Debunking Myth: Dual Relationships are Unethical

In the mid 1990s, I stepped into the ring to dispute the whole notion of the so-called depravity and danger of dual relationships in psychotherapy and counseling and, through my writing and teaching, emphasized the importance of healthy connections and community. In 2002, I co-authored, with Dr. Arnold A. Lazurus, a break-through book, Dual Relationships and Psychotherapy, on the eponymous subject.

APA DID Publish my Boundaries Book

In 2007, the American Psychological Association published my book on Boundaries in Psychotherapy which invites therapists to be more flexible in regard to issues, such as touchmultiple relationshipsgiftshome visitbartering, and self disclosure. This also signified that psychology, as a result of the relentless work of a few colleagues and myself, now embraces a more flexible and context-based view of therapeutic boundaries.

Risk of Risk Management — Re-Thinking Care

So-called risk management ‘experts’ have in effect hijacked parts of the fields of general medicine, including mental health, by inducing exaggerated fears of lawsuit. Some of risk management’s standard, yet unfounded, instructions in psychotherapy have been: Never touch a client, don’t self-disclose, don’t leave the office with a client, and don’t engage in any form of dual relationship. These overly cautious ‘defensive medicine’ practices, often perpetuated by purported risk management experts and attorneys, can actually hurt clients, as they in effect deny them adequate focus on effective patient care. In my article on the Risk of Risk Management I document how, even though the healing benefits of touch, therapist self-disclosure, or meeting clients where they feel most comfortable or safe have been scientifically documented in the last 50+ years, many poorly trained and frightened psychotherapists regularly avoid doing what is therapeutically right and helpful out of regulatory fear.

One of my clients was a gentle, pleasant older man in his 50’s, suffering from paranoid schizophrenia, with whom I worked in the East Coast. As part of therapy, I was continually in touch with his parents, his three children and sisters, as well as his landlord, employer, psychiatrist, and everyone else involved in his life. He happened to be a Starsky and Hutch TV show ‘junky’ who closely identify with the show and even drove a car that mimicked the signature car of the show. My curly dark hair reminded him of Starsky—in fact, at times, he confused me with the character. So it came to be that his car was the ‘office space’ where we met for most of our weekly therapy sessions. He never liked my office—being there made him nervous, frightened, paranoid and withdrawn—but he felt relaxed, engaged, and receptive while tooling around town with me in his signature car. As we cruised, like in the TV series we checked out the hotspots, all the while talking about the client’s relationships, dreams, fears, and work. He felt safe going into the stores to do basic shopping, knowing that Starsky was ‘backing him up’ from the car. As I described in my Ethical Eye article, several ethicists and attorneys warned me of the dangers of leaving the office or being involved in what they labeled as a dual relationship. After consulting with several ‘true’ experts, I decided to continue my approach to therapy with this client, for the simple reason that it was effective. At all times I reminded myself that I was being paid to help him, not to practice defensive medicine.

Out-of-office Experiences (aka OOE)

As previously discussed, the adoption of rigid risk management practices has taken a serious toll on client care in the medical field in general as well as on mental health services. In the following I want to hone further in on the ill-advised rule ‘never leave the office with a client.’ This rather irrational ‘one size fits all’ dictum bears the consequence that mental health services are denied to the agoraphobic, the paranoid, and the millions of home-bound patients. It equally interferes with treatment for ‘side-by-side’ (rather than face-to-face) oriented clients who could benefit from a walk on a local trail rather than the standard face-to-face mode in the office. Equally, it denies services to disorganized, homeless, or poor clients who are not capable of finding their way to a therapist’s office.

I have incorporated Out-of-Office Experiences (aka OOE) into my therapeutic practice by making perfectly legitimate, clinically sound visits to home-bound or hospitalized patients, as well as conducting sessions with the mentally ill homeless at street corners. I met with one highly distrustful and resistant adolescent client on the basketball court after he refused to show up at the office. My approach—meeting him, a dedicated athlete, on his turf—provided a good context for connection, particularly since this was also my game! With this tactic I succeeded in gaining my client’s trust and, most importantly, engaging him in psychotherapy (albeit somewhat unorthodox!). An older, rather depressed and isolated old lady with three beloved dogs, from whom she would not separate, refused to come to my office due to her dogs, but agreed to a walk-and-talk session on a nearby trail. She was also a ‘side by side’ kind of a woman.

