Dual relationship - Wikipedia
Dual relationships between therapist and client come in many forms and may Dual relationships, multiple relationships & boundaries in. This article by Michael C. Gottlieb presents a decision-making model to help therapists and counselors consider potential dual or multiple relationships and to . home» dual relationships» guide to nonsexual multiple relationships ( American Psychologist); Dual Relationships Between Therapist and Client: A National.
Although avoidance of all conflicts of interest and potential exploitation of others in not possible, some are of such high risk to protecting the interests of members of the public and to maintaining the trust of the public, that they are considered never acceptable The risk level of other conflicts of interest e.
- Dual relationship
It is the responsibility of psychologists to avoid dual or multiple relationships and other conflicts of interest when appropriate and possible. Conflict-of-interest situations are those that can lead to distorted judgment and can motivate psychologists to act in ways that meet their own personal, social, political, financial, or business interests at the expense of the best interests of members of the public.
Although avoidance of all conflicts of interest is not possible, some are of such a high risk to protecting the best interests of 24 members of the public and to maintaining the trust of the public, that they are considered never acceptable see Standard III.
The risk level and acceptability of other conflicts of interest e. In some situations, for instance, a dual or multiple relationship might be inevitable or culturally expected e. However, in all such situations, the psychologist is responsible for making an honest appraisal of the benefits and risks involved in the context of the specific situation, including determining the feasibility of alternatives in light of those risks and benefits, deciding whether to enter into or continue the relationship, establishing relationship boundaries appropriate to the work being done e.
If containment of the therapeutic situation becomes insufficient, the therapist terminates the therapy. Further procedure as above. Generally the therapist does not enter into private or other types of professional relationships, e.
Be acutely aware of the problematic nature of dual relationships for example, with trainees, business associates, employees or clientsand recognize that it is not always possible to avoid them e.
Where it is possible, practitioners shall avoid such relationships; where it is not, they shall take appropriate steps to safeguard the interests of those involved. Code of Ethics Excerpt: Code of Professional Ethics Excerpt: Where it is possible, psychologists shall avoid such relationships; where it is not, they take active steps to safeguard the students', employees' or clients' interests.
In fact, the placement, management, flexibility, and negotiation of therapeutic boundaries constitute a cultural enterprise.The Dont's of Dual Relationships
The cultural context provides the structure from which to consider the therapeutic relationship and its boundaries. In Session,vol. They can also undermine the therapy, severe the therapist-patient alliance, and cause immediate or long-term harm to the client. Choices about whether to cross a boundary confront us daily, are often subtle and complex, and can sometimes influence whether therapy progresses, stalls, or ends. We put ourselves in the best position to make sound decisions when we develop an approach to boundary crossings that is grounded in our general approach to ethics; stay abreast of the evolving legislation and case law, ethical standards, research, theory, and practice guidelines; take into account the relevant contexts for each client; engage in critical thinking that avoids the common cognitive errors to step away from our clinical responsibilities, avoid personal responsibility for our decisions, and rationalize our choices and behavior; and, when we make a mistake or suspect that our boundary decisions have led to trouble, use all available resources to figure out the best course of action to respond to the problem.
The results are interpreted taking into account cultural aspects which means a gift, as well as local constructions of what constitutes ethical behavior.
Interpersonal and Biological Processes, While such excesses are often proffered as indicia of patient protection, the perversion of boundary theory may place professionals at risk for undeserved sanctions and may potentially harm patients themselves by frightening the professionals into rigidity in therapeutic interactions.
This extreme position is captured by a cartoon that shows a male patient putting forth his hand for a handshake with his female therapist: Boards themselves vary to a striking degree in their rigor, flexibility, and, regrettably, punitive attitudes toward the clinicians they license.
The conduct of psychotherapy is an impossible task because there are no perfect therapists and no perfect therapies. Knowing one's boundaries, however, makes the impossible task easier. I have also had occasions when a client invites me to a special event in which we might have more of a social interaction. These situations all fall under the heading of dual and multiple relationships. I am going to explain both concepts and discuss why they are generally avoided and what some of the exceptions may be.
What is a Multiple Role? It can also be if a therapist is in a professional role with a person and promises to enter into another relationship in the future with that person or someone closely related to the individual. Dual roles refer to two different roles and multiple roles are when more than two overlapping roles exist. Some Examples of Multiple Roles Dr.
Jones has a close friend, Andrea, who talks a lot about issues with her husband, Mike, and their intimacy problems. Over time, the Andrea convinces Mike to seek therapy.
Jones for referrals and the Dr. Jones says that finding a therapist can be difficult so she would be happy to save Andrea and Mike the trouble and she will be happy to treat Mike herself. Smith is seeing a patient, Jim, for whom she feels a strong sexual attraction. Several months into treatment, she tells Jim that she is looking forward to the end of therapy because then they can become friends and possibly even lovers.
Nelson is seeing a patient who is an art dealer. During the course of treatment, the client talks about a piece she wants to sell by Dr. The next sessions focus more on the particular painting and during the therapy, Dr. Why Are Multiple Roles Avoided? The short version is this: Regarding sexual intimacies with former patients, Standard It should be noted that the mere suggestion of a possible future sexual relationship during the course of treatment is in and of itself an ethical violation and would invalidate the legitimacy of such a union.
