Physiotherapists build effective working or therapeutic relationships with their patients through the course of treatment. Research has demonstrated that effective therapeutic relationships have an important positive influence on treatment outcomes.
Physiotherapists are also required to establish and maintain appropriate professional boundaries with their patients. When appropriate boundaries are in place, they help the physiotherapist to establish an effective therapeutic relationship and enable quality physiotherapy care. When boundaries are not maintained, the line between professional and personal relationships can be blurred leading to problems including:
- Inappropriate behaviour
- Taking short cuts or making assumptions in assessments, treatments or communications
- Allowing professional judgment to be affected by the personal relationship
These problems can lead to poor outcomes and a loss of trust in the physiotherapist and the health-care system in general.
Effective therapeutic relationships differ from personal relationships in several ways.
- Limited to the duration of treatment
- Limited to the treatment location
- To provide physiotherapy services to the patient
- Organized around the provision of physiotherapy services
- Unequal. The physiotherapist is in a position of power, having more knowledge, influence, and access to private information
- The physiotherapist is primarily responsible to establish and maintain the professional relationship
- The physiotherapist offers their training and experience and the patient places their trust in this
- The physiotherapist receives payment for patient care
- No limit - may be lifelong
- No restriction, anywhere
- Pleasure, companionship
- Shared power
There is also an inherent power imbalance between you and your physiotherapist. This power imbalance is due to the physiotherapist’s unique knowledge and skills, their access to your private information, and your reliance on them for care. While physiotherapists must be mindful of and seek to equalize the balance of power in the therapeutic relationship, it is acknowledged that this is never fully achieved.
This power imbalance means that physiotherapists must avoid circumstances in which they may use that power inappropriately, realizing that you are in a vulnerable position when seeking care.
Due to the risks of combining personal and professional relationships, physiotherapists need to avoid personal relationships with their patients outside of work, personal contact through social media, and treating people with whom they have a close personal relationship. Sometimes the physiotherapist may not be able to avoid treating people with whom they have a personal relationship. If this happens, the physiotherapist needs to be very careful to develop and maintain an appropriate therapeutic relationship and professional boundaries.
Under the rules established by Bill 21 and Physiotherapy Alberta’s Standards of Practice, the physiotherapist must avoid sexual relationships with current patients or patients they have treated within the last year. It does not matter if you are the one making the advances, are an adult, and provide consent to the relationship. The legislation is very clear - if the physiotherapist engages in the sexual relationship, they are breaching their professional obligations and may permanently lose their license to practice.