Maintaining Professional Boundaries Part 2

Working as a healthcare professional means that you will be in a position of trust and your profession therefore demands that you maintain appropriate and respectable professional boundaries between you and your patient. You might be treating someone who is emotionally or physically vulnerable, therefore the balance of power is often tipped in your favour.

In my last article we looked at a case involving a social worker who crossed professional boundaries, but what about a situation in which you might feel manipulated by your patient?

In this article we look at a real life case involving a clinical psychologist who found themselves manipulated by a patient, leading to them and members of their clinical team being investigated by the Health and Care Professions Council following a complaint by the patient when things did not go their way.

Case study

A clinical psychologist was looking after a patient with a complex history and abandonment issues stemming from childhood. The patient formed a close bond  with the clinical psychologist and only wanted to see them, insisting all their appointments were arranged with this clinical psychologist only. The clinical psychologist was an experienced and well respected member of their team but found this patient demanding and difficult. They found it easier to agree to the requests of the patient and so they arranged all their appointments for when they would be in clinic and could see the patient. They also accepted and exchanged cards and small gifts.

Slowly, however, overtime the patient’s requests became more demanding. The patient asked for more time and insisted the clinical psychologist make themselves available at short notice. The patient and their family would complain to them, if they were not available at short notice and were unhappy when the clinical psychologist took annual leave.

Taking into consideration the patient’s abandonment issues, the clinical psychologist started to make further allowances and made sure they were available, even when they were on leave. However, the demands increased. The patient sometimes waited outside their office, waiting for them to finish appointments with other patients. The patient also waited for the clinical psychologist by their car.

Although the clinical psychologist was an experienced practitioner they did not raise early issues with their colleagues, thinking they could manage the situation. By the time the clinical psychologist identified their relationship with the patient was not a healthy one, they had fallen into depression and internalised their problems.

The situation came to light by chance when the clinical lead answered an incoming phone call from the patient. The clinical lead then investigated why the patient’s appointments were not being booked through the central booking system and were instead being managed by the clinical psychologist directly.  It transpired that because the clinical psychologist worked part time, and had two different supervisors, it wasn’t picked up that the clinical psychologist was struggling. The clinical lead notified building security of the situation and arrangements were made to transfer the care of the patient to a different team. The plan was for the patient’s care to be weaned to another team, however the clinical lead came to know the patient had turned up at the clinical psychologist’s home looking for an explanation.

The patient complained to the HCPC about the clinical lead and the clinical psychologist. The investigation by the HCPC was lengthy as the patient raised many issues which needed investigating and answering. With the writer’s help, the clinical lead was eventually cleared of misconduct. The lead had prepared detailed notes which helped them. Sadly, the clinical psychologist did not return to work due to the impact on their mental health.

Conclusion

Maintaining professional boundaries will protect you as well as the patient. Listen to and look out for early alarm bells and seek objective advice as soon as possible to avoid matters from escalating.