What Makes Dual or Multiple Relationships So Problematic?

What Makes Dual or Multiple Relationships So Problematic?

Wk 3 – Inmate Manipulation and Boundaries Presentation [due Mon]

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1.

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Identify possible ways that inmates may try to use a personal traumatic experience you have had to manipulate you.

Create a scenario to describe one of these situations.

Create a 10- to 12-slide Microsoft® PowerPoint® Presentation including the following:

· Summarize the manipulation scenario.

· Develop a plan for how to maintain boundaries in this situation.

· Explain possible obstacles in setting and maintaining these boundaries.

· Identify ethical and legal consequences to not maintaining boundaries in this situation.

Include a minimum of two sources.

Format your presentation consistent with APA guidelines.

Submit your assignment.

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Determine strategies for maintaining boundaries for interpersonal relationships with diverse clients in the correctional setting.

How can employees avoid being manipulated by an inmate? What changes do you think you would need to make in your life to make sure an inmate does not manipulate you?

Chapter 1 Boundary Issues in Perspective
Dual or multiple relationships occur when a professional assumes two or more roles simultaneously or sequentially with a person seeking his or her help. This may involve taking on more than one professional role (such as counselor and teacher) or combining professional and nonprofessional roles (such as counselor and friend or counselor and lover). Another way of stating this is that a helping professional enters into a dual or multiple relationship whenever the professional has another, significantly different relationship with a client, a student, or a supervisee.

Multiple relationship issues exist throughout our profession and affect virtually all counselors, regardless of their work setting or the client populations they serve. Relationship boundary issues have an impact on the work of helping professionals in diverse roles, including counselor educator, supervisor, agency counselor, private practitioner, school counselor, college or university student personnel specialist, rehabilitation counselor, and practitioner in other specialty areas. These issues affect the dyadic relationship between counselor and client, and they can also emerge in complex ways in tripartite relationships (such as client/supervisee/supervisor or client/consultee/consultant) and in family therapy and group work. No professional remains untouched by the potential difficulties inherent in dual or multiple relationships.

This book is a revision of our earlier editions, Dual Relationships in Counseling (Herlihy & Corey, 1992) and Boundary Issues in Counseling: Multiple Roles and Responsibilities (Herlihy & Corey, 1997, 2006b), but with an expanded focus. Since we last wrote together about this topic, helping professionals have continued to debate issues of multiple relationships, roles, and responsibilities; power; and boundaries in counseling.

Because of the complexities involved, the term multiple relationship is often more descriptive than dual relationship. Dual or multiple relationships occur when mental health practitioners interact with clients in more than one relationship, whether professional, social, or business. In the most recent versions of the ACA Code of Ethics(American Counseling Association [ACA], 2005, 2014), both of these terms have been replaced with the term nonprofessional interactions to indicate those additional relationships other than sexual or romantic ones. In this book, we continue to use the terms dual or multiple relationships to describe these nonprofessional relationships as well as dual professional relationships.

This revised edition is based on the assumption that counseling professionals must learn how to manage multiple roles and responsibilities (or nonprofessional interactions or relationships) effectively rather than learn how to avoid them. This entails managing the power differential inherent in counseling or training relationships, balancing boundary issues, addressing nonprofessional relationships, and striving to avoid using power in ways that might cause harm to clients, students, or supervisees. This book rests on the premise that we can develop ethical decision-making skills that will enable us to weigh the pros and cons of multiple roles and nonprofessional interactions or relationships.

Beginning in the 1980s, the counseling profession became increasingly concerned with the ethical issues inherent in entering into multiple relationships and establishing appropriate boundaries. Much has been written since then about the harm that results when counseling professionals enter into sexual relationships with their clients. Throughout the 1980s, sexual misconduct received a great deal of attention in the professional literature, and the dangers of sexual relationships between counselor and client, professor and student, and supervisor and supervisee have been well documented. Today there is clear and unanimous agreement that sexual relationships with clients, students, and supervisees are unethical, and prohibitions against them have been translated into ethics codes and law. Even those who have argued most forcefully against dual relationship prohibitions (e.g., Lazarus & Zur, 2002; Zur, 2007) agree that sexual dual relationships are never acceptable. We examine the issue of sexual dual relationships in detail in Chapter 2.

