Is seeing a therapist you know a good idea? Learn why therapy with a relative or friend can backfire, what dual relationship ethics say and the alternatives.
At the bayram (religious holiday) table, your cousin is talking about the counselling practice she has just opened. For months you have been having sleepless nights and feeling that something is going wrong at work. Over coffee she leans towards you and says, "Come and see me one day, we'll talk. It's not as if I'm going to charge you." The offer is sincere, warm and tempting. And telling your troubles to a stranger feels like a big step. But is seeing a therapist you know really a good idea? Can therapy be carried out with a psychologist who is a relative, a close friend, a neighbour or a colleague's spouse? In this article I look at why this question is more complicated than you might think, what professional ethics say about it and how you can draw on a psychologist you know in a healthier way.
Why Is Seeing a Therapist You Know So Tempting?
There are understandable reasons why the idea of working with a psychologist you know is so appealing.
- A sense of trust: The thought "She already knows me, I don't need to explain everything from the start" is reassuring. Opening up to a stranger can be frightening, especially for someone going to therapy for the first time.
- Financial ease: At times when the rising cost of living is keenly felt, an acquaintance's offer of free or discounted sessions is hard to turn down.
- Accessibility: Having someone you can reach easily by message or phone, without waiting for an appointment, seems practical.
- Family encouragement: "Our own girl is a psychologist, why would you go to an outsider?" is a sentence often heard, especially in large extended families. Going to someone else when there is an acquaintance available can be seen as a lack of trust in the family.
- Fear of stigma: The cover of "a chat with my cousin" seems to reduce the worry that people will hear you are in therapy, compared with walking into an unfamiliar office.
There is also the comfort of "She already knows everything about me." Yet a therapist knowing you beforehand is often not an advantage but a source of preconceptions: she may know you as you were at fifteen, or through the story the family tells.
All of these reasons are human and understandable. But when you look at how therapy works, it becomes clear that most of these conveniences take something away from therapy itself.
What Is a Dual Relationship, and Why Does It Make Therapy Harder?
In psychology's professional ethics, a "dual" or "multiple relationship" means a therapist maintaining another relationship with a client (such as kinship, friendship, a business partnership or being neighbours) alongside the therapeutic one. Professional ethical principles generally call for avoiding dual relationships that risk harming the client or undermining the objectivity of therapy. There are several concrete reasons for this.
There are more things you can't say
Therapy should be a space where a person can say what is on their mind without censoring it. But if your cousin is sitting opposite you, you will think twice before describing the anger you feel towards your mother, the tension you have with your partner's family or something about yourself you are ashamed of. Because this person knows those people too and sits at the same table with them. Without realising it, you filter what you say and never get to the real issue.
Objectivity is compromised
A psychologist you know already has certain ideas about you, and perhaps information that contradicts what you tell her. When you talk about people she might think of as "not really like that", it becomes harder for her to listen to you impartially. Her own position in the family can affect how she interprets what you say.
Confidentiality becomes fragile
A professional therapist is firmly committed to confidentiality, and a psychologist you know will no doubt abide by this principle too. But a sentence that might slip out at a family gathering, such as "How's that thing we talked about going?", creates constant unease in your mind. Confidentiality is not only about whether the therapist says something or not; it is also about the client feeling safe.
Your real relationship can be damaged
Therapy includes difficult moments. The therapist asking a question that challenges you, pointing out a pattern, or you getting angry with them are natural parts of the process. When these moments happen with a therapist you don't know, they stay in the therapy room. But when they happen with your cousin or your best friend, they spill over into the relationship itself. Many people find that after such an experience they can no longer be as relaxed with that relative or friend as before.
The therapist's role becomes blurred too
The problem is not only on the client's side. A psychologist you know responds while listening to you both as a therapist and as a cousin, friend or neighbour. If her own mother's name comes up in a family quarrel you describe, it is genuinely hard for her to stay calm and neutral. Your pain also upsets her personally; this can sometimes lead her to offer more comfort than is helpful, and at other times to avoid approaching difficult subjects. What therapy needs is a stance that is warm yet able to keep a certain distance. In a close relationship, keeping this distance is not easy even for the most experienced professional.
Ending becomes harder
When therapy isn't helping, or you want to try another approach, stopping work with a therapist you don't know is relatively easy. But when you are working with someone you know, worries such as "It would be rude," "She'd be hurt" or "It would be talked about in the family" can keep you in an unproductive process.
What Degree of Closeness Becomes a Problem?
Not every acquaintance creates the same degree of difficulty. To sketch a general framework:
Unsuitable situations: First- and second-degree relatives, close friends, neighbours living in the same house or the same block of flats, colleagues you work with, former partners and their close family members. In these relationships it is very hard to carry out therapy in a healthy way, and professional ethics recommend avoiding them.
Situations that can be assessed case by case: Distant acquaintances, a friend of a friend, people who live in the same town but have no close contact. Especially in small towns, some degree of mutual acquaintance is unavoidable. In this case, the decision depends on how close the relationship is, how wide the shared circle is and how free the client will feel.
In small towns, the line between seeing a therapist you know and finding one you don't is sometimes thin, because the number of professionals in town is limited and everyone may turn out to have a mutual acquaintance. In this case, rather than the perfectionism of "I must find someone with no connection to anyone," it is more realistic to talk openly about the shared connection and, if needed, to consider online options.
