Dealing with a Dual Relationship with My Therapist

Reader’s Question

I have been in a dual relationship as a friend with my therapist for 4.5 years now and things are starting to crumble and get complicated. I feel unsafe and I feel like if I pull out, there are consequences to my life that will happen.

I have been friends with her for 4.5 years now; this friendship has entailed celebrating holidays, birthdays, emailing and texting sometimes daily, and at least two calls per week. Things were going great until the last year. I am responsible for wanting this relationship, but I am not a therapist, so I didn’t realize the consequences. The additional layer of this is she has befriended my boyfriend who is 13 years younger than me and 23 years younger than her. They go out to events together and she uses him to organize her house, and cat sit, as well as clean her office. Things started getting hairy when she and I started having disagreements. My boyfriend and I are in a couples group as well as individual groups with her, and recently she has lashed out at me in my group when I messed up and interrupted her.

I want to end this relationship with her, but I feel like she will expose my problems to my boyfriend and use her disagreements with me as an arsenal.

Psychologist’s Reply

There have been times in working with my clients that they have said to some degree or manner that they wish we could be friends or that they consider me a close friend. I often see that dealing with others and their personal problems creates a unique sense of closeness. This is a very natural event in therapy as sharing personal information and emotions can bring this about. As clinicians, we are trained and guided by ethical rules to understand and manage this closeness in ways that are ethical and non-exploitative to our clients.

Boundary crossings and boundary violations are the most common issues that present when dealing with or mismanaging this closeness. Boundary violations are typically harmful to our clients and occur when the relationship is exploitative, such as sexual contacts with current clients. In addition, exploitative business relationships also constitute boundary violations.

Boundary crossings, on the other hand, can be an important part of an evidence-based treatment plan. Examples I have personally seen are things like having lunch with someone who is anorexic, making a home visit to an agoraphobic client who is too fearful to leave their home, going for a vigorous walk with a depressed person, or flying in an airplane with a patient who suffers from a fear of flying. Boundary crossings are sometimes even unavoidable, such as when working in rural communities or the military where the therapist finds themselves in dual roles with their clients. Boundary crossing with some clients (especially those with a diagnosis of borderline personality disorder) must be approached with caution and have set limits and clear structure. These issues should always be discussed within therapy should they happen or be likely to happen. We are even beginning to explore our digital boundaries now as well. Questions like “can I be friends on Facebook with my therapist?” are topics of much debate and discussion.

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These feelings you have are the result of a dual relationship with your therapist and common to therapeutic relationships that have boundary violations and boundary crossings. It seems that the dual relationship you describe is interfering with your therapeutic relationship. When the relationship outside therapy begins to moderate what you feel comfortable talking about or addressing in therapy, the issue only become worse. If you feel safe to discuss and resolve this with your therapist in therapy then I would encourage you to do so. Resetting the boundaries and redefining the relationship with her can help repair the long relationship you have worked on with her. However, there are times when we may not feel safe to do so, and finding treatment elsewhere may be the best option. Talking with your boyfriend about your feelings could help as well.

It is the responsibility of the therapist to ensure that the dual relationship is not damaging or exploitative. Therapists need to ask themselves the following questions when entering into dual relationships with clients:

• Is the dual relationship necessary?
• Is there potential for it to be exploitative or damaging to the client?
• Who does the dual relationship really benefit?
• Would it risk or harm the therapeutic relationship?
• Can I be objective in this decision or should I seek consultation?
• Has the client given explicit consent for the relationship?

Finally, the decision making process around dual relationships should be adequately documented in the treatment records.