Many people these days, during the pandemic especially, are suffering from stress, exhaustion, loneliness, anxiety and sadness. It’s understandable. Everyone struggles with something. Everyone is going through something hard!
Many choose to turn to a therapist for support. Sometimes, they ask around and find out who their friends or family members see. Maybe their friend tells them the name of a super therapist. This seems like a fine idea at first, but is it?
When two friends or family members see the same therapist, it is not a good idea for many reasons. It becomes especially problematic when the relationships are adversarial (like an ex). It creates a weird triangle.
The therapeutic relationship requires a whole lot of trust. Like any doctor-patient or therapist-client relationship in any field, trust is crucial. Psychologists and therapists are not treating broken limbs, though. They are dealing with the brain, the most complicated and complex organ of all. They are dealing with vulnerable clients who open up to them with very private details of their lives. The weird triangle can make people more vulnerable.
We are dealing with broken hearts and traumatized brains. Some people have a harder time with trust, like those who are going through relational issues. Or, those who have suffered abuse.
Therapists and psychologists are bound by confidentiality ethics (HIPAA). Confidentiality is key, but aren’t there other important ethical factors to consider? Are there factors that therapists overlook?
So often, therapists assume that the only issue is confidentiality. Total privacy is not the only factor that makes a therapeutic alliance great!
Neutrality and Loyalty
The therapeutic relationship is a sacred one. Like trust and confidentiality, neutrality and loyalty are paramount. Without these, it is not possible to have a good alliance and grow in therapy. It will be hard to talk about relationship issues about the friend, family member or ex-spouse who is also seeing your therapist.
The therapist can develop subconscious bias, even if he or she does not try. Feelings of disloyalty are bound to arise in certain cases. Even if a therapist does have the superhuman ability to remain neutral, the client might not view it that way. This interferes with the alliance.
Here is an example. You leave your therapy session having just vented about your traumatic experiences and trust issues with your ex. Shockingly, you bump into your ex in the parking lot when he or she is on the way to see your therapist!
Given that you were your therapist’s well-established client first, how would you feel? Stress with your ex, betrayal trauma from his or her cheating, and financial secrets were the reasons you were going to therapy in the first place.
Would this destroy your trust? Your view of your therapist’s neutrality? Your sense of your therapist’s loyalty to you? For many, this could be very damaging.
I have come across many cases like these
In rural communities, there is sometimes no getting around seeing the same therapist or counselor. This is because the population is so small that there are not enough to choose from. Consequently, your therapist could be your mother’s therapist too. You know this from the get-go.
In large towns and cities, this is usually avoidable.
Are there many therapists to choose from in your area? You might want to pick one that your friend, family member or ex is not seeing. You might want to be clear with your therapist about who you would not like them to see (like your ex or a previous abuser).
As coaches and therapists, we must be extra sensitive to these dynamics. If we aren’t, we could add to our client’s trauma. We are dealing with brains, not broken ankles. We don’t just treat the person who walks through the door. Our current clients come first. Many therapists already have rules against this.
We must give these issues more thought and care. There is high potential to cause the client harm if we don’t.
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?
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.”
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 offutureconflict 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.
Have you ever gone through something so peculiar and wondered, “Now what the heck was the point of that?” or “What good could possibly come of it?” Has it left you desperate for a word of comfort or encouragement?
I have found myself in this thought process in the past where situations didn’t make sense and all seemed like a giant heap of ashes. We all go through this. Situations can end up feeling like a giant wasteland.
Sometimes, we get to see the point of it all. Other times, we just don’t. It can feel frustrating because we don’t see the big picture.
One time, I felt that a situation was so horrible that nothing good could ever come out of it. Looking back, I see how the sad situation actually kickstarted an endeavor – a goal – which I ended up completing. I don’t believe I would have accomplished my goal had I not gone through the hardship. In the end, other people were helped and comforted. Also, I was strengthened, and I appreciate my new insights going forward.
There can be sweet that comes out of the bitter (sort of like turning life’s sour lemons into lemonade).
Take a look at this beautiful inspirational message from Mildred Page* who shares the following encouragement and wisdom:
“There are some scriptures that are so familiar that we tend to almost hurry by them and forget the benefit and grace they are meant to bring to our lives. Romans 8:28 is one of those verses. It says, ‘And we know that in all things God works for the good of those who love him, who have been called according to his purpose.’ Who doesn’t go through something in life that for all appearances doesn’t show any possibility of producing good in our lives? The world is full of circumstances that feel as if after the heat of the trial, all that could remain are ashes devoid of hope.
Let this verse in Romans, and God’s love comfort your heart and bring a peace of mind that no matter what you have gone through or are facing now, God promises that His love will actively work in it and weave his story in your life that will be for your good and bring glory to Him. He will be faithful to work in all things, and that leaves nothing untouched by His sovereign, loving hand.
Be strengthened with comfort and encouragement as you journey through difficult, seemingly impossible times that while God works in it for your good, He will be right by your side, helping and strengthening you, and holding you up.
Isaiah 41:10 ‘Do not fear, for I am with you. Do not be dismayed for I am your God. I will strengthen you. I will help you. I will uphold you with my righteous right hand.'”
“People seldom see themselves changing. It’s like going out in the morning or in the springtime to pick flowers. You pick and you wander ‘til suddenly you find that the light is gone and the flowers are withered in your hand.” – Zora Neale Hurston