Sexual relations between an occupational therapist (OT) and client are
always unethical and abusive, are considered a serious breach of trust, and involve a fundamental abuse of power.
The College of Occupational Therapists of Ontario has adopted a position of zero tolerance toward all forms of sexual abuse within the client-therapist relationship. The client-therapist relationship is based on mutual trust, respect, professional boundaries, collaboration and communication.
Maintaining a professional relationship with a client is the only way an OT can remain objective when providing service and is necessary for the OT to ensure clients receive safe, effective, ethical care. Any act of sexual abuse is a misuse of power and a betrayal of the client-therapist relationship. Accordingly, the College will hold all OTs accountable for their behaviour with clients at all times. Any form of sexual abuse of the client under any circumstances is unacceptable and will not be tolerated.
As set out in the
Regulated Health Professions Act, 1991 (RHPA), it is considered sexual abuse and against the law for occupational therapists to have sexual relations with clients.
What is sexual abuse?
Sexual abuse of a client by a regulated health professional is defined in the RHPA as:
- Sexual intercourse or other forms of physical sexual relations between the member and the client;
- Touching, of a sexual nature, of the patient by the member; or
- Behaviour or remarks of a sexual nature by the member towards the client.
“Sexual nature” does not include touching, behaviour or remarks of a clinical nature appropriate to the
services provided.
Who is the client?
The College uses the term “client” to refer to individuals who receive occupational therapy services from an OT. Client is used to reflect the client-centred principles of the profession. Under the RHPA, the term “patient” is used to refer to the recipient of health care service provided by a regulated health professional. For the purpose of these Standards, the terms “client” and “patient” have the same meaning.
Under the RHPA, for the purpose of sexual abuse, a “patient” is defined as:
- an individual who was a member’s patient within one year or such longer period of time as may be prescribed from the date on which the individual ceased to be the member’s patient, and
- an individual who is determined to be a patient in accordance with the criteria in any regulations
This means
a client remains a client for one year after the date the client-therapist relationship ended.
In addition to the definition of patient, there are other criteria in regulations under the RHPA for determining whether an individual is a patient of a regulated health professional:
- An individual is a patient of a member if there is direct interaction between the member and the individual and ANY of the following conditions are satisfied:
- The member has, in respect of a health care service provided by the member to the individual, charged or received payment from the individual or a third party on behalf of the individual.
- The member has contributed to a health record or file for the individual.
- The individual has consented to the health care service recommended by the member.
- The member prescribed a drug for which a prescription is needed to the individual.
- An individual is not a patient of a member if ALL of the following conditions are satisfied:
- There is, at the time the member provides the health care services, a sexual relationship between the individual and the member.
- The member provided the health care service to the individual in emergency circumstances or in circumstances where the service is minor in nature.
- The member has taken reasonable steps to transfer the care of the individual to another member or there is no reasonable opportunity to transfer care to another member.
Notwithstanding these criteria, there are situations where an individual may not meet some or all of these prescribed criteria, and where the individual may still be deemed to be a patient.
OTs like all health practitioners, are in a unique relationship of trust and authority with their clients. The client-therapist relationship is inherently unequal, which results in a power imbalance in favour of the OT. The client is relying on the OT’s clinical judgement and experience to address health-related issues, the OT knows the client’s personal information and has the ability to influence the client’s access to other resources and services. The impact of OT power and influence can be broad as the OT operates within a system where client information provided by an OT, in the form of documentation, for example, has the potential to influence the perceptions of other service providers. If an OT uses this position of authority to violate boundaries, this is an abuse of power. OTs are responsible for setting and managing boundaries to ensure that the trust a client has placed in the OT is not betrayed.
OTs are fully responsible for managing and maintaining professional boundaries with clients. A client’s consent or willingness to participate in a sexual relationship or engage in sexual relations will not be accepted as a defence for inappropriate behavior or sexual abuse.
The Standards for the Prevention of Sexual Abuse describe expectations of conduct for occupational therapists in managing the client-therapist relationship, specifically related to the prevention of sexual abuse.
The values and principles outlined in the College’s Code of Ethics provide a framework for the expectations of the relationships between occupational therapists and their clients. Occupational therapists (OTs) can look to these values and principles in their efforts to promote appropriate professional relationships and prevent sexual abuse. OTs must also refer to the Standards for Professional Boundaries which outline additional expectations for the preservation of appropriate boundaries between the OT and the client in all circumstances.
The College will formally investigate all sexual abuse complaints or reports made against an OT. When warranted, appropriate disciplinary action will be taken against the OT pursuant to the legislation and standards of the profession. Disciplinary action may include mandatory revocation of the OT’s certificate of registration meaning the OT will no longer be entitled to practice.