Barter for Psychotherapy?

From time to time I’ve had folks tell me that bartering within a particular industry is “not allowed.”  Usually the person I’m talking to will vaguely refer to the IRS, the SEC or some other regulatory agency without any specifics.  Not satisfied with this, I’m trying to track down some hard facts and here’s the first area that I’ve nailed down.

Based on my research it appears that bartering for psychotherapy services is NOT in and of itself illegal, however it does raise some serious ethical issues and could quite possibly be against the ethical code for some professional organizations in the industry.  The concern here is that a patient/therapist financial relationship needs to be extremely strait-forward so as not to allow for the possibility of the patient to be taken advantage of due to the therapeutic relationship.

In California (where I am) the primary concern of the Calif. Bd of Behavioral Sciences and the Calif. Assn of Marriage and Family Therapists (CAMFT) is the issue of “dual relationships”.

1.2 DUAL RELATIONSHIPS-DEFINITION: Marriage and family therapists are aware of their influential position with respect to patients, and they avoid exploiting the trust and dependency of such persons.

Marriage and family therapists therefore avoid dual relationships with patients that are reasonably likely to impair professional judgment or lead to exploitation. A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship either simultaneously with the therapeutic relationship, or during a reasonable period of time following the termination of the therapeutic relationship.
Not all dual relationships are unethical, and some dual relationships cannot be avoided. When a concurrent or subsequent dual relationship occurs, marriage and family therapists take appropriate professional precautions to ensure that judgment is not impaired and that no exploitation occurs.
1.2.1 UNETHICAL DUAL RELATIONSHIPS: Other acts that would result in unethical dual relationships include, but are not limited to, borrowing money from a patient, hiring a patient, engaging in a business venture with a patient, or engaging in a close personal relationship with a patient. Such acts with a patient’s spouse, partner or family member may also be considered unethical dual relationships.

The former legal analyst for CAMFT, Richard Leslie,  adds to this in a recent article:

Do not permit the patient to pay for therapy by rendering personal services to you (e.g., fixing your car, landscaping, cleaning your house, editing a book, giving a massage, cutting your hair). Do not permit the patient to barter for therapy with items of subjective value (paintings, sculptures, hackies, collectibles).

Even barter of items with an objective value (cord of wood, bag of horse oats) may present difficulties. While the barter has a fixed value, the trade of it may entail meetings outside of session or meetings at the patient’s or therapist’s residence.

Ultimately it appears that it is up to the individual therapist to determine if they feel that bartering for services constitutes an unethical dual relationship.  I can see both sides of the issue on this one.  From the one point of view, if the specifics of a barter are determined before the therapeutic relationship starts and the terms of the arrangement are as strait-forward as a cash relationship (as they should be if the barter was conducted through an exchange) then I really don’t see a problem here.  That being said, my friend who is a therapist and helped me with this research did not feel that barter has a place in his business.  He feels that patient/therapist relationships must be so squeaky clean that all possible grey areas are to be avoided.

Added 9/27/10
Here’s an article on the topic that appears to be very well thought-out:  http://www.zurinstitute.com/bartertherapy.html