One Challenge of being a Therapist in Small Town USA

At Issue: Whether or Not to Disclose When There Is an Indirect Connection to a Potential or Current Client

Therapists and counselors have ethics which guide them in setting healthy boundaries with clients in regards to associating outside of session and avoiding dual relationships. But what if the situation is that the client knows your family or friends (but not you). Just because you may not know each other directly, something the client says or where they live might suggest to you that your paths may cross in some way outside of session/office. My concern is that if this connection is later discovered the client may feel deceived that this was not brought to their attention from the start. As much as you try to separate your professional and personal social media presence, what if you and the client are both Facebook friends with the same person and see each others’ comments? Do you proceed and hope nothing comes of it or do you disclose and let the client make an informed decision based on their comfort level.

In all situations that come to my mind where this has been the situation, I have always chosen to be upfront and explain the connection, giving the client the choice based on if it is a concern for them. During this discussion I am sure to reiterate that the expectation of confidentiality is not different for them and it would be unethical for me to disclose any of their information or acknowledge a therapist-client relationship.

Certainly the connection might not be known at the start of therapy and might come up later. I think this involves many of the same factors except you may already know a good deal about the client at this point rather them knowing the situation at the time of informed consent. In our less populated area of the country it is not uncommon to unexpectedly run into a client at a social gathering. This would likely be handled by me the same way as if your paths cross at the grocery store. It would be on the client to acknowledge they know you or the extent of the relationship. If no acknowledgment is made, then it is on the therapist to act non-chalant and normal and discuss the situation at the next session on how to proceed.

Although, for me, full disclosure upfront is the best policy, it is unfortunate that I have to risk a client choosing to not work with me for reasons outside of my control that have little to nothing to do with myself professionally. This is certainly something I can accept as being what it is, as ultimately the comfort and trust of the client are the biggest priorities.

I hope this blog entry demonstrates my adherence to professional ethics in regards to boundaries with clients and respecting their autonomy.

Rita Hansen is a licensed professional counselor with Sioux Falls Wellness Counseling. She can be reached by calling (605) 610-9228.