Much of what we do in counseling or therapy is enculturated. Confidentiality, the 50 minute session, avoiding dual relationships…these things developed out of the culture of psychoanalysis. Now, that is not a criticism. I personally agree that good therapy requires privacy and the assurance of confidentiality. Who would talk about the deepest matters of the heart if they thought it would be broadcast to the world? And it isn’t as if this is a modern invention. Pastors have been practicing this since the early church.
One of those culture founded practices is seeing patients only in the office setting. Supposedly, this would maintain the “frame” of the counseling hour so as to avoid unnecessary outward intrusions. Further, it maintains one picture of the therapist. Having coffee with your therapist at the local diner would completely change that frame–and reduce confidentiality when your neighbor comes up and says, “Oh, I saw you go into the diner with Dr. Monroe. How do you know him?”
But there are some reasons why a counselor might intentionally see a client outside the office. Here are some reasons I have:
- Observation of a child in a school or home setting as part of an assessment
- Visiting a client in the hospital (either as a courtesy call or as part of a treatment continuity plan)
- Joint meeting with other providers (therapists, pastors, care team) at another location
- Part of a treatment plan (e.g., to practice walking over a bridge, get on an elevator, etc.
I have been asked to have coffee by current clients. I have been invited to house-warming parties. I have been asked to attend other celebrations. I’m more inclined to attend celebrations for kids or if the relationship is quite limited (wedding of a pre-marital client seen for 6 sessions only). I have taken clients outside my office for one reason or another (a brief walk, thrown a ball with a kid, etc.).
Whatever you choose to do. Be sure to evaluate the effect it will have on your relationship with the client. What potential pit-falls exist? Talk to them about it. Afterwards, continue to see if such actions introduce any relationship confusion. Be wary of informality. You don’t have to be stiff but informality breeds complacency and soon you are doing things you never dreamed of doing. Also be especially wary if the client has any history of abuse or boundary violations. Take care to protect those boundaries for their sake.
While psychological ethics are built on “Do no harm,” we know that the bible also supports this. Watch out for your weaker brother or sister!
6 responses to “Seeing clients outside the office”
doesn’t change take place in relationship? why does that change have to be stuck to the boundaries of only being in certain places? i’m not trying to antagonize. but, i’ve been questioning for a long time if the whole office, boundaries of not seeing the person anywhere else, etc, is the healthiest thing. i don’t know.
I think this relates to the whole issue of a professional model of therapy compared to a pastoral model of soul care. In pastoral ministry, we constantly engage in not just “dual relationships,” but multiple layers of relationship–pastor, co-minister, friend, etc. I see a myriad of benefits in the pastoral model.
Are there times when the layers must be separated into different parts? If so, how do you do that? And, doesn’t that fracture the person? How does one be a true friend and an authority to the same person? Or are pastors not to be authorities? Or, not to be friends?
What are the drawbacks in the pastoral model? If pastors don’t have the same strictures on relationship, does that make it easier for them to cross the line into an inappropriately intimate relationship?
D., It’s not a matter of having no structure. It’s an issue of what are the biblical principles we should follow? Looking at passages like Phil. 1:9; Eph. 4:15; 1 Thess. 2:8; Col. 1:26-2:3; the model of Jesus, the model of Paul; etc., sure seems to suggest that the arms-length, office-only, no “dual-relationship” model is not the one to follow. And “inappropriate relationships” can develop anywhere–they are a heart issue, not simply a rules/boundary issue (again, that’s not to deny any structure). I simply happen to believe that we have move way too far toward a non-Jesus-like model of pastoral and lay care.
Bob, I’ve seen many benefits of dual relationships as well. I’m not against them. However, I’ve also seen many injuries to unthinking dual relationships. AACC ethics code gets it right. The problem is harm, not dual relationships. I’ve seen many counselors hide behind the biblical model of dual relationships (because they see the deficit of the distant, idealized analyst) and not do the serious work of discerning harm and the possibility of it. In short, we get sloppy. True, inappropriate is a heart issue but blindess is part of the problem. Education and being wary of subtle boundary crossings (not the same as boundary violations) is important. I don’t see many biblical counseling programs really giving that much attention. Do you?
I’ve been intrigued with what Larry Crabb terms “SoulCare”, in which some folks are called to the important role of “spiritual friendship”, while others are called to the role of “spiritual direction.” He strongly emphasizes the “de-professionalization” of the helping relationship, and though he was warned early on that he was sabotaging his professional career as a psychologist and professional therapist, I think he’s on to something. I’m not ready to turn in my license, since it opens doors for me that my non-licensed comrades cannot step through.