COTBC Preventing Sexual Misconduct (PSM) Practice Standards

Date posted: May 11, 2017

Statement of Purpose

The College is committed to the prevention of sexual misconduct. While most sexual misconduct is easy to identify, boundary violations that may lead to sexual misconduct may be harder to discern and can be the result of an accumulation of boundary crossings over time. These Practice Standards for Preventing Sexual Misconduct were developed to assist the occupational therapist to recognize and prevent boundary crossings and violations that may lead to sexual misconduct as well as appropriately respond to situations where the occupational therapist identifies potential sexual misconduct. The reader will note that these standards closely mirror the Practice Standards for Professional Boundaries. This design is intentional. While sexual misconduct is an example of a professional boundary issue, its significant risks and impacts warrant a separate, tailored set of standards to direct occupational therapy practice.

When used alongside COTBC’s Practice Standards for Professional Boundaries, Practice Standards for Conflict of Interest, Obtaining Consent to Occupational Therapy Services, Code of Ethics, and Bylaws, and the Essential Competencies of Practice for Occupational Therapists in Canada (3rd ed.), the Practice Standards for Preventing Sexual Misconduct help clarify the occupational therapist’s accountabilities and the College’s expectations.

Overview

Every client has the right to safe, competent, and ethical occupational therapy services. To meet this commitment, the occupational therapist accepts responsibility for his or her practice, including the maintenance of therapeutic relationships and professional boundaries. COTBC’s Practice Standards for Professional Boundaries discusses therapeutic relationships and professional boundaries in more detail:

The occupational therapist is in a fiduciary relationship with his or her clients, and as such, has an ethical and legal responsibility to act in the client’s best interest. In therapeutic relationships, the occupational therapist acknowledges his or her position of power, recognizes that the client’s trust is both delicate and a privilege, demonstrates respect for the client, and ensures that the occupational therapist’s personal opinions, beliefs, and values do not affect the care provided. Additionally, the occupational therapist demonstrates empathy, balancing the ability to remain objective with sensitivity regarding issues of personal closeness and/or disclosure that arise during the course of treatment. Finally, the occupational therapist uses professional judgment to adapt his or her approach, meeting professional responsibilities in the most appropriate manner for a given situation. (p. 7)

Sexual misconduct is a serious boundary violation and is considered professional misconduct. It is an abuse of the occupational therapist’s power in the therapeutic relationship. As such, significant harm can come to the client, occupational therapist, and occupational therapy profession.

Acts of professional misconduct are subject to disciplinary action. The College will formally investigate all allegations of sexual misconduct made against an occupational therapist, and when warranted, take appropriate disciplinary action.

The College recognizes the sensitive nature of allegations of sexual misconduct and the potential vulnerability of clients who lodge such complaints. The College provides an accessible process that is fair to all parties, sensitive to their needs, and in compliance with its governing statute, the Health Professions Act. Occupational therapists may be under criminal investigation for alleged sexual misconduct at the same time they are investigated by the College.

PSM Practice Standard #1: Recognizing Sexual Misconduct

Principle Statement:
The occupational therapist will understand what constitutes sexual misconduct and recognize warning signs that become apparent during the course of providing occupational therapy services.

Practice Expectations
The occupational therapist must do the following:

  1. Recognize that a power imbalance in the therapeutic relationship exists and that the trust inherent in the relationship can lead to nontherapeutic dependence or vulnerability on the part of the client.
  1. Assume responsibility for anticipating, establishing, maintaining, and communicating appropriate professional boundaries with clients, regardless of the client’s actions, consent, or participation.
  1. Recognize types of sexual misconduct.
  1. Recognize any personal or professional risk factors that may make the occupational therapist vulnerable to boundary crossings or violations (e.g., his or her own physical and mental health, personal stressors, social or professional isolation, loneliness, or lack of knowledge about professional boundaries).
  1. Monitor the occupational therapist’s own warning signs and psychological, emotional, and physical reactions that may indicate an emerging professional boundary issue of a sexual nature, such as
    • selecting a client based on looks, age, or social standing;
    • providing increased attention or continued therapy when not professionally required;
    • disclosing information about his or her personal situation when not with the intent of benefiting the client or the therapeutic relationship;
    • being preoccupied with the client’s social life outside the therapeutic relationship;
    • looking forward to physical contact with the client and feeling betrayed if the client pulls back;
    • dressing differently for specific clients;
    • experiencing discomfort or defensiveness when discussing or documenting client interactions; or
    • receiving feedback that others perceive potential boundary issues with the client.
  1. Monitor the client and the therapeutic relationship for warning signs that may indicate an emerging professional boundary issue, such as the client
    • discovering a dual relationship during the course of treatment,
    • pulling away when touched neutrally or indicating jealousy regarding physical contact,
    • disclosing more personal information than necessary,
    • inviting the occupational therapist to social or personal events or to be friends on social media platforms, or
    • appearing to be sexually attracted to the occupational therapist.
  1. Recognize risks within the occupational therapist’s practice context in relation to the potential for sexual misconduct (e.g., providing sexual education, supporting self-care activities of a private nature, or providing service in a more intimate setting such as a bedroom).
  1. Consider feedback from others who may perceive a professional boundary issue of a sexual nature.
  1. Seek proper advice when uncertain whether there is a professional boundary issue of a sexual nature.
  1. Identify any professional boundary–related policies and procedures within the occupational therapist’s workplace.

