Ethical Dilemmas: When Therapy Clients Refer Their Friends

• 00:00 The ethical gray area of friend referrals
• 03:49 Handling Referrals from Clients
• 07:29 Redirecting Personal Referrals
• 15:15 Handling Unexpected Client Connections
• 19:00 Practicing Ethical Boundaries
• 20:41 Gray Areas and Subtle Ethical Dilemmas

Lisa Marie Bobby: If you’re a helpful, effective therapist, which I know you are, it’s only a matter of time before a client refers a friend to you, but saying yes to this can put you in a gray area, ethically speaking, and And it can also create problems. Like for example, what happens if the friends have a falling out and you’re seeing both of them hearing different sides of the story, trying to remain neutral, this actually happened to me.

And let me tell you, it was tricky. And that is why I decided to record a podcast episode on this topic and how to handle it when clients refer their friends.  If this is your first time listening to love, happiness and success for therapists, I’m so glad you’re here and that you found me. Um, I am Dr. Lisa Marie Bobby.

I’m the founder of Growing Self Counseling and Coaching. And for years, I have done the love, happiness and success podcast, which is for civilians. But this endeavor is really, this is so exciting. This is for us. This is for therapists, just like you and me, who also need a space to learn and grow and develop, to hear the things that are important to us that are on our minds and in our hearts.

Um, Be discussed. And so that is what I’m doing here every week for you. And every week on the show, we’re talking about a different topic related to the life and times of being a therapist. I would love to hear from you about what has been on your mind lately. And if you have questions or things that you would just feel like need more visibility or need to be discussed, I’d love it.

If you got in touch with me. Come to my website, growingself. com forward slash therapists, and there you will find everything for you. I have podcasts, I have videos, I have articles, I have little quizzes that you can take, like my flourish and thrive assessment to help you keep track of whether or not you’re heading towards burnout or not.

Um, as well as a bunch of other resources. And you can get in touch with me to let me know what’s going on with you these days and how I can be part of your support community.  So that’s what we’re up to today. And, and on this, you know, I was thinking about all of the different things that can potentially blow up in our faces and, uh, And that on more than one occasion, I have had clients refer friends to me, um, and have also been in situations just because I have been practicing as a therapist in the Denver area for a while now and have also had organically  clients, um, That I’ve known for a while come in, we’re talking about things, you know, we’re doing this stuff and they start telling me a story about somebody and their lives.

And I think,  oh, my gosh, they are talking about another client that I also have a relationship with either currently or in the past. And there was actually not a referral. It was just. Magic. That was a coincidence. And that that too has been challenging to navigate. So I really just wanted to talk about this, you know, talk about pros and cons, talk about different strategies for how to handle this complex train because it is a little bit gray, right?

I mean, just to dive in. Um, We know very clearly we are taught in any ethical counseling school that we can’t have dual relationships. Like, I can’t be  person A’s therapist and then also be working with their  family. I can’t be somebody’s individual therapist and also be their couple’s therapist. I can’t serve as a therapist of multiple family members.

Like, those boundaries are clear.  But what happens when People start referring their friends, um, that’s not explicitly outlined in the APA code of ethics. And it’s also a little bit flattering, right? I mean, it means they trust us. They value the work that we’re doing together. Um, But again, it can cause problems.

And I’ll just, I’ll share a de identified personal story. But years ago, I had a client who we were, you know, doing all the things. And this client referred a close friend to me and it seemed fine. You know, like, Foundries their friends. It’s okay. This was, you know, obviously much earlier in my career, but these two individuals also, in addition to being very close friends and socializing together, they ran a business together and as it does, things took a turn.

They began having disagreements. About the business and the way that it should be run. And, um, there was some stuff going on relationally and wouldn’t, you know, I was now in a situation where I would spend a therapy session talking to one client about all of the horrible things that their friend, my other client had done to them over the previous week.

And not, you know, two hours later, then. This next client is in my office and I’m hearing about it from the other side and it was pretty awful because it put me in a terrible  ethical bind because I had information about A client that this client did not share with me, their friend of me was sharing it with me.

Um, and then of course, you know, that terrible bind of what, what do I do with this information? Also having to maintain confidentiality between both people. So I can’t talk about any of this stuff with either of them. Um, it’s, it was a pretty uncomfortable. Couple of months, because I also, you know, couldn’t reveal that either of them were seeing me, there were no consent documents signed, etc.

And, and it got, it got bad, the whole business blew up, they became like mortal enemies. And it was, it was pretty, pretty bad.  I think that I was able to maintain neutrality and, you know, compartmentalize, like, okay, so this is what this person is telling me may or may not have anything to do with a lived experience of this one.

