Clinical Boundaries Question For Early Career and Seasoned Folks

[DrMaxPsyD]

Just got this from one of the listservs and wanted to get SDNs view on the issue:

I am hoping that perhaps some of you that are early career and seasoned may be able to answer this question as a colleague is struggling with this issue.

Therapist is seeing a family for family therapy. Presenting issues within the family are varied and individual but also collective ie there is a collective reason why they are in therapy, however all struggle with their own individual issues as a result of the collective issue which brought them into therapy. Therapist is also seeing one of the children in individual therapy. The mother now also wants to be seen by the same therapist for individual therapy and also wants her other children to be seen by the same therapist for individual therapy.

The therapist is uncomfortable with seeing what would amount to all family members in individual and well as family therapy. This is in part due to the fact that the therapist has to make reports of progress and findings to the court because the case is court involved.

Is it appropriate for the therapist to refer each family member to have their own individual therapist and just continue as the family therapist? What is the appropriate clinical/ethical line of action?

Thoughts?

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[bmedclinic]

First off, as a disclaimer, I've only been doing therapy for only a year.
That said, this is my personal guideline. I'd absolutely not put myself in that situation.
To be quite frank, I'd try to steer clear of making a habit of doing individual therapy with one person and group with their family. I'd certainly never do individual with multiple members of the family and group with all of them. Just seems like you're getting too far into the zone of multiple relationships and conflict of interest there.


On top of all the issues involved, I'd be very concerned that either I'd accidentally slip a detail or an insight into one session learned in another session. This seems like a great time to refer to a colleague.
For all you (or anyone) know, they may have incompatible treatment agendas. Sure, they're at family therapy for one similar reason, but that doesn't mean that when you get into it in individualized therapy you wont get something completely different happening or becoming the focus of the treatment.


As a general rule, I try my best to avoid anything that could be perceived as an ethical conflict at all. Better safe than sorry. And to me, there's no time to be better safe than sorry then when treating patients.