Let’s talk about S*X

Sharon’s young. Ali’s great looking. She’s treating the rotator cuff he tore playing ultimate Frisbee. They both like House of Cards. The next thing you know, Ali is offering to meet Sharon at a local pub and teach her how to play pool. She finds him attractive, can she say yes?

Joan is recovering from a bad car accident. Chaitan provides home care and sees her alone in her bedroom. She’s afraid she’ll never walk again and she’s in a lot of pain. Chaitan helps relieve the pain and gives her the hope and the therapy that lead to her recovery. Because of Chaitan, she is able to return to work when she never thought she would. The next thing you know, she’s planning to leave her husband for him. He finds her attractive. Can he pursue it?

What do these two situations have in common? They both cross the appropriate border of the physiotherapist-patient relationship.

Physiotherapists need to remember how special they are. Your expertise gives you an exceptional position in patients’ lives. Patients are likely to trust you more readily than they would trust someone they met in a different way. They are likely to feel grateful to you for helping them. They may feel intimidated by you because you have skills and knowledge they need but don’t have themselves. You spend time with them in treatment, you touch them, you see them alone and outside of their street clothes. All of these things can lead to a feeling of closeness that would not likely develop if you were to meet elsewhere.

I know that we all think we can tell when it’s “the real thing” but the law says that Ali is not himself in that relationship—Sharon has a position of power over him that makes her more desirable or compelling than she would otherwise be. Maybe this is even more apparent with Joan and Chaitan—who wouldn’t fall in love with someone so kind and important in their life? In both cases, the law says that if the couple were to have sex, it would be abuse and the physiotherapist would lose his or her licence.

Does the law go too far? Maybe. But the law is meant to protect the most vulnerable. When a doctor trades sex for drugs, it is easy to see he has taken advantage of a weak patient. But the patient is nearly always a little bit vulnerable. That’s why I want to remind you that you are special and powerful: you help patients to get better. But you must also hold the patient-therapist relationship sacred, by keeping a clear professional distance and remembering that they are your patients, not your friends.

Related Resources:
Standard: Therapeutic Relationships and Professional Boundaries
Guide to Therapeutic Relationships and Professional Boundaries

11 thoughts on “Let’s talk about S*X

  1. Yes, good to review this topic which has been well-reviewed in the past. It is clear and well-written, including the title, until the very last sentence. The column is about sex, relationships, love etc. Then suddenly there is “friends”. These people are not asking if they can be friends. They want intimate relationships.

    A separate column on the greyer area of friends would be a good idea. Can a PT go for coffee with a client? A movie? Play tennis? Play pool not in a bar if she doesn’t find him attractive? Play pool but no sex? With same-sex client, opposite sex, same sex if PT is gay?


  2. “Patients are likely to trust you more readily than they would trust someone they met in a different way. They are likely to feel grateful to you for helping them.” & “They may feel intimidated by you because you have skills and knowledge they need but don’t have themselves. ”
    Are you suggesting that as a member of the public I am an idiot? Are you suggesting that because I am grateful I am going to offer my physiotherapist sex? I think it is time for you to accept the position of physiotherapist for what it really is. Physiotherapists are an integral part of a health care team, unless I am a child or someone with an intellectual delay, I am able to make decisions for myself. While having physiotherapy allows me to return to my regular daily living, it is not a treatment that addresses my psychological well being, it is not a treatment that is addictive and it certainly is not a treatment that I am willing to traffic my body for. For you to assume that I, as a member of the public, see a physiotherapist as someone who has control over me when I am a fully functioning member of society is not only ridiculous, it is also an insult. Shame on you for treating those you “represent” in such a belittling manner.


  3. Don’t get too excited madam / sir. I am a PT and don’t look that pretty but a patient said he (married) should bring me to his function as his friends would think I’m hot. I’m pretty sure some of my colleagues get that shock/insult/innuendo/compliment whatever you call that, but we do not stoop to that level. Another client (lady) thought it would be great that we hang out in Zumba class or be BFF’s. These people may not be “idiots”, innocent teenagers nor suffering from mental delays or depression, but they are vulnerable- i.e., susceptible, at the moment. We PT’s are also humans, but we know better, not because we think we are knowledgeable, but because we read and re-read the CPO policy and learn from mistakes through personal and professional experience. We were taught highest standards of care. Through sharing of experience, of “what simply works”, we try to abide by our common rule, as it was tested and tried.

    I think same goes with other professionals, business owners or even priests when dealing with “laymen”. I am a layman to an engineer or a member of a parliament, etc., and I may try to assume a degree of closeness, also try to use my influence, etc., I may not be able to comprehend the seriousness of the issue compared to the member of the profession or group, not necessarily that I am imbecile. However, being professional myself, I should also use my judgement. But also, being a member of the public, one should also use common sense. However, I would not be commenting if this cannot happen TO ANYONE, even you or your loved one.

    Just to let you know also, there are more harassments from the public but we try to be strong(er) enough to handle situations.


  4. You can tell the sensitive nature of a subject when more people commenting remain totally anonymous compared to other subjects. Over all the years of my practice, this stance and guidance in regard to this topic has never changed but it also has never become any more clear. It’s always left to the professional’s judgement. Luckily, in terms of an intimate relationship push I have never found myself having to personally deal with this but have observed colleagues struggle with this.

