Standard for Professional Boundaries and the Prevention of Sexual Abuse
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:
1. Form appropriate therapeutic relationships
1.1
Never provide occupational therapy services to spouses or partners.
1.2
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.
1.3
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.
1.4
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.
1.5
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.
2. Recognize power dynamics
2.1
Be aware of the power imbalance inherent in the client-therapist relationship
2.2
Understand how power dynamics are related to intersectionality.
2.3
Maintain professionalism by limiting excessive sharing of personal or private information, and consider how communication is being interpreted.
2.4
Avoid creating situations where dependencies develop between clients and the occupational therapist.
2.5
Educate students, occupational therapy assistants, and others being supervised about maintaining professional boundaries.
2.6
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.
3. Monitor and manage boundaries and boundary violations
3.1
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.
3.2
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.
3.3
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.
3.4
Recognize and manage any shifts in clients’ expectations of boundaries (in-person or online) within the client-therapist relationship.
3.5
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).
3.6
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.
3.7
Address boundary risks or violations committed by those under the occupational therapist’s supervision or direction (for example, assistants, students, or support persons).
3.8
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.
4. Prevent sexual abuse
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.
4.1
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.
4.2
Always obtain informed consent before initiating any clinical services that involve touching unless in an emergency.
4.3
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.
4.4
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.
4.5
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
4.6
Know and follow all other mandatory reporting requirements for sexual abuse.
