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Ethical decision making is an ongoing process with no easy answers.

In order to promote the well-being of clients, counsellors must constantly balance their own values and life experiences with professional codes of ethics as they make choices about how to help their clients effectively. Therefore, knowing ethical codes and the consequences of unsanctioned practice can be useful tools to counsellors during their attempts to establish therapeutic relationships with clients (Herlihy & Corey, 1997). However, although professional codes of conduct provide guidelines for how counsellors should behave with clients, they do not furnish absolute answers for how counsellors must act in every situation (Remley, Hermann, & Huey, 2003). Consequently, practitioners must combine their understanding of ethical codes with sound judgment to serve the best interests of their clients. Some of the most challenging ethical situations result from dual relationships between counsellors and others. “A dual relationship is created whenever the role of counsellor is combined with another relationship, which could be professional (e.g., professor, supervisor, employer) or personal (e.g., friend, close relative, sexual partner)” (Herlihy & Remley, 2001, p. 80). For example, a counsellor who serves as both a therapist and a business partner or friend to a client is engaged in a dual relationship. Because there are many types of dual relationships and because ethical codes provide only general guidelines for handling these relationships, counsellors sometimes have difficulty understanding what dual relationships are and how to handle them. There is a wide range of viewpoints on dual relationships. Many writers focus on the problems inherent in dual relationships. St. Germine (1993) maintains that although dual relationships are not always harmful to clients it is essential for professionals to recognise the potential for harm associated with any kind of blending

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yet both mentors and learners can certainly benefit from this relationship.of roles. Pope (1991) and Pope and Vasquez (1991) contend that dual relationships tend to impair the therapists judgement. regardless of work setting or client population. Those who take a more moderate view see the entire discussion of dual relationships as subtle and complex. promotes an objectification of the therapeutic relationship. ethical and legal risks. Within the interpersonal context. Counsellors can misuse their power and influence in a variety of ways that can harm clients. increasing the potential for conflicts of interest. Despite certain clinical. Although the ethical codes of most professions caution against engaging in dual relationships. Herlihy and Corey (1997) suggest that dual relationships are inherent in the work of all helping professionals. boundaries suggest a ‘psychological space’ or 2 . “mentoring” involves blending roles. In many situations. some blending of roles is unavoidable. For example. and it is not necessarily unethical or unprofessional. and tends to promote a vertical hierarchy in the relationship. He contends that maintaining interpersonal distance focuses on the power differential. It is useful to frame the discussion of dual relationships within the context of boundaries. exploitation of the client. nor are they necessarily harmful. not all such relationships can be avoided. In general terms boundaries imply the defining or determining of a limit. defying simplistic solutions or absolute answers. Tomm (1993) makes an excellent observation when he points out that simply avoiding dual relationships does not prevent exploitation. She mentions that errors in judgement may occur when a professional’s selfinterest becomes involved. it is not always possible to remain within the context of a single role. and blurred boundaries that distort the professional nature of the therapeutic relationship.

on the other hand. refer to benign and sometimes beneficial departures from traditional therapeutic settings or constraints (Scopelliti et al.distance between individuals. 3 . the patient or both. p. legal and broader communities there is a strong consensus that boundary violations are in no way acceptable. neutrality and objectivity (Corey. These may include such things as attending a function such as a funeral with a patient or socializing with a patient. 1995. Breaching of professional boundaries refers to actions that involve going outside the limits of the therapeutic relationship. 500). Not all boundary crossings can be considered to be instances of dual relationships. Such breaches can occur as a result of actions on the part of the clinician.. 1998). Corey and Callanan. 2004). one that is often used to emphasize the clinician’s stance of anonymity. Self-disclosure and (non-sexual) physical contact with patients are examples of the latter. Within the professional. Examples include sexual or financial exploitation of patients. (2004). Boundary crossings. The former are used to refer to ‘actions on the part of the clinician that are harmful. adequate boundary management is a clinical imperative for which responsibility rests principally with the clinician. According to Scopelliti et al. Its importance in the development of an effective therapeutic alliance is highlighted by Smith and Fitzpatrick (1995): “Proper boundaries provide a foundation for this relationship by fostering a sense of safety and the belief that the clinician will always act in the client’s best interest. Indeed.. exploitative and in direct conflict with the preservation of clients’ dignity and the integrity of therapeutic process’ (Smith and Fitzpatrick. p. A useful distinction can be made between so-called boundary ‘violations’ and boundary ‘crossings’. 6). This foundation permits the client to develop trust in the therapist and to openly express secret fears and desires without fearing negative consequences” (1995.

