Ethical considerations for couples therapists

If you’ve provided therapy to couples, you know that it can be an incredibly rewarding and challenging experience. Couples therapy requires the therapist to view the couple (or all relationship partners) as the client. This unique dynamic often means that there is greater potential for ethically ambiguous situations to arise. Couples don’t always come to therapy with an identical level of commitment to the work and motivation for being there. And while helpful, professional standards couldn’t possibly provide guidance for every couple’s situation. 

What does “couples therapy” mean today?

Traditionally, couples therapy has been centered on two (often married) individuals in a romantic relationship who engage in therapy together with shared relational goals.  Since it’s still part of the most common therapeutic nomenclature, we’ll be using the term “couples therapy” throughout this article. But a better descriptor for systems-focused treatment that involves romantic partners could be “relationship therapy” since it can also support people in:

• Polyamorous relationships
• LGBTQ+ relationships
• Open relationships 
• Young relationships
• Age-gap relationships

What is the end goal of relationship therapy?

Thanks to the way couples therapy has been portrayed in the media, many people mistakenly think that its goal is always to preserve the relationship or “save the marriage.”  Although it’s often seen as a last resort, couples therapy does not have to be the last attempt to save a relationship. Partners don’t need to be in crisis to start couples therapy. In fact, its chances of success increase the earlier it’s started.  With that said, “success” in couples therapy does not necessarily mean that the relationship improves. It’s essential for couples therapists to approach their work with an unbiased, agendaless stance. This leaves it up to the couple to define their goals for therapy, which can be a very empowering part of the experience.  At the outset of couples therapy, the therapist will assess both the couple and each individual and work to build a foundation of rapport. Throughout the experience, the therapist must continually ascertain what each person wants within the relationship, and from couples therapy overall.  The end of couples therapy should be determined by assessing what the couple reports experiencing outside of sessions. Perhaps they met their goals and feel stable in their relationship. Or perhaps conflict has remained and it’s clear that the two are simply not a good match. Sometimes couples choose to continue working with the therapist after deciding to end the relationship in order to gain support on co-parenting, or navigating healthy separation. These are all appropriate ways to conclude couples therapy over time.  

Three ethical dilemmas to be aware of in couples work

There will always be the potential for ethical and legal issues in counseling, no matter the format. However, couples therapists often face unique challenges due to the complex nature of conducting multi-person therapy. Here are a few examples of ethical dilemmas you may face as a couples therapist.

Countertransference

Example scenario: You’re seeing Alex and Ben for couples work. Throughout the first few sessions, Ben frequently answers for Alex whenever you ask them a question. You find yourself getting frustrated with Ben for not allowing Alex to speak up. It’s a dynamic you recognize from your past and it’s getting harder to demonstrate empathy for Ben during sessions. Therapists risk experiencing countertransference during couples therapy more so than other types of therapy. This may be due to the highly relatable experiences that many couples go through. It’s likely that you have experienced some degree of what your couples client is disclosing, and this can make neutrality more difficult.  You can keep countertransference at bay by ensuring that you have your own outlet, like seeing your own therapist or engaging in case consultations. This will give you a space to process your reactions to clients and identify any blind spots or biases that might be impacting your work.  Therapists must also have the self-awareness to know when they need to step back from couples work. If you’re going through your own breakup, divorce, or navigating a difficult relationship, be mindful of how your personal circumstances might impact your clinical work. 

Secret keeping 

Example: Sal, Brandon, and Dana are in a non-hierarchical polyamorous relationship. Lately, they’ve experienced an increase in conflict and they’ve come to therapy to decide whether or not they need to change the structure of their relationship. After several sessions, Sal sends you an email disclosing a violation of Brandon and Dana’s trust and asks you not to tell them about it. Sometimes in couples work, one partner will privately tell their therapist something that could negatively impact the other partner(s).  In these instances, most couples therapists will give a timeframe for the partner to disclose this “secret” to the other partner(s), or they may terminate couples therapy. This is due to the therapist’s duty to “do no harm” and the idea that keeping this secret from the other partner(s) is doing harm by contributing to a dynamic of distrust.

Conflicts of interest

Example: You’ve been working with Jade for the past year. During this time, the majority of your sessions have been focused on conflict with her partner, Sam. The ongoing conflict has taken a toll on Jade’s mental health and the situation doesn’t seem to be improving. So she asks you if you would be willing to work with her and Sam as a couple.  When individual work and couples work occurs simultaneously, it’s best practice for a therapist to only provide one service at a time. So a therapist seeing a couple would only see the couple and vice versa.  Combining individual and couples therapy can create a conflict of interest and a dual relationship that can be harmful for clients. If one of your individual clients requests couples therapy for themselves and their partner(s), or if a member of a couple you’re seeing requests individual therapy, it’s considered best practice to refer them to a trusted colleague. Explain the rationale for the referral and communicate that your goal is to ensure that your clients get the best support possible both individually and with their partner(s).

When is couples therapy not appropriate?

While emotional abuse is often discussed in couples therapy, couples therapy is not appropriate if active physical or sexual abuse is present. This is because the work of couples therapy can be intense and emotionally taxing. So if a couple is not in a stable and nonviolent state, therapy could trigger abusive episodes.  If active abuse is present, refer the client(s) to individual therapy along with local crisis resources, if appropriate. If any partner displays a risk of harm to themselves or others, follow your standard protocol regardless of who the primary patient is. This may include:

• Completing the Columbia Suicide Severity Rating Scale and following up with a safety plan
• Documenting this, and anything suggestive of risk, in the progress note
• Making sure there is emergency contact information for both partners at the start of treatment. Couples often list each other as emergency contacts, but it’s best practice to encourage them to list someone not in the relationship. 

How Rula supports couples therapists 

Whether you specialize in couples therapy or other types of care, the Rula community provides a space for therapists to come together to support each other through challenging ethical dilemmas and other professional concerns.  If you’re interested in adding more couples to your practice, Rula can help you connect with your ideal clients — no minimum caseload required. To learn more about joining the diverse network of couples therapists who work with Rula, visit our website.