And so, you know, able to go all the way into those spaces. I hope that I was able to contribute and help in full ways to both of those people. But I swear to myself, like, never again, am I going to do that? Um, and it’s just really.  Highlighted for me, the complexity, the potential conflicts of interest that are inherent when, um, working with two people who have a relationship with each other, because, you know, even with the best intentions, things can get messy.

So  what I have done going forward is just as a general rule. And this is also something that I coach my clinical supervisees around is that.  You know, it might be okay, but if it isn’t okay, it’s going to be really not okay. And so to, as a general rule, avoid putting yourself into the situation. So how do we handle that?

How do you decline or redirect a personal referral? Especially. Especially when you know that somebody is getting in touch with you because your current client encouraged them to, and also maybe your current client is like feeling really happy and excited about this. Like, Oh my gosh, they need to talk to you.

They’re going to get so much out of this, like, because that’s a relationship that you need to maintain on the other side of that too. Right? So.  That’s you to just talk about this a little bit. The art of gentle declining and redirection. Um, and first of all, I think it is always important to acknowledge the referral to your current client. 

Without, of course, here’s where it gets tricky again, compromising the confidentiality of somebody that reached out to you at your client’s suggestion, because you can’t say, Your friend, Amy, got in touch with me the other day. Oh my gosh, she’s awesome. I would love to work with her, but you can’t even do that.

So like, how do you even acknowledge the fact that something nice happened? Um,  you could, and I have been known to say this, I’ve heard  a little birdie told me that you were saying nice things about me, and I’m so grateful. for that. And that just makes me feel really good that you think well of me, you know, that you’re benefiting from our work together and my dear client.

Um, I am yours only. I, um, you know, all, no therapists can have relationships with people who know each other while you are always welcome to bring anybody into your life. Therapy session to support your individual work with me doors always open for that. But, um, you know, I’m, I’m, we are having a monogamous, uh, therapy relationship with each other, just to say that.

And I think also to help them understand because their friend, Amy now might be going back to them and saying, yeah, you know, I reached out to Lisa, but she told me that she couldn’t work with me. And so, again, not that you’re. Telling your client to convey information for you, but I do think so that your current client understands.

Um,  you know, why, why you can’t do that. I do think that they, they deserve to know just, you know, how this works. It’s like demystifying it a little bit, but find a, You know, hopefully a nice way to do it without mentioning that a specific somebody got in touch. And then on the other side of that, of course, we cannot acknowledge the fact that we are working with anybody, even if they know that we’re working with somebody.

And so the, the the The formula that I’ve kind of come up with is thank you so much for considering me as your therapist. I am so honored and I really appreciate that and at this time I’m not able to take you on as a client.  And that’s it. I don’t go into any more detail than that. At this time. I’m not able to take you on as a client, but here’s what I can do for you.

I can refer you to another fantastic therapist, a close colleague of mine, somebody that I really know, like, and trust who I think is going to be a fantastic fit for you. And then I will make that introduction and I will say God speed and.  I also don’t engage in conversation about it. If somebody’s like, but why?

I really want to work with you. You could just, I’m so sorry. I wish I could work with you at this time. I am not able to do that without explaining yourself because if you started to offer more information than that, It, it could create problems that could bump up against confidentiality. Um, because we, as therapists can’t confirm or deny that we are in a relationship with anybody.

So that is my, my standard operating procedure when it comes to this kind of thing. And, you know, in my experience, even though sometimes people can be a little. Disappointed, right? I think the way of framing this, it shows appreciation. It maintains confidentiality. It shows, uh, offers an alternative solution, which I think that we do have responsibility to do.

And if you don’t have close colleagues that you feel good, like referring people to, that would be another professional development piece. I think it’s important for all of us to have a trusted network because part of ethical practice is. Always referring clients for various things. Um, because again, we, we can’t have dual relationships and to practice ethically, we have to have a scope of practice and say, actually, that’s not my jam.

Let me refer you to somebody who does this. Uh, and we also sometimes need to end relationships with clients and we cannot abandon clients. We have to provide referrals as part of their, their continuing care. So having a trustworthy professional network is part of this gig and it means having relationships with other therapists that you know, like and trust.

So that’s one piece of this puzzle that I want you to see.  Now, when you are referring a client to redirecting them, it’s important that you redirect them with care and ensure that the therapist that you are suggesting that they see is going to be the right person to support what they need. So that can mean spending a few more minutes with them on the phone or, you know, just a quick, uh, Um, discovery call to say, let me hear just a tiny bit more about your hopes and goals.

