For example, multiple relationships are mandated in military settings where In fact they are a normal and healthy part of such interconnected. excerpts addressing dual relationships and multiple relationships from the of Psychologists, Psychiatrists, and Social Workers"; "Dual Relationships: Examples include counseling plus personal, fraternal, business, financial, Unless justified by compelling necessity, customer relations with clients are normally avoided. Engaging in dual relationships is risky business for social workers. This is a case example from the National Association of Social Workers (NASW): An She refers to the American Psychological Association, which provides the following.
Ethical issues related to professional boundaries are common and complex. We should be concerned with dual relationships primarily because they can hurt clients but also because they can hurt the profession and social workers. Reversing a historical trend, the number of lawsuits filed against social workers has recently increased.
A primary reason why clients sue is because they feel they have been exploited, and exploitation is at the core of the dual relationship issue. A debate has emerged in the social work field about dual relationships. On one side are those who support avoiding dual relationships at all costs. On the other side are those who say these relationships are situationally and contextually determined. They argue that being too dogmatic about avoiding dual relationships diminishes the essence and authenticity of social work.
An absolutist believes that certain actions are ethically right or wrong and that certain values should always determine the moral course of action. A relativist believes that moral standards are personal, subjective, and situational. The morality of a decision is measured by the goodness of the outcome. The deontological view focuses on process; the utilitarian view emphasizes outcome.
An oncology client with a terminal diagnosis, widowed six months earlier, is unemployed and has a 5-year-old daughter for whom she feels incapable of providing good care. She has no next of kin, so she has decided to relinquish her daughter for adoption. The client notices that her social worker is good with her child. The client also overhears the social worker talking about her plans to try to adopt a child.
The client asks the social worker if she would consider being the adoptive parent for her daughter. An absolutist might argue that there should be no blurring of roles because there is a foreseeable risk of exploitation.
A relativist might argue that it is a win-win situation. In this context, the mother would feel relief, the child would have a good home, and the social worker could adopt as desired. The decision is measured by the goodness of the outcome for the most people. The social work Code of Ethics stipulates that if a dual relationship is exploitative, whether it begins before, during, or after a professional relationship, it should be avoided. There is room for interpretation, and many of the dual relationships social workers encounter are much more subtle than the egregious exploitation of a sexual relationship: The potential for exploitation or harm to a client is what makes dual relationships insidious.
Dating, bartering, and entering into business arrangements with clients represent examples of situations that are best avoided. But are these situations always wrong? Often they are inevitable, especially when the social worker is in private practice or practices in a rural setting or a denominational agency.
In a small community, same sex social activities are limited and thus may be attended by both client and worker. The incidental occurrence of boundary crossings may be unavoidable. And there may be therapeutic reasons for crossing the professional boundaries, too, such as eating a meal in a family-based treatment visit or attending the funeral of a hospice patient.
Freud a has written about the inadequacy of the Code of Ethics in addressing dual relationships. In fact, she prefers calling them consecutive or concurrent relationships, arguing that the contexts in which dilemmas arise do not easily fit into the guidelines of the code.
She agrees that there is a need for clear boundaries for the following three reasons: Protection of the therapeutic process: The professional relationship is a fiduciary one.
It is not a friendship and even minor boundary transgressions can give a mixed message; a boundary symbolizes limits of a professional transaction. Protection of clients from exploitation: Clients are vulnerable, and social workers are entrusted to protect them from more harm. Protection of social workers from liability: The previous discussion of malpractice suits attests to this need.
However, Freud also asserts that maintaining the rigid power hierarchy of professional-client relationship adds to distancing and reduces authenticity. She objects to the concept of perpetuity, the belief that once someone is a client, he or she is always a client, meaning a social worker should never have any relationship with a former client. She refers to the American Psychological Association, which provides the following specific contextual factors when deciding whether a dual relationship is appropriate: It could be argued that these criteria provide a loophole for retrospective rationalization for impaired objectivity.
But does this trend toward legitimization serve only to rationalize poor judgment Johner, ? In some cases, risk management may call for avoidance. Conceptual distinctions proposed in the literature may help put decision making in perspective: A boundary crossing occurs when a professional is involved in a second relationship with a client that is not exploitative, coercive, or harmful.
Boundary crossings have been defined as bending the code, whereas boundary violations are breaking the code.
They are not inherently unethical, but they could be. The crossing becomes a violation when the dual relationship has negative consequences for the client.
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The distinction between crossings and excursions may lie in the difference between inadvertent and deliberate. A blurring may occur unexpectedly when you see a client in the grocery store and he or she introduces you to family members.
An excursion, however, may be more deliberate, as when you serve as an evaluator for an adoption to someone you know. Rural communities often have a limited pool of healthcare and mental health providers. In rural or small towns, the possibility of simultaneous personal and professional involvement is high if not inevitable Brownlee, If there is no other referral source, is it better to leave the need unmet or provide the service?
This is a case example from the NASW: A rural social worker who provides clinical services at a nursing home has agreed to assume medical power of attorney for a number of patients who have no other appropriate resources. The social worker differentiates the roles, never providing counseling to the patients for whom he has the fiduciary role and responsibility. One effect is that clients to whom he provides counseling can never have the opportunity to select him as their legal representative, and clients for whom he has power of attorney cannot receive clinical services.
