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526 Dual relationships

Ethical review of dual relationships in therapy
by

holly grupe

on 12 December 2012

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Transcript of 526 Dual relationships

photo (cc) Malte Sörensen @ flickr Dual Relationships in Counseling Multiple Relationship in Small Communities Deaf
Latin America
LGBT
Rural Dual Relationships in Counseling Deaf Communities Small and geographically close
By refusing treatment to members of the Deaf community because they may already know each other practitioners are denying "their only culturally accessible means of receiving treatment" (Kessler & Waehler, 2005). Latin America Combining roles is normal and succinct with Latin culture (Kertész, 2002)
"Latin American cultures emphasize stronger family and community bonds than dominant U.S. culture and that multiple relationships between health service providers and clients are seen as the norm rather than exception" (Kessler & Waehler, 2005, p. 67).
Creating strict boundaries may appear rude and disrespectful in the community (Kessler & Waehler, 2005).
If dual relationships are used to meet the needs of a lonely therapist then the bounderies will become too blurry (Kertész, 2002) LGBT Stigmatized individuals seek out people similar to them
Members of the LGBT community offer seek out LGBT therapists to avoid
Homophobia, heterosexism, stereotypes etc.
Like with Deaf Communities, avoiding multiple relationships by refusing to see clients is a great loss to the community
(Graham & Liddle, 2009) Barret et al.’s (2001) eight-step model
for making ethical decisions Identifying my personal response
Review the facts of the case
Consult and make a tentative plan considering
Ethical Guidelines
Identify legal issues
Identify and assess available option
Collaborate with client
Implementing the action and evaluating outcomes In the LGBT community you don't
want to handle MR this way... 1. Setting boundaries too rigid

2. Not setting boundaries at all

3. May avoid contact with LGBT communities sacrificing self
(Kessler & Waehler, 2005). Things to Consider LGBT therapist act as role model
Issues of social justice
Prepare clients for multiple relationships and how to handle them
ALWAYS HAVE A RATIONALE FOR ACTIONS
(Kessler & Waehler, 2005). Rural Communities Multiple relationships are unavoidable
Not all out of session contact is the same
Therapists need to have higher tolerance for blurring the lines
Therapists take on a public role in the community and can have a great impact on the entire community
Rural Communities tend to have lower resources and higher needs, though the stereotypes suggests otherwise
(Campbell & Gordon, 2003) Things to Consider with Rural Communities and MR Worst case scenarios
Seek consultation
Maintain as clear of boundaries as possible
Maintain confidentiality Characteristics of Rural Communities Rural psychologists are comfortable with a rural lifestyle and likely grew up in a rural environment.
Rural psychologists take active steps to integrate into the community.
Rural psychologists are comfortable with a relatively high pro- file in the community.
Rural psychologists have a higher tolerance for a blurring of personal and professional boundaries. (Campbell & Gordon, 2003) (Campbell & Gordon, 2003) Scenario Cathy tells her supervisor, Ralph, that she has been getting increasingly angry with her father lately. She tells Ralph that her father used to be gone a lot on business trips and that she never felt close to him. Now he wants to be involved in her life as if he had always been around.

Having had a similar background, Ralph is empathetic towards Cathy and tells her she has a right to be angry. He encourages her to talk more about her past during their meeting and further tells her that he is available to talk with her about this issue whenever she needs to. ACA Code of Ethics F.3.a. Relationship Boundaries With Supervisees

Counseling supervisors clearly define and maintain ethical professional, personal, and social relationships with their supervisees. Counseling supervisors avoid nonprofessional relationships with current supervisees. If supervisors must assume other professional roles (e.g., clinical and administrative supervisor, instructor) with supervisees, they work to minimize potential conflicts and explain to supervisees the expectations and responsibilities associated with each role. They do not engage in any form of nonprofessional interaction that may compromise the supervisory relationship. Set healthy boundaries from the outset.

Secure the informed consent of clients and discuss with them both the potential risks and benefits of dual relationships.

Remain willing to talk with clients about any unforeseen problems and conflicts that may arise.

Consult with other professionals to resolve any dilemmas.

See supervision when dual relationships become particularly problematic or when the risk for harm is high.

Document any dual relationship in clinical case notes.

Examine your own motivations for being involved in dual relationships.

