Boundary violations and sexual misconduct resources

Boundary violations and sexual misconduct resources

A safe therapeutic relationship depends on careful monitoring of professional boundaries at all times. Boundary violations and sexual misconduct cause profound harm, undermine trust and can result in serious regulatory and legal consequences.

Unfortunately, boundary violations tend to rank highly in the list of complaints to Ahpra.

Some boundary risks emerge gradually or unintentionally. However, the National Law governing the regulation of Health Practitioners in Australia makes clear that certain behaviours are always unacceptable, regardless of intent or consent.

Under a recent amendment to the National Law, proven sexual misconduct – including serious boundary violations – may be permanently recorded on Ahpra’s Register of Practitioners, regardless of whether criminal charges are laid. This information may be published in perpetuity and is accessible to the public.

As a ‘hands-on’ profession, physiotherapists are more susceptible to boundary violations complaints than some other professions. While it may be obvious that an intimate relationship with a patient is wrong, routine clinical contact can be also be the subject of a complaint if it is not adequately explained or it is misinterpreted. Therefore, you should be aware that gaining consent to touch is just as important as gaining informed consent to treat.

All physiotherapists should be aware of Ahpra and National Board's Shared Code of Conduct, which contains explicit guidance on communication, consent, relationships and professional boundaries. Ensure you review it.

In addition, use this compilation of resources and learning prompts to help you and/or your employees/colleagues understand boundary violations and sexual misconduct.

Knowledge and early action protects your patients, your colleagues, you, and your registration. If you are unsure whether a situation is appropriate, seek advice.

Read the Code of Conduct

Reflective practice and building self-awareness

Ask yourself these questions and use them for discussion about boundary issues in your workplace or team meetings:

  • What do I understand about the power imbalance in a therapeutic relationship?
  • Are communication and consent agreements explicit and consistently documented?
  • Have I gained consent to touch my patient and explained why?
  • Is every examination or touch clearly justified by clinical need?
  • Could any aspect of my behaviour be misinterpreted as personal or intimate?
  • Do I have social contact in addition to the professional relationship that could blur boundaries? Do I know how to manage this?
  • Am I alert to communication or behaviour from patients that may indicate a boundary is being crossed?
  • Do I know when and how to escalate concerns?
  • Do I understand my legal obligation to report a sexual boundary violation, as one of Ahpra’s Mandatory Reporting requirements?

If your answer is ‘not sure' to any question, seek guidance and use the resources below.

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Featured articles

These InMotion articles from the APA Risk Mitigation Series highlight common boundary risks, unsafe behaviours and protective strategies. Refer to these articles in supervision and team discussions:

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Education

This eTalk was produced in 2021 by Ian Cooper, former Chair of APA’s National Professional Standards Panel. The current NPSP consider it to have ongoing relevance.

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Podcasts and videos

These podcasts and videos were developed and funded by the Physiotherapy Council of NSW.

From further afield, the Federation of State Boards of Physical Therapy (USA) have developed the following four brief FSBPT Educational videos:

  • Nature of Relationships (5 minutes)
  • Process Oriented Boundaries (4 minutes)
  • Power Dynamics (4 minutes)
  • Sexual Misconduct: The Big Picture (2 minutes)

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Regulation

From 2026, under amendments to the National Law, where a tribunal finds that professional misconduct has a basis of sexual misconduct, that finding may be permanently published on Ahpra’s Register of Practitioners. This publication may occur regardless of whether criminal charges were laid, the conduct was consensual or the conduct occurred outside direct clinical care.

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Regulatory case examples

There are also several Tribunal outcomes published on the Ahpra website related to sexual boundary violations (search ‘sexual boundaries’ in Ahpra’s search field).

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Minimum policy checklist: professional boundaries and sexual misconduct

Clear, practice-level boundaries policies protect patients from harm, support practitioners to make safe and professional decisions, and reduce the risk of complaints, regulatory investigation, and disciplinary action. They also help ensure compliance with Ahpra’s Code of Conduct and the National Law, recognising that physiotherapists hold a position of trust and are responsible for maintaining professional boundaries at all times.

Each physiotherapy practice should have a written Policy that, at minimum:

1. Defines professional boundaries and prohibits sexual misconduct

States that practitioners must maintain professional boundaries at all times and that sexual relationships, sexualised behaviour, or any form of sexual misconduct with patients are strictly prohibited and may result in disciplinary and regulatory action.

2. Requires informed consent and clinically justified physical contact

Requires practitioners to explain and obtain informed consent for examination and treatment, ensure all physical contact is clinically necessary, and protect patient dignity and privacy.

3. Sets clear expectations for professional communication and behaviour

Requires professional communication at all times (including SMS, email, and social media), and prohibits behaviour that could be perceived as personal, exploitative, or inappropriate.

4. Provides clear reporting and escalation pathways

Requires staff to report boundary concerns or incidents internally and recognises practitioners’ legal obligation to make mandatory notifications to Ahpra where required.

5. Requires appropriate documentation, training, and compliance with Ahpra guidance

Requires documentation of consent and concerns, staff awareness of boundary obligations, and alignment with Ahpra’s Code of Conduct and National Law requirements.

