Lesson 6 - Professional Boundaries
1. Lesson Overview
Professional boundaries define the limits of the assistant practitioner’s relationship with patients and families. They help ensure that appointments remain safe, respectful and focused on their agreed purpose.
The assistant practitioner should be warm and approachable without becoming personally involved. They must also remain within the limits of their role, competence and authority.
Professional boundaries protect the patient, practitioner and service. A boundary concern should be discussed with a supervisor at an early stage.
Suggested duration: 60 minutes
Delivery method: Self-directed learning followed by case discussion
Practical requirement: Role-play involving common boundary challenges
2. Learning Outcomes
By the end of this lesson learners should be able to:
Explain what professional boundaries are and why they matter.
Maintain a warm but professional relationship with patients and families.
Recognise the limits of the assistant practitioner role.
Respond appropriately to requests for clinical advice.
Use self-disclosure cautiously.
Maintain boundaries in electronic communication and on social media.
Manage gifts, personal requests and contact outside appointments.
Recognise dual relationships and conflicts of interest.
Respond appropriately when a patient or family becomes overly dependent.
Identify and escalate potential boundary concerns.
3. The Lecture
What are professional boundaries?
Professional boundaries are the limits that keep the relationship between a practitioner and patient safe and purposeful.
The relationship exists because the patient has accessed a healthcare service. It is not the same as a friendship, family relationship or ordinary social contact.
The assistant practitioner may know sensitive information about the patient. The patient may be distressed or feel dependent on the service. This creates a difference in responsibility and power.
The practitioner must use the relationship only to support the patient’s agreed care or assessment process.
Why boundaries matter
Clear boundaries help:
Protect patients from harm or exploitation.
Maintain trust.
Keep appointments focused.
Prevent confusion about the practitioner’s role.
Support fair treatment.
Protect confidential information.
Reduce emotional dependence.
Prevent conflicts of interest.
Support accurate clinical decisions.
Protect staff wellbeing.
Maintain public confidence in the service.
A boundary may be crossed with good intentions. For example a practitioner may give a personal telephone number because they want to be helpful. This can still create confusion and risk.
Good intentions do not remove the need for professional boundaries.
Warmth and professionalism
Maintaining boundaries does not require the practitioner to be cold or distant.
A professional relationship can be:
Warm.
Respectful.
Compassionate.
Patient.
Reassuring about the process.
Interested in the person’s experience.
Flexible within approved procedures.
Responsive to communication needs.
Professional warmth means helping the person feel heard while remaining clear about the practitioner’s role.
A practitioner can say:
“Thank you for telling me. I will make sure this is recorded clearly for the clinical team.”
They should avoid saying:
“Do not worry. I will personally make sure everything gets sorted.”
The second statement creates a promise that may be outside the practitioner’s authority.
Boundaries of the assistant practitioner role
The assistant practitioner’s role is to collect and record approved information.
They may:
Explain the purpose of the appointment.
Follow an approved form or template.
Read questions aloud.
Clarify unfamiliar wording.
Ask neutral follow-up questions.
Request examples.
Record answers accurately.
Record direct observations where authorised.
Identify unanswered questions.
Pass questions to the clinical team.
Escalate risk or safeguarding concerns.
They must not independently:
Make a diagnosis.
Decide whether diagnostic criteria are met.
Interpret questionnaire scores.
Recommend medication.
Advise a patient to start, stop or change medication.
Recommend treatment.
Provide therapy or counselling.
Determine the level of risk.
Make safeguarding decisions.
Give legal advice.
Promise a particular clinical outcome.
Speak on behalf of the responsible clinician.
Expand their role without training and authorisation.
Responding to clinical questions
Patients and families may ask:
“Do you think I have ADHD?”
“Does my child sound autistic?”
“Should the medication be increased?”
“Do you think therapy would help?”
“Is this behaviour normal?”
“Will the clinician diagnose me?”
“What would you do in my situation?”
A suitable response is:
“That question needs to be considered by the clinician. My role today is to collect and record the information. I will make sure your question is passed to the clinical team.”
The practitioner should not provide an informal opinion followed by a disclaimer.
For example they should not say:
“I am not a clinician but it definitely sounds like ADHD to me.”
The disclaimer does not make the clinical opinion appropriate.
Avoiding promises
The practitioner should not promise:
A diagnosis.
A prescription.
A referral.
A particular report wording.
A letter for school or work.
A particular appointment date.
A refund.
That information will remain completely confidential.
