Part Six: Thinking about professional boundaries: what would you do?

This is the sixth and final scenario in this series presenting some tricky situations for you to think about (by yourself or perhaps more helpfully with others), with the aim of helping to support you in the application of the Osteopathic Practice Standards (OPS) in your practice. If you missed it, you can read last month’s blog before scrolling down to see my response to the fifth scenario – or you could just get started with the latest scenario (number 6) now.

Professional Boundaries Scenario 6

A female osteopath sees a new male patient, presenting with thoracic pain. She sees him three times over a four-week period, and he responds very well to treatment. At the third visit, he reports an 85% improvement and brings her a bunch of flowers to say thank you. At the end of the session, the osteopath suggests that they book a follow-up appointment in two to three weeks, but the patient says that he’s already booked in for the following week as he enjoys the sessions so much, and enjoys seeing her. He also says ‘it’s always nice to spend some time in the company of an attractive young woman’. The osteopath does not respond to this. The next day, the osteopath receives an email from the patient, telling her how much he likes her, and asking her out for a drink. The osteopath feels very uncomfortable, and is unsure how to handle this situation.

Q: Some questions for you to consider:

• What are the boundaries issues in this case?
• What are the relevant OPS and areas of guidance to support decision making?
• If a colleague reported this case to you and asked for your guidance, what would you say/do?
• If you were presented with a similar scenario, how would you manage this?

This is the final scenario in this series. However, we will be continuing to examine and discuss professional boundaries over the coming months. If there are any specific scenarios you would like us to consider, or if you would like to share your reflections with us on any aspects of professional boundaries, we would be pleased to hear from you. Please email: standards@osteopathy.org.uk

My response to Scenario 5

In earlier scenarios, we looked at standard D2 of the OPS and its guidance, which states that you must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

We have looked at some cases where boundaries issues were arising with current patients, or those that were particularly vulnerable during their osteopathic care. In this particular case, the therapeutic relationship was brief and some three years earlier, so a considerable period has elapsed since the patient underwent treatment.

It is much easier, therefore, in this case, to see a way forward for the osteopath and patient forming a personal relationship. At the time of the treatment there was no hint of a breach of boundaries, no acting on any feelings of attraction, and nothing that would have called the osteopath’s behaviour into question. The patient was not especially vulnerable at the time, and there is now no current or ongoing therapeutic relationship.

Things to consider now would be if the former patient was likely to seek treatment from the osteopath again. If this were to be the case, and a sexual relationship were then to develop, this would be a different scenario. Another issue that might be a factor to consider would be if the osteopath continued to treat any members of the former patient’s family – suppose a sexual relationship between them were to develop, might this impact in some way on any other therapeutic relationships?

If you would like to share your reflections with us or discuss any aspect of this or other scenarios, we would be pleased to receive your thoughts. Please email: standards@osteopathy.org.uk