Nearly half of the practitioners responding to a survey by Stake and Oliver (1991) reported treating clients who had sexual contact with a previous therapist. 289) as never ethical. understanding and connection. Despite the honourable attitudes reflected in surveys regarding counsellor–client intimacies. They state that dual relationships and familiarity with patients tend to in fact decrease the probability of exploitation – not increase it– as the power differential in a more egalitarian relationship is reduced. Lazarus and Zur. On the continuum of dual relationships. 1998).800 mental health professionals to examine opinions and practices regarding various dual relationships. behaviour indicates that there remains cause for serious professional concern. Moleski and Kilesica (2005) cited the following: “The percentage of psychologists reporting sex with current clients has ranged from 3% to 12% among male therapists and from 0. and hence increase the likelihood of success for the clinical work. Indeed. Perhaps most alarming was the study by Pope and Bajt (1988) in which 100 senior psychologists were chosen to participate by virtue of their apparent familiarity with ethical professional behaviour. (2004) and many others argue that boundary crossings are likely to increase familiarity. there seems little disagreement among clinicians that a sexual relationship between a counsellor and a current client is the most harmful. Ninety-eight percent of the respondents cited “sexual activity with a client before termination of therapy” (p. 2002).Scopelliti et al. family and interactions within the community gives context to patient’s accounts of their lives (Pope and Vasquez.5% to 3% among female therapists” (Introduction section.. Patients often emphasize the benefits that accrue when clinicians interact with them in the community outside the office. A fuller picture of the patient’s history. The participants were current or former members 4 . Borys and Pope (1989) surveyed 4.

9% indicated that they had engaged in sex with a client. The tragic cost for the patient of such a relationship may include cognitive dysfunction. the client’s diminished trust in future caregivers. and from case study reports. p. 1994. authors of legal or ethical psychology textbooks. they also make the client especially susceptible to the practitioner’s authority and influence” (Kagle & Giebelhausen. and reliance on the practitioner make giving and receiving help possible. Stake and Oliver (1991) cited the destruction of the integrity of the therapeutic relationship. 5 . the APA’s ethics committee. ambivalence. psychosomatic disorders. both core moral principles underlying ethical codes (McLeod. 216). 1995). suppressed rage. sexual confusion. and the exacerbation of the very symptoms for which the client had sought help as further negative results of sexual contact. depression. the sexual relationship becomes primary and the counsellor has failed in his or her obligation to promote autonomy and nonmaleficence. Because of this power imbalance. “It is clear from survey research. willingness to share. and risk of suicide (Kagle & Giebelhausen. Sexual intimacies with current clients demonstrate the counsellor’s disregard for the counselling relationship in favour of the sexual one.of state ethics committees. Lazarus and Zur. Furthermore. that therapist sexual contact has almost universally negative consequences for the client” (Introduction section. 1994. By its very compelling nature. 2002). guilt. Pope and Bajt found that even in this prestigious sample of psychologists. and diplomats of the American Board of Professional Psychology. 2003). clients may feel they have neither the freedom to choose to enter or not enter into a sexual relationship with their counsellor nor the freedom to leave it. Smith & Fitzpatrick. “The client’s need for help.

“Rather than viewing their attraction to a therapist as a normal event that may safely emerge in a context with no possibility of ever being consummated. Conversely. clients may consciously or unconsciously sabotage their own therapeutic efforts (Moleski and Kiselica.g. Harm to Patients and the Therapeutic Process) The patient hoping to fulfil this attraction may attempt to hide from the practitioner any aspects of him. 6 . sexual union with the person serving as their therapist is a real possibility. the counsellor’s finding him..or herself attracted to a client may alter the nature and duration of therapy to expedite the process in hopes of a future sexual relationship. Even if a relationship has been terminated. “Patients who may have wanted or needed a relationship free from sexual possibilities (e. at least eventually. patients may come to recognize that. The implicit threat of exploitation facing former clients.or herself that may appear unattractive or prolong the therapeutic process. albeit under very specific conditions. Counsellors have access to intimate and sensitive information concerning their clients that could be abused in certain situations. the client’s autonomy remains at high risk because of the inherent power differential that continues after counselling. who come to believe their trust was broken and wish to file a complaint. is all too real. Hence. 1994a. (Gabbard. those who seek therapy because they have been victims of rape or incest) may find themselves evaluated by a therapist as potential future sex partners” (Gabbard. in hopes of pursuing this secondary relationship with their counsellor. The concern that post-termination sexual relationships may drastically alter the nature of therapy is twofold. On the other hand. recognized and condoned by the ethics code”. to engage in sexual intimacies with clients two years after termination demonstrates this ambivalence. Harm to Patients and the Therapeutic Process). 2005).Sexual relations with former clients do not elicit the same unanimous concern from professionals in the mental health field. 1994a. The decision to allow counsellors.

