Zero Tolerance for Sexual Abuse of Clients by Members

The College of Registered Psychotherapists of Ontario (CRPO) regulates its members in order to protect the public. As part of this public protection, CRPO has a zero tolerance policy for any form of sexual abuse or sexual boundary crossing.

Any act of sexual abuse on the part of a Registered Psychotherapist (RP) is a misuse of power and a betrayal of trust. Sexual abuse is an extremely serious form of professional misconduct that can result in loss of registration and/or other mandatory penalties.

CRPO is committed to preventing and dealing with sexual abuse of clients by members and works to ensure that we are doing all that we can to support and protect the public. This page contains information for the public to help in understanding sexual abuse, making a complaint, and accessing funding for therapy or counselling if you have been sexually abused by an RP.

Understanding Sexual Abuse Under the RHPA

The Regulated Health Professions Act, 1991 (RHPA) is the Act that regulates RPs. The RHPA defines sexual abuse not only as any physical sexual contact, but also includes actions such as sexually suggestive comments and jokes made by a member in the presence of a client.

The RHPA states that “sexual abuse” means:

  1. sexual intercourse or other forms of physical sexual relations between the member and the client,
  2. touching, of a sexual nature, of the client by the member, or
  3. 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 service provided.

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Client Relations Position Statement on Terminology Related to Sexual Abuse by Members

Preamble

Foundational to the work of the Client Relations Committee (CRC) is a shared understanding of terms that are relevant to the prevention of sexual abuse by members and to an effective process for responding to sexual abuse allegations.

Ensuring that each committee and panel of the College is operating from the same working understanding of terminology – stated in unambiguous language – will assist in fostering a clear and empathetic appreciation of the impact that sexual abuse by members has on individual clients and on the public’s trust in Registered Psychotherapists. It will also allow for consistency of approach to dealing with allegations of sexual abuse.

Communicating with members using these terms will assist in fostering comprehension of their obligations (including around mandatory reporting of sexual abuse), and of zero tolerance.

Most importantly, the consistent use of these terms in all information offered to the public will not only educate them about the role of CRPO in providing them with protection from sexual abuse, but will increase the transparency of College processes as well.

Client

The revised definition of patient, which will come into force when the relevant provision of the Protecting Patients Act, 2017 is proclaimed, is as follows:

For the purposes of the sexual abuse provisions of the Code, the definition of “patient”, without restricting the ordinary meaning of the term, is expanded to include an individual who was a member’s patient within the last year or within such longer period of time as may be prescribed from the date on which they ceased to be a patient, and an individual who is determined to be a patient in accordance with the criteria set out in regulations.

Note: The Regulated Health Professions Act, 1991 uses the term “patient”, whereas CRPO prefers “client”.  Given the nature of psychotherapy, “client” is intended to be a more humanistic and inclusive term for individuals, couples and families seeking the benefits of therapy. The College acknowledges that some members will use the word “patient” and intends the use of client and patient to be interchangeable.

Relationship

A therapeutic relationship is a professional working alliance between the client (potentially including a client’s family members, substitute decision maker and/or guardians) and the RP that has the aim of developing a level of trust that will support assessment and treatment intended to enhance the client’s well-being.

An RP’s relationship with clients must be both professional and therapeutic. Both of these aspects require RPs to conduct themselves in a way that is free of all forms of abuse, including sexual abuse.

Note: It is not possible for a client to have a sexual ‘relationship’ with a Registered Psychotherapist. Sexual contact between a client and an RP (including an individual who is no longer under the care of the RP but who meets the definition of “client” as it relates to post-termination involvement) is considered to be sexual abuse.

Boundary

Boundaries are derived from ethics, morality and law. They ensure the professional, therapeutic relationship and exist to protect clients from harm. Boundaries delineate the expected and accepted psychological and social distance between practitioners and clients, transgression of which involves the therapist stepping out of the clinical role or breaching the clinical role[1].

