Key takeaways:
Therapist’s ethics codes discourage therapists and clients from being friends.
When a therapist and client are friends, it can negatively impact a therapist’s ability to effectively treat a client.
When the boundaries of a therapy relationship are violated, it can cause harm to the client and may lead to a therapist losing their license.
The relationship between a therapist and client is unique. Clients often share things with their therapists that they have never told anyone else before. Sometimes this can cause the relationship to feel like more of a friendship. But therapy is different from a friendship.
And therapists and clients shouldn’t be friends with each other; there are risks to crossing these lines in therapy.
Are therapists allowed to be friends with their clients?
Therapists are strongly discouraged from being friends with their clients.
Therapists have a responsibility to provide ethical care to their clients. There are many parts of ethical care such as:
Working to not cause harm to their clients
Maintaining professional boundaries
Avoiding relationships with clients outside of therapy
Professional organizations set ethical guidelines for therapists based on their license. Organizations that state therapists cannot be friends with clients if it would impair their objectivity include the:
Being friends with a client complicates the therapy relationship and blurs the lines of treatment. When a therapist and client become friends, it changes the dynamic. And as a result, therapy can become less effective for clients.
The therapist will likely have a harder time not bringing their own feelings into therapy. Their friendship can make it hard for the therapist to guide the client toward making a decision for themselves.
For example, as a friend, the therapist may feel strongly that the client should make a change, like breaking up with a partner or quitting a job. But as a therapist, it’s often more important to help the client explore their options and come to their own conclusions.
What is the purpose of the therapist-client relationship?
The therapist-client relationship, or therapeutic alliance, refers to the connection between a therapist and client. The therapist-client relationship is one of the most important parts of therapy.
Studies have found that clients who have a positive relationship with their therapist have better outcomes from therapy.
The therapist-client relationship is based on:
How the therapist and client work together
The bond between therapist and client
Whether the therapist and client can agree on goals
The purpose of the therapeutic alliance is to provide a foundation for therapy. Many therapists believe that a good working relationship is key for a client to get the most out of therapy. Without a solid relationship, a client may not benefit from the interventions and treatment that a therapist provides. Clients are also more likely to drop out of therapy early before reaching their goals.
What are the boundaries of a therapist-patient relationship?
Boundaries are the limits that a therapist must keep to maintain an appropriate relationship with a client. Some boundaries are very clear, while others are up to the therapist’s discretion.
Therapist’s ethics codes are very clear when it comes to boundaries around sex, romantic relationships, and dual relationships. Therapists should never:
Have sex with clients or anyone who is close to a client
Accept previous sexual partners as therapy clients
Form romantic relationships with clients or anyone who is close to a client
Form dual relationships with clients if it could harm them (more on this below)
Other boundaries require that therapists consider the risks and benefits to the client. These include:
Discussing the therapist’s personal life with clients
Accepting gifts from a client
Providing a non-sexual hug or other forms of non-sexual touch
As a client, it is important that you feel safe with your therapist. If your therapist ever acts inappropriately, you should either discuss this with them or contact your state’s licensing board to file a complaint.
What is a dual relationship in psychology?
A dual relationship refers to when a therapist and client have a separate relationship with one another outside of the therapy relationship. It is also referred to as having multiple relationships.
The problem with dual relationships is that they can get in the way of a therapist’s ability to be objective, competent, and effective. They can also lead to boundary violations that can cause harm to the client.
Dual relationships are not always unethical. In some cases, a dual relationship cannot be avoided. And at other times, for cultural reasons, having certain types of dual relationships with clients may be appropriate.
Examples of dual relationships that cannot be avoided include:
A therapist is mandated to testify in court on behalf of a client.
A therapist’s child is in the same class as their client’s child.
A client and therapist live in the same community and run into one another from time to time.
The safest option is to avoid dual relationships altogether. If they cannot be avoided, it is the therapist’s responsibility to put boundaries in place to protect the client from harm.
Consequences of therapists crossing relationship boundaries
When a therapist crosses a boundary in the therapeutic relationship, there can be serious consequences for the client, as well as the therapist’s career.
Possible consequences to the client include:
Less effective treatment, especially if the therapist’s objectivity is lost
Feeling taken advantage of by the therapist, which could trigger feelings connected to past traumas
Harm to the client’s mental health
Possible consequences for the therapist could be:
Actions against their license, which can limit their ability to provide therapy
Loss of the therapist’s license
Damage to their reputation
Arrest and criminal charges
The bottom line
Therapists have a responsibility to maintain appropriate boundaries with their clients. This includes avoiding any dual relationships that could affect their ability to be objective. Therapists should not become friends with their current or former clients. Violating these boundaries could harm the client’s mental health and lead to negative consequences for the therapist’s career.
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References
American Association for Marriage and Family Therapy. (n.d.). Code of ethics.
American Counseling Association. (2014). 2014 ACA code of ethics.
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct.
APA Dictionary of Psychology. (n.d.). Boundary. American Psychological Association.
Behnke, S. (2015). The ethics of multiple relationships: A clinical perspective. American Psychological Association.
Black, S. C. (2017). To cross or not to cross: Ethical boundaries in psychological practice.
Corey, G., et al. (2015). Issues and ethics in the helping professions, updated with 2014 ACA codes. Brooks/Cole CENGAGE Learning.
DeAngelis, T. (2019). Better relationships with patients lead to better outcomes. American Psychological Association.
Jasper, S. (2018). Dual relationships and avoiding liability. California Association of Marriage and Family Therapists.
Kelly, R. (2009). Ethical considerations within multicultural counseling: Dual relationships, global psychology & action for today’s counselors. University of Minnesota.
National Association of Social Workers. (n.d.). 1. Social workers’ ethical responsibilities to clients. Code of Ethics of the National Association of Social Workers.
Stubbe, D. E. (2018). The therapeutic alliance: The fundamental element of psychotherapy. Focus.