filing a complaint compels the client to waive the right to privilege and confidentiality. rather than merely taught ethical codes as a part of a set curriculum. What was once held in the strictest confidence may well become a matter of public record (Gabbard. felony conviction. “The practitioner’s influence and the client’s vulnerability carry over to the second relationship” (p. expulsion from professional organizations. the counselling relationship is subverted and held hostage by the counsellor’s own needs. As such. 1986. Furthermore. and termination—is well summarized by Corey et al. Sonne (1994) has argued that the nature of such dual 7 . “Psychologists need to.Furthermore. having their licenses revoked. In many situations. In this case. Kagle and Giebelhausen (1994) argued that nonsexual dual relationships violate professional boundaries. the practitioner is in a position to exploit the client for his or her own personal gain. Some clinicians believe the risk that the secondary relationship will override the counselling relationship is too great and therefore harmful to the client. 315). To avoid such instances. (1998). arrive at ways to render priorities so that their responsibility to monitor their own practices is taken more seriously” (Bernard & Jara. . Indeed. nonsexual dual relationships can also be caustic to the counselling relationship. . loss of insurance coverage. 1994a). p. 215). It is essential that mental health professionals understand the laws and regulations that govern this issue in their respective locales. Moleski and Kiselica (2005) argue that counsellor–client sexual contact represents all that is problematic in boundary violations. For instance. Bernard and Jara (1986) contend that professionals in training should be motivated to apply their knowledge of ethical standards to their professional lives. The professional and personal concerns of counsellors about to begin a sexual relationship with a current or terminated client loom large. The potential damage to counsellors—lawsuit.

) that he or she may put before the best interests of the client. Because of this second relationship. etc.relationships undermines the fiduciary relationship a practitioner has with his or her client. p. 172). as Moleski and Kiselica (2005) illustrate. the counsellor is now susceptible to other interests (personal. Such circumstances may in fact enhance the client’s feelings of trust and provide the counsellor with additional information helpful to the counselling relationship. 1997. the effectiveness of the counselling sessions may be jeopardized because of the counsellor’s use of self-disclosure at the meeting. such circumstances may place counsellor and client in a secondary relationship that is not only potentially detrimental to counselling but possibly damaging for the practitioner as well. “Both the client’s right to confidentiality and the counsellor’s anonymity are at risk” when both individuals belong to the same group. On the other hand. they do not recognize the conflict of interest inherent in the situation” (p. In addition. For example. these counsellors may encounter a current client at a local AA meeting. 430). or social. Welfel (1998) cautioned that even well-meaning counsellors should think twice before beginning a dual relationship: “Counsellors with good intentions to help people who need therapy are often especially vulnerable because they underestimate the limits their other role places on them and overestimate their capacity for objectivity in the face of strong personal interests. In other words. financial. “From the counsellor’s perspective. Because the opportunity for substance abuse counsellors and their clients to meet in therapeutic arenas is great 8 . his or her anonymity as a recovering person [could be] compromised” (Doyle. the dynamics of dual relationships can be troublesome for the counsellor recovering from substance addiction. Because meetings at associations such as the AA play an integral role in the recovery process.

1997. Such behaviour merely trades one ethical concern for another. Herr (1999) summarized cross-cultural counselling as “therapeutic techniques designed to be sensitive and responsive to cultural differences between counsellors and clients” (p. maintaining such boundaries may in fact place a needless emphasis on the power differential and the hierarchy of the relationship. p. They contend that the ways in which counsellors can misuse their power and influence are varied. some dual relationships are harmful to the therapeutic process. 153). a dual relationship of reciprocal trust and ‘connectedness’ may be required” 9 . In working with clients from other cultures. In fact. 228). clinicians can often find themselves crossing boundaries to promote the counselling relationship. such as a rural setting] prevent people in need [of aid] from receiving assistance” (Doyle. in such instances. Corey et al. “Simply avoiding a dual relationship does not prevent exploitation” (p. “In other cultural contexts. where people are unaccustomed to depending on strangers or outsiders for advice and help and where objective detachment would not be understood as facilitative. and enhance the counselling relationship. it is vital that counsellors receive proper training regarding these dual relationships. The counsellor who is about to begin a dual relationship is not always destined for disaster. They argue that in some instances. Ironically. on the other end of the continuum are secondary relations that complement. enable. the secondary relationship is destructive to the counselling relationship because it was avoided. It is the receptiveness to their client’s culture that has led therapists to cross into additional relationships with them in order to enhance the helping relationship. to refuse “to provide counselling to individuals with whom one has another relationship would [in certain instances. However. 428). Clearly.(especially in small communities). Furthermore. (1998) examined the issue of client autonomy from another perspective.

