This is a complex ethical situation that many therapists find themselves in at some point in their career. On the one hand, seeing two people who know each other violates confidentiality principles. On the other hand, denying care to someone in need also presents an ethical dilemma. There are several factors to consider when determining whether it is appropriate for a therapist to see two friends.
The ACA Code of Ethics
The American Counseling Association (ACA) Code of Ethics provides some guidance on this issue. According to section A.5.d., counselors are expected to avoid seeing multiple members of the same family, couples, or group. The rationale is that this could compromise the counselor’s effectiveness or client rights due to the potential conflicts involved. The code does not expressly prohibit counselors from seeing two friends, but the underlying principles still apply.
Section A.2.d. of the ACA Code of Ethics also states that counselors should refrain from professional relationships that could reasonably be expected to impair their objectivity, competence, or effectiveness. Seeing two friends simultaneously could certainly impact objectivity and introduce multiple relationship issues. However, the code acknowledges that in some communities with limited access to services, counselors may be called upon to take on multiple roles out of necessity.
Confidentiality Concerns
One of the biggest ethical concerns with seeing two friends is maintaining confidentiality. Friends often talk to each other about the intimate details of their lives. It would be extremely difficult for a therapist to keep information about each friend completely confidential. Even if the therapist upholds perfect confidentiality, the two friends may feel uncomfortable knowing the therapist holds private information about both of them.
There is also a risk that one or both friends could feel betrayed if they found out the therapist was seeing their friend at the same time. Trust is essential in therapy, and seeing two friends simultaneously could undermine that. At minimum, the therapist should obtain written informed consent from both parties acknowledging they are aware the therapist sees their friend and the limits of confidentiality.
Conflicts of Interest
Seeing two friends also introduces potential conflicts of interest for the therapist. If the friends are having relationship problems, their interests may be at odds, making it difficult for the therapist to remain objective. The therapist could experience divided loyalties and struggle to balance the needs of both clients.
Even if the friends’ issues seem unrelated on the surface, information shared in one therapy session could influence the therapist’s perspective. Maintaining neutrality and exercising independent professional judgment are essential ethical duties, which could be compromised in this situation.
Boundaries
Clear boundaries are necessary in the therapist/client relationship. When seeing two people who have an existing relationship, maintaining boundaries becomes even more challenging. Multiple relationships present a slippery slope the therapist must carefully navigate to avoid damaged therapeutic relationships or inappropriate boundary crossings.
For example, the friends may expect favors or flexibility from the therapist given their shared connection. The therapist must be vigilant against relaxing boundaries or normalizing out-of-session contact in an effort to appease both parties. Seeing friends also increases the chances the therapist may unintentionally encounter a client in a social setting, further blurring boundaries.
Weighing Benefits vs. Risks
Given all these concerns, in most cases, the potential risks likely outweigh the benefits of a therapist seeing two friends simultaneously. However, there may be exceptional situations where the needs of the clients make it necessary.
For instance, if the two friends live in a remote area with no other counseling services available, denying treatment to one friend could constitute abandonment. In such cases, the therapist should clearly explain the situation, potential risks, and boundaries to both parties before agreeing to see them. Ongoing transparency and consent are crucial.
Likewise, if one friend is already an established client with a strong therapeutic relationship, abruptly terminating treatment when the second friend seeks counseling could be damaging. The therapist may determine it is in the best interest of both parties to continue, with full disclosure of the dual relationship.
Best Practices
When seeing two friends is unavoidable, therapists should take precautions to protect client confidentiality and maintain appropriate boundaries. Some best practices include:
- Holding sessions at distinct times to avoid encounters
- Conducting sessions off-site or remotely using teletherapy
- Instituting strict confidentiality policies and obtaining written consent
- Declining to share details about either friend with the other
- Keeping extensive process notes to avoid confusion
- Enlisting clinical supervision to ensure objectivity
- Referring one or both friends to another therapist if issues arise
- Avoiding out-of-session contact with both friends
Conclusion
Seeing two friends poses significant ethical challenges for therapists related to confidentiality, boundaries, and conflicts of interest. In most cases, the prudent choice is to decline working with one person to eliminate issues. However, extenuating circumstances may occasionally make it justifiable with special safeguards in place. Therapists must carefully assess the risks and benefits to determine the best course of action.
By prioritizing open communication, obtaining informed consent, implementing strong policies, consulting supervisors, and making referrals when needed, therapists can uphold their ethical responsibilities even in these delicate situations.