Therapist-Client Relationship

Therapist-Client Relationship

Psychological Ethics and Legal Issues

The therapist-client relationship is governed by psychological ethics and legal considerations that are crucial to maintaining professionalism in therapy.

APA Code - Therapist-Client Relationship

Unfair Discrimination

  • APA Code: 3.01 Unfair Discrimination: Psychologists must not engage in any form of unfair discrimination in work-related activities. This includes prohibitions against discrimination based on:

    • Age

    • Gender

    • Gender identity

    • Race

    • Ethnicity

    • Culture

    • National origin

    • Religion

    • Sexual orientation

    • Disability

    • Socioeconomic status

    • Any other basis that is prohibited by law.

Importance of Non-Discrimination

  • It is vital for psychologists to actively avoid any form of discrimination in their practice to foster an inclusive therapeutic environment for all clients.

Handling Discrimination

  • Psychologists should take proactive measures when addressing discrimination:

    • Recognize the impact that different social situations have on behavior and mental health.

    • If necessary, refer clients to other professionals, consult with supervisors, or pursue further training to enhance cultural competence.

    • Understand that it may not be possible to assist every individual who seeks help.

Survey Findings from Hansen et al., 2006

  • A survey involving 149 psychologists revealed inconsistencies between beliefs and practices, where:

    • 86% of the individual items explored showed disparity between espoused values and actual practices.

    • 42% of respondents rarely or never implemented a professional development plan aimed at improving multicultural competence.

    • 39% rarely or never sought culture-specific case consultation.

    • 27% had never referred a client to a more culturally qualified provider (as cited in Koocher, Keith-Spiegel, 2016).

Addressing Bias and Stereotypes

  • Combating bias and stereotypes requires self-reflection and awareness:

    • Self-reflection: Acknowledge and confront your own unconscious stereotypes, biases, and prejudices.

    • Awareness of Others: Be conscious of discrimination or bias you observe in others, and feel empowered to speak up about it.

APA Code - Additional Considerations

Multiple Relationships

  • APA Code: 3.05 Multiple Relationships: Psychologists should avoid dual relationships that could impair their objectivity, competence, or effectiveness in their professional role, or that could risk harming the client.

Fees and Financial Arrangements

  • APA Code: 6.04 Fees and Financial Arrangements: Psychologists must reach an agreement regarding compensation and billing with clients early in the professional relationship. This agreement must comply with the law and should not exploit the client.

Reporting Ethical Concerns

  • Additional details regarding ethical concerns are covered under section 10 of the APA guidelines.

(Sexual) Attraction in Therapy

  • It is common for therapists to experience some level of attraction towards clients:

    • According to a self-reported survey (Pope, Keith-Spiegel & Tabachnick, 1986), 95% of male therapists and 76% of female therapists admitted to feeling attraction towards clients.

  • APA Code: 10.05 Sexual Intimacies with Current Therapy Clients/Patients: Psychologists are explicitly prohibited from engaging in sexual intimacies with their current clients.

Causes of Attraction (Pope et al., 1986)

Several factors contribute to why psychologists may feel attracted to clients, including:

  • Physical attractiveness of the client

  • Positive mental or cognitive characteristics

  • Sexualized traits

  • The client's vulnerability

  • Certain personality traits that resonate with the psychologist’s experiences or needs.

Client's Influence on Psychologist's Attraction

  • Psychologists might feel attraction if clients appear to fulfill their needs and desires or remind them of someone else in their life. In rare instances, if clients have personality disorders, this may influence attraction as well.

Impact of Attraction (Ladany et al., 1997)

  • The attraction that psychologists feel for clients can have various impacts, such as:

    • Increased engagement with the client.

    • Heightened attention but potential distractions from the therapeutic topics at hand.

    • A diminished level of objectivity in professional interactions.

  • Notably, only 50% of respondents discussed their feelings of attraction during supervision.

Importance of Supervision

  • Supervision serves as an essential avenue for psychologists to reflect upon and discuss their emotional responses, particularly regarding issues of sexual attraction to clients. It is crucial to address these feelings before they affect the therapeutic relationship. Should the attraction become unmanageable, terminating the relationship and referring the client to another professional may be necessary.

Managing Attraction

  • In many cases, feelings of attraction may remain at a low level and may dissipate over time. Therefore, focusing on managing these feelings can be sufficient.

  • However, in instances where feelings escalate quickly, it is important not to trivialize the experience.

Red Flags of Attraction

  • Therapists should remain vigilant to noticeable signs of attraction, which may include:

    • Frequently daydreaming about the client.

    • Taking additional care with personal grooming on the day of the client's appointment.

    • Unwanted urges to touch or be physically close to the client.

    • Eliciting irrelevant personal information from the client.

    • Experiencing difficulty maintaining focus during therapy sessions.

Addressing Attraction in Therapy

  • Therapists face a dilemma when considering whether to discuss feelings of attraction with the client. Most therapists advise against this due to:

    1. The potential for the client to become confused or uncomfortable.

    2. Risk of projecting the therapist’s issues onto the client’s therapeutic process.

    3. The threat of the client perceiving the conversation as harassing or unwanted.

    4. Clients might misinterpret the conversation as an invitation to establish a relationship outside of therapy.

Recommended Actions

  • Instead of discussing these feelings directly with clients, therapists are encouraged to consult with colleagues, experienced peers, or supervisors who can offer guidance and support regarding the situation.

Forms of Harassment

  • Harassment in the context of clinical practice can take many forms, including:

    • Solicitation

    • Physical advances

    • Verbal and nonverbal conduct

    • Humor that may be inappropriate

    • Can be single instances, multiple incidents, or persistent behavior towards:

    • Employees

    • Supervisees

    • Students

    • Colleagues