Ethical Decision-making and Dual Relationships
An in-depth look at the situation of dual relationships in a counselling context. The recent revision of the ACA Code of Ethics significantly changes the ethical guidelines related to dual relationships. Careful review of the. Examples of dual relationships are when a client is also a student, friend, employee or Lack of goals and reflection on progress in therapy.
Some relationships, such as those that include sexual or financial involvement, clearly violate the ethical codes of almost all professional organizations. Others, such as allowing a client to buy the therapist a cup of coffee after a chance meeting in a restaurant, appear to be quite harmless. Mental health professionals diverge in opinions when it comes to dual relationships. However, the vast majority of therapists agree that dual relationships should be avoided, arguing that transference and counter transference are powerful responses that will inevitably influence the therapeutic relationship.
Along with most ethical dilemmas, it is largely a matter of each case: According to Karen Kitchenerthe types of dual relationships which were most likely to be detrimental to a therapeutic relationship included the following aspects: To surpass difficulties with dual relationships, counsellors ought to ascertain clear and realistic boundaries around the professional relationship with their clients.
Such boundaries need to consider the needs and characteristics of each client, and how that will reflect in the overall relationship. Codes of practice and guidelines are important to set these boundaries; however, professionals must be sensitive to particular needs in each relationship and apply such knowledge to improve decision-making in the counselling process.
Mandatory Reporting Mandatory reporting, or duty to warn, is one of the most sensitive topics in therapy and mental health. The bare existence of this concept already conflicts with ethical principles of confidentiality, thus deciding to report a client is a paradoxical pattern of thinking for any such professional. Nevertheless, it is an extremely important issue. When laws and values conflict, which side should you take? Most cases of information disclosure in therapy are for the benefit of the client, such as sharing information with colleagues or supervisors in order to obtain an alternative opinion or perspective.
Thus, the default answer to the previous question is in fact, the law. Needless to say, counsellors should be flexible when making decisions regarding mandatory reporting. There are several law frameworks which govern countries, states and regions, and each of them has its own agenda in respect to mandatory reporting requirements.
Additionally, a wide variety of codes of conduct are also likely to influence the decision-making process for therapists and mental health professionals. Usually the determination of whether or not a professional committed a violation of professional practice is arrived at retrospectively when experts or ethics committees evaluate a case. Thus, and consistent with the risk management model of the APA Insurance Trust, when one chooses to enter into a dual relationship one is forced prospectively assess how these professionals might retrospectively view a specific case, potentially years after it occurred.
So, when assessing whether or not to enter into a dual relationship, one is almost forced to predict future reactions to their conduct, something that is not at all easy to do. Hopefully, by answering the following questions in a step by step fashion a professional who is considering entering into a dual relationship will increase the likelihood that he or she will make the correct choice in the matter: Is the dual relationship necessary?
This is a very important question for the mental health professional to answer. Therapy by itself is complex and difficult to perform without the introduction of other factors. Thus, at the outset a professional must address whether he or she even needs to enter into a dual relationship.
Simply put, unnecessary dual relationships can be fraught with unnecessary risk. As a rule, it is likely to be in the best interests of the professional, regardless of location, to avoid dual relationships if at all possible. However, if the dual relationship is necessary, then the professional is forced to answer the next question. Is the dual relationship exploitive? This is an easy one. Exploitation of patients is unethical and if the proposed dual relationship is exploitive of the patient, then it is unacceptable.
If exploitation is not evident or if it can be avoided, then the professional is forced to move on and answer the next question. Who does the dual relationship benefit? Since it is unethical to exploit patients, just whom does the relationship benefit?
This is a dilemma often faced by those who work in small communities. However, not all dual relationships are as easy to assess as this small town dilemma. For example, what about purchasing a car from the local dealership in a small town when the owner of the dealership is your patient and when failure to do so would make people in the community wonder just why you did not buy the car locally?
Benefit in this case is not as easy to assess. To purchase the car elsewhere would not only raise wonder in the community but also could impact your therapeutic alliance.
The answer to this example only becomes more complex when trying to decide whether or not to negotiate the price of the vehicle with your patient? So, assessing just who benefits by the decision to enter into a dual relationship is not so easy to assess.Ethics- Client & Therapist Relationships
Is there a risk that the dual relationship could damage the patient? This also is not an easy question to answer and it calls for a great amount of objectivity on the part of the professional.
Dual relationship - Wikipedia
Consistent with the principles of biomedical ethics, interventions should not harm patients, or at least an attempt must be made to minimize the risk of harm. In that spirit, an additional relationship that is combined with therapy must be assessed for harm and its harmful effects must be controlled for and minimized.
That is not to say that a professional entering into a dual relationship must completely prevent risk, but that each of us has a fiduciary obligation to be in touch with risk factors, to manage them and to minimize them.
Is there a risk that the dual relationship could disrupt the therapeutic relationship?
This question is one that not only requires consideration before entering into the dual relationship but also is one that must be asked throughout the treatment process. In the spirit of minimizing risk, the therapist who chooses to enter into a dual relationship with a client, or one who is even forced into the dual relationship, must manage the relationship in such away that the therapeutic component is not damaged by the secondary relationship.
In this spirit, the therapist has an obligation to discuss this factor in detail with the patient prior to entering into the dual relationship and must also keep this topic and related issues at the forefront of treatment to avoid any damage to the therapeutic alliance.
Am I being objective in my evaluation of this matter? This is a very difficult question to answer since it is arguable that no one is really objective.
The answer to this question requires consultation with others, and not only those in the mental health field but also in related fields, like law. Personal needs are not things with which we are always in touch and given the inherent high level of risk that is associated with this type of conduct, one must not only answer the above questions by oneself, but should go through them with another individual to assure that the answers are as objective as they could be.
Once a therapist has addressed the above questions, he or she is now forced to move into what could be termed "risk management mode. In that spirit, the mental health professional that has addressed the previous questions and has obtained a positive outcome, must now address the following.