Professional bodies for psychotherapy in many countries, including the UK, require that therapists commit to, and maintain, clearly stated ethical frameworks designed to protect the integrity and wellbeing of clients. While such codes of conduct call for the therapist to avoid relationships that are a disadvantage for the client, there are occasions when the association between therapist and client, or for that matter between psychotherapy trainer and psychotherapy student, may grow into something new and potentially positive for both parties. We look here at a case in which a client, who is now an accredited psychotherapist herself, became a student, a supervisee and ultimately a friend, of her former therapist. The relationship took over a decade to mature and this article only touches the surface of the process. Many questions about ethics will no doubt be raised and it would be of great interest, as well as potentially contributing to our understanding of this important issue, to hear from other practicing psychotherapists about their experiences around the possibilities of friendship – and indeed other dual relationships such as trainer or supervisor.
Kate & Emma – How Client and Therapist became Friends
Over the twenty years that Kate and Emma (not their real names) have known each other their relationship has evolved from client/therapist through trainee/trainer, supervisee/supervisor to, finally, friends. Both now practice as UKCP registered integrative psychotherapists. When I talked to her, Kate was open in telling her story, but I was curious about Emma’s reasons for allowing the friendship to develop. Unfortunately I was unable to speak to Emma, so what follows is Kate’s view of their mutual history, overlaid with my own perceptions.
Kate was welcoming and graceful when I met her at her home. As she told me her story she spoke fluently, with engaging energy, and at some level I was enchanted. I was intrigued by the idea that someone could ultimately become friends with their therapist. Questions about safety and ethics jostled with my curiosity but I was also particularly interested to learn what new possibilities might exist in my relationship with my own therapist.
In her early twenties when she moved to the UK, Kate was suffering from anxiety and depression and taking drugs to numb herself. Although very much in love with her then partner, they subsequently separated and not long afterwards he killed himself. In the aftermath of that shocking event, concerned by her inability to feel anything, Kate began seriously to consider going to therapy and one day Emma walked into the shop where she was working. Kate, immediately struck by Emma’s vibrancy and uniqueness, thought: “If she’s a therapist she’s the one.” Emma handed Kate her card and asked if it could be put up on the notice board. The card said “Therapist” and that’s how they first met.
Emma was Kate’s therapist for seven years. Although Emma was the first person really to ‘see’ her, Kate also described how she initially kept Emma at a safe distance by continuing to use drugs over this period, often coming to sessions stoned. She treated Emma as a goddess: “Emma was more than on a pedestal, she was everything to me. I was so completely in love with her.”
As time passed, Kate began to think of training as a psychotherapist herself. After six years of therapy, she attended an introductory workshop at the integrative psychotherapy training centre where Emma was a trainer and although she says that she didn’t choose the training for that reason, it seems unlikely that her choice was completely independent of this knowledge.
Kate loved the workshop. “For the first time in my life some people were appreciating something in me that felt very true to me so I was, again, in love. I kept falling in love with this world. I applied for the first year of the training … and then I started the year not believing for a minute that I would pass it.”
While the training centre was aware of the therapeutic relationship between Kate and Emma, they allowed it to continue for the first year because Emma was not, initially, one of Kate’s trainers. It was subsequently jointly agreed that the therapy would stop at the end of the year so that Kate could have a break over the summer before re-encountering Emma as a trainer during the second year.
When May came, as well as stopping the therapy, Kate also left the work where she had found a new family,
stopped taking drugs and left her husband. All these losses resonated with experiences Kate had had when she was six years old and she suffered the second breakdown of her life. Over this period she had no contact with anyone, apart from a new therapist: “I wanted to die … [Therapy] was the only thing I was doing the whole week … [I] couldn’t eat, couldn’t drink … couldn’t see anyone, I couldn’t do anything, it was a really terrible six months…. I was very different after it.”
By the time the second year of the training started Kate was beginning to recover. She was glad that Emma was only teaching a few seminars but also missed her and wanted to tell her what had been happening. “The first time I saw [Emma] in a group was torture because she was my goddess … I felt that she was going to be embarrassed about me … so it was hell at first … I don’t recommend it, it was really very, very difficult.”
Kate never had any difficulties finding clients – “I loved it, absolutely adored it straight away, I still love it.” – and in the third year of her training she had so many clients that she needed additional supervision. Not having had much contact with her for about a year, and feeling that “…the person who had been in therapy somehow wasn’t me any more” she chose Emma for her supervisor. Surviving her breakdown was a major factor in Kate’s transformation; she believes that while her core stayed the same, she “…really worked through something and there was a clarification. I really aged, not just physically or mentally but also emotionally and psychologically. By coming through it I matured a lot.”
Kate and Emma’s relationship now became more equal: “… I felt such a relief because I was in front of a human being, and I was a human being, and I was talking about my clients and I was a professional and, yes, I felt still a bit shy, I was chronically shy, but I wasn’t so ashamed and she looked so different. I remember looking at her and thinking ‘Oh right, that’s who she is’.
