Avoiding Liability Bulletin – November 2006
… A therapist or counselor may be asked to attend the wedding, graduation, or funeral of a particular patient or former patient. While this may happen infrequently, the therapist or counselor must be prepared for such a possibility. The request by the patient or the patient’s family may arise quite unexpectedly. Among the questions I am usually asked by the mental health practitioner are: Is it permissible? Is it lawful? Is it ethical? Does it constitute a dual relationship? Could I get in trouble? We examine these issues and questions below.
Generally, there is no requirement that a therapist or counselor attend a celebration or other event involving the patient or the patient’s family. Therapists or counselors should thus feel free to respectfully decline an invitation to attend any such event, and can usually do so in a manner that is not insulting or hurtful to the patient. On the other hand, it is this writer’s view that attendance at a significant event in the patient’s life is generally permissible, lawful, and ethical – if handled appropriately. Some practitioners, because of their belief system and orientation, may want to attend. They may want to attend because of their long and meaningful professional relationship with a particular patient or in order to show respect for the family’s wishes, or for other appropriate reasons.
State laws and regulations, as well as applicable ethical standards, generally do not directly address these issues. If they do, therapists and counselors must of course abide by applicable requirements and standards. Generally, mere attendance at such an event would not constitute a dual relationship, since the therapist or counselor would be attending not as a friend, but as a caring and supportive professional. Thus, there is no secondary or “multiple” relationship. Moreover, if there is no reasonable likelihood of impairment of the practitioner’s judgment or no exploitation of the patient, the likelihood of an unethical dual relationship is minimal at best.
Attendance at an event or occurrence as mentioned above should generally be at the request of the patient or the patient’s family, and not as a result of the therapist or counselor’s request or the result of a unilateral and unannounced decision of the therapist or counselor. A therapist or counselor may be asked by relatives of a deceased patient to attend the funeral or burial of a deceased patient. Under many circumstances, attendance can occur without much ado and without any problem for the practitioner. This of course assumes that the practitioner acts discreetly and that he or she quietly “gets lost in the crowd.” Under some circumstances, survivors of the deceased patient might be offended if the therapist or counselor did not attend the funeral service. It is important to remember, however, that the duty of confidentiality generally survives the death of the patient.
Thus, if attending an event, one must be prepared to not only protect against the disclosure of confidential information or communications, but if possible, to protect against the disclosure of the fact of the relationship. This is especially important in situations where the fact of the therapist-patient relationship is not disclosed to the attendees by the patient or the patient’s family. The possibility of recognition by others should be discussed in advance with the patient or the patient’s family, especially where there is a desire to keep the therapist’s relationship with the patient from others.
When I have been asked whether or not it was permissible for a therapist to attend a patient’s wedding, I have facetiously asked one question and seriously asked two others. I have facetiously asked (to make a point) whether the therapist is going to climb up on the table when drunk or near drunk and dance with great fanfare. I have seriously asked whether the patient will be disclosing the identity of the therapist or whether the patient wants the therapist’s true relationship to the patient to be suppressed. What will the therapist say or be expected to say when someone at the wedding asks – “how do you know the bride and groom?” The answer cannot be – “I can’t tell you because of the nature of the work I do!”
The other serious question I have asked is whether the therapist will get a gift for the patient, and if so, how much will be spent? If no gift is to be given, how will the therapist explain the lack of a gift to the patient – who may have been paying the therapist $125 week for the past three years? These questions make the therapist think carefully about the decisions that need to be made. Depending upon circumstances, a wedding gift for the patient might be permissible and ethical. It may be preferable for some therapists, however, to find an appropriate, respectful, and straightforward way to explain the reason why no gift will be given. This becomes easier when only the ceremony is attended or the therapist declines the invitation entirely.
Whether or not therapists or counselors could get in trouble for attending such events is yet another question. The short answer is “yes.” The potential for trouble, even if attendance is lawful and ethical, always lurks. Unanticipated events can occur, so therapists and counselors must carefully examine the pros and cons of each situation. Therapists who desire to minimize risk are likely to assiduously avoid attending weddings, funerals, or other events involving the patient, former patient or deceased patient. While this may be a reasonable approach for many, exceptions do on occasion occur.
When an exception does occur, the outcome depends upon how the situation is handled. With respect to a wedding, for example, the practitioner might be wise attending only the wedding ceremony and staying away from the dinner/dance. This might be done, for instance, if the patient did not want anyone to know that he or she was in therapy. Of course, in smaller communities and even in larger urban areas it is possible that someone in attendance may recognize the therapist and put two and two together or make certain assumptions. Thus, a problem or uncomfortable situation could arise, even for the careful therapist. On the other hand, simply because someone may recognize a therapist at some quasi-public event should not be an absolute or immutable bar to attendance.