Therapists: Boundaries in Professional Relationships

By Sarah Earles, MS, LPC, NCC | April 19, 2024

Professional mental health is a unique career field. Professional mental health therapists are helpers but not healers, listeners but not advisors, hearers but not consequence givers. As professionals, therapists must follow specific ethics codes. These impact the ways in which therapists can and cannot interact with clients. These ethics codes set boundaries that prevent therapists from personal friendships with clients in order to preserve client well-being.

Professional mental health therapists hold a variety of licenses, as set forth by their state. These include but are not limited to licensed professional counselors (LPCs), licensed marriage and family therapists (LMFTs), and licensed clinical social workers (LCSWs). The American Counseling Association [ACA] and its Code of Ethics (2014) govern LPCs.  LMFTs subscribe to the American Association for Marriage and Family Therapy’s Code of Ethics (2015). LCSWs follow the National Association of Social Worker’s [NASW] Code of Ethics (2021). What do all these ethics codes say? That therapists cannot be friends with their clients. Most of the ethics codes call these dual relationships and can include friendship and/or business relationships. The ethics codes forbid these types of relationships because of the potential “risk of exploitation or potential harm to the client” (NASW, 2021). In dual relationships, such harm could occur because friendship clouded the professional’s judgment. The purpose of counseling is to promote a client’s progress, not hinder it.

When clients make progress, though, can therapists attend celebrations of that progress? Is it appropriate for therapists to go to major events such as birthday parties, graduations, and weddings? In classic therapist fashion, the answer is, “it depends.” The ACA Code of Ethics (2014) states that this is an extension of counseling boundaries. This means that therapists must seek informed consent from the client, as well as receive consultation and supervision with regards to why such attendance benefits the client. At least one risk of a therapist attending such an event is loss of client confidentiality. Perhaps the client has told others about his or her therapist, but perhaps the client has not, and the therapist’s presence would expose it. There is also the issue of role. A therapist does not provide counseling services at an event outside of the office, and this lack of support may feel like a loss to a client. The medical mandate to “do no harm” applies here, as it does in situations that involve physical health and medicine (Shmerling, 2020). Therapists want to work for, not against clients.

In short, while therapists and clients might be the types of people who could have been friends prior to engaging in services, the therapeutic relationship prevents it. This is for the good of the client, and to promote achieving of the client’s goals. While therapists and clients cannot be friends, therapists can help clients pursue goals of making and keeping healthy relationships. Such connections might promote ongoing therapeutic growth and healing, and one day, even be enough that clients are able to graduate from services, a ceremony that therapists can attend, since they are the ones initiating it.

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Professional mental health is a unique career field. Professional mental health therapists are helpers but not healers, listeners but not advisors, hearers but not consequence givers. As professionals, therapists must follow specific ethics codes. These impact the ways in which therapists can and cannot interact with clients. These ethics codes set boundaries that prevent therapists from personal friendships with clients in order to preserve client well-being.

Professional mental health therapists hold a variety of licenses, as set forth by their state. These include but are not limited to licensed professional counselors (LPCs), licensed marriage and family therapists (LMFTs), and licensed clinical social workers (LCSWs). The American Counseling Association [ACA] and its Code of Ethics (2014) govern LPCs.  LMFTs subscribe to the American Association for Marriage and Family Therapy’s Code of Ethics (2015). LCSWs follow the National Association of Social Worker’s [NASW] Code of Ethics (2021). What do all these ethics codes say? That therapists cannot be friends with their clients. Most of the ethics codes call these dual relationships and can include friendship and/or business relationships. The ethics codes forbid these types of relationships because of the potential “risk of exploitation or potential harm to the client” (NASW, 2021). In dual relationships, such harm could occur because friendship clouded the professional’s judgment. The purpose of counseling is to promote a client’s progress, not hinder it.

When clients make progress, though, can therapists attend celebrations of that progress? Is it appropriate for therapists to go to major events such as birthday parties, graduations, and weddings? In classic therapist fashion, the answer is, “it depends.” The ACA Code of Ethics (2014) states that this is an extension of counseling boundaries. This means that therapists must seek informed consent from the client, as well as receive consultation and supervision with regards to why such attendance benefits the client. At least one risk of a therapist attending such an event is loss of client confidentiality. Perhaps the client has told others about his or her therapist, but perhaps the client has not, and the therapist’s presence would expose it. There is also the issue of role. A therapist does not provide counseling services at an event outside of the office, and this lack of support may feel like a loss to a client. The medical mandate to “do no harm” applies here, as it does in situations that involve physical health and medicine (Shmerling, 2020). Therapists want to work for, not against clients.

In short, while therapists and clients might be the types of people who could have been friends prior to engaging in services, the therapeutic relationship prevents it. This is for the good of the client, and to promote achieving of the client’s goals. While therapists and clients cannot be friends, therapists can help clients pursue goals of making and keeping healthy relationships. Such connections might promote ongoing therapeutic growth and healing, and one day, even be enough that clients are able to graduate from services, a ceremony that therapists can attend, since they are the ones initiating it.

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References

American Association for Marriage and Family Therapy. (2015). Code of Ethics. Retrieved from https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

American Counseling Association. (2014). ACA code of ethics. Retrieved from http://www.counseling.org/docs/ethics/2014-aca-code-of-ethics.pdf

National Association of Social Workers. (2021). Code of Ethics. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

Schmerling, R.H. (2020, June 22). First, do no harm. Harvard Health Publishing. https://www.health.harvard.edu/blog/first-do-no-harm-201510138421

References

American Association for Marriage and Family Therapy. (2015). Code of Ethics. Retrieved from https://www.aamft.org/Legal_Ethics/ Code_of_Ethics.aspx

American Counseling Association. (2014). ACA code of ethics. Retrieved from http://www.counseling.org/docs/ethics/ 2014-aca-code-of-ethics.pdf

National Association of Social Workers. (2021). Code of Ethics. Retrieved from https://www.socialworkers.org/About/ Ethics/Code-of-Ethics/Code-of-Ethics-English

Schmerling, R.H. (2020, June 22). First, do no harm. Harvard Health Publishing. https://www.health.harvard.edu/blog/first -do-no-harm-201510138421