“Can you see my [mom, dad, best friend, kid, etc] for therapy, too?”

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This is a good question and surprisingly, a pretty common one for therapists. I am always so honored and grateful when my clients can confidently recommend me to their loved ones. (I care about all my clients and as an extension of my clients, I care deeply about their loved ones as well!) This brings me to the next question that comes up for me (and all therapists) when I’m approached to do therapy with a client’s loved one- “What decision would ensure the best clinical outcome for both clients?”

There’s a few different answers to this question.

It’s different for every case. There are many factors to consider, but here’s a few that come to mind right away- what the client’s presenting problems are and if they are related/impact one another, risks related to client confidentiality, the treatment status of both client and potential client, potential risks, the feelings the client(s) have about sharing a mutual therapist, potential benefits, and the amount of cross-over that occurs between clients.

“The 2014 ethics code prohibits engaging in counseling relationships with family members with whom the counselor cannot remain objective. In earlier versions of the ethics code, this language was
more restrictive, forbidding counselors from treating all family members at all. The latest iteration of the ethics code allows counselors to treat their relatives in certain circumstances. As long as the counselor maintains objectivity, it may be permissible for him or her to treat a relative.” (Natwick, 2017.)

“As a counselor, we are sworn to uphold the confidences of our clients unless they are of harm to themselves or others,” Ivankovich said. “Bringing friends into the practice often makes the referring client feel as if they have the right to know things that may be going on in their friend or family member’s session, but that is simply unethical for us to discuss.” 

However, the “middle man” issue is especially common when there’s a big issue in a family or among friends. This is where the problem-solving process may start to get counterproductive.

“When friends or family members share the same therapist, and crisis exists, clients bring it to the therapist to process,” Ivankovich said. “In doing so, you might have several people’s hands in the puzzle, making it difficult to address the primary issue.” 

You want your therapist, in some ways, to be “unbiased” and “impartial,” ideally, Ajjan said, which is really tough to maintain if she’s getting information from multiple sources.

“And if there is ever conflict or an issue with your friend or family member, triangulation may occur,” she said. “You may both draw your therapist into your relationship to deal with discomfort or communicate with each other.” This can be “problematic” if it’s the expectation because your therapist for individual counseling is not a mediator to solve full-blown issues between parties not speaking to one another.

So, Should You Really Do It?

The answer is likely “perhaps” or “it depends how close you really are and how comfortable you feel.” But Ajjan is cautious of the practice.

“I do not think it is a good idea to use the same therapist as a close friend or family member,” she advised. “There are just too many ways it can become complicated or ineffective.”

Ivankovich explained that occasionally one of her patients will make a referral to solve an interpersonal problem or conflict. (This, of course, is different from something like family or relationship counseling, which thrives on both parties being present with the therapist.)

“In this case, I will typically refer to another therapist in the practice,” she said. While one goal is to have a great therapist, and someone you know well can help you find that person, another is to have an effective therapist. Your therapist’s totally impartiality to issues can only help you come to better solutions.

BirCh, huffpost.com

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