Bartering is a particular kind of multiple role which can come up with clients. The Ethics Code states in Standard 6. If one party decides down the line that they have a different opinion about the exchange value of the services provided, this arrangement could quickly go south. It is reasonable, however, to expect that therapists in practice settings that emphasize or demand extra-therapeutic involvements e. As noted above, one of the most celebrated changes reflected in the APA ethics code regarding multiple relationships is the recognition that such nonsexual relationships are not always avoidable and are not always unethical.
Research suggests that the locale is a significant element in therapists' perception of the ethicality of nonsexual multiple relationships and their decisions regarding entering into them.
Further, small town therapists engaged in financial multiple relationships significantly more frequently than practitioners in other practice locales. Clarity of change in nature and function of relationship: Kitchener argues that the potential for harm to a client in a multiple relationship increases with confusion and misunderstanding about the changes in the roles of both the client and the therapist imposed by the existence of another relationship in addition to the therapy relationship.
Other colleagues emphasize the importance of the client's informed consent regarding the additional relationship e. Professional's motivation for engaging in the other relationship: The key question which has been integrated into subsequent models [e. Professional's affective response to the potential additional relationship: Existing models and guidelines for decision-making regarding nonsexual multiple relationships reflect a historical emphasis on the role of reason in ethical judgments.
More general ethical decision-making literature posits that such judgments are also greatly influenced by the feelings that the situation evokes and that moral dilemmas vary in the extent to which they trigger emotional processing e. We know practitioners who can recite the rational reasons why they should not engage in a multiple relationship with a high probability of resulting in client harm, but do so anyway.
Later they ask themselves: By definition, multiple relationships involve at least two roles for the therapist and two for the client.
Dual Relationships, Multiple Relationships, & Boundaries
For instance, a therapist who enters into a business deal with a client assumes a second role of business partner, as does the client. Kitchener and Ebert argue that the decision to enter a multiple relationship should necessarily depend on the degree to which the roles may become incompatible.
Potential for Benefit for Client: Several colleagues have spoken and written about the potential for benefit for the client involved in a nonsexual multiple relationship e. Specifically, a decision to engage in a multiple relationship with a client may take into account the potential for an additional relationship to enhance the therapist's knowledge of the client, the client's trust in the therapist, and the enhancement of the therapeutic alliance.
Potential for Harm to Client: The APA ethics code outlines four domains of potential harm to the client that, if present, would define the multiple relationship as unethical. First is the impaired objectivity of the therapist, a likely by-product of role incompatibility for the therapist.
Demystifying Therapy: What are Dual and Multiple Roles?
Second, the multiple relationship may impair the competency of the therapist. For instance, the addition of a second relationship may add to the therapist's sense of involvement with and responsibility for the client's life. The therapist may then be tempted to extend clinical interventions into arenas beyond those of the therapist's training or experience. The third domain of potential harm is that the multiple relationship may impair the ability of the therapist to safeguard the client in the primary professional relationship i.
For example, the secondary relationship may threaten the client's confidentiality. It may not be clear to the client or to the therapist which communications that are protected ethically and legally and which are not.
The last domain of potential for harm is the exploitation of the client by the therapist. The risk for exploitation is undoubtedly linked to other factors described above-for example, the character of the therapist, the strengths and vulnerabilities of the client, the power differential in the therapy relationship, and the therapist's motivations for entering into the multiple relationship.
Potential for Harm to Third Parties: Burian and Slimp present a model for decision-making regarding social multiple relationships during internship. One of the elements they include in their model is the degree to which the addition of another relationship to the supervisory relationship negatively impacts third parties i.
In the same manner, the involvement in a nonsexual multiple relationship between a therapist and a client may cause confusion, dissillusionment, anger, feelings of envy, or other regative reactions in third party observers i. Setting of the Other Relationship: The degree to which the setting of the other relationship is distinct from that of the therapy relationship likely influences the therapist's perception of the nonsexual multiple relationship and the decision to enter into it.
For example, the decision-making process is different for the therapist who considers employing a client to work in his or her office or home than for one who considers employing a client in a business in another town that therapist co-owns with his cousin. Locale of the Other Relationship: Just as in the case of the locale of the therapy relationship, the locale of the other relationship may be in one of the small, specialized communities in which the multiple relationship is unavoidable and not necessarily unethical.
Dual Relationships, Multiple Relationships, & Boundary Decisions
Conclusion Nonsexual multiple relationships between therapists and clients have received much attention lately in the professional literature and in various law and ethics workshops.
Unfortunately, the attention has not generated clarity and calm, the best conditions for engaging in complex decision-making. The purpose of this article was two-fold. First, I presented a clarification of the definition of nonsexual multiple relationships because confusion continues to hampet meaningful discussion of the construct.
Second, I presented a new model that integrates several elements of existing theoretical models, research findings, and clinical guidelines regarding nonsexual multiple relationships specifically, and moral reasoning more generally. The model is designed to serve as a practical checklist of elements for therapists to consider as they engage in the complex process of recognizing and then deciding whether or not to enter nonsexual relationships with their clients.
Ethical principles of psychologists and code of conduct. Nonsexual dual relationships in professional practice, with special applications to rural and military communities.
The Independent Practitioner, 14 5 Integrating emotional and contextual awareness with rational analysis. Research and Practice, 30 3 Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers.
Demystifying Therapy: What are Dual and Multiple Roles? - Dr. Keely Kolmes
Research and Practice, 20 5 Available online at http: Ethical clinical practice and sport psychology: When two worlds collide. Social dual-role relationships during internship: A concept whose time never should have come.
Applied and Preventive Psychology, 6, In a different voice: Psychological theory and women's development. Avoiding exploitive dual relationships: