This article was first published in in the January 2022 Communiqué
This note considers how CRPO standards apply to providing individual therapy to family members or other close contacts of an existing individual client. This situation is distinct from couple and family therapy, where the collective client includes more than one person, and where there are parameters around seeing individuals one-to-one as a component of therapy, as well as for transitioning between individual, couple, and family therapy.
Navigating this issue requires consideration of conflicts of interest and confidentiality. CRPO Professional Practice Standard 1.6, Conflict of Interest notes that a conflict of interest is a “situation that could interfere with a registrant’s ability to exercise appropriate professional judgment. A conflict of interest may be actual, potential, or perceived. The standard for judging a conflict of interest is to ask what a reasonable person, aware of the situation, would conclude. It is unnecessary to prove that the registrant’s judgment is actually compromised.”
Treating individuals who are closely related could lead to a situation where the registrant cannot promote the interest of one client without adversely affecting the interest of the other client. This is a conflict of interest. Another aspect of a conflict of interest is the perception that a registrant is taking advantage of inappropriate client referrals.
Another risk with treating someone close to a client is that the registrant might inadvertently disclose confidential information about one client to the other. (See Standard 3.1, Confidentiality.) Confidentiality prevents the registrant from discussing details about the conflict of interest with either client. For example, the registrant cannot identify one client to the other or specify how their treatment may be affected by the conflict.
It is generally best to avoid this situation, though in some circumstances doing so may be difficult. Examples include if the connection between clients is discovered after therapy has begun, or if it would be difficult for the potential client to find treatment elsewhere. In these circumstances, significant ethical consideration and clinical judgment are required. Seek clinical supervision and consider whether treating or referring one or both clients is appropriate.
The following questions can help a registrant reflect on this issue further:
- Can you as the therapist maintain objectivity when working with this client given your history working with a family member or close relation (e.g., friend who referred)?
- Can you ensure the client will not talk about the other person during the session and is it fair to the client to restrict the topics discussed during therapy?
- What will you do if the other person enters the conversation?
- What if the other person who you have previously treated learns you are treating their close contact?