Managing confidentiality can be tricky when you are combining joint and individual sessions. Here are some considerations before you switch modes from couples therapy to individual or visa versa:
Who is the Client?
You must be clear on who you are counseling, the individual or the couple? If you change from individual to couples, or couples to individual, then all parties must agree on the change and understand its implications. Although there are other implications when switching modes, this post will focus on confidentiality.
According to the ACA ethics code A.6.d:
“When counselors change a role from the original or most recent contracted relationship, they obtain informed consent from the client and explain the client’s right to refuse services related to the change. Examples of role changes include, but are not limited to
1. changing from individual to relationship or family counseling, or vice versa;
2. changing from an evaluative role to a therapeutic role, or vice versa; and
3. changing from a counselor to a mediator role, or vice versa.
Clients must be fully informed of any anticipated consequences (e.g., financial, legal, personal, therapeutic) of counselor role changes.”
Your Secrets Policy
Because clients may share information during their individual sessions that they do not want discussed in front of their partner, you need a secrets policy. This policy will guide how confidentiality is handled when switching modes from individual to joint sessions. If your secrets policy is complete confidentiality (i.e. you hold secrets), then there isn’t a confidentiality issue with switching modes, and you can skip reading the rest of this post. However, if your secrets policy is partial or complete transparency (i.e. you may share any relevant clinical information), there could be confidentiality implications.
Confidentiality considerations: switching from individual to couples:
As soon as your individual client mentions wanting couples therapy, you need to make sure he or she understands that anything he or she has told you that is relevant to the relationship will be shared. If that is not OK with them, then you must refer out for couples therapy.
Confidentiality considerations: switching from couples to individual:
Prior to beginning individual therapy with one or both partners you must explain to both individuals (preferably together) that you may not be able to return to a couples therapy mode afterwards in the event that a secret is revealed during individual therapy. There may also be other reasons why you can’t see them both individually, but that goes beyond the scope of this post.
As always, if you are under supervision you should discuss the particulars with your supervisor before making clinical decisions of this nature.
Yours in the Joy of Knowledge,
Dr. Barb LoFrisco