Other legitimate contexts for disregarding risk management’s arbitrary injunctions against interaction outside the office include: engaging in adventure/outdoor therapy; going on a therapeutically initiated tour with an architect client to her newly designed house pursuant to the therapist’s helping her find her ‘voice’ via architecture; attending the funeral of a client at the request of the spouse whom the therapist has seen in couples therapy intermittently for 20 years; or attending a theatrical performance of a young client whom the therapist has successfully helped to overcome shyness and stage fright.

Ahead of game: Taming the Roaring HIPAA

In 2003, a new federal privacy regulation called HIPAA (Health Insurance Portability and Accountability Act) took effect. In an attempt to help psychotherapists make sense of the complex and often confusing regulations, I wrote my third book, The HIPAA Compliance Kit distributed by Norton Publishing. It was significantly revised several times over the years to keep up with the ongoing changes of the Security Rule, new telemental health technologies and practices and much more…

Teaching Therapists to Work Outside Managed Care

In the mid 1990’s I completed the first of many editions of The Complete Fee-for-Service Private Practice Handbook. This handbook encouraged and guided psychotherapists how practice creatively, ethically, and heartily without relying on the mostly financially-profit focused managed care and insurance companies and without being blindly wedded to the pharmacological companies controlled DSM or to risk-management ideologies. Following these principles have been a major focus of my contribution to the field of psychology and mental health services since the mid 1990’s.

Eitan’s Bar Mitzva Ritual on Masada & at the Desert with the Guys

In 2006 we celebrated the Bar-Mitzvah of our oldest son, Eitan, on top of the ancient and inspirational Jewish stronghold of Masada, followed by a ‘for men only’ rite of passage in the Negev Desert in Israel, where I had the dubious pleasure of jogging in 114° F heat.

Desert Was My Sanctuary – Motorcycle Was My Vehicle

Eitan’s bar-mitzvah reminded me how as a young man I often spent time in the desert, enjoying the dry heat and powerful, arid landscape. I rode motorcycles (and camels) and drove jeeps in the Sinai and Negev Deserts, as well as hiking and backpacking. I was once drawn to a sacred place there: Saint Catherine’s Monastery located on Mount Sinai, which, according to some Jewish, Christian, and Islamic traditions, was the place where the Ten Commandments were given.

Summiting Kilimanjaro – Exploring the Boundaries

In 2007, after finishing my fourth book on Boundaries in Therapy, published by the America Psychological Association (APA), watching the movie Motorcycle Diaries threw me into an “existential funk” that sent me searching for meaning and new experiences of beauty, adventure, connection, and heights. The result was my resolve to explore the challenging ‘altitude boundaries’ of air, or lack of, by climbing the awesome heights of Mount Kilimanjaro, the highest stand-alone mountain in the world–also known as the “Roof of Africa” in Tanzania. I undertook this journey with my oldest son, Eitan (14 at the time) and our dear family friend Sarah (24). We departed in June 2007 and took a seven-day journey on the Rongai (northern) Route up this magically impressive mountain. Starting at the northern side, our trail passed through stunning coniferous forest and offered fantastic views along the way. While not ‘technical,’ the climb was steep, long, and challenging. After summiting Kilimanjaro, we proceeded on a Safari at the spectacular Serengeti and the Nogorongoro Crater game reserves, the same route that I drove safaris on as a 26–year-old.

At 18,000 feet, where the oxygen level drops from the normal of 20.9% at sea level to as low as ‘effective oxygen %’ level of 10.5, I could not tell right from left, or front from back. Oddly enough, and rather disorientingly, I also could not tell the difference between up from down. We all succeeded in reaching the summit (at 19,341 feet or 5,892 meters) and took in the spectacular view of the earth’s curve from this truly magnificent height. While there was very little air to breath, the three of us were nevertheless permeated with a deep sense of care, support, camaraderie and love. Needless to say, the experience also re-affirmed the boundless connection between father and son.

