Clear professional boundaries are key to fostering effective therapeutic relationships. They allow a physiotherapist and a patient to engage safely and effectively within this therapeutic relationship. The therapist-patient relationship is not equal due to the power imbalance. Clear professional boundaries also apply to the professional relationships involving students and research participants.
Professional boundaries refer to the clear separation that should exist between professional conduct that is associated with meeting the health needs of patients and a practitioner’s personal views, feelings and relationships, which are not relevant to the therapeutic relationship. The purpose of clear professional boundaries is to encompass the therapy and do no harm.
The Physiotherapy Board of New Zealand (Board) does not tolerate any behaviour of a sexual nature between physiotherapists and patients. Sexual behaviour in a professional context is almost always abuse.
Professional boundaries between a physiotherapist and a student under the physiotherapist’s supervision, or research participants under the physiotherapist’s supervision also need to be respected due to the power imbalance.
New Zealand law
New Zealand law states that sexual harassment is unlawful (Human Rights Act 1993).
The Code of Health and Disability Services Consumers’ Rights 1996 states that Health
Consumers have a “Right to Freedom from Discrimination, Coercion, Harassment, and
Exploitation.” (Right 2)
Definition of transgressions
The transgression of professional sexual boundaries is sexual harassment; this is divided into three broad groups. These are sexual impropriety (behaviour that is demeaning to the patient); sexual transgression (inappropriate touching); and sexual violation (sexual activity that may be patient or therapist initiated). Any of these three categories could involve criminal charges.
1.1. Maintaining clear professional boundaries is integral to the physiotherapist-patient relationship.
1.2 A sexual, emotional or inappropriate relationship is never acceptable with a patient. This includes relationships as a result of using the professional position with those close to the patient such as their carer, guardian, parent, spouse or parent of a child patient.
- The consideration of when a patient is no longer determined to be a patient is not limited to the date of discharge.
A person can still be considered a current patient depending on:
- the nature of the professional consultation
- the length of the professional relationship
- the degree of dependency involved in the professional relationship
- and the level of knowledge and personal disclosure that occurred during the relationship.
- A sexual relationship with a former patient is not recommended. As therapist-patient relationships are individual, the Board has no specific rules on when it is acceptable, or not, to have a relationship with a former patient.
- A sexual relationship with a former patient is never acceptable when the patient is discharged for the sole purpose of starting a relationship, or if there is any use of the power imbalance gained from the therapist-patient relationship.
- A sexual, emotional or inappropriate relationship is never acceptable with a student under a physiotherapist’s supervision and not recommended with a former supervised student.
2. Safeguarding professional boundaries
2.1. Ensure appropriate informed consent is gained for all examinations, treatment and asking the patient to disrobe (see Informed Consent Standard).
2.2. Ensure appropriate patient draping.
2.3. Use chaperones in any situation where the patient or therapist may feel uncomfortable (see Involvement of an Additional Person during a Consultation Standard).
2.4. Every consumer has the right to have present one or more support persons of their choice, as per legislation. It may be appropriate to draw this to the attention of some patients (see Involvement of an additional person during a consultation standard).
2.5. Only relevant personal details should be included in a patient assessment.
2.6. Never use sexually demeaning words or actions.
2.7. Ensure professional boundaries are maintained when using electronic communication, including social media (see Internet and electronic communication standard).
2.8. Do not involve patients in your problems. Seek professional help.
2.9. Inform all colleagues and staff of the Board’s standards in this area.
2.10. Physiotherapists have an ethical obligation to inform an appropriate authority (the Board, Health and Disability Commissioner) in ‘good faith’ if they become aware that another physiotherapist is, or may be breaching sexual boundaries (see Aotearoa New Zealand Code of Ethics and Professional Conduct 10.2).
2.11. Consult with respected colleagues in any situation where there is uncertainty in regards to a specific professional boundary.
Aotearoa New Zealand Code of Ethics and Professional Conduct (2018) Principle 2.9, 2.10, 2.11, 10.2
Physiotherapy practice thresholds in Australia & Aotearoa New Zealand (2015) Role 2
Physiotherapy New Zealand Position Statement (2012), Clear sexual boundaries in the patient – physiotherapist relationship: a guide for physiotherapists/patients
Involvement of an additional person during a consultation standard
This statement is scheduled for review in 2023. Legislative and/or technical changes may make this statement obsolete before this review date.