In the 1990s and until the turn of the century, nonsexual dual and multiple relationships received considerable attention in professional journals and counseling textbooks. The codes of ethics of the ACA 2014), the American School Counselor Association (ASCA; 2010), the American Psychological Association (APA; 2010), the National Association of Social Workers (NASW; 2008), and the American Association for Marriage and Family Therapy (AAMFT; 2012) have all dealt specifically and extensively with topics such as appropriate boundaries, recognizing potential conflicts of interest, and ethical means for dealing with dual or multiple relationships. Since this book was last revised in 2006, new articles on these topics have slowed to a trickle in the professional literature. There has been an increasing recognition and acceptance that dual or multiple relationships are often complex, which means that few simple and absolute answers can neatly resolve ethical dilemmas that arise. It is not always possible for counselors to play a singular role in their work, nor is this always desirable. From time to time we all will wrestle with how to balance multiple roles in our professional and nonprofessional relationships. Examples of problematic concerns associated with dual relationships include whether to barter with a client for goods or services, whether it is ever acceptable to counsel a friend of a friend or social acquaintance, whether to interact with clients outside the office, how a counselor educator might manage dual roles as educator and therapeutic agent with students, how to ethically conduct experiential groups as part of a group counseling course, and whether it is acceptable to develop social relationships with a former client.

In this chapter, we focus on nonsexual dual relationships that can arise in all settings. One of our guest contributors, Arnold Lazarus, makes a case for the potential benefits of transcending boundaries. He takes the position that benefits can accrue when therapists are willing to think and venture outside the proverbial box. The following questions will guide our discussion:

· What guidance do our codes of ethics offer about dual or multiple nonprofessional relationships?

· What makes dual or multiple relationships problematic?

· What factors create the potential for harm?

· What are the risks (and benefits) inherent in dual or multiple relationships, for all parties involved?

· What important but subtle distinctions should be considered?

· What safeguards can be built in to minimize risks?

Ethical Standards
The codes of ethics of all the major associations of mental health professionals address the issue of multiple relationships. To begin our discussion, consider these excerpts from the codes of ethics for mental health counselors, marriage and family therapists, social workers, school counselors, and psychologists.

The ACA Code of Ethics (ACA, 2014) provides several guidelines regarding nonprofessional interactions. Counselors are advised that:

Sexual and/or Romantic Relationships Prohibited

Sexual and/or romantic counselor–client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. This prohibition applies to both in-person and electronic interactions or relationships. (Standard A.5.a.)

Previous Relationships

Counselors consider the risks and benefits of accepting as clients those with whom they have had a previous relationship. These potential clients may include individuals with whom the counselor has had a casual, distant, or past relationship. Examples include mutual or past membership in a professional association, organization, or community. When counselors accept these clients, they take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs. (Standard A.6.a.)

Extending Counseling Boundaries

Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or graduation), purchasing a service or product provided by a client (excepting unrestricted bartering), and visiting a client’s ill family member in the hospital. In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs. (Standard A.6.b.)

Documenting Boundary Extensions

If counselors extend boundaries as described in A.6.a. and A.6.b., they must officially document, 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. When unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, the counselor must show evidence of an attempt to remedy such harm. (Standard A.6.c.)

The standard of the AAMFT Code of Ethics (AAMFT, 2012) dealing with dual relationships advises therapists to avoid such relationships due to the risk of exploitation:

Marriage and family therapists are aware of their influential position 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 document the appropriate precautions taken. (1.3.)

The NASW (2008) code of ethics, using language similar to that of the AAMFT, focuses on the risk of exploitation or potential harm to clients:

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.) (1.06.c.)

The Ethical Standards for School Counselors (ASCA, 2010) also advises that school counselors avoid dual relationships that carry a potential risk of harm and, like the ACA, suggests safeguards. The school counselors’ code is the only one, among those reviewed here, that addresses the burgeoning usage of social media and its potential for creating inappropriate relationships between students and professionals.

Professional school counselors:

Avoid dual relationships that might impair their objectivity and increase the risk of harm to the student (e.g., counseling one’s family members, close friends or associates). If a dual relationship is unavoidable, the school counselor is responsible for taking action to eliminate or reduce the potential for harm to the student through the use of safeguards, which might include informed consent, consultation, supervision and documentation. (A.4.a.)

Maintain appropriate professional distance with students at all times. (A.4.b.)

