Guidelines For Non-Sexual Dual Relationships in Psychotherapy Ofer Zur, Ph.D.   The purpose of this page is to: Give clear and accurate facts, information and guidelines about dual relationships Fight the dogma and fear that has been dominating the issue of dual relationships. Bring critical thinking and rationality to the discussion of dual relationships Increase the effectiveness of therapists

Definition:

Dual relationships in psychotherapy refers 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, family member, employee or business associate of the therapist. This page focuses only on non-sexual dual relationships.

For free online articles on dual relationships, click here.

NON-SEXUAL DUAL RELATIONSHIPS
Eleven Key Points

1. Non-sexual dual relationships are not necessarily unethical or illegal. Only sexual dual relationships with current clients are always unethical and illegal.
2. 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.
3. Almost all ethical guidelines do not mandate a blanket avoidance of dual relationships. All guidelines do prohibit exploitation and harm of clients.
4. Dual relationships may not be avoidable in rural communities, the military and among small communities, such as churches, gays, lesbians, the deaf, people with AIDS, Hispanic, African American and many other minorities.
5. The prohibition of dual relationships may be unconstitutional as it may infringe on people's constitutional rights of freedom of association.
6. Exploitative therapists will exploit with or without dual relationships.
7. Avoiding all dual relationships keeps therapists in unrealistic and inappropriate power positions, increasing the likelihood of exploitation.
8. The prohibition of dual relationships leads to increased isolation, which has several serious ramifications:
   1. Isolation increases the chance of exploitation of clients by therapists.
   2. Isolation in therapy reduces effectiveness because client's difficulties, which were often caused by familial/childhood isolation, often cannot be healed by further therapeutic isolation.
   3. Isolation forces the therapist to rely on the client's report as the main source of knowledge. Therapeutic effectiveness can be diminished by excluding collateral information and by exclusive reliance on a client's subjective stories.
9. Not all therapeutic approaches disparage dual relationships. The most practiced and empirically based approaches, such as Behavioral, Humanistic, Cognitive, Family Systems, Group and Existential therapy at times see dual relationships as an important and integral part of the treatment plan.
10. Most graduate and post-graduate education not only instills fear of licensing agencies and lawsuits, but also delivers inadequate instruction in personal integrity, individual ethics, and how to navigate the complex issues of boundaries, duality, and intimacy in therapy.
11. Celebrating dual relationships may alter the power differential between therapists and clients in a manner, which can facilitate better health and healing.

 
Guidelines
for Non-Sexual Dual Relationship in Psychotherapy

Treatment plans:

1. Develop a clear treatment plan for clinical interventions which are based on client's problems, needs, personality, situation, environment and culture.
2. Intervene with your clients according to their needs, as outlined in each of their treatment plans, and not according to any graduate school professor's or supervisor's dogma or even your own beloved theoretical orientation.
3. Some treatment plans may necessitate dual relationships however, in other situations dual relationships should be ruled out. Make sure you know the difference.
4. If planning on entering a dual relationship you must take into consideration the welfare of the client, effectiveness of treatment, avoidance of harm and exploitation, conflict of interest, and the impairment of clinical judgment. These are the paramount and appropriate concerns.
5. Do not let fear of lawsuits, licensing boards or attorneys determine your treatment plans or clinical interventions. Do not let dogmatic thinking effect your critical thinking. Act with competence and integrity while minimizing risk by following these guidelines.
6. Incorporate dual relationships into your treatment plans only when they are not likely to impair your clinical judgment, or create a conflict of interest.
7. Do not enter into sexual relations with a client because it is likely to impair your judgment and nullify your clinical effectiveness.
8. Remember that treatment planning is an essential and irreplaceable part of your clinical records and your first line of defense.
9. Consult with clinical, ethical or legal experts in complex cases and document the consultations well.

   Prior to and during therapy which includes dual relationships:

10. Study the clinical, ethical, legal and spiritual complexities and potential ramifications of entering into dual relationships.
11. Attend to and be aware of your own needs through personal therapy, consultations with colleagues, supervision or self-analysis. Awareness of your own conscious and unconscious needs and biases helps avoid cluttering the dual relationship.
12. Before entering into complex dual relationships, consult with well-informed and non-dogmatic peers, consultants, and supervisors.
13. When you consult with attorneys, ethics experts and other non-clinical consultants make sure that you use the information to educate and inform yourself rather than as clinical guidelines. Separate knowledge of law and ethics from care, integrity, decency and above all effectiveness. Remember you are paid to help and heal, not to protect yourself.
14. Discuss with your clients the complexity, richness, potential benefits, drawbacks and likely risks that may arise due to dual relationships.
15. Make sure that your office policies include the risks and benefits of dual relationships and that they are fully explained, read and signed by your clients before you implement them.
16. Make sure your clinical records document clearly all consultations, substantiations of your conclusion, potential risks and benefits of intervention, theoretical and empirical support of your conclusion, when available, and the discussion of these issues with your client.

    Clinical integrity and effectiveness:

17. Remember you are setting an example. Model civility, integrity, emotionality, humanity, courage, and, when appropriate, duality.
18. As a role model, telling your own stories can be an important part of therapy. Make sure that the stories are told in order to help the client and not to satisfy your own needs.
19. Remember that you are being paid to provide help. At the heart of all ethical guidelines is the mandate that you act on your clients' behalf and avoid harm. That means you must do what is helpful, including dual relationships when appropriate.
20. Answer clients' basic and legitimate questions about your values and beliefs, including your thoughts on dual relationships.
21. Continue to keep excellent written records throughout treatment. Keep records of all your clinical interventions, including dual relationships, additional consultations and your own and your clients assessment of treatment and its progress.
22. Evaluate and update your approach, attitudes, treatment plans and above all effectiveness regularly.
23. If you find yourself in a dual relationship which either is not benefiting the client or is causing distress and harm, or has unexpectedly brought about conflict of interest, stop or ease out of the dual relationship in a way that preserves the client's welfare in the best possible way.

 
Published articles by Dr. Zur on Dual Relationships available free online:

In celebration of Dual Relationships

Out of Office Experience

Going Too Far in the Right Direction

Upcoming Book on Dual Relationships

 

To order the extensive paper on Dual Relationships, click here.

Additional online articles available, taking a non-dogmatic approach to dual relationships:

Barnett, J.E.: Must some boundaries be crossed? 42 Online

Lazarus, A.A.: Not all 'dual relationships' are taboo; some tend to enhance treatment outcomes

Skidmore, M.: Dual Relationships: An Ericksonian Perspective

Williams, M.: Boundary Violations: The (Inappropriate) Lethal Weapon of Plaintiffs' Attorneys in Psychotherapy Malpractice Lawsuits

If you would like to be placed on our e-mail listfor free lectures, seminars and updates on new products, CLICK HERE
* Please note: this is a private list and your name and e-mail address will remain confidential.

If you are a Psychotherapist and would like to develop or sustain a thriving managed-care-free private practice, click here.