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Client-Therapist Dual Relationships
by Amber Maccione
The definition of a dual or multiple relationship is a relationship in which a person plays two different roles with the same individual, with one of the roles being professional. For example, APA states that it is “one in which a practitioner is in a professional role with a person in addition to another role with that same individual, or with another person who is close to that individual” (Corey, Corey, & Callanon, 2011). As a professional, there are three aspects of the job that require attention before deciding to jump into a dual relationship: ethical, legal, and personal. To demonstrate these three things, there will be two dilemmas viewed: one with a client who is no longer seeing her psychologist and wants to hang out socially with her ex-psychologist and the second one with a present client who would like to enter into a sexual relationship with his psychologist.
Dilemma 1: Termination & Friendship
Veronica is the ex-client of Dr. Molly Stanton. A few days after both decided to part ways on therapy because Veronica had met all her goals within, Veronica decided to stop by Dr. Stanton’s office. She wanted to see if Molly could come to her daughter’s graduation and then out to dinner with the whole family to celebrate. In the conversation, Veronica also made direct reference to the two of them hanging out after this as well: get dinner, go to local community events, and even get their younger children together for family outings. Dr. Stanton was a little thrown aback with this as this was the first time a client whom she had seemed to make a connection with had ask for a friendship after their professional relationship had ended. How was she to respond to such an invitation?
Ethics are the things that are made from what we value and believe, which make up our morals. In the field of psychology, there are certain ethics that psychologists are asked to live by and eventually perfect. These are called the Code of Ethics, which the American Psychological Association has complied for each professional in this field. Within this code of ethics, there is direct reference on how to handle sexual relationships, but this could also be used to refer to any type of relationship with a client whom no longer is our client, like in the dilemma above:
10.08 SEXUAL INTIMACIES WITH FORMER THERAPY CLIENTS/PATIENTS
(a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy.
(b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client's/ patient's personal history; (5) the client's/patient's current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the client/patient. (See also Standard 3.05, Multiple Relationships.) (Behnke, 2004).
Basically in the excerpt above, the relationship would have to be after the termination of services and at least two years after. Also, if it comes to the knowledge of others that there is a relationship, the burden of proving innocence is placed on psychologist, not the client. The psychologist would have to prove that the relationship is free from exploitation and manipulation ((Dobrenski, 2008). Mostly this obtains to a sexual relationship, but can also be applied to a social relationship since there is still the power differential: there is a distinct power advantage that the psychologist has over the client (Hankins, Vera, Barnard, & Herkov, 1994). When a psychologist and client enter into their professional relationship, there is a sacred trust that is built, like a priest to those that come to confess their sins (Hankins, Vera, Barnard, & Herkov, 1994). The professional relationship is one-sided with the client revealing much and the psychologist next to nothing (Dobrenski, 2008). Therefore, ethically, having a relationship, even if social, with an ex-client may not be such a good idea.
Along the same lines of the psychologist’s role being compared to a priest, the psychologist is expected to abide by confidentiality laws. The client probably has told the psychologist more than she would possibly tell a friend, especially a person that the buds of friendship are just being planted (Dobrenski, 2008). The psychologist who enters into a social relationship with a client after termination knows much more about the person than the person knows about her. This sets up a foundation that shows one person at a higher advantage than the other person (Dobrenski, 2008). From a legal aspect, this could cause problems especially if the psychologist intentionally or even accidentally mentions something in a group setting about the individual that was meant to stay quiet and locked up within the walls of therapy. The client could claim the psychologist broke their confidentiality agreement and this could cause problems for the psychologist, not to mention harm to the client.
In response to dilemma one, ethically and legally, it would wise for a psychologist to decline a social relationship with a former client. One reason is that the relationship could be viewed as one-sided with the psychologist manipulating and exploiting the client for their own benefit because of an understanding that the psychologist has the upper advantage. Secondly, the psychologist could cause harm to the client because of the amount of information that she knows about the client, putting her again at an advantage that could even destroy her own career. It is probably best, to decline such a relationship since there was already a defined relationship before this one.
