Standard 1.6: Conflict of Interest

RPs must be alert to any circumstance where a conflict of interest may develop or may be perceived by others and respond by taking appropriate action. Most conflicts of interest are preventable if the situation is avoided at the outset.

Not all conflicts of interest are of equal concern. Some situations may be very serious and must be avoided entirely. There are other situations where a conflict of interest may develop, but is unavoidable, or not in the best interest of the client to avoid. These situations must be managed carefully.

An example of the latter could include working in a small or isolated community where a registrant may be the only person who can provide psychotherapy services to local residents. As a result, the registrant may provide psychotherapy to someone who is also their mechanic, hair stylist, lawyer, doctor, etc.

The following are some examples of situations that place a registrant in a conflict of interest, and potential mitigation techniques:

• Accepting a benefit for referring a client to any other person.
  A benefit is any advantage or gain, whether direct or indirect, and whether or not it is monetary in nature. A conflict may exist even if the benefit is not to the registrant directly, but to a related person or related corporation. A related person is someone connected with the registrant by blood, marriage, common-law, or adoption. A related corporation is a corporation that the registrant or a related person wholly or substantially owns. A registrant refers a client to another service provider only if the client requires or requests the service. The registrant shall choose the place of referral solely on the basis of merit and benefit to the client, and not because the registrant hopes to receive a benefit as a result of that referral.

Additionally, accepting commission fees or otherwise benefitting materially from providing referrals to other professionals is prohibited under Standard 1.9.4.

• Offering a benefit for receiving a referral.
  This situation is the inverse of the previous one. Referral recommendations must be made solely for the benefit of the client. Referrals for the benefit of the registrant can promote unnecessary services.

• Offering a benefit to a client where the registrant’s services are being paid for by a third party.
  Where a third party pays for the service (e.g., an insurance company), it is inappropriate to give the client gifts to encourage them to continue therapy. Inducing a client to come in for a service paid for by a third party through gift-giving promotes unnecessary treatment and could involve fraud. The giving of a small, health-promoting product is acceptable (e.g., a free stress ball).

• Accepting materials or equipment.
  A registrant shall not accept a benefit in the form of materials or equipment in return for using or recommending a supplier’s product or service. The registrant’s choice of product or service shall be based solely on quality for the client. This does not preclude acceptance of nominal gifts (e.g., a small number of free sample stress balls).

The following are some examples of situations that place a registrant in a conflict of interest, and potential mitigation techniques:

• Using premises or equipment without reasonable payment.
  This example is given to prevent registrants from placing themselves in a conflict of interest with a landlord or supplier (e.g., obtaining the use of a free or low-cost office from someone who could benefit from a registrant’s recommendations to clients). Registrants pay for all premises and equipment at a reasonable, market rate. Otherwise, there is at least an appearance that the registrant will favour the landlord or supplier in the registrant’s recommendations.

• Entering into an agreement or arrangement that interferes with the registrant’s ability to properly exercise their professional judgment.
  A registrant may not enter into an agreement or arrangement, or coerce another registrant into an agreement or arrangement, which prevents the registrant from placing the needs of clients first. For example, an agreement that a registrant will provide a certain treatment to all clients is improper because decisions must be based on an assessment of each client’s individual needs. Avoiding this type of conflict reassures the public that, despite any contractual obligations, the registrant will always place the needs of clients first. Registrants may describe this rule when negotiating agreements with other parties.

• Engaging in any form of revenue sharing except in specific circumstances as set out below.
  In some practice arrangements, a registrant might not receive the entire fee paid by the client or a third party for providing professional services but may share it with others within the organization or practice. To avoid a conflict of interest, registrants may share revenue only with one or more of the following: i. another registrant of the College; ii. a member of another regulated health profession; iii. a health professional corporation; iv. A social worker or social service worker or a professional corporation for a social worker or a social service worker; or v. any other person if there is a written contract with the person stating that the registrant will have control over, and be responsible for, their own professional decisions, and for maintaining professional standards.

• Selling a product to a client or recommending a product that is sold in any premises associated with the registrant, without first advising the client that they may purchase the product elsewhere without affecting the client-practitioner relationship.
  A registrant may not pressure the client into purchasing products from the registrant’s practice or the registrant’s landlord. Avoiding this type of conduct assures the public that any sale or recommendation made by the registrant is in the client’s interest only. It also gives the client the opportunity to obtain products elsewhere, perhaps at a lower price or at a more convenient location. If recommending a product to a client that is sold in any premises associated with the registrant, the registrant also issues a written description of the product. In addition, the registrant advises the client that they may purchase the product elsewhere without affecting the client-practitioner relationship.

Registrants often receive referrals of new clients from current or past clients. It is often acceptable to treat clients who know each other. However, when one of those clients discusses the other in therapy, the RP may not be able to promote the interests of all clients equally. This amounts to a conflict of interest. Treating clients who know each other could also increase the likelihood of a breach of confidentiality, as an RP may inadvertently disclose – either verbally or through body language – what another client has told them.

Generally speaking, it is best to exercise caution when separately treating individuals who know each other, and to avoid treating individuals who are in conflict with one another.

When deciding whether it is possible to continue the therapeutic relationship with one client who knows another, an RP must consider several factors. These include but are not limited to:

• • The ability for the RP to remain objective
  • The ability for the RP to uphold client confidentiality
  • Whether any mitigating efforts – like limiting topics of conversation in therapy – would be fair to the clients in question

• • Whether the RP thinks they can successfully redirect a conversation that approaches the conflict of interest
  • The availability of comparable services
  • The stability of the client in question

Practitioners in small communities are at an increased risk of encountering a conflict of interest. As a result, RPs in small communities should make an effort to mitigate potential conflicts of interest before they arise.

For example, an RP could integrate a discussion of conflict of interest into an intake session, noting an increased likelihood for a potential conflict of interest and the procedure to manage any conflicts that arise.

Additionally, RPs operating in small communities where a conflict of interest occurs must be aware of how power dynamics may transfer from the clinical space or otherwise influence social relationships and actively seek to mitigate such effects.