Some ethical concerns regarding the individual psychotherapy of the married client.

Abstract

A brief review of the literature establishes the high potential for disturbance of a client's marital relationship following individual psychotherapy. Several problems possibly inherent in the conduct of therapy with only one member of a marital dyad are discussed, as well as some of their probable sources. The importance of informed consent to treatment is stressed with regard to ensuring that potential clients are aware of the possible negative effects of therapy on their marital relationship. The systemic view of the spouse as necessarily involved in the maintenance and modification of the client's complaints provides an alternative to individual psychotherapy: the spouse must be a part of the therapy from the beginning. The ethical responsibility of the therapist is toward the greatest overall benefit for the client, and should concern the interpersonal as well as the psychological environments of the clients they serve.

Relationship‐undermining statements by psychotherapists with clients who present with marital or couple problems

“…In addition to an ongoing concern expressed by couple therapists about harm to the relationships of clients who present individually, there is a small literature on the topic by psychotherapists who mainly treat individuals. In the early 1980s, Phillips addressed ethical issues involved when marital relationships deteriorate following the kind of individual psychotherapy that does not engage the perspective of the spouse (Phillips, 1983). Following that paper, a handful of studies examined whether marital and other romantic relationships deteriorate following individual therapy.…”

Why consider the client's partner in psychotherapy?

“…Whilst many psychotherapists lean towards the classical approach which involves only meeting with and treating the individual, Phillips (1983) warned that focusing on an exclusively individual format overlooks the important point that "any form of therapy is an intervention in a system of interpersonal relationships" (p. 11). When an individual is having psychotherapy their treatment affects their significant other, regardless of whether the therapist thinks this way or not.…”

“…Likewise, Lefebvre and Hunsley (1994) suggested that partners of clients in therapy should be included in discussion about the possible impact therapy can have on a relationship, and that both partners are made aware that any impact to their relationship could be positive or negative. Phillips (1983) said that, in order to practice ethically, therapists need to develop and hold a clear premise of what constitutes appropriate concern for their clients' overall wellbeing, and, if necessary, they should broaden this view so that it includes the patient's wider socio-psychological environment and not simply be confined to resolving unconscious conflict in the individual: "realistic expectations of the potential benefits and costs of entering treatment should be fostered from the beginning, and include sufficient information regarding possible, albeit unintended, negative side-effects" (p. 10).…”

“…Whilst the views expressed so far have all leant towards an ethical obligation to inform the client of the potential outcomes of therapy at the onset, it is true that real life practicalities may not always make this possible, for example, if the client presents in crisis. However, whilst the practicalities of attending to the client's immediate concerns may make these explanations unwelcome or even unhelpful, Phillips (1983) maintained that "therapists must accept the ethical obligation to continually examine the effects of their interventions on the lives of the clients they serve" (p. 12). Therefore, if practical matters make the timing of this conversation inappropriate, then, once the crisis is over, the ethical conversation should be initiated by the therapist if the client intends to continue therapy.…”

Untitled

“…What do other therapists write on the ethics of treating married clients with individual treatment, given the findings of possible marriage harm? Phillips (1983) has recommended that clinicians who work with married clients in individual therapy routinely inform their clients prior to treatment of the significant probability that their treatment will have detrimental effects on their marriage. This advice is in keeping with the ethical duty to inform patients of the risks of any medical or other health-promoting intervention.…”