Managing Boundaries and Multiple Relationships

Tara Sandmayr

Client Rights/Ethics

11/22/11

Awareness of ethical codes and legal standards is an essential aspect of critical thinking about ethics and of making ethical decisions. Codes and standards, however, inform rather than determine our ethical decisions. They cannot substitute for thinking and feeling our way through ethical dilemmas, and cannot protect us from ethical struggles and uncertainty (http://kspope.com/ethics/boundary.php).

Boundaries are a crucial element in patient-therapist interaction. First and foremost, they recognize the inherent power inequality of the relationship and set limits for the therapist's expression of power. Second, they set a structure for the relationship, providing a consistent, reliable, predictable, knowable frame for a process that remains somewhat mysterious (http://www.psychologytoday.com/articles/199905/drawing-boundaries).

Your therapist probably won't be your friend because that would create a "dual (or multiple) relationship." Dual relationships occur when people are in two very different types of relationships at the same time. Many dual relationships are unethical in therapy. It is unethical for a psychologist to treat a close friend or relative, for example.

Dual roles can be classified as either foreseeable or unforeseeable. Foreseeable (or contemplated) dual roles are those that the therapist has time to consider or contemplate before engaging in them. An example of a foreseeable dual role would involve considering whether or not to provide psychotherapy to someone with whom you have had a prior social or business relationship. Unforeseeable (unpredictable or random) dual roles are those that cannot be reasonably foreseen. An unforeseeable role might involve joining a gym and later learning that one of the fitness instructors or gym members is one of your former clients (http://gapsychology.org/displaycommon.cfm?an=1&subarticlenbr=282).

One of the difficulties with dual relationships is that a problem in one relationship (such as a friendship or sexual relationship) can then cause problems in the other relationship (the therapy relationship). Some therapists have married former-clients, but current ethical guidelines (such as APA's Ethical Principles) often require several years to pass beforehand (http://mentalhealth.about.com/cs/psychotherapy/a/dualrelshps.htm).

A gradual erosion of boundaries can lead to very problematic multiple relationships that bring harm to clients. Gabbard cites the slippery slope phenomenon as one of the strongest arguments for carefully monitoring boundaries in therapy. This argument is based on the premise that certain actions can lead to a progressive deterioration of ethical behavior. To avoid the slippery slope therapists are advised to have a therapeutic rationale for every boundary crossing and to question behaviors that are inconsistent with their theoretical approach.(ethics page 278)

The code of ethics of most professional organizations warn of the potential problems of multiple relationships. The Ethics code caution professionals against any involvement with clients that might impair their judgment objectivity, affect their ability to render effective services, or result in harm or exploitation to the client. The therapist should be aware that any interaction outside of the therapy room is actually considered therapy. Actually both the therapist and the client needs to know this. Unfortunately the reality is that too many therapists have difficulty distinguishing where appropriate boundary lines should be drawn.

Dual or multiple relationships exist on a continuum ranging from boundary crossing for a clients benefit to sexual dual relationships that cause major harm to a client. The legal implications pertaining to dual relationships depend on the nature of the relationship and whether the client suffers harm. The mere existence of a multiple relationship does not constitute malpractice rather it is if the therapist abuses power, harms or exploits a client (ethics pg 269)

If a multiple relationship is going to be entered into there are some questions that should be asked; is this necessary, could it harm the client, would it prove beneficial, would it risk the therapeutic relationship, and finally can the therapist evaluate the matter objectively? Counselors must discuss with the client the potential problems involved in a multiple relationship and it is a practice to actively involve the client in the decision making process. If the multiple relationship is judged to be acceptable the therapist should document the entire process, including having the client sign an informed consent form. Other counselors should be involved as well because as hard as the therapist tries the counselor therapist relationship may dissipate over time. The therapist needs to get counseling during this time to make sure that transference is not happening and other dangers are not happening, to make sure that the therapist isn’t exploiting the client in some way. To repeat though the therapist needs to document everything of what happens in the dual relationship.

If the therapist finds that due to unforeseen factors, a potentially harmful multiple relationship has arisen, the therapist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.

Kenneth S. Pope, Ph.D., ABPP, Patricia Keith-Spiegel, Ph.D. (2007) A Practical Approach to Boundaries in Psychotherapy. Retrieved from;

http://kspope.com/ethics/boundary.php

By Deborah A. Lott (1999) Drawing Boundaries. Retrieved from;

http://www.psychologytoday.com/articles/199905/drawing-boundaries

William F. Doverspike, PhD, ABPP (2008) Dual Relationships and Psychotherapy. Retrieved from;

http://gapsychology.org/displaycommon.cfm?an=1&subarticlenbr=282

Leonard Holmes (2006) Why your Therapist is not your Friend. Retrieved from;

http://mentalhealth.about.com/cs/psychotherapy/a/dualrelshps.htm

Gerald Corey, Marianne Schneider Corey, Patrick Callana. (2007). Issues and Ethics in the Helping Profession. Belmont, CA: Brooks/Cole, Cengage Learning.