Even though they were both aware of their previous relationship as client/therapist, Emma’s knowledge of Kate was only discussed where it was relevant to Kate’s client work. As their professional relationship developed they began to exchange books, initially about psychotherapy and then wider topics, but the critical event in their evolving relationship – the point at which they began to realise that they would like to be friends and to wonder whether that would be possible – happened when they were both invited to the wedding of a mutual friend (a student from the training). Kate stopped supervision with Emma some months before this first meeting outside of the therapeutic/supervisory environment, and they discussed openly the need to take things a step at a time and be aware of any issues – specifically those around residual therapy – that might come up. “Emma spoke to her own supervisor before we took the step of becoming friends; I really appreciated that. She did all along, actually, and we talked a lot about it. We didn’t just jump in, we took it very slowly.” Kate herself “… worried about it being an issue and me not seeing it was an issue….” but ultimately felt satisfied that it was safe to move forward.
What followed for Kate was a process of filling in the blanks and rebalancing the relationship “…because she knew everything about me but I didn’t know her…” and her perceptions of Emma have changed over the years. “I think she’s a very excellent therapist, excellent teacher and supervisor as well. And that’s not putting her on a pedestal; I can see her failings as well which is also a relief, I can see where she’s not that good.” She realises that Emma is much closer to her in age than she first thought and she is able to see her as a fellow human with her own failings; she thinks that Emma has probably forgotten half of all that she once knew about her and they have now been friends for close on ten years.
I asked about the changes in the power balance as the relationship moved through the different phases. Kate mused on where the responsibility lay and thought that it had probably been more difficult for Emma than for her: “…she was the Therapist and she was the Supervisor. I was clean, I was just the client” but then she wondered whether she might have seduced Emma-the-therapist.
Kate believes that while unexpected relationships can happen in life, they need to be very carefully assessed and not just blindly accepted; inviting outside opinion for perspective is also crucial in her view “…because I’m sure we don’t want to see what’s in the blind spots that are inside us…. I know it sounds strange because I met my [current] partner on the training and I’m friends with Emma, but I think we need to keep very strict and strong boundaries for certain things.”
Kate’s philosophy of balancing the need for strong boundaries without being rigid in the face of the unexpected strikes me as pragmatic; it seems that her breakdown and the maturity that followed are key to the story. Kate also identifies as key the fact that she herself is now also a therapist and I wonder how much this equality of profession, and the mutual awareness of process between Kate and Emma, contributed to their successful navigation of what many might regard as a dangerous path. It also seems important that each transition was considered and planned – both with each other and with outsiders – and executed with sufficient time allowed to elapse between the different stages.
From what Kate has said, it seems clear that Emma took her responsibility as therapist, trainer and supervisor seriously. Kate speculates on what might have happened had she seduced Emma into being her friend while the initial therapy was ongoing. She concludes that this could have been a form of abuse, as she was, at that time, in an almost infant-like relationship with Emma. Kate says: “…I had always been troubled by the way she was my everything, I was troubled by that. I didn’t know at the time about transference and projections and all those kinds of things.”
Although Kate talked about the importance of reflection and outside perspectives, I did not get a clear sense of their content. It seems to me that although Kate can recognise Emma’s humanity, internally she still holds an idealised aspect of her – something Kate recognises as characteristic and says will “…be a work in progress for a long time.” I think I also expected Kate to have examined the possibilities and consequences offered by the relationship in more depth. In particular I think that being special, a theme that emerged from Kate’s training, might be a fruitful area for further consideration. Kate later agrees that: “There was an issue of being special, I tried to blank it out during my training because it felt dangerous; due to my early history, creating jealousy in my peers was unbearable.”
I asked Kate how she thinks her friendship with Emma may have affected her own practice. She described two situations where clients offered friendship after their therapy ended: in the first instance – an invitation to meet the client’s family – there was no question in Kate’s mind as to the inappropriateness of the suggestion and she declined. The second client’s invitation seemed less clear-cut: Kate’s experience with Emma perhaps let her consider the possibility without automatically shutting the door on it and, while she felt a connection with this client, on reflection she came to the very clear realisation that: “…imagining talking like friends and telling [her] about my life or the things I’m interested in… didn’t feel natural.” She also decided against seeing her in social settings and is now careful to ensure that they don’t cross paths.
Kate concludes by saying that she has always been open to new possibilities but that her friendship with Emma, has given her more confidence to consider them. “Boundaries, respect and mindfulness are three things which are my rules in a way. Except for those I’m open to anything and any possibilities because I think … it’s the denial that anything can exist that can create shadows, material that can hit people from behind. So I think being open to every possibility is better really, I really believe in that.”
Although Kate’s situation with her clients is very different to her own with Emma, I think a question worth asking is whether there is a possibility that Kate is taking care of her clients in a way she herself might have preferred. Her friendship with Emma feels, on the whole, grounded and safe but, as with any decision, it is not possible to know what might have happened had the choice been otherwise. The beauty of our minds is that we can imagine and explore a parallel universe and, in that creative act, we can sometimes learn something new about ourselves. My feeling of enchantment after speaking with Kate prompts me to question where might Kate have been had the boundaries between her and Emma not been renegotiated. Is their relationship as settled as it appears on the surface? Perhaps the answer to that question is that the relationship has not yet fully evolved and perhaps Kate’s participation in this interview heralds the start of a new exploration of herself and her relationship with Emma.
Louise Buckle is a knowledge manager, statistician and musician, playing cello and piano. She is currently a third year psychotherapy student at the Minster Centre.
Image: cascine_15 by boskizzi