Can you talk to your therapist on the internet? Online dual relationships


Online dual relationships.

By David Joel Miller

Has the internet changed relationships between clients and therapists?

A member of an online group to which I belong sent in this question

“Is it ever proper for a life coach or therapist to invite their clients to an online group, or for a client and therapist to be in the same group, or work on online projects together?  Can that cause a lot of problems?”

How this affects life coaches and how it might affect therapists and counselors are miles apart.

This is a problematic area for therapists and counselors. We are taught to avoid “Dual relationships” with clients. Some of these issues are pretty clear, dating, sex, borrowing money and so on. Some dual relationships are easy to see and clearly, can cause problems.

The goal of avoiding dual relationships is to avoid harming the client, once you see the client outside the office there are risks for the client and the therapist.

We do not want to do or say things outside the office that identify this client as a patient in a mental health treatment setting. Sometimes there is just no way of avoiding the client when we are out in the community, so in those settings, most therapist’s will not say anything to the client and wait for them to say something first. That way they do not identify this person as a patient.

The smaller the town the more the risk of a second relationship. I live in Fresno; my clients live in Fresno, so far no problem. They shop at the same grocery store as I do.  I do not need to stop shopping there but I do need to not make the first move to say hi and especially we do not talk about their therapy in the store.

Then let’s say I go visit a new church. I run into a client there. Now can I talk to them? Maybe. I do not think I need to avoid churches or schools or civic organizations because my client might attend. What I do need to avoid is getting into a close friendship relationship with a client.

What happens when we both belong to a local group, say NAMI and then we end up on a committee together? This may begin to create problems. I need to remember what they said in therapy and keep that separate from what they told me at the group meeting.

In that kind of situation, I might consider not being on the committee or ending therapy with the client so we do not have two separate relationships going. At this point, no matter what I do there are ethical implications. Dropping a client to be on the committee is a problem, being on together is a problem, telling the client they can’t be in this group is a huge problem.

Therapists need to consult.

Once these problems begin, or that possibility crops up, we therapists should get an opinion from our colleagues, maybe from a lawyer, and we may talk this over with the client.

Some therapists try to avoid these things by not joining or attending meetings, but you can only go so far with that before you give up you right to have a life.

Some therapists have tried to avoid these problems by not being online or having a social media account. While this may prevent some problems it can create others.

The hard part is keeping all your separate roles or “hats” separate.

Lots of therapists teach classes. We may see current or former clients there. I do trainings, Mental Health First Aid for example. Good chance that a former or current clients could show up there. I do not cancel the class or throw the client out of the training because they have seen me for therapy, but it can be a challenge if they start asking questions and I know this is an issue we have worked on in therapy.

The internet has changed all that.

Millions of people all over the world are now connected. I can run into clients current and former and not ever know it. So we need to work on making sure that while we all engage in those activates nothing I do might harm any client current past or even a potential future client.

So here are some suggestions for both therapists and counselors and clients on the multiple relationships that can form on the internet. Let’s get specific with this reader’s questions.

Is it ever proper for a life coach or therapist to invite their clients to an online group?

Therapists should not be maintaining email lists of clients and then start mailing anything to them. If they happen to subscribe to my blog or a list of trainings or classes I treat them just like any other subscribers, not like clients.

For a client and therapist to be in the same group or work on online projects together? 

If they join a group and I join, so be it. I do not suggest this as a rule but if they are interested in homelessness and so am I, then I might give them the information about an online group. What they do with that web address is up to them.

Working together on an on-line project sounds like something I would not do until a lot of time had elapsed between them being a client and the project. If I had a client who was a web designer I would not pull out his file and call him for some help on my website.

If someone who worked for me got a list of designers and called him, then next session I would need to discuss this with him and we would need to decide if we were going to end therapy or he would not be able to also be working for me.

Can multiple relationships cause a lot of problems?

Yes having multiple relationships can cause lots of problems. I do not let that keep me from writing a blog or teaching classes but I am always looking out for these possible conflicts and avoiding them whenever I can.

Therapists and clients do run into each other, in the community and on the internet. The rules are essentially the same.

Do not get into a second relationship that will harm the client. Do not do things to identify them as clients or to violate their confidentiality and treat you various roles professionally and appropriately.

About life coaches.

