home» dual relationships» guide to nonsexual multiple relationships First, the definition of nonsexual multiple relationships tends to "morph" during The APA ethics code states: "A multiple relationship occurs when a psychologist is in a Seen in this light, none of the examples of therapist behavior cited above. In the mental health field, a dual relationship is a situation where multiple roles exist between a The American Psychological Association (APA) Ethical Principles of For example, the National Association of Social Workers [NASW], which. A dual or multiple role is when a therapist is in a professional role with a client (or or effectiveness in performing his or her functions as a psychologist, . If you think your therapist has a significant relationship that may have an you the impact and meaning of the multiple roles on the therapy and your.
Years of Experience as a Therapist: Interestingly, in the same study this element is not related to the therapist's actual decision to become involved in such relationships. Certain character traits are also likely to influence the therapist's ability to recognize an ethical dilemma regarding a nonsexual multiple relationship, as well as to move through the decision-making process Ebert, As noted above, Street et al.
For example, a therapist with a strong need to please others may be less likely to recognize the potential ethical challenges that arise when a client requests that the therapist share a business venture. Other influential character traits may include the therapist's tolerance of ambiguity, narcissism, need for control, and risk-taking orientation.
The client's gender is another important element in the therapist's decision-making process. For example, a male therapist may assume that a male client would likely benefit from playing on the same team in a community baseball league as the therapist because men "relate" through sports.
The therapist's advance to help the client take off her coat, which in his Viennese culture was regarded as polite and chivalrous, was interpreted by her as intrusive and even exploitative. In the same vein, an invitation by a therapist of one culture to engage in a social multiple relationship, though intended to be gracious, may be perceived by a client of another culture as pushy. Therapist and client expectations of and reactions to a potential nonsexual relationship are likely affected by the fact that they share a religious affiliation, or even a specific congregation or spiritual group, or, conversely, that they come from very different religious or spiritual orientations.
Psychosocial Strengths and Vulnerabilities: Much has been written admonishing the therapist to consider the client's psychological and social strengths and vulnerabilities when confronted with the challenge of a potential nonsexual multiple relationship e.
Most of the guidelines highlight the extreme care that must be exercised when the client is diagnosed with borderline or narcissistic personality disorder.
Certainly the degree to which the client suffers from any psychological disorder including personality disorders, psychotic disorders, delusional disorders, dissociative disorders that impairs the ability to understand or negotiate boundaries in the therapeutic relationship is a crucial element. Social strengths and vulnerabilities, including the depth of the client's social network beyond the therapist, are also important elements for consideration.
History of Prior Boundary Violations: Clients commonly enter therapy with a history of prior boundary violations such a childhood sexual abuse, domestic violence, or inappropriate boundary crossings with another professional including teachers, clergy, and prior therapists.
Such experiences often leave a client with persisting feelings and confusion regarding roles and boundaries in subsequent intimate relationships, requiring careful monitoring and managing by the therapist.
Nature of Therapeutic Relationship: Previous investigators suggest that there are several features of the therapy relationship that are likely to influence the therapist's recognition of and decision about a potential multiple relationship. One such feature is the degree to which the client fully understands the nature of the therapy and engages in informed consent e.
The process of informed consent offers both the therapist and client the opportunity to clarify their respective roles and expectations in the therapy relationship, including the termination of the therapy. The absence of such clarity undoubtedly contributes to confusion regarding the boundaries of the relationship. A second critical feature is the nature of the client's emotional reaction or transference to the therapist. For example, the decision regarding whether to enter into a multiple relationship with a client is no doubt more complicated when the client has an intensely and unrealistically positive or negative emotional reaction to the therapist.
Gottlieb presents one of the earliest decision-making models for therapists deliberating about entering a multiple relationship. He argues that the power differential between the therapist and the client is a central element in the process-the greater the power differential, the higher the risk that entering into another relationship will result in harm to the client. Gottlieb adds that the power differential must be assessed both from the perspective of the therapist and of the client.
Gottlieb's model also highlights the importance of the duration of the therapy relationship. Short-term biofeedback therapy implies a different kind of therapeutic relationship than psychodynamic psychotherapy that has spanned ten years. The existence of another relationship, and another role for the therapist and the client, will likely have very different meanings in each situation. Some research suggests that the settings in which therapists work i.
