Dual and Multiple Relationships

Can you spot the:

Boundary Crossing

Boundary Violation

Dual or Multiple Relationship

Name! That! Violation!

Name! That! Violation!

http://youtu.be/g_RLVWPBq4w

What are dual and multiple relationships?

Dual or multiple relationships occur when a professional assumes two or more roles at the same time or sequentially with a client or with someone who has a significant relationship with the client

In most cases, having a personal relationship with someone can affect the professional/business relationship in a negative way, causing one of the relationships to suffer

Conflict of interest and why does it matter?

• Dual and multiple relationships are more commonly understood by the term “Conflict of Interest.”

• According to the APA:• A psychologist refrains from entering into a

multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

What are the differences betweendual and multiple relationships?

Doverspike prefers the term “dual relationship” over “multiple relationship” because most boundary crossings involve a duality rather than a multiplicity. Even when there are multiple roles being taken part in, the dual relationship is established first.

1. Social or personal 2. Sexual or improper physical contact 3. Business or financial 4. Caretaking5. Improper gift giving or receiving 6. Interference with personal autonomy or undue influence 7. Self-disclosure 8. Advocacy or enmeshment 9. Employment of patients or interns, monetarily or

otherwise

Examples of DualRelationship Violations

Relationships that affect professional judgment tend to fall in at least one of nine categories

Boundaries and Slippery Slopes

Boundary crossings often involved clinically effective interventions, such as self-disclosure, home visit, non-sexual touch, gifts or bartering. Boundary crossings are not unethical. Not all boundary crossings constitute dual or multiple relationships.

Boundary violations occur when therapists cross the line of decency and violate or exploit their clients.

Slippery slope phenomenon claims that minor boundary crossings can lead to boundary violations and deterioration of ethical behavior.

Significance

In the helping profession, it is absolutely imperative, not

only to keep these relationships separate, but to

prevent the co-existence of personal and professional

relationships altogether!

American Psychological Association

Ethical Principles of Psychologists and Code of Conduct The Ethical Standards set forth enforceable

rules for conduct as psychologists.

Multiple Relationships Ethical Standard 3: Human Relations

3.05 Multiple Relationships

A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely

associated with or related to the person with whom the psychologist has the professional relationship, or

(3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

Foreseeable and Unforeseeable Dual Roles

Foreseeable dual roles are those that the therapist has time to consider or contemplate before engaging in them. For example considering whether or not to provide psychotherapy to someone with whom you have had a prior social or business relationship.

An unforeseeable dual role is a role that cannot be reasonably foreseen. Ex. joining a gym and then finding out one of the fitness instructors is a client of yours.

Concurrent Vs. Consecutive Dual Roles Concurrent dual roles exist when a therapist has two roles at the same time

with the same client, or with a person who is in a significant relationship with the client. The two roles occur simultaneously.

Consecutive dual roles involve a prior relationship that involves either a professional or nonprofessional role followed by the development of a second relationship at a later point in time.

A foreseeable concurrent dual role might involve considering whether to provide therapy to your personal trainer or member of the gym.

An unforeseeable concurrent dual relationship might involve one of your psychotherapy clients is married to your personal trainer or a member of the gym where you take an exercise class.

A foreseeable consecutive dual relationship might involve considering whether to provide psychotherapy to your former personal trainer.

An unforeseeable consecutive dual relationship might involve learning that your personal trainer or member of your gym is one of your former psychotherapy clients.

Can you really prevent multiple relationships from forming?

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.

When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur.

Conflicts Check• When you are operating in a professional role and you are

contemplating a dual relationship with a patient, client, employee, supervisee, research participant, or student consider asking yourself these five questions:

1.Is there a chance of loss of effectiveness of the professional? 2.Is there a chance of loss of objectivity of the professional? 3.Is there a chance of loss of competence of the professional? 4. Is there a chance of risk of exploitation of the client?

5. Is there a risk of harm of the client?

If the answer is “no” to all these questions then proceed withcaution only after consulting with a colleague to determine theclient’s best interests and to identify any ethical blind spots on thepart of the professional.

1. Set healthy boundaries from the outset2. Secure the informed consent of clients and discuss with them

both the potential risks and benefits of dual relationships3. Remain willing to talk with clients about any unforeseen

problems and conflicts that may arise4. Consult with other professionals to resolve any dilemmas5. Seek supervision when dual relationships become particularly

problematic or when the risk for harm is high6. Document any dual relationship in clinical case notes7. Examine your own motivations for being involved in dual

relationships8. When necessary, refer clients to another professional

Protection for Therapists

Case Studies

The Case of Monica Descamps• Jill Davis sued her former therapist in May 2006.

• In her lawsuit, Jill Davis said she sought counseling with Monica Descamps in February 2003, which lasted until February 2004. At that point the psychologist ended counseling and initiated a romantic relationship with Davis, which lasted nine months.

• In court papers, Descamps acknowledged the improper conduct.

The Case of Alfonso Bustamante

A lawsuit filed July 19th, 2012, in Orange County Superior Court 

• Accuses Alfonso Bustamante of repeatedly abusing his position as a licensed psychologist by secretly engaging in a “side relationship” with the female half of a married couple undergoing counseling with him.

