Michael Griffin
Staff Attorney
The Therapist
(May/June 1993)

Each of the following brief vignettes describes a hypothetical scenario that involves a therapist interacting with his or her current or former patient outside of the context of therapy. You are invited to provide CAMFT with your written analysis of the legal and ethical issues evident in each of the following three vignettes and the actions taken by the therapist. In an upcoming issue of, CAMFT will print the best overall response(s), as judged by Mary Riemersma, David Jensen, Catherine Atkins, and Michael Griffin.

Vignette 1
Cathy is a licensed marriage and family therapist in private practice in a small town in central California. Because Cathy is one of very few therapists practicing in the local geographic area, she receives a wide variety of referrals from local family practice physicians. Since Cathy set-up her office about a year ago, her practice has flourished. She benefits from the fact that there is limited competition in the area. By comparison, there is a large population of therapists practicing about an hour’s drive away.

Dr. Bob, a local physician, has been so impressed by Cathy’s friendly and professional demeanor that he calls her to ask whether she could provide therapy to himself and his wife. He informs Cathy that he hasn’t been very impressed with other therapists in the area and he feels much more comfortable going to see someone whom he knows and trusts. Cathy is uncertain about whether or not to accept Dr. Bob and his wife as clients. She recognizes that she has a pre-existing relationship with Dr. Bob, but feels fairly certain that their relationship is professional and not at all social in nature. Her interactions with Dr. Bob are generally limited to occasional, brief phone consultations concerning their mutual patients. Once, Cathy saw Dr. Bob at a breakfast marketing meeting that is attended by local professionals. The meeting is held infrequently, (only about once every three months), and she hasn’t always attended due to the fact that it is held at 7:00 a.m.

Vignette 2
John is a licensed marriage and family therapist in a large metropolitan area where he has been in private practice for nearly ten years. John prides himself as being an ethical therapist who strives to maintain appropriate professional boundaries. However, in spite of his careful and professional conduct, John tends to worry that someday he may end up being listed in the Disciplinary Actions of the BBS. In fact, a few of his colleagues tease him and tell him he’s being overly obsessive about making a mistake. Once, when John unexpectedly encountered one of his clients at a local supermarket, he gave his patient a quick wave of his hand and immediately left the store. John recently discovered that more than one of his patients attends exactly the same church services that he does. Now John wonders whether he ought to attend a different church

Vignette 3
Howard is a licensed clinical social worker with a very busy private practice. Howard’s office manager, Susan, is an extremely competent individual who performs her job with great skill. One day Susan informed Howard that she would have to take a leave of absence from her position immediately due to an emergency in her family. Due to the nature of the emergency, Susan states that she will probably be unable to return to work for several months or longer. Howard is caught off-guard and is understandably worried about the prospects of finding a qualified replacement for Susan in so little time. To make matters worse, he seriously doubts that Susan will ever return to her job. After a few days, at the point that Howard is beginning to feel overwhelmed, a solution seems to drop into his lap. Ann, one of Howard’s current patients, informs Howard that she knows someone who would be “perfect” for the vacant office manager job. Surprisingly, the person that Ann recommends is actually a former patient of Howard’s by the name of Tara. Howard knows Tara well, having treated her for almost two years. He recalls that Tara is a very bright and responsible person and that she probably would be perfect for the job. Although Tara completed therapy with Howard about six months ago, he still has her file in his office cabinet. Howard recognizes that this decision is important. Consequently, after giving it some very serious thought, Howard called Tara the following day and offered her the job.

Instructions
You may analyze as many of the vignettes as you wish. Please address the following questions for each vignette that you choose to analyze:

A. Discuss whether or not, in your opinion, the therapist’s conduct is appropriate in the context of any and all laws, regulations, and ethical standards that may apply.

B. Consider whether or not the therapist’s actions suggest or demonstrate the potential for, or presence of, a dual relationship, conflict of interest, and/or unclear or inappropriate boundaries between the therapist and his or her patient.

C. Explore the options that are available to the therapist and any potential consequences of those options. Indicate what you believe to be the best course of action, in light of the applicable laws, regulations, and ethical standards.

We are interested in the specific reasons for any positions that you take. Mailed responses must be typed and submitted to: CAMFT 7901 Raytheon Rd., San Diego, CA, 921. Responses may be submitted as e-mail attachments to: eileen@camft.org In order to be considered, your response must be received by CAMFT on or before July 13, 2007.

Michael Griffin, J.D., is a Staff Attorney at CAMFT. Michael is available to answer members’ questions regarding business, legal, and ethical issues.

This article appeared in the May/June 2007 issue of The Therapist, the publication of the California Association of Marriage and Family Therapists, headquartered in San Diego, California. This article is intended to provide guidelines for addressing difficult legal dilemmas. It is not intended to address every situation that could potentially arise, nor is it intended to be a substitute for independent legal advice or consultation. When using such information as a guide, be aware that laws, regulations and technical standards change over time, and thus one should verify and update any references or information contained herein.