Clients and/or their representatives may be emotionally and otherwise vulnerable. At the same time, clients may be particularly influenced by the views or suggestions of their psychotherapist. It is important therefore to ensure that clients feel safe with their therapist, and that they are not subjected to inappropriate influence or abuse.
Upholding this standard includes apologizing for minor lapses in courtesy or use of inappropriate language, and consulting colleagues and/or the College if a member is unsure how to behave in particular situations. In addition, members sometimes work with clients who are dealing with life-changing events and end-of-life decisions (for example, when clients are executing a will or power of attorney). Members must guard against influencing the autonomy of clients in these decisions.
The College’s Professional Misconduct Regulation requires that members not inflict any form of verbal, physical, psychological and/or emotional abuse on clients. Sexual abuse is an extremely serious form of professional misconduct, and is dealt with directly in the Regulated Health Professions Act, 1991. It is so serious, in fact, that the RHPA prescribes specific penalties; sexual intercourse with a client, for example, carries a mandatory revocation of registration for a minimum of five years. Other forms of sexual abuse may result in equally severe disciplinary action. The College’s Client Relations Program is primarily devoted to preventing and dealing with
sexual abuse of clients.
The RHPA defines sexual abuse as:
a. sexual intercourse or other forms of physical sexual relations between the member and the patient;
b. touching, of a sexual nature, of the patient by the member; or
c. behaviour or remarks of a sexual nature by the member towards the patient.
The RHPA also states that the term “sexual nature” does not include: “touching, behaviour or remarks of a clinical nature appropriate to the service provided.” Therefore, the RHPA does not prevent members from taking a sexual history relevant to the services provided, discussing sexual issues in therapy, or even, referring a client to a sexual surrogate. In the latter instance, however, the surrogate shall not be an employee of the member or an associate supervised by the member. In addition, there is an onus on the member to try to ensure that the surrogate is appropriately trained/certified, and that s/he adheres to accepted norms and standards for sex surrogacy. While some forms of touch or bio-energetic work may form a legitimate part of psychotherapy practice, it is clear that any form of disrobing or sexual touching of clients is inappropriate conduct on the part of members.
The Standard: Undue Influence and Abuse
Members are respectful of clients and their representatives. They refrain from verbal, physical, psychological, emotional and sexual abuse, and do not influence clients or their representatives unduly, particularly with regard to financial decisions such as those relating to wills, power of attorney and other testamentary instruments.
Demonstrating the Standard
A member demonstrates compliance with the standard by, for example:
- practising the profession with integrity and professionalism;
- refraining from any form of verbal, physical, emotional, psychological or sexual abuse;
- being cognizant of the individual vulnerabilities of clients and/or representatives;
- being respectful of the best interests of clients;
- apologizing for minor lapses in courtesy or inappropriate language;
- ensuring that the member’s influence does not affect the personal decision-making of a client, particularly in financial matters and end-of life decision-making;
- consulting another member or the College if the member finds him/herself in questionable circumstances.
Standard 1.9 Referral
Professional Misconduct Regulation, provisions 2, 32
Note: College publications containing practice standards, guidelines or directives should be considered by all members in the care of their clients and in the practice of the profession. College publications are developed in consultation with the profession and describe current professional expectations. It is important to note that these College publications may be used by the College or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained.