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.

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The short, successful relationship?

In the Sex and the City movie, lead character Carrie Bradshaw narrates something to the effect of “Not all great love stories are novels. Some are short stories. But they are just as filled with love.” Can a relationship with a short life span be properly labeled a success?

It’s not just a philosophical question. Marriage and family therapists must regularly wrestle with the question of how “pro-marriage” or “pro-relationship” to be with their clients. We balance the ethical requirement, to respect clients’ freedom to make their own decisions about their relationships, with the research base for our field, which shows that (1) people live happier, healthier, and wealthier lives when they stay married, and (2) a large majority of couples who stay together through difficult times report strong marital satisfaction five years later.

In my own practice, I am unabashedly pro-relationship. I tell clients who come in for Emotionally Focused Therapy that I will work to preserve and improve their relationship until they call me off, no matter how desperate the situation may seem. Final decisions on whether to stay together are always up to them, but they need to know what I believe and how I work — another ethical responsibility, this one for informed consent.

In A Vindication of Love,” Christina Nehring argues that short, passionate relationships are no less noble, and may be more so, than the modern standard of a long-term, companionate marriage. Passionate relationships, even if brief, force one to live in the moment, to experience life in a deeper, more mindful way than is possible when planning out a long-term coexistence. Meghan O’Rourke at Slate was not convinced, and I tend to side with her.

Still, the topic leads me to think about the couples who come to me for therapy. Of course, many come in seeking to restore or strengthen their mutual sense of security and stability in the relationship, to ensure they can make it over the long term. But there are also those who seek exactly what Nehring vindicates: Immediacy, passion, feeling. These couples often have security in spades — they have a strong commitment to each other (and, often, their children). What they want is to get out of that long-term mindset and back into the intense, spinning experience that, ironically, may have led to the conception of said children.

There’s nothing wrong with either goal, of course. And as therapists, we’re able to accommodate either, though I would readily admit therapy tends more toward the restoring-security side than the restoring-passion. (With notable exceptions.) But in either case, we’re talking about therapeutic processes designed to maintain and strengthen a long-term relationship. I’ve never had a client openly tell me, “I would happily trade the security I feel now for a little excitement,” possibly because they believe it sounds immature or hedonistic. Yet that precise willingness is often reflected in their behavior, through affairs or other kinds of risk-taking that may enliven the moment but damage the primary relationship. So therapy sometimes will seek to heighten excitement or intimacy without negatively impacting the couple’s security — see “Mating in Captivity” — a trade that some couples find difficult if not impossible.

The careful balance between excitement and security is often a challenge for one person on his or her own, and becomes even more complicated when two people, whose needs change over time, are involved. A short relationship can be filled with love, and could be labeled a success if it meets the goals and desires of both partners — of that I’m sure. Whether short, risky relationships are a worthwhile goal for therapy… that’s a whole different question, and much harder to answer.