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Dual Relationships: Dr. Ruth and Mary Case Study

Student’s Name

Department, University

Course

Professor’s Name

Date of Submission
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Dual Relationships

In the counseling profession, the issue of dual relationships is common. According to

GoodTherapy (2019), a Dual relationship occurs when the psychologist, therapist, or counselor

decides to have another relationship with the client besides the client-counselor professional

relationship that has already been established. Code of Ethics section A.5 prohibits the counselor

from establishing any non-counseling roles and relationships with the client. However, section

A.6.b. states that in a situation where the counselor decides to extend counseling boundaries, he

or she should take appropriate professional precautions such as informed consent, supervision,

consultation, and documentation to ensure that judgment is not impaired and no harm occurs

(ACA, 2014). That confirms that the establishment of dual relationships can sometimes be

unavoidable but a professional counselor should take necessary precautions to ensure they do not

cause harm to either the client or the counselor. This paper describes a case study of a

psychologist who had established a dual relationship with her client and the external relationship

was adversely affecting the professional relationship with the client. The counselor, Dr. Ruth,

visited our offices seeking Client-centered case consultation after her client’s performance in

school continued to worsen even after recoding a positive response on her psychology sessions.

The paper discusses the unethical decisions made by Dr. Ruth, equal treatment, objectiveness,

and causing conflict of interest. As a professional counselor, it is essential to understand how to

avoid dual relationships and what to do in case they are unavoidable.

Case Study

Dr. Ruth visited our offices to seek Client-centered case consultation and my supervisor

assigned me to handle that case. Dr. Ruth was a professional psychologist who had started
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private practice two years ago where she was providing counseling services. Dr. Ruth also

doubled as a psychology teacher in one of the colleges in her community. She had practiced

teaching for over five years and her students were performing well. In her profession as a

psychologist, Dr. Ruth enrolled Mary, the client, who was struggling with depression after the

death of her biological parents in a fatal road accident. Mary lost her mother and father four

months ago in a car accident as they were coming from vacation. Mary was in the car but by

God’s mercies, she escaped with minor injuries. However, her parents were not lucky and they

all perished. Since that time, Mary started experiencing some depressive symptoms that include

difficulty sleeping at night, screaming at night, and having increasing episodes of crying

outbursts. She was admitted to a psychiatric hospital and after three weeks she was discharged.

However, her condition worsened, and therefore, she sought help from Dr. Ruth who offered to

help her. Their counseling sessions were successful and Mary had started showing significant

improvement. After two weeks of psychology sessions, Mary’s condition stabilized. Mary was

very happy with the help she had received from Dr. Ruth and vowed to enroll in a psychology

course so that she could help other people struggling with mental disorders in the future.

Coincidentally, Mary enrolled in her course at the college where Dr. Ruth was teaching.

She went ahead to register for a psychology class where Dr. Ruth was the teacher. Now, Dr.

Ruth became both a professor and a psychologist to Mary. She could teach Mary in school and

attend her counseling sessions in the evening. Even though Dr. Ruth hesitated to decide if she

should let Mary take her class, she finally gave in and allowed Mary to register for the class. Dr.

Ruth was in a dilemma since she felt allowing Mary to take the psychology class would bring

problems due to her relationship with Mary as her counselor. Dr. Ruth and her client, Mary,

vowed to keep their professional relationship outside class. They both agreed not to discuss their
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counseling sessions outside of the office. Dr. Ruth had also signed the confidentiality form and

vowed to keep information regarding their professional relationship confidential and private. She

never talked about their professional relationship with Mary while in class.

After a while, Mary started doing poorly in class but well in her counseling treatment

plan. Dr. Ruth found herself being lenient with Mary’s grades and allowed her to get away with

some inappropriate behaviors that include sleeping in class, coming to school late, and

absenteeism behavior. Dr. Ruth becomes conflicted and confused about whether or not to keep

Mary in class. As her counselor, Dr. Ruth knew Mary’s condition was improving and she would

get back to her normal life soon. However, her behavior in class was becoming unbearable and a

nuisance since she could often quarrel with her classmates because of minor issues. Dr. Ruth was

in a dilemma and she needed urgent assistance on how she could deal with the situation. Dr.

Ruth did not intend to create more issues in Mary’s life since she was in the progress of getting

better. Dr. Ruth knew very well expelling Mary from her class would negatively affect her well-

being. Mary viewed Dr. Ruth as a motherly figure and therefore, she wanted to retain their close

relationship. Dr. Ruth was Mary’s support system and her condition would worsen if she was

expelled from school. I listened to Dr. Ruth actively as she narrated the case. I could ask her

open-ended questions to extract more information regarding her personal relationship with Mary.

I made Dr. Ruth understand that she was being heard and therefore, she would get assistance on

how she could handle the ethical dilemma.

