Upholding confidentiality when working with couples.
Steve Miner, MS, MFT-LPC a marriage and family therapist with Willow Sage Services Behavioral Health Clinic has counseled many couples about maintaining confidentiality within the counseling relationship when individual therapy is conducted apart from the couple therapy.
In working with couples, Miner states the therapist must balance the needs of two individuals and their relationship to determine the best course of therapeutic action. In particular, the handling of confidentiality within the couple raises unique ethical dilemmas. Does conducting individual counseling with the couple affect the couple counseling in terms of upholding confidentiality and doing no harm? When, if ever, is it ethical to break confidentiality with the couple? What responsibility does the therapist assume in protecting the individual’s confidentiality within the couple dynamic? The function of marriage counseling is to create a safe and respectful environment in which the couple can communicate with each other without hostility. If, after understanding the needs and desires of the other, one person refuses to accommodate the other, then individual psychotherapy can be prescribed, so as to uncover and heal the cause of the resistance. When a husband and wife or couple is being seen in marriage/couple counseling, the counselor may occasionally arrange to see one or both individuals in individual sessions. Usually, to avoid clinical disaster, these individual sessions are often conducted under the rule that there will be no secrets, and that anything spoken in the individual sessions must be brought into the joint counseling. If either person has the sort of psychological problems that could warrant individual psychotherapy under strictly confidential conditions, the individual(s) should be referred to a separate psychotherapist, someone who has no connection to the marriage counseling.
Defining the Client:
Essential to couple therapy is defining the client. Some couple therapists define the couple’s relationship as the client at the beginning of therapy and only work to improve the relationship. While this approach may appear to provide a clear-cut answer to the ethical dilemmas of working with couples, each relationship consists of two individuals who each have their own needs, thoughts, and emotions that must be considered. It is important to explain clearly at the outset of therapy that the couple’s relationship and both individuals are clients in therapy, and that the counselor will seek to have a balanced relationship with each individual while all work together to improve the couple’s relationship.
Valuable information can be gathered regarding each individual’s history and commitment to the relationship and treatment. However, sometimes during these sessions, one individual will take the opportunity to divulge a secret to the therapist, which can create an ethically difficult situation. Some couple therapists choose not to hold individual sessions at all so that they do not have to confront this issue. Yet, this decision may limit the therapists’ ability to gather important information, and so many choose to conduct individual assessment sessions with each partner at the start of therapy.
If a therapist does hold individual evaluation sessions with a couple or has outside contact with one partner, it should be determined at the beginning of therapy with all parties involved how to manage secrets or other information that have not been shared within the couple. What does the therapist do if one partner discloses information and asks the therapist not to tell the other partner? Based on system theories, seeing a couple together portrays a better picture of their interactions and relationships. On the other hand, separate individual sessions function in gathering more personal information and relational histories. In general, no matter what type of format a therapist applies, the major goal of couple therapy is to facilitate (bettering communication, emotional attachment, etc…) relationships for a couple. However, the problem occurs when “secrets” are revealed in separate sessions. From the client’s perspective, secrets are often best kept unknown to the other partner. From the therapist’s perspective, secrets have profound clinical implications. They are actually the key factor interfering with the couple’s relationship and triangulating the therapist.