One of the wonderful things that happened to me after I started my private practice was that some of my clients were also therapists. It makes sense that a therapist would seek therapy in a solo-practice setting; you don’t want to risk running into future or past colleagues by getting services from a counseling center or agency. If you’re in private practice, the odds are very good that you’ve had a number of clients that are fellow therapists.
I decided to write about this topic because there seems to be a lot of questions about it. What if your therapist-client admits to doing unethical behavior? Are you required to report them to the Board or other oversight agency? To answer this question, I want you to imagine that your client wasn’t another therapist. If the client wasn’t a therapist, but say a businessman who was doing unethical behavior at his place of business, would you report him? No, because that information is considered confidential. The same is true for your therapist-client. Remember, we are only mandated reporters if we learn of child or elder abuse or if a person’s life is in danger (The client tells you that they plan on killing themselves or someone else). Of course, if a client tells us that they are doing unethical behavior, we should make that a focus of therapy and to encourage the client to stop doing it.
I think where a lot of people get confused is that they feel that we are mandated reporters if we were to discover that a coworker or another therapist in the community were doing unethical things with their client. For example, nearly all of the ethics codes for therapists tell us that if we know that another therapist is acting unethically, that we need to do something about it. This causes a lot of therapists to worry that if they don’t report the offending therapist and it somehow gets out that they knew the unethical behavior was going on, that they will be considered to be a type of accomplice. So, individuals feel compelled to rush and report the offending therapist to the board. HOWEVER, the ethics code also tells us:
This standard does not apply when an intervention would violate confidentiality rights
That’s right, your therapist-client’s right to confidentiality supersedes any responsibility to report or notify the Board. Furthermore, even if confidentiality were not an issue, the ethics code also states:
When (therapists) believe that there may have been an ethical violation by another (therapist), they attempt to resolve the issue by bringing it to the attention of that individual
There have been many times when I became aware of another therapist acting in an unethical manner. Rather than go running to the Board, I talked with the therapist instead. Most of the time I found that they didn’t even realize that they were being unethical and thanked me for letting them know. The unethical behavior stopped and everyone left happy. Of course, there are times when you do need to go to the Board, either because the violation was especially serious, there is a significant risk to you of retaliation from the therapist in question, or you find the therapist in question unable to be reasoned with. But as stated earlier, either way it doesn’t count if that therapist is also your client.
In addition to potential ethical issues, there is often a question of roles. What are you to the client exactly? It’s important to be clear about this. The client may not just see you as their therapist. To the therapist-client, you may also be a mentor, supervisor, or consultant. Know the difference between all of these is key. I remember on therapist-client I had a few years ago. One day she came to me with a hand full of paperwork. She wanted me to sign off on her supervision for licensure. When I reminded her that I was just her therapist, not her supervisor, she disagreed. It made for a tense moment.
Make sure you know what your client expects from you. A lot of therapist-clients see it as a way of getting their health insurance to pay for their clinical supervision. However, insurance will never pay for supervision or consultation. Also, being a therapist’s supervisor also puts you at a great deal of risk and legal responsibility. It’s not something to take likely. Make sure your client fully understands the role you are taking. Of course, it’s okay for them to talk about work in therapy, but they need to understand that you are not their supervisor.