A female psychologist works with a male patient for about one year in a suburban area. They agreed to meet weekly for the first four months of psychotherapy, and then they agreed to meet twice per month. They developed a good therapeutic alliance. During the course of their work, he discussed significant facts about his troubled past, numerous details about failed past relationships, and sexual fantasies. The main therapeutic issues are depression and loneliness.
During the current session, the patient related having made a new female friend. As social isolation, loneliness and depression are regular themes in treatment; the psychologist frames this as positive progress.
As the conversation continues, the psychologist is surprised to learn that the patient’s new friend is the ex-wife of the psychologist’s husband. The patient reveals that he became aware of that information after several dates and recently felt comfortable revealing this to the psychologist. He also indicated that the relationship is taking on a more serious tone.
The ex-wife moved back to the area about six months ago. The psychologist knows that the ex-wife had been struggling with isolation and loneliness as well. The psychologist, her husband, and his ex-wife are on good terms. They see her regularly for informal family events and do holidays together with their adult children and grandchildren.
After the session is over, the psychologist has time to reflect on her concerns. The psychologist feels stuck and overwhelmed by her present situation. She calls you for an ethics consult.
What are the ethical issues involved?
What would you suggest that she does?
With whom does the psychologist discuss the multiple roles?
With only the patient?
With the patient and the ex-wife?
With her husband, the patient and the ex-wife?
Can the psychologist continue the treatment relationship with the patient?
Even if they terminate therapy, how does the psychologist cope with family gatherings since she knows significant details about her patient’s life?
What are the ethical issues involved?
ReplyDeleteThe situation is complicated for a number of reasons. The therapist unwittingly had become part of a dual relationship with the client due to factors beyond her control. Clearly her client and her divorced friend have a right to date each other socially. The client has a right to disclose information about being in therapy with the psychologist. But the psychologist does not have a right to discuss the information with her friend without formal release from the client.
What would you suggest that she does?
I would suggest that the psychologist explore the situation during the next regularly scheduled session, explaining the concern about dual relationships and her duty to protect the client's confidentiality. I'd also want to explore the client's perception of the situation and what he views as some solutions to the challenges of confidentiality and dual
relationships.
With whom does the psychologist discuss the multiple roles?
I would suggest that the psychologist reach some sort of plan with the client in understanding multiple relationships. It seems reasonable that the therapy continue, since it had started prior to the initiation of the dating relationship with the psychologist's friend. It is possible that the psychologist will want to have some peer supervision on this matter, though the code for the professional practice of psychology does describe situations in which dual relationships are unavoidable and describe ways to address such situations.
With only the patient?
I might want to share the regulations in writing with the client governing dual relationships to see what sense they could make of them together. Explore whether the client feels comfortable remaining in therapy with the psychologist, knowing that they will be at social events together.
With the patient and the ex-wife?
It seems to me that the client might be the one to discuss the matter with the ex-wife and reach some sort of agreement with the therapist about signing a release of information. It may be that the option of changing therapists would be more efficient and supportive of the dating
relationship.
With her husband, the patient and the ex-wife?
Technically, the psychologist can only discuss the matter with the client unless a written release is signed.
Can the psychologist continue the treatment relationship with the patient?
It seems that the psychologist can continue in therapy with the client if it is possible to maintain confidentiality.
Even if they terminate therapy, how does the psychologist cope with family gatherings since she knows significant details about her patient’s life?
I believe that the client would control the release of confidential information in family and social settings. While it is not ideal, it would be possible to continue therapy. However, I would probably prefer to refer the client to another therapist. If the current psychologist were the only option, then both would have to exercise discretion.