Earlier this year I had a number of colleagues contact me and ask questions about Dual Relationships. As I gathered their questions, responses from a variety of knowledgeable people, and concerns into one file I realized that all of us would benefit from revisiting the concept “dual relationship”. In this initial entry, we will see if there is some common definition that we could use. Then in subsequent postings we can take a look at some relationships and consider whether or not some Dual-ity might exist.
Factors which might contribute to or constitute a Dual Relationship
AAMFT (American Association for Marriage and Family Therapists) Code of Ethics . . .
Principle I – Responsibility to Clients . . .
1.3 Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client’s immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions. . .
Principle IV – Responsibility to Students and Supervisees . . .
4.1 Marriage and family therapists are aware of their influential positions with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships that could impair professional objectivity or increase the risk of exploitation. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions. . .
Principle V – Responsibility to Research Participants . . .
5.3 Investigators respect each participant’s freedom to decline participation in or to withdraw from a research study at any time. This obligation requires special thought and consideration when investigators or other members of the research team are in positions of authority or influence over participants. Marriage and family therapists, therefore, make every effort to avoid multiple relationships with research participants that could impair professional judgment or increase the risk of exploitation.
American Counseling Association’s Code of Ethics addresses dual relationships (without using that terminology):
A.5.c. Nonprofessional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships)
Counselor–client nonprofessional relationships with clients, former clients, their romantic partners, or their family members should be avoided, except when the interaction is potentially beneficial to the client. (See A.5.d.)
A.5.d. Potentially Beneficial Interactions
When a counselor–client nonprofessional interaction with a client or former client may be potentially beneficial to the client or former client, the counselor must document in case records, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. Such interactions should be initiated with appropriate client consent. Where unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, due to the nonprofessional interaction, the counselor must show evidence of an attempt to remedy such harm. Examples of potentially beneficial interactions include, but are not limited to, attending a formal ceremony (e.g., a wedding/commitment ceremony or graduation); purchasing a service or product provided by a client or former client (excepting unrestricted bartering); hospital visits to an ill family member; mutual membership in a professional association, organization, or community. (See A.5.c.)
Counselors may barter only if the relationship is not exploitive or harmful and does not place the counselor in an unfair advantage, if the client requests it, and if such arrangements are an accepted practice among professionals in the community. Counselors consider the cultural implications of bartering and discuss relevant concerns with clients and document such agreements in a clear written contract.
A.10.e. Receiving Gifts
Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and showing gratitude. When determining whether or not to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, a client’s motivation for giving the gift, and the counselor’s motivation for wanting or declining the gift.
Florida Chapter 64B4 (relating to clinical social workers, marriage and family therapists and mental health counselors) has a section related to the supervision of Registered Interns that begin to clue us into situations which might constitute or be related to Dual Relationships.
64B4-2.003 Conflict of Interest in Supervision.
Supervision provided by the applicant’s therapist, parents, spouse, former spouses, siblings, children, employees, or anyone sharing the same household, or any romantic, domestic or familial relationship shall not be acceptable toward fulfillment of licensure requirements. For the purposes of this section, a supervisor shall not be considered an employee of the applicant if the only compensation received by the supervisor consists of payment for actual supervisory hours. Specific Authority 491.004(5) FS. Law Implemented 491.005(1)(c), (3)(c), (4)(c) FS. History–New 1-4- 90, Amended 2-13-91, 10-7-92, Formerly 21CC- 2.003, 61F4-2.003, 59P-2.003.
NASW (National Association of Social Workers) Code of Ethic
1.06 Conflicts of Interest
(a) Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients’ interests primary and protects clients’ interests to the greatest extent possible. In some cases, protecting clients’ interests may require termination of the professional relationship with proper referral of the client.
(b) Social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests.
(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.)
(d) When social workers provide services to two or more people who have a relationship with each other (for example, couples, family members), social workers should clarify with all parties which individuals will be considered clients and the nature of social workers’ professional obligations to the various individuals who are receiving services. Social workers who anticipate a conflict of interest among the individuals receiving services or who anticipate having to perform in potentially conflicting roles (for example, when a social worker is asked to testify in a child custody dispute or divorce proceedings involving clients) should clarify their role with the parties involved and take appropriate action to minimize any conflict of interest. . .
