Professional Boundaries: Starting a Dialogue

There is a court case that just concluded in Pennsylvania, one in which I know not of the therapist’s true innocence or guilt. The therapist, who specializes in Myofascial Release, was convicted of groping female clients. He claims that he was simply performing the normal duties of a therapist and treating the areas of the body that a myofascial release therapist normally touches. The court saw it differently and convicted him and he is now facing time in jail.

This whole affair has made me reflect on the extreme care that I take every day to assure this does not happen to me. While many things are out of our control, as therapist’s our ability to communicate our needs and intentions in a clear and concise manner is crucial. We routinely touch areas of the body that may not be a big deal to us, but may indeed push a patient’s alarm button. I strive for open communication in my treatment room.

As myofascial release therapists, placing a hand on the bare sacrum or sternum is routine…for us. I have no issue with performing techniques that require handholds in these location such as these, even on a first visit, as long as my communication is clear and unambiguous.

“In order to provide proper traction to stretch the low back region, I would like to place my hand under your pelvis, directly on your sacrum. Are you clear with what I’m asking and are you OK with this?”

Sound awkward? It is much less awkward than a lawsuit.

I speak in these sorts of clear terms to my patients every day. If they show any sign of not understanding what I am asking or saying or seem at all ill-at-ease, I back off and figure out a workaround. I dress professionally, have proper lighting in my treatment room, speak to them clearly and unambiguously, and always get permission for what I am about to do. I clearly know and honor my professional boundaries as a physical therapist, knowing fully what I am and am not licensed to perform. If I am to work in an area that seems to make my patient uncomfortable, I ask them to sit up and I sit at a level lower than them and we discuss the issue at hand. Placing them in a lower (subordinate) position while you stand over them is not always the best approach.

Can this avoid every type of problem? No, but communicating your intentions clearly and gaining verbal permission goes a long way to assure you will work another day.

How do you present yourself to clients?

For Now,

Walt Fritz, PT

Foundations in Myofascial Release Seminars

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