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The physician-patient relationship is the cornerstone of psychiatric practice, and its goal is to promote patient health and well-being, embodying the key ethical considerations of respect for persons, fairness or equity, and beneficence. This is no ordinary relationship however, as the power differential between a physician and a patient, as well as the patient’s dependency on the physician for help managing their healthcare needs place the patient in a vulnerable position.

Strict therapeutic boundaries are therefore required to ensure that the psychiatrist does not take advantage of or exploit a patient and to ensure that there is no appearance of impropriety in the psychiatrist-patient relationship. While not all boundary crossings are harmful, the risk of harm is so high that the psychiatrist must be alert to all boundary crossings. It is the obligation of the psychiatrist and not the patient to protect the boundary as its violation may cause harm to the patient.