Because there is always the possibility that a past patient will want to return to your practice, it’s best to think of this situation as a potential multiple relationship, which is not always unethical but warrants caution and thoughtful consideration. But before undertaking a multiple relationship, any psychologist needs to think through the pros and cons of the situation.
Standard 3.05 of APA’s Ethical Principles of Psychologists and Code of Conduct has a test for when a multiple relationship is unethical: Could the multiple relationship reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing their duties or risk exploitation or harm to the patient? Figuring that out requires a psychologist to be proactive and think through the range of risks and benefits involved.
Often, the cleanest approach is to find out if there are other options in your area for your former patient to join a different peer consultation group. If not, consider if your former patient could be harmed in any way by participating in your group. Also factor in how much time has passed since you treated them, the likelihood that they will need a therapist in the future, and whether any issues arose in therapy that could compromise the well-being of the patient. It is also important to think about whether you will be able to facilitate the group effectively with a former patient there, and how you would manage any complications, including the possibility that you could have concerns about their well-being or professional competence.
Consider whether there are benefits to the former patient joining your group and how these benefits stack up to the risks involved. If there are few benefits, the answer is an easy one.
Once you’ve determined the sticky areas, talk to your former patient directly about whether and how the two of you can manage this new relationship. Make it clear that you would not be able to resume being their therapist if they join the group. Decide how an unexpected clinical issue would be handled and what their other options are for care. In this situation, the patient might choose to keep the psychologist as their future therapist and elect not to participate in the peer consultation group, having discussed the situation with the psychologist.
It is also wise to consult with colleagues and your risk management carrier to determine if you are missing anything or if any biases are impairing your judgment. Do not inadvertently disclose who this former patient is, and do not consult with a colleague in the peer consultation group who would meet the former patient if they joined.
From a risk management perspective, it is also wise to consider that a licensing board could potentially view this situation as a boundary violation. Thoroughly documenting your decision-making and patient consent processes is a good way to protect yourself.
Every situation will be different, but the Ethics Code provides a clear roadmap to help you thoughtfully determine whether a multiple relationship is unethical or one you can undertake.
