Therapist, counselor or psychologist: Is seeing your client’s family member, best friend or ex ethical? Ethics, boundaries and hidden pitfalls

If you are a coach, therapist, counselor or psychologist, there are many reasons to avoid a certain therapeutic pitfall. This is the pitfall of seeing good friends, family members, abusers or ex’s of your established clients.

If you live in a small rural town, there could be exceptions. Wherever we live, ethics and boundaries should be kept in mind. In the pursuit of “Do our client no harm”, how would our clients feel if we saw their ex’s? Their spouses? Their best friends? Their abusers?

As a caregiver and certified coach, I enjoy writing about ethics which would benefit the service and care for others. The truth is that when ethics and boundaries are violated, life gets more difficult (for not only the client, but for the coach or therapist as well).

Imagine these dicey scenarios of boundary crossing…

  • You have been seeing a client, Linda, for over one year now. Linda came to you for the treatment of betrayal trauma from her mother and spouse. Linda trusts you and has made great progress. One day, her mother shows up to an appointment with you for the first time. This is the mother that your Linda continually vents about! Linda and her mother do not share the same last name, but Linda has told you her mother’s last name before. The fact that they are related doesn’t “click” for you until the fifth session. What do you do? Linda is bound to find out, and it will register as a severe betrayal for her. At the same time, Linda’s mother doesn’t want to be abandoned.
  • Linda also sees you for help with the trauma of physical abuse from her sister. One day, Linda’s sister shows up at your office for mental help because she is going through a hard time. You don’t realize until eight sessions in that she is Linda’s sister (they don’t share the same last name either). What do you do? Are you obligated to see the sister? If Linda found out, which is bound to happen, she would not trust you anymore. The reason Linda was coming to you in the first place was for betrayal trauma and trust issues!
  • You are fully aware that Linda was raped when she was a teen. You know the first and last name of the perpetrator. You are now seeing the rapist who has come to you for help. This doesn’t “click” for you until halfway through the first appointment. Your scheduler did not inform you of the name of your new client. Linda would be traumatized if she found out you saw her abuser. What on earth do you do now?

As long as you keep everything “confidential” between the parties, the above scenarios are no problem, right?

Wrong!

To our own peril and that of our clients, we don’t often think of these situations as ones that would lead to unethical violations of the established client’s personal boundaries.

My friends, as coaches and mental health caregivers, when a client comes to us, they are putting their trust in us. Many of our clients are already suffering from relational and betrayal traumas. For so many of us, it takes a lot of courage to open up to someone. Trust is the foundation of any good alliance! It can be easily broken, and it’s not easily repaired.

There are many reasons why you and I, as a coach, therapist, counselor or psychologist, should not touch these scenarios with a ten-foot pole. This is not only for your client’s good, but for ours! We might be tempted to think or say, “I am fully capable of remaining objective, neutral and keeping total confidentiality between parties.” While that could be partially true, please be aware that even with our best intentions, we will not be able to avoid subconscious bias and other pitfalls of the inevitable triangle. We will probably not be able to preserve our client’s trust and their view of our loyalty (especially, in Linda’s case). Besides, there is much more to the story than confidentiality!

The 2014 ACA Code of Ethics (Section A.5.d. “Friends or Family”) says,

“Counselors are prohibited from engaging in counseling relationships with friends or family members with whom they have an inability to remain objective.”

https://www.counseling.org/knowledge-center/ethics/code-of-ethics-resources

Violations and compromises of trust, loyalty and neutrality – the hidden pitfalls unseen by the coach, therapist, counselor or psychologist

Why don’t the ethics boards at the APA and NASW address these issues more thoroughly? Shouldn’t there be clearer, more detailed protocols as to protect human relationships in these problematic situations?

Alas, the hidden pitfalls of treating your client’s best friend, spouse or ex!

The problem is that therapists often believe that because they have the ability to “remain confidential” or “honor HIPAA”, there is neither risk nor concern. The truth is there is high risk to do horrible damage to the client and the therapeutic relationship. These scenarios can totally destroy trust. Therefore, a risk/benefit analysis needs to be done before taking on a client’s best friend, enemy or relative! Better yet, avoid it like the plague! Remedy these situations as best you can!

