Private practice psychologists are often tempted to offer couple therapy to appease referrers and potential clients despite having little or no training in the area. Unfortunately, as more psychologists are drawn to meeting this demand, the number of complaints received by Council has also increased. Psychologists need to be aware that couple therapy poses a number of significant professional and ethical challenges.
Before providing any psychological service to a couple, the psychologist should ask themselves, “Am I competent?” The provision of couple therapy is complex and is not simply individual therapy with multiple clients. Issues commonly raised include violence, abuse, sexual problems, custodial disputes, betrayal and separation. Sessions can be emotionally intense, often escalating quickly with participants yelling and threatening each other and, on occasion, the therapist. Psychologists must be able to effectively manage the emotions in the room, as well as the dynamic between the couple, the dynamic between the psychologist and the couple, and the dynamic between the psychologist and each participant. To be truly effective in such settings requires specialist training and supervised experience.
Couple therapy raises significant informed consent issues. At the beginning of treatment, the psychologist needs to establish whether they will work with each participant individually. If so, the psychologist should gain informed consent regarding whether information obtained in individual sessions will be shared during subsequent couple sessions. Psychologists need to be aware of the significant therapeutic complexities of such arrangements, as well as the ethical issues raised. For example, one participant may reveal in an individual session that he or she is having an affair. The impact on the therapeutic alliance between the psychologist and the other participant can be terminal if the psychologist’s knowledge and non-disclosure of the affair is subsequently revealed. Gaining and documenting informed consent can effectively manage the couple’s expectations of therapy and reduce the potential for misunderstandings and feelings of betrayal that lead to complaints being made.
Psychologists should also document who can legally consent to the release of information. Assuming both members of the couple are adults, both participants’ signatures are needed in order to release information gathered during the couple therapy sessions. This is especially pertinent if one participant seeks a report from the psychologist when legal proceedings are instigated.
Psychologists should also be aware of arrangements that may unintentionally produce perceptions of bias. For example, it is not uncommon that on presenting for individual therapy, a client’s relationship is identified as a significant factor and that couple therapy is indicated. The client’s partner may then feel coerced into attending couple therapy with the client’s psychologist despite perceiving that the psychologist is already better engaged with the client and is therefore biased. Similarly, when a relationship ends after couple counselling, the decision to continue to work with one participant needs to be carefully considered. The ex-partner may perceive that the psychologist had colluded with their ongoing client to end the relationship. Further, should the decision be made to resume couple counselling, the perception of bias towards the ongoing client may be difficult to overcome.
The scientist-practitioner model is at the core of our profession and it extends to couple therapy. Providing evidence-based interventions in which you have been thoroughly trained combined with regular supervision will help to ensure safe and effective practice and positive outcomes for couples.