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It is the very nature of physical therapy to become very close with patients. As a health care professional, we are granted a license to touch other people. There is a delicate balance between the important interpersonal relationship developed between the therapist and their patient while still maintaining the necessary boundary that reinforces the integrity of the patient–therapist relationship. At the core of this relationship is trust and that is another reason why the boundary must be defined. There are many potential opportunities for boundary crossings. Some of them are just a small crossing of the line such as accepting an invitation to an event hosted by a patient, and returning to the “safe side” of the line is easy to do. Other boundary crossings are quite egregious and obviously inappropriate such as having intimate relationships with a patient. There is a definite professional barrier to returning to the appropriate side of the line. Another common boundary issue in PT is managing dual relationships for example, the patient who is also the therapist’s friend. A patients family member who becomes romantically involved with the PT or PTA. The ultimate responsibility for maintaining a professional relationship belongs with the therapist. However, it is not always the therapist who crosses boundaries. Sometimes, it is the patient who crosses the line; however, the responsibility to maintain professional limits still is of the therapist. Confounding boundary issues is also the responsibility of the therapist to recognize the potential for a power gradient issue. The physical therapist by virtue of their role has power and must have the self-awareness to recognize when that power could be used inappropriately or misinterpreted by a patient.

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A Family Affair A dual relationship
Who Sent Me a Text? Social media boundary violation
Crossing the professional chiasm Power gradient


A dual relationship

It’s the goal of every physical therapist (PT) to ensure that his or her patients receive the best possible care. But what if a prospective patient is the PT’s spouse, and the PT is the best option among local PTs for his spouse’s particular physical condition? Consider the following scenario.

Larry has focused his entire career as a PT on issues related to the cervical spine, as he long has been fascinated by the mechanical challenges of its role supporting the head. Accordingly, Larry is a board-certified orthopedic clinical specialist. In addition to serving this patient population in his solo private practice, he is a credentialed clinical instructor who offers at least two rotations a year to doctor of physical therapy students interested in taking a very manual approach to patient care.

Larry also is quite active in the community as a youth soccer coach, Boy Scout leader, Special Olympics volunteer, and accessibility consultant to the town planning board. In short, he’s quite well known and respected in the community, and his ...

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