Dual Relationships and Boundaries in the Helping Professions

Boundaries and multiple relationships are highly complex issues, especially in a therapeutic relationship. It is always the responsibility of the therapist to maintain appropriate boundaries with clients and their families. However, clients will frequently challenge the boundary levels with their therapist in many different ways. But it is critical that only one relationship is maintained as often as possible, the one of a therapist and client. Whenever there is a question regarding whether or not a specific type of relationship is appropriate, the deciding factor is always the client's health and safety. There exist many professional codes of ethics that warn against dual or multiple relationships. In this article we will discuss several different views on dual roles in psychology.

Sexual relationships between patients and doctors have been prohibited since the dawn of the Hippocratic era. The purpose was to prevent those in a position of influence from advantage of those in a weakened state. While the harmful effects of sexual relations between a therapist and their patient has been documented extensively, sexual relationships with former patients has not been discussed nearly as often. While there are a few studies that point out this situation has the potential for harm to the patient, there have been no documented direct evidence that proves it definitively. However, as the article points out, an absence of evidence of harm does not constitute an absence of harm. The fact is that 95% of therapists consider sexual relationships with patients as harmful, but not necessarily so with former patients. The number is as low as 70% for psychiatrists and 50% for psychologists, according to the article's sources. Once treatment with a patient is terminated, it opens the door for the possibility of several different types of relationships including friendship, business, and sexual relationships. Once the therapy is terminated there is no longer a power discrepancy, nor are there any trust issues to be taken advantage of; however, there are still a myriad of possible issues. First is the potential for terminating therapy simply to facilitate a sexual relationship. Also it can be argued that the patient, depending on his or her state of mind at the time of termination, may never have given “true” consent. In either of these cases a trust issue still remains, as well as the possibility of potential harm coming to the patient due to premature termination of treatment. The author then argues that it is possible that there cannot ever be true consent to a sexual relationship where the power disparity is so large, such as the one between a patient and their doctor. This would invalidate any argument made that would insinuate a former client more suitable than a current one to give their consent to a sexual relationship. There is also concern that patients would begin to see therapy sessions as a dating service and that certain predatory therapists would possibly terminate therapy in order to exploit their clients. In certain situations, the patient may even subconsciously fail to get better in order to remain close to their therapist. The author concludes the article with his personal view on the matter in question. The author feels that the potential damage to the patient outweighs and danger of unfair discrimination. In so many words, the author is against sexual relationships with former clients regardless of the circumstances as it creates the potential for harm to the former client.

Claudia J. Dewane explains why a therapist should not engage in a dual relationship with their clients. A therapist may give a client mixed messages and the client needs to understand that this is not a friendship but a professional relationship they have with their therapist. Having a dual relationship may cross some boundaries in which the client may begin to feel exploited and can lead to legal issues. Once someone becomes a client, they should always been seen as just a client no matter how much time has gone by since their last visit. It is important for all therapists to handle each situation professionally and to seek help whenever it may be needed to avoid conflict. 

  Although there can be many conflicts when it comes to dual relationships there can also be positive influences.  In an article by Dr. Zur, he discusses dual relationships that he has had with his clients and how these relationships were beneficial for them. The doctor shares stories of meeting clients outside the office in places where they felt most comfortable, or in places such as airplanes for a client who was afraid of flying. He has attended house warming parties, weddings, and anniversaries of his clients as well. Dr. Zur says that “All of the interventions where I left the office were preceded by thorough consideration, were consistent with behavioral, humanistic, and existential treatment plans and were geared to enhancing client welfare. All resulted in an increase of therapeutic alliance, knowledge of the clients, and most importantly, enhanced effectiveness of treatment”. He does point out that there are situations when meeting clients outside of the office and offers home study classes and workshops on ethical dual relationships.

Janet Schank and Thomas Skovholt address the issues of dual relationships in rural communities and small towns. The dilemma of dual relationships is harder to avoid in communities like this because everyone knows everyone and everyone interacts with everyone. Another problem often faced by small town therapists are that there are very few of them, so often a therapist will be asked to treat multiple people in the same family. As stated in most of the other articles it is very important for the therapist to discuss the presence of a dual relationship with the client and discuss the possible effects on the therapy. 

BunmiBuhari describes in this article “Therapeutic Relationships And Professional Boundaries” (Buhari, 2013) rules the therapist should follow so they can maintain a positive appropriate relationship with their clients. It is important that therapists understand positive relationships are constituted with an agreed upon contract with a client. The contract will specify rules of engagement including relationship boundaries, procedures, and goals necessary to maintain a better outcome for the client. Terms of patient consent, length of sessions, and fees are also deemed as mandatory requirements for a professional service. A list of precautions given by Buhari helps the professional set the foundation for honesty and trust to be developed between client and therapist. If professional guidelines are followed, there is a better outcome and set goals of helping the client is more easily obtained.  

Dual relationships are not avoidable and will always exist. There are some communities where they are easier to avoid and some places where they exist more frequently but no matter what the relation is or where you are located it is something that must be addressed in order to lessen the negative impact on the clients therapy. It is crucial for the therapist to be aware when there are negative implications due to a dual relationship and deal with it appropriately. Although there can be negative implications dual relationships will always exist and can also have positive effects on therapy.

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