It is reasonable, however, to expect that therapists in practice settings that emphasize or demand extra-therapeutic involvements e. As noted above, one of the most celebrated changes reflected in the APA ethics code regarding multiple relationships is the recognition that such nonsexual relationships are not always avoidable and are not always unethical.
Research suggests that the locale is a significant element in therapists' perception of the ethicality of nonsexual multiple relationships and their decisions regarding entering into them. Further, small town therapists engaged in financial multiple relationships significantly more frequently than practitioners in other practice locales. Clarity of change in nature and function of relationship: Kitchener argues that the potential for harm to a client in a multiple relationship increases with confusion and misunderstanding about the changes in the roles of both the client and the therapist imposed by the existence of another relationship in addition to the therapy relationship.
Other colleagues emphasize the importance of the client's informed consent regarding the additional relationship e. Professional's motivation for engaging in the other relationship: The key question which has been integrated into subsequent models [e.
Professional's affective response to the potential additional relationship: Existing models and guidelines for decision-making regarding nonsexual multiple relationships reflect a historical emphasis on the role of reason in ethical judgments. More general ethical decision-making literature posits that such judgments are also greatly influenced by the feelings that the situation evokes and that moral dilemmas vary in the extent to which they trigger emotional processing e.
We know practitioners who can recite the rational reasons why they should not engage in a multiple relationship with a high probability of resulting in client harm, but do so anyway.
Later they ask themselves: By definition, multiple relationships involve at least two roles for the therapist and two for the client. For instance, a therapist who enters into a business deal with a client assumes a second role of business partner, as does the client. Kitchener and Ebert argue that the decision to enter a multiple relationship should necessarily depend on the degree to which the roles may become incompatible.
Potential for Benefit for Client: Several colleagues have spoken and written about the potential for benefit for the client involved in a nonsexual multiple relationship e.
Specifically, a decision to engage in a multiple relationship with a client may take into account the potential for an additional relationship to enhance the therapist's knowledge of the client, the client's trust in the therapist, and the enhancement of the therapeutic alliance. Potential for Harm to Client: The APA ethics code outlines four domains of potential harm to the client that, if present, would define the multiple relationship as unethical.
First is the impaired objectivity of the therapist, a likely by-product of role incompatibility for the therapist.
Second, the multiple relationship may impair the competency of the therapist. For instance, the addition of a second relationship may add to the therapist's sense of involvement with and responsibility for the client's life. The therapist may then be tempted to extend clinical interventions into arenas beyond those of the therapist's training or experience. The third domain of potential harm is that the multiple relationship may impair the ability of the therapist to safeguard the client in the primary professional relationship i.
For example, the secondary relationship may threaten the client's confidentiality. It may not be clear to the client or to the therapist which communications that are protected ethically and legally and which are not. The last domain of potential for harm is the exploitation of the client by the therapist. The risk for exploitation is undoubtedly linked to other factors described above-for example, the character of the therapist, the strengths and vulnerabilities of the client, the power differential in the therapy relationship, and the therapist's motivations for entering into the multiple relationship.
Potential for Harm to Third Parties: Burian and Slimp present a model for decision-making regarding social multiple relationships during internship. One of the elements they include in their model is the degree to which the addition of another relationship to the supervisory relationship negatively impacts third parties i. In the same manner, the involvement in a nonsexual multiple relationship between a therapist and a client may cause confusion, dissillusionment, anger, feelings of envy, or other regative reactions in third party observers i.
Setting of the Other Relationship: The degree to which the setting of the other relationship is distinct from that of the therapy relationship likely influences the therapist's perception of the nonsexual multiple relationship and the decision to enter into it.
For example, the decision-making process is different for the therapist who considers employing a client to work in his or her office or home than for one who considers employing a client in a business in another town that therapist co-owns with his cousin.
Locale of the Other Relationship: Just as in the case of the locale of the therapy relationship, the locale of the other relationship may be in one of the small, specialized communities in which the multiple relationship is unavoidable and not necessarily unethical. Conclusion Nonsexual multiple relationships between therapists and clients have received much attention lately in the professional literature and in various law and ethics workshops.
Unfortunately, the attention has not generated clarity and calm, the best conditions for engaging in complex decision-making. The purpose of this article was two-fold.
