Dual Relationship
In psychotherapy, a dual relationship occurs when a therapist has a second, significantly different relationship with their client in addition to the traditional client-therapist bond. For example, a therapist may find that the person seeking treatment happens to be their neighbor.
Some dual relationships are unavoidable, as may be the case when a therapist is mandated to testify in court. But there are others which are voluntary or coincidental, such as when a therapist and client shop at the same stores in a small community. Regardless of the circumstances in which a dual relationship arose, a therapist should be careful to follow ethical guidelines and maintain healthy boundaries.
TYPES OF DUAL RELATIONSHIPS
According to the Zur Institute, the following are common types of dual relationships:
- Social dual relationship: The therapist is also a friend.
- Professional dual relationship: The therapist doubles as someone’s work colleague or collaborator.
- Business dual relationship: The therapist is also involved with someone in a business capacity.
- Communal dual relationship: Both the therapist and client are members of a small community and will likely run into each other or be involved in the same activities outside of the office.
- Institutional dual relationship: The therapist serves an additional role inherent to a particular institution, such as a prison, hospital, or military base. For example, a therapist could be a prisoner’s counselor and their parole evaluator.
- Forensic dual relationship: The therapist is a counselor as well as a witness in legal trials or hearings involving his or her client.
- Supervisory dual relationship: The therapist is also responsible for overseeing and supervising the client’s development as a professional therapist, as often occurs in educational settings.
- Digital, online, or Internet dual relationship: The therapist is connected with the client on social media sites such as Facebook, Twitter, and LinkedIn.
- Sexual dual relationship: The therapist and client are engaged in a sexual and/or romantic relationship.
SEXUAL DUAL RELATIONSHIPS
The APA Ethics Code forbids therapists from being sexually intimate with current clients due to ethical conflicts of interest. Likewise, therapists should not take on clients with whom they’ve been intimate in the past. The APA does allow therapists to pursue a romantic relationship with a former client, assuming at least two years have passed since the therapy ended. Yet even this kind of relationship is still highly discouraged.
On the surface, sexual dual relationships may appear to occur between two consenting adults. However, the nature of therapy puts a client in a uniquely vulnerable position. Therapy often involves sharing intimate thoughts and emotionally raw experiences. The client may be reluctant to share these things with a romantic partner, leading them to either avoid important issues in therapy or to cross their personal boundaries.
Research suggests most clients who have sex with their therapists ultimately view this intimacy as harmful. Even clients who initially enjoyed the sex generally found it exploitative in hindsight. These feelings may increase the clients’ symptoms of depression, suppressed anger, or suicidal ideation. The client may be more likely to isolate themselves and mistrust others, making it harder for them to receive adequate care in the future.
Therapists who have sex with clients can face severe consequences. They may be sanctioned by licensing boards and professional organizations. Their professional reputation may be damaged to the point that they no longer get new clients or referrals. They could also rack up expensive legal fees. As such, even when a therapist has sexual feelings for a client, it is not recommended that they act on said impulses.
ETHICAL CONCERNS WITH NONSEXUAL DUAL RELATIONSHIPS
Nonsexual dual relationships can be ethical or unethical depending on the circumstances. The distinguishing factor is often the establishment of mutual trust. Can each party rely on the other to respect their boundaries and needs? Or does one party misuse the other’s vulnerability?
In some cases, the dual nature of the relationship may be beneficial from a clinical standpoint. For example, if the therapist and client are colleagues in the mental health field, they may be interested in exploring certain techniques together. This exploration could prove useful for both parties so long as guidelines are agreed upon ahead of time.
In other cases, the dual relationship can be a detriment to the therapeutic relationship. A dual relationship is more likely to be harmful when:
- There is a lack of objectivity.
- Example: A therapist may treat an influencer they follow on social media. Their admiration of the client may skew their clinical judgment.
- The boundary between roles is unclear.
- Example: If a client and therapist are friends, they may inadvertently begin to discuss mental health issues outside the office.
- There aren’t any guidelines for when therapy will end.
- Example: A client may be reluctant to terminate therapy with a close neighbor for fear of awkward encounters later.
- The difference in power makes it easy for the therapist to potentially harm the client.
- Example: The therapist is also the client’s teacher and can give the client a bad grade.
When assessing the ethics of a dual relationship, it is important to ask whether the relationship is truly beneficial for both therapist and client.
References:
- Capawana, M. R. (2016, June 9). Intimate attractions and sexual misconduct in the therapeutic relationship: Implications for socially just practice. Cogent Psychology, 3(1). Retrieved from https://www.tandfonline.com/doi/full/10.1080/23311908.2016.1194176
- Ethical principles of psychologists and code of conduct. (2017). American Psychological Association. Retrieved from https://www.apa.org/ethics/code/index?item=13#1005
- Herlihy, B., and Corey, G. (1992). Dual relationships in counseling. Alexandria, VA: American Association for Counseling and Development. Retrieved from http://files.eric.ed.gov/fulltext/ED340985.pdf
- Miller, J. (2014, January 30). Utah therapist admits to sexual relationship with teen client. The Salt Lake Tribune. Retrieved from http://www.sltrib.com/sltrib/news/57473599-78/peterson-police-abuse-girl.html.csp
- Zur, O. (2013). Dual relationships, multiple relationships & boundaries in psychotherapy, counseling & mental health. Retrieved from http://www.zurinstitute.com/dualrelationships.html
Last Updated: 09-19-2019
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Ofer Zur
December 27th, 2014 at 1:59 PMA recent summary chart of different types of multiple relationships (or dual relationships) is available at zurinstitute.com/DualRelationships2.pdf
Gia
February 13th, 2017 at 11:35 PMI have known my therapist for 20 years, 10 years through church and then 10 years now as her patient. My probation officer just told me it is considered a boundary issue and I can no longer see my therapist of 10 years and must be getting an entirely new therapy with an outside agency. I have dissociative identity disorder and my therapist and I have established a mutual trusting and respectful relationship that do not cross any ethical boundaries. Does anyone have any feedback on this? I’m falling into a deep depression because I am being severed from my therapy and isolated away from my therapist of 10 years. I’m being re traumatized by a new therapist because I have to discuss issues that trigger my trauma and are tearing me apart. Please I would really appreciate someone’s feedback on this. Thank you very much.
Alison
February 7th, 2018 at 3:09 PMI agree with your probation officer. It’s about the issue of being in therapy. The therapist/client relationship is a power relationship. In other words, the client often views the therapist as the one with the most power. While therapists may not view that to be true, it just is. If a therapist says something with regard to the client making changes and the rapport has been built, the client would be more likely to take the therapist’s advice. The therapy relationship is supposed to be separate from other relationships. If you see one another in church, that is not a big deal, but if you see one another in church and other people see you and you have multiple conversations and share life with one another, that’s what you want to avoid. If the current new therapist is not working for you, I would encourage you to find one who does. In addition, it hurts my heart that your previous therapist did not try to end this sooner. I’m sorry you’re hurting, but your probation officer is correct. Even in DID, 10 years is too long. There comes a time when you terminate therapy. That’s healthy and the way we are trained. At some point after a few years of therapy, the therapist should have transferred you to a new therapist. It’s called a soft transfer. It’s when the therapist introduces the client to the new therapist in the last couple of sessions before the new therapist takes over the therapy process.
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