Scenario Two: Romantic transference in the clinical space
Marcus, 28, begins therapy with Naomi, an inexperienced young 25-year-old counsellor. Naomi gives her number to all her clients, including Marcus, as she is just starting in private practice and works in isolation. Marcus nervously presents with relationship difficulties and reveals his struggle with depression, afraid of opening up and coming to therapy. Naomi shares her experiences with interpersonal difficulties and childhood adversities to make Marcus feel more comfortable and foster trust. As therapy continues, Marcus begins to compliment Naomi and discusses his intimate life and how he likes to please women sexually in detail. He also begins texting her, looking for longer and more frequent appointments, expressing how amazing it feels to be around her. Naomi questions if her actions have prompted romantic feelings from Marcus and is not sure how to address them. Further complicating matters, Naomi also finds Marcus attractive, but she does not want a romantic relationship with him or to break any ethical standards.
Using the inclusive ethical decision-making model to make a decision
Step one: Define the ethical dilemma. Although it is abundantly clear that the correct decision is not to engage with the client sexually, the scenario begs the question of what the most ethically appropriate way is forward with the therapeutic relationship. It would be wise for the counsellor to consult a supervisor or personal therapist to explore their feelings in the situation and see how deep they go, as this will influence the course of action. If the feelings are enmeshed, it may not be ethically correct for the counsellor to decide alone, as their judgement would be clouded. It is important not to minimise and avoid these uncomfortable feelings as it can cause them to be missed and unchecked (Jenks & Oka, 2021). This is in accordance with section 6 (c) of the PACFA (2017) Code of Ethics, which directs practitioners to address feelings of attraction to clients through dialogue with a supervisor.
Step two: Mapping Legitimacy. The people included in this situation’s legitimacy and decision-making process are the counsellor, their supervisor and potentially the counsellor’s personal therapist. It is never appropriate to inform the client of the therapist’s romantic feelings; doing so harms the client and places them under pressure and stress (Jenks & Oka, 2021). Engaging in sexual or romantic relationships with clients directly violates a key ethical standard in professional conduct — nonmaleficence, as it has been well-documented that sexual relationships with clients can cause serious long-term damage (Ybañez-Llorente, 2019).
Step three: Gathering information. The Health Practitioner Regulation National Law No 86a of 2009 (NSW) states in section 140 (b) that engaging in sexual activity with a current client constitutes sexual misconduct, regardless of consent. The law is not limited to sexual intercourse but includes all sexually related behaviours towards clients. The ethical standards that are relevant to this scenario are section 3.0 (a) xiii, 4.2 (a) ii, 4.10 (a) ii and (b) ii of the ACA Code of Ethics. All of these pertain to the responsibility to the client and not engaging in any dual relationships (be they sexual or non-sexual) for a minimum period of two years from cessation of counselling (ACA, 2022). PACFA has similar sentiments in sections 1-3, 6 (c), (d), (e) and (j); however, it goes into much more detail about the nature of the relationship, the duty to not harm, and has an explicitly prohibited exclusion period of at least five years, but preferably never (PACFA, 2017).
Step four: Alternative approaches and action. After the therapist has recognised and acknowledged their feelings of countertransference, the question is how the therapist addresses the transference in the therapeutic relationship. Option one is if the therapist does not feel comfortable with continuing the therapy in light of the circumstances, they could refer the client in a way that does the least harm to the client as possible, discussing with their supervisor how to do this sensitively. Option two, which is the chosen option for this scenario, is to bring the experience of transference into the therapeutic relationship by explaining that it is common for therapy to elicit strong feelings in clients due to the nature of the intimate conversations and feeling heard and safe for the first time in their lives (Jenks & Oka, 2021). It needs to be addressed in a way that reinforces professional boundaries and does not make the client feel ashamed or wrong for developing feelings while being aware of potential harm if the conversation is not handled appropriately.
Step Five: Critical Analysis and Evaluation. In any situation, the therapist must engage in self-reflection and address their feelings of countertransference and any gaps in their own life that may have allowed the feelings to sneak in. It is also important to look at their part in how the feelings developed for the client and take precautionary steps to avoid these situations in the future, such as getting a business phone number, avoiding self-disclosure, not practising in isolation and engaging in self-reflection (Jenks & Oka, 2021).
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