Good intentions don’t matter all that much. If we have made some of these mistakes, let’s not fall into the trap of “I had the best intentions for my client; there was no ill will.” The consequences of our actions are the same. Even with the best intentions, seeing certain friends, close family members or abusers of clients has a high potential to damage or completely destroy the following:

  • The client’s trust and and view of the therapist’s loyalty. Trust is the basis of any relationship. Linda could start to feel disloyalty from the therapist. If Linda has relationship problems with Client B that the therapist knew about (or didn’t), feelings of distrust and disloyalty could become overwhelming to Linda. Linda could feel that she was betrayed or cheated on – not only by the therapist, but in some cases, by the new client. Client B could also share information about the therapist with Linda that would betray Linda’s trust and sense of loyalty. For example, if Linda and Client B are in a dispute, Client B could tell Linda that the therapist thinks a certain way about the dispute.
  • Neutrality. It doesn’t matter if we think we are such amazing coaches, psychologists or therapists that we could remain neutral and keep information shared in sessions separated and private. Even if we could, Linda would suspect that we couldn’t. In turn, this leads to more distrust. Any hint of siding with the new client creates distrust for Linda, who already has trust issues. In fact, we don’t even have to try for this to be a problem! It will be a problem for both clients. Even the appearance of information blurring from session to session will destroy the therapeutic alliance. As a therapist, this is bound to happen, even by accident. Intent aside, the effect on the client is the same.
  • Honor of human relationships. That is, Linda’s relationship with Client B as well as our relationship with Linda. One goal of therapy is to do our client no harm (malfeasance) and to honor/respect his or her personal boundaries. The NASW Code of Ethics promotes the value of human relationships. Inevitably, a tricky triangle develops in these scenarios. Linda didn’t ask for this; it has crossed her boundaries and comfort zone. For instance, the therapist cannot defend himself or herself if Client B says something about the therapist to Linda due to HIPAA regulations. This pushes Linda deeper into a gray area of unknowns as the therapist’s “hands are tied” due to now seeing Client B. Linda is harmed in the process of tied hands, which is antithetical to the goals of therapy.
  • Honor of the sanctity of our relationship with the client. Let’s face it. When a triangle is formed between parties A, B and C, it only gets hairy. What once was a trusting alliance is now contaminated and complicated. This is unfair to Linda because this is not what Linda signed up for when coming in for therapy. Intent aside, this registers as a betrayal for Linda. Since Linda came in for betrayal trauma, fear of abandonment and other relational issues, this can get messy and stressful for all.
  • Freedom to discuss life problems. Linda may feel now that she needs to talk about situations that involve client B (either to a greater extent or to a lesser extent). This totally interferes with therapy and what truly needs to be addressed in sessions.
  • Freedom from unneeded relational burdens. In some cases, if Linda is feeling empathetic, she will worry and experience guilt if Client B does not get therapy. This creates more anxiety and stress for Linda.
  • An alliance free of future conflict of interest. Even if the relationship is not complicated at present, it could become that way in the future. By taking in Client B as a patient or client, we are unknowingly giving Client B power over Linda (even, power to emotionally or verbally abuse Linda). This is an unfair use of the power dynamic too: when we allow a new client power over an existing client. It is a dilemma no matter what, but it is more unethical if we already knew that Linda was abused by Client B!
  • The established client’s finances and work life. If Linda and Client B are business partners or own property together, now we are interfering in their business relationship or even their finances, when tension arises because we neglected to avoid or fix the situation! Now, we are part of the peculiar business triangle. For example, Client B tells Linda that you said something about Linda in a session about the their mutual business dealings. Due to privacy laws, we cannot explain to poor Linda what really went down during the session. Our hands are tied, and Linda suffers. This creates more distrust between all parties leading to poorer mental health for all.
  • Confidentiality and privacy. I put this last for a reason! Linda only wants to share certain parts of her life in therapy. When Client B enters the warped triangle, this becomes a sort of violation of personal boundaries for Linda. It allows for an outside source to bring in information about Linda’s life situations, some of which Linda might not want shared or addressed. It affects neutrality, even subconsciously. It definitely creates extra, unneeded anxiety for Linda! It lends to a feeling of powerlessness, and creates resentment and a sense of personal boundary violation in the therapeutic alliance and the relationship between Linda and Client B. Linda worries that information will get leaked, even subtly.

Tell your coach, therapist, counselor or psychologist how you feel!

If you are the client, there are many reasons why you should think twice before revealing the name of your coach, therapist, counselor or psychologist to your ex, close friends and family members (especially, if the relationships are complicated and/or adversarial in nature). You know, it never hurts to inform your therapist of those individuals that could harm your alliance.

Sooooooo….my dear coach, therapist, counselor or psychologist – what do you say? Do you also think that seeing your client’s best friend, family member or ex is a poor idea? Situations vary case by case. Bad intent is usually not the case. In my opinion, intent and motive are neither here nor there! What matters is the client’s harm – the effect. At best, these scenarios, if not fixed, are ethical dilemmas. At worst, if they are not remedied, are severe ethical violations.

What can be done?

https://www.self.com/story/should-i-see-my-friends-therapist

Thanks for reading!

COACH, THERAPIST, COUNSELOR OR PSYCHOLOGIST, Ethics in therapy, counselor, psychologist, therapist, therapy, confidentiality, HIPAA, Neutrality, Loyalty, Ethical Codes, APA, Trust