Monday, January 28, 2008
Non-Sexual Dual Relationships - Conclusion
One of the core problems in blurred, dual, or conflictual relationships is the core idea presented by Pope. Pope made the claim that, " non-sexual dual relationships, while unethical and harmful per se, foster sexual dual relationships". The great fear and ethical taboo among therapists is sex with a client. According to Pope's reasoning, the primary rationale for avoiding all dual-relationships has been that they may eventually lead to a sexual relationship. This is not the only fear, but it is one of the greatest among professionals. Obviously not all non-sexual dual relationships lead to sexual ones, but it is likely that almost all sexual relationships have had to pass through a dual relationship stage at some point before turning into a fully sexual relationship. But, is it possible that some dual relationships can be beneficial to a client? In some circumstances they may be.
In the survey previously mentioned it was found that respondents considered some dual relationships to be useful. For example, some dual relationships provide role modeling, nurturing and a giving quality to therapy. This is one of the main dilemmas that people working in residential addiction treatment programs face. In many cases, the counselor/therapist can provide vital role modeling to clients.
Throughout the history of addiction treatment, addiction treatment professionals have struggled with this dual relationship dilemma. A national survey of 827 certified drug and alcohol counselors was conducted to determine their ethical beliefs and practices in the area of dual relationships. The results were compared to a national study of psychologists, psychiatrists, and social workers around 13 areas of practice behavior involving dual relationship situations and no significant difference was found between the groups. The results indicate that the same concerns over dual relationships plague professionals in many different counseling fields, not just those with graduate degrees.
Often professionals working in the field of residential addiction treatment are in recovery themselves. This presents both a unique problem and a unique opportunity for both the client and the clinician. Clinicians working in addiction treatment who are also recovering addicts are able to provide a model for recovery from addiction. However, problems arise when the clinician's recovery program coincides with the client's recovery program. This presents an unusual and tricky situation when clients, current or former, attend publicly held recovery meetings (Alcoholics Anonymous meetings, Narcotics Anonymous meetings, and other 12-step based community meetings) within their community.
The situation is this: A clinician attends her regular, local 12-step based recovery meeting. She walks into the meeting and suddenly one of her former, or perhaps current, clients waves at her from across the room. At first this may appear no different from any other situation where a professional runs into a client in a social setting, but the main difference here lies in the nature of the situation. When the addiction treatment clinician attends a recovery meeting and happens to encounter his client in the same meeting, the clinician is suddenly presented with an awkward situation. The therapist's role is now compromised. She is both therapist and patient.
The positive aspect of this particular compromising situation is that the addiction counselor is modeling positive behavior in the above example. The therapist/counselor is living what she is prescribing to the client, namely that addiction is something that can be overcome and something that she continues to address by attending recovery meetings. In this situation the dual role can be beneficial to the client.
At one time, ethical guidelines for addiction counselors were full of varying opinions on how to handle the situation mentioned above. Only recently have most of the addiction treatment licensing organizations adopted the wording of the APA ethical guidelines regarding dual relationships. According to Dr. Jerry Brown, an experienced clinical psychologist with over 20 years of experience working in the field of addiction treatment, in the past the general consensus among professionals working in the addiction treatment field was that no addiction treatment professional should attend a 12-step based meeting where his or her client(s) were also in attendance. In these situations it was suggested that the counselor or treatment professional immediately leave the meeting upon seeing the former or current client. This rule has widely been abandoned for more general statements in their ethical guidelines regarding dual relationships. The Department of Alcohol and Drug Programs Text of Final Regulations ยง13060 (c)(4) now states the following regarding dual relationships: "Engaging in social or business relationships for personal gain with program participants, patients, or residents, their family members or other persons who are significant to them" is prohibited. The attempt at defining what to do in certain situations, once an aspiration of addiction treatment licensing organizations, has become a thing of the past.
The law remains intentionally vague in certain areas so as to leave the judge and lawyers room to argue a particular angle based on the facts and circumstances of a case. It seems that the APA has chosen to do the same thing with its ethical code regarding dual relationships. If the APA were to attempt to do what addiction licensing boards have attempted to do in the past and define particular instances where dual relationships might occur and as far as to outline what the professional should do in each situation, then the APA would undoubtedly produce an exhaustive volume of rules and regulations that not even the most astute and cautious psychologist would read. Perhaps it is better that the APA keep the guidelines on dual relationships as they are and leave the interpretation to professionals. As discussed previously, not all dual relationships are harmful to the patient, but it is better left to the psychologist, the psychiatrist, the social worker and the addiction counselor as to where the line should be drawn.