1.13 Payment for Services. . .
(b) Social workers should avoid accepting goods or services from clients as payment for professional services. Bartering arrangements, particularly involving services, create the potential for conflicts of interest, exploitation, and inappropriate boundaries in social workers’ relationships with clients. Social workers should explore and may participate in bartering only in very limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community, considered to be essential for the provision of services, negotiated without coercion, and entered into at the client’s initiative and with the client’s informed consent. Social workers who accept goods or services from clients as payment for professional services assume the full burden of demonstrating that this arrangement will not be detrimental to the client or the professional relationship.
2.07 Sexual Relationships. . .
(b) Social workers should avoid engaging in sexual relationships with colleagues when there is potential for a conflict of interest. Social workers who become involved in, or anticipate becoming involved in, a sexual relationship with a colleague have a duty to transfer professional responsibilities, when necessary, to avoid a conflict of interest. . . .
3.01 Superivsion and Consultation. . .
(c) Social workers should not engage in any dual or multiple relationships with supervisees in which there is a risk of exploitation of or potential harm to the supervisee.
3.02 Education and Training. . .
(d) Social workers who function as educators or field instructors for students should not engage in any dual or multiple relationships with students in which there is a risk of exploitation or potential harm to the student. Social work educators and field instructors are responsible for setting clear, appropriate, and culturally sensitive boundaries. . .
5.02 Evaluation and Researc
(o) Social workers engaged in evaluation or research should be alert to and avoid conflicts of interst and dual relationships with partiicpatns, should inform participants when real or potential conflict of interest arises, adn should take steps to resolve the issue in a manner that makes participants’ interests primary.
NBCC (National Board for Certified Counselors) Code of Ethics . . .
Section B: Counseling Relationship . . .
2. Certified counselors know and take into account the traditions and practices of other professional disciplines with whom they work and cooperate fully with such. If a person is receiving similar services from another professional, certified counselors do not offer their own services directly to such a person. If a certified counselor is contacted by a person who is already receiving similar services from another professional, the certified counselor carefully considers that professional relationship as well as the client’s welfare and proceeds with caution and sensitivity to the therapeutic issues. When certified counselors learn that their clients are in a professional relationship with another counselor or mental health professional, they request release from the clients to inform the other counselor or mental health professional of their relationship with the client and strive to establish positive and collaborative professional relationships that are in the best interest of the client. Certified counselors discuss these issues with clients and the counselor or professional so as to minimize the risk of confusion and conflict and encourage clients to inform other professionals of the new professional relationship.
3. Certified counselors may choose to consult with any other professionally competent person about a client and must notify clients of this right. Certified counselors avoid placing a consultant in a conflict-of-interest situation that would preclude the consultant serving as a proper party to the efforts of the certified counselor to help the client. . .
9. Certified counselors who have an administrative, supervisory and/or evaluative relationship with individuals seeking counseling services must not serve as the counselor and should refer the individuals to other professionals. Exceptions are made only in instances where an individual’s situation warrants counseling intervention and another alternative is unavailable. Dual relationships that might impair the certified counselor’s objectivity and professional judgment must be avoided and/or the counseling relationship terminated through referral to a competent professional. . .
Section C: Counselor Supervision. . .
In addition, because supervision may result in a dual relationship between the supervisor and the supervisee, the supervisor is responsible for ensuring that any dual relationship is properly managed.
Summary and conclusions
From these professional standards of practice guidelines we can see that the following issues must be considered in our efforts to ensure that we “do no harm” while providing the best possible services to our clients. Be Aware. . .Avoid situations and relationships. . .Act in client’s best interest
- With real or potential conflicts of interest, especially in which the client might be harmed
- Having a non-professional relationship with a client outside of the therapeutic relationship
- A relationship in which the psychotherapist/field instructor/supervisor
- can or does exploit the client
- objectivity and professional judgment is impaired
- Bartering is only allowed by some professions and only when no exploitation nor harm nor possibility of the psychotherapist having an unfair advantage over the client
- Sexual relationships with colleagues
- Sexual relationships with clients
- Relationships with research subject/participants beyond the research study
We will continue to explore Dual Relationships in future posts. Please post your comments and questions.
The educational responses provided by Dr. Waltz do not constitute a legal opinion. If legal advice is needed, it is recommended that contact be made with an attorney qualified in the jurisdiction in which you practice or is applicable to your case. We recommend that you use your knowledge of the law and your code of ethics in conjunction with this information (and any others) when deciding upon your course of action.