Boundaries, apps, and dispensaries: Seeing clients in public

Brodie Vissers / Burst / Used under licenseAs mental health clinicians, we all know the importance of setting and maintaining boundaries with clients. We have several posts on this blog about setting boundaries online, specifically in regards to social media use (1 2 3). One boundary that we have not discussed is how to manage situations when you see a client outside of the regular therapy setting.

Therapists generally agree that we do not to approach clients outside of therapy, out of respect for the client’s confidentiality. If someone else knows that you are a therapist, they may make the connection that the person you are interacting with is a client. If a client approaches the therapist first, however, engaging is often considered appropriate. Even so, many therapists agree that it is difficult to maintain professional boundaries while also engaging clients socially.

Legal and technological changes are further complicating the potentially uncomfortable situations where we might encounter clients outside of the office. More specifically, we may see clients in settings that were not previously socially acceptable or accessible. Therapists today are at risk of seeing clients on dating apps, at meet-up groups, and at marijuana dispensaries. The potential for seeing clients in social situations has always been present, but there is added risk that those interactions will reveal private details about your personal life.

An LMFT colleague recently shared with me an anxiety-provoking experience where he had entered a local marijuana dispensary, only to notice that one of his current clients was also there. [Ed. note: We’ve of course changed some details here to protect confidentiality of all involved.] The colleague shared that he immediately froze and his mind began racing through all the potential consequences of their interaction. Would it impact the therapeutic relationship? Would it negatively impact progress or future sessions? Would the client feel compelled to report him to his state licensing board, regardless of merit? On the other hand, would the client actually feel more comfortable if he noticed my colleague in such a setting? Would the client more openly and honestly discuss marijuana use in sessions?

The colleague told me that the situation was even more complicated because he had actually been working with this client to minimize the client’s marijuana use.

Despite being terrified about the potential negative consequences, the colleague decided to stay at the dispensary. He mentioned that the client did eventually recognize him, but that they did not interact while there. Fortunately, he shared that the experience at the dispensary ultimately did have a positive impact on the therapeutic process. He and the client were able to more honestly discuss the client’s marijuana use and develop strategies for realistic triggers that the therapist could help to identify.

Although my colleague had a relatively positive experience, it is easy to imagine how that same situation could have ended much differently. It is also easy to imagine that if not at the dispensary, the same kind of moment could have very easily have happened at a bar or club. The potential for clients to see therapists in social situations seems to be increasing, especially those situations (like at dispensaries or on dating apps) that reveal aspects of personal life.

What you can do

We have compiled a list below of some tips to help better manage these situations yourself. As always, don’t take any of this as legal advice. Rather, some ideas from one clinician to another:

1. Establish clear boundaries and expectations regarding social interactions with clients at the onset of therapy, rather than once it has already become a problem.

2. Be mindful of the limits to privacy that exist in the world today, specifically regarding social media, geo-location, and video footage. Even if clients don’t see you in a social situation themselves, they may be able to see video footage that would impact the therapeutic relationship.

3. Don’t swipe on dating apps at work. If you use a dating app that targets your geographic location, using the app at the office greatly increases the chances that clients will be among those who can see you on the app.

4. If you use marijuana in a state where it has been legalized, consider use of a delivery service to help avoid seeing clients at a dispensary.

Of course, you could take more dramatic steps. Some therapists make it a point to live a good distance away from where they work. This reduces the chances you’ll see clients at the grocery store or gas station. But given how social media works, even if you live in a different state from your clients, you still may “run into” them from time to time. Best to plan ahead, knowing that it will happen.