From the Practice Advisors
Have you had a friend or family member approach you for professional services? A friend requests that you review their rehab exercises after surgery. A relative asks you to design a meal plan. A neighbour wants you to assess their child’s speech development.
These requests often come from a place of trust and convenience. For many licensees, the instinct to help can feel both natural and professionally aligned, and it may feel awkward to refuse these types of requests. Yet when personal and professional roles overlap, there is a risk of crossing professional boundaries.
Professional boundaries are dynamic lines intended to set limits and clearly define safe and therapeutic connections between healthcare professionals and their patients. Providing services to a friend or family member may compromise a healthcare professional’s objectivity. Healthcare professionals may be more prone to making assumptions about someone they know personally, and the patient may not feel comfortable asking or answering questions or providing feedback honestly. A personal relationship may also suffer if the professional relationship is not successful.
Guiding principles in practice
1. Set the stage with appropriate boundaries.
When a health professional is approached for advice, clarity matters. Explaining your professional role and its limits helps manage expectations from the outset. Even informal conversations may be interpreted as clinical advice when role boundaries are not explicit.
How you respond shapes future interactions. Offering detailed advice in social settings may signal that ongoing informal consultation is appropriate. Know when to redirect to a formal appointment or another healthcare professional.
2. Be aware of potential personal vulnerabilities and professional risk factors.
What puts you at risk of crossing the line? Personal vulnerabilities can include physical and mental health issues, stress, and social isolation. Professional risk factors can include professional isolation, being new to a profession, and not being aware of real or perceived conflicts of interest.
If you are able to refer to a colleague in the same profession, you may be able to avoid developing a therapeutic relationship with a person with whom you have a pre-existing personal relationship.
If there is no appropriate professional to refer to – for example, in a small community – you may need to consider how to manage both a personal and therapeutic relationship at the same time. For example, you may want to only see the patient professionally in your clinic or office, during regular business hours (and keep personal meetings separate).
3. Identify boundary blurring.
Boundary violations are often preceded by minor and seemingly innocent actions. These may be especially difficult to identify if there is a pre-established personal relationship between you and your patient.
Some questions you may want to consider are: Are you spending more time with certain patients in a therapeutic setting? Are you sharing excess personal information about yourself to make a connection? Are you connecting with, or thinking about connecting with a patient outside of the therapeutic relationship?
Consider the guiding questions in the Decision Tool, found on page 13 of the Where’s the Line? Professional Boundaries document (PDF).
4. Re-establish the professional boundaries.
Re-establishing the professional boundaries may be challenging. Steps you may want to take include clarifying your role as the healthcare professional and realigning the care plan and treatment goals. It may also be important to communicate that in your therapeutic relationship, your patient’s needs come first. And you may want to consider how to separate your professional conversations from personal ones and how to restore these boundaries as needed.
5. Document as needed.
When considering the College Standards for record keeping, it would be important to document any boundary blurring that has occurred, including the steps taken to re-establish the professional boundary and therapeutic relationship. Another consideration would be documenting real or perceived conflicts of interest and how these were mitigated.
6. Maintain clear professional boundaries.
Professional boundaries are dynamic and evolving. Reflect on your professional boundaries with patients regularly to ensure you are protecting your patients and yourself.
Resources
CHCPBC Practice Support (2025). Where’s the Line? Professional Boundaries in a Therapeutic Relationship (PDF).
About the Practice Support service
CHCPBC has profession-specific Practice Advisors for each of the nine professions the College regulates. Questions that are sent by licensees will be answered by a Practice Advisor in the same profession. Submissions are treated confidentially.
Our practice advisors provide guidance on how standards of practice, clinical policies, clinical practice guidelines and protocols, and related documents may be interpreted and can be implemented in practice. The goal is to assist licensees to find solutions to their practice issues given the complexity of healthcare delivery today.
Anyone – licensees or members of the public – with a question about CHCPBC’s expectations for safe, ethical and quality practice is welcome to contact our Practice Support team.