Areas where there is a risk of boundary crossing or violation in relation to sexual abuse in psychotherapy include, but may not be limited to:

  • self-disclosure
  • length and place of sessions
  • giving or receiving gifts
  • bartering
  • activities outside the office
  • incidental encounters, social and other nontherapeutic contacts
  • digital boundaries (e-mail and text contacts, telehealth, Google, and issues regarding online social networking between therapists and clients)
  • various forms of dual relationships
  • established customs
  • offering personal opinions
  • becoming personal friends
  • touching

Boundary Crossing
“Boundary crossing occurs any time a professional deviates from the strictest professional role.  Boundary crossings can be helpful, harmful, or neutral. Boundary crossings can become boundary violations when they place clients at risk for harm[2].”

Boundary Violations
Boundary violations are harmful. They typically occur when therapists are engaged in exploitative dual relationships.

Abuse

Sexual Abuse
Sexual abuse of a patient is defined in the Health Professions Procedural Code (HPPC), which is Schedule 2 to the RHPA, as:

  1. sexual intercourse or other forms of physical sexual relations between the member and the patient,
  2. touching, of a sexual nature, of the patient by the member, or
  3. behaviour or remarks of a sexual nature by the member towards the patient.

“Sexual nature” does not include touching, behaviour or remarks of a clinical nature appropriate to the service provided.

Sexual Assault
Sexual assault is defined in the Criminal Code of Canada (CCC) as:

“… any form of sexual contact without both parties’ voluntary consent.”

Sexual Harassment
The Ontario Human Rights Code defines harassment as:

“… engaging in a course of vexatious comments or conduct that is known or ought to be known to be unwelcome.”

Sexual harassment is defined as any behaviour or communication directed at someone with the intention of attacking their sexuality, sexual identity, or sense of safety.

Physical Abuse
(e.g., pushing, shoving, shaking, slapping, hitting or other physical force that may cause harm)

Verbal Abuse
(e.g., derogatory or demeaning comments, cultural slurs, use of profane language, insults)

Emotional Abuse
(e.g., threats, intimidation, insults, humiliation and harassment, dismissive behaviour, manipulation, scolding)

Financial Abuse/Exploitation
(e.g., theft, forging a person’s signature, influencing a patient/client to change his or her will)

Cyber Abuse
(e.g., cyber bullying by conveying inappropriate images and words through any form of electronic media)[3]

Consent

In the client-therapist relationship, there is an inherent power imbalance and, therefore, it is never possible for a client to legitimately consent to any sexual contact. Any such contact constitutes an abuse of the RP’s position of trust, power or authority.

Power

A therapist’s power can be used to empower or control clients in therapy. This power results from the imbalance between the therapist and client in the therapeutic relationship. This imbalance exists because of the helping role, knowledge or expertise of the therapist compared with the client.

[1] Based on the definition from V. K. Aravind, V. D. Krishnaram, and Z. Thasneem (2012). Boundary Crossings and Violations in Clinical Settings Indian J Psychol Med. 2012 Jan-Mar; 34(1): 21–24.

[2] Knapp, S. and Slattery, J. M. (2004). Professional boundaries in nontraditional settings. Professional Psychology, 35, 553-558.

[3] From the College of Respiratory Therapists of Ontario

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Complaints and Reports of Sexual Abuse

Any member of the public who has a question, concern or complaint about an RP can contact CPRO. To learn about the complaints process, visit the Filing a Complaint About a Member page of CRPO’s website.

The process of making complaints can be uncomfortable but it is important that CRPO be made aware of any instances of abuse so that RPs can be held accountable for their actions and the impact they might have on clients. Please do not assume that someone else will report the RP or worry if you are mistaken. It is important that the College investigates these situations and is committed to doing it in a way that is fair and respectful.

CRPO will make every effort to support individuals who come forward with information about sexual abuse by a member. In particular:

  • the individual’s privacy will be respected – only relevant staff, investigator(s) and committee members will have access to your information;
  • wherever possible, CRPO will accommodate a request to speak with a staff member of either gender;
  • individuals can withdraw from the complaints process at any time;
  • individuals can bring support persons with them, e.g. to an interview with College staff or an investigator, or to a hearing;
  • College staff are trained in sensitive, non-judgmental ways of collecting information;
  • staff will explain the complaints/discipline process; and
  • if a matter is referred to a discipline hearing, such hearings are generally held in public; however, the identity of witnesses (such as the complainant) can be protected by a publication ban in cases involving sexual abuse. A publication ban would mean that the College, the public or the media could not publish or otherwise communicate certain details that would not normally be shared.

