Why your Therapist can't be your Couples Counsellor as well

Here's another type of enquiry I get surprisingly regularly: someone I have either worked with on a one to one basis or who's been referred to me for therapy is asking me to also be their couples counsellor or work with another close family member. 

They're usually disappointed when I tell them that this isn't possible. I once even had another therapist express their surprise at me, because "surely you can remain neutral?!" Unfortunately, it's not quite as simple as that. 

In the field of mental health, maintaining ethical boundaries is paramount to ensure the effectiveness and integrity of therapeutic relationships. One common ethical dilemma that arises is whether it is appropriate for a counsellor to see an individual client while also serving as their couples counsellor, or providing therapy to another family member. In very, very rare occasions it can be ok to make an exception, for example where the work is very specific and limited, such as a few self-contained EMDR sessions to treat an acute phobia, but even then it's usually not a good idea. 

The primary concern with a counsellor wearing multiple hats within the same family unit is the potential for conflicts of interest. When a therapist sees an individual and then also works with that individual in a couples or family setting, it can create situations where confidential information shared in individual sessions might influence the counsellor’s perspective in the group context. This can lead to biases, conscious or unconscious, that can affect the counsellor’s neutrality and objectivity. Much more importantly though, it can also influence how openly each family member communicates with the therapist. Therapy is supposed to be a place where you're able to express all of your most personal thoughts and feelings without a filter. Imagine sitting there and holding back on what you'd really like to say, because you're wondering whether your therapist might already have heard your story from another family member's perspective. 

Confidentiality is another critical issue. In individual therapy, clients share personal and often deeply private information with the expectation that it will remain confidential. If the same counsellor then sees the client in a couples or family setting, the boundaries of what is shared and what remains private can become blurred. This overlap can lead to a breach of trust if clients feel that their confidential disclosures are influencing the counsellor’s stance in joint sessions.

There is also an important difference in how confidentiality works in individual therapy versus couples counselling and systemic family therapy. In the latter two we have what's called "shared confidentiality". this means that anything said to your therapist one to one might come back up in the couples or family session. What this refers to in practice is this: whilst in couples and family therapy most sessions will be conducted with all parties present, it isn't uncommon to also have some appointments where only one partner is present, or where the therapist works with one family member on a specific issue. Anything said in those one to one sessions may also come up in the couples or group session (i.e. a couples or family therapist won't keep secrets for you). This is explained and agreed on by all parties during the intake session. That's also why it is absolutely crucial for both partners (or in family therapy, all family members who are going to attend future sessions) to be present. 

Additionally, the dynamics of power and trust within therapeutic relationships can become complicated. For instance, if a counsellor is privy to one partner’s personal struggles in individual therapy, they might, even unintentionally, carry those insights into the couples therapy sessions. This can create an imbalance where one partner feels understood or supported more than the other, potentially skewing the therapeutic process.

Another ethical consideration is the potential for divided loyalties. A counsellor’s primary responsibility is to their client, and this can become complex when the counsellor has multiple clients within the same family unit. In a couples therapy context, the counsellor must remain neutral and support the relationship as a whole, rather than aligning with one partner over the other. This neutrality can be compromised if the counsellor is also seeing one partner individually.

Furthermore, when working with multiple members of the same family, the potential for triangulation increases. Triangulation occurs when two people in conflict use a third person to communicate, often leading to the third person feeling caught in the middle. In therapy, this can disrupt the therapeutic alliance and hinder the progress of treatment.

In some cases, therapists may attempt to navigate these complexities by setting clear boundaries and discussing potential conflicts openly with all parties involved. However, even with the best intentions, the overlapping roles can still compromise the therapeutic process and lead to unintended ethical violations.

Ultimately, to maintain the highest ethical standards and ensure effective therapy, it is generally advised that counsellors avoid dual relationships within family systems. This approach safeguards confidentiality, supports unbiased therapeutic intervention, and maintains the trust essential for effective therapy. If you ever do find yourself in a situation where overlapping roles are a concern, discussing these issues openly with your therapist and seeking a referral to another professional can be an important step to ensure that you as well as the other parties involved receive the most ethical and effective care possible.