Buying into my own Bullshit about “A Glamorous Place to Die”

As Eitan and I were training for the Kilimanjaro climb, many friends and acquaintances confronted me. They wanted to know why at the age of 57, after having suffered a major cardiac arrest, I was so keen on risking my life with this climb of Mt. Kilimanjaro alongside my 14-year-old son. After growing tired of the questioning, and what felt like narrow-mindedness, lack of imagination, and subtle guilt-inducing harassment, I started responding with, “You are absolutely right. I may die on the mountain! However, can you think of a better place to die than on top of the highest, most gorgeous, stand-alone mountain in the world?”

When people continued to challenge me about having my 14-year-old son with me on this venture, supposedly risking my life, I came up with this response, which I told the ‘concerned/questioning ones’: “If I am to ‘glamorously’ die on top of spectacular Kilimanjaro, I will be cremated there, and my ashes will be placed in a Tanzanian ebony box. Eitan will bring me down the mountain and back home in this beautiful small carved memento.” This ebony box story was repeated whenever I was confronted or accused of being irresponsible by friends, colleagues, and guest at dinner tables. While Eitan did not seem to be flabbergasted, distressed or upset by this story, many other people did.

The final twist to this story came at 18,000 feet, where I became disoriented and suddenly unable to breath and experiencing severe heart pains. This was a clear sign of (another) potential heart failure. Instead of asking Eitan who, according to plan had carried my nitro (Nitroglycerin), to stay nearby and be ready to hand it to me, I found myself believing my absurd story and (yes, sincerely) telling myself “There is no better place to die…” Miraculously, I survived, in spite of myself.

Conquering New Boundaries: Backpacking the Glaciers in Alaska:

In 2008 I was invited to give a keynote address at the Social Workers Annual Convention in Anchorage, Alaska. Being there, I heard ‘the call of the wild’ and took the opportunity to go embark on another adventure, this time backpacking on the vast glaciers of Alaska. For a person who thrives at 114° F, the subfreezing temperatures of the glaciers, with their bear footprints, provided an exciting challenge. I decided to hire a guide to take me backpacking on the Matanuska Glacier. As the temperature dropped into the low teens at night, we heard the deep, resounding reverberations of glaciers cracking, like tectonic movements rumbling far inside the earth. The sounds and vibrations evoked in me a deep sense of awe and wonder, as if I were tapping into something larger than life itself. By day, learning glacier survival techniques for climbing the ice was another exhilarating experience. All told, this endeavor opened a new world for me. I am used to and feel very much at home at the desert, in the mountains, or on and under the ocean. But being on a slippery ice surface was an utterly new sensation and way of being, affording me a new relationship to ‘the earth’… calling for great precision, and technical awareness. I was delighted to learn these new skills practice this level of physical attentiveness.

At the Alaska Bear Footsteps & Hearing the Glaciers Roars

While my keynote addresses focusing on introducing psychotherapists in Alaska to the legitimized view of flexible therapeutic boundaries (such as unavoidable multiple relationships, home visits, therapy sessions outside the office, gifts, bartering, etc.) the subfreezing temperatures and bone-piercing windchill factor while camping on the ice gave me a glimpse of the edges of human endurance. I was deeply impressed by the awesome power, immensity and out-of-this-world experience of these glaciers.

Before I had gone on this glacier journey, I had asked my family over dinner whether it was time for me to walk on the ice, as the old Eskimo legend is told, and feed myself to the bears so that my sons could ‘hunt the bear to feed the tribe.’ They nodded with a smile, knowing too well that I would very likely return to regale and ‘feed’ them with stories of yet another amazing adventure!

Introducing Eitan to Scuba Diving in the Red Sea

As my oldest son, Eitan turned 17, it was time for me to revisit the depths of the ocean and the boundaries of air and water – this time with my son. It was a true joy to introduce him to that glorious other world. We both earned our scuba certifications, and I had the thrill of diving once again into the serene, clear blue waters of the Red Sea in Israel. Eitan has seriously taken to scuba diving and continues to dive in San Diego, Catalina Island, Hawaii, and the Caribbean, among other places.

