1. Professional Boundaries
Welcome to Professional Boundaries.

2. Scenario 1
Jim Bradley walks into the STAR Physical Therapy clinic for his first physical therapy visit. He is greeted by Jane, the receptionist.
Jane: Do you have an appointment?
Patient: Yes, Jim Bradley, at 10:00. Sorry I’m a bit late, I was stuck in traffic.
Jane: Well, Mr. Bradley, you are 10 minutes late and there is a lot of paperwork to complete before you can be seen. I’ll have to check with the PT, he has a very busy schedule to keep. (Jane gets on the intercom and says “Steve, your 10:00 eval is late and still has forms to complete. Should I just reschedule him?”)
What is your first impression of this facility (positive, negative)?
Do you trust that your needs will be met?
Why do you feel this way?

3. Therapeutic Relationship of Trust
PT’s and PTA’s, like most healthcare providers, are in a unique therapeutic relationship of trust with their patients. Although the patient’s needs are always foremost in the therapeutic relationship, there exists an inherent imbalance of power. This is due to the PT professional’s knowledge and authority to direct and make decisions regarding the patient’s care. Even though the patient should be involved in decision-making, patients may not want to compromise the knowledge and expertise of the PT clinician. Patients may be dependent on the care of the clinician and trust that the clinician is acting in the patient’s best interest at all times.

4. Scenario 2
Conversation during initial evaluation between a PT and a 70-year-old patient recovering from an ankle fracture:
Patient: Since my ankle fracture, I’ve felt a bit wobbly when walking, so I started using a cane about 2 months ago and feel so much better. It really helps my balance and my ankle doesn’t hurt when I use the cane. I’ve been getting around much better since I started using it.
PT: Well, you didn’t use a cane before you broke your ankle, you really shouldn’t need it now either—your injury was four months ago. I can work with you to improve your balance so you can get rid of the cane.
Patient: Well, you are the expert, but I’ve really developed a fear of falling and I’m not afraid when I am using my cane. I feel real stable.
PT: Oh, don’t worry about it, you’ll do fine once you complete this balance program I have in mind for you. It’s important you not rely on the cane and build your balance skills instead.
Patient: Well….I guess…if you think that is what’s best for me (with doubtful tone)
The PT thinks he is doing his job, but is he really listening to the patient?

5. Boundaries
PTA’s have a professional responsibility to establish and maintain effective relationships with their patients. They must understand and establish professional boundaries through clear and effective means of communication. They must remain objective and nonjudgmental in their patient interactions. They need to be aware of risks for potential boundary violations and anticipate how to manage those issues.
A PTA must communicate with patients in a way that fosters trust and mutual respect, yet demonstrates empathy and compassion. Compassion is essential in your work, and emotion is an important component of compassion. But you must be careful to not allow emotion to extend beyond professional boundaries to where the relationship might now be seen as more personal than professional.

6. Scenario 3 What are the potential boundary violations?
28 year old PTA Josh, has been working for several weeks with 40 year-old, recently widowed Kathy, who is being treated for a back injury.
What are the potential boundary violations?
What positive communication elements are present in this scenario?
Kathy (teary-eyed): I just don’t think I can do much therapy today. My back is really hurting.
Josh (leaning forward, hands clasped, full eye contact, soft tone): Maybe we can modify your treatment a bit. Why do you think your back is hurting so much today?
Kathy (beginning to cry): I just can’t keep up with things at home since John passed away. There’s so much he used to do that I can’t do with my back the way it is right now. I try, but I just hurt more. My lawn is overgrown and I can’t find anyone to mow it. Money is very tight. Maybe you could help me? Could you mow my yard?
Josh: I’m sorry Kathy, our clinic policies prevent me from being able to help you with that, but I can try to help you with your back pain today. I have a good friend who has a yard business, let me see if he can find some time to help you with your yard. Also, my boss knows a social worker who has done some consulting with patients having financial concerns. I can get her information if you’d like. Now, let’s get you set up with some E-stim to try and get your pain under control.

7. Effective Communication
Effective communication in patient-professional relationships encompasses a variety of skills that include verbal and non-verbal exchanges, listening, and introducing physical contact and touch in an appropriate and non-threatening manner.
Think about some ways in which you as a PTA work to establish trust and mutual respect in your initial encounter with a patient. How do you demonstrate professionalism balanced with an attitude of caring that helps your patient feel comfortable and share information that will assist you in providing effective treatment? What methods do you use to maintain a consistent, effective relationship with your patient throughout their course of care? What communication strategies do you employ to facilitate optimal learning and understanding for your patient? Do you recognize a patient’s barriers to motivation and work toward helping them to overcome some of those barriers?

8. Summary
Establishing strong professional relationships with patients, complete with clearly defined boundaries, provides the foundation for effective interactions, good communication, and optimal therapeutic outcomes.