Ethically Speaking Q&A's

Q: My client hints that she'd like to be friends. She teases me about having coffee after her treatments and occasionally calls me at home to ask me a question about something we've discussed during her session. We usually end up chatting but I feel a little uncomfortable when I hang up. Yesterday she "poked" me on a social networking site and asked to "be my friend". I don't think I should answer but I don't want to lose her as a client. What should I do?

A: To answer this question, I've got to ask you another. Are you her friend or her massage therapist? What is in the client's best interest? If you value her as a client, then you need to help her understand the difference between therapist and friend. Therapists don't socialize with their clients because if they do, their ability to put the client needs first are compromised. If you first met her as a client, then that client-therapist relationship will always be the history between you and defines how you will relate as friends.

Gently explain that you cannot go for coffee, hang out between sessions or chat online because she is your client. In a professional therapeutic relationship, you express your caring by listening attentively and providing good care during each session, not by socializing. She may be disappointed when you draw the line. but your boundary clarity will support her client goals better than if you indulge in a relationship that may ultimately frustrate or hurt both of you.

Q: The owner of the clinic where I work tells me that if I move to another location, all my client files are her property and they have to stay with her. Is that fair? How am I supposed to maintain my practice? I wasn't planning to leave but after this came up, I feel like leaving.

A: Your clients' files are the property of the clients. But clients are not expected to keep or hold onto their own files. This is the job of either the therapist or the clinic. Client files must be maintained for a period of 10 years after the last session was provided so that they are available should there be either a medical or legal reason to consult them. Under the Regulated Health Professions Act (RHPA 1994) in Ontario (this may be slightly different in other jurisdictions), clients should be consulted as to where they would like the files to be stored or kept. This is what is required by law.

In practice, many clinics insist that they will hold onto client files and therapists are given no access to them when they leave. This is because clinic owners suspect that departing therapists  may steal their client base. Who maintains the files is an important issue to discuss at the outset of any contract negotiation. If a clinic shuts out a therapist on the mistaken belief that the files are theirs for the keeping, then the client loses. Such clinics don't refer clients on to the therapist's new location, even when requested. If a therapist does not let a client know the new location, it is considered client abandonment and a form of professional misconduct.

So how do you solve this dilemma?
If you haven't done so already, you need to negotiate an exit strategy with the clinic owner that supports your professional obligations and acknowledges her business interests. If you do this now, long before you are ready to go, then the departure will be less painful when it arises. For example, why not suggest to the clinic owner that you agree to her maintaining the files as long as you have access to them. You may want to separately identify those clients who were directly referred by the clinic ('their clients") and those who came to you by word of mouth or sources outside the clinic ("your clients"). Document client names and contact information in the event that you decide to leave. When you are ready to move to another location, send your clients a letter explaining your decision to move and ask them where they would like their files stored. 

Q: When is it OK to discharge a client? I've been in practice for 2 years, I'm happily married and love my work. Unfortunately, one of my clients keeps flirting and I'm really uncomfortable during his sessions. I have told him that I don't want to play any games with him and that I am not interested in becoming involved. No matter what I say, he still turns my words back on me, teasing and making suggestive comments. I really want to be professional but I wish he would just go away.

A: If you feel harassed by your client, you are not obligated to see him. But in order to fulfill your professional obligations, you should explain your reasons for discharge and find another therapist for him so that you do not leave him without any options for treatment. If you are reluctant to send him to another female therapist because of his harassing behavior, give this client the names of one or two male therapists. If he tells you that he only wants to see a female therapist, you can explain that your responsibility is to provide the names of other therapists who can give him treatment. You do not have to put your female colleagues in jeopardy as well.

Important Notes


Confidentiality is more than a concept. It is the law.

Under the Personal Health Information Privacy Act, (ON 2004; other provinces and states have similar laws) healthcare providers are required to keep cases confidential. The legislation does allow for consultation with peers for the purposes of supporting the client, as long as the identifying information is not shared and the details of the consultation are kept confidential.

When submitting questions or discussing cases, make sure that you keep all identifying information out of the case to protect the confidentiality of your clients. For example, you may discuss the age, gender, condition, occupation of the client but do not include personal identifying information such as name or address or any other specific details that might lead us to identify the individual.

Cancellation fee

If you book a phone consultation with Pam and are unable to attend the session without giving at least 3 hours notice, you will be billed a cancellation fee of $30.