Know what pulls you to bend the rules: Avoiding the conflict of interest trap

I often see the question “is it ok to see my client’s husband, friend, brother… insert known person to current or former client here….”

My answer is always no. And it’s not just because the code of ethics for psychologists clearly states that it is a conflict of interest and that where possible we should avoid seeing clients known to each other unless there are no other options to see another therapist such as in a small community. 

It’s also because of the following messy types of scenarios that can occur:

You agree to see to friends as clients, Jack and Mike. Jack and Mike go to a party on the weekend. They come to the following session and give totally different accounts.  Mike tells you Jack got drunk and took meth had to be taken home because he tried to kiss Mike’s girlfriend and she became frightened. Jack tells you in the session he had the best night of his life and leaves out the detail of his destructive behaviour. You are now left holding information about Jack that is concerning that you can’t ask him about because you heard it from Mike. Or the flip side, Mike knows you see Jack so he doesn’t mention the incident at all, even though it was something he wanted to discuss as he is troubled by his friendship with Jack and Jack’s behaviour when he is using.

You agree to see Cheryl’s husband Andrew because Cheryl says Andrew has never really clicked with other psychologists. Cheryl says she knows you will work well with Andrew because you are so good. Andrew tells you he is having an affair and doesn’t want to stop the affair or leave Cheryl. Later Cheryl finds out about the affair and confronts you in session as to whether you know about it. Cheryl feels betrayed by you and can no longer trust you. Two years later, both Andrew and Cheryl’s lawyers subpoena their treatment files in the couple’s family court hearings.

You are seeing two women, Cathy and Sandra and then realise about 6 sessions into Sandra’s therapy that the women are sisters. Then Susie, a third sister contacts wanting to see you, as you know she sees both of her sisters. You decide that it’s ok, you have been managing the sisters well, as their issues seem separate, Sandra has career issues and Cathy has fertility issues. And you think your model of therapy allows you to work in a neutral way with all clients and you respect each sister’s confidentiality like you would any other clients. Susie then discloses that her father sexually abused her but her sisters don’t know yet. This leads to sessions where all the sisters are talking about each other and their family relationships. Cathy is non- affirming of Susie and blames Susie for ruining their family.

You agree to see Alex, a family member of Kelly, an old client you haven’t seen for years for EMDR on a specific single incident trauma. Alex says he has another therapist for his more general mental health issues. It seems like it would be a discrete episode of treatment. Some weeks later the Kelly returns in crisis and has moved in with Alex. Both Alex and Kelly present to the next session complaining about each other and the family tensions.

Reilly recommends her best friend Layla to you, her previous therapist and you agree to see Layla. Later Layla expresses disappointment to Reilly that you are not able to help her at the same speed you helped Reilly. Layla is critical of some of your suggestions and thinks that you aren’t a good therapist. Reilly feels caught between loyalties and blames herself for recommending you to Layla. The following year when Reilly has another episode of anxiety she would like to return to see you but doesn’t feel she can. You know nothing about it. 

All of the above equals messy. For therapists and clients. All of the above can also be managed after the fact but it can also be avoided by not seeing clients who are known to each other.

I wish for you to avoid messy. I offer the insights below without judgement because I’ve learned some of this the hard way. I would love for you to avoid the hard way.

Become aware of what pulls at you when you take on clients. Learn what drives you when you find yourself wanting to take on a client even when you know it breaches the relationship bias/ conflict ethic.

Some of the common ones are:

  • You find it hard to say no to people who appeal to you in desperation, seeming or actual 
  • You get caught up in the belief that you can be “the one” to help this client where others have failed. Don’t underestimate the pull of the early career training you’ve had which emphasized how every client can be reached with the right approach.
  • You are charmed by their appeal to your specialness, your talents as a therapist (we can be starved of feedback so you don’t even have to be particularly self-aggrandizing for this to work)
  • You have a niche area not many people work in and are passionate about working this group of people. You believe other therapists don’t do a good job with this group of clients.
  • You have a history of triangulation in your family and you don’t see the issue for the problem it is
  • You are trying to fill your books and a booked client helps pay the rent
  • You overestimate your ability to manage boundaries and underestimate your clients’ inability to manage boundaries 
  • You have difficulty trusting others and over-empathise with the clients need to find a known trusted source 

We all have soft spots and patterns that get us into avoidable trouble if we don’t know what those patterns are and in which situations they activate.

Avoid messy. Say no. You don’t need the stress or the added mental load.

Delivering therapy is challenging enough without managing these scenarios. If you are in one of these types of situations, seek supervision for further guidance.

If you want to stop these patterns and finding it difficult, supervision and/or individual therapy is helpful.

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