    Everyone can probably remember Rick Hansen’s and his “Man in Motion” tour for spinal cord research? It was quite a public promotion — similar to Terry Fox. Well if he didn’t he marry his physiotherapist–right? So with this displayed decision, within a few years of that I watched a colleague decide to date her paraplegic, good looking male patient (in our rural small town). Right or Wrong? Cognitively, we can be all quick to re-iterate the expected response by the College that it is a resounding “wrong” (or is it?) To this day, I don’t necessarily agree that it is always the case. I think it all really does depend on the people involved, the evolution of events and the outcome. It only reinforces our belief it is “wrong” when the patient makes a complaint (and has an avenue to complain and may or may not be justified). If there was no College and no place to complain would it be “wrong”? Would the patient even think— oh I should have somewhere to complain to (for my broken heart, lost relationship…) Now don’t get me wrong I am not talking about sexual coercion for care or harassment (excuse me for going to be sexist) but when the profession was female dominated (even no males) this would not have been an issue I would surmise; meaning if the PT wanted to have relations with a male patient and then it didn’t work out, the male would move on in the relationship— no issue. It was more likely the PT was being harassed by the male patient and would have had to (and be expected to) manage the situation themselves.

    I think after the patient has been discharged or transferred care, it should be no issue. I always found it amazing to think that we are prevented from creating social relationships at all with the people we meet through our day (patients and family) when that might mean pretty much every person in the area you live (such as our small town— same for doctor’s or any other health regulated profession) or where we spend so much of our dedicated life that we don’t get other time and places to meet the “right” person or “the very interesting” person, that we would strike up a friendship with normally for similar likes. Hence, now to that part of the blog—friends even. Really? (I have treated thousands of patients in the same place I have lived and worked my whole career and the town is only a few thousand large. I really am not able to have ANY friends based on the guidelines and don’t actually (just the few I met in the early career or colleagues who I hadn’t yet treated).

    I agree there are vulnerable persons that can’t necessarily use the best judgement in these cases and therefore the professional is the more liable/responsible for all actions of the parties BUT I do also agree with the one comment from what appeared a person who was not a physiotherapist that felt they were belittled by the very nature of the content and implication; treating them “less —what? savvy, smart, wise, With more experience with life and people, I think anyone can learn how to tell the warning signs of a problem relationship or learn to recognize the vulnerable. You can’t teach everything. What do you think? Should Rick Hansen’s physiotherapist lost her license to practice or my colleague? Would that be ridiculous? We might say so because—- why? Because it worked out for them? Still grey and no clear cut rules or strategies that I can see. So should we be making relationships with our patients and their family be always wrong? I don’t think so. Then, it becomes even more grey when you might consider your young patient as a good friend match for your child…… So you can see, over 29 years I have thought and encountered reason for thought many, many times and have felt the injustice of this apparently clear cut line we should not cross. (I am stopping now…. for today…. Lol)!


  5. A sensitive issue. So sensitive that our College feels the need to censor the title of the blog. Thankfully, the PTs I work with are mature enough to discuss these important matters openly which necessitates the use of clear and frank language.

    This blog made a rather abrupt detour when it changed from discussing romantic sexual (no need for an asterisk) situations to a discussion on friends. These are two very different issues, and two different discussions. Hopefully our College can make the distinction, and we can have some straight forward, uncensored dialogue regarding both issues.


  6. Human relationships are complicated. They are not formed and based through intellect alone. That is why we need guidelines – to remind us of the boundaries that separate parts of our lives, to remind us that there are power differences, to protect us when we encounter vulnerabilites in ourselves and others. As a wise PT colleague used to say, ‘if all it took was knowledge, we would all be thin’. But we aren’t, are we, and by extension, we are not all completely cut and dried in our relationships. The blog started an important conversation.


  7. Good topic and great conversations so far; although I was a bit surprised at the ferocity of the response from the PT speaking from the point of view of the member of public. Having practiced for over 30 years in a variety of sectors it behooves us as the professional to be aware that patients can and are in a ‘different place’ and may be at their most vulnerable as a result of their illness, accident etc. It is up to us , the professional, to maintain those therapeutic boundaries and be aware that there can be a real power imbalance which will manifest itself in different ways with different individuals. Having re-read the standards again I do believe it is up to our judgment as to if/ when we can have a friendship, business relationship and even an intimate relationship with someone that we may have treated in the past. There are times when it will be wrong. There are times when it will be right. However it will never be right if we haven’t thought about the ramifications, taken the time to self reflect, made sure we are doing it for all the right reasons and be crystal clear that it is mutual. We should be very comfortable saying to anyone….”.yes I did meet my friend/lover/partner through my work!”


  8. And on the friend note….What about when your friends become your patients? As a private practise owner I have learned that you attract patients with your community involvement. Sometimes those patients are result of a casual acquaintance. Other times, especially in a small city like where I practise, those patients could be friends first. Are we to drop a patient as a friend once they become a patient? This is an extremely grey area that needs further discussion…


    • If I think friendship hinders my ability to therapeutically motivate my friend / patient to listen to my sound advice, I would transfer his care to another PT or pause / stop the friendship and focus on the therapeutic goal. Example: An alcoholic patient may just take my professional advice lightly if I were to play cards or golf together if she sees me drink one can of beer myself. It is risky to befriend clients this way. I have colleagues who hired their patients or relatives for employment in the clinic and there are abuse of power on the part of the latter (they believe they are not only friends but also patients of the HCP and that they can overthrow you in your position). It is a matter of discovering a genuine friendship you can find in this setting which is unfortunately rare nowadays.


  9. To “Anonymous March 26” re: the “PT speaking on behalf of the public”. Don’t forget this blog is public. We don’t log in. So that person could indeed be a public member, not a PT.


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