That a clinician will agree with the family.
That a concern will be resolved in a particular way.
They can explain the process and pass requests to the appropriate person.
For example:
“I cannot confirm whether a letter will be provided. I will record your request so the clinical team can consider it.”
Personal opinions
Patients may ask for the practitioner’s personal view.
This may include views about:
Diagnosis.
Medication.
Parenting.
Schools.
Other professionals.
Diet.
Religion.
Politics.
Relationships.
Alternative treatments.
Previous care.
The practitioner should not use the appointment to promote personal beliefs.
A neutral response is:
“I am not able to give a personal or clinical opinion on that. I can record your question for the appropriate clinician.”
The practitioner should not criticise another professional or service.
If the patient reports a concern about previous care the practitioner should document the concern accurately and explain the appropriate complaints process where required.
Self-disclosure
Self-disclosure means sharing personal information about oneself.
Examples include talking about:
Personal mental health.
A family member’s diagnosis.
Medication.
Relationships.
Religious beliefs.
Political views.
Financial circumstances.
Personal experiences of healthcare.
Home address.
Personal telephone number.
Social media accounts.
Occasional limited self-disclosure may appear to build rapport. It can also shift attention away from the patient or create a sense of friendship.
Before sharing anything personal the practitioner should ask:
Is this necessary?
Does it benefit the purpose of the appointment?
Could it influence the person’s answers?
Could it invite further personal contact?
Would I be comfortable for this to be recorded and reviewed by my supervisor?
Is there a more professional way to respond?
In most information-gathering appointments personal disclosure will not be necessary.
A brief neutral response is usually enough:
“Many people find long forms tiring. We can take a short break if that would help.”
The practitioner does not need to describe their own experience of completing forms.
Personal contact details
The practitioner should use only approved WMI Psychiatry contact systems.
They should not provide:
A personal mobile number.
A personal email address.
A home address.
A personal messaging account.
A private social media account.
Contact details for a family member or friend.
They should not store a patient’s contact details in a personal device unless this is specifically authorised through an approved process.
If a patient contacts the practitioner through a personal channel the practitioner should:
Avoid entering into a clinical conversation.
Preserve relevant evidence where required.
Inform their supervisor.
Redirect the person to an approved WMI Psychiatry channel.
Record the contact where clinically relevant.
Follow any information governance or incident procedure.
Social media
The practitioner should not:
Send or accept friend requests from patients.
Follow patients from a personal account.
Invite patients to follow a personal account.
Send direct messages through personal social media.
Search for a patient out of curiosity.
Comment on a patient’s posts.
Discuss patient information online.
Post details that could identify a patient indirectly.
Share appointment experiences even if names are removed.
use a patient’s online information within the assessment unless specifically authorised.
Privacy settings do not remove professional responsibility. Screenshots can be copied and shared.
If the practitioner already has an online connection with a person who becomes a patient they should tell their supervisor.
Dual relationships
A dual relationship exists when the practitioner knows the patient or family in another context.
Examples include:
A relative.
A family friend.
A neighbour.
A member of the same close community.
A colleague.
A former colleague.
A child who attends the same school as the practitioner’s child.
A person who uses the practitioner’s other business.
A person known through a religious or social organisation.
A previous connection does not always mean that the practitioner can have no involvement. It must be disclosed and considered.
The practitioner should not decide alone that the relationship will not affect the appointment.
They should tell their supervisor before accessing the record or conducting the appointment where possible.
The supervisor can decide whether:
Another practitioner should complete the appointment.
The relationship can be managed safely.
Specific limitations are needed.
The patient should be informed.
The situation should be documented as a conflict of interest.
Accidental contact outside the service
A practitioner may unexpectedly meet a patient in a shop, school or community setting.
The practitioner should protect confidentiality.
They should not greet the person in a way that reveals the professional relationship unless the patient initiates contact.
If the patient begins discussing confidential information in public the practitioner can say:
“It is good to see you. This is not a private place to discuss your appointment. Please contact the clinic through the usual channel.”
The practitioner should not continue a clinical conversation in public.
Gifts
Patients and families may offer gifts to show appreciation.
The practitioner should follow the WMI Psychiatry gifts and hospitality policy.
Factors that may require consideration include:
The value of the gift.
The reason it was offered.
The timing.
Whether refusal may cause offence.
Whether acceptance could create obligation.
Whether the gift is personal or intended for the team.
Whether the patient is vulnerable.
