How can a therapist in a small community avoid conflicts of interest?

Therapists in small communities often have requests by community members for treatment, but the therapist is already treating one of the prospective patient’s family members. This raises two issues. First, professional codes of ethics usually state that therapists shouldn’t treat two people from the same family, as the therapist could inadvertently reveal information that violates the confidentiality of one of the family members. But if the therapist avoids any familial overlap, she will be unable to see many community members, since many are related. Second, if the therapist decides not to take on a new patient because of a conflict of interest, she needs to tell the patient why without revealing that she is treating a family member, which could also violate confidentiality.

The appropriate clinical ethics response is twofold. One point is recognition that professional practice guidelines are often overly black and white and biased toward urban settings, where avoiding conflicts of interest is easier. Therapists must decide for themselves, based on their experience and the specifics of the situation, if the risk of violating confidentiality outweighs the benefits of the therapeutic relationship. Another point is that, especially since the pandemic began, rural therapists can now ‘trade’ patients more easily to avoid conflicts.