Lloyd has been working with Julie and Tom for around six weeks. He has not found the work easy and has sometimes struggled to contain the couple's aggression, some of which is directed towards him. One day, Lloyd comes across a blog written by Tom called ‘Couples counselling – a true story’. Should Lloyd bring this up in their next session?
Dilemmas – Transference in couples therapy
This month’s dilemma
Lloyd, an experienced counsellor, has been working with a couple, Julie and Tom, for around six weeks. The impetus for the counselling came from Julie, and Lloyd is aware that Tom only comes to please Julie. Lloyd has not found the work easy, and has sometimes struggled to contain their aggression, some of which is towards him, particularly from Tom.
One day, when Lloyd is idly scanning the internet, he comes across a blog written by Tom entitled ‘Couples counselling – a true story’. Lloyd is very tempted but decides not to read further. However he wonders whether he should tell Tom that he has seen it or wait for Tom to bring it up first.
What are the ethical dilemmas involved in this scenario, and what should Lloyd do?
Tim Branson (psychological therapist/specialist counsellor and senior accredited supervisor of groups)
From a supervisor’s perspective, it seems clear that Lloyd needs help with working with the anger in the room and with any negative transference from Tom. I wonder if he might role-play in supervision different ways of openly addressing Tom’s aggression?
Is Tom’s aggression ‘communication’, in the same way that the blog is a communication? Perhaps part of the therapy is to encourage him to find more straightforward ways to communicate his feelings. Indeed, it seems both parties are holding anger and clearly Tom has feelings about being in therapy and about the therapy itself that he cannot express in the moment. I wonder if challenge and encouragement to bring his feelings to the session could be key?
As to Lloyd’s ethical dilemma about disclosing that he has discovered the blog, he does not know if Julie is aware of it (this, perhaps, representing a very ‘non-verbal’ communication from Tom), so raising the issue directly could be unhelpful for them.
That Tom hasn’t talked about the blog suggests it is negative about the therapy, although this is not necessarily the case. It may state that the therapy is helpful but Tom is unable to express this in session.
It might also be better for Lloyd if he doesn’t read the blog at this stage as it may negatively influence his ability to sit with Tom and Julie’s issues. However, knowing that there is a public statement about his work with Tom and Julie may in itself prevent Lloyd developing a stronger therapeutic alliance.
Perhaps a task of supervision might be to work with Lloyd’s fantasies about what the blog might say, so that he becomes more comfortable sitting with this unknown element of what is, ostensibly, simply client material.
Lloyd might benefit from reading the blog when the therapy has finished, however. How often do we get an opportunity for uncensored and honest feedback – even if it is from an angry client’s perspective? And, after all, the blog is in the public domain for all to see. That said, if the outcomes of therapy are positive the blog may totally diminish in importance. From a cautionary perspective, if Tom wrote it when angry, it might include inaccurate or inappropriate material and, however painful, it would perhaps be better if Lloyd knows what it says and can bring it to supervision.
William Johnston (person-centred counsellor in private practice)
Experienced as Lloyd might be, it seems to me that the issue here is to do with boundaries.
I was struck by the phrase ‘idly scanning the internet’. Presumably this is Lloyd’s phrase. It would, I think, be difficult to come across such a blog, written by a client, unless Lloyd were in some way looking for it, or at least looking for something about Tom, as a way to help him out of the difficulties he is experiencing with this couple.
As a point of speculation, I have a suspicion that Tom may either be working beyond his competence – a difficult admission for an experienced counsellor to make – or may be reluctant to challenge the dynamic of the sessions for fear of Julie and/or Tom terminating therapy and leaving Lloyd feeling a failure.
As described, there is a serious inequality here. If Tom really is only there to please Julie, then that needs to be confronted head on. I can see no point in continuing the sessions unless this is done. If Tom is venting his aggression against Lloyd, then that would suggest that this issue has not been confronted and Tom may well feel in some way ganged up against. Lloyd’s contract is with the two of them and their relationship, not with Julie at the expense of Tom.
It might well be that, once this imbalance is acknowledged, Tom will be far more willing to continue with the sessions and to engage as an equal partner.
All credit to Lloyd for not reading Tom’s blog. Regardless of whether he does or not, however, I suspect that inviting Tom to own his feelings about being at the sessions at all is likely to bring up all the issues that he may have confided to the ‘private’ setting of an online blog. At that point, the issue of the blog becomes somewhat irrelevant.