Avoid dual relationships with students through communication mediums such as social networking sites. (A.4.c.)

The APA (2010) code addresses multiple relationships quite extensively:

(a) 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.

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.

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

(b) 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.

(c) 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. (3.05.)

As can be seen, the ethics codes for mental health professionals all take considerable care to address dual and multiple relationships. Ethical problems often arise when clinicians blend their professional relationships with other kinds of relationships with a client. The ethics codes of most professional organizations currently warn against crossing these boundaries when it is not in the best interests of the client. The emphasis is no longer on an outright prohibition of dual or multiple relationships; rather, the focus has shifted to avoiding the misuse of power and exploitation of the client. Also, it is increasingly acknowledged that some nonprofessional relationships are potentially beneficial.

What Makes Dual or Multiple Relationships So Problematic?
Dual and multiple relationships are fraught with complexities and ambiguities that require counselors to make judgment calls and apply the codes of ethics carefully to specific situations. These relationships are problematic for a number of reasons:

· They can be difficult to recognize.

· They can be very harmful; but they are not always harmful, and some have argued that they can be beneficial.

· They are the subject of conflicting views.

· They are not always avoidable.

Dual or Multiple Relationships Can Be Difficult to Recognize
Dual or multiple relationships can evolve in subtle ways. Some counselors, counselor educators, or supervisors may somewhat innocently establish a form of nonprofessional relationship. They may go on a group outing with clients, students, or supervisees. A counselor may agree to play tennis with a client, go on a hike or a bike ride, or go jogging together when they meet by accident at the jogging trail. Initially, this nonprofessional interaction may seem to enhance the trust needed to establish a good working relationship in therapy. However, if such events continue to occur, eventually a client may want more nonprofessional interactions with the therapist. The client may want to become close friends with the counselor and feel let down when the counselor declines an invitation to a social event. If a friendship does begin to develop, the client may become cautious about what he or she reveals in counseling for fear of negatively affecting the friendship. At the same time, the counselor may avoid challenging the client out of reluctance to offend someone who has become a friend.

It can be particularly difficult to recognize potential problems when dual relationships are sequential rather than simultaneous. A host of questions present themselves: Can a former client eventually become a friend? How does the relationship between supervisor and supervisee evolve into a collegial relationship after the formal supervision is completed? What kinds of posttherapy relationships are ever acceptable? These questions are explored in later chapters.

Dual or Multiple Relationships Are Not Always Harmful, and They May Be Beneficial
A wide range of outcomes to dual or multiple relationships is possible, from harmful to beneficial. Some dual relationships are clearly exploitive and do serious harm to the client and to the professional involved. Others are benign; that is, no harm is done. In some instances, dual relating may strengthen the therapeutic relationship. Moleski and Kiselica (2005) provide a review of the literature regarding the nature, scope, and complexity of dual relationships ranging from the destructive to the therapeutic. They suggest that counselors who begin a dual relationship are not always destined for disaster. They describe some therapeutic dual relationships that complement and enhance the counseling relationship. For example, in counseling clients from diverse cultures, practitioners may find it necessary to engage in boundary crossings to establish the counseling relationship. Moleski and Kiselica maintain that the positive or negative value of the secondary relationship is determined by the degree to which it enhances the primary counseling relationship. Therapeutic dual relationships are characterized by the counselor’s commitment to doing what is in the best interest of the client.

Consider the following two examples. The first is a harmful dual relationship; the second could be described as benign or even therapeutic.

· A high school counselor enters into a sexual relationship with a 15-year-old student client.

· All professionals agree that this relationship is exploitive in the extreme. The roles of counselor and lover are never compatible, and the seriousness of the violation is greatly compounded by the fact that the client is a minor.

· A couple plans to renew their wedding vows and host a reception after the ceremony. The couple invites their counselor, who attends the ceremony, briefly appears at the reception to offer her best wishes to the couple, and leaves. The couple is pleased that the counselor came, especially because they credit the counseling process with helping to strengthen their marriage.

· Apparently, no harm has been done. In this case the counselor’s blending of a nonprofessional role with her professional role could be argued to be benign or even beneficial to the counseling relationship.