Whether gifts have been offered repeatedly.
Cash and significant personal gifts should not be accepted.
A polite response might be:
“Thank you for thinking of me. I am not able to accept a personal gift but I appreciate the gesture.”
Any accepted gift should be declared where required by policy.
Favouritism and special arrangements
All patients should be treated fairly.
The practitioner should not:
Give one family priority because they are personally liked.
Offer appointments outside the usual process.
share information that other patients would not receive.
Complete unpaid additional work privately.
Influence waiting-list decisions.
Promise faster clinical review.
Ask a clinician to reach a particular conclusion.
Alter information to help a patient obtain a diagnosis or service.
Hide information because the family requests it.
Reasonable adjustments are not favouritism. They support equitable access and should be arranged through the appropriate process.
Money and financial relationships
The practitioner should never:
Lend money to a patient.
Borrow money from a patient.
Buy or sell personal items to a patient.
Enter into a business arrangement with a patient.
Ask a patient to donate to a personal cause.
Recommend a personal business in which they have an interest.
Offer private services outside WMI Psychiatry.
Discuss personal financial problems with a patient.
If a patient raises a question about clinic fees the practitioner should provide approved information or refer the question to the administrative team.
Physical contact
Physical contact should be limited to what is necessary and appropriate.
Most structured information-gathering appointments do not require physical contact.
A patient may initiate a handshake or attempt to hug the practitioner. The practitioner should consider the person’s needs, the setting and WMI Psychiatry policy.
They should not initiate unnecessary physical contact or use touch as a substitute for appropriate support.
If a physical examination or observation is required the practitioner must:
Be trained and authorised.
Explain what will happen.
Obtain consent.
Maintain privacy and dignity.
Use a chaperone where required.
Follow the approved procedure.
Document what was completed.
Emotional dependence
Some patients or family members may begin to rely heavily on a particular practitioner.
Possible signs include:
Requesting only that practitioner.
Seeking frequent contact between appointments.
Sharing increasing amounts of unrelated personal information.
Asking the practitioner to keep secrets from the clinical team.
Describing the practitioner as their friend.
Becoming distressed when the practitioner is unavailable.
Asking for contact outside the service.
Requesting help with matters outside the appointment.
Giving repeated gifts.
Attempting to extend appointments regularly.
The practitioner should not manage this alone.
They should:
Maintain a consistent response.
Reconfirm the purpose of their role.
Use approved communication channels.
Avoid providing additional personal contact.
Inform their supervisor.
Document relevant interactions.
Agree a team approach.
Requests for secrecy
A patient may say:
“Do not tell the clinician.”
“Do not put this in the notes.”
“Promise you will not tell my parents.”
“This is just between us.”
The practitioner should not promise secrecy.
A suitable response is:
“I will treat what you tell me respectfully and confidentially. I may need to share relevant information with the clinical team. If I am concerned about safety I must seek support.”
Questions about whether information can be withheld from a parent or another person should be referred to a qualified clinician.
Communication outside the appointment
The practitioner should only communicate with patients for an approved work purpose.
Messages should be:
Sent through approved systems.
Professional.
Relevant.
Clear.
Recorded where appropriate.
Limited to the practitioner’s role.
Sent at appropriate times unless part of an authorised urgent process.
The practitioner should not engage in informal ongoing conversation or use emojis and language that could make the relationship appear personal.
If a patient sends extensive clinical information the practitioner should ensure that it is transferred to the appropriate record and reviewed by the clinical team.
Maintaining time boundaries
Appointments should begin and end according to the agreed schedule where possible.
The practitioner should not repeatedly extend appointments because a family wants additional personal support.
They can say:
“We have reached the end of the allocated time. I will record that there is further information you would like to provide and ask the team how this should be completed.”
Risk or safeguarding information should not be cut short merely because the appointment time has ended. The practitioner should seek immediate clinical support.
Managing complaints or criticism
A patient may criticise the service or another team member.
The practitioner should:
Listen calmly.
Avoid becoming defensive.
Record the concern accurately.
Explain the complaints process where appropriate.
Inform the relevant manager.
Avoid agreeing with criticism that they cannot verify.
Avoid criticising colleagues.
Escalate any immediate safety concern.
A suitable response is:
“I am sorry to hear that you are unhappy with what happened. I will record the concern and make sure it is passed to the appropriate person.”
Maintaining boundaries with colleagues
Professional boundaries also apply within the team.
The practitioner should:
Share patient information only for a work-related reason.
