At Rula, we’re committed to supporting both patients and therapists in creating a space that is safe, respectful, and conducive to healing. When a patient violates Rula’s Code of Conduct, it’s not just a procedural issue—it’s a moment that invites clinical reflection, boundary-setting, and often, compassionate redirection.
This article offers support for navigating those moments: you’ll find examples of what to say, how to assess the clinical context, when to end a session, and what steps to take afterward.
The Clinical Value of Boundaries
Maintaining boundaries isn’t punitive—it’s therapeutic. When you set clear expectations and follow through with care, you’re helping patients:
- Understand and repair relational patterns
- Practice emotional regulation in the context of a secure relationship
- Learn what safety and mutual respect look like in real time
- Engage in therapy that protects their dignity and yours
- By following best practices and standards of care
Setting boundaries supports clinical outcomes and protects the therapeutic alliance.
Before You Respond: Clinical Considerations
When a patient violates the Code of Conduct, it’s helpful to pause and reflect on what might be driving the behavior:
- Is this a trauma response? Some patients may react with anger, dissociation, or hypervigilance that feels disrespectful, but is rooted in survival strategies.
- Is this related to a diagnosis? Symptoms of mania, psychosis, personality disorders, or neurodivergence may present as boundary-pushing behavior.
- Is this a learned relational pattern? Patients who’ve never experienced healthy limits may test them unconsciously as part of building trust.
- Is this an intentional strategy to cause harm? In some cases, the behavior may be deliberately harmful and must be addressed directly.
You don’t need to know why in the moment, but holding curiosity can help you choose your next step with both clarity and care.
What Not To Do
Don’t take it personally or react in the moment. Strong feelings are normal, but pausing helps you stay grounded. Lean on Rula afterward to process and reflect.
Don’t make promises you can’t guarantee. For example, avoid assuring a client they’ll be re-matched. When conduct involves serious boundary violations, Rula investigates and determines next steps about their continued ability to remain in care at Rua.
Don’t stay if you feel unsafe or if your boundaries are crossed. Your safety and well-being are as important as the care you provide. Trust your instincts and step away if needed.
Don’t keep it to yourself or turn it inward. Document what happened and reach out for consultation and support. Difficult encounters are not a reflection of your worth or skill—they’re opportunities to strengthen boundaries and resilience.
1. Set Expectations Early
Introducing the Patient Code of Conduct during early sessions can help prevent future issues and give you language to refer back to if concerns arise.
Suggested Script:
“To make this a space that feels safe and productive for both of us, I want to share a quick note about expectations. Rula has a Code of Conduct that applies to all sessions and communication, which includes treating each other with respect, avoiding harmful language, and maintaining professional boundaries.”
Framing this as part of the therapeutic container sets a collaborative tone.
2. When to Give a Therapeutic Warning
If the behavior violates the Code of Conduct but is not immediately threatening, you can offer a gentle but firm warning. This is often clinically appropriate, especially when the behavior may stem from dysregulation, past trauma, or interpersonal dynamics.
Suggested Script:
“I want to check in for a moment. Some of the language/behavior today doesn’t feel aligned with the safe space we’re working to create. If it continues, I’ll need to end our session early. Let’s take a breath and talk about what’s coming up.”
“I can tell that you are not in a private setting right now. I want to ensure the confidentiality of our conversation and so you can fully participate without being overheard. I’d like you to move to another area or we will end this session early. Having a session in a public space is against Rula’s policy.”
“Driving your car during sessions isn’t safe and it’s against Rula’s policy. I’d like you to pull over and park somewhere safe or we can reschedule for when you’re back home.”
This language protects the therapeutic space while offering an opportunity to repair and re-engage.
Navigating Ambiguity: What if You’re Not Sure?
Some moments aren’t so clear-cut. The behavior may feel off, but not severe. In these cases, hold space for clinical curiosity.
Ask yourself:
- How does this relate to the client’s presenting concerns?
- Does the patient show insight or willingness to repair?
- Is there a repeated pattern of behavioral conduct in session or communication?
