As a Clinical Psychologist, can I treat my family members or friends?

As a clinical psychologist, my family members and friends frequently ask me for advice in mental health, relationship issues and other problems, such as work stress. Sometimes, someone in my social network may request formal psychotherapy for his or her spouse or close friends. I usually politely turn down their request and try my best to refer my colleagues with similar background to provide psychotherapy for them. Why is it so important to maintain an appropriate boundary in offering psychological services? What are the exceptions that a psychologist can have multiple relationships with someone?

As registered clinical psychologists, we need to follow the ethical standards of our profession. According to the ethical code of most psychological registration bodies, concurrent multiple relationship between a therapist and a client should be avoided. In a concurrent multiple relationship, the therapist and the client have a social or business relationship outside the professional therapeutic relationship. For example, providing psychotherapy for a friend or a family member is a concurrent multiple relationship.

When a clinical psychologist enters a concurrent multiple relationship, he or she runs the risk of the relationship between the therapist and the client to be influenced by the self-interest of the therapist. In psychotherapy, the welfare of the client is the main concern for the therapist. A therapist should not use the client to satisfy his or her own needs. For instance, ethical standard may be violated if a therapist uses the therapist session to talk about his or her personal issues or gossips another client with one’s client. It may also be a problem if a therapist asks the client to work for him or her in a project.

The clinical psychologist may not be able to remain being objective in psychotherapy if there is a concurrent multiple relationship between the therapist and the client. Even if the therapist tries one’s best to remain objective, the client may not be able to reciprocate. In fact, the therapeutic effectiveness may be affected if objectivity is compromised. For instance, a therapist may not be able to analyze the problem a client is facing if he or she has prior conflicts with this client as a friend.

The differential power between the therapist and the client is the major reason for the possibility of the client being exploited in a concurrent multiple relationship. It is because the clinical psychologist has professional status and personal knowledge of the client. In addition, the client is in a vulnerable state that one is emotionally dependent on the therapist for psychological healing. In a concurrent multiple relationship, the therapist may be able to use the personal information of the client to exploit him or her for one’s personal interest.  For instance, the client who also has a social relationship with a therapist may be exploited by the therapist for his or her personal interest due to the difference in power. The exploited client’s psychological well-being and interest may be compromised and further harm may be caused in the client.

In fact, the ethical code of avoidance of concurrent multiple relationship is not black and white. Exceptional cases may be acceptable. For example, if the clinical psychologist is the only one in the area who could provide a certain specialized treatment, concurrent multiple relationship may be justified. Another example is a clinical psychologist seeking psychotherapy from another clinical psychologist who may be in one’s social or work network in the city. In theses circumstances, the therapist needs to make sure issues related to confidentiality, informed consent and boundaries crossing are addressed with the client.

Psychotherapy is a serious journey for treating vulnerable clients with specific needs. The general public needs to have knowledge in choosing a suitable and qualified clinical psychologist to meet their therapeutic needs, so that they may not run the risk of being in a concurrent multiple relationship with a therapist or being exploited. It is recommended that the general public choose clinical psychologists who have registrations with a recognized professional body to protect one’s interest and obtain quality psychological services.

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