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.