Thank you to everyone who responded to our September Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
September Quandary: I recently moved to a small town and found out that one of my client’s children attends the same school as my nine-year-old son. The two get along well, and our family was recently invited to attend a barbecue at my client’s house. I feel uncomfortable attending, especially since my client has spoken to me about issues in her marriage, but don’t want to jeopardize my son’s friendship or my chance at having a social life in this new town. Should I stay home or go?
1) Examine Potential Outcomes
Dual social relationships are often unavoidable in small towns. If this was my client, I’d feel that this scenario would warrant an important conversation with her in advance about what could inexorably change in the therapeutic relationship if I attended the barbecue. Whether I'd attend or not would depend also on the psychological, social, and emotional functioning of the client and the possible implications for her marriage and family health. If I determined that both my client and I could handle difficult scenarios that might arise, and it wouldn't pose a considerable risk to our children’s social lives, I might consider attending.
After making my decision, I'd schedule a session with this client before the barbecue and listen to her response, underscoring that I’d be making the final decision. I might ask her questions like, If I went, would the guests know I'm your therapist? Why or why not? If not, given that confidentiality is one of the hallmarks of therapy, what are the implications of holding this secret at the social event? What might happen if our therapy relationship were leaked by another party? What might we do to avoid a confidentiality breach? I’d make suggestions too.
I’d also ask what she feels it might mean for our work together if our children became good friends. This could mean that our therapy might end prematurely. After my client is aware of the pros and cons of a dual-social relationship, I’d consider her preference. But above all, I’d emphasize my role in preserving and protecting the integrity of our work together.
Jason Linder, MA, LMFT
San Diego, CA
2) Protect the Therapeutic Relationship
In small towns, running into clients will most often be incidental. For example, your child might attend the same school as your client’s. You might cross paths at the grocery store. Or you might attend the same church. Sometimes, there are steps you can take to minimize these run-ins. For instance, if I was teaching a Sunday School class or leading a group at my church and found out a client or his family member was attending, I’d relinquish the role or find a time to teach when my client or his family wasn’t present.
However, in this situation, where the therapist has to choose between accepting or declining an invitation, the answer should be no, and they should explain their decision to the client during the next session.
If I was in this situation, I might also have to explain to my son why this decision was necessary. The future of his friendship with my client’s child would also be a point of concern. Given the circumstances, I’d probably allow my son to continue the friendship, since this is a small town with only a few schools and chances for socializing, and the children’s friendship technically falls outside the boundaries the therapist-client relationship. Still, I’d remain vigilant about these boundaries as the friendship progresses, and check in with my son about them if necessary.
Steve Harmon, LMFT
Spring Valley, CA
3) Stick to Your Ethical Guns
As a therapist, I’d consider attending a social event at a home of a client to be an unethical decision and entering into a dual relationship, as described and prohibited in the laws and ethics of professional counseling. Currently, the client has professionally engaged this therapist and is seeing them in a professional setting with complete confidentiality.
Once I step into a client’s home, a secondary relationship is formed that can alter our professional relationship and negatively impact our work in the consulting room. Additional, risks could come in to play if I attended a barbecue at a client’s home. Other guests might ask how I know the host, or I could be in a difficult position if the client introduced me as her therapist. Whether other guests know your role or not, hearing about your client’s life from other people could consciously or subconsciously influence treatment. Or, if I was to become friendly with other guests, my client could begin to lose trust in me as a clinician, perhaps worrying that I might inadvertently share confidential information.
We have an obligation to ourselves, our clients, and our profession to maintain professional conduct and professional client relationships, holding ourselves to high standards of ethical professional decision-making and behavior.
Debra Newman, LPC, MSED
4) Keep Your Work at Work
Dual relationships in small towns are often unavoidable. Since this client invited her therapist to the event and wants to foster a relationship between his and her children, I think it’s perfectly appropriate to attend with some caveats. If I was this therapist, I’d restate my commitment to confidentiality and then set strong, appropriate boundaries for when we’re together socially. In these cases, she must understand that I’m off the clock and discussions about therapy are unacceptable.
I’d also emphasize that blurring the line between therapist and friend could be detrimental to both of us. Professional relationships are very different from friendships and it’s incumbent upon us as therapists to maintain boundaries. In a social setting, I’d want to keep our discussion light and friendly, being careful not to self-disclose too much or discuss her problems in detail. Judgment about this woman’s husband must be suspended as well.
If this client is unwilling to adhere to boundaries, then it’s crucial to have a discussion with her about terminating therapy and finding her a new therapist. Remember: you’re the professional here, and you’re in charge of the situation. And, of course, document, document, document!
Suze Smith, MS, MSED, PCC
5) Find a Happy Medium
If this was my client, I’d want to have a conversation with her—before the scheduled barbeque—to ask her whether she was part of the decision to invite my family to the event and how she feels about me being there. I’d assure the client that her feelings of safety and the confidentiality of our relationship are of upmost importance to me as her therapist, and for that reason I’d like to discuss the issue with her.
It’s important to ensure that personal encounters don’t intrude on the therapeutic relationship. I’d tell this client that there are several ways we can decide to handle this issue and that I’d like us to find the best one for both of us. Then, we’d explore options by examining potential problems in continuing therapy while facilitating our children’s friendship. Of course, my comfort level would be determined by the complexity of the issues this client is dealing with and my ability to keep our contact outside the office from affecting how I work with her.
If it looks like encountering this client outside of the office will be inevitable, I might tell her that we’ll need to find her another therapist so we can continue to see each other socially.
Sheri Levens, LMHC
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