You might choose to explore further with the client, rather than issue a warning right away:
Suggested Script:
“I’m noticing some tension in how we’re connecting today. I want to make sure we stay grounded and aligned in this space—can we talk about what might be coming up?”
Use your discretion. If the behavior escalates or continues, you always have the option to pause, issue a warning, or end the session immediately.
3. When to End a Session Immediately
There are times when ending a session is the most ethical, therapeutic choice. Use your clinical judgment to end a session immediately if:
- The patient is threatening, harassing, or sexually inappropriate
- Hate speech, targeted insults, or discriminatory language is used
- You feel unsafe or unable to remain grounded as the provider
- A significant boundary has been crossed and cannot be repaired in the moment
Suggested Script:
“I’m ending the session now due to a violation of Rula’s Code of Conduct. This behavior isn’t acceptable in a therapeutic space. You’ll receive follow-up from our team shortly.”
This moment may later become a turning point in care—or a necessary boundary to preserve your well-being.
What Not To Do
Try not to take it personally or react in the moment—we’re here to support you to process afterward.
Make promises about what will or won’t happen. For example, telling a patient they will be re-matched with another provider. If their conduct is a serious violation Rula may determine we can no longer provide services to them.
Stay in a session if you feel unsafe or if your personal or professional boundaries have been violated—your mental health matters too.
4. What to Do Afterward
If a Code of Conduct issue arises, please document the incident in the progress note for the session. We also ask that you complete an Adverse Incident Form within the same day. This supports safety tracking, follow-up planning, and coordinated care.
Please include:
- A factual description of what occurred
- Whether a warning was given or the session was ended
- Any notable quotes or actions
- Your recommendation (e.g., continue with new boundaries, refer out, discontinue care)
- If your recommendation involves you choosing to discontinue care for this patient, we ask that you complete a discharge note, as well.
- If you are recommending a rematch to another Rula provider, please use this form and include as much information as possible to help Rula find an appropriate provider.
This helps ensure the patient receives appropriate follow-up, while protecting your time and safety.
Your Safety Is Our Priority
One or more of the following actions may occur in response to our investigation of the Adverse Event:
- A member of the Patient Programs Team will review the Adverse Event, and may contact you for additional information (e.g. like requesting screenshots of harmful messages) and to offer support.
- Re-match your patient to another Rula provider or refer out to other services if appropriate
- Issue a warning to the patient that if their behavior continues they may be removed from the Rula platform
- Instate an immediate lock on the patient’s account so they cannot schedule with any Rula provider
- Block emails from specific addresses
- Report criminal behavior to the authorities
If you feel unsafe or emotionally impacted, we encourage you to reach out for 1:1 consultation with a member of our Patient Safety team. You deserve care too.
5. Documentation Tips
When documenting in your clinical note:
- Use clear, objective language
- Describe what was happening before the client’s action/language.
- Focus on observable behavior, not assumptions about intent
- Note any clinical rationale for your response
- Document any statements used by the patient (e.g. “Patient stated ‘xxxxxxx’”)
Per CPT billing requirements, if a session ends early, only the actual face-to-face time with the client may be billed.
Example:
“The patient used sexually explicit language directed toward the therapist. The therapist issued a warning, referencing Rula’s Code of Conduct. When the behavior continued, the session was ended early.”
Avoid value judgments like “inappropriate” unless you clearly define the behavior.
6. Growth-Oriented Repair (When Appropriate)
If the moment of concern was not egregious and the patient remains engaged, consider whether a repair conversation might be helpful in the next session. This can be an important therapeutic opportunity to process what happened, reinforce boundaries, and build trust.
Suggested Framing:
“I want to revisit something from our last session. I care about your progress here, and part of our work is building a space where we both feel safe. What happened impacted that, and I’d like us to talk through it together.”
Only re-engage if it feels safe, clinically appropriate, and aligned with your capacity.
Difficult sessions can be draining, even for experienced clinicians. Rula’s Patient Safety Team team is here to support you in navigating tough moments with grace and clarity. Whether you need a sounding board, a second opinion, or just a place to process, we’re in your corner.
Boundary-setting isn’t about being punitive, it is about protecting the therapeutic setting, honoring values, and guiding patients toward healthier ways of being.
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