Undergoing MyBlogLog Verification
In the survey previously mentioned it was found that respondents considered some dual relationships to be useful. For example, some dual relationships provide role modeling, nurturing and a giving quality to therapy. This is one of the main dilemmas that people working in residential addiction treatment programs face. In many cases, the counselor/therapist can provide vital role modeling to clients.
Throughout the history of addiction treatment, addiction treatment professionals have struggled with this dual relationship dilemma. A national survey of 827 certified drug and alcohol counselors was conducted to determine their ethical beliefs and practices in the area of dual relationships. The results were compared to a national study of psychologists, psychiatrists, and social workers around 13 areas of practice behavior involving dual relationship situations and no significant difference was found between the groups. The results indicate that the same concerns over dual relationships plague professionals in many different counseling fields, not just those with graduate degrees.
Often professionals working in the field of residential addiction treatment are in recovery themselves. This presents both a unique problem and a unique opportunity for both the client and the clinician. Clinicians working in addiction treatment who are also recovering addicts are able to provide a model for recovery from addiction. However, problems arise when the clinician's recovery program coincides with the client's recovery program. This presents an unusual and tricky situation when clients, current or former, attend publicly held recovery meetings (Alcoholics Anonymous meetings, Narcotics Anonymous meetings, and other 12-step based community meetings) within their community.
The situation is this: A clinician attends her regular, local 12-step based recovery meeting. She walks into the meeting and suddenly one of her former, or perhaps current, clients waves at her from across the room. At first this may appear no different from any other situation where a professional runs into a client in a social setting, but the main difference here lies in the nature of the situation. When the addiction treatment clinician attends a recovery meeting and happens to encounter his client in the same meeting, the clinician is suddenly presented with an awkward situation. The therapist's role is now compromised. She is both therapist and patient.
The positive aspect of this particular compromising situation is that the addiction counselor is modeling positive behavior in the above example. The therapist/counselor is living what she is prescribing to the client, namely that addiction is something that can be overcome and something that she continues to address by attending recovery meetings. In this situation the dual role can be beneficial to the client.
At one time, ethical guidelines for addiction counselors were full of varying opinions on how to handle the situation mentioned above. Only recently have most of the addiction treatment licensing organizations adopted the wording of the APA ethical guidelines regarding dual relationships. According to Dr. Jerry Brown, an experienced clinical psychologist with over 20 years of experience working in the field of addiction treatment, in the past the general consensus among professionals working in the addiction treatment field was that no addiction treatment professional should attend a 12-step based meeting where his or her client(s) were also in attendance. In these situations it was suggested that the counselor or treatment professional immediately leave the meeting upon seeing the former or current client. This rule has widely been abandoned for more general statements in their ethical guidelines regarding dual relationships. The Department of Alcohol and Drug Programs Text of Final Regulations ยง13060 (c)(4) now states the following regarding dual relationships: "Engaging in social or business relationships for personal gain with program participants, patients, or residents, their family members or other persons who are significant to them" is prohibited. The attempt at defining what to do in certain situations, once an aspiration of addiction treatment licensing organizations, has become a thing of the past.
The law remains intentionally vague in certain areas so as to leave the judge and lawyers room to argue a particular angle based on the facts and circumstances of a case. It seems that the APA has chosen to do the same thing with its ethical code regarding dual relationships. If the APA were to attempt to do what addiction licensing boards have attempted to do in the past and define particular instances where dual relationships might occur and as far as to outline what the professional should do in each situation, then the APA would undoubtedly produce an exhaustive volume of rules and regulations that not even the most astute and cautious psychologist would read. Perhaps it is better that the APA keep the guidelines on dual relationships as they are and leave the interpretation to professionals. As discussed previously, not all dual relationships are harmful to the patient, but it is better left to the psychologist, the psychiatrist, the social worker and the addiction counselor as to where the line should be drawn.
Undergoing MyBlogLog Verification
Labels: Dual-Relationships
Friday, January 25, 2008
Non-Sexual Dual Relationships - Surveys
A survey was conducted of 4,800 psychiatrists, psychologists, and social workers to determine their ethical attitudes and practices towards dual relationships It was determined that most of those surveyed believed that dual role behaviors were unethical in most circumstances and most reported that they had rarely, if ever, engaged in such behavior. This being said, "sexual and nonsexual relationships form the major basis of financial losses in malpractice suits, licensing disciplinary actions, and ethics complaints against psychologists (Ethics Committee of the APA,".
