Therapeutic Relationships: Boundaries, Ethics, and Considerations
Your relationship with your therapist* is invaluable, and it’s natural to want to extend their support to other aspects of your life. However, it’s crucial to understand why your therapist may not be able to fulfill these roles. Below are some frequently asked questions along with corresponding answers that may offer deeper insight into therapeutic relationships.
“I have a good relationship with my therapist. Why can’t I also see the same therapist for family or couples counselling?”
The bond you’ve formed with your therapist is fragile, relying on trust and confidentiality. Moving from individual therapy to couples or family counselling with the same therapist brings complications that can upset this balance. Your therapist, already connected to you, might unintentionally favour one side or possess knowledge that affects their fairness when working with your family or partner. This imbalance could disrupt the counselling process, making it less effective. This is why you should not meet with your individual therapist for couples or family counselling.
“I want both of my children to attend counselling sessions, why can’t they both see the same therapist?”
Similarly to the last question, if children don’t have counselling together with their family right from the beginning, it’s not a good idea for the same counsellor to see them one by one. The counsellor might accidentally have preferences or know things about each child that could make it hard for them to be fair when helping the children. The same way that a teacher who teaches both children can unintentionally pick favourites, a therapist should never be put in this position. If you want both children to attend counselling, they should each have their own individual therapist. Meeting with the same therapist could also be compared to giving both children the same diary to write in. They should each have their own therapist to express thoughts and feelings with a neutral person.
“I was able to reach my goals with my current therapist and want to recommend the therapist to my friends and family. Why can’t I do this?”
Recommending your therapist to friends and family, while well-intentioned, presents ethical challenges. Therapists are bound by professional standards that prioritize client welfare and confidentiality. Seeing a client’s friend or family member could potentially compromise the therapist’s ability to maintain confidentiality and provide impartial care. To avoid such conflicts of interest and uphold ethical principles, therapists typically refrain from treating individuals with close personal connections to their existing or former clients.
“The therapist I want to see says that they cannot see me due to a conflict of interest, but won’t tell me what the conflict of interest is. Why is that?”
Regarding the situation where a therapist declines to disclose the specific conflict of interest, it’s important to recognize that therapists prioritize client confidentiality and professional integrity. While they may not divulge the exact nature of the conflict of interest, rest assured that it is rooted in ethical considerations aimed at preserving the integrity of the therapeutic process. Examples of potential conflicts of interest include mutual acquaintances, existing relationships with close friends or family members, or professional connections outside the therapeutic setting. By maintaining discretion in these matters, therapists uphold ethical standards and prioritize the well-being of their clients.
“I don’t feel like the therapist is a good fit for me, do I need to continue to see them?”
As with any interpersonal connection, the relationship between therapist and client may not always be perfectly aligned. Therapists possess unique styles, personalities, and areas of expertise, and ensuring compatibility with your preferences is integral to the therapeutic journey. Should you ever feel that the therapy you’re undergoing isn’t resonating with you, it’s imperative to communicate this with your therapist. Doing so allows them to pivot to a different therapeutic approach or recommend another professional who may better suit your needs and preferences.
“My therapist is recommending that I see a different therapist, why might this be?”
The therapist always has the clients best interest at heart. If your therapist is recommending you cease services with them and see someone else, this may be for several different reasons. Perhaps in the course of therapy the therapist uncovers a new conflict of interest that needs to be mitigated. The therapist may recognize that they do not have the required training or specialization to continue to assist you. The therapist may also uncover that they have their own biases that they are unable to mitigate, compromising the therapeutic relationship.
“What happens if I see my therapist in public?”
If your therapist sees you accidentally outside of the therapy office, they will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance. However, if you choose to acknowledge the therapist first, they will most likely be happy to acknowledge you, taking your lead to ensure your privacy. It is also important to maintain and respect boundaries with your therapist, who may choose not to engage in lengthy discussions with you outside of their regularly scheduled hours.
“I had a good rapport with my therapist, now that therapy is done, can we be friends?”
Even though some dual relationships might happen, especially in small communities, therapists must always put their clients’ well-being first. The Ontario College of Social Workers and Social Service Workers, as well as the College of Registered Psychotherapists of Ontario, stress the importance of avoiding dual relationships with current or past clients. They highlight how crucial it is to maintain professional boundaries even after treatment has ended.
In situations where a dual relationship is deemed unavoidable, such as when a former client becomes a colleague, enters into a romantic relationship with someone close to the therapist, or starts volunteering at the same organization, the Ontario College of Social Workers and Social Service Workers (OCSWSSW) offers the following guidance:
” In a situation where a personal relationship does occur between the member and a client or former client, it is the member, not the client or former client, who assumes full responsibility for demonstrating that the client or former client has not been exploited, coerced or manipulated, intentionally or unintentionally.”
“The therapist I want to work with is known to me. Would this cause a conflict of interest?”
This question presents a nuanced scenario, and the answer hinges on various factors. While therapists strive to minimize dual relationships, situations may arise where you are acquainted with a therapist but they lack sufficient knowledge about you to pose a conflict of interest. If there’s no other therapist available, there could be exceptions. In these cases, it’s best to talk with the therapist first. They can check if there might be any issues and talk through the situation with you. Then you can decide if you’re okay with continuing therapy like this, making sure everything is clear and follows ethical rules. The exception only applies if there is absolutely no other option to work with another therapist. If there is another therapist available to see you, the dual relationship or conflict of interest should ethically be avoided.
“I show appreciation by giving gifts. Can I give my therapist a gift to show them that I appreciate their services?”
While the gesture of giving a gift to your therapist is often well-intentioned, it can potentially pose an ethical dilemma for the therapist. While there are no strict prohibitions against this practice, therapists are tasked with delicately evaluating the motives behind such gestures and assessing whether accepting or declining the gift could potentially compromise the therapeutic relationship or jeopardize the well-being of the client in any way. To avoid potential boundary violations, it is advisable to abstain from giving gifts.
In summary, while your positive relationship with your therapist is wonderful, it’s essential to respect the boundaries and ethical guidelines that govern the therapeutic profession. By doing so, you ensure that the integrity of the therapeutic relationship remains intact, thereby facilitating the most effective and ethical delivery of mental health care.
*For clarity and simplicity, the term “therapist” is used herein to encompass both Registered Psychotherapists and Registered Social Workers authorized to perform the controlled act of Psychotherapy.
References:
College of Registered Psychotherapists of Ontario. (n.d.). Standard 1.7: Dual Relationships. Retrieved from https://www.crpo.ca/standard-1-7/
Ontario College of Social Workers and Social Service Workers. (n.d.). Dual Relationships: Approach with Caution. Retrieved from https://www.ocswssw.org/wp-content/uploads/PN-Dual_Relationships_Approach_with_Caution.pdf
Ontario College of Social Workers and Social Service Workers. (2018, July 10). Professional Practice Note: Boundary Violations. Retrieved from https://www.ocswssw.org/wp-content/uploads/PN-Boundary_Violations-revised-20180710.pdf
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