Welcome to the Winter 2016 edition of the dilemmas page, in which we ask for answers to fictional ‘what if’ nightmare scenarios that we might find ourselves in as psychotherapy trainees. The range of responses from our readers from within the psychotherapy world provides us with tools should anything similar ever happen to us in our personal practice.
You recently started your first counseling placement and have started seeing your first client, Holly. Holly’s is coming to counseling to get support regarding her boyfriend and his depression. You have also volunteered to conduct client assessments at the placement. As you prepare for an assessment, you realize the prospective client was Holly’s boyfriend and so alerted your placement manager. You are told to go ahead with the assessment and check that the client (Holly’s boyfriend) was fine to talk to you (Holly’s counselor). The assessment goes ahead. Afterwards you reflected upon the potential impact of assessing Holly’s boyfriend and are not sure how to approach your next session with Holly.
What matters do you need to consider?
Suzie (psychotherapist) says:
” First of all I am bemused as to why the placement manager gave the go ahead to still do the assessment despite the conflict being identified. I can imagine having to find someone else at short notice to conduct the assessment or to postpone may have been problematic but it would have been preferable to what did happen.
I feel for the trainee counselor in this situation. It can be difficult when first starting out at placements to find your voice and stand by your ethical position, especially when the placement manager, in a position of authority, over rules you.
What has happened is an ethical breach of the trainee’s working relationship with Holly. Regardless of whether Holly’s boyfriend gave consent, (it wasn’t his decision to make), the trainee counselor has a duty of care to Holly, meaning her best interests are put first and this has been severely compromised.
I would recommend that first the trainee counselor makes immediate contact with his/her supervisor to discuss this breach, especially if the next session with Holly is before her usual supervision.
In the session with Holly, I would make this issue paramount so it can be given lots of space to be considered. What is it like for Holly to know that you’ve now met and assessed her boyfriend? I would personally apologise to Holly for what happened and voice my concerns as to the blurring of boundaries.
One aspect I would keep in mind is that Holly’s presenting issue revolves around her boyfriend, indicating an over pre-occupation with the other instead of herself. It might be interesting to see what has happened as a reflection as to how Holly is in relationship to herself and others. You have a real life example in the here and now to work with so this is a great opportunity for some insights to be drawn.
Depending upon the outcome of discussions with the supervisor, I would also make clear that your assessment of Holly’s boyfriend might mean you need to end your work with Holly. This is I feel the only sensible way forward. The container has become unstable and the work now feels very unsafe to me. There is no way back from this in my opinion. The sooner this is named in session, the sooner Holly can begin to process her reaction. Again this may reflect her way of relating, where she comes second and can even be dismissed through the fault of others. So there are a fruitful areas to explore but in a time limited fashion as I strongly feel the current therapy has to end.”
Nick (psychotherapist) says:
“In this situation I would flat out refuse to perform the assessment with Holly’s boyfriend. If I have been working with Holly specifically for issues regarding her relationship it would not be ethical for me to assess him – I would be unable to provide an unbiased opinion of what problems he is presenting with, as I would be heavily influenced by my previous work with Holly. This may mean that I provide him with an assessment tinted with the information that she has given me about him, including her own biases and judgements. It would be extremely hard to detach from this and provide him with an adequate assessment session.
There would simultaneously be a breach of trust in terms of my work with Holly and this may be traumatic for her depending on the content she has provided around the boyfriend, there is an incestuous feel to ‘sharing the therapist’ in this triad which I would also be curious and wary around – what is this situation that I am being forced into about in terms of unconscious content (codependence, siblings sharing a parent, one partner eclipsing another etc). My priority would be to ensure her safety as my current client, even if that meant refusing his assessment – he would have to come back and have an assessment on a different day (which is something that could be arranged with minimal pain) whereas if I saw him as a client the psychotherapeutic container would be damaged perhaps beyond repair. My responsibility would be first to my client’s welfare and to the placement second and so I would definitely refuse.
I would of course explore this situation in supervision, however if presented with this situation on the spot this would be my choice.