Please note that it can be difficult for the College to investigate complaints of sexual abuse if the subject of the abuse is not willing to share their story with the College.

To speak with someone at the College about your concern, please contact:

Tel: 416-479-4330, ext. 109
Toll-free: 1-844-712-1364 (General toll-free line)
Fax: 416-639-2168
Email: complaints@crpo.ca
Mail: Attn: Director, Professional Conduct
College of Registered Psychotherapists of Ontario
375 University Avenue, Suite 803
Toronto, ON M5G 2J5

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Funding for Therapy or Counselling for Clients Alleging Sexual Abuse by an RP

Under the RHPA, each college is required to establish a program to provide funding for therapy or counselling for clients alleging sexual abuse by members of that college. The Client Relations Committee determines eligibility and administers the fund.

The following information is intended for persons considering applying for funding from CRPO.

Who is able to apply for funding?

A client is able to apply for funding when an allegation of sexual abuse has been made in a formal complaint or report about a Registered Psychotherapist.

How much funding is available?

The maximum funding available to each applicant is established by the RHPA and amounts to approximately $16,000 over a five-year period. Under the RHPA, applicants are required to use other available sources of funding, such as private insurance, first.

Choice of Therapist/Counsellor

Applicants are free to choose any therapist or counsellor to provide treatment, as long as the therapist or counsellor is not a relative and has not been found guilty of sexual abuse.     

Note: If the therapist or counsellor is not a member of a regulated profession, they are not subject to professional discipline by CRPO or by any other regulatory body should you have a complaint or concern about their conduct or the care they provided. 

Applicants can use the funding to see more than one therapist or counsellor if they so choose. Funds are paid directly to the chosen therapist(s) or counsellor(s) for treatment provided.

How do I apply?

Applicants must submit an application form and will be asked to keep any information about their application confidential.

Form A: Funding for Therapy and Counselling Application – to be completed by the applicant
Form B: Therapist/Counsellor Information – to be completed by the therapist/counsellor

Completed applications can be sent to one of the following:

Mail: Attn: Client Relations Committee
College of Registered Psychotherapists of Ontario
375 University Avenue, Suite 803
Toronto, ON M5G 2J5

Email: clientrelations@crpo.ca

If you have further questions about the therapy and counselling fund, please contact clientrelations@crpo.ca.

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Funding for Therapy or Counselling for Primary Partner

Under the RHPA, each college is required to establish a program to provide funding for therapy or counselling for clients with allegations of sexual abuse by members of that college. The Client Relations Committee determines eligibility and administers the fund.

The College of Registered Psychotherapists of Ontario (CRPO) believes that therapy or counselling sessions for the primary partner of someone with allegations of sexual abuse is often needed and can be beneficial to the recovery and well-being of the individual alleging abuse. Given this, CRPO will consider requests for funding for a limited number of therapy or counselling sessions for the primary partner of an individual with allegations of sexual abuse by an RP where a formal complaint or report has been made with CRPO.

Who is able to apply for funding?

The primary partner of an individual alleging sexual abuse by an RP, where a formal complaint or report has been registered with CRPO.

How much funding is available?

The maximum funding available to the primary partner is $600 or four one-hour sessions (whichever is the lesser amount).

Choice of Therapist/Counsellor

The primary partner is free to choose any therapist or counsellor to provide treatment, as long as the therapist or counsellor is not a relative and has not been found guilty of sexual abuse.     

Note: If the therapist or counsellor is not a member of a regulated profession, they are not subject to professional discipline by CRPO or by any other regulatory body should you have a complaint or concern about their conduct or the care they provided.

Funds are paid directly to the chosen therapist or counsellor for treatment provided.

How do I apply?

The primary partner must submit an application form and will be asked to keep any information about their application confidential.

Application for Funding for Therapy or Counselling for Primary Partner – to be completed by the primary partner of the client alleging sexual abuse by an RP

Completed applications can be sent to one of the following:

Mail: Attn: Client Relations Committee
College of Registered Psychotherapists of Ontario
375 University Avenue, Suite 803
Toronto, ON M5G 2J5

Email: clientrelations@crpo.ca

If you have further questions about the therapy or counselling fund, please contact clientrelations@crpo.ca.