PSM Practice Standard #2: Avoiding Sexual Misconduct

Principle Statement:
The occupational therapist will take action to prevent circumstances that may lead to sexual misconduct. 

Practice Expectations
The occupational therapist must do the following:

  1. Respect the privacy and dignity of the client at all times.
  1. Establish, maintain, and communicate professional boundaries with the client, his or her family, and other stakeholders in both clinical and nonclinical settings.
  1. Advise the client that his or her consent does not make professional boundary violation permissible (e.g., client cannot provide consent to enter into a sexual relationship or a situation that may lead to a sexual relationship with the occupational therapist).
  1. Have sufficient knowledge of how various cultural, religious, racial, ethnic, and language factors affect professional boundaries (e.g., impact of culture and religion on touching).
  1. Modify the practice setting or therapeutic approach to minimize any identified or emerging professional boundary concerns of a sexual nature (e.g., ask the client whether he or she would like to invite a family member to attend, drape the client appropriately, dress appropriately, provide therapeutic rationale if offering services outside traditional practice settings, or create private professional treatment spaces).
  1. Touch clients in a therapeutic manner only, and obtain and maintain informed consent when completing interventions that involve touching or that could be misconstrued to be of a sexual nature. This includes but is not limited to explaining the nature of or reason for the therapeutic intervention and the rationale or purpose of any touching, and documenting the discussion. (Refer to Obtaining Consent to Occupational Therapy Services.)
  1. Refrain from making remarks that could be construed by the client as seductive, sexually demeaning, or disrespectful.
  1. Avoid special or discriminatory treatment towards a particular client, such as
    • making exceptions in scheduling client appointments (e.g., special after-hours appointments when not clinically indicated);
    • providing personal telephone numbers or other means of nonprofessional contact (e.g., personal social media pages or email addresses);
    • receiving or exchanging gifts (refer to Practice Standards for Conflict of Interest); and
    • completing for clients activities that do not conform to the therapeutic relationship.
  1. Avoid participating in activities or establishing therapeutic relationships where the occupational therapist’s objectivity, judgment, or competence could reasonably be expected to be impaired because of his or her present or previous familial, social, sexual, emotional, financial, supervisory, political, administrative, or legal relationships. For example, avoid entering into dual relationships with his or her own partner or past romantic partners, except in emergency or unavoidable situations, such as can occur when working in small, rural, or remote communities.
  1. Never enter into nontherapeutic relationships that could adversely affect an existing therapeutic relationship, or otherwise compromise the occupational therapist’s objectivity, judgement, or competence. Examples include entering into nontherapeutic relationships with  any of the following:
    • A current client.
    • A former client, unless it can be established that sufficient time has passed since the professional relationship ended and that it will not be reestablished. If the care provided involves an especially vulnerable client, the occupational therapist should never enter into a personal relationship with the client.
    • A client’s parent, a colleague’s client, or a client receiving care in the same service or area of practice.
  1. Provide colleagues with feedback if the potential for a professional boundary issue of a sexual nature is identified.
  1. Apply any workplace policies and procedures related to therapeutic relationships or professional boundaries. Where they do not exist or are insufficient, advocate for or participate in their development as able (e.g., policies related to consent, gift giving, dual relationships, and nontherapeutic interactions with clients).
  1. Seek proper guidance if there are concerns about professional boundaries of a sexual nature.

PSM Practice Standard #3: Addressing Concerns Related to Potential Sexual Misconduct

Principle Statement:
The occupational therapist will take action to address any concerns related to sexual misconduct identified within his or her own practice.

Practice Expectations
The occupational therapist must do the following:

  1. Accept accountability for a professional boundary violation as it occurs, including sexual misconduct.
  1. Seek proper assistance as required.
  1. Discuss any identified potential professional boundary issues or concerns with the client (e.g., those encountered when entering into an unavoidable dual relationship).
  1. Clarify roles and reestablish professional boundaries, if possible.
  1. Obtain and revisit informed consent, acknowledging that there are circumstances when it is never acceptable to cross a professional boundary despite the client’s consent.
  1. Document the circumstances including an account of why a dual relationship is unavoidable (if applicable), risk assessment, precautions taken, plan, client reactions, and informed consent process.
  1. Where there is a potential or actual professional boundary issue that cannot be adequately resolved, arrange for care by another occupational therapist or appropriate health care professional, and end the client relationship, ensuring that the client is not adversely affected during this process.
  1. Follow duty to report obligations and report in writing to the appropriate regulatory body if there is good reason to believe that a health professional has engaged in sexual misconduct. If concerns about sexual misconduct are based on information from a client, the occupational therapist must first obtain the client’s consent before making a report. If the client does not have the capacity to consent to health care treatment, the occupational therapist must obtain the consent of the client’s parent, guardian, or substitute decision maker.