Ethics Consult: Is It Ethical to Accept a Therapy Client’s Invitation to Speak at His Company?

Dear Ethics Consult,

I’m doing therapy with a man who is a business owner. He appreciates the themes of what we talk about and wants to share it with people in his company. He asked me to do a seminar on mental health with employees at his company and has given my name to other business owners.

 

If I maintain confidentiality about him as my client, would it be unethical to accept that opportunity and speak with his company or other companies that he refers me to?

 

Sincerely,

Trying to Be an Ethical Business Owner

Confidentiality and ethical business ownership

Dear Ethical Business Owner,

First off, it sounds like you are doing a wonderful job and making a difference in this client’s life. This client clearly recognizes that for himself and his business.

It also sounds like your client views you as an expert in mental health, which is evident by the fact that he has asked you to share your expertise with employees at his company and has referred other business owners to you. 

As therapists, we know how impactful therapy can be for our clients, and this is especially true when there’s a strong rapport and trusting relationship between the client and therapist. 

Like any relationship though, we must establish clear expectations and boundaries with our clients. Usually, this happens during the initial stages of therapy and then later if and when specific issues arise during the therapeutic process. 

Therapists continue to encounter ethical issues surrounding how to set and maintain these appropriate professional boundaries in the therapeutic relationship.

Our professional boundaries as therapists set the frame around the therapeutic relationship and create safety for our clients. When this sense of safety for our clients is threatened or our professional boundaries are misunderstood by clients, this can lead to legal and ethical dilemmas for the therapist—so we all have to tread carefully. 

So, let’s take a look at your specific situation from a legal and ethical standpoint. 

How to consider the ethics of client confidentiality 

Confidentiality is the legal and ethical responsibility of therapists not to reveal information about their clients to unauthorized individuals without written consent from the client or unless mandated or permitted by law to do so (Health Insurance Portability and Accountability Act of 1996).

From what you wrote in your letter, you recognize the importance of maintaining confidentiality about him as your client outside of the therapeutic space. 

While you may intend to maintain confidentiality about him as your client, there’s still a chance that anyone you interact with at his workplace may become aware that you’re his therapist.

Granted, the client may choose to acknowledge you as such—but it’s your professional responsibility to maintain the privacy of your relationship with the client. 

In general, knowingly being in a place where your client is affiliated with or will be in attendance poses a confidentiality risk.

For instance, someone may ask how you know your client during the seminar or while conducting business with the companies he referred you to.

If you wish to minimize this confidentiality risk, I might consider avoiding such an ethical pitfall. 

Of course, in rural areas or other smaller communities, the likelihood of you being in the same place at the same time as your client may be unavoidable.

That said, I would advise avoiding these situations if you can to protect the best interests of your client. 

Examining conflicts of interest

Therapists are bound to a professional code of ethics, which set forth professional standards for clinicians with the purpose of protecting the dignity and well-being of our clients.

For example, the National Association of Social Workers (NASW) has a code of ethics that states: 

“Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client.

In instances where a dual or multiple relationship is unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries.”

Accepting the opportunity to conduct a seminar at your client’s business and/or accepting referral for business from your client could constitute a business relationship between you and the client outside of the client-therapist relationship. 

Additionally, NASW’s code of ethics states that: “Social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests.” 

So, in addition to confidentiality concerns, you have an ethical obligation to avoid dual relationships with clients and to refrain from professional relationships to further your own business interests.

We also want to consider the power differential between you and your client. There’s no way to foresee how the business relationship between the two of you will play out for your client in the future and whether or not the primary client-therapist relationship may be negatively impacted by the other relationships being established simultaneously between you and your client. 

I should note here again that there may be certain situations where a dual relationship with a client is unavoidable. However, I’d recommend that therapists acknowledge this early in the therapeutic relationship and discuss it with their clients before getting into treatment. 

These kinds of ethical and legal boundaries can be really difficult for clients and even therapists to understand or implement, because there’s a lot of gray area. There are no black and white answers to these questions, and each client-therapist relationship is unique.

Overall, there are two main legal and ethical risk factors being addressed here: confidentiality and conflict of interest by nature of a dual relationship with a client. While you can’t fully control the possibility of recognition by others as your client’s therapist, you can control whether or not you chose to engage in a dual relationship with your past or current clients.

If you need further guidance, I’d suggesting seeking supervision or a consultation group to explore the underlying factors that may influence this decision. 

Good luck!

Sincerely,

Tacha Fletcher, LCSW 

Disclaimer: While I am referencing the code of ethics set by NASW for social workers, you should refer to your profession’s code of ethics for specific guidance on professional standards and conduct.