Read further on Boundary violations and sexual misconduct policy.

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Next steps

Reflect. Review. Report.

  • Reflect on your own practice.
  • Discuss boundary expectations in your next team meeting.
  • Share this resource.
  • Include a discussion of communication, consent, and maintaining appropriate boundaries with new staff as part of routine orientation procedures.
  • Review your organisation’s policies to ensure they comply with current National Law. To ensure you are compliant and to safeguard your own practice you must have a Policy in place.
  • Seek advice early if you are concerned about your own behaviour or someone else’s.
  • Discuss and escalate concerns without delay if there is a perceived or actual risk to patient safety.

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Terminology

Therapeutic relationship 1,2

A therapeutic relationship is a structured, time limited, goal directed professional interaction characterised by trust and psychological safety, clear role boundaries, respectful person centred communication and an appropriate balance of power. Ahpra and the National Boards emphasise that the practitioner always holds more power in the therapeutic relationship, and therefore carries the responsibility to maintain appropriate boundaries at all times.

Boundary crossing 1

A boundary crossing is not formally defined by the Physiotherapy Board of Australia but the concept is described within Ahpra's Shared Code of Conduct, under Professional Boundaries. It can be described as a departure from commonly accepted professional interaction that occurs within a therapeutic relationship. Boundary crossings are not automatically unethical or harmful. However, they create potential risk, require careful professional judgment, and should be approached with reflection, clear clinical justification, documentation where appropriate, and supervision. Ahpra recognises boundary crossings as early warning signs, as repeated or unexamined boundary crossings may escalate into boundary violations or sexual misconduct.

Boundary violation 3

A boundary violation is a harmful, exploitative, or self-serving action that damages the therapeutic relationship. Ahpra describes a boundary violation as a breach of the professional–patient relationship, where the practitioner behaves in a way that exploits, manipulates, or harms the patient. It occurs when a practitioner puts their own needs, interests, or desires ahead of the patient’s, or engages in conduct that compromises professional integrity. Boundary violations can be sexual, emotional, financial, or social, and they often involve a misuse of power or trust. A sexual boundary violation is a form of sexual misconduct.

Sexual misconduct 3, 4, 5

Sexual misconduct is a broad concept that is not defined by the National Law. It encompasses sexual activity or other forms of sexual conduct undertaken by a health practitioner in connection with their practice and with persons under the practitioner’s care, or connected to their practice, or occurring outside of practice.

Conduct which constitutes sexual misconduct may include, but is not limited to:

  • conducting a physical examination which is not clinically indicated or when the patient has not consented to it
  • touching patients or clients in a sexual way and/or without consent
  • flirtatious or sexual behaviour in front of patients
  • seeking information about sexual history unrelated to the provision of healthcare
  • making sexual remarks towards, pursuing a sexual relationship or engaging in sexual activity with patients.

Sexual misconduct can take many forms and can often begin with grooming behaviour by a practitioner. It might be a single act, or a pattern of repeated behaviour. 

Sexual misconduct may also be referred to as sexual abuse, harassment, exploitation, or a breach of professional boundaries. It can occur within the therapeutic relationship, outside the therapeutic relationship, or between colleagues. A practitioner may also be found to have engaged in sexual misconduct as a result of criminal or other inappropriate conduct of a sexual nature which occurred outside their role as a health practitioner.

Any sexual contact between a practitioner and a patient would be considered sexual misconduct.  Sexual misconduct may occur in relation to a person under the practitioner’s care even if the person consents to, initiates, or willingly participates in the conduct. Sexual misconduct is never the fault of the person who experienced it.

Professional misconduct 6

Conduct undertaken by a registered health practitioner which is substantially below the standard reasonably expected of a practitioner with equivalent training or experience. It may also encompass various instances of unprofessional conduct which, collectively considered, fall below the required standard, as well as conduct within or outside practice that is inconsistent with the practitioner being a fit and proper person to hold registration.

Mandatory notification 7

A mandatory notification is a legal requirement under the National Law for registered health practitioners to notify Ahpra if they form a reasonable belief that another practitioner has engaged in notifiable conduct, including sexual misconduct, in connection with practice. Failure to make a mandatory notification when required may itself constitute grounds for regulatory action.

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References

1 Ahpra and National Boards, ‘Shared code of conduct’, November 2024 (accessed 7 February 2026)

2 Ahpra and National Boards, ‘Reporting health practitioner sexual misconduct’, (accessed 7 February 2026)

3 Ahpra and National Boards, ‘Sexual Misconduct and the National Law’, December 2025 (accessed 7 February 2026)

4 Medical Board of Australia, ‘Guidelines: Sexual boundaries in the doctor-patient relationship’, December 2018 (accessed 7 February 2026)

5 Ahpra and National Boards, ‘Guidelines: Mandatory notifications about registered health practitioners’, March 2020 (accessed 7 February 2026)

6 Ahpra and National Boards, ‘Health Practitioner Regulation National Law – section 5 definition of ‘professional misconduct’’, (accessed 7 February 2026)

7 Ahpra and National Boards, ‘Making a mandatory notification’, (accessed 7 February 2026)

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