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Upcoming Changes

In May 2017, the Ontario legislature enacted Bill 87, the Protecting Patients Act, 2017. This legislation strengthens CRPO’s ability to prevent and respond to sexual abuse of clients by members. It does this, for example, by:

  • Increasing penalties for sexual abuse of clients by members.
  • Instituting a mandatory “cooling off”* period of one year for sexual conduct toward former clients. This is a minimum and may be increased by individual colleges, including CRPO, in the future. In some cases, it may be determined that sexual conduct with former clients may never be appropriate.
  • Increasing access to funding for sexual abuse complainants and witnesses.
  • Increasing fines for failing to report sexual abuse by a regulated health professional.
  • Improving the discipline process for sexual abuse complainants and witnesses.
  • Giving the College the ability to suspend a member’s Certificate of Registration earlier in the investigation process, where there is a likelihood of harm to other clients or the public.

CRPO is working to implement these changes. We will update stakeholders with further developments, including changes to CRPO policies and processes, as they occur.

*A cooling off period refers to the time when a relationship between a member and former client is prohibited.

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Client Relations Committee

CRPO’s Client Relations Committee oversees the Client Relations Program. In addition to the general responsibility for supporting and enhancing effective relations between RPs and the public they serve, this committee has a specific responsibility for developing and overseeing measures for preventing and dealing with sexual abuse of clients by members. This work includes:

  • providing clients who have been sexually abused with access to funding for therapy and counselling;
  • educating members;
  • educating the public;
  • developing and issuing guidelines for the conduct of RPs with their clients; and
  • training College staff.

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Standards of Practice

CRPO members are required to abide by the College’s Professional Practice Standards for Registered Psychotherapists. This comprehensive document is based on CRPO’s Professional Misconduct Regulation, and sets out minimum expectations for member conduct. The Standards cover numerous topics related to preventing and dealing with sexual abuse. These include conflict of interest, dual or multiple relationships with clients, undue influence and abuse, and illegal conduct. Clients and members of the public are encouraged to familiarize themselves with this document in order to understand the obligations of RPs.

The standard of practice for members with regards to sexual abuse is informed by best practice in psychotherapy and the definition of sexual abuse under the RHPA (which is broader than in criminal law).

In the future, the College will develop additional resources and guidelines on preventing and responding to sexual abuse of clients by members.

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Misconduct Related to Sexual Abuse

Members must understand that there are no circumstances in which sexual activity between a member and current client is acceptable. In the context of a therapeutic relationship, there is a power imbalance between therapist and client. As a result, the client is never a mutual participant in any form of sexual contact, remark or relationship.

By definition, sexual abuse is detrimental to appropriate care and cannot be tolerated. Members are always responsible for their conduct. Even if the client makes sexual advances, the member is responsible for maintaining professional boundaries. Breaching boundaries is a betrayal of the therapeutic relationship and may result in disciplinary action, including revocation of membership.

Various kinds of behaviour, while not sexual abuse within the legal definition, raise similar concerns and are taken very seriously by CRPO. These include:

Having a Romantic/Sexual Relationship with a Former Client

Members should understand that it may never be appropriate to enter into a romantic or sexual relationship with a former client, e.g. where the therapeutic relationship was long or intense, or where a power imbalance continues to exist between the member and the former client.

CRPO urges members in the strongest possible terms to avoid romantic or sexual relationships with former clients. In most cases, relationships with former clients are inappropriate, inadvisable and potentially damaging to the parties concerned.

Members must, therefore, carefully consider the following factors before entering into such a relationship with a former client:

  • the nature and length of the former client-therapist relationship;
  • the issues presented by the client in therapy;
  • the length of time since the client-therapist relationship ended; and
  • the vulnerability of the client.

Ultimately, a member may be called upon to defend their actions before a panel of peers and public members if a complaint or report is made against the Member.

Inappropriate Conduct or Relationships with Psychotherapy Students or Supervisees

Due to the authority and trust that members hold over their psychotherapy students and supervisees, inappropriate relationships in these situations will be approached in a manner similar to boundary violations or abuse of clients.