(Pedersen. it is the well earned trust of the population that will enable the therapist to effectively serve the community. In many small communities. Schank and Skovholt (1997) conducted interviews with psychologists who lived and practiced in rural areas and small communities.. a culturally common practice to show gratitude and respect in many Asian communities is gift giving. the culture of smaller and more remote locales calls for familiarity. Brown. In a controversial article that incited numerous responses (Borys. 1994. Lazarus (1994) addressed the 1992 revised ethical principles of psychologists and warned that “when taken too far [the ethical guidelines regarding dual relationships] can become transformed into artificial boundaries that serve as destructive prohibitions and thereby undermine clinical effectiveness” (p. (2004) who claim that dual relationships in rural mental health care practice are common and are a “predictable” part of everyday practice. Smith and Fitzpatrick (1995) explained that mental health professionals in rural settings are often regarded with suspicion. Gabbard. Citing the positive outcomes of 10 . 255). 1997. 1994b. 25). In order to be accepted. These findings are similar to those of Scopelliti et al.. 1994. 1994). Participants were asked to describe multiple relationships they routinely came across in daily practice. Inhabitants of such environments may view a counsellor who participates in community activities as more approachable than those who avoid outside office contact. a refusal of the gift may result in the client feeling insulted (Corey et al. While Western-trained professionals may believe that accepting a gift would blur boundaries. Unlike large urban environments where anonymity is well received. Gottlieb. these psychologists found they needed to work within the existing community system. 1994. 1998). p. Gutheil. For example.

The effects of crossing commonly recognized boundaries range from significant therapeutic progress to serious. some 11 .e. where they are often of little help to their clients. playing tennis. taking long walks. abuse. As a result of the present litigious climate. 1994. “I would say that one of the worst professional or ethical violations is that of permitting current riskmanagement principles to take precedence over humane interventions” (Lazarus. “Boundary issues regularly pose complex challenges to clinicians. he explained that his attitudes and practices are not completely contrary to accepted belief: “I remain totally opposed to any form of disparagement. p..numerous boundary crossings with clients (i. 259). although well intentioned. accepting and giving small gifts). Lamb and Catanzaro (1998) proposed that professional attitudes regarding nonsexual boundaries are influenced by theoretical orientations. clinicians may Because these orientations vary widely. 259). p. and I am against any form of sexual contact with clients. Recommendations and Conclusions). I feel that most other limits and proscriptions are negotiable” (Lazarus. indelible harm” (Smith & Fitzpatrick. 260). The current ethics and boundaries in counselling and psychotherapy. But outside of these confines. socializing. exploitation. Lazarus (1994) acknowledged that he is more cautious and “a less humane practitioner today” (p. are also in response to the profession’s growing concern about liability and the constant threat of legal suits. or harassment. 1994. 1995. The assorted theoretical viewpoints of mental health professionals further complicate the issue of dual relationships. He cautioned colleagues not to hide behind rigid boundaries.

Introduction section). there is also a greater danger that the client will lose autonomy and a greater potential for harm to the client. Therefore. It appears that a variable that makes sexual relationships with clients or posttermination sexual relationships destructive is also found in toxic nonsexual dual relationships. Mistakes 12 . What one professional may deem as appropriate behaviour. another professional may view as a boundary violation. Furthermore. Hence. to the degree that the intensity of the counsellor’s personal concerns increases in the second relationship. It is also important to note that entering into a helping profession does not automatically make one superhuman. in positive dual relationships. the interest of the counsellor stays focused on the well-being and autonomy of the client. 1998. the risks and benefits of dual relationships are best understood in the broader context of the counselling relationship. the positive or negative value of the relationship is determined by the degree to which it enhances the primary counselling relationship. Indeed.be confused about how “to identify and make appropriate decisions regarding nonsexual boundary events or behaviors with individuals with whom psychologists interact in their professional roles” (Lamb & Catanzaro. This variable is the intensity of the counsellor’s additional interest or interests that have developed as a result of the second relationship. It appears that the increase in the secondary interest necessarily fosters a decrease in the primary relationship of counselling.

and whose needs are primary cannot be understated. it would appear that a willingness to be honest in selfexamination is perhaps one’s greatest asset in becoming an ethical practitioner. The importance of reflecting on these mistakes. Indeed. 13 .will be made as one learns and grows as a practitioner. what one is doing at the moment.