There is no licensing for life coaches that I know of. Some have taken classes, anything from a one hour webinar on up. Some join coaching associations and they may or may not have codes of ethics. But coaches do not get confidentiality and you get no privilege in talking to them. They can say and do what they want and they may engage in all sorts of multiple relationships. If they hurt you really badly you have to sue them. It is common for coaches to keep mailing lists of former clients and to keep trying to sell you thinks and they can use your name or story in their materials or trainings. While there are some good coaches out there coaching is not meant to help you with emotional problems that might include a mental illness.

I am sure that this will not be the last time we need to look at how the internet, blogs, and social media are changing relationships and how that might affect clients and therapist’s, but at least it is a start.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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11 thoughts on “Can you talk to your therapist on the internet? Online dual relationships

    • Thanks for sending the link to your article. Some interesting stuff there. Hard to define dual or multiple relationships as there are so many variations. As you point out in your article the various professions all have different codes of ethics. If you join an association you agree to follow their code. If a psychotherapist has multiple licenses they may be subject to conflicting requirements. This is especially problem for those who work in Substance abuse or specialize areas. We all have the duty to explain this to clients especially when we may have to repeat something they say because of the work setting. This needs to be part of informed consent. Here in California the largest license is the Marriage and Family Therapy one. As your article points out the CAMFT code of ethics is more restrictive than other codes in some areas. I think this is because if you are working with a family there are many ways to end up in unhelpful multiple relationships with members of the family. I agree that not all multiple relationships are harmful to the client. But when these other relationships present themselves the counselor not the client has the duty to be sure that the other relationships do not harm the client.Thanks again for the coment and the link to the article.

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    • P.S. I believe your article is incorrect in one aspect. NASW code of ethics (section 1.09c) says Social Workers should NEVER get into a sexual relationship with a former client. I do not see 2 years or any other time frame mentioned in their code. This makes Social workers the most restrictive in that area, followed by the ACA at 5 years. Thanks again for your thought provoking comments.

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  1. I appreciate your thoughtful response. While there are some variations between the codes of ethics regarding sexual dual relationships with former patients, the general theme of all major codes of ethics is that a. not all dual relationships are unethical and b. in the words of APA code “Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.”

    The substance abuse field that you mentioned routinely face many unavoidable dual relationships when therapists and clients meet in AA or NA meetings and when ex or current clients end up as therapists, working alongside their own therapists. Here is a recent short piece on the topic, which include some resources as well: http://www.zurinstitute.com/dual_relationships_recovery_resources.html .

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  2. David, you wrote that “NASW code of ethics (section 1.09c) says Social Workers should NEVER get into a sexual relationship with a former client.” That is almost true the actual NASW code of 1.09 c states:
    “Social workers should not engage in sexual activities or sexual contact with former clients because of the potential for harm to the client. If social workers engage in conduct contrary to this prohibition or claim that an exception to this prohibition is warranted because of extraordinary circumstances,….”
    It does not define “extraordinary circumstances.”

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    • Thanks for that complete wording. As social work is taught in our area, and the correct answer to this question on social work tests has been NEVER. This has caused a lot of problems when social workers teach classes for substance abuse counselors. Most of the Drug and alcohol counseling registries in California use the two year rule.
      One other “ethical principle I was taught was if you start thinking that exceptions are allowable then you are likely to be the one to take advantage of the exception.
      Thanks for the clarification and the conversation.

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  3. Regretfully, many so-called ethics experts focus on rigid risk-management rather than thoughtful context base analysis of the ethics codes, states’ laws and the specific context of each and every situation. As we seem to agree (and my resources page confirms), that the rehab community is fraught with complex and unavoidable multiple relationships. The sexual dual relationships with former client issue and what “extraordinary circumstances” may mean is still vague. Do you know of any licensing board’s or court’s interpretation of this term?

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    • There are no specific court cases or rulings I can point to. What I have seen in practice is that if the former client complains to the license board or in court that another relationship harmed them, it will be really hard for the counselor to prove otherwise. Most of the actions on licenses here in California over the last few years occurred when the counselor and the former client ended that other relationship on bad terms.

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  4. In the digital age when people post pictures and their feelings regarding their relationships, vacations, etc. it is sometimes easier to determine whether the sexual relationships between therapists and former clients were harmful or not. I have seen, heard and were involved in cases where FB and other online pictures and entries were major factors in the courts’ decisions. [Of course sexual relationships with current clients is always unethical and illegal.]

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