On Digital Natives & Digital Immigrants

In the new millennium, it became increasingly evident that technology, in its many forms, was shaking and reshaping the world. The implications for professionals in psychology and allied professions were emerging and I had become increasingly aware of how the digital-technical divide between the older, pre-computer generation of “Digital Immigrants” and the younger generation of “Digital Natives” would impact us. My digital native daughter, Azzia Walker, and I co-authored an article and a PowerPoint presentation on the subject.

Jungle Trekking in the Remote Tropical Forest in Malaysia

When I was invited to speak on the Digital Divide in Singapore in 2009, as usual, I looked around for possible local adventures in that part of the world and decided to do some jungle trekking in the tropical forests of Malaysia. Endless drenching by the monsoons in a remote jungle area gave me a new sense of what rain can be. Despite my efforts, the leeches were undeterred. The main reason for my trip to Malaysia was to walk the stunning longest suspension bridge in the world in the Titiwangsa Mountains. However walking on this amazing bridge was not possible, at that time, because the bridge was closed due to the monsoons.

I WAS Heard – Was nominated APA Fellow

In 2009, I was nominated as an American Psychological Association (APA) Fellow (Div. 42) in recognition of my contribution to the field. This award marked the arrival of much-needed changes in professional ethics from rigid and fear-based to more humane and care-based. Besides my private psychotherapy practice and teaching on ethics and other topics, I have been consulting with therapists and have been retained as forensic expert (expert witness) where I could combine my knowledge and expertise on ethics and standard of care issues with my sense of fairness and justice.

Moving to Liberal Sebastopol – ‘The Berkeley of the North’

In 2009, the family moved west from the beautiful wine country town of Sonoma to the more rustic and interesting town of Sebastopol, also known as the “Berkeley of the North.” We were intrigued by the political sensibilities and the artistic and spiritual qualities of the town, which were a better fit for us than ‘perfect’ Sonoma. The move also eliminated the Sonoma to Santa Rosa commute for the boys who attended the Summerfield Waldorf School in Santa Rosa, not far away.

Rewarding 4 years of Assistant Coaching Ilan in High School

Life in Sebastopol has been quite wonderful. The culture, community, arts, and the politics have been a good match for us. The boys enjoyed their Waldorf school, although Eitan jumped ship to our local high school in his junior year. Ilan, however, continued at Summerfield, playing and starring on their basketball team for all 4 years. I had the honor to be the assistant coach for the basketball team during that period.

Zur Institute Reaches 180 (!) Online Courses

By 2014, our Zur Institute online continuing education program had expanded to include 180 Online Continuing Education Courses. Every year, thousands of psychotherapists, counselors, MFTs, nurses, and lay people have been benefiting from our innovative and unique offerings.

Studying the Impact of Technology on Culture & People

Modern Internet technologies and social media have drawn me to explore the boundaries involved in “digital ethics,” which include issues of online searchese-mail in therapytelemental health, and clients as Facebook friends.

Riding to Freedom on my new Retro Triumph Bonneville

Turning 60, and now living closer to the Pacific Ocean, I purchased a 2007 classic-looking Triumph Bonneville motorcycle (850 cc) that I could ride along the ocean and also teach my boys (15 and 18) the love of motorcycles as my dad did with me.

Paddling to Freedom in my 18ft Ocean Kayak

With the motorcycle, I also acquired an 18 foot ocean kayak that gives me freedom and much needed humility. I found keeping myself in the kayak in rough water simply impossible.

Teaching in Singapore on the Impact of Technology

Returning to teach in Singapore in 2010 gave me a chance to further explore this unique, tiny country, which focuses on a healthy balance between community and individual needs and rights. They also had just completed a 55 story man-made wonder called Marina Sands SkyPark.

Tracking Genghis Khan Footsteps & Walking the Great Wall of China

Being in this part of Asia, I also could not miss the opportunity to experience that wonder of the world (age 60),  the Great Wall of China. (Reluctantly, I had to give up the idea of retracing the steps of Gengis Khan and his journey from Mongolia towards the Great Wall.) Stretching over 5,000 miles through treacherous terrain, this wall is undeniably the ultimate physical boundary.

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