Friends with an ex-client?

[JedMosley]

Hi all! Curious about a scenario. A grad student in my cohort works at our UCC and mentioned that one of the psychologists working at the UCC recently got a new job out of state and became friends on *insert social media site, I don't even remember which one* with an ex-client that they were working with while at our UCC. I'm curious to know if that is something unethical that I should consider reporting, or if it's a gray area since the psychologist moved and is no longer seeing that client? Thanks 🙂

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[deleted343839]

It's a little concerning, but I think that reporting the person without any other context would be inappropriate. This type of "relationship" is not necessarily unethical. Also, remember the ethics code:

1.04 Informal Resolution of Ethical Violations
When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved.

 

[psych844]

Wait....we can't have sex with our patients?








*quits Clinical Phd program and joins bangbros crew*

 

[WisNeuro]

Yeah, as long as this person isn't sleeping with an ex-client, any state board is likely to say, "so what?" Not something that I'd ever do, personally, but for it to be an ethical violation, there generally needs to be a demonstrated harm or potential abuse of a power hierarchy to rise to a violation.

 

[Harry3990]

I agree with what others are saying in terms of it likely not being an actionable ethical violation through a state board. However, I wanted to add some emphasis for any future readers that this is definitely something that people should NOT do because it can open up other doors to more significant ethical breaches. The former client also presumably has access to your personal information or pictures. I find it akin to making your home address, cell phone number, or personal email available to the client (or former client). Such boundaries (i.e., not doing these things) are common practice for important reasons during the counseling relationship and some of these reasons still apply even after that relationship has terminated. They are there to not only protect the client from dual relationships and power differentials but also to protect the clinician by establishing appropriate professional boundaries.

Nutshell: probably not an actionable offense, but don't do it yourself.

 

[deleted760483]

I cannot imagine why anyone would ever do this. I really, really like a lot of my clients as people but I would never want to navigate those relationship dynamics.

 

[DynamicDidactic]

I agree that I would not likely do something like this but I am also not on Facebook. I do hope people also understand that clients are people and its ok to treat ex-clients like people.

I find it akin to making your home address, cell phone number, or personal email available to the client (or former client).

For DBT therapists, their clients likely have their personal cell number and email address. Home address is less likely but often that information is easily available on the internet. Not long ago it was very common to have your therapy office in your home, may still happen.

Nowadays the APA ethics code is created to protect the practitioner more so than the clients, which does not fit with my view of ethics. Its important to understand that ethics are not categorical, black/white rules to follow.

 

[Harry3990]

Excellent points Dynamic. These are not things I have experience with personally, and certain therapists do seem to do just fine with the home-office setups. And of course being on-call with DBT clients is a helpful and admirable thing. And yes, you're absolutely right that they are not black and white. We should certainly always strive to put the client's best interests first.




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[Justanothergrad]

We should certainly always strive to put the client's best interests first.

I agree with that to a point. Up til there are situations where my safety is at risk for doing so, I'm willing to put clients first. I worked on a assertive community treatment team where one of my team members was hostage held at gun point for several hours by a client in a remote area. I disagreed with the decision to retain the client and continue providing home-based services out of a fundamental belief that safety of us as providers must be first.

 

[Therapist4Chnge]

Violence can happen most anywhere, so we need to take every opportunity to limit risk.

 

[WisNeuro]

Remember folks, the only thing that can stop a bad patient with a gun, is a good patient with a gun. Or, something like that. Logic.

 

[123EW]

I err on the conservative side when it comes to such issues. I am not comfortable becoming FB friends with a previous supervisor yet, let alone a previous patient/client.

 

[smalltownpsych]

Remember folks, the only thing that can stop a bad patient with a gun, is a good patient with a gun. Or, something like that. Logic.

I completely disagree. Nothing beats a well-armed medical team.

I'm just wondering why she doesn't get a gun?

 

[deleted343839]

I'm just wondering why she doesn't get a gun?

