What is a Dual Relationship?
In the mental health professions, dual relationships are generally ill advised or if they are unavoidable, at the very least, the professional must take responsibility to make sure the client/patient is not exploited. An example of an unavoidable dual relationship would be a therapist who lives in a small town and inevitably runs into the client on a regular basis or must do business with the client (e.g. the client runs the only local grocery store). Here is how the NASW Code of Ethics defines a dual relationship:
(c) Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.)
That definition makes it crystal clear that dual relationships do not have to be quid pro quo or business, a misunderstanding John Knapp appears to have, based on the discussion with me that he has now posted on his blog. Being a friend or colleague to a current or former therapy client can also constitute a dual relationship. A therapist becoming a client’s “friend” can also constitute a dual relationship, even in a non-sexual relationship and the code indicates that these relationships that occur consecutively are also included as problematic (e.g. therapist and then friend after termination of therapy).
The therapeutic relationship is, by nature, unequal and therapists have a fiduciary responsibility towards their clients. In professions such as accounting or brokerage, the fiduciary trust involves money. In therapy, it involves highly intimate, personal details of a person’s emotional wellbeing that the client has placed in the therapist’s hands. In a friendship, there is give and take, where both parties may share personal material. Even though that too might not be perfectly equal, there is nothing in the role of friend that would preclude both parties sharing personal material with one another. In contrast, the therapist most likely knows all kinds of intimate personal details about the client, but not vice versa. Although the therapist might selectively share some personal material, it would be highly inappropriate for the therapist to share in the way a client shares. No matter how egalitarian a therapist attempts to be, the fact is that the relationship is not equal and the therapist has power that must not be abused.
In a chapter entitled New Age Therapies from the edited volume (Lilienfeld, Lynn & Lohr, 2003) Science and Pseudoscience in Clinical Psychology, Margaret Singer and Abraham Nievod discussed the fiduciary nature of the therapist-client relationship (p 191):
Under the laws of most states, both licensed and unlicensed clinicians who hold themselves out to the general public as performing the functions of a therapist establish a relationship with their clients based on trust, confidence and confidentiality. In the law, when a relationship occurs between individuals based on trust and confidence and one individual has greater knowledge, experience, training and skill, than the other, then that relationship is generally considered in the eyes of the law to be a fiduciary relationship. In many states, therapists are considered fiduciaries. Because of their disproportionate knowledge, training and experience, fiduciaries are held to a higher standard of care and responsibility for (1) the services provided to a client and (2) the appropriateness of the services to aid the client in overcoming problems.
We propose that all therapeutic relationships be considered fiduciary relationships and that the standard of care against which a therapist is judged be the standard applied to fiduciaries.
Margaret Singer was interested in fiduciary relationships as they applied to several of her areas of interest including cults, elder abuse, and therapist abuse, which could include the use of bogus therapy techniques, as well as interpersonal exploitation. There are a number of therapy cults where the issue of dual relationships arose. For example, in some therapy cults she wrote about, therapists had clients doing work for them, for free. In that case, not being paid made the exploitation even worse. Also, there are a number former members of the late Fred Newman’s Social Therapy (aka the New Alliance Party) who have blown the whistle on what they now consider to be exploitation where their therapist pressured them to do hours upon hours of “volunteer” work for their political cause. Rick Ross’ website has a number of interesting articles on this group.
One part of the code of ethics that is open to interpretation is that it specifies “in which there is a risk of exploitation or potential harm” but how is one to predict whether that could occur? In some cases it seems obvious, but in others, not so much. Although some therapists appear to be overconfident that it won’t and they can handle it, we are all human beings and there is really no reliable/valid way to predict how two human beings will react in the role change (for example, from therapist/client to friends). The bottom line, however, that is made clear in this ethical code is that if something does go wrong, the responsibility is on the therapist. Hence, the wise thing to do, in my opinion, would be to avoid such situations wherever possible.
From → Social Work