The recent decision of the Psychology Board of Australia v Frances (Review and Regulation) [2022] VCAT 372 is a reminder to psychologists of the importance of establishing and maintaining professional boundaries with all clients. It is clear that failure to do so, even when the circumstances do not amount to exploitation or sexual conduct, can result in censure.
This article provides an overview of the decision and its implications for psychologists.
Background
Ms Robyn Frances has been a registered psychologist since 1993. The proceedings concerned two notifications made to Ahpra. The first notification, made on 22 January 2016, arose after Ms Frances consulted with her client, W1. She then wrote and signed a letter addressed to W2, W1's then wife. The letter allegedly advocated for W1 with regard to matters outside the scope of her professional practice, namely parenting plans and child access arrangements. Ms Frances' evidence about this letter was that the letter was intended to be a draft only, to assist W1 in preparing his own letter.
The second notification was made on 14 August 2017 and concerned clients W3 and W4, to whom Ms Frances provided both individual and couples' therapy. At the conclusion of a therapy session with W3, Ms Frances discussed with W4 some building work that she wished to have completed at her private residence. Subsequently, Ms Frances emailed W3 and W4, listing the work she wanted performed. This email was sent while she was providing ongoing services to W3. Between April and December 2016, she engaged W3 to undertake building work. It became apparent that W4 envisaged that Ms Frances would be providing ongoing psychological services to W3 while he worked on her house. This is not what occurred and it would be a breach of the APS Code of Ethics, had Ms Frances provided care in that setting. The fact that W4 became frustrated that Ms Frances was not providing therapy to W3 while he was working at her house and that W3 had shown no improvement throughout his time doing the building work, represents one of the risks of mixing a treating relationship with a non-treating relationship.
After the first notification was made, the Psychology Board of Australia (the Board) took immediate action under section 156 of the Health Practitioner Regulation National Law (the National Law) and suspended Ms Frances' registration on the basis that Ms Frances' practice posed a serious risk to persons.
Ms Frances appealed this decision and in March 2018 the Victorian Civil and Administrative Tribunal (the Tribunal) stayed the immediate action decision but imposed conditions on Ms Frances' registration, requiring her to obtain regular supervision from an experienced practitioner.
In December 2018, following an investigation into the two notifications, the Board referred five allegations to the Tribunal. The National Law mandates referral to the relevant Tribunal if the Board reasonably believes the practitioner has behaved in a way that constitutes professional misconduct. Misconduct is defined in the National Law as unprofessional conduct that is substantially below the standard reasonably expected of health practitioners of equivalent level of training or experience.
The Tribunal conducted three separate hearings to come to its final determinations in this matter.
Findings of fact decision
The first hearing was conducted in 2019 and the Tribunal made findings of fact on the allegations made by the Board. The Tribunal was satisfied that each of the allegations had been proved.
With respect to the first notification, the Tribunal found that by writing a letter to the partner of her client, Ms Frances acted outside the scope of her clinical practice, failed to consider the impact of the letter on the client's partner, and engaged in advocacy on behalf of her client. The Tribunal did not accept Ms Frances' evidence that she did not intend for the letter to go to W2 as written from her but from her client, W1.
In terms of the second notification, the Tribunal found Ms Frances:
- Actively engaged in a discussion of a future non-professional relationship while a professional relationship was in place. This created a risk of multiple relationships and, in doing so, Ms Frances failed to manage the reasonably foreseeable consequences of her conduct;
- Failed to exercise appropriate clinical judgment as she did not properly consider the professional implications of having W3 undertake building work for her. On becoming aware of the impact on W4 of her conduct, the action she took was ineffective because of her failure to give proper consideration to her overarching professional obligations;
- Failed to make and keep sufficiently detailed records of the services provided to W3 and W4. The records she did make fell substantially below the standard expected; and
- Did not regularly seek professional supervision or consultation either in relation to particular matters, or generally.
Characterisation of conduct decision
In June 2021, the Tribunal determined that Ms Frances' conduct satisfied the definition of unprofessional conduct as set out in section 5 of the National Law. Unprofessional conduct is defined as professional conduct that is of a lesser standard than that which might be reasonably expected of the health practitioner by the public or the practitioner's professional peers. We note that the Tribunal did not characterise her conduct as professional misconduct, despite the Board's referral seeking such a characterisation.
In reaching this decision, the Tribunal noted at [39]:
"The provision of psychological services creates a special relationship which necessarily involves a degree of vulnerability for each client. The nature of the relationship and the nature of the training and expertise of a registered psychologist, make it imperative that registered psychologists are vigilant in managing potential impacts of their conduct on the client, including boundary issues".
Determination decision
After a further hearing on 12 April 2022, the Tribunal handed down its decision to impose a reprimand on Ms Frances' registration. The Tribunal found that, while Ms Frances' conduct did not involve exploitation or sexual conduct, it was nevertheless unacceptable. The Tribunal believed it was appropriate to reprimand Ms Frances to send a clear message to the public and to the profession that her conduct was unacceptable.
As the Tribunal noted at [91]:
"It is well understood that a reprimand is not a trivial determination. For a professional person, it has the potential for serious adverse implications. A reprimand is a professional rebuke and signals that the conduct is condemned. It tells the public, clients and other practitioners that the standards expected of a practitioner have not been met and that the practitioner has been censured."
The Tribunal emphasised that its role in making a determination is to protect the public and the reputation of the profession. At [76] the Tribunal reiterated that "the purpose of determination is not to punish the practitioner, although a decision may involve a degree of punishment for the purpose of specific deterrence, that is, to deter the individual from repeating their misconduct, or for general deterrence, that is to warn others in the profession against similar misconduct."
The Tribunal did not believe Ms Frances represented an ongoing risk to the public. It noted that Ms Frances had undergone some 40 months of supervision since the Tribunal imposed conditions in March 2018, and had provided evidence of her supervisor's support. As such it concluded that the need for specific deterrence was low in this case. The Tribunal did not find there to be a continuing need for conditions on her registration.
The Tribunal also considered general deterrence would be addressed sufficiently by the reprimand imposed, as well as the publication of its reasons (and its previous decisions) as well as the lengthy period of supervision Ms Frances has already undertaken.
Implications
This case highlights the importance of psychologists being aware of, and taking steps to establish and maintain proper professional boundaries with clients at all times. While the failure to maintain professional boundaries is often associated with romantic or sexual relationships, this case demonstrates that, even by engaging in apparently innocuous conduct, a psychologist can risk creating multiple relationships and blurring professional boundaries.
Ms Frances was subject to suspension, extended periods of supervision and was ultimately reprimanded, which is in itself a significant censure. The fact that the litigation in this matter extended for several years is a reminder of the need for psychologists to be vigilant in establishing professional boundaries and attentive in carefully maintaining boundaries with each and every client.
