There are a number of examples of what constitutes a conflict of interest in therapy. Just as in medicine, treating certain patients may not be in the best interest of the patient or the therapist. A therapist, for instance, would have a direct conflict in trying to counsel his or her own family members, just as a doctor would be unlikely to treat the illnesses of his or her own immediate family (beyond offering some basic care as needed). The premise of most therapy is that a therapist is to bring objectivity to sessions, and he or she cannot bring the same level of distance to those people who he or she knows very well.
These examples are called non-sexual dual relationships, and they are not illegal, though they may not always be advised. Additional non-sexual dual relationships, where a conflict of interest might occur include the following:
- A therapist and client have a friendship outside of therapy, where the therapist and client have a business relationship.
- The client and therapist live together in very small communities or belong to the same communal organizations.
- The therapist works not only as a therapist for a person, but also may evaluate them in some way.
- This last is the case in institutions and in prisons, when therapists may also make judgments about the client’s future, and such a relationship could also exist in organizations that employ a counselor for their employees to visit.
Not all outside relationships with a therapist will pose a significant conflict of interest in therapy. For instance, if someone attends a large church that her therapist also happens to attend, this may be relatively harmless, though it can potentially affect the patient's privacy, or make her feel slightly uncomfortable if she meets her therapist in a social setting. The therapist is still bound by confidentiality, and cannot disclose that the person is his client, which may make for a few awkward moments. If a patient does share this type of dual relationship with a therapist, discussing in therapy how meetings in the “outside world” should be handled makes good sense.
On the other hand, not all clients want to see their therapist in the outside world, and really prefer anonymity and privacy when attending therapy. They may feel more conflicted about discussing their problems with someone they know or are likely to meet regularly. When dual relationships exist, it’s important to find out if they have the potential to create a discomfort in therapy, for either the therapist or client, and to decide if the client would be best served with another therapist.
Another way that conflict of interest in therapy may occur is when a therapist treats more than one client of the same family. It is very important, especially in couples or family counseling, to clearly define the degree of confidentiality each person being counseled will have. Many times, therapists who work with more than one family member will very directly state that anything said by clients is not confidential to related clients. Of course, this may affect the degree of honesty people in family or couples therapy will exhibit. If it seems clear that one person is struggling with issues or needs greater confidentiality, the therapist may recommend that person seek counseling with a private therapist too.
Similarly, therapists may feel it is a conflict to treat more than one client of the same family in private settings. Since each client would have total confidentiality, but might be speculating about their family members, it may be hard to preserve this privacy. This is especially the case when the therapist has information about each related client from other family members. It is often in the best interest of the clients if they each have their own therapist.
Professional therapy should never include sexual relations between therapist and client. This is undoubtedly a conflict of interest in therapy. Adding a sexual component to the relationship can prove tremendously damaging to a client, since that person is incredibly vulnerable in the therapeutic setting.
What Would Be a Conflict of Interest for a Therapist?
Any situation that compromises a therapist's objectivity is a conflict of interest. Sometimes, recognizing these situations is easy. There are some situations that therapists should avoid, as they are almost always conflicts of interests, such as:
- The client is a close friend or relative of the therapist
- The client is a colleague or employee of the therapist
- The therapist accepts gifts from the client
- The therapist accepts goods or services in lieu of payment
Often, however, the therapist must use his or her judgment as to whether the situation constitutes a conflict of interest.
Identifying Conflicts of Interest
A common dilemma in small towns and close-knit communities is that therapists and clients may encounter one another in social situations. Whether this constitutes a conflict of interest depends on the nature of these encounters.
For example, if the therapist's children and the client's children attend the same school, this is not necessarily an issue. However, if the therapist and client are both on the school board, this could become a problem. Situations that occur during school board meetings could affect the therapist's objectivity in treating the client.
Even if there is no conflict, the client may decide to seek therapy elsewhere if he or she is uncomfortable. For example, a client who does not want to encounter his or her therapist in public may look for a therapist who does not live in the community. On the other hand, the client may decide that he or she can live with the occasional awkward social interaction if the therapist is otherwise a perfect fit.
Is It a Conflict of Interest for Family Members To See the Same Therapist?
Unless the therapist is providing family or couples counseling, it is generally considered a conflict of interest for spouses or family members to see the same therapist.
Family counseling usually involves both individual and group sessions, and the therapist establishes expectations and boundaries from the start. The clients agree to receive counseling together and understand what information may be shared.
This is different from a situation in which multiple family members seek individual counseling from the same therapist. A therapist may choose not to work with a client if he or she is already treating someone the client is close to. In such a case, confidentiality prevents the therapist from specifying why he or she is declining to work with the client.
What Is Conflict of Interest in Psychology?
In psychology, a conflict of interest is any relationship or concern that interferes with the psychologist's professional role. Such relationships can be problematic even if no actual conflict exists; the appearance of a conflict is sometimes enough to damage the provider-client relationship.
Financial Conflicts of Interest
Conflicts of interest may be financial, such as a therapist getting paid to refer a client to a certain provider or paying for referrals from others. Bartering for services can also be a conflict of interest; for example, a psychologist provides free counseling to a plumber in exchange for the plumber's services.