Avoid discussing patients casually.
Ask for supervision when needed.
Be honest about mistakes.
Avoid working beyond their competence because of pressure.
Follow agreed decisions.
Raise concerns respectfully.
Avoid asking colleagues to bypass procedures.
Declare personal connections or conflicts of interest.
A colleague’s request does not make an unsafe task appropriate.
Pressure to work outside the role
A practitioner may feel pressure from:
A patient.
A parent.
A colleague.
A clinician.
Time constraints.
A desire to be helpful.
Fear of appearing inexperienced.
The practitioner should say:
“I have not been trained or authorised to complete that task. I need to check with my supervisor.”
They should not attempt a task and hope that it will be acceptable.
Boundary crossings and boundary violations
A boundary crossing is a departure from the usual professional boundary. It may be minor or accidental. It still needs reflection and may require discussion.
Examples include:
An appointment running significantly over time.
Limited personal disclosure.
Accepting a small gift without first checking the policy.
Responding briefly to an unexpected personal message.
A boundary violation is more serious and places the patient or professional relationship at risk.
Examples include:
A sexual or romantic relationship.
A financial relationship.
Deliberate exploitation.
Sharing confidential information.
Repeated secret contact.
Giving preferential treatment for personal reasons.
Using the relationship to meet the practitioner’s emotional needs.
Falsifying records to help or harm a patient.
Potential violations must be reported promptly.
Responding to a boundary concern
If the practitioner becomes concerned about a boundary they should:
Stop any further inappropriate contact or action.
Preserve relevant records.
Inform their supervisor or manager promptly.
Document the facts clearly.
Follow the relevant incident or safeguarding procedure.
Avoid discussing the matter with unrelated colleagues.
Participate honestly in review and supervision.
Follow any agreed plan to protect the patient.
The practitioner should not hide a boundary concern because they feel embarrassed.
Early discussion may prevent a minor issue from becoming more serious.
A useful boundary check
Before acting the practitioner should ask:
Is this within my role?
Is this for the patient’s benefit?
Is this part of the agreed service?
Would I do the same for another patient?
Would I be comfortable documenting this?
Would I be comfortable telling my supervisor?
Could this create obligation, secrecy or dependence?
Am I using an approved communication channel?
Does this require clinical judgement?
Do I need advice before proceeding?
If the answer raises concern the practitioner should pause and seek supervision.
4. Clinical Perspective
Clinical pearl: Clear boundaries make relationships safer
A patient may be disappointed when a practitioner cannot answer a clinical question or offer personal contact. A respectful limit is safer than an unclear promise.
Clinical pearl: Warmth does not require friendship
The practitioner can be compassionate and attentive while keeping the relationship professional.
Clinical pearl: The disclaimer does not remove the boundary
Saying “I am not a clinician” before giving a clinical opinion does not make the opinion appropriate.
Clinical pearl: Small concerns should be discussed early
Boundary problems often develop gradually. Early supervision can prevent confusion and protect everyone involved.
Common pitfall: Becoming the patient’s personal point of contact
The practitioner should direct communication through the service rather than creating a private route.
Common pitfall: Using personal experience to build rapport
Self-disclosure may shift attention away from the patient and encourage a personal relationship.
Common pitfall: Making exceptions for a distressed family
Distress may require support or escalation. It does not automatically justify bypassing procedures.
Common pitfall: Keeping information secret
The practitioner must not agree to hide clinically relevant or safety-related information from the team.
Common pitfall: Assuming an existing relationship is harmless
A personal connection should be declared so that the service can decide how to manage it.
When to escalate
The practitioner should seek support if:
A patient requests personal contact.
A patient sends a friend request.
A patient offers a significant gift.
The practitioner knows the patient socially.
A patient asks the practitioner to keep information secret.
The practitioner feels personally responsible for solving the patient’s difficulties.
Contact is becoming frequent or emotionally dependent.
A patient makes romantic or sexual comments.
The practitioner has shared too much personal information.
The practitioner has communicated through an unapproved channel.
A colleague asks them to work outside their competence.
Any interaction feels uncomfortable, secretive or difficult to explain.
5. Case Examples
Case Example 1: A request for a personal number
A parent states that clinic emails take too long and asks for the practitioner’s mobile number.
The practitioner should say:
“I am not able to provide personal contact details. Please continue to contact the clinic through the approved email address or telephone number.”
They should not provide the number as an exception.