Analysis

The case described above shows that Dr. Ruth’s behavior was unethical based on the

Codes of Ethics. The National Association of Social Workers Code of Ethics states that a
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professional counselor should avoid dual relationships when possible. In this case, Dr. Ruth did

not try to avoid the dual relationship with Mary and established the personal relationship

knowingly. Consequently, it is evident that Dr. Ruth had a conflict of interest due to her

knowledge of Mary’s psychological state, and also she had a professional relationship with Mary

outside of the classroom. The action to establish a personal relationship with Mary caused Dr.

Ruth to make unethical and non-rational decisions. Dr. Ruth’s interest in Mary as her professor

in psychology class conflicted with her interest in Mary as her counselor. As a professor, Dr.

Ruth wants Mary to perform well in class and stop her ill behaviors while as a counselor, she

wants Mary to recover from her condition soonest, and therefore, she would not suspend her

from school since such a decision would worsen her condition. Ethical principle two of social

justice advocates for equal treatment for every individual in every situation. In this case, Dr.

Ruth was treating Mary unequally and as a special student to an extent of awarding her grades,

she did not deserve it simply because she knew Mary’s history. Therefore, this case has a

conflict of interests, unequal treatment, and unethical decisions simply because Dr. Ruth had

agreed to establish a dual relationship with Mary.

Solution

As a professional counselor, it was my responsibility to guide Dr. Ruth on how she could

handle her client, Mary. ACA C.2.a states that counselors should consult with their counselors

about the ACA Ethics and professionals regarding their professional practice (ACA, 2014). In

this case, Dr. Ruth consulted with me on the best or ethical solution to do as a way of solving the

ethical dilemma. In this case, I decided to use an ethical decision-making model where I would

consider the relevant ethical standards and principles. I asked Dr. Ruth to focus on setting

boundaries in her relationships with clients. I advised Dr. Ruth that her decision to establish a
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dual relationship with Mary was unethical even though it was unavoidable. Therefore, I asked

her to set firm boundaries with Mary to ensure their personal relationship does not affect the

professional relationship. It was important for Dr. Ruth to separate the two relationships; the

Teacher-student relationship and the Counselor-client relationship.

According to Brown & Armstrong (2022), boundaries are essential to a healthy

relationship with any client. Without firm boundaries, the counselor can be tempted to allow

problematic client behavior to continue for fear of upsetting or losing the client. In this case, Dr.

Ruth was not ready to confront Mary for her ill behavior of sleeping during classes and coming

to school late. She felt her action to confront Mary would worsen her condition. However, Dr.

Ruth’s unequal treatment of Mary can lead to a bigger problem down the road. As a matter of

fact, Dr. Ruth’s actions of awarding Mary good grades even when she is not performing well can

harm both her and her client. This is because Mary will graduate as an incompetent psychologist

while Dr. Ruth will have spoilt her reputation as a reputable and outstanding counselor and

professor. Boundaries make the relationship professional, and safe for the client and set the

parameters within which psychological services are delivered. ACA A.6. asks counselors to

maintain and manage boundaries and professional relationships (ACA, 2014). Therefore, Dr.

Ruth should have established clear boundaries between herself and Mary. I went further to

advise Dr. Ruth to use the two normative ethical theories that include deontology and

consequentialism to solve the dilemma. Dr. Ruth should value three critical principles of

decision-making: the moral consequences of an action, intrinsic morality, and the duty of care

(Wedding & Corsini, 2018). The integrative approach would be most appropriate to solve the

ethical dilemma in this case. Therefore, I advised Dr. Ruth to use an integrative approach in a

move to counseling sessions.

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Conclusion

Based on the case, Dr. Ruth had made unethical decisions to establish personal

relationships with Mary. Her unethical decision led to unequal treatment of Mary and a conflict

of interests. The personal relationship was a threat to their professional relationship and

therefore, Dr. Ruth had to seek help on how to deal with the ethical dilemma. The most

appropriate counseling technique to use in solving the dilemma was to set clear boundaries with

Mary. During class time, Dr. Ruth ought to treat Mary equally with other students and avoid

awarding her grades she does not deserve. During counseling sessions, Dr. Ruth should serve

Mary ethically according to the Codes of Ethics. Therefore, setting boundaries would help a lot

in this case. Dr. Ruth should also use the two normative ethical theories which include

deontology and consequentialism.

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References

American Counseling Association. (2014). 2014 ACA code of ethics: As approved by the ACA

governing council. [Electronic version].

Brown, T. A., & Armstrong, S. A. (2022). Use of Ethical Decision-Making Models Among

School Counselors. Journal of Professional Counseling: Practice, Theory & Research, 1-

12.

GoodTherapy. (2019). Dual Relationship. GoodTherapy, LLC. Retrieved on November 14, 2022

https://www.goodtherapy.org/blog/psychpedia/dual-relationship-definition

Wedding, D., & Corsini, R. J. (2018). Current Psychotherapies (11th ed.). Cengage Limited.

https://bookshelf.vitalsource.com/books/9780357191514