Professional Boundaries: Navigating Dual/Multiple Relationships

1. Professional Boundaries: Navigating Dual/Multiple Relationships Dan Yearick, LPC-S

2. Dual or multiple relationships occur when professionals assume two or more roles simultaneously or sequentially with a person seeking their help. • The ACA Code of Ethics (2005) does not use the terms “dual” or “multiple” relationships, but rather refers to these relationships as “nonprofessional interactions”, which do not include sexual or romantic relationships.

3. Respond to: It is not always possible for counselors to play a singular role in their work, nor is this always desirable. It is likely that counselors will have to wrestle with balancing multiple roles in their professional and non-professional relationships.

4. Some potentially problematic issues related to multiple relationships: • Whether to barter with a client for goods or services. • Whether it is ever acceptable to counsel a friend or social acquaintance. • Whether to interact with clients outside the office. • Whether it is acceptable to develop a social or business relationship with a former client.

5. ACA Code of Ethics (2005) “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.”

6. ACA Code of Ethics (2005) “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.

7. 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

8. 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.”

9. What ACA’s Code of Ethics (2005) does NOT say: -That all dual or multiple relationships are prohibited. • What ACA’s Code of Ethics (2005) DOES say: -A sexual/romantic dual relationship is always unethical. -Counselors must avoid relationships that are harmful, exploitive or can negatively impact the professional relationship.

10. Current codes of ethics no longer prohibit multiple relationships. Instead the emphasis has shifted to avoiding the misuse of power and exploitation of the client, and to acknowledge that some nonprofessional relationships are potentially beneficial.

11. Boundary Crossing vs. Boundary Violations • Boundary crossing: A departure from commonly accepted practices that could benefit a client. • Boundary violation: occurs when a professional misuses his/her power, which results in harm or exploitation to a client. A violation is a serious breech that is unethical and often illegal.

12. A rule-based approach to ethics prevents counselors being creative in decision making. Counselors must use their best judgment in situations to determine if there is a potential for harm or a misuse of power.  • Therapeutic multiple relationships are those in which the counselor’s commitment to the best interest of his/her client outweighs risk management strategies aimed at protecting the counselor. Moleski and Kiselica (2005)

13. Boundary crossings are not unethical; rather, they often embody the most caring, humane and effective interventions”. • Dual relationships are neither always unethical nor do the necessarily lead to harm and exploitation, nor are they always avoidable”. Lazarus and Zur (2002), Zur (2007)

14. Key Themes Surrounding Multiple Roles in Counseling • Multiple relationship issues affect all of us in the mental health profession, regardless of our work setting or clientele. • The professional code of ethics caution us about the potential exploitation involved in dual relationships, and current codes acknowledge the complex nature of these relationships. • Multiple relationships cannot always be avoided; they are not necessarily always harmful. • Multiple role relationships challenge us to monitor ourselves and examine our motivations for our practices. • Whenever we consider becoming involved in a dual or multiple relationships, a wise course is to seek consultation from trusted colleagues or a supervisor.

15. There are few absolute answers pertaining to the resolution of dual or multiple relationship dilemmas. • Cautions against entering into dual or multiple relationships should be for the benefit of our clients or others served, rather than to protect ourselves from censure. • In determining whether to proceed with a dual or multiple relationships, we need to consider whether the potential benefit outweighs the potential for harm. To the extent possible, it is good practice to include the client in making this consideration. Herlihy and Corey (2006b)

16. Questions to ask • Is entering into a relationship in addition to the professional one necessary, or should I avoid it? • Can this relationship potentially cause harm to the client? • If harm seems unlikely, would the additional relationship prove beneficial? • Is there a risk that the dual relationship could disrupt the therapeutic relationship? • Can I evaluate this matter objectively? It is good practice to discuss with the client the potential problems of entering into a multiple relationship and to actively involve the client in the decision-making process as fully as possible. Younggren and Gottlieb (2004)

17. Safeguards & Risk-minimizers • Set healthy boundaries from the outset. • Involve the client in setting the boundaries of the professional or nonprofessional relationship. • Informed consent needs to occur at the beginning of and throughout the relationship. • Practitioners who are involved in unavoidable dual relationships or non-professional relationship need to be aware that, despite informed consent and discussion of potential risks at the outset, unforeseen problems and conflicts can arise. • Consultation with fellow professionals can be useful in getting an objective perspective and identifying unanticipated difficulties. • When dual/multiple relationships are particularly problematic, or when the risk for harm is high, practitioners would be wise to work under supervision. • As a legal as well as an ethical precaution, professionals would be wise to document any dual relationships in their clinical case notes (Including actions taken to minimize risk of harm). • If necessary, refer the client to another professional.

18. Situation 1 You have been counseling an adolescent for several months. Unbeknown to you, your daughter is in school with your client and they are working on a project together. Your client is the “friend of mine who’s coming to dinner tonight so we can work on our project together”. As your client leaves your office after a session she states, “See you tonight at supper.”

19. Situation 2 Every morning for the past year you’ve stopped at Starbucks for coffee on your way to work. Almost every day the same barista makes your coffee. Although only on a first name basis, you’ve come to know each other fairly well; you’ve discussed your children, weekend plans, etc. You enter the waiting room and are both taken aback when you discover that he is your new client.

20. Situation 3 You receive a phone call from an attorney who has a practice in the same town in which you practice. He regularly refers clients to you. Although you aren’t “friends”, you have used him in the past for legal advice and help and attend the same church. He is currently in the midst of a crisis and wants your professional help. When you suggest to him that he might be more comfortable working with someone other than you, he asserts that he has little trust for people in the community, but does trust you. He also states that with his busy schedule it’s not possible to travel outside of the county for weekly sessions.

21. Situation 4 You are a counselor in full time private practice. You also teach as an adjunct instructor at the local university. When you receive your class roster you notice that one of your students is a long standing client.

22. Situation 5 You are working with a 19 year old male. Although not the primary issue for which he sought counseling, a year ago his best friend died tragically. Your client has never been to the grave site and believes that he must. He is unable to go alone, with other friends or family. He has asked if you would go with him.

23. References American Counseling Association. (2005). Code of Ethics. Alexandria, VA: Author. Herlihy, B., & Corey, G. (2009). Boundaries in Counseling: Ethical & Clinical Issues. Hobart, NY: Hatherleigh Publishing company, LTD. Herlihy, B., & Corey, G. (2006b). Boundary issues in counseling: Multiple roles and responsibilities (2nd ed.). Alexandria, VA: American Counseling Association. Moleski, S. M., & Kiselica, M. S. (2005). Dual relationships: A continuum ranging from the destructive to the therapeutic. Journal of Counseling and Development. 83(1), 3-11. Younggren, J. N., & Gottlieb, M. C. (2004). Managing risk when contemplating multiple relationships. Professional Psychology: Research and Practice, 35(3), 255-260. Zur, O. (2007) Boundaries in psychotherapy: Ethical and clinical explorations. Washington, DC: American Psychological Association. Zur, O., & Lazarus, A. A. (2002). Six arguments against dual relationships and their rebuttals. In A. A. Lazarus & O. Zur (Eds.), Dual relationship and psychotherapy (pp. 3-24). New York: Springer.