Case Example 2: A diagnostic opinion
A patient asks:
“Off the record do you think I have ADHD?”
The practitioner should say:
“I cannot give a diagnostic opinion on or off the record. The clinician will review the information collected during the assessment.”
Case Example 3: A social media request
A young person sends the practitioner a friend request after the appointment.
The practitioner should not accept it. They should inform their supervisor and follow the agreed procedure for documenting or managing the contact.
Case Example 4: An existing relationship
The practitioner recognises a patient as a close friend of their sibling.
They should not access the clinical record further than necessary. They should disclose the connection to their supervisor before conducting the appointment.
Case Example 5: A gift
A family offers the practitioner an expensive gift after an assessment appointment.
The practitioner should decline the gift politely and inform their manager in accordance with the gifts and hospitality policy.
Case Example 6: A request for secrecy
A young person discloses self-harm and says:
“You have to promise not to tell anyone.”
The practitioner should not make this promise.
They should explain:
“I cannot keep information about your safety secret. I need to involve the clinical team so that you can receive the right support.”
Case Example 7: Frequent messages
A parent begins sending the practitioner personal messages each evening about family difficulties.
The practitioner should not continue the informal conversation. They should redirect the parent to the approved service channel and discuss the situation with their supervisor.
Case Example 8: Pressure from a colleague
A colleague asks the practitioner to complete a clinical risk assessment because the clinician is running late.
The practitioner has not been trained or authorised to do this.
They should decline and contact the appropriate supervisor or clinician. Time pressure does not change their scope of practice.
6. Summary
Professional boundaries keep the relationship safe, respectful and focused.
The assistant practitioner should:
Be warm and professional.
Explain the limits of their role.
Use approved communication channels.
Avoid unnecessary self-disclosure.
Protect confidentiality.
Treat patients fairly.
Declare personal connections.
Follow policies about gifts.
Avoid financial or personal relationships.
Respond consistently to requests for clinical advice.
Seek supervision when a boundary feels unclear.
Report concerns promptly.
The assistant practitioner should not:
Give clinical opinions.
Offer personal contact details.
Form friendships with patients.
connect with patients through personal social media.
Accept significant gifts.
Enter financial relationships.
Promise secrecy.
Promise clinical outcomes.
Provide special treatment for personal reasons.
Work beyond their competence.
Hide a boundary concern.
7. Further Reading
WMI Psychiatry Assistant Practitioner Role Description
WMI Psychiatry Professional Boundaries Policy
WMI Psychiatry Code of Conduct
WMI Psychiatry Confidentiality and Data Protection Policy
WMI Psychiatry Social Media Policy
WMI Psychiatry Gifts and Hospitality Policy
WMI Psychiatry Conflicts of Interest Policy
WMI Psychiatry Safeguarding Policy
WMI Psychiatry Incident Reporting Procedure
WMI Psychiatry Complaints Policy
8. Reflective Exercise
The learner should consider:
How can you be warm without becoming personally involved?
What would you say if a patient repeatedly asked for your diagnostic opinion?
What personal information would be inappropriate to share?
How would you respond to a social media friend request?
What would you do if you discovered that you knew a patient socially?
Why can a small exception create a boundary problem?
How would you respond if a patient asked you to keep information secret?
What signs might suggest that a patient is becoming dependent on a particular practitioner?
How would you respond if a colleague asked you to work beyond your competence?
Which boundary concerns would require immediate escalation?
The learner should discuss their responses with their supervisor.
9. Practical Competency Activity
The learner should complete role-plays involving:
A request for a diagnostic opinion.
A request for medication advice.
A request for a personal telephone number.
A social media friend request.
An offer of an expensive gift.
A patient known socially to the practitioner.
A request to keep a disclosure secret.
A parent seeking frequent contact outside appointments.
A colleague asking the practitioner to work outside their competence.
A patient who wants the practitioner to promise a particular outcome.
The learner should demonstrate that they can:
Respond warmly and clearly.
Explain the limits of the role.
Decline inappropriate requests.
Redirect communication to approved channels.
Avoid clinical advice.
Avoid promising secrecy or outcomes.
Recognise a dual relationship.
Recognise signs of dependence.
Seek supervision appropriately.
Document and escalate a boundary concern.
The supervisor should assess whether the learner maintains clear boundaries without becoming dismissive or defensive.
10. Knowledge Check
Complete the short knowledge check below to consolidate your learning and check your understanding of the key principles covered in this lesson. You can review the lesson content again before submitting your answers.
