Guidelines for interactions outside the therapeutic relationship
Dual relationships in the counseling setting refer to those situations where the therapist and the client are engaged in interactions of a personal or professional nature in addition to the therapeutic relationship. Areas of concern regarding boundary issues include, but are not limited to, social interactions, business interactions, romantic interactions, mentoring interactions, and collegial interactions (Bowman et al., 1995; Glosoff et al., 1996). These dual relationships present significant challenges for the therapist and the client. Because of the sensitivity and uniqueness of the therapeutic relationship, and in light of the many moral, legal and ethical issues that stem from this collaboration, the additional roles and interactions can sometimes conflict with the boundaries and the delicate balance of dynamics in the counseling relationship.
The Controversy of Dual Relationships
Dual relationships, or more specifically their appropriateness and/or their effects upon clients, are highly controversial. Perhaps no other ethical dilemma is so strongly debated, with supporters at every point along the continuum of opinion. Kitchener (1988) has argued that all dual relationships have the possibility of being ethically challenging regardless of the specific nature of the roles of the participants. Others contend that not only are personal relationships an integral part of the counseling relationship, but they are difficult to preclude (Herlihy & Corey, 1997). Practicing therapists often find multiple roles problematic but difficult to avoid, particularly in small communities or areas with limited mental health treatment choices. Clear guidelines as to what constitutes multiple personal relationships and to what degree they represent problems in the areas of social, business, and personal interactions, have yet to be firmly established among practitioners, educators and ethicists (Bowman et al., 1995).
As the literature indicates, a pervasive lack of consensus regarding appropriate ethical boundaries exists among practitioners in the field (Bowman et al., 1995). Corey (2001) contends that effective counselors possess the ability to avoid inappropriate personal involvement with their clients, supervisees and co-workers. Effective counselors, he continues, recognize their influence on others, are content with their power, do not take advantage of vulnerability in a relationship or use their power to negatively or adversely affect others, acknowledge the power other individuals possess, and support others to utilize their power in healthy, functional ways.
Conversely, staunch opponents of multiple relationship situations insist that a fiduciary relationship is a necessary component of the therapeutic alliance, whereby the best interest of the client is the fundamental priority. When dual relationships exist, they argue, this crucial focus may be compromised (Feldman-summers, 1989; Higgins, M., personal communication, January 20, 2005). Others espouse a more flexible middle ground regarding the issue, arguing that the degree to which a multiple relationship may be problematic depends on the specific dynamics operating within the professional relationship (Borys, 1992; Gabbard & Pope, 1989; Pope & Vasquez, 1991).
Guidelines for Practitioners
Kitchener and Harding (1990) identified three factors that counselors should consider when evaluating the viability of an ethical dual relationship with a client. The first aspect is related to the inherent imbalance of power and authority that exists in the therapist-client dyad, which leaves the client more open to influence, vulnerability and manipulation. They argue that when engaging in an additional relationship beyond the therapy roles, there is a greater risk of harm when the expectations of client and counselor are incompatible. When clients have one set of assumptions about the roles and rules of the relationship, and the professional has a different set of assumptions, there is an increased likelihood of vulnerability. Another principle for consideration involves circumstances where the responsibilities inherent in the dual roles are divergent or conflicting. In such situations, there is potential for conflict of interest, opposing roles and a concomitant loss of objectivity. Therapists, who also have personal, political, social or business relationships with their clients, are at risk for their self-interest compromising their obligation to act in the client's best interest. Finally, by the very nature of the counselor/client relationship, clients are more dependent, have less authority and are vulnerable. Due to this power differential, it is the responsibility of the professional to ensure that the client in the relationship is not harmed. These complex and often ambiguous challenges can lead practitioners to conclude that dual relationships create conflicts of interest, and thus compromise the objectivity needed for sound professional judgment.
In an attempt to provide additional direction in these complex situations, the National Association of Social Workers (1994) has published the following guidelines, suggested to help social workers who may be struggling with questions of dual relationships:
- Define clearly the nature of the dual relationships.
- Examine carefully the risk of exploitation or harm to the most vulnerable person.
- Anticipate possible consequences, positive and negative, of proceeding with a dual relationship.
- Discuss with colleagues and supervisor the advisability of maintaining a dual relationship.
- Ascertain if any other part of the Code might help with deciding to continue a dual relationship.
- Remember that our responsibility as professional social workers is to avoid even the possibility of exploiting or harming the most vulnerable, whether they are clients, supervisees or students.
These directives provide a philosophical basis for considering the various aspects of this ethical dilemma. However, they remain somewhat vague and general in regard to the complicated and multifaceted aspects of most real-life counseling situations.
Intimate Interactions
While the majority of dual relationships are the subject of widespread debate, there is clear consensus among the professional associations (counselors, psychologists, social workers, etc.) that concurrent sexual and professional relationships are highly unethical. Furthermore, most ethical codes draw strong distinctions between sexual and non-sexual dual relationships. Ethical codes vary in their requirements regarding the length of time that must pass for another "significantly different" relationship, especially a sexual one, to be permissible (Herlihy & Corey, 1992, p. 3). Although the codes prohibit the counselor from having a sexual relationship with a current client, variation occurs in the prohibition of such a relationship with former clients and the length of time that must pass for such a relationship to be permissible. Considerations include: amount of time that has passed since termination; nature and duration of therapy; circumstances surrounding termination; client's personal history; client's mental status; and any statements or actions by the therapist suggesting a romantic relationship after terminating the professional relationship (American Counseling Association, 1995; National Association of Alcoholism and Drug Abuse Counselors, 1995). However, many professionals argue that the transference elements of the therapeutic relationship persist forever, and therefore, romantic relationships with former clients are always unethical.
Despite the fact that there is a greater consensus regarding the unethical nature of concurrent sexual relations with clients, erotic interactions comprise a majority of ethical complaints. Herlihy, Healy, Cook & Hudson (1987) found that sexual dual relationships comprised 20% and other dual relationships comprised 7% of complaints made to state counselor licensure boards. Perhaps this occurs because the nature of the therapeutic encounter fosters intense and emotionally intimate interaction, which, without proper processing, can lead to the inappropriate management of these emotions. In this way, it is essential for therapists to manage their own reactions and counter-transference in the therapeutic relationship as well as helping clients to manage theirs. Furthermore, given the potential for such grave emotional and psychological harm to clients, this area should be closely monitored and regulated by ethical standard and client advocacy agencies as well as through peer guidance within the field.
Conclusion
When dual relationships exist, the therapist has a responsibility for guarding against a secondary role interfering with the functions and responsibilities of each party in the primary professional relationship. Developing and sustaining appropriate boundaries remains an essential task for all parties involved in the therapy so that objectivity is not lost, individuals are not manipulated, and the balance of power and equality is maintained.
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