Professional Predicaments

Answer:

Providing services to family and friends falls into the zone known as ethically grey interactions that require the use of good judgment and careful consideration of the context. As outlined in the Ethically Grey Interactions/Boundary Blurring section of ACSLPA’s Guideline on Professional Boundaries:  Therapeutic & Professional Boundaries, a case-by-case analysis of these interactions should involve the following:

• The regulated member’s personal values;
• The client’s needs;
• Professional standards and ethics; and
• Any institutional or organizational policies.

Generally, it is recommended that regulated members avoid treating family and friends as overlapping personal and therapeutic relationships can make maintaining boundaries a challenge.

The key issues to consider in these instances include:

• How one manages professional boundaries to ensure objectivity and a client-centred focus, while respecting both privacy and confidentiality.
• The importance of considering how the interplay between professional and personal might impact the client. For example, while they might initially think having a family member or close friend treat their adult family member or young child would be ideal, how comfortable will they be sharing confidential information with that friend or family member?

It is also important to understand what a friend or family member’s expectations might be when they approach you about professional services.

• Are they expecting preferential treatment in relation to billing or scheduling?
• How much accommodation are you prepared to provide, if any?
• How comfortable will you be with having difficult conversations about these types of issues?
• What happens if the therapeutic or professional relationship is not successful? How will this impact the personal relationship going forward?

Prior to embarking on a therapeutic relationship, is it possible to discuss these issues openly to arrive at a mutual understanding on how to proceed?

If a regulated member chooses to proceed, it is important to be informed regarding any potential liability concerns. Also, be aware that third party payers may require that these types of treatment relationships be disclosed. The potential conflict of interest and the processes put in place to manage the conflict of interest must be documented in the client file. Things to consider:

• Even if no actual conflict of interest arises, what about the perception of conflict of interest?
• How might other clients view a treatment relationship with a family member or friend?
• Would the rationale for providing such services stand up in the face of inquiry from others?

In some instances, (e.g., when practicing in a rural setting, when providing highly specialized services) it may initially appear difficult to avoid treating relatives or friends as there may not be another provider available. However, while at first glance one might think that there are limited-service options available, given that virtual services are more readily available than ever before, there may be options for clients and their families to consider, which could be discussed prior to initiating a therapeutic relationship.

A final note, specifically with regards to treating a spouse, an adult interdependent partner or other person with whom the speech-language pathologist or audiologist is in an existing sexual relationship: We encourage regulated members to review ACSLPA’s Standard of Practice Area 5.5 on Existing Sexual Relationships.

Regulated members are reminded that they may contact the College if they have questions or need further clarification. Please do not hesitate to reach out at any time using the Contact Us form.

If there is a conflict or discrepancy with the information or advice set out on this webpage and the information contained in a more official ACSLPA document, then the information contained in the more official ACSLPA document applies and not the information or advice set out here. For the purposes of this disclaimer, ACSLPA’s more official documents include the governing legislation (including the Health Professions Act and the Speech-Language Pathologist and Audiologist Profession Regulation) as well as ACSLPA’s Bylaws, policies, Standards of Practice, Code of Ethics, manuals and/or any other official document approved by Council, a statutory committee or a college official. Persons interacting with ACSLPA are responsible for reviewing and familiarizing themselves with the relevant information contained in ACSLPA’s official documents.