Dear Ethics Consult,
My grandmother taught me to be a good hostess—whether that means for family, friends, or clients. In my practice, I have a warm and inviting reception area with snacks, tea, coffee, water, and a small play area for kids. Overall, it has the feel of a large and comfortable living room. I’m proud of my office. I like how clients say they feel when they visit for the first time.
The other therapists I know have been asking increasingly uncomfortable questions about this. My friends and old coworkers from the agency where I used to work make faces when I show them my office. One even compared the reception area to a snack bar and said, “I hope you’re charging people for what they eat and drink here.” (I don’t.)
Another suggested I was violating local health code by having coffee and tea dispensers. (I checked with the city, and it’s fine.) No one has told me directly that they think it’s not okay, but their questions and their faces say something different.
Is there some kind of rule against this type of hospitality in a private practice? Am I violating some unwritten custom of therapy? Will my clients be as turned off by all of this as my colleagues are?
—Just Trying to Be A Good Host
Dear Good Host,
I suppose there might be some reasonable limit on welcoming clients. I wouldn’t send a limo to pick up clients for each session, for example, as that feels like it would cross the line into a different kind of relationship.
But in the world of community mental health care, austerity is often a genuine virtue. Caseloads can be so heavy that clinicians working in those settings may feel like it’s an inappropriate indulgence to give any time to social niceties. By staying squarely focused on providing care to as many people as possible at the lowest cost possible, agencies and mental health clinics serve a vital function for their communities. It makes perfect sense that clinicians who work in these settings would adopt those professional values, and that they might hold judgment for practitioners whose offices they see as needlessly luxurious.
Don’t get me wrong. “It makes perfect sense” is not the same as “Their behavior is fine.” It’s rude, and is causing you some needless self-doubt. Your grandmother would surely side with you.
It sounds like your friends from your time in agency work may have been reacting to the difference between the service they offer—which you used to offer with them—and the service you now offer, which may be similar in concept but is markedly different in context. You chose to make a transition in your career that they’ve either not chosen to make or not yet been able to make.
As you would certainly know, agency work is a different animal from private practice. Perhaps your friends expected that you would carry some of the austerity-oriented practices from the agency world into your private practice, and were struck to see how far you’ve moved in the other direction. But that’s their concern to navigate, not yours.
“The differences between your friends’ work environment and your own aren’t deserving of their judgment or self-doubt.”
You’re not breaking any rule, written or otherwise, that I’m aware of. Your hospitality can be a strong selling point for your practice. I hope you have photos of your reception area on your website!
As for your colleagues, I would hope that they could find it within themselves to celebrate your success. I would also hope that you might be forgiving of their reactions. You’re practicing in accordance with your values, and so are they. The differences between your friends’ work environment and your own aren’t deserving of their judgment or self-doubt.
One other suggestion: Spend more time inviting over clinicians who are in the world of private practice with you, and who are likely to support and applaud your hospitality rather than questioning it. You can and should continue to spend time with your friends from the clinic—just maybe not at your office.