By Ofer Zur, Ph.D.
Reference: Zur, O.. Going too far in the right direction: Reflection on the mythic ban of dual relationships.
California Therapist, 23/4: 14,16. Reprinted by permission.
Out of the sincere effort to protect the public from exploitive therapists a myth has developed about the evils of dual relationships. This essay invites the reader to critically examine one of the most sacred cows of the psychotherapeutic community, the prohibition of dual relationships.
Dual relationship refers to any circumstance whereby a therapist assumes a role additional to that of a clinician. Besides having sex with a client, other examples of dual relationships are: seeing a student also in therapy, employing or having any other business relationship with a client, belonging to the same church as a client, or having lunch with a client.
The prohibition against dual relationships, originates from two sources: a. Psychotherapists and regulatory agencies valid and appropriate concerns with the power differential between therapists and clients and the corresponding attempt to protect clients from exploitation and harm. b. The traditional psychoanalytic emphasis on neutrality and transference work.
Teachers of Ethics, memo’s from our insurance companies, supervisors and graduate school professors and endless attorneys’ advice columns have all warned us specifically against having sexual relationships with clients and the dangers of dual relationships in general. Professional organizations, consumer protection agencies, and legislators, use the therapist-client prohibition of sexual relationship and the concern with exploitation as the basis for all their protective policies and guidelines. The original intention of the regulatory agencies to protect the welfare of clients by establishing a ban on sexual relationships between therapists and clients has emerged as a massively broad prohibition of all dual relationships. As a result, the absolute avoidance of all dual relationships is raised as a magical amulet against any and all possible harm to patients involved in therapeutic treatment. In fact, “dual relationship” has been used interchangeably with “exploitation,” harm” or “sex with client” in most of our professional literature. Kenneth Pope, a leading expert in ethical matters, makes a claim that not only exemplifies the above belief, but has become a strict standard of therapeutic ethics and law: ” . . . non-sexual dual relationships, while not unethical and harmful per se, foster sexual dual relationships” (1990, p. 688). This is a fair reflection of the general consensus, which does not much differentiation between sexual and non-sexual dual relationships and believes that non-sexual dual relationships inevitably lead to sexual dual relationships and ensuing harm.
What is most interesting about the prohibition is that, unlike the former guidelines, the most recent 1992 APA Ethical Guidelines does not even mention the term dual relationship, let alone prohibit non-sexual dual relationships. Section 1.17 does warn us against “entering into or promising another personal, scientific, professional, financial, or other relationship if it appears likely that such a relationship reasonably might impair the psychologist’s objectivity or otherwise interfere with the psychologist’s effectively performing his or her functions as a psychologist, or might harm or exploit the other party.” (APA, 1992). Even, Bruce Ebert, Ph.D., J.D., the former director of our dreaded California Board of Psychology wrote to all psychologists in the BOP Updates, “Not all multiple-role relationships are unethical” (1998, p 5) and published himself the most extensive analysis challenging the constitutional of the prohibition against dual relationships (1997). In spite of all these, the myth of the evils of dual relationships and the perceived ban is as intact as ever.
In this light, one must wonder how come if dual relationships aren’t unethical, why the prohibition isn’t dead? If we dare to examine the myth of demonizing dual relationships, at least three questions must be pondered: a. What is so wrong with clients’ familiarity or “duality” with therapists? b. Is it possible that the prohibition is not only about protecting our clients but actually is in the therapists’ own self interest and c. Does the prohibition truly protect patients from exploitation? The scope of this paper will not allow a thorough elaboration on these questions. However a brief comment on each may serve as a stimulant for further inquiry and dialogue.
In regard to familiarity: As happens in most rural communities and military settings, most of my clients chose me because they know me. Some attended several of my lectures and workshops, others served with me on task forces or committees in our community yet others chose to engage in therapy with me after they got to know me well as a trusted neighbor, doting father, or competitive basketball player. I found these methods of selecting a therapist appropriate, intelligent and sensible. They chose me on the basis of real first hand personal knowledge of my behavior, morals, ethics, and personality. In my opinion, it is far superior than a blind selection of a soul-doctor from a Yellow Pages listing. The fact that some of my clients end up on a field trip with me or on a committee or on the basketball court significantly reduces the chance of sexual or other forms of exploitation. It has not interfered with any transference work, rather it has been made more complex, but also richer.
Regarding the last two questions about who may benefit from and who may be protected by the prohibition. Isolation, as a rule, tends to increase the risk of exploitation. I suspect that one reason the prohibition is not dead is because it enables incompetent and ineffective therapists to stay unexposed in business without any accountability. In the isolation of the office they can blame clients for failed therapy (“resistance”) and continue to collect fees even though the goods are not delivered.
When it comes to dual relationship it seems like we have the answer before we have formulated the question very well. Rather than focusing on punitive enforcement of the imaginary ban on dual relationship, the real question is how to prevent exploitation. This is the question of how to educate caring clinicians who can practice with integrity and competency rather than frightened technicians. This short essay is an invitation to dare to rethink the demonization of dual relationships and to explore how best we can protect clients from exploitive therapists and how we can train therapists to increase their effectiveness and accountability.
- American Psychological Association (APA). (1992). Ethical Principles for Psychologists. Washington, D.C.: American Psychological Association.
- Ebert, W. B. (1977). Dual-relationship prohibition: A concept whose time never should have come. Applied & Prevention Psychology, 6: 137-156.
- Ebert, W. B. (1998). Message from the chairperson. BOP Update, July, 1, 4, 5.
- Pope, K. S. (1990a). Therapist-patient sexual contact: Clinical, legal, and ethical implications. In Margenau, E.A. The encyclopedia handbook of private practice. pp. 687-696. New York: Gardner Press, Inc.
- Zur, O. (1999). The demonization of dual relationship: How prohibition on non-sexual dual relationships compromises effective therapy and keep incompetent therapists in business. Oakland: Independent Thinking Review: Critical Thinking about Psychology series, Monograph #2.
Published articles available online by Dr. Zur on Dual Relationships: