Therapist Turns Out to be Neighbor

I would like to know if this scenario is unethical. My wife and I go into marriage counseling with a clinical therapist (PHD, APA, etc). We divulge all of our dirty laundry. After several weeks we discover that the therapist is our neighbor living on the same street several doors down. My wife and I miss the next appointments out of embarrassment, shame, fear, and paranoia. A few days later we receive bills from her indicating that we are going to be charged for the missed appoinments (clearly an indication that she KNEW we were neighbors)…..It seems that she should have disclosed this to us and to continue treatment was unethical because of the, what I perceive to be, a conflict of interest. We discovered this while sitting on our porch and watching her drive by a few times. Finally I looked in the county’s real estate/tax database and sure enough…..she lived there.

Since we’ve had no response yet to sharing your question with a psychologist ethics resource, we will, for now, provide our own perspective, but we don’t represent ourselves as experts on this score. We have reviewed the American Psychological Association’s ethical code. It prohibits “fraud” or “intentional misrepresentation of fact,” and also cautions against “multiple relationships” (e.g., if your psychologist also had a social or business relationship with you) that “could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness” or risk “exploitation or harm” to the patient/client. It also warns that psychologists should refrain from taking on a role in which there is a conflict of interest. None of these seems to precisely apply to the situation you describe.

Nevertheless, if the psychologist realized, before or during her meeting with you, that she was a close neighbor, we think she showed poor clinical judgment by not disclosing that fact to you and giving you an opportunity to switch therapists if you were uncomfortable with her residential proximity. (We say “if,” because, depending on her system for acquiring patient data, she may not have noticed your address until she was sending you the bill for the missed appointments; if she hires a billing service to handle these functions, she may still not be aware of it.) As you probably know, other issues aside, it is standard practice to bill clients/patients for “no-shows” and for sessions cancelled with less than 24-hour notice. It’s not clear why, in your dismay, you didn’t call to cancel further sessions.

Please realize that, in any case, the psychologist is very clearly prohibited from disclosing to others any confidential information that was shared in the course of the therapy, including the fact that you saw her, without your written permission (except as necessary in the billing process, or in the case of imminent potential harm, child/elder abuse, or court order). For example, to tell a neighbor something she knew about you via a therapy session would be a serious ethical/legal breach.

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