The Case of Alan Shulik

The couple, named as John and Jane Doe in the lawsuit to protect their privacy, list 13 counts against Guilford psychologist, Alan Shulik in a complaint filed recently in Superior Court in New Haven.

Shulik allegedly had a sexual relationship with Jane Doe for more than a year beginning in 2008 after she came with her husband for marriage counseling to his practice.

Shulik advised the pair that separate sessions would be more effective, and began an on-off relationship with Jane Doe.

Jane Doe stated that Shulik makes degrading remarks about her husband.

The Case of James Stewart

James Stewart, Ph.D, was found to have violated multiple laws and regulations governing the practice of psychology in Virginia.

The Case of James Stewart: Patient A

Patient A– From 1999 - 2004, Dr. Stewart provided

therapy to Patient A and her family, during which time he developed an intimate knowledge of the family system. Dr. Stewart, while acting as therapist to Patient A• Slept in the same bed with her• Acted amorously toward her• Used her car.

The Case of James Stewart: Patient B

Patient B– Shortly after providing ten years of weekly,

individual psychotherapy to Patient B, Dr. Stewart moved into patient’s B home approximately the summer of 2002, until August, 2003.• He occupied a room in the patient’s home

without paying rent.• Used said patient’s credit card for his own

purchases.• Borrowed her money.

Dual and Multiple Relationship Scenario #1

I am an activities therapist and one of my clients was divorced recently. We discuss his marital problems fairly frequently, and I feel that I understand his former wife very well. She called me the other day to talk about him and his treatment, which I told her I couldn’t do. The conversation turned flirtatious and we made a date for drinks. Before things go too far, are there any ethical requirements about how far I can take this?

What were the ethical (if any) of the previous scenario?

• Remember the ethical standards involved with dual and multiple relationships

• Remember the different types of ethical traps from Ch. 1• The “Commonsense, Objectivity” Trap• The “Values” Trap• The “Circumstantiality” Trap• The “Who Will Benefit” Trap

• What action should take place, or is the behavior in the scenario ethically legitimate?

• Could there be any foreseeable consequences from taking this action or inaction?

What were the ethical (if any) of the previous scenario?

• The ethical standard involved (dual relationships) says that helping professionals should avoid emotional involvement of any kind with their clients. By implication, this includes family members and close friends…and former spouses.

• There is a danger of falling into the “objectivity trap”, because emotional involvement with a client’s former wife could substantially distort your objectivity about your client and erode his confidence in you as a helper

• What should you do?• Preliminary response: You should cancel your date, explaining

your ethical concerns, (and ask yourself “what was I thinking”?)• It is important that you find a way to meet y our needs for social

and intimate interactions outside of your client relationships

Dual and Multiple Relationships Scenario #2

I mentioned the fact that I’m gong to be moving to another apartment in a couple of weeks to a client. Now he seems to have taken this on as his own move, offering me a truck and his help in loading and unloading it. He seems sincere and I really need the help. May I accept it from him?

What were the ethical (if any) of the previous scenario?

• The ethical standard involved (dual relationships) says that helping professionals should refrain from “all forms of dual relationships with clients, including emotional, sexual, and BUSINESS involvement.”

• Also the possibility of falling into the “objectivity” Trap.

• What should you do?• Carefully decline, and make sure your client

understands that you are required to do so by your ethical code. Discuss the issue in a way that is most beneficial to your client, never demeaning his offer. (Re-establish Boundaries?)

Dual and Multiple Relationships Scenario #3

The hairdresser I’ve been going to for several years has been hinting that she has some emotional problems. Now she’s shown up at my agency and wants to become my client. May I accept her as a client? If I do, can she still do my hair?

What were the ethical (if any) of the previous scenario?

• Ethical standard of Dual Relationship• Once again the “objectivity trap” is the possible ethical trap• What should you do? Not accept her as a client, explaining

why you may not do so, and make sure she understands the reasons for this and help her find another counselor in your agency. (Does it have to be your agency?)

• Circumstantiality: If you found another hairdresser, you could taker her on as a client, but this abrupt change in your relationship would not be helpful to her either therapeutically or financially

• Ethical resolution: Discourage her from discussing her counseling with you while she is doing your hair.

Can you spot the:

Boundary Crossing

Boundary Violation

Dual or Multiple Relationship

Name! That! Violation!

Name! That! Violation!

http://youtu.be/jark7NzEf0g

References American Psychological Association (2010). American Psychological Association Ethical Principles of

Psychologists and Code of Conduct. Retrieved October 18, 2013 http://www.apa.org/ethics/code/index.aspx.

Corey, G., & Corey, M. S. (2011). Issues and ethics in the helping professions (8th ed.). Australia: Brooks/Cole/Cengage Learning.

Jensen, D. (2005, September). Unlawful and/or Unethical Dual Relationships: A Word to the Wise. Retrieved November 2, 2013, from http://www.camft.org/ScriptContent/CAMFTarticles/Legal_Issues/DualRelationshipsUnlawful.htm

Zur, O. (2013). Dual Relationships, Multiple Relationships & Boundaries In Psychotherapy, Counseling & Mental Health. Retrieved November 6, 2013 http://www.zurinstitute.com/dualrelationships.html.