Therapy: Confidentiality/conflict of interest?

February 7, 2007 7:28 AM

I've been seeing a psychotherapist since last summer. A few months ago, my boyfriend joined me in seeing the same person for couples counseling. Now, my boyfriend is also seeing her for private sessions. Q1: Is there a conflict of interest because she sees both of us separately? Q2: I am thinking of breaking up with him. Does confidentiality prevent her from "leaking" this info to him?
posted by desjardins to human relations (16 comments total)

Yes there is a conflict of interest. She shouldn’t have agreed to see you both. That says something about her judgement and competence, and you might want to break up with both of them at this point.
posted by kika at 7:40 AM on February 7, 2007

One of you you needs to stop seeing her and see someone else. I agree with kika that this speaks volumes about the therapist.
posted by caddis at 7:49 AM on February 7, 2007

I'm a therapist, but not your therapist.

1) There is no conflict per se, by which I mean that there is nothing in any of the codes of ethics with which I am familiar (I'm not sure what her training is) that would absolutely preclude her seeing both of you. Some times that kind of thing is inevitable, and can't be helped. I would try to avoid it in my own practice, unless there were no other choice, because I don't think it works very well, but it isn't either illegal or censurable on its face.

2) Your therapist should not disclose your thoughts about anything non-threatening to your boyfriend. She should be bound by her code of ethics and state or federal law to not disclose information that does not put you or he at risk. She should have been clear about this with both of you when she started to see you both. The fact that this question comes up is one of the reasons that it can be a bad idea to see both parts of a couple.
posted by OmieWise at 7:50 AM on February 7, 2007

Were either of you in couples counseling and individual counseling at the same time with the same therapist? Were you both in individual counseling at the same time with the same therapist? To the best of my recollection, those scenarios are not ethical. However, it's fine to have individual counseling pre/post couples counseling, and it's also fine for the therapist to have seen both of you for individual counseling as long as said counseling isn't happening at the same time.
posted by bobot at 8:20 AM on February 7, 2007

I'm in the midst of sorting through the Marriage and Family Therapists' ethics code right now for a class. If you're not seeing an MFT this may not apply exactly, but it's probably still relevent.

To the best of my understanding, seeing both halves of a couple individually in order to help facilitate couples counseling is actually often very helpful -- if the couple is having problems, and it turns out those problems are due to the woman having anger management issues or something, for example, maybe that's best dealt with in individual sesssions for a while. In other words, there are certainly situations in which seeing people in both couples and individual sessions would be ethical, and helpful -- we're reading a lot about how and when to break up family or couples counseling into individual sessions; such a thing is pretty much fully expected.

It is, therefore, also fully covered by confidentiality guidelines. Anything said in an individual session with an MFT cannot be shared with the rest of the family or couple, unless you've given prior written permission for the therapist to do so.

Again, the ethics codes will be a bit different if she's not an MFT (though I'd expect them to be similar; our textbook covers the AAMFT, APA, and various social work and school counseling organizaitons all together). And she may very well have created a conflict of interest in this particular situation, but there's nothing always inherently unethical or unexpected about seeing couples individually.
posted by occhiblu at 9:30 AM on February 7, 2007

Some therapists are better about respecting confidentiality than others. Even if it's ethically required, it's not a given.
posted by croutonsupafreak at 9:32 AM on February 7, 2007

bobot: we're currently both in individual and couples counseling with the same therapist.

occhiblu: yes, she is a LMFT. Thanks for the relevant answer.

croutonsupafreak: yep, I've been burned by this one before, hence my caution/misgivings.
posted by desjardins at 9:43 AM on February 7, 2007

yes, she is a LMFT

Then you get an actual citation. The relevent section of the AAMFT Ethics Code is:

2.2 Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.