The client is not expected to make this decision alone. Ethical responsibility lies first with the therapist: a professional psychologist will usually decline a request for therapy from a close acquaintance politely and refer them to a colleague. When the psychologist you know does this, it is important to understand that she is not rejecting you but protecting you and your relationship.
Often the most valuable help a psychologist can give someone they love is to entrust them to another colleague they trust.
What Can You Do Instead of Seeing a Therapist You Know?
Having a psychologist among your acquaintances is not a resource you should never use. It simply needs to be used in the right way.
- Ask for a referral. The psychologist you know is far better acquainted with colleagues in the field than you are. Asking, "Who would you suggest I see for what I'm going through?" is the healthiest way to benefit from her knowledge. She can refer you to someone trustworthy with experience of your difficulty.
- Get general information, not therapy. Questions such as "What is therapy like?", "What's the difference between a psychologist and a psychiatrist?" or "What kind of approach might suit me?" can comfortably be discussed with a psychologist you know. Getting information about the process without going into the details of your personal problems does not create a therapy relationship.
- Consider a professional in another town or one who works online. If you are very worried about a shared social circle, working online with a professional who has no connection to your circle can increase your sense of privacy.
- Set your criteria for choosing a psychologist. Criteria such as area of expertise, training, approach and communication style are far more decisive than familiarity. The article on how to choose a psychologist can guide you on these criteria.
Let's say your close friend from university is a psychologist and you are going through a divorce. Rather than going to her as a therapist, asking, "Is there someone you trust who could support me through the divorce?" both protects your friendship and lets you benefit from her knowledge. Your friend can also continue to offer you her love and support as a friend, without taking on the role of therapist.
When a Psychologist You Know Offers You Support
Sometimes the offer comes from the acquaintance, and turning it down can be hard. Especially when elders in the family have pushed you towards it, saying "no" can feel rude. Here are a few sentences you could use in situations like this:
- "Thank you so much, this offer means a lot to me. But I want to protect our relationship; could you suggest someone you trust?"
- "I'm not sure I could talk freely with you, because we have so many people in common. I think it would be better for me to see someone else."
- "I'd love to hear your view on this, but I'm thinking of seeing someone else for therapy."
These sentences help you express your boundary without hurting the other person. As a psychologist, the person you know will most likely respond to this decision with understanding, because she knows professional ethics too.
Another common situation is "informal counselling": the psychologist you know keeps offering opinions about your problems at weddings, on the phone or by message. Conversations like these can bring short-term relief, but they are no substitute for regular, structured therapy, because there is no assessment, no shared goals and no continuity. They can also complicate the relationship between you over time.
When Should You Seek Professional Support?
Knowing that working with a psychologist you know is not appropriate should not lead you to put off getting help. Waiting for months with the thought "The only psychologist I know is my relative, and I can't go to her" can allow the problem to grow.
Consider contacting a professional without delay in the following situations:
- If there have been disruptions in basic areas such as sleep, appetite and energy for several weeks,
- If you are struggling to meet your responsibilities at work, school or home,
- If anxiety, sadness or anger has begun to take up a large part of your life,
- If you are experiencing recurring, unresolved problems in your relationships.
If you are having thoughts of harming yourself or ending your life, do not wait to decide who your therapist will be; in an emergency, call 112 (emergency services) or go to the nearest emergency department.
Even a short initial meeting with a professional you don't know can ease your worry about taking the first step. In the first meetings of the individual therapy process, confidentiality principles, mutual acquaintances and your concerns can all be discussed openly.
How Are Mutual Acquaintances Handled in Therapy?
Unexpected mutual acquaintances between therapist and client can emerge in the middle of the process, especially in small towns. A friend the client talks about may turn out to be someone the therapist knows, or the client may realise they work at the same place as one of the therapist's relatives.
In such situations, the professional approach is generally as follows: when the therapist notices it, they talk openly with the client and assess together how close the relationship is and how it might affect therapy. If the shared acquaintance is distant and its effect on therapy limited, the process can continue with a reminder of the confidentiality principles. If a closer relationship is involved and it would prevent the client from expressing themselves freely, a referral to another colleague may be considered. These decisions are made within the framework of ethical rules in therapy and with the client's interests in mind.
It is also important for the client to voice their feelings about this. Saying, "Since I found out you know my friend, I've found it hard to talk about her," is valuable feedback for the health of the process.
Frequently Asked Questions
Can I see the same psychologist my friend sees?
This is often possible, but the therapist needs to assess the situation. Seeing the same therapist as your friend can make it harder for you or your friend to feel free, especially if you may need to talk about each other. Mentioning this connection at the outset when you get in touch allows the therapist to make an appropriate decision.
My psychologist relative referred me to someone else; should I feel hurt?
No. This is a sign of professional responsibility and of the care she has for you. She made this decision because she knows that if she worked with you as a therapist, both the therapy and the relationship between you could be harmed. The professional she recommends is usually someone she trusts and considers suitable for your needs.
Can I become friends with my therapist after therapy ends?
Professional ethics generally take a cautious view of forming friendships or other close relationships with clients even after therapy has ended. One reason is the possibility that you might need therapy again in future; another is that the power imbalance created in therapy does not easily disappear. For this reason most therapists politely decline offers of this kind.
When a psychologist I know refers me, will she share my information with her colleague?
Not without your permission. A referral is usually made with just the professional's name and contact details; you tell your new therapist whatever you want to share. If information does need to be passed on, this is only done with your explicit consent.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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