Procedural Code says that, in the context of the rules on sexual abuse, a person continues to be a patient for one year after the professional relationship ends. In these Standards, the terms “patient” and “client” are used interchangeably.

The College has a position of zero tolerance toward all forms of sexual abuse that may occur within client-therapist relationships. Consent is never a defence. In situations involving sexual abuse, clients are not able to consent. It is always considered inappropriate to enter into a sexual relationship with a client. The RHPA sets out the penalties for occupational therapists who have been found guilty of sexually abusing patients. These include revoking the occupational therapist’s certificate of registration (see Appendix 1).

Occupational therapists are expected to:

Never provide occupational therapy services to spouses or partners.

Avoid providing services to an individual the occupational therapist knows personally or with whom they have a relationship. Exceptions may apply when alternative services are not available or in emergency situations.

Never form intimate, personal, or romantic relationships with current clients, their relatives, or their support people. Such relationships would exploit the power imbalance inherent in the client-therapist relationship, and objectivity could not be maintained.

Never form intimate, personal, or romantic relationships with clients currently receiving treatment from colleagues. In these cases, the occupational therapist may be privy to the client’s personal information, and objectivity could not be maintained.

Never form intimate, personal, or romantic relationships with previous clients who were especially vulnerable, no matter how much time has passed since the client-therapist relationship ended.

Be aware of the power imbalance inherent in the client-therapist relationship

Understand how power dynamics are related to intersectionality.

Maintain professionalism by limiting excessive sharing of personal or private information, and consider how communication is being interpreted.

Avoid creating situations where dependencies develop between clients and the occupational therapist.

Educate students, occupational therapy assistants, and others being supervised about maintaining professional boundaries.

Never form intimate, personal, or romantic relationships with current students or anyone under the occupational therapist’s supervision. Such relationships would exploit the power imbalance in the professional relationship.

Know that boundaries extend beyond clients and include those who support them. Boundaries also extend to people the occupational therapist supervises. Maintain all boundaries regardless of the actions, consent, or participation of clients, their support people, or those being supervised.

Respect each client’s boundaries, which are unique to their beliefs, capacity, choices, culture, disability, ethnicity, gender, language, life experiences, lifestyle, past trauma, race, religion, socioeconomic status, and values.

Be sensitive to how the practice setting and service location (for example, in the client’s or therapist’s home or in a community setting) may affect boundaries.

Recognize and manage any shifts in clients’ expectations of boundaries (in-person or online) within the client-therapist relationship.

Be aware of and reflect on any feelings that are developing toward clients and could result in boundary violations (for example, the desire to form intimate connections or the internalization of a client’s grief).

Immediately take steps to document, address, and rectify boundary violations if they occur. This can include discontinuing services and facilitating a referral to another provider.

Address boundary risks or violations committed by those under the occupational therapist’s supervision or direction (for example, assistants, students, or support persons).

Ensure that policies and procedures are in place to identify and manage boundary risks or violations, including those related to conflicts of interest. Policies should include the documentation process for boundary violations, resulting actions, and resolutions.

Sexual abuse includes remarks or behaviour of a sexual nature, touching of a sexual nature, or sexual relations between occupational therapists and clients. Sexual abuse is unethical and involves a serious breach of trust and a fundamental abuse of power.

Never engage in sexual abuse of clients, including behaviour, remarks, or touching of a sexual nature, sexual intercourse, or other forms of physical sexual relations. The consequences of sexual abuse are listed in Appendix 1.

Always obtain informed consent before initiating any clinical services that involve touching unless in an emergency.

Respect clients’ privacy and dignity. For example, use curtains or dividers in assessment and intervention spaces, use draping and garments to minimize exposure, and provide the option of an observer for potentially sensitive situations.

File a mandatory report if there is reason to believe that another regulated health professional has sexually abused a client. See Appendix 2 for details. 

Never form intimate, personal, or romantic relationships with previous clients or their relatives and support people unless the following four conditions are met:

At least one year has passed since therapeutic services were last provided or since the client was discharged from the occupational therapist’s care and

The occupational therapist can demonstrate that any previous power imbalance no longer exists and

The person involved is not dependent on the occupational therapist and

No future client-therapist relationship is ever resumed

Know and follow all other mandatory reporting requirements for sexual abuse.

