Boundary CrossingsQuiz

Boundary Crossings


Select the best answer to each of the following questions. Consider the reason for your choice. Review the correct responses.  

1. In the scenario, "Hiring a Client", what is the primary concern?
a. You are seeing a client in your own home
b. You should not be giving money to a client
c. House cleaning is a demeaning service to perform
d. Your dual relationship will create conflicting duties.

The best answer is (d). Boundary crossings often interfere with the professional relationship in unexpected ways.

Answer (a), while a real concern, is not the primary concern in this circumstance especially as the attendance at the home is for a limited, non-therapeutic purpose and there are no romantic or other connotations to it. Answer (b), while a real concern, does not address the core of the boundary issue. Answer (c) only has significance because of the boundary issue. House cleaning is honest work. By becoming the client's boss, you create an imbalance in the therapeutic relationship.

2. If a client expresses a romantic interest in you, which of the following applies?

a.. There is no boundary crossing unless you respond.
b. You should transfer the client.
c. You should politely explain that you can only have a professional relationship with the client.
d. Tell the client to "hold that thought" until after treatment is completed.

The best answer is (c). It is your responsibility to maintain the boundaries. You may have to take additional action, depending on the response to your attempt to reestablish the boundaries (e.g. transfer the client's care), but that is the first step.

Answer (a), while perhaps technically true, looks to your responsibility for the client's actions rather than a solution to the problem that has been created. You need to take some action.  Answer (b) may ultimately be necessary in some cases but is not necessary in every case. Answer (d) leaves hope that there may be a romantic relationship in the future. Such a response does not deal with the harm that is occurring now to your professional relationship and is inappropriate. With regards to sexual abuse, the Regulated Health Professions Act stipulates that an individual remains a patient or a client for an entire year after the therapeutic dietitian-client relationship has ended. Having romantic or sexual relationships with a client during that time is strictly forbidden. It is considered sexual abuse, even if the client consents.

3. What is the MOST important concern about a boundary crossing?

a) It interferes with your professional judgment.
b) It undermines your client's ability to maintain a therapeutic relationship with you.
c) It can confuse your client.
d) It can confuse other clients who observe it.
The best answer is (b). The concern that is paramount really depends on the circumstances of  the case, although (b) would often be at the top of the list. All of the answers are in fact true.   Answer (c) is really a subset of answer (b).

4. If a client tells a sexual joke, what should you do?

a) Laugh so that the client does not feel bad, but tell the client not to do that again.
b) Laugh only if no other clients are present, but tell the client not to do that again.
c) Report the client on a mandatory basis for sexual abuse.
d) Politely advise the client that such comments are not appropriate in the treatment setting.

The best answer is (d). You can convey this message to the client in a way that does not  embarrass the client or attack their self-esteem. For example, you can suggest that jokes that make fun of dietitians are the only humour permitted in your practice setting.

Answers (a)  and (b) involve your legitimizing the conduct. It is true that answer (a) may not involve sexual abuse on your part, and answer (b) does technically involve sexual abuse on your part.  However, both answers involve at least a technical crossing of a boundary. Answer (c) is incorrect as the mandatory reporting obligations only apply to health practitioners, not  clients.

5. Which of the following statements is true?

a) Boundary considerations are designed to protect the client.
b) Boundary considerations are designed to protect the dietitian.
c) Boundary considerations are designed to protect other clients.
d) Boundary considerations are designed to protect the client, and others exposed to the behaviour.
The best answer is (d). This response is the most inclusive. Answers (a) and (c) are true, but are incomplete. Boundary rules protect the client, and others who observe or otherwise learn of the conduct.