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Dual Relationships for Therapists: Knowing What’s Right

dual relationshipYou all know you should avoid getting into dual relationships with clients whenever you’re able, but what about those situations you can’t control?

Especially for therapists who live and practice in the same community, these issues come up all the time: your child is a classmate of a client’s child; you belong to the same tennis or athletic club as a client; or you find yourself in the same adult education class as a client.

PsychCentral’s “Ask the Therapist” experts Marie Hartwell-Walker, Ed.D. and Daniel J. Tomasulo, Ph.D., TEP, MFA, recently sat down together to talk about how they manage dual roles with their clients.

You can see this video, and lots more great content, on Psych Central’s YouTube channel.

Dual relationships, or dual roles, between therapists and clients can be a murky area to navigate. Dr. Tomasulo recounts a situation in which a client from a therapy group he ran became a student in a graduate school class on group therapy that he was teaching. He couldn’t ask her to leave the therapy group, which would basically equate to abandonment, and he couldn’t ask her to leave the class, as it was the only group therapy course available.

So, what to do?

Dr. Tomasulo called both his state and his national professional psychological organizations for guidance, a move both he and Dr. Hartwell-Walker recommend others in similar situations do. “It doesn’t happen often,” says Dr. Hartwell-Walker, “but when it does, it’s a really good idea to get some advice.”

With the direction of his professional groups, Dr. Tomasulo made sure his client was fully informed—and it was documented that she understood—that he held no unusual power over her in either his role as her therapist or his role as her professor.

“The truth is, it was a very muddy situation,” says Dr. Tomasulo. “And I was glad to have professional organizations help me think it through.”

“It turned out really well,” he adds. “She was a great student.”

Unsure of how you should handle similar situations? Here are some guidelines from the major professional organizations.

APA Code of Ethics Regarding Dual Relationships

According to the APA code of ethics, Dr. Tomasulo’s situation with his client-student definitely fell under the definition of “Multiple Relationships,” being one in which “…a psychologist is in a professional role with a person and…at the same time is in another role with the same person” (American Psychological Association, Ethical Principles of Psychologists and Code of Conduct 2011).

The APA says that in such an unavoidable case, “at the outset [the psychologists should] clarify role expectations and the extent of confidentiality and thereafter as changes occur.” Dr. Tomosulo did this with the documented discussion of role expectations between him and his client. He also fulfilled the standard of “preventing harm” through this action, because he took “…reasonable steps to avoid harming [his] clients/patients, students, supervisees, research participants, organizational clients and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.”

 National Association of Social Workers Code of Ethics 

While Dr Tomasulo is not a social worker, many readers of Psych Central Pro are. Here’s what that group has to say about dual relationships (National Association of Social Workers Code Of Ethics. Section 1.06 Conflicts of Interest): “Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client.”

What if you can’t avoid this type of situation? Read on: “In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries.”

 American Counseling Association

According to section A6 of the ACA Code of Ethics, Managing and Maintaining Boundaries and Professional Relationships, “Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters.” The ACA uses attending a client’s wedding as an example, but perhaps Dr. Tomasulo’s student-teacher relationship may fall into this gray area as well.

When you come across one of these situations, like other professional organizations, the ACA recommends you discuss and document the change: “If counselors extend boundaries as described…they must officially document, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. When unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, the counselor must show evidence of an attempt to remedy such harm” (American Counseling Assocation, Code of Ethics 2014).

None of these summaries are intended to be a replacement for professional advice. If you find yourself in a sticky dual relationship situation like Dr. Tomasulo, it’s best to do what he did: call your professional organization for advice on staying within their specific ethical guidelines.

Image courtesy of renjith krishnan at FreeDigitalPhotos.net

Dual Relationships for Therapists: Knowing What’s Right