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Terminating a Therapeutic Relationship

A frequently asked question by RMTs is about when an RMT can or should terminate a therapeutic relationship.

The Code of Ethics outlines the following circumstances for terminating a therapeutic relationship:

  • Therapy is no longer indicated.
  • The patient no longer wishes to receive treatment.
  • Another health care professional has assumed primary care responsibility.
  • The RMT provides written notice of termination to the patient.

The first three circumstances tend to occur naturally in practice.

  • Therapy is no longer indicated.
    • This could occur when a patient’s presenting condition resolves, you have completed the agreed upon treatment plan, and you discharge the patient from your care.
  • The patient no longer wishes to receive treatment.
    • This could occur when a patient moves to a different community and cannot continue treatment with you.
  • Another health care professional has assumed primary care responsibility.
    • This could occur when you refer a patient to a colleague for ongoing care.

The fourth circumstance, the RMT provides written notice of termination to the patient, does not occur naturally in practice. Providing written notice of termination to a patient is proactive, meaning that the RMT decides that treatment is discontinued and takes action to ensure that the therapeutic relationship will end.

Terminating the therapeutic relationship can occur, and is permitted to occur, at the RMT’s discretion provided the RMT presents the patient with written notice of termination. The exception to this is that an RMT cannot terminate a therapeutic relationship by written notice for a reason that is discriminatory towards the patient.

A patient whose treatment has been terminated by written notice is entitled to be referred to another licensed health care practitioner.

When can immediate termination of the therapeutic relationship occur?

RMTs may immediately terminate a therapeutic relationship if the patient:

  • Sexualizes or attempts to sexualize the treatment or treatment environment.
  • Directly or indirectly acts in a discriminatory manner.
  • Harasses, abuses, or threatens the RMT, or otherwise engages in behaviour that places the RMT at risk of harm.

If an RMT immediately terminates treatment with a patient for one of the above circumstances, an RMT can proceed in the following way:

  • The RMT can stop treatment immediately.
  • The RMT is not required to refer the patient to another licensed health care practitioner.
  • The RMT is not obligated to explain to the patient the specific reasons for the immediate termination.

RMTs should carefully document the reasons for any termination of a therapeutic relationship. When documenting, RMTs should strive to answer the questions of who/what/when/where/how. This is especially important in cases where the termination occurs as a result of the patient sexualizing the treatment, acting in a discriminatory manner or harassing, abusing, or threatening the RMT or engaging in behaviour that places the RMT at risk of harm. The documentation may be kept in the patient health care record, and should consist primarily of direct facts and observations rather than judgments or subjective comments.

In some cases, an RMT may also need to call the police or seek out further support after the termination has occurred. If RMTs have questions about patient-therapist confidentiality in this scenario, they should contact the College.

Example of a patient acting in a discriminatory way.

An RMT has been treating a patient over the last month to aid in the recovery of an ankle injury.  Recently, the news has covered a variety of stories about reconciliation with Indigenous Peoples across Canada.

During treatment, the patient begins to discuss the recent news coverage along with their personal views and makes racist remarks about a nearby First Nations community. 

The RMT is Indigenous themselves, however, has not disclosed this personal information to the patient.  The RMT does not engage with the patient’s racist and negative remarks about their own community and heritage.

Due to the patient’s racist and negative remarks towards Indigenous people and the local First Nations community, the RMT does not feel safe to continue the treatment. The RMT makes the decision to immediately stop treatment due to the patient acting in a discriminatory manner. The RMT informs the patient that treatment is ending immediately and that all further appointments are cancelled. The RMT ensures they carefully document the termination of the therapeutic relationship in the patient’s health care record.

RMTs who have questions about terminating a therapeutic relationship can contact [email protected].

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