Another example is if a social worker attends the same step group as a client. Should the social worker limit his or her involvement in the group? Possible courses of action in such a situation include the following: But while the social worker may be modeling the importance of attending meetings for the client, he or she may be deprived of a full personal experience. The three general principles noted may constitute the critical distinguishing factors in subsequent challenges between a crossing and a violation.
All revolve around a basic question: What elements of our private world will we express to the outer world? Most often, disclosures involve negotiating an appropriate balance between the helpfulness of sharing a part of ourselves with another and the inappropriateness of even danger of overdoing it, of perhaps sharing too much too soon.
Psychotherapy, a place of nearly total confidentiality, provides a rich and unique settings in which to examine this quintessentially human conflict. In doing so, in studying the nature and consequences of disclosure, we can enrich our understanding of interpersonal relations in general and of something fundamental about the psychotherapeutic process.
Dual Relationships, Multiple Relationships, & Boundaries
Fantasy and Reality" in Professional Psychology: Research and Practice, August,p. A pilot comparison study of two disciplines" in American Journal of Family Therapy,vol. We again acknowledge the impossibility of setting firm boundaries appropriate for every consumer under every circumstance.
We are concerned, however, that inappropriate crossings are often rationalized as benevolent or therapeutic. As Brown states, 'In the many cases in which I have testified as an expert witness regarding abuses in psychotherapy and the standards of care, it is a very common experience for me to hear the accused therapist pleading the cause of greater humanity, and even love, as the rationale for having had sex with, breast fed, slow-danced with, gone into business with, move in with, and so on with the complaining client'p.
You may have heard in workshops or read in books or journals that hugging a client, giving a gift to a client, or meeting a client outside of the office constitutes a multiple relationship and is prohibited by our ethics code or by the standard of care sustained by professional licensing boards.
You may also have heard or read that telling a client something personal about yourself or unexpectedly encountering a client at a social event are examples of unprofessional multiple relationships.
The inaccuracies, or errors, in our thinking about nonsexual multiple relationships, mire us in confusion and controversy. The errors cripple our movement towards a comprehensive and practical model of ethical decision-making regarding multiple relationships with clients.
This study also showed that male therapists are more likely to engage in nonsexual dual relationships with clients of the opposite sex than their female counterparts. A Practical Guide, 4th EditionWiley, Clarity in thinking through boundary issues for each client is essential. Reflexively applying a rigid set of rules A central theme of this book is that we cannot shift responsibility to a set of rules Every client is unique in some ways, as is every therapist. Each situation is unique in some ways, and situations continue to change.
Nothing can spare us the personal responsibility of making the best effort we can to assess the potential effects of boundary crossings Decisions about boundaries must be made with the greatest possible clarity about the potential benefits and harm, the client's needs and well-being, informed consent and informed refusal, and the therapist's knowledge and competence.
What about multiple social roles? Is it helpful, hurtful, or completely irrelevant for a therapist to provide therapy to a close friend, spouse, or step-child? Are there any potential benefits or risks to social outings with a client meeting for dinner, going to a movie, playing golf, or heading off for a weekend of sightseeingso long as there is no sexual or romantic involvement?
What about lending a client money to help pay the rent or buy food and medications? Under what circumstances should a therapist accept bartered services or products as payment for therapy sessions?
The 15 years or so from the early s to the mids saw these and other questions about multiple relationships and boundaries discussed—and often argued—from virtually every point of view, every discipline, and every theoretical orientation.
On Seeing Acquaintances as Patients. Similarly, in the edition of their widely used textbook Ethics in Psychology: Professional Standards and Cases, Patricia Keith-Spiegel and Gerald Koocher discussed ways in which boundary crossings may be unavoidable in good clinical practice and presented ways to think through the ethical implications of specific dual relationships or other boundary issues.
Patrusksa Clarkson, who wrote 'In Recognition of Dual Relationships,' discussed the 'mythical, single relationship' and wrote that 'it is impossible for most psychotherapists to avoid all situations in which conflicting interests or multiple roles might exist'p.
Vincent Rinella and Alvin Gerstein argued that 'the underlying moral and ethical rationale for prohibiting dual relationships DRs is no longer tenable'p. Jeanne Adleman and Susan Barrett took a fresh and creative look, from a feminist perspective, at how to make careful decisions about dual relationships and boundary issues. Laura Brown ; see also b examined the implications of boundary decisions from another perspective in 'Beyond Thou Shalt Not: Thinking about Ethics in the Lesbian Therapy Community.
Elisabeth Horst and Amy Stockman were among those who explored issues of dual relationships and boundaries in rural settings. Melanie Geyer examined some of the decision-making principles that had evolved for evaluating multiple relationships and boundary issues in rural settings and adapted them for some of the unique challenges faced by Christian counselors and counselors for whom other religious faiths are a focus of practice.
The care with which these diverse articles and books in the s and first half of the s examined a diverse array of contextual issues such as the nature of the community e. They can also undermine the therapy, disrupt the therapist-patient alliance, and cause harm to clients.
Building on Gutheil and Gabbard's conceptualization of boundary crossings and boundary violations, this article discusses and illustrates grounding boundary decisions in a sound approach to ethics.