She's the smartest of the bunch. What do you think she's doing with her right arm? 😉

 

[Ollie123]

We are actually required to give out our cell phone number to patients in our clinic (or get a pager...but no one does and I was encouraged not to do so). There is a DBT team so I think it emerged from that world (even though I'm not part of the DBT team). That said, I see a fairly high-functioning population and haven't gotten a single call in the 8 months.

I think a lot of the digital communication issues have become less of an issue these days - it wasn't that long ago places absolutely freaked out at the notion that any patient communication would happen by email and now its very common. Cell phone providers can generally block numbers these days if it became a serious issue. Facebook is a somewhat different issue, though I could see a provider maintaining a separate "professional" facebook page for purposes of working with patients. I actually think outreach in formats like that could be a very positive thing, though obviously there are a lot of issues to think through.

Still haven't "friended" my graduate advisors, but have several other faculty I have worked with over the years. Also have several former students/RAs. Have also denied some requests from people I felt less comfortable having that kind of access to my personal life. Seems this has become the norm and I actually have fewer former supervisors as friends than many of my colleagues. These are tricky issues and my views over the years have shifted to involve far more shades of grey. Which I think is appropriate for ethics (and arguably what distinguishes it from "rules").

 

[AcronymAllergy]

I'm still somewhat conservative when it comes to this as well. "Friending" a patient (past or present), no. "Friending" a student or trainee, no. "Friending" a work colleague, sure.

I don't think there's anything actionable about "friending" a former patient, but it's not something I'd do. As was mentioned above, it just removes one more safeguard (of sorts) between appropriate and unethical or dangerous. Unless, as Ollie mentioned, I developed a professional Facebook page (which, particularly for private practice, I could see being advantageous).

 

[CheetahGirl]

Agreed. I draw similar boundaries.

I'm still somewhat conservative when it comes to this as well. "Friending" a patient (past or present), no. "Friending" a student or trainee, no. "Friending" a work colleague, sure.

I don't think there's anything actionable about "friending" a former patient, but it's not something I'd do. As was mentioned above, it just removes one more safeguard (of sorts) between appropriate and unethical or dangerous. Unless, as Ollie mentioned, I developed a professional Facebook page (which, particularly for private practice, I could see being advantageous).

 

[Therapist4Chnge]

Remember folks, the only thing that can stop a bad patient with a gun, is a good patient with a gun. Or, something like that. Logic.

Wayne LaPierre would approve!

While it irks me that I am not allowed to CC at work, I understand not everyone holds my same beliefs and my employer is well within their rights to restrict this preference.

I wish we could just hug the violence away, but alas…hugs are not sufficient.

 

[deleted343839]

I wish we could just hug the violence away, but alas…hugs are not sufficient.

On behalf of Certified Professional Huggers(TM) everywhere, I take offense.

 

[Justanothergrad]

I err on the conservative side when it comes to such issues. I am not comfortable becoming FB friends with a previous supervisor yet, let alone a previous patient/client.

I agreed about clients for sure. There should be a clear therapeutic rationale for things. I don't see why FB friends with clients or other boundary crossing stuff does them any favors that could not be done in other ways. Advisors.. eh. If they want to be bored by my reposting of PhD comics and IFLscience when I do get on FB... be my guest lol.

hugs are not sufficient.

is this one of those necessary, but not sufficient things?

 

[DrMikeP]

The longer you are in practice the more you are able to grasp how things are not always black or white. When starting out in school/just practicing boundaries should be very tight. Friends with a client on social media can be a boundary issue or completely appropriate depending on the particular content posted. Our ethics doesn't disallow such, so unless there are other issues I don't have a problem with someone who does such (even though I don't). I agree with the previous poster that you should if in question contact the professional about such and discuss it. That is the ethical thing to do.

I had a professor once tell our class about kissing a client. Just the statement would initially evoke concerns but when placed in context of an elderly client dying in hospice, a kiss on the cheek goodbye was completely appropriate.