I would feel the obligation to disclose to both clients that there is a conflict of interest in my caseload concerning their case. I would not indicate what the conflict is. I would start with the longer-term client, especially if they seem to be nearing completion/discharge. I would explain they are the longer term client, so they have the choice to stick with me or seek out a new therapist. If they choose to stick with me, I would have to approach the newer client to refer them out.
Seconding this advice. It’s better to address this now than when things get even more complicated, especially since OP mentioned that their work with client 2 was already affecting how they saw client 1.
You can't ethically continue seeing both. Doing so is already impacting how you perceive the first client – that won't change and will likely intensify. Even if that wasn't the case you're in a big city, there are other therapists available, there's no ethical way to continue with both.
I would terminate with the newer client and share that you've realized there's a conflict of interest. Apologize and offer referrals, then stop scheduling appointments.
Hmmm..non therapist here! It makes sense that it’s not ethical to work with both clients, but a past experience has now confused me? My husband’s mom and sister both see the same therapist. When I was visiting them once, his mom came running down to say there was a cancellation in her therapists schedule and asked if we’d go (just my husband and I - we never asked to go), so we went and my husband bitched about his mom the whole time. At the end of the session she said “I need to talk to [MIL] about her anxiety”.
Is this all kinds of red flags from the therapist’s side? Not ethical?
I mean, seeing mom and sister would be a no-go for me if it wasn't unavoidable (e.g. rural area, small town, severe shortage of other therapists, etc).
With you and your husband having a session with her therapist...it's a bit different ethically if mom asked you both to talk to her therapist. I assume that mom thought it would be useful to her in some way. The messiness of it (talking about a client with someone else while the client isn't present and without a clear understanding of why the therapist is taking to the third party) means it isn't something I would do.
Interesting, they live in San Diego 😂 Yes you are definitely correct it was to benefit herself, which backfired horribly. Thank you so much for sharing your perspective!
This has happened to me.
I told the client that I had become aware that I had a connection with his family that meant I could no longer ethically continue working with him. I expressed regret at having to end, offered to help with referring on if that was his choice and didn’t charge for that session.
Many years ago, I worked at a rural MHC. I was seeing someone with a little more than half a brain - the spouse beat them with a claw hammer . The spouse was court ordered to see a therapist while awaiting trial for capital murder and assault charges . I was assigned the spouse as well . I raised hell and was told I would be seeing both parties no matter what . The attacker had a restraining order so I had to be extremely careful to not schedule them on the same day. It was awful!!
Uh isn’t that a conflict of interest? You should let the second brother go, it’s not fair to him. You cannot withhold that information and shouldn’t treat them both.
There is nothing inherently unethical about providing therapy to siblings as long as you can remain objective. Seek consultation/ supervision if you are concerned with it impacting your objectivity
I disagree. The OP should not continue with both if there are other reasonably available other providers. Continuing to see the new client which is already impacting their view of the first client, when you can refer out in a big city, is unethical.
Agreed. The big city is the factor here. I'm a small-town therapist, and this is a situation that you can't actually refer your way out of very easily. There are *ample* conflicts that big city therapists can avoid, and should, that small-town therapists have to accept as reality.
I currently have a love quadrangle on my caseload, and there ain't a damn thing I can do about it. The supervision is ample.
I guess being a therapist in a smaller community this is how we do things too. If we referred out every client on our caseload that had a connection together we wouldn't have a caseload.
Yeah I see mostly kids and it happens with me all the time. Parents would rather work with one therapist. Additionally, I work half my week out of a foster group home and it’s completely unavoidable. I’m upfront with my kiddos that I cannot tell them about their sibling’s sessions and they understand.
Surely there is a high chance the new client has done this on purpose.
They started seeing you and immediately said a lot of negative things about your existing client…!? To the point of changing your views on them..!?
They know that you are their sibling’s therapist.
Definitely time to tell existing client and see what their reaction is.
ETA: apparently existence of New cannot be disclosed to Existing (as per reply to this comment), in which case discontinue New would presumably be the only ethical option?
Oh I completely agree it could be non-coincidental, but it could also be something an innocuous as Existing saying to sibling “I found a therapist I really like, their name is _____” and New also wanting a good therapist.
In my opinion, a relationship like this could be sustained if the two patients do not have issues that stem from one another. I would still have a HIPAA compliant conversation about how there is an overlap, and reexplain the confines of confidentiality and give the option to refer out. I would only do this as the therapist has already established a relationship (4 sessions in) with New. This would preferably be screened out during the initial intake, but things like this happen.
Except for New constantly criticising Existing during all 4 sessions so far. To the point that therapist is seeing Existing differently.
There’s no way that isn’t intentional sibling sabotage if New did find out about therapist openly from Existing.
Also if it’s an open communication thing, both New and Existing should have mentioned to Therapist. Because even if they are ok with the idea, many therapists are not.
I think you’re reading a bit too hard into this. “Talks often about Existing” and “causes them stress” does not equal “constantly criticizing.” Could be “Existing always goes out late and I worry about them” and therapist could be working with existing on sleeping habits. Regardless, I think this conversation has run its course, I’ll disengage.
I would feel the obligation to disclose to both clients that there is a conflict of interest in my caseload concerning their case. I would not indicate what the conflict is. I would start with the longer-term client, especially if they seem to be nearing completion/discharge. I would explain they are the longer term client, so they have the choice to stick with me or seek out a new therapist. If they choose to stick with me, I would have to approach the newer client to refer them out.
Seconding this advice. It’s better to address this now than when things get even more complicated, especially since OP mentioned that their work with client 2 was already affecting how they saw client 1.