Dual and Multiple Relationships Are the Subject of Conflicting Views
The topic of dual and multiple relationships has been hotly debated in the professional literature. A few writers argue for the potential benefits of nonsexual dual relationships, or nonprofessional relationships. Zur (2007) asserts that boundary crossings are not unethical and that they often embody the most caring, humane, and effective interventions. Other writers take a cautionary stance, focusing on the problems inherent in dual or multiple relationships and favoring a strict interpretation of ethical standards aimed at regulating professional boundaries. Persuasive arguments have been made for both points of view.

Welfel (2013) points out that many ethics scholars take a stronger stance against multiple relationships than that found in codes of ethics, especially those in which one role is therapeutic. Perhaps this is because their study of the issues has made them more keenly aware of the risks. Through their work on ethics committees, licensure boards, or as expert witnesses in court cases, they may have direct knowledge of harm that has occurred.

Even when practitioners have good intentions, they may unconsciously exploit or harm clients who are vulnerable in the relationship. If the professional boundaries become blurred, there is a strong possibility that confusion, disappointment, and disillusionment will result for both parties. For these reasons, some writers caution against entering into more than one role with a client because of the potential problems involved. They advise that it is generally a good idea to avoid multiple roles unless there is sound clinical justification for considering multiple roles.

Although dual relationships are not damaging to clients in all cases, St. Germaine (1993) believes counselors must be aware that the potential for harm is always present. She states that errors in judgment often occur when the counselor’s own interests become part of the equation. This loss of objectivity is one factor that increases the risk of harm.

Gabbard (1994) and Gutheil and Gabbard (1993) have warned of the dangers of the slippery slope. They caution that when counselors make one exception to their customary boundaries with clients, it becomes easier and easier to make more exceptions until an exception is made that causes harm. They argue that certain actions can lead to a progressive deterioration of ethical behavior. Furthermore, if professionals do not adhere to uncompromising standards, their behavior may foster relationships that are harmful to clients. Remley and Herlihy (2014) summarize this argument by stating, “The gradual erosion of the boundaries of the professional relationship can take counselors down an insidious path” (p. 206) that could even lead, ultimately, to a sexual relationship with a client.

Other writers are critical of this notion of the slippery slope, stating that it tends to result in therapists practicing in an overly cautious manner that may harm clients (Lazarus & Zur, 2002; Pope & Vasquez, 2011; Speight, 2012; Zur, 2007). Overlapping boundaries and crossing boundaries are not necessarily problematic; instead, they can be positive and beneficial within therapeutic relationships (Speight, 2012). G. Corey, Corey, Corey, and Callanan (2015) remind us that ethics codes are creations of humans, not divine decrees that contain universal truth. They do not believe dual or multiple relationships are always unethical, and they have challenged counselors to reflect honestly and think critically about the issues involved. They believe codes of ethics should be viewed as guidelines to practice rather than as rigid prescriptions and that professional judgment must play a crucial role.

Tomm (1993) has suggested that maintaining interpersonal distance focuses on the power differential and promotes an objectification of the therapeutic relationship. He suggested that dual relating invites greater authenticity and congruence from counselors and that counselors’ judgments may be improved rather than impaired by dual relationships, making it more difficult to use manipulation and deception or to hide behind the protection of a professional role.

Lazarus and Zur (2002) and Zur (2014) make the point that none of the codes of ethics of any of the various professions takes the position that nonsexual dual relationships are unethical per se. They believe that “dual relationships are neither always unethical nor do they necessarily lead to harm and exploitation, nor are they always avoidable. Dual relationships can be helpful and beneficial to clients if implemented intelligently, thoughtfully, and with integrity and care” (Lazarus & Zur, 2002, p. 472). They remind counselors that dual relationships are not, in and of themselves, illegal, unethical, unprofessional, or inappropriate. Instead, unethical dual relationships are those that are reasonably likely to exploit clients or impair professional judgment.

We agree that duality itself is not unethical; rather, the core of the problem lies in the potential for the counselor to exploit clients or misuse power. Simply avoiding multiple relationships does not prevent exploitation. Counselors might deceive themselves into thinking that they cannot possibly exploit their clients if they avoid occupying more than one professional role. In reality, counselors can misuse their therapeutic power and influence in many ways and can exploit clients without engaging in dual or multiple relationships.

Some Dual or Multiple Relationships Are Unavoidable
It seems evident from the controversy over dual or multiple rela

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