M.. M. (2005). psychiatrists. Professional Psychology: Research and Practice. 3-11. 17(4). & Kiselica. (1989). 20. Journal of Counseling and Development. M. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. Herlihy. & Kiselica. B. Gabbard. Borys. 75. (2005). M. 313-315. 428–432. 3-11. S. J. Issues and Ethics in the helping Professions. Journal of Counseling & Development. S. London: Brooks/Cole Publishing Company. & Callanan. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. & Pope. & Corey. (1998). Corey. (1997) as cited in Moleski. Substance abuse counselors in recovery: Implications for the ethical issue of dual relationships. 14 . & Jara. G. (1997). Corey. S. (1986). M. L. Professional Psychology: Research and Practice. 83.Bibliography Bernard. and social workers. O. The failure of clinical psychology students to apply understood ethical principles. Journal of Counseling and Development. K. D. S. Doyle. C.. S. G. 283–293. (1994a) as cited in Moleski. Dual relationships between therapist and client: A national study of psychologists. K. G. 83. S. P. S.

). (2005). S. CA: Sage. S. & Kiselica. L. M. S. 279-295. Journal of Counseling and Development. Buckingham: Open University Press. 3-11. Myers. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. M. (1994) as cited in Moleski. (2007). M. (2005). Journal of Counseling and Development. S. 15 . O. 69–90). How certain boundaries and ethics diminish therapeutic effectiveness. Lazarus. J. & Kiselica. Kagle. (1994). D. Herr. C. 253–261. (2002) as cited in Moleski. S. P. & E. Psychology and Psychotherapy: Theory. L. & Remley. McLeod. & Zur. E. 83. T. Dual relationships between clinical psychologists and their clients: A survey of UK clinical psychologists’ attitudes. M. & Kiselica. In D. 80. 83. A. B. E. The handbook of counseling (pp. M. 83. N. J. & Sperlinger. J. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. M. 4. C. A. (2005). Research and Practice. & Giebelhausen.Herlihy. S. Legal and ethical challenges in counseling.. 3-11. (2001). Herr (Eds. Ethics and Behavior. (1999) as cited in Moleski. An Introduction to Counselling. Lazarus. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. D. Locke. Journal of Counseling and Development. Thousand Oaks. (2003). 3-11. Kitson.

76. 1(1). Social Work.. & Kiselica. Journal of Counseling and Development. 16 . Pope. G. 83. M. Journal of Counseling and Development. 3-11. M. P. M. (2003). 48(1). Journal of Counseling & Development. M. Dual Relationships in Psychotherapy. T. S. T. 121-133.Moleski. Reamer. Ethics and Behaviour. K. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. The cultural context of the American Counseling Association code of ethics. 21-34. B. San Francisco: Jossey-Bass. S. S. T. (1988) as cited in Moleski. Pope. (1991). Pope. Boundary Issues in Social Work: Managing Dual Relationships. S. 3-11. Ethics in Psychotherapy and Counseling: A Practical guide for Psychologists. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. J. 83. Nigro. Counselors' Experiences With Problematic Dual Relationships. 14(1). K. S. (1997). & Vasquez. F. M. (2005). K. S. Pedersen. R. (2004). 23–28. S. 51-64. & Kiselica. & Bajt. Ethics and Behavior. (1991). (2005).

& Callanan. P. Journal of Counseling and Development. S. G. 22. (1998). T. S. Issues and Ethics in the helping Professions. (2005). (2003) as cited in Moleski. & Huey.. The ethics of dual relationships. Sexual contact and touching between therapist and client: A survey of psychologists’ attitudes and behavior. 83. Professional Psychology: Research and Practice. J. 83. Welfel.. 499–506. W. (1991). 7-19. (1993).. Corey. (2004).. & Oliver. London: Brooks/Cole Publishing Company. The California Therapist. Dual relationships in mental health practice: issues for clinicians in rural settings. P. Hermann. 953-959. E. S. M. Smith D. Australian and new Zealand Journal of Psychiatry. (2005). 17 . Fitzpatrick M. St. Journal of Counseling and Development. Professional Psychology. S. E. & Kiselica. Stake. M. C. & Kiselica. (1998) as cited in Moleski. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. R. Germine (1993) as cited in Corey. 26. Patient–therapist boundary issues: An investigative review of theory and research. M. M. 3-11. M. (1995). 297–307. M. Tomm.Remley. J. Research and Practice.. J. K. Scopelliti. et al. 3-11. Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic. 38.