Ethical risks in conducting individual therapy with a married client: The case for new standards of care.

Starting with Freud, individual psychotherapy has long been the standard treatment format for most mental health interventions.Unless distressed individuals explicitly seek couple or family therapy, they most likely will find themselves receiving their psychological treatment in the format of individual therapy.The literature review and case examples in this article suggest, however, that for a client who is married, individual psychotherapy may be less effective and at the same time may carry more potential for harm than a combined individual and couples therapy treatment format.With a married client, a well-intentioned individual therapy is likely inadvertently to violate the profession's fundamental ethical principles: beneficence and nonmaleficence.Without spousal involvement in the treatment, a therapist lacks key diagnostic data, cannot utilize the spouse as a resource, and is able to impact only one side of problematic reciprocal interactions-all of which decrease beneficence.As to nonmaleficence, without access to both marital partners, the therapist has no way to assure that the treatment does not harm the spouse, the marriage, and thereby also the client.Ethical treatment with married individuals therefore generally necessitates inclusion of couple-format sessions, particularly at the outset of treatment, plus the option of individual sessions for both spouses, all with one therapist (the "one-therapist rule").In addition, therapists who treat a client who is married must reconsider their assumptions regarding the ethical issues of dual relationships, confidentiality, and competence. Clinical Impact StatementThe research review and case examples in this article pose a major challenge to the currently common practice of conducting individual therapy with a married client without spousal participation.To maximize treatment benefits (beneficence) and prevent harm (nonmaleficence), that is, for the treatment to be ethical, the article recommends a one-therapist rule: One therapist must evaluate and then, as needed, treat both spouses and also the couple's interactions.