Sometimes, the potential of an ethical violation we face with a client becomes so subtle and complex that we may alienate clients when we’re trying our best to protect them. Regardless of how careful and painstaking we try to be, the vagaries of life, human temperament, and personal limitations can be counted on to prevent us from ever becoming proud of our own perfection.
Louise, a client who was a caterer, had entered therapy with a history of childhood sexual abuse from several people close to her and a violent first marriage. She had a pattern of wanting to be the favorite of teachers and other authority figures, which led to many one-sided relationships where Louise’s needs weren’t be met or even recognized.
Although I regularly give my boundary issues and safety spiel to everyone in the beginning stages of therapy, it was clear that with Louise, this discussion was crucial. I assured her that I wouldn’t be a person in a position of power who’d use her as my prize.
Then one day, I got a call from my son informing me that he had hired Louise’s catering company for his upcoming wedding. Now what? Clearly, I couldn’t tell my son, “You can’t use her; she’s in therapy with me,” without compromising her confidentiality. I had to have a conversation with Louise, and luckily, I thought, we had spent a lot of time discussing boundary issues, so we were both prepared for this discussion and it should go fairly smoothly.
But Louise walked into her next appointment with a huge smile and excitedly told me the news of her catering my son’s wedding. She was under the impression that since she would be paid for her work, rather than doing it for free, mitigated any concern of an ethical violation.
I explained to her that her catering the wedding was not only an ethical violation of my own personal sense of ethics, but it was also an ethical violation of the official ethical codes of social workers and family therapists.
She immediately became angry and told me I couldn’t stop her, as the catering plans were between her, my son, and his fiancée, and I was the one with the problem, not her. At this point, some might reason, “This is really not such a big deal,” but not only was it an “official” ethical violation, it was an avoidable dual relationship.
I was convinced that allowing Louise to cater the wedding would compromise her therapy. I wasn’t going to become another in the line of teachers, guides, or mentors who used her talents to benefit or satisfy themselves. Louise’s pattern was to take care of others in order to feel good about herself.
Louise and I began exploring both the positive and negative consequences of her catering or not catering the wedding. We also explored her personal history as it related to the current problem with a renewed immediacy. As we spoke and she began to truly take in what I was saying, her eyes started to tear up. “I get it,” she said softly. “This relationship has changed my life and I don’t want to risk it. I’ll find some way of cancelling the job with your son.”
What constitutes an ethical violation may seem obvious until you get embroiled in one. Most of what takes us, as therapists, close to the “no-go” line aren’t the biggies (sex, expensive gifts, business partnerships), but the less obvious ones, which make hard cases in the end. At the margins, many times an ethical violation is really a judgment call.
Mary Jo Barrett
Mary Jo Barrett, MSW, is the founder and director of Contextual Change and coauthor of Treating Complex Trauma: A Relational Blueprint for Collaboration and Change and The Systemic Treatment of Incest.