First, I presented a clarification of the definition of nonsexual multiple relationships because confusion continues to hampet meaningful discussion of the construct. Second, I presented a new model that integrates several elements of existing theoretical models, research findings, and clinical guidelines regarding nonsexual multiple relationships specifically, and moral reasoning more generally.
The model is designed to serve as a practical checklist of elements for therapists to consider as they engage in the complex process of recognizing and then deciding whether or not to enter nonsexual relationships with their clients. Ethical principles of psychologists and code of conduct. Nonsexual dual relationships in professional practice, with special applications to rural and military communities. The Independent Practitioner, 14 5 Integrating emotional and contextual awareness with rational analysis.
Research and Practice, 30 3 Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers. Research and Practice, 20 5 Available online at http: Ethical clinical practice and sport psychology: When two worlds collide.
Social dual-role relationships during internship: A concept whose time never should have come.
Applied and Preventive Psychology, 6, In a different voice: Psychological theory and women's development. Jones that Andrea is physically abusing their child.
Jones because he fears negatively influencing his and her friendship with Andrea. This is an unfair burden for Mike to hold. Clearly, in the above scenario, there are a number of role conflicts that could get complicated very quickly. Jones having to hold confidential information that she hears from Mike that she cannot share with Andrea.
Jones may have very good boundaries around protecting confidential information, it can still be easy to slip up and forget who has shared what when she is hearing stories about the same events and relationship from two different people. Here is a different scenario which provides an example of multiple roles leading to potential exploitation: After a few sessions, Dr.
Bloom attends a dance class and discovers that Anthony attends the same class. They discuss this in the next therapy session and decide that it seems okay to continue both therapy and attending the same dance class. After a month, Anthony stops attending the dance class and starts coming late to sessions. He seems easily angered by the therapist.
Dual Relationships, Multiple Relationships, & Boundary Decisions
Bloom tries to explore this with Anthony, he angrily accuses Dr. Bloom of using the dance class to monitor his progress on social anxiety issues and admits that his anxiety has worsened due to his feelings of being scrutinized by Dr. Bloom to consider attending another dance class. The above examples illustrate how even with the best intentions, multiple roles can create an array of potential problems.
Demystifying Therapy: What are Dual and Multiple Roles? - Dr. Keely Kolmes
This is a time in which it may be better to look for a therapist who is a bit more removed from the relationship. And this may also help you to understand why some therapists make particular decisions to avoid such situations. Of course, not all multiple roles will be apparent to you or your therapist from the beginning. Social Networking and Multiple Roles Social networking is creating new opportunities for therapists and clients to encounter one another out-of-session, and one of the discoveries it may provide for both therapist and client is social overlap.
You may uncover information via the internet that leads you to find you have friends or other contacts in common with your therapist. This can be magnified when you are a member of a minority group and are seeking a therapist who serves such minorities or identifies as one. This can happen in ethnic, religious, disability, or sexual minority circles.
Dual relationship - Wikipedia
Therapy is a place where you need to feel secure and comfortable. If you think your therapist has a significant relationship that may have an effect on your feelings of safety in therapy, then it is reasonable to bring this up with your therapist.
Be aware that if the other person is an actual client of your therapist, your therapist will be unable to disclose or confirm this fact. But a competent therapist should be able to address your feelings around this and talk to you about it. In some situations, it can make sense to get a referral to another therapist, if the role conflict has could interfere with your therapy and your experience of safety as a client.
The ethics code is explicit that sexual role conflicts are always unethical, but there are times when non-sexual multiple roles cannot be avoided or when they may not be harmful. Multiple relationships that cannot be expected to cause impairment, risk exploitation, or cause harm are not considered unethical. Different situations offer unique characteristics that need to be weighed on a case-by-case basis.
For example, when practicing in small or rural communities in which it is difficult to find a therapist nearby, it may be more common to work with a therapist who you encounter in other social or professional settings. Similarly, if you are a member of a ethnic, cultural, or sexual minority group and you are seeking care from a therapist in that community, there may be some overlap of activities and social circles. Some therapists are comfortable accepting invitations to special occasions such as graduations, speeches, or sporting events, feeling that their presence can be incorporated into the therapy.
A skilled therapist will be able to discuss with you the impact and meaning of the multiple roles on the therapy and your feelings about it, and he or she should also be able to discuss how you may interact in other settings when your paths cross.