The Truth About Multiple Relationships

By Ofer Zur, Ph.D.

Most therapists have attended so-called “ethics” workshops where they were repeatedly told that all dual or multiple relationships are unethical and should be avoided at all costs . . . because they are likely to lead to exploitation and . . . sex.

I remember when I moved to the relatively small town of Sonoma over 20+ years ago and how surprised and refreshing it was to realize that clients sought my services because they knew me, my values, my spiritual orientation and some even appreciated my existential struggles.

Many therapists are not aware that:

  • Some types of dual relationships are unavoidable and others are mandated.
  • Rigid risk management advocates do not seem to know the difference between risk management and true ethics of care.
  • Dual relationships are a normal part of health and interconnected communities where people are connected to each other in various and, at times, complex ways.
  • Therapists ought to avoid only dual relationships that could reasonably be expected to impair their objectivity, competence, or effectiveness or otherwise pose risk of exploitation or harm to the patient.
  • In the last decade, I have successfully testified in licensing boards’ hearings and civil malpractice suits that not all dual relationships are unethical, illegal or harmful.

Non-Sexual Dual Relationships And Multiple Relationships In Psychotherapy

Our online course Dual Relationships: The Ethical Way
is available for 6 CE credits. It fulfills the law/ethics requirement in CA and many other states.

Definitions and Key Points:

Multiple Relationships

“Dual relationships” or “multiple relationships” in psychotherapy refer to any situation where multiple roles exist between a therapist and a client. Examples of dual relationships are when the client is also a student, friend, colleague, employee or business associate of the therapist.

  • Non-sexual dual relationships are not necessarily unethical or illegal. Sexual dual relationships with current clients are always unethical.
  • Non-sexual dual relationships do not necessarily lead to exploitation, sex, or harm. The opposite is often true. Dual relationships are more likely to prevent exploitation and sex rather than lead to it.
  • Almost all ethical guidelines do not mandate a blanket avoidance of dual relationships. All guidelines do prohibit exploitation and harm of clients.

Types of Dual Relationships:

  • A social dual relationship is where therapist and client are also friends or have some other type of social relationship. These can be in person or online. Having a client as a Facebook ‘friend’ on a personal, rather than strictly professional basis, can constitute a social dual relationship.
  • A professional dual relationship or multiple relationship is where the psychotherapist or counselor and client are also professional colleagues in colleges, training institutions, presenters at professional conferences, co-authoring a book, or other work-related situations.
  • A special treatment-professional dual relationship may take place if the professional is, in addition to psychotherapy and counseling, also providing additional medical services, such as progressive muscle relaxation, nutrition or dietary consultation, Reiki, etc.
  • A business dual relationship is where therapist and client are also business partners, colleagues or have an employer-employee relationship.
  • Communal dual relationships are where therapist and client live in the same small community, belong to the same church or synagogue or where the therapist shops in a store that is owned by the client or where the client works. These multiple relationships are common in small communities.
  • Institutional dual relationships take place in the military, prisons, some police department settings and mental hospitals where dual relationships are an inherent part of institutional life. Some institutions, such as state hospitals or detention facilities, mandate that clinicians serve simultaneously or sequentially as therapists and evaluators.
  • Forensic dual relationships involve clinicians who serve as treating therapists, evaluators and witnesses in trials or hearings. Serving as a treating psychotherapist or counselor as well as an expert witness, rather than fact witness, is considered a very complicated and often ill-advised dual relationship.
  • A sexual dual relationship is where therapist and client are also involved in a sexual relationship. Sexual dual relationships with current clients are always unethical.
  • An additional and rather rare form of dual relationship includes adoption, when a therapist legally adopts a former child client who was put up for adoption.
  • Multiple relationships also occur when a client refers a friend, family member or colleague to therapy with the same therapist that he/she works with.

Dual Relationships can be…

  • Voluntary-avoidable: Usually these dual relationships take place in large cities or metropolitan areas where there are many therapists, many places to shop, worship or recreate.
  • Unavoidable: These dual relationships are often found in isolated rural areas, small minority groups, disabled groups or spiritual communities or any small community in big metropolitan areas and training institutions. They are also often unavoidable in sports psychology and spiritual counseling.
  • Mandated: These dual relationships take place in the military, prisons and in some police department settings.
  • Unexpected: Unexpected multiple relationships occur when a therapist is not initially aware that the client they have been working with is also a friend, colleague, co-worker or even an ex-spouse of another client. Similarly, unexpected dual relationships take place when, unbeknown to the psychotherapist, the client joins the therapist’s church, book club, or baseball recreation league.

Dual Relationships can be Concurrent or Sequential.

  • A concurrent dual relationship takes place at the same time as therapy.
  • A sequential dual relationship takes place after therapy has ended. For example, after therapy ends a therapist and ex-client decide to embark on a social, business or other relationship as described above.

Level of Involvement

  • Low-minimal level: When a therapist runs into a client in the local market or in the theater parking lot.
  • Medium level: When a client and therapist share occasional encounters, as in attending church services every Sunday or occasional PTA meetings.
  • Intense level: When therapist and client socialize, work, attend functions or serve on committees together on a regular basis.

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