When “Helping” Hurts: A Cautionary Look at Ethics in Therapy with Married Clients

When “Helping” Hurts: A Cautionary Look at Ethics in Therapy with Married Clients

By Locke Curfman, LPC, Co-Clinical Director

At this year’s APA Convention in Denver, psychologist Dr. Susan Heitler is taking center stage with a provocative claim: individual therapy for a married person—if done without involving the spouse—can be ethically risky and may even harm the marriage. She’s urging the field toward a “new standard of care,” one where therapists routinely invite spouses into the therapy room or intentionally incorporate couples work into treatment, even when the original referral was for individual therapy.

It’s an interesting premise—and one worth examining closely. But in the real world of clinical practice, especially where abuse and power dynamics are at play, I’ve found that this proposed standard can easily miss the mark. And in some cases, it can even put clients in danger.

Let’s unpack this.

Dr. Heitler’s Position: Ethics Through a Marital Lens

Dr. Heitler has written extensively about what she sees as the ethical pitfalls of individual therapy with married clients. In her article “Treating Married Clients—Ethical Considerations and Standard of Care Proposals” (available on ResearchGate), she argues that therapists who meet with only one half of a married couple run the risk of:

●     Developing a one-sided view of the marriage

●     Reinforcing client narratives that may not reflect reality

●     Unwittingly steering clients away from reconciliation

She cites studies suggesting that individual therapy, when isolated from marital dynamics, is correlated with higher divorce rates. On her training platform, she puts it plainly: “Studies have shown that individual therapy for married clients risks harming the marriage—while couple therapy helps the marriage.”

Her solution? In many cases, she recommends that therapists invite the spouse into at least one session—or ideally, develop the competency to shift into couples work entirely. This, she argues, provides a fuller picture and safeguards the therapeutic process from inadvertently undermining the marriage.

To be clear, her position comes from a desire to help and protect relationships. I respect that.

But here’s the rub: what if the marriage itself is the source of the harm?

My Experience: When Involving the Spouse Makes It Worse

In my years as a therapist, I’ve seen a different side of this issue—one that Heitler’s proposal doesn’t seem to account for. Many of the married individuals who walk into therapy aren’t just struggling with “marital dissatisfaction” or communication breakdowns. They’re in relationships marked by emotional manipulation, coercive control, gaslighting, or outright abuse. And for them, individual therapy may be the first safe space they’ve had in years.

To bring the abusive spouse into that space—or even suggest doing so prematurely—can:

●     Trigger retaliatory abuse once the session ends

●     Undermine the fragile trust forming between client and therapist

●     Reinforce the client’s internalized fear that their pain doesn’t matter unless it’s balanced by their spouse’s narrative

I’ve had clients whisper their stories in the smallest of voices. Not because they’re being dramatic—but because they’ve been conditioned to believe that speaking their truth will cost them everything. In those moments, the most ethical thing I can do isn’t to strive for marital neutrality. It’s to protect the vulnerable.

What the Research Says About Abuse, Therapy, and Safety

It’s not just anecdotal. Research consistently shows that:

●     The most dangerous time for someone in an abusive relationship is when they try to leave (Campbell, 2005)

●     Couple’s therapy is contraindicated when coercive control or violence is present, especially if the abuser can manipulate the narrative (Stith et al., 2011)

●     Trauma-informed care demands a posture of curiosity, not assumptions—especially when assessing who is safe to involve and when

Even the APA Ethics Code reminds us in Principle A to “avoid harm” and in Principle E to respect “people’s rights and dignity.” When applied thoughtfully, these aren’t abstract ideas—they’re safeguards that remind us: therapy is about the client’s well-being, not the preservation of a system that may be hurting them.

So What’s the Real Ethical Standard?

Dr. Heitler’s concerns aren’t without merit. There absolutely are risks when therapists fail to acknowledge the relational context of their clients’ struggles. We should be thoughtful about how individual therapy may influence broader family systems.

But ethics aren’t about broad-brush rules. They’re about discernment. About sitting in the tension. About listening more than assuming. Instead of adopting a one-size-fits-all “spousal inclusion” standard, I believe the wiser path is this:

Treat each client’s story as sacred.

Evaluate risk and power dynamics.

Prioritize safety and agency.

Final Thoughts

It has been said that we should “weep with those who weep.” That doesn’t mean calling in the spouse for a balanced perspective. It means showing up with compassion, humility, and wisdom. It means recognizing that sometimes, the most ethical thing we can do is protect the client’s space to speak freely and heal deeply.

There may indeed be marriages saved by couples therapy. But there are also lives preserved by individual therapy that honors the client’s story, protects their autonomy, and allows healing to begin without coercion.

And that, in my experience, is the kind of standard of care that stands the test of real life.