Exchanging Services for Therapy

A therapist is treating a young adolescent who has mild mental retardation. He demonstrates serious peer relation problems (i.e. his classmates pick on him and make fun of him and he lacks social skills to deal with this). He has poor self esteem, gets frustrated easily, and responds with occasional temper outbursts. You have developed good rapport with him and he is making progress toward his therapy goals. His parents indicate that he is visibly improving.

Mom works in a factory and has the insurance that covers her son's treatment. She gets laid off. the patient’s Dad is a bricklayer. He offers to build a planter in front of the therapists office, trading the normal rate he would charge a customer against the normal rate charged for psychotherapy with his son.

What are the issues here and what should the therapist do?

Ben's Answer:

I don't want to take the position of giving you legal advice here, but I'll give you some food for thought. Legal and ethical issues are often the same issues - but sometimes not. You can sometimes do something that is "illegal" but is done for ethical reasons. And you can sometimes do things within the law, but be totally unethical at the same time.

This situation is obviously one that is motivated by a desire to provide a needed, and wanted, and much valued service to someone in need. There was a time in history when bartering was the norm of society. And maybe it should be again.

In California, I believe it is an "ethical" violation for a therapist to barter with a client for services. If you think about it - that's for the protection of the client - to avoid messy boundaries, and avoid disputes, as well as duel relationships (getting too familiar on a non-professional level). Other states may have different laws and standards regarding that issue.

You have to balance doing what you heart says is "right" - with doing what will minimize the risk of harm. I believe we should take into account the place we are working (like a small community), and the times we are working in.

For the definitive answer, you'd have to contact your state's licensing board and get their advice.

Best wishes,
Ben Schwarcz, MFT
Santa Rosa Psychotherapist

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