The survey conducted by Pope and Borys examined eighteen dual relationship situations that are common among health professionals:
1. Accepting a gift worth under $10.
2. Accepting a client's invitation to a special occasion.
3. Accepting a service or product as payment for therapy.
4. Becoming friends with a client after termination.
5. Selling a product to a client.
6. Accepting a gift worth over $50.
7. Providing therapy to an employee.
8. Engaging in sexual activity with a client after termination.
9. Disclosing details of current personal stresses to a client.
10. Inviting clients to an office/clinic open house.
11. Employing a client.
12. Going out to eat with a client after a session.
13. Buying goods or services from a client.
14. Engaging in sexual activity with a client.
15. Inviting clients to a personal party or social event.
16. Providing individual therapy to a relative, friend, or lover of an ongoing client.
17. Providing therapy to a current student or supervisee.
18. Allowing a client to enroll in one's class for a grade.
The above situations are common among health professionals, but even more so among health professionals in certain situations, particularly settings where dual relationships exist naturally. As mentioned previously, this often occurs in small rural communities, military settings, and residential alcohol and drug treatment programs. In these settings therapists are forced into relationships that according to the definition of dual relationships in the code of ethics would be considered unethical. For example, active duty military psychologists fulfill dual roles as therapists and commissioned military officers, which means that they not only have a professional duty to their clients, but also to the military or Department of Defense.
For this reason, many professionals have called for further clarification of the definition of dual relationships. In a study conducted by Kenneth Pope, a leading expert in the field of ethics, and Valerie Vetter a random sample of 1,319 members of the American Psychological Association were asked to describe incidents that they found ethically troublesome. Their intention was to gather information that might be useful in considering possible revisions of the code.
Their report produced the following statement from Pope and Vetter regarding dual relationships:
A national survey of psychologists resulted in a call for changes to the APA ethical principles in the areas of dual relationships, multiple relationships, and boundary issues so that the ethics code would:
(1) define dual relationships more carefully and specify clearly conditions under which they might be therapeutically indicated or acceptable,
(2) address clearly and realistically the situations of those who practice in small towns, rural communities, remote locales, and similar contexts (emphasizing that neither the current code in place at the time nor the draft revision under consideration at that time fully acknowledged or adequately addressed such contexts), and
(3) distinguish between dual relationships and accidental or incidental extra-therapeutic contacts (e.g., running into a patient at the grocery market or unexpectedly seeing a client at a party) and to address realistically the awkward entanglements into which even the most careful therapist can fall.
The survey conducted by Pope and Borys examined eighteen dual relationship situations that are common among health professionals:
1. Accepting a gift worth under $10.
2. Accepting a client's invitation to a special occasion.
3. Accepting a service or product as payment for therapy.
4. Becoming friends with a client after termination.
5. Selling a product to a client.
6. Accepting a gift worth over $50.
7. Providing therapy to an employee.
8. Engaging in sexual activity with a client after termination.
9. Disclosing details of current personal stresses to a client.
10. Inviting clients to an office/clinic open house.
11. Employing a client.
12. Going out to eat with a client after a session.
13. Buying goods or services from a client.
14. Engaging in sexual activity with a client.
15. Inviting clients to a personal party or social event.
16. Providing individual therapy to a relative, friend, or lover of an ongoing client.
17. Providing therapy to a current student or supervisee.
18. Allowing a client to enroll in one's class for a grade.
The above situations are common among health professionals, but even more so among health professionals in certain situations, particularly settings where dual relationships exist naturally. As mentioned previously, this often occurs in small rural communities, military settings, and residential alcohol and drug treatment programs. In these settings therapists are forced into relationships that according to the definition of dual relationships in the code of ethics would be considered unethical. For example, active duty military psychologists fulfill dual roles as therapists and commissioned military officers, which means that they not only have a professional duty to their clients, but also to the military or Department of Defense.
For this reason, many professionals have called for further clarification of the definition of dual relationships. In a study conducted by Kenneth Pope, a leading expert in the field of ethics, and Valerie Vetter a random sample of 1,319 members of the American Psychological Association were asked to describe incidents that they found ethically troublesome. Their intention was to gather information that might be useful in considering possible revisions of the code.
Their report produced the following statement from Pope and Vetter regarding dual relationships:
A national survey of psychologists resulted in a call for changes to the APA ethical principles in the areas of dual relationships, multiple relationships, and boundary issues so that the ethics code would:
(1) define dual relationships more carefully and specify clearly conditions under which they might be therapeutically indicated or acceptable,
(2) address clearly and realistically the situations of those who practice in small towns, rural communities, remote locales, and similar contexts (emphasizing that neither the current code in place at the time nor the draft revision under consideration at that time fully acknowledged or adequately addressed such contexts), and
(3) distinguish between dual relationships and accidental or incidental extra-therapeutic contacts (e.g., running into a patient at the grocery market or unexpectedly seeing a client at a party) and to address realistically the awkward entanglements into which even the most careful therapist can fall.
