Last night in our ethics class we took up the issue of multiple or dual relationships. For those of you who haven’t heard of either term, it refers to the situation where a counselor is not only a person’s counselor but they also have another relationship with the client as well: counselor and pastor, counselor and friend, counselor and business partner, counselor and friend of a child, and the like.
Every professional ethics code (secular or not) raises concerns about dual relationships given their potential for causing harm to the client. The AACC code recognizes that dual relationships are a given in Christian communities and something not to be banned outright. But even this code suggests that forming a dual relationship is a breakdown of professional relationships.
Over the years, I would estimate that 2/3 of the students in my program come thinking that dual relationships are good, even optimal and that those who would outright refuse more influenced by old psychotherapy models. So, part of my class is to talk about the benefits and liabilities of dual relationships. There are success stories and horror stories. But what is the value behind limiting these kinds of counseling relationships? It is to, “Do no harm,” to work for the client’s best interest and not one’s own.
Here’s what I asked my students last night. In an area filled with counselors, why would you think YOU ought to engage in a dual relationship? I want to push them to consider their reasons. Is it people pleasing? Is it to feel valued? Is it arrogance that no one else can help?
I am not against dual relationships and have engaged in some superficial one’s myself. But I do think we ought not engage in them without having forced ourselves to consider that maybe the reasons we do so are not really for our client’s best interests.
What do you think?
Of course, the answer to my title question is this: Even one unexplored dual relationship (exploring reasons why, options not to, possible dangers, informed consent, etc.) is too many.
Much of what we do in counseling or therapy is enculturated. Confidentiality, the 50 minute session, avoiding dual relationships…these things developed out of the culture of psychoanalysis. Now, that is not a criticism. I personally agree that good therapy requires privacy and the assurance of confidentiality. Who would talk about the deepest matters of the heart if they thought it would be broadcast to the world? And it isn’t as if this is a modern invention. Pastors have been practicing this since the early church.
One of those culture founded practices is seeing patients only in the office setting. Supposedly, this would maintain the “frame” of the counseling hour so as to avoid unnecessary outward intrusions. Further, it maintains one picture of the therapist. Having coffee with your therapist at the local diner would completely change that frame–and reduce confidentiality when your neighbor comes up and says, “Oh, I saw you go into the diner with Dr. Monroe. How do you know him?”
But there are some reasons why a counselor might intentionally see a client outside the office. Here are some reasons I have:
- Observation of a child in a school or home setting as part of an assessment
- Visiting a client in the hospital (either as a courtesy call or as part of a treatment continuity plan)
- Joint meeting with other providers (therapists, pastors, care team) at another location
- Part of a treatment plan (e.g., to practice walking over a bridge, get on an elevator, etc.
I have been asked to have coffee by current clients. I have been invited to house-warming parties. I have been asked to attend other celebrations. I’m more inclined to attend celebrations for kids or if the relationship is quite limited (wedding of a pre-marital client seen for 6 sessions only). I have taken clients outside my office for one reason or another (a brief walk, thrown a ball with a kid, etc.).
Whatever you choose to do. Be sure to evaluate the effect it will have on your relationship with the client. What potential pit-falls exist? Talk to them about it. Afterwards, continue to see if such actions introduce any relationship confusion. Be wary of informality. You don’t have to be stiff but informality breeds complacency and soon you are doing things you never dreamed of doing. Also be especially wary if the client has any history of abuse or boundary violations. Take care to protect those boundaries for their sake.
While psychological ethics are built on “Do no harm,” we know that the bible also supports this. Watch out for your weaker brother or sister!
All counseling ethics codes address the potential problem of multiple or dual relationships (when counselors have other relationships with their clients or former clients (e.g., counseling a friend or a child of a friend, having a former client as a business partner, etc.). Some codes make it appear that dual relationships are either always or likely wrong and so should be avoided. The AACC code is a bit more liberal in that it (rightly) defines the problem as increasing the problem of exploiting or harming the client. However, this code explicitly defends the biblical nature of dual relationships since we are all brothers and sisters of the same body. Other codes have recognized that it is not possible to always avoid dual relationships. But all codes remind the counselor that it is their duty to defend the healthiness of any dual relationship. In essence, it will be “guilty until proven innocent.”
There are 3 forms of dual relationships (sexual and client; nonsexual social and client; financial and client). Not every dual relationship is with the client (e.g., a counselor has a relationship with the mother of a teen client, a client is under discipline at your large church where you provide consultation to the elders). Dual relationships may happen AFTER counseling is over (begin a friendship with a former client). Finally, it is not merely harm or exploitation that may be the negative outcome of a dual relationship. A counselor may find that a dual relationship hinders or decreases her effectiveness to provide adequate care. [See Lamb et als article in the 2004 Professional Psychology: Research & Practice (35:3), pp 248-254 for a study on these issues].
This last one is the one I want to hang out with for a bit. I had a former client who I had known and highly respected before we started counseling. At the beginning we explored the potential harm that might come from this dual relationship. Both of us deemed that we could manage the slight dual relationship. And I think we did well and the client found the counseling helpful. However, there was a period in the counseling where the client became severely depressed and suicidal. I found myself less willing to hospitalize because I had an image of this client in my head that was much more stable than was actually true. Now, I never like or want to hospitalize. Most psych hospital stays provide protection but little more in the way of healing. But, I know I would have been much quicker to pull the trigger (bad pun I guess) if I hadn’t previously formed an opinion of health before starting the counseling relationship. We should not forget the possibility of reduced effectiveness in dual relationships.
Let me take this one step further. You may have a client who shares your same faith or doctrinal positions, graduated from the same school (but a different time). Any of these connections MIGHT cause you to be less effective in your work because of bias, groupthink, etc. These are not reasons to NOT counsel them but things to keep in mind. Reduced effectiveness because of dual relationships should not be neglected just because we are too busy talking about the rare counselor who decides to have sex with his clients.