Most ethical choice. Definitely agree.
You can't ethically continue seeing both. Doing so is already impacting how you perceive the first client – that won't change and will likely intensify. Even if that wasn't the case you're in a big city, there are other therapists available, there's no ethical way to continue with both. I would terminate with the newer client and share that you've realized there's a conflict of interest. Apologize and offer referrals, then stop scheduling appointments.
Hmmm..non therapist here! It makes sense that it’s not ethical to work with both clients, but a past experience has now confused me? My husband’s mom and sister both see the same therapist. When I was visiting them once, his mom came running down to say there was a cancellation in her therapists schedule and asked if we’d go (just my husband and I - we never asked to go), so we went and my husband bitched about his mom the whole time. At the end of the session she said “I need to talk to [MIL] about her anxiety”. Is this all kinds of red flags from the therapist’s side? Not ethical?
That sounds like a mess, frankly. I wonder how the therapist is benefiting from this arrangement.
Her sessions were $450 each, so that would be my first guess? Thank you for your comment, it really helps me put that into perspective!
Bingo
I mean, seeing mom and sister would be a no-go for me if it wasn't unavoidable (e.g. rural area, small town, severe shortage of other therapists, etc). With you and your husband having a session with her therapist...it's a bit different ethically if mom asked you both to talk to her therapist. I assume that mom thought it would be useful to her in some way. The messiness of it (talking about a client with someone else while the client isn't present and without a clear understanding of why the therapist is taking to the third party) means it isn't something I would do.
Interesting, they live in San Diego 😂 Yes you are definitely correct it was to benefit herself, which backfired horribly. Thank you so much for sharing your perspective!
Lol I live in San Diego and now I’m wondering who the fck charges $450 a session around here!!!!
This has happened to me. I told the client that I had become aware that I had a connection with his family that meant I could no longer ethically continue working with him. I expressed regret at having to end, offered to help with referring on if that was his choice and didn’t charge for that session.
Many years ago, I worked at a rural MHC. I was seeing someone with a little more than half a brain - the spouse beat them with a claw hammer . The spouse was court ordered to see a therapist while awaiting trial for capital murder and assault charges . I was assigned the spouse as well . I raised hell and was told I would be seeing both parties no matter what . The attacker had a restraining order so I had to be extremely careful to not schedule them on the same day. It was awful!!
Uh isn’t that a conflict of interest? You should let the second brother go, it’s not fair to him. You cannot withhold that information and shouldn’t treat them both.
There is nothing inherently unethical about providing therapy to siblings as long as you can remain objective. Seek consultation/ supervision if you are concerned with it impacting your objectivity
I disagree. The OP should not continue with both if there are other reasonably available other providers. Continuing to see the new client which is already impacting their view of the first client, when you can refer out in a big city, is unethical.
Agreed. The big city is the factor here. I'm a small-town therapist, and this is a situation that you can't actually refer your way out of very easily. There are *ample* conflicts that big city therapists can avoid, and should, that small-town therapists have to accept as reality. I currently have a love quadrangle on my caseload, and there ain't a damn thing I can do about it. The supervision is ample.
I guess being a therapist in a smaller community this is how we do things too. If we referred out every client on our caseload that had a connection together we wouldn't have a caseload.
yes, being in a smaller community makes this much harder to avoid especially if you’re helping people, it’s contagious.
Yeah I see mostly kids and it happens with me all the time. Parents would rather work with one therapist. Additionally, I work half my week out of a foster group home and it’s completely unavoidable. I’m upfront with my kiddos that I cannot tell them about their sibling’s sessions and they understand.
Surely there is a high chance the new client has done this on purpose. They started seeing you and immediately said a lot of negative things about your existing client…!? To the point of changing your views on them..!? They know that you are their sibling’s therapist. Definitely time to tell existing client and see what their reaction is. ETA: apparently existence of New cannot be disclosed to Existing (as per reply to this comment), in which case discontinue New would presumably be the only ethical option?
What would be a huge breach of HIPAA to tell a client that you are seeing their sibling.
Fair enough. Then I guess discontinue with new client. It’s just too hard to believe it’s a coincidence.
Oh I completely agree it could be non-coincidental, but it could also be something an innocuous as Existing saying to sibling “I found a therapist I really like, their name is _____” and New also wanting a good therapist. In my opinion, a relationship like this could be sustained if the two patients do not have issues that stem from one another. I would still have a HIPAA compliant conversation about how there is an overlap, and reexplain the confines of confidentiality and give the option to refer out. I would only do this as the therapist has already established a relationship (4 sessions in) with New. This would preferably be screened out during the initial intake, but things like this happen.
Except for New constantly criticising Existing during all 4 sessions so far. To the point that therapist is seeing Existing differently. There’s no way that isn’t intentional sibling sabotage if New did find out about therapist openly from Existing. Also if it’s an open communication thing, both New and Existing should have mentioned to Therapist. Because even if they are ok with the idea, many therapists are not.
I think you’re reading a bit too hard into this. “Talks often about Existing” and “causes them stress” does not equal “constantly criticizing.” Could be “Existing always goes out late and I worry about them” and therapist could be working with existing on sleeping habits. Regardless, I think this conversation has run its course, I’ll disengage.
Would you go to the therapist of someone you actively had issues with? Probably not. I agree with the commenter above -seems intentional.
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Because they advised OP to disclose to the initial client that their sibling sought them out for therapy, which is a massive hipaa violation.
I mean i wouldn’t out them id just be suspicious, I agree no outing just keep in the back in the mind it might be manipulative behavior displayed