If Lloyd cannot establish an equality of engagement between Julie and Tom, then I think he might in any case have to consider terminating the sessions.
Margaret Akmakjian-Pitz (psychotherapist and supervisor in private practice)
When I was in therapy, I found the impersonal ‘blank screen’ and rational approach so chilling that I was totally unable to be open and vulnerable. Reading Lloyd’s dilemma re-evoked those feelings of being pushed away, along with an unwelcome and uncomfortable feeling that, from a purist’s point of view, he might be doing ‘the right thing’ in not reading Tom’s blog.
It may be ‘right’ but is it in the client’s best interests? Everything is grist for the mill, so it could be quite useful to discuss with Tom what he writes in his blog that he isn’t able to bring to the sessions – and why that might be. Perhaps putting things in a written form is a way for Tom to get feelings out. Maybe Lloyd needs to use what is in the blog and move forward to Tom actually talking directly to him? In his shoes I’d be grateful to Tom for helping me find a way into the things that he is not able to tell me directly.
Tom is telling his story in the only way he knows how, through his blog. Perhaps Lloyd needs to explore with Tom how and why this is his chosen safe way to communicate, and demonstrate that both he and Julie can deal with what Tom says without retaliating. It will only be when Lloyd shows true empathy and understanding that Tom will be able to speak directly about his feelings. Possibly, in Tom’s case, it would be about his (and Julie’s) aggressiveness.
I hope Lloyd can be courageous enough to read Tom’s blog. Whatever its content, it’s wonderful grist. As his therapist, I would want to work with the feeling in order to understand the aggressiveness.
Mandy Pitts (trainee counsellor)
Lloyd needs to think very carefully about what steps to take if he wants to avoid any major damage to the relationship he has built up with Tom and Julie.
First, I am assuming from the information provided that Lloyd did not go looking online for information on Tom, which would of course raise concerns in itself. However, having discovered the blog, he now has to decide whether to look at it or not.
Although Tom puts his own name on the blog, a bigger concern is whether he has given details that would make Lloyd recognisable, such as his full name and the address of his workplace.
Unless Lloyd looks at the blog, he cannot know what is written, but once he has read it, he can’t unread it. My suggestion would be that Lloyd asks a colleague, or his supervisor, to read the blog, primarily to check that it maintains Lloyd’s confidentiality, but also to check that nothing has been written that would cause concern to the therapeutic process, such as threats of aggression towards Lloyd. If there is nothing like this, I think that Lloyd should avoid reading the blog. It is something personal by Tom, and he is entitled to post his thoughts on the therapy, although the fact that he has included his full name suggests he might have actually wanted Lloyd to find it, possibly as a way to intimidate him outside of sessions.
Whether to mention the blog in a counselling session is another consideration. Julie may not know about the blog and may not agree with its contents. By bringing it up in front of her, Lloyd could be seen to be breaking Tom’s confidentiality – perhaps the blog is his way of expressing what he does not want or feel able to share with his wife. Instead, Lloyd could ask the couple how they think their counselling is going, so that they have an opportunity to discuss any issues about it that they are willing to share.
I would suggest that Lloyd does not disclose that he is aware of Tom’s blog, unless he feels that he has no choice. Tom is already sceptical about the counselling; if the blog was intended as a way of expressing his thoughts on the process, which could be therapeutic in itself, knowing that Lloyd has found it is likely to cause anger, and even a feeling that Lloyd has been interfering in their life beyond the limits of the counselling. This is likely to make it impossible to maintain any sort of relationship in the therapy room and also risks affecting Tom’s relationship with Julie.
Next month’s dilemma
Deidre works as a therapist in a local voluntary counselling service, where she also has a managerial role and is expected to attend outreach and networking meetings.
However, at a recent event she notices that a client of hers is also present. Deidre leaves the event and tells her manager, who is not very pleased that she left the meeting. The manager is now considering appointing only non-practitioners as managers of the counsellors and counselling service.
What ethical issues are involved and what should Deidre and/or her manager do in this situation?
Please email your responses (500 words maximum) by 31 October to Heather Dale at firstname.lastname@example.org. Outline how you would manage the dilemma and make your thinking as transparent as possible. Readers are also welcome to send in their dilemmas for consideration for publication, but these will not be answered personally.