Ethics of Treating Two Psychotherapy Clients who Know Each Other By Stephen Feldman, JD, PhD & Marnee Milner, JD, PhD on 5/18/12 - 2:50 PM

A question was recently posed to us about what to do when you discover in an early session with a new client that they are the former partner of another well-established client. Well, for those of you who actually stopped to think, “Oh, this may be a problem,” then you are certainly one step further away from sliding down the slippery slope of unethical behavior than those who did not recognize that this situation may pose a potential ethical dilemma. Professional codes of ethics (e.g. APA 3.06, NASW 1.06) ask us to be mindful of conflicts of interest that arise and to take steps to resolve them. The best resolution is to refer the new client to another therapist (if possible).

For those of you who can refer this new client to another therapist, then the question arises as to how to do so in an ethical manner. First, remember that you cannot ask permission to disclose your relationship with the other client because this will breach patient confidentiality. You can, however, simply express that in reviewing this new client’s case you believe he/she would be better served by a different therapist who is more closely matched or specialized with his/her needs. Remember, you are not mandated to treat every client who seeks treatment from you. Second, provide the names of two or three therapists who currently have openings for new clients in their practice. It is important that these referral therapists have the capability to accept new clients at the time so that continuity of treatment is maintained and the client’s (potential) feelings of abandonment are diminished. Third, if you terminate in a responsible clinical manner then you will likely be terminating in a responsible ethical manner. Thus, if you terminate in accord with the standard of care for your theoretical orientation, using good clinical skills to transition the new client and allowing them to feel heard about your decision, then you again decrease the probability of the client feeling abandoned which often leads to board complaints. Last, provide a written termination letter confirming the termination of treatment and the referral therapists contact information. Keep a letter in your file as part of the clinical record.

Earlier I mentioned that this situation “may” pose a dilemma because if you practice in a small or rural town then you may encounter this situation frequently since you are one of the few practitioners available. In those situations, if you cannot refer out then it is best to have a clear plan as to how you will keep from falling down that slippery slope of potentially unprofessional conduct. For example, how will you handle information you learn from your well established client from seeping into your sessions with your new client, and vice versa? How will you identify and handle information learned from one client inadvertently influencing how you think about the other client? Consultation, and of course subsequent documentation of decisions and rationale, is a good way to keep your own personal biases and such influences in check.

As a general rule of thumb remember that our professional codes of ethics require us to be mindful of conflicts of interest that arise and to take steps to resolve them. While the best resolution (especially in this scenario) is to refer the new client to another therapist, if this course of action is not possible, and refusing service to a client is clearly detrimental to the client’s welfare, then chart and note the steps taken to minimize potential conflicts and difficulties that arise in the course of treatment. Such documentation is part of good (and mandated) record keeping procedures but also demonstrates your contemporaneous judgment, which is always your best proactive defense.

File under: Law & Ethics