Dual Relationships

Dual Relationships

Dual relationships or multiple relationships in psychotherapy refers to any situation where multiple roles exist between a therapist and a client

What is a Dual Relationship?

(a) A multiple relationship occurs when a psychologist is in a professional role with a person and

• (1) at the same time is in another role with the same person
• (2) at the same time is in a relationship with a person closely associated with or related to the person with whom they have the professional relationship, or
• (3) promises to enter into another relationship in the future with the person or a person associated with or related to the person. APA (2002, p. 1065) Ethical Standard 3.05 (Multiple Relationships)

Non-sexual dual relationships are not necessarily unethical or illegal. Only sexual dual relationships with current clients are always unethical and sometimes illegal.

Almost all ethical guidelines do not mandate a blanket avoidance of dual relationships.

All guidelines do prohibit exploitation and harm of clients

Concurrent vs. Sequential

Let's go deeper...

A concurrent dual relationship takes place at the same time as therapy

A sequential dual relationship takes place after therapy has ended. For example, after therapy ends a therapist decides to embark on social or business relationships.

Levels of Involvement

Different Types

Low-minimal level: When a therapist runs into a client in the local market or in the theater parking lot.

Medium level: When a client and therapist share occasional encounters, as in attending church services every Sunday or occasional PTA meeting.

Intense level: When therapist and client socialize, work, attend functions or serve on committees together on a regular basis.

1) Voluntary-avoidable: Usually these dual relationships take place in large cities or metropolitan areas where there are many therapists, many places to shop, worship or recreate.

2) Unavoidable: These dual relationships are often found in isolated rural areas, small minority groups, disabled groups or spiritual communities or any small community in big metropolitan areas and training institutions. Supervisory relationships inherently involve multiple relationships as part of the triangle of supervisor-supervisee-client.

3) Mandated: These dual relationships take place in the military, prisons and in some police department settings. These mandated priorities often put them in difficult conflict-of-interest situations in which they may need to act in a way that may harm the client but serve the institution.

4) Unexpected: Unexpected multiple relationships occur when a therapist is not initially aware that the client they have been working with is also a friend, colleague, co-worker or even an ex-spouse of another client.

What do I do now?

Act immediately

• don't wait for the client to bring it to your attention. you're the professional

make a note in the client's file about any and all interactions

Seek consultation

• decisions about the relationships should be made in a way that is the least harmful to the client

consult the client

• make sure there is no immediate harm to the client and to develop future treatment recommendations and wishes

work toward restoration of a healthy therapeutic relationship

• develop a way to terminate without harming the patient through abandonment.

Mandated Dual Relationship cont.

Military law mandates that military psychologists give higher priority to national defense, unit integrity, and combat readiness than to concerns with the welfare of the individual psychotherapy client (Johnson, 1995; Lazarus & Zur, 2002; Staal & King, 2000, Zur, 2007).

Forensic psychotherapists who work in prisons and jails must give higher priority to matters of security (i.e., escape risk and violence) than to concerns with the welfare of their individual clients. Police psychology also presents a complex and often unavoidable multiple relationship situation in which the psychologists may be concurrently involved in training, fitness-for-duty evaluations, consultation, hostage negotiation, and other roles (Zelig, 1988).

Boundary Crossing vs. Boundary Violation

boundary violation includes deviations from traditional, "in-the-office," strict counseling

refers to length and place of sessions, touching, activities out of the office, gift exchange and non-therapeutic forms of contact

boundary crossing can be helpful in the therapeutic process and a part of a well thought out treatment plan

lunch with an anorexic patient, home visit to bed ridden patient, attending a special event etc

boundary crossings are not unethical, violations ARE