If she's not a member of the AAMFT then she can't be held to the letter of these codes, but they're certainly considered the standard against which she'd be judged for ethical practice in the field.
posted by occhiblu at 9:49 AM on February 7, 2007

And I meant to add: It would certainly be appropriate for you to ask her for clarification, if you're worried or if she's been unclear.
posted by occhiblu at 9:53 AM on February 7, 2007

Hmm- that's odd. My only context was group therapy, in which it is very much frowned upon to see a member of the group for individual counseling apart from group sessions. I was assuming that carried over to family/couples therapy as well, but it looks like I was wrong, in which case I apologize for giving an uninformed opinion!
posted by bobot at 10:29 AM on February 7, 2007

This is mostly hypothesizing, but it would seem that group counseling is not designed to get the members functioning outside the counseling session as a unit, in the way that family or couples therapy is. In a group, you'd want to make sure that the therapist was treating each member equally because the only time the group interacts would be in the therapist's office, so it should stay a neutral space. In a family, the only real goal is getting the family unit working with each other in a functional way outside the therapist's office; the therapist, while she must be careful not to take sides, wouldn't have to be quite as careful about giving everyone exactly equal time and attention.
posted by occhiblu at 10:42 AM on February 7, 2007

Some people do this, but I strongly advise against it just for the reasons that you're talking about. You're going to feel inhibited talking about the other partner, and both of you will be curious about what each other is saying. It may not be strictly unethical, but I think it's ill-advised.

From the therapist side, even if the therapist is capable of keeping each partner's secret (which he or she MUST), the therapist is always going to have "extra" knowledge working around in the back of his or her head. For instance, if she knows that you're planning on breaking up with him, or if she knows that he's cheating on you, I believe that knowledge is going to contaminate her ability to hear and respond to you where you are at.

The best couples therapists I know insist that there can be no secrets in the couples therapy, and lay that out as a rule from the get go.
posted by jasper411 at 10:43 AM on February 7, 2007 [1 favorite]

The LMFT practice explained by occhiblu is the particular situation where a couple go together for couples therapy. The LMFT may then decide that in order to further the goals of the couples therapy, individuals may be seen separately. In this instance there is no conflict of interest because the goals of therapy remain those identified in couples therapy.

If I am being seen individually by my own therapist, we are working together towards my goals. If I then start couples therapy with my SO and the same therapist, we have two sets of therapy going on: one individual with my goals, and one couples with the couple goals.

Unless the couples therapy is assumed to be an extension of the individual therapy and is carried on to further my goals. Then my SO is left out in the cold.

I have no problem with continuing individual therapy by one or other of the couple after the couples therapy is terminated. But the order you have described does not sound right.

Even if there is no theoretical conflict of interest, you feel as though there is one, if only on your part. That’s enough reason not to do it. Number one rule: never do something that feels wrong. You’ll always get into trouble.
posted by kika at 11:01 AM on February 7, 2007

I would agree that if you're serious about breaking up with the boyfriend, then you could land in the midst of some conflict of interest problems -- the goal of the couples therapy should be to keep you guys together, so that's pretty much shot! None of my points were meant to imply that you may not need to change things, just that it does not sound, from what you've said, that anything unethical is currently going on. (Again, I could be wrong; we don't have all the info.)

But you really should just talk to your therapist about this, including your concerns about confidentiality and whether she feels her therapy with you as you go through the break-up is going to be unduly influenced by having worked with him. But there doesn't seem to be a hugely compelling reason to assume that there are all sorts of problems currently happening, or that she's been acting unethically. But that doesn't rule out her being unable to see you (or him) in the future.

(My view would change if you said you'd already been uncomfortable with things she'd said or done, or if you've already talked to her about this stuff and she seemed unconcerned or confused.)

In other words, it seems fair to give her the benefit of the doubt now, unless she's actually done something to make you uncomfortable. But that doesn't mean you're required to keep her as a therapist going forward, either, if your change in circumstances means you'll now be uncomfortable with her.
posted by occhiblu at 11:48 AM on February 7, 2007

I just don't believe that anyone could keep her allegiance to her client(s) clear at all times. And how in the world could she remember what you told her vs. what he told her vs. what both of you told her? Not a good set-up!
posted by Carol Anne at 2:13 PM on February 7, 2007 [1 favorite]

Your asking the question suggests that you have doubts about sharing a therapist with your boyfriend. Maybe it just doesn't feel right in some vague way. If you trust her, talk with her about it -- not just the confidentiality aspect, but about whatever awkwardness you feel about the set-up. If you don't trust her, talk about that (if you can). If you continue to feel awkward, then don't continue the arrangement. If you don't want to share, you could actually tell your boyfriend (possibly in a joint session) that you feel uncomfortable and that you'd like to be the only one working with the current therapist. Then if he won't stop meeting with her, you should find a different therapist for yourself.
posted by wryly at 6:54 PM on February 7, 2007