Posted by: Marie | May 18, 2010

(315) A question of bartering

Post #315
[Private journal entry written on Monday, January 11, 2010]

During our session this week, Mark and I talked about scheduling future sessions. I brought up the possibility of bartering because my budget is so tight I can’t afford full-rate weekly sessions. I know that Mark would like to take piano lessons. So, bartering seemed like a good solution to the issue.

Mark said he had considered that option, as well. He did some research on the ethical issues around bartering and found that bartering for therapeutic services is greatly frowned upon. He said it is very important to him to operate in an ethical manner and to remain beyond reproach. He said that, if anyone ever accused him of unethical practices (like making sexual advances), he knows that his reputation would stand as evidence in support of his innocence.

So, he isn’t willing to engage in bartering with a client because it would not be consistent with the industry’s standard of practice and his personal standard of behavior.

I didn’t push the issue – clearly Mark does not feel comfortable with the idea and he is setting a boundary to that effect. Even though it seemed to me he is taking it to an extreme, I backed off. He said he is not willing to go there, so I won’t push him to go there. (Unlike him, I do honor boundaries even when I don’t understand them.)

Today, I did some research so I could better understand his position. Here is one article I read that provided some really great information: Avoiding Exploitive Dual Relationships.

Lo and behold, I found that he wasn’t taking to an extreme . . . bartering for therapeutic services really is frowned upon in the industry. It really is a big deal.

Through my research, I learned a whole lot of new vocabulary!

Our first relationship was the therapeutic relationship. It is known as a “contemplated relationship” because we actively negotiated and planned it.

Since we live in a small town, we are both small business owners, and we both are active in the community’s business networking organizations . . . it is usual for us to run into each other at networking events 2-3 times a month. We usually visit for a few minutes; then we move on to talk with other people. This kind of relationship is known as an “incidental social relationship” – in other words, it happened without advanced planning on the part of either of us.

The two relationships started within a couple of weeks of each other – which means we have always had a “dual relationship”. The duality remained intact during the time I wasn’t actively having sessions with him because I had left open the possibility of future sessions when I stopped seeing him.

A dual relationship can be of major concern for a therapist. However, our dual relationship is not very concerning because of the aggregate nature of the two relationships. The following two charts map the nature of the two relationships.

Each of the charts has the same text as the other chart. The only difference between them is which of the boxes are highlighted in yellow. Each relationship’s nature creates a different pattern of highlighted boxes.

The industry guidelines tend to indicate:

If the yellow boxes tend to be in the right column, no dual relationship should occur.

If the yellow boxes tend to be in the center, carefully considered and crafted dual relationships could occur.

If the yellow boxes tend to be in the left column, most dual relationships are permissible.

It appears to me that the boxes tend to fall in the middle. Therefore, a carefully crafted dual relationship would be permissible. Special circumstances also weigh in on the situation . . . for example, because we live in a small town, dual relationships are difficult to avoid and are to be expected. Therefore, the current arrangement seems to be allowable.

However, for example, if Mark were to invite me over to his house for dinner with him and his wife, that would be crossing the line into dangerous territory.

If we add a tertiary bartering relationship, the table for that relationship would look like this:

The yellow boxes tend to fall to the middle and/or right. So, it is not clear whether this tertiary relationship would be permissible or not. However, there is another element specific to bartering that needs to be considered.

According to Whitney van Nouhuys:

“Another problem is that bartering creates a dual relationship because the therapist assumes a second role with the client, which has the potential for exploitation. The delivery of the goods or services to the therapist’s satisfaction may also impair his or her judgment. If the client’s goods or services don’t meet the therapist’s expectations, it may be the therapist who feels exploited. Therapist and client have moved outside the structure created by professional standards of practice making it difficult to examine the interpersonal exchange within the psychotherapeutic frame. The boundary is violated and the treatment is compromised.”

In that light, I can see how this tertiary relationship would be harmful to our existing therapeutic relationship. So, now, after thoughtful consideration, I agree with Mark’s stance on this matter.

Something caught my attention while I was studying this topic. I realized in what ways I have been giving Mark power over me – during our first round of therapy, I allowed him to have profound personal influence over me. I looked to him to be my solitary source of male attention and approval.

This time around, I have been allowing him to have that type and level of influence over me to some extent . . . but not to the extent I was before. My anger and frustration towards him is causing his influence to diminish.

I’m seeing that it would be much healthier for me to reduce his personal influence even more. I believe I can do that by giving more weight to my own feelings and experiences and by giving less weight to his opinions.

I have been assuming that I am the broken one, the naive one, the confused one – and I have been viewing him as the educated one, the savvy one, the grounded one. But, now that I am staring his shortcomings in the face, I can see I have been mistaken.

He really doesn’t have “life” figured out any more than I do. He has education on some specific psychological disorders, but he is not very emotionally mature and his interpersonal skills are suspect. He can’t teach me what he doesn’t know.

So, I can glean some clinical information and support from him, but I really can’t expect more than that from him. He is not in a position to be a hero for me. I am my own hero.


Responses

  1. I think the solution to any problems with a dual relationship is to have more relationships.

    I don’t think bartering is a problem at all. To see exchange of time instead of money is unethical is just loony as far as I can see.

    In the columns it seems to be differentiated by closeness and power. First I think the power attributions are decidedly simplistic (and can someone name just one where they are balanced in the way these humourless columns seem to contemplate)

    Is it really beyond the possibility of human maturity to have someone as your boss and friend or spouse and co-worker. The prejudice against dual relationships seems to entrench emotional immaturity. (To guard the therapist – I don’t really think that the core concern is the client’s maturity but the therapists vulnerability to litigation).

    I think your seeing his limitations is an interesting study for power in the relationship. This kind of change is not contemplated by those columns (they can’t capture the fluid and complex nature of a relationship).

    I am quite a contrarian to the professionalist way of doing relationship (the mainstream view). I think it is real relationships that heal – and fake ones don’t (even though they make insulate therapists from anything messy like having to deal with their own problems in a real relationship).

    I realise that my views are about 90 degrees to the orthodoxy. But I did want to voice them.

    • Hey, Evan –

      Why am I not surprised that your views are about 90 degrees to the orthodoxy, LOL . . . I figured out a while back that you march to your own drummer!

      You make some awesome points . . . and, I think part of the equation has to do with the nature of what is being bartered. Both the therapy (what Mark provides) and the piano lessons (what I provide) require two separate, regularly scheduled, longer term relationships that must both remain “civil” in order for either to be effective.

      Given the volatility of our relationship, it seemed like it would be difficult to maintain civility on a consistent basis for any serious length of time.

      Other than that – and the fact it could cause him to be pinged by the licensing agencies – I agree that the bartering could have been a great solution in this situation.

      Thanks for more thought-provoking prose!!

      – Marie

  2. I love the way you thought about this, researched it and worked it through. I have read a stack of case studies on dual relationships and how they have damaged the therapy outcome – not because of money or bartering but because of the way it affects the delicate balance of power in the relationship.

    Still, rules should always be questioned rather than just blindly adhered to.

    Great post.

    Best

    WG

    • Hi, WG –

      Good point . . . rules need to be questioned often . . . I think it was the Dalai Lama who said, “Learn the rules so you know how to break them properly.”

      Thanks for your input!

      – Marie


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