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Penalties for Sexual Abuse Under the RHPA

The RHPA requires that if a member is found to have committed any of the following acts of sexual abuse of a client, their registration must be revoked for a period of at least five years:

  1. Sexual intercourse.
  2. Genital to genital, genital to anal, oral to genital, or oral to anal contact.
  3. Masturbation of the member by, or in the presence of, the client.
  4. Masturbation of the client by the member.
  5. Encouragement of the client by the member to masturbate in the presence of the member.
  6. Touching of a sexual nature of the patient’s genitals, anus, breasts or buttocks.

If the College’s Discipline Committee finds that a member committed any other form of sexual abuse of a client, it must reprimand the member and suspend their Certificate of Registration for a period of time.

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Mandatory Reporting of Sexual Abuse

Mandatory reporting is one of the ways in which CRPO protects the public. It ensures that the College becomes aware of and can investigate incidents of possible professional misconduct, incompetence or incapacity on the part of its Members.

Under the RHPA, a member of any regulated health profession in Ontario, and those who employ or have a business relationship with them, is required to report if they have reasonable grounds, obtained while practising the profession, to believe that another regulated health professional has sexually abused a client.

The report must:

  • be made in writing within 30 days of receiving the information;
  • be made immediately if it appears that the health professional will continue to sexually abuse the client or will sexually abuse other clients, or that they are likely to expose a client to harm or injury and there is urgent need for intervention;
  • be directed to the Registrar of the college to which the alleged sexual abuser belongs;
  • include the reporter’s name and the alleged grounds of the report; and
  • to protect the privacy of potentially vulnerable clients, it must not include the client’s name unless the client has consented in writing.

There are additional reporting requirements if the person making the report, e.g. a CRPO member, is providing psychotherapy to another regulated health professional who may have sexually abused a client. Specifically, the report must also include an opinion, if the reporter is able to form one, of whether the suspected abuser is likely to sexually abuse clients in the future. The reporter must file an additional report to the College if they cease to provide psychotherapy to the member who was the subject of the first report.

Additional mandatory reporting obligations exist for anyone who operates a facility where a member practises (e.g. hospital, clinic). Similarly, there is a mandatory reporting obligation for anyone who terminates a business or employment relationship with a member due to incompetence, incapacity or professional misconduct, including sexual abuse. These obligations apply whether the facility operator or employer/business associate is a regulated health professional or not.

For more information about mandatory reporting obligations, see CRPO’s Professional Practice Standards for Registered Psychotherapists (Standard 1.3: Reporting Unsafe Practices), Professional Practice & Jurisprudence for Registered Psychotherapists (Section 3: Law (B. IV. Mandatory Reports), and sections 85.1-85.6 of the Health Professions Procedural Code, which is part of the RHPA.

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Professional Practice and Jurisprudence e-Learning Module

One of CRPO’s registration requirements for all applicants is successful completion of our Professional Practice and Jurisprudence (JRP) e-Learning Module. The JRP Module covers several topics related to the prevention of sexual abuse of clients by members. These include: maintaining professional boundaries, definitions and examples of sexual abuse, and mandatory reporting of sexual abuse. The companion document to the JRP Module, Professional Practice and Jurisprudence for Registered Psychotherapists, is available to the public on CRPO’s website, and is free of charge.

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Related Laws and Legislation

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Therapy and Counselling Fund

Form A: Funding for Therapy or Counselling Application – to be completed by the applicant
Form B: Therapist/Counsellor Information – to be completed by the therapist/counsellor
Application for Funding for Therapy or Counselling for Primary Partner – to be completed by the primary partner of the client alleging sexual abuse by an RP

Client Sexual Abuse Resources

Sexual Assault Centres – Help for survivors of recent sexual assault, past sexual assault, sexual harassment and childhood sexual abuse. Find a sexual assault centre near you.
Helplines and Resources – If you are a woman in crisis, there are a number of helplines and support resources available to you. If you are a male who has experienced sexual abuse, there are support resources and a helpline available to you.
Sexual Harassment – The Ontario Human Rights Commission also offers information and resources related to sexual harassment.