Dr. John has an Ethical Dilemma (Therapy and Ex-Girlfriends do Not Mix)

I received this email from John:

To: RDobrenski@aol.com
From: XXXXX@gmail.com
Subject: Fuck!

A guy came into the office today for an initial appointment due to work problems. As we talked about his current situation, he mentioned that a positive in his life is his new girlfriend. Apparently he’s been with this woman for about three months. As he started to describe her (e.g., job, personality, looks) I realized she sounded an awful lot like XXXXXX!!!!!!!! And, sure enough, when I asked him what her name was, he said, “XXXXXX!!!!!!!!” My patient is dating my ex-girlfriend! I didn’t say anything to the guy and he’s already made a 2nd appointment. What do you think? I’d ask you not to put this on your dumb website but I’m sure that’s a waste of time.

Here is my reply:

To: XXXXX@gmail.com
From: RDobrenski@aol.com
Subject: Re: Fuck!

Hello Dear Friend,

Don’t worry, I promise I won’t put this on my dumb website. When did you and XXXXXX!!!!!!!! break-up, anyway? I’m really sorry to hear about this. She’s a great lady. And hot, too! I’ll bet that client of yours is probably on an amazing date with her right now, perhaps even in his apartment. He’s a lucky man.

Lunch tomorrow?

Best Wishes Always,
Rob

John made a crucial error in keeping his mouth shut about his prior relationship with the client’s new love. Starting off therapeutic work with a fairly large lie of omission is definitely not the way to go. John simply got caught in the intersection of our work and life’s realities and turned into a deer in the headlights. I’m not sure if this was due to sheer surprise, jealousy at the fact that his ex-girlfriend has a new (and probably better-looking) lover, or something else altogether. But when you keep information like that to yourself you’re simply asking for trouble.

As I had strongly advocated, a shrink isn’t obligated to alter much of his life simply because a client may see him in a different role. However, this rule is for out-of-the office behavior. When working it’s the therapist’s responsibility to protect a client from a possible conflict of interest. Although the client didn’t come in specifically to talk about his relationship, the reality is that love interests almost invariably works their way into the conversation. If John keeps the information to himself there’s no way he can remain objective. If he confesses later on, the client has every right to feel betrayed to the point that the therapeutic relationship might be beyond repair. Either way John will have royally screwed up as a professional.

I called up John later that day and told him to man up and simply call the guy to give him the truth. He simply had to refer him to another therapist because of the dynamics involved. John agreed but dreaded making the confession, although I’m guessing the client will appreciate the honesty and accept a referral elsewhere. Some clients will insist on still being seen, believing that the therapist can still do the job despite the issue at hand. Why this is the case is not entirely clear, although many readers tell me that it’s simply very difficult to find a good shrink. Perhaps once someone believes a strong connection is present they are hesitant to give that up. But although I’m not a huge believer in protecting people from themselves, this is one of those times where that philosophy applies. So even if this guy sees John as the next Freud, he’s got to find someone else with whom to work.

Knowing John he’ll probably tell the client to avoid me as a therapist at all costs, but there’s not much I can do about that. He’s just jealous of my success. When you’ve blessed yourself with a wedding photographer’s drinking water and have had a child accuse you of being a terrorist people will envy you. It’s just a fact of life.

(Visited 126 times, 1 visits today)

7 Responses to “Dr. John has an Ethical Dilemma (Therapy and Ex-Girlfriends do Not Mix)”

  1. Yikes! I can’t believe he didn’t “man up” immediately and needed you to tell him to do it. If that’s not a conflict of interest, I don’t know what is.
    Just curiously though, how often does something like that happen to a shrink?
    Dr. Rob: A lot of it depends on where one is practicing. In NYC it’s pretty rare.

  2. Martin says:

    At least now Dr. John knows why the client needs therapy.

  3. Anonymous says:

    Rob, do you think this is true when there are other connections, not ex’s but mutual friends or something like that?
    Dr. Rob: It can be true, but the devil’s in the details. It all depends on the nature of the relationships involved.

  4. Chris says:

    Clinical 101
    Multi-Role Relationships = Bad

  5. sandy says:

    Great post! I’ve often wondered how I would handle something like this. Clearly the answer is to NOT see this patient. But I could also see buying myself time, i.e, scheduling until I figure out what in the heck to say. Followed by a phone call before the next session, once I gathered my senses.
    I think though, I would be reluctant to reveal the exact reason, i.e., “I’m her ex” (or “his ex”, as my case would be) but would maybe opt for something like, “In taking your history, there were details mentioned which represent a conflict of interest to me personally. I will have to refer you elsewhere.” With apologies and explanations of dual role ethics. That’s probably just a personal preference. But perhaps I could spare him feeling embarrassed by our mutual connection.

  6. Rosie says:

    I found myself in a similar situation when I went to a new therapist and it turned out that she was a friendly acquaintance of my mother’s. Some of the issues I needed to talk about in therapy involve my mom. Even though the shrink fessed up right away, I chose to stay with her. I think I relished the thought of turning my mom’s friend against her once she learned what an evil person my mother truly is. Pretty sick, huh? Anyway I don’t see that therapist anymore. I wonder if I succeeded in changing the way she looks at my mother? Wow, I’m vindictive =p

  7. Dorothy says:

    So if he referred the guy to you , would you accept him as a client or do you think that ethically it’s still too close?

Leave a Reply