This is not any kind of session. I’m just, I really want to refer you to the right person. Having a general sense of what you’re hoping to get out of this will help me. Do that. Well,  so another thing to consider is how to handle it. If you have a sleeper situation that surprises you again, I have been in situations where I was working with two people.

There was no referral. Neither of them knew that the other person saw me, but because Denver can be a small town, I was sitting here thinking, Oh, my gosh, I’m hearing. The others, this is the friend my client has told me about and vice versa. So, um, what to do in the situation?  Um, I will tell you what I did in the situation.

I think that there are probably a number of different ways to handle it, but when I realized what was happening,  And realized that both of these individuals were currently in a conflictual again, uh, relational situation with each other. There was like a kind of a business arrangement happening. Um,  I started to feel uneasy and, uh, Did not want to replicate, you know, the horror show that I lived through with those 2 clients.

I told you about previously 1 of the clients. I had been working with for quite a long time. We had a years long relationship.  The other had not had the same level of. Of history with, and for the client that I had a less established relationship with, I made a professional referral. Um, she was telling me, and this is truly the case.

In addition to the situation that was conflictual with the one friend that I felt uncomfortable with, she was dealing with some other. Dynamics and life experiences that could benefit from a specialization, specialized clinical expertise that I could have worked with her and.  I happen to have an amazing colleague who would do great work with her, so was able to have a conversation to say, you know, um,  based on what you’re telling me about what’s going on with you these days, I am really so, uh, invested in your growth and your success here.

Bye. Skillsets of my limitations and also thinking about my professional network, it occurred to me that I have a colleague that I’ve known for years. I think so highly of her. She does exactly what you are hoping to do. And I would love to introduce you to her. Would you be open to that? Um, and she was, you know, I think if this client had had different variables, I mean, it could have been different.

Theoretically, I could have done some of that compartmentalization again, but it’s really, it’s, it’s not, it’s not the right, it’s not the right thing to do, because again, as therapists,  we.  Run into trouble when we have information about our clients that our clients did not disclose to us, and that we can’t really do anything  with like, we can’t bring it into the thick because it starts to create this distance in this, um, Obstacle in the authenticity of that primary relationship.

So it’s really, it’s really something to avoid. Anyway, in this case, um, the, uh, other client was happy to take the referral, did a little consultation with my colleague to kind of, you know, get, get her off and running, did a little warm handoff. And, um, as far as I know that that wound up  going very well.

For that client. So anyway, it was a happy ending. I think for everybody involved, I was able to maintain my ethical boundaries. The work with my more longstanding client was protected. And also this other client was able to really not not just have her needs be met. But probably better than, than I could have done through a thoughtful referral.

So I hope that that discussion kind of helps you because again, sooner or later, this is going to happen to you. And it can be tempting, especially if you’re in a solo private practice, especially if you don’t have that many clients yet. Right. To say yes to things because you’re like, well, you know, they want to come see me.

I guess the founder is like, we can talk ourselves into doing all kinds of stuff. stuff, right? But I think that this is another reason why it’s very important to be practicing a lot of self reflection, journaling. Like  why am I making the decision to maybe accept this client when I know ethically it probably isn’t a great idea.

Is it because I would like to have another paying client in my practice? If that’s the reason then, you know, part of being an ethical practitioner is doing the right thing. Even if it’s the hard thing, and even if it’s not always the most economically viable thing, I think that that’s another reason why part of ethical practice, particularly in private practice, is to have have a flow of clients so that you aren’t connecting with clients. 

In a way that meets your own needs that has less regard for their needs when clinicians get into a private practice situation, and they’re worried about how many clients they’re seeing, it makes them ethically vulnerable. So saying yes to clients that they should say no to, because the clients presenting issue is really not.

In their scope of practice, if they’re being really honest with, I see people do this with couples counseling all the time, or God forbid,  an individual therapist being like, yeah, bring your husband, let’s do couples, keep the party going in some ways, but also accepting these kinds of referrals that are a little bit too close to home.

So ethical practice means that energy flow and it means having boundaries and, and saying no sometimes, um, particularly when saying no is. Uh, protective against conflicts of interest.  There are other gray areas when it comes to the world of therapy. So subtle ethical dilemmas, things that we can run into.

I just shared one of mine. That was on my mind lately. And I’d love to hear about some of yours. If there are gray area, ethical dilemmas that have come up for you in your practice, shoot me an email. You can send it to hello at growing self. com. Suggest it as a possible topic for an upcoming love, happiness, and success for therapist podcasts, or of course, get in touch with me on the socials.

I’m in all the places. I’m on LinkedIn. That’s a great way to get in touch with me. Yeah. Um, and we will continue the conversation on the next episode, but I hope this was helpful to you today. And until next time, I’ll talk to you later.