Please respond to the 3 bullets that correspond to "The Case of Therapist Quandry."

A Case of a Therapist's Quandary

A man is involved in individual therapy to resolve a number of personal conflicts, of which

the state of his relationship is only one. Later, his girlfriend comes in for some joint sessions.

In their joint sessions much time is spent on how betrayed the girlfriend feels over having

discovered that her boyfriend had an affair in the past. She is angry and hurt but has agreed

to remain in the relationship and to come to these therapy sessions as long as the boyfriend

agrees not to resume the past affair or to initiate new ones. The boyfriend agrees to her

requests. The therapist does not explicitly state her views about confidentiality, nor does she

explain a "no secrets" policy, but the boyfriend assumes that she will keep to herself what she

hears in both the girlfriend's private sessions and his private sessions. During one of the conjoint

sessions, the therapist states that maintaining or initiating an affair is counterproductive

if they both want to work on improving their relationship.

In a later individual session the boyfriend tells the therapist that he has begun a new affair.

He brings this up privately with his therapist because he feels some guilt over not having lived

up to the agreement. But he maintains that the affair is not negatively influencing his relationship

with his girlfriend and has helped him to tolerate many of the difficulties he has been

experiencing in his relationship. He also asks that the therapist not mention this in a conjoint

session, for he fears that his girlfriend will leave him if she finds out that he is involved with.

another woman. Think about these questions in deciding on the ethical course of action:

3 Questions to answer:

The therapist has not explicitly stated her view of confidentiality and has not discussed her

"no secrets" policy. Is it ethical for her to bring up the boyfriend's new affair in a conjoint

session?

Should the therapist attempt to persuade the boyfriend to give up the affair? Should she

persuade the client to bring up this matter himself in a conjoint session? Is the therapist

colluding with the boyfriend against the girlfriend by not bringing up this matter?

Should the therapist discontinue therapy with this couple because of her strong bias? If she

does suggest termination and referral to another professional, what reasons would she give

for doing so? What might the therapist say if the girlfriend is upset over the suggestion of

a referral and wants to know the reasons?

Commentary.It was crucial for this therapist to clearly state her stance on secrets when she

began working with the couple, especially how she would deal with secrets pertaining to

affairs. This case is a good example of what can happen when a therapist fails to clearly inform

her clients from the outset about the limits of confidentiality. Because of her failure to provide

for informed consent by stipulating a "no secrets" policy, this therapist is limited in her ability

to work with this couple therapeutically.

Ethical standards do not mandate that affairs must be disclosed. As a clinical issue, however,

such secrets can pose a real challenge to the therapist's work and may influence the outcomes

with couples. Shaw (2015) aptly states this challenge: "A practice policy about disclosure of

secrets is both crucial and simultaneously fraught with tensions about competing accountabilities

in relationship work" (p. 513). If therapists fail to make clear to couples how secrets will be

handled when they are revealed by one of the partners, this issue takes on ethical dimensions.

Unless the secrets are brought to the surface and explored, progress will likely be impeded in

the therapy sessions.