When necessary, refer clients to another professional (Corey et al, 1998). Recommendations Supervision Gone wrong Possible solutions Best Practices - ACES (2011)
The supervisor explains to the supervisee the appropriate parameters of addressing the supervisee’s personal issues in supervision (identifies the issue, helps the supervisee see the clinical implications, works to minimize the detrimental effects in the supervisee’s clinical work, contributes to a plan for resolution that does not directly involve the supervisor) and acts accordingly. Why are DR’s so problematic? Pervasive

Difficult to recognize

Sometimes unavoidable

Sometimes harmful but may also be beneficial

The subject of conflicting advice Holly Grupe′
Jessica Rycroft
Maggie Johnston
Nadine Haffar Business/Professional
Supervisor and Trainee
Faculty and student
Sexual/Non-sexual
Romantic
Social/Friendship
Familial
Miscellaneous
Small Communities Dual Relationships
Multiple Relationships
Exploitation
Detriment Terminology MFT Code (2011)
1.2.2 SEXUAL CONTACT: Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient’s spouse or partner, or a patient’s immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical. Should a marriage and family therapist engage in sexual intimacy with a former patient or a patient’s spouse or partner, or a patient’s immediate family member, following the two years after termination or last professional contact, the therapist shall consider the potential harm to or exploitation of the former patient or to the patient’s family. 1.2.2 SEXUAL CONTACT: Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient’s spouse or partner, or a patient’s immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical. Should a marriage and family therapist engage in sexual intimacy with a former patient or a patient’s spouse or partner, or a patient’s immediate family member, following the two years after termination or last professional contact, the therapist shall consider the potential harm to or exploitation of the former patient or to the patient’s family. MFT Code (2011) 1.2.3 PRIOR SEXUAL RELATIONSHIP: A marriage and family therapist does not enter into a therapeutic relationship with a person with whom he/she has had a sexual relationship or with a partner or the immediate family member of a person with whom he/she has had a sexual relationship. Lamb and Catanzaro (1998) study
Lamb, Catanzaro, Moorman (2003) study
Dissatisfaction of therapists with themselves and relationships
Preventing sexual boundary crossings Boundary Violations Problematic therapist-client characteristics
Talking about taboo sexual feelings
The client is ALWAYS harmed when the sexual boundary has been ruptured Folman (1991)
Mark O’ Brien
Sex Therapy
Individuals who have suffered traumatic brain injuries Sexual Healing Physical intimacy
Sexual gratification
Physical and emotional stimulation
Ability to give pleasure
Relearning social and interpersonal skills Benefits of Sex Therapy Encounters and Overlapping Relationships Encounters: randomly encounter client outside of therapy
Running into your client at the mall
Overlapping Relationships: sharing a onetime or ongoing relationship that does not have clearly defined roles or involve a clear power differential
Attending the same church Dual Relationships CAMFT Ethical Standard 1.2Marriage 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 relationships. Not all dual relationships are unethical, and some dual relationships cannot be avoided. When a dual relationship cannot be avoided, therapists take appropriate professional precautions to insure that judgment is not impaired and that no exploitation occurs. Nonsexual Dual Relationships When is it okay? - Assess your client
- Comprehensive evaluation of benefits and consequences
-Take thorough notes throughout process
- Discuss implications with client
- Be ready to end it if it becomes necessary Social Media: The Final Frontier Let’s (not) Get It On Definition: Structured Multiple Professional Roles
Professionals enter into dual relationships when they "assume two roles simultaneously or sequentially with a person seeking help. This may mean-two professional roles, such as counselor and teacher, or combining a professional and a personal role," (Herlihy & Corey, p.3, 1992) such as supervisor and friend. Association for Counselor Education and Supervision (ACES) Best Practices in Clinical Supervision


The supervisor operates within the supervisory relationship with emotional intelligence, maturity, flexibility, humility, and transparency.

The supervisor gives deliberate attention to creating a safe environment that fosters mutual trust.

The supervisor clearly defines the boundaries of the supervisory relationship and avoids multiple roles or dual relationships with the supervisee that may negatively influence the supervisee or the supervisory relationship. When this is not possible, the supervisor actively manages the multiplicity of roles to prevent harm to the supervisee and maintain objectivity in working with and evaluating the supervisee.

Adopted by the ACES Executive Council (2011) The Scenario:
Supervisors or faculty members may be tempted to provide therapy services/counseling to their students.

The Problem:
Becoming a counselor to students and supervisees results in loss of objectivity regarding evaluation. Also it is unlikely that the student will freely disclose information that might be used negatively in a professional evaluation (Herlihy & Corey, 1992). What's the problem Uh-Oh moments:
I wouldn’t normally do these things with my other patients
I cannot deny the demands of this patient, he/she needs me
Especially vulnerable time for you
Lengthening sessions, giving rides home, offering your home as a place to stay, arranging for meetings outside the therapy hour, scheduling appointments when no one else is around
Patient is beginning to take care of your needs
Folman proposes more training for therapists Folman (1991) Uh-Oh moments:
I wouldn’t normally do these things with my other patients
I cannot deny the demands of this patient, he/she needs me
Especially vulnerable time for you
Lengthening sessions, giving rides home, offering your home as a place to stay, arranging for meetings outside the therapy hour, scheduling appointments when no one else is around
Patient is beginning to take care of your needs
Folman proposes more training for therapists Folman (1991) Questions?
Comments?
Concerns?
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