Labels: Dual-Relationships
Wednesday, January 23, 2008
Non-Sexual Dual Relationships - Intro
Non-sexual dual relationships within the field of counseling are a controversial issue. The essential question to be answered is, where is the professional boundary line between counselor and client? Underneath this general ethical umbrella lies many more specific questions that ethicists struggle with. Among these are: Is it alright to provide therapy to a friend or relative? Is it OK to borrow money from clients? If so, how much is OK? Is it OK to go into business with a client? If not, what about going into business with a client's father? These are just a few of the questions that abound within the questionable, debatable ethical realm of dual relationships.
Ethical questions are determined on a case-by-case basis. There are no clear black and white rules that do not warrant debatable alternatives to be discussed and considered. There is one golden rule which stands above the rest within the clinical world of counseling: Do not have sex with a patient. But, apart from this golden rule, there is little that cannot be discussed and deliberated.
Within the counselor's office there is little left to the imagination as to what is ethical and what is not. It is an ethical embassy of sorts, a sanctuary where client exists on one side and counselor, or psychologist, is on the other. The line between them is palatable. The relationship begins and ends within the confines of a physical space. Patient enters and patient leaves. The more difficult dual relationship questions arise when the physical safety of the ethical embassy, which is the counselor's office, becomes invaded, or perhaps does not exist. Small rural communities, military bases, and residential addiction treatment communities are just a few places where the confines of an office are sometimes limited and less geographically defined and private. Even if a psychologist practices in one location and lives in another, there are situations that may occur which puts the psychologist in the middle of a dual relationship ethical dilemma. What is worse is when there are situations or circumstances that inevitably place the psychologist in a dual relationship situation.
All major mental health professional codes contain a proscription against dual relationship. Role theory is often used to describe the process of dual relationships. "Social roles contain inherent expectations about how a person in a particular role is to behave as well as the rights and obligations which pertain to that role". Conflicts within these relationships arise when either role's expectations of the other exceed that which is inherent. When expectations are exceeded, dual relationships are created.
Although dual relationships are generally frowned upon, not all dual relationships are bad. The American Psychological Association ethical principles recognize multiple or dual relationships as something that is sometimes unavoidable. The APA states that, "it may not be feasible or reasonable for psychologists to avoid social or other nonprofessional contact with persons such as patients". The primary warning is in developing a dual relationship when it appears likely that the relationship will interfere with the therapeutic process. If, "it appears likely that such a relationship reasonably might impair the psychologist's objectivity or otherwise interfere with the psychologist's effectively performing his or her functions as a psychologist, or might harm or exploit the other party".
Ethical questions are determined on a case-by-case basis. There are no clear black and white rules that do not warrant debatable alternatives to be discussed and considered. There is one golden rule which stands above the rest within the clinical world of counseling: Do not have sex with a patient. But, apart from this golden rule, there is little that cannot be discussed and deliberated.
Within the counselor's office there is little left to the imagination as to what is ethical and what is not. It is an ethical embassy of sorts, a sanctuary where client exists on one side and counselor, or psychologist, is on the other. The line between them is palatable. The relationship begins and ends within the confines of a physical space. Patient enters and patient leaves. The more difficult dual relationship questions arise when the physical safety of the ethical embassy, which is the counselor's office, becomes invaded, or perhaps does not exist. Small rural communities, military bases, and residential addiction treatment communities are just a few places where the confines of an office are sometimes limited and less geographically defined and private. Even if a psychologist practices in one location and lives in another, there are situations that may occur which puts the psychologist in the middle of a dual relationship ethical dilemma. What is worse is when there are situations or circumstances that inevitably place the psychologist in a dual relationship situation.
All major mental health professional codes contain a proscription against dual relationship. Role theory is often used to describe the process of dual relationships. "Social roles contain inherent expectations about how a person in a particular role is to behave as well as the rights and obligations which pertain to that role". Conflicts within these relationships arise when either role's expectations of the other exceed that which is inherent. When expectations are exceeded, dual relationships are created.
Although dual relationships are generally frowned upon, not all dual relationships are bad. The American Psychological Association ethical principles recognize multiple or dual relationships as something that is sometimes unavoidable. The APA states that, "it may not be feasible or reasonable for psychologists to avoid social or other nonprofessional contact with persons such as patients". The primary warning is in developing a dual relationship when it appears likely that the relationship will interfere with the therapeutic process. If, "it appears likely that such a relationship reasonably might impair the psychologist's objectivity or otherwise interfere with the psychologist's effectively performing his or her functions as a psychologist, or might harm or exploit the other party".
Labels: Dual-Relationships