The RHPA sets out the penalties for health professionals, including occupational therapists, who have been found guilty of sexually abusing a patient. A discipline hearing is the most serious proceeding that a regulated health professional can face under the Act.

If a panel of the College’s Discipline Committee finds that an occupational therapist has sexually abused a patient, Schedule 2 of the Health Professions Procedural Code, s. 51 (5), requires the Committee to reprimand the occupational therapist and revoke their certificate of registration if the sexual abuse includes any of the following:

Sexual intercourse.

Genital to genital, genital to anal, oral to genital or oral to anal contact.

Masturbation of the [occupational therapist] by, or in the presence of, the patient.

Masturbation of the patient by the [occupational therapist].

Encouraging the patient to masturbate in the presence of the [occupational therapist].

Touching of a sexual nature of the patient’s genitals, anus, breasts, or buttocks.

Other conduct of a sexual nature prescribed in regulations […].

Even if the act of sexual abuse was not one to which the mandatory revocation provision applies, depending on the seriousness of the conduct, the panel of the Discipline Committee may also take one or more of the following actions (Health Professions Procedural Code, s. 51 [2]):

Directing the Registrar to revoke the [occupational therapist’s] certificate of registration.

Directing the Registrar to suspend the [occupational therapist’s] certificate of registration for a specified [or indefinite] period of time.

Directing the Registrar to impose specified terms, conditions and limitations on the [occupational therapist’s] certificate of registration for a specified or indefinite period of time.

Requiring the [occupational therapist] to appear before the panel to be reprimanded.

Requiring the [occupational therapist] to pay a fine of not more than $35,000 to the Minister of Finance.

[…] requiring the [occupational therapist] to reimburse the College for funding provided for that patient [for therapy and counselling].

[…] requiring the [occupational therapist] to post security acceptable to the College to guarantee the payment of any amounts the [occupational therapist] may be required to reimburse [the College for funding provided to the patient for therapy and counselling].

The RHPA requires occupational therapists to make a mandatory report when they have reasonable grounds, obtained while practising the profession, to believe that another regulated health professional (of the same or a different College) has sexually abused a patient. A mandatory report must also be made by the operator of the health facility.

The mandatory report must be in writing to the alleged abuser’s College. It must be made within 30 days after the obligation to report arises. However, if the occupational therapist has reasonable grounds to believe that the alleged abuser will continue to abuse the patient or will abuse others, the occupational therapist must file the report immediately.

If the occupational therapist becomes aware of the possible sexual abuse through a patient’s disclosure, they must inform the patient that the occupational therapist is obliged to make a mandatory report. They must obtain the patient’s written consent to disclose the patient’s name to the College. If the patient does not consent to disclose their name, the occupational therapist will withhold it from the report.

Furthermore, if the occupational therapist becomes aware of possible sexual abuse of a patient while providing psychotherapy to another regulated health professional, the occupational therapist is required to make a report, and if they are able to form one, provide an opinion concerning whether the abusing practitioner is likely to sexually abuse patients in the future. The occupational therapist must make a report even if they stop providing services to the abusing professional.

If the occupational therapist fails to make a mandatory report, they will be subject to a fine of not more than $50,000.

Health facilities that fail to make a mandatory report are subject to a fine of not more than $50,000 in the case of an individual and $200,000 in the case of a corporation.

In addition, if the College finds that the occupational therapist has failed to make a mandatory report, the College may deem the occupational therapist to have engaged in an act of professional misconduct.

Family Law Act, Revised Statutes of Ontario (1990, c. F.3). Retrieved from the Government of Ontario website: https://www.ontario.ca/laws/statute/90f03

Ontario Regulation 95/07, Professional Misconduct. (2007). Retrieved from the Government of Ontario website: https://www.ontario.ca/laws/regulation/070095

Ontario Regulation 260/18, Patient Criteria Under Subsection 1 (6) of the Health Professions Procedural Code. (2018). Retrieved from the Government of Ontario website: https://www.ontario.ca/laws/regulation/r18260

Regulated Health Professions Act, 1991, Statutes of Ontario (1991, c. 18). Retrieved from the Government of Ontario website: https://www.ontario.ca/laws/statute/91r18

Schedule 2: Health Professions Procedural Code. (1991). Retrieved from the Government of Ontario website: https://www.ontario.ca/laws/statute/91r18#BK41