Regulators need to understand sexual misconduct and boundary violations in physical therapy, including power dynamics, informed consent, and cultural competency, to ensure ethical practices and patient well-being. This article is based on a 2024 Annual Education Meeting session presented by Sherri Paru, Mira Mariano, Samantha Mohn-Johnsen, and Michael Noonan.
In the world of physical therapy, the patient-provider relationship is built on trust, respect, and professionalism. Yet, sexual misconduct and boundary violations remain critical challenges that threaten the integrity of the profession and the safety of patients. These issues, ranging from subtle boundary crossings to explicit sexual advances, have far-reaching consequences—not only for individuals directly involved but also for the broader physical therapy community. How can physical therapists navigate the complexities of power dynamics, informed consent, and cultural competency to uphold the highest standards of ethics and care?
Sexual misconduct and boundary violations in healthcare are not new concerns, but the physical therapy profession is increasingly recognizing the need for proactive, structured, and accessible education on these issues. The Federation of State Boards of Physical Therapy (FSBPT) has taken a leadership role in this effort through the work of its Sexual Misconduct and Boundaries Committee. The committee was formed to promote awareness of sexual misconduct and boundary violations and develop educational resources for regulators, licensees, students, and the public.
The committee’s work is informed by research, including a 2017 study by Jill Boissonnault and colleagues that found 84% of PT and PTA students and clinicians had experienced inappropriate sexual behavior during their careers. Nearly half reported such experiences within the past year alone. These findings underscore the urgency of equipping students with the tools to navigate these situations.
The committee has developed a suite of resources tailored to different stakeholders, including providers, patients, students, and regulatory boards. These materials are designed to be accessible, practical, and adaptable to various settings.
One of the committee’s most impactful contributions has been the development of a white paper on power imbalance. This document explores the inherent power differential between provider and patient, emphasizing that even seemingly consensual interactions can be problematic when viewed through the lens of professional ethics and regulatory standards. The white paper is available to members in the FSBPT members portal and serves as a foundational resource for understanding the dynamics at play in therapeutic relationships.
The committee made easily digestible infographics to help students understand their roles and responsibilities. For instance, the provider infographic includes a traffic light system that categorizes behaviors into "green" (acceptable), "yellow" (warning signs), and "red" (unacceptable). This visual tool helps therapists gauge their professional conduct and make adjustments to maintain ethical boundaries.
Social media presents unique challenges for physical therapists, as the line between personal and professional interactions can blur. To address this, the committee included guidelines for maintaining separate professional and personal accounts, such as avoiding the use of emojis or casual language in patient communications and adhering to clear boundaries in online interactions. These measures aim to prevent misunderstandings that could lead to complaints or ethical violations.
The patient-provider relationship in physical therapy involves inherent power imbalances, where patients rely on therapists for care and expertise. Addressing these dynamics is essential for maintaining safe therapeutic environments. Recognizing the need for impactful resources, the committee has developed four three short educational videos that focus on authority imbalances, boundary-setting, and effective communication. These videos provide actionable strategies for both students and practitioners to uphold professionalism and prevent misconduct.
The committee has helped with multiple webinars, including one geared toward students and practitioners, titled This Could NEVER Happen to Me! Protecting Yourself and Preventing Sexual Misconduct, which featured speakers Mira Mariano, Samantha Mohn-Johnsen, and Sherri Paru. The session addressed the inevitability of encountering challenging or inappropriate situations in clinical practice. Attendees gained essential insights into maintaining professional boundaries, understanding the profound consequences of sexual misconduct, and exploring actionable steps to foster a safer and more ethical healthcare environment. The webinar underscored the importance of vigilance and proactive measures in preserving the integrity of physical therapy as a profession.
The committee developed a website audit tool to help regulatory boards assess the accessibility and clarity of their complaint processes. The tool uses a red-yellow-green rating system to evaluate how easy it is for the public to find and understand how to file a complaint. This initiative was inspired by findings that many state websites are difficult to navigate or contain language that may discourage reporting.
The committee is finalizing a comprehensive module that will include pre-tests, post-tests, slide decks, case scenarios, and talking points. This resource will allow physical therapist and physical therapist assistant educators to tailor content to their programs while instilling ethical principles in future therapists.
Addressing sexual misconduct and boundary violations in physical therapy is not just an ethical imperative—it is a commitment to the safety and well-being of patients and the integrity of the profession. By understanding power dynamics, prioritizing informed consent, embracing cultural competency, and investing in education and support systems, physical therapists can create a safe and respectful environment for all. As the profession continues to evolve, it is important for state boards to interact and collaborate on additional resources and strategies to help better protect the public.
The committee remains dedicated to developing resources, fostering accountability, and promoting a culture of respect. Through initiatives like educational modules, testimonial videos, and enhanced outreach efforts, the FSBPT’s Sexual Misconduct and Boundaries Committee is paving the way for a safer, more ethical profession.
Sherri Paru
Sherri has served as the clinical advisor and investigator for the Oregon Board of Physical Therapy since 2002. Sherri is currently the chair of the Sexual Misconduct and Boundaries Committee for FSBPT. She has served on the FSBPT’s Education and Nominating committees and was awarded the FSBPT Outstanding Service Award in 2021. Sherri is a certified investigator through the Council on Licensure Enforcement and Regulation (CLEAR) and serves on several CLEAR training and planning committees. Sherri has presented at the annual meeting for the FSBPT, FSMB, and CLEAR on the topics of investigations, ethics, and professional boundaries.
Mira Mariano
Mira Mariano is serving her second term on the Virginia Board of Physical Therapy and is Vice-Chair after previously serving as Chair. She is faculty in the DPT program at Old Dominion University with a master’s degree in Orthopedic physical therapy and PhD in urban services and urban education from the same institution. Mira's bachelor’s degree in physical therapy is from the University of Pittsburgh.
She is board-certified as an Orthopedic Clinical Specialist since 1999 and she continues her clinical practice in concierge physical therapy at ODU Monarch Physical Therapy. She is engaged in professional service on the FSBPT Sexual Misconduct & Boundaries Committee, mentoring students, and scholarly activities in fall risks, physical therapy education, and incontinence in female athletes.
Samantha Mohn-Johnsen
Samantha is an Associate Professor and the Director of Clinical Education for the Department of Physical Therapy at the College of St. Scholastica. Samantha completed her doctor of physical therapy training at the University of Wisconsin- La Crosse in 2008 and has an educational doctorate in healthcare education and leadership from Clarkson College in 2018.
She has practice expertise in both orthopedics and pediatrics and currently practices locally in inpatient pediatrics and the NICU. She is an active member of the MN State Board of physical therapy and participates in regulation at the national level as a member of the Sexual Misconduct and Boundary Issues Committee.
Michael Noonan
Michael is a member of the FSBPT Sexual Misconduct and Boundaries Violation Committee. He served for fourteen years on the Rhode Island state Licensure board for Physical Therapy. He also served as the president, treasurer, and legislative committee member of the Rhode Island APTA. He owned and operated a private practice for thirty-two years. Michael was a founding member and president of the Physical Therapy Private Practitioners Group of Rhode Island. He has served as a Pastor at Living Truth Church since 2000.