Dilemma 2: Therapy, Sex, & Problems
Victor had been going to therapy with Dr. Vanessa Baxtor for about two months now. After three sessions with Dr. Baxtor, Victor felt a strong connection and attraction to her. He wanted more than what therapy was offering. He approached Vanessa after their fourth session to ask her if she would like to have dinner with him that evening. He confessed that he really enjoyed his time with her and would like to see if they could see how things went between them outside of the sessions. Although Vanessa thought Victor was attractive, she wasn’t sure pursuing a relationship with him while he was in therapy would be a good idea. How was she to respond to his obvious romantic interest in her without damaging the progress they had made in his therapy sessions?
With this second dilemma, the ethical code applied to the previous dilemma applies. The client is wanting a romantic relationship with his psychologist, which would be considered a dual relationship and unethical. Secondly, the Hippocratic Oath, “In every house where I come, I will enter only for the good of my patients; keeping myself far from all intentional ill-doing and all seduction, and specially from the pleasures of love with women and men” (Hankins, Vera, Barnard, & Herkov, 1994). Since the job of the therapist is to help the client heal and solve their problems, having a sexual relationship with that client would cause complications that could be detrimental to the client’s progress (Behnke, 2004) and also seen as the psychologist using the client for her own personal gratification (Hankins, Vera, Barnard, & Herkov, 1994). Therefore, boundaries are to be in place to avoid such things (Hankins, Vera, Barnard, & Herkov, 1994). Personal is one of those things that stays out of a psychologist and client’s professional relationship.
When looking at this dilemma under legal eyes, the psychologist could lose their job and their license could become suspended or terminated (Dobrenski, 2008). The rule, which most people do not even know how it came about to be this, says that there must be a two year window before a psychologist can have a romantic relationship with an former client (Dobrenski, 2008). When a sexual relationship transpires, whether during the professional relationship or after termination, it gives people the wrong impression – that there could be or has been an abuse of power by the psychologist (Kaplan, 2006). When clients come to therapy, they are emotionally and psychologically impressionable (Kaplan, 2006). To engage in a sexual relationship with one, even if it is consensual, could be seen as the psychologist taking advantage of the client and, therefore, be legally labeled malpractice (Kaplan, 2006). Hence, it is prohibited to have a sexual relationship with a present client and frowned upon to have one with a past client (Kaplan, 2006).
In response to dilemma two, ethically and legally, it would be wise for a psychologist to decline a sexual relationship with her client. Even further, it would probably be wise to terminate the professionally relationship and refer the client to someone else to avoid the temptation and to also ensure that the client can be open instead of reluctant to share in reaction to being rejected romantically by the psychologist. Also, looking at protecting yourself from legal implications and the possibility of losing her license, it would be wise to not act upon attraction and to refer the client elsewhere.
Dual Relationships: Should the rule always be - Once a client, always a client?
“Once a client, always a client” (Mattison, Jayaratne, & Croxton). This is something that psychologists should live by to avoid problems. There are things such as privacy, confidentiality, and transference to think about. There is a professional responsibility to abide by ethics to protect these things. By entering into a social or romantic relationship while in the professional relationship or even after that professional relationship has been terminated would cause these things to be in the open instead of safely protected within the walls of therapy. Time really has no relevance (Mattison, Jayartne, & Croxton). Even with the passing of two years, the information the psychologist knows hasn’t changed, nor has her duty to protect that information. Also, a client could return to therapy. If a psychologist has entered into a dual relationship with the client, it would make it difficult for the client to return to the source of help he used to receive (Mattison, Jayaratne, & Croxton). Therefore, whether social or romantic, it is advised that psychologist should maintain boundaries as the former clinician with the former client (Ryczek, 2002).
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