Sunday, May 10, 2015

Crossing professional boundaries can be scary

A family therapist had been working with a particular family for several years. Because she was seeing one of the younger children in the family as a client, she also grew to know the child's parents quite well. Eventually, the need for ongoing therapy was deemed unnecessary, but the parents still consulted with the therapist occasionally when they had a concern.

Recently, about a year after regular therapy sessions ended, the therapist received a call from the mother of the child she'd been seeing. The mother filled her on family affairs, but the purpose of the call was different. The family had found a new apartment they wanted to rent and the mother wondered if she could list the therapist as a character reference.

The therapist is torn. On one hand, she'd like to help the family. On the other, she wants to make sure she doesn't inappropriately cross any boundaries.

Much has been written about the need for psychotherapists to maintain clear boundaries with their clients. Even more has been written about Sigmund Freud's views and those of others on the boundaries needed to develop and maintain effective treatment for clients or patients. Yet many therapists still find themselves facing questions about whether and when to something for a client that goes beyond the one-on-one therapy that's the primary focus of their relationship.

Freud himself, according to an article in the American Journal of Psychiatry by Thomas G. Gutheil and Glen O. Gabbard, is reported to have "sent patients postcards, lent them books, gave them gifts, corrected them when they spoke in a misinformed manner about his family members, provided them with extensive financial support in some cases, and on at least one occasion gave a patient a meal."

Just because Freud might have done so from time to time, however, doesn't mean that it's the right thing to do.

Licensed psychotherapists have professional codes of ethics. These are typically not specific enough to address every situation, however, nor do they replace a therapist's good judgment in making a decision. Still, these codes are a good first source of counsel on making such decisions as the one posed by the therapist who contacted me.

While I'm not a psychotherapist, it seems wise to set up clear boundaries with clients at the outset of their therapy (or in the case of children, to set those boundaries with their parents or guardians). Even then, situations will likely arise when the therapist has to make a choice of whether to stretch the boundaries of the relationship.

In the case of the therapist asked for a character reference, the right thing to do is to think through whether serving in such a role compromises anything about the therapeutic relationship. It would also be wise to consult with trusted colleagues for feedback on the matter.

The most important thing is to determine what's in the best interests of the client, and that doesn't undermine the ongoing professional relationship. The therapist did this very thing and ultimately agreed to provide the reference. 

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1 comment:

Anonymous said...

I, also, have no idea what laws or rules govern this case. Should there be any, the answer is "I cannot do it because of my job." This may be appropriate even if no such rule exists and the caregiver feels uneasy.
Should all be OK, answer and explain if appropriate the connection with the client. Do not lie and answer as if you were the landlord or future tenant.
Alan Owseichik
Greenfield, Ma.