A divorced father with one child living with a domestic partner begins psychotherapy by the use of internet communication (predominantly emails) with a female licensed social worker in another state.
The patient had been struggling for years with symptoms posttraumatic stress due to emotional and sexual abuse from his childhood where the sexual abuse was perpetrated by his father. When his current partner engages in infidelity, the patient begins to question his sexuality. He searches the internet for help and finds a website offering therapy and counseling via email with the social worker.
Over the course of two years, the emails between the patient and social worker blossom into a friendship, where the two share personal and intimate details of their lives; exchange gifts and photographs; and celebrate holidays "together." The social worker through therapy also encourages the patient to be "unforgiving" of his partner's infidelity and shares her own marital and divorce problems with her husband.
The emails turn flirtatious. The patient confesses his love to the social worker.
At this point, the social worker begins to understand why the ethical rules of her profession forbid "dual relationships." She seeks help and advice from a supervising social worker and is told to end the therapy. When she abruptly emails regarding termination, the patient is left with an overwhelming sense of loss, betrayal and feelings of abandonment. This improper treatment and termination process causes an aggravation of a pre-existing condition such as the symptoms of post traumatic stress disorder.
The patient had paid many thousands of dollars to the social worker for therapy which turned out to be useless and damaging. The internet therapy had compounded and magnified the problems which drove the patient into therapy in the first place. Over the next few years, the patient becomes isolated and unable to trust other therapists. He is despondent and retreats into an inner world of depression and despair uncaring of his child and his job; and suicidal at times.
The rules of ethics of the National Association of Social Workers states that social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.)
When a patient enters therapy they expect help for the problems that brought them to therapy. Good therapy helps the patient with those problems without subjecting them to additional traumas . It is the therapist's responsibility to monitor the relationship at all times to prevent what happened to the patient in this case. A few words early on at the beginning of therapy explaining to the patient that dual relationships are fraught with danger and must be guarded against might have saved this patient a world of harm and the costs of more therapy to attempt to correct that harm.
There was also negligence in this case because the therapist did not provide the information needed to obtain informed consent of the patient to have this psychotherapy.