Dual Relationships

In psychotherapy, a dual relationship occurs when a therapist has a second, significantly different relationship with their client in addition to the traditional client-therapist bond. For example, a therapist may find that the person seeking treatment happens to be their neighbor.

Some dual relationships are unavoidable, as may be the case when a therapist is mandated to testify in court. But there are others which are voluntary or coincidental, such as when a therapist and client shop at the same stores in a small community. Regardless of the circumstances in which a dual relationship arose, a therapist should be careful to follow ethical guidelines and maintain healthy boundaries.

TYPES OF DUAL RELATIONSHIPS

According to the Zur Institute, the following are common types of dual relationships:

• Social dual relationship: The therapist is also a friend.
• Professional dual relationship: The therapist doubles as someone’s work colleague or collaborator.
• Business dual relationship: The therapist is also involved with someone in a business capacity.
• Communal dual relationship: Both the therapist and client are members of a small community and will likely run into each other or be involved in the same activities outside of the office.
• Institutional dual relationship: The therapist serves an additional role inherent to a particular institution, such as a prison, hospital, or military base. For example, a therapist could be a prisoner’s counselor and their parole evaluator.
• Forensic dual relationship: The therapist is a counselor as well as a witness in legal trials or hearings involving his or her client.
• Supervisory dual relationship: The therapist is also responsible for overseeing and supervising the client’s development as a professional therapist, as often occurs in educational settings.
• Digital, online, or Internet dual relationship: The therapist is connected with the client on social media sites such as Facebook, Twitter, and LinkedIn.
• Sexual dual relationship: The therapist and client are engaged in a sexual and/or romantic relationship.

SEXUAL DUAL RELATIONSHIPS

The APA Ethics Code forbids therapists from being sexually intimate with current clients due to ethical conflicts of interest. Likewise, therapists should not take on clients with whom they’ve been intimate in the past. The APA does allow therapists to pursue a romantic relationship with a former client, assuming at least two years have passed since the therapy ended. Yet even this kind of relationship is still highly discouraged.

On the surface, sexual dual relationships may appear to occur between two consenting adults. However, the nature of therapy puts a client in a uniquely vulnerable position. Therapy often involves sharing intimate thoughts and emotionally raw experiences. The client may be reluctant to share these things with a romantic partner, leading them to either avoid important issues in therapy or to cross their personal boundaries.

Research suggests most clients who have sex with their therapists ultimately view this intimacy as harmful. Even clients who initially enjoyed the sex generally found it exploitative in hindsight. These feelings may increase the clients’ symptoms of depression, suppressed anger, or suicidal ideation. The client may be more likely to isolate themselves and mistrust others, making it harder for them to receive adequate care in the future.

Therapists who have sex with clients can face severe consequences. They may be sanctioned by licensing boards and professional organizations. Their professional reputation may be damaged to the point that they no longer get new clients or referrals. They could also rack up expensive legal fees. As such, even when a therapist has sexual feelings for a client, it is not recommended that they act on said impulses.

ETHICAL CONCERNS WITH NONSEXUAL DUAL RELATIONSHIPS

Nonsexual dual relationships can be ethical or unethical depending on the circumstances. The distinguishing factor is often the establishment of mutual trust. Can each party rely on the other to respect their boundaries and needs? Or does one party misuse the other’s vulnerability?

In some cases, the dual nature of the relationship may be beneficial from a clinical standpoint. For example, if the therapist and client are colleagues in the mental health field, they may be interested in exploring certain techniques together. This exploration could prove useful for both parties so long as guidelines are agreed upon ahead of time.

In other cases, the dual relationship can be a detriment to the therapeutic relationship. A dual relationship is more likely to be harmful when:

• There is a lack of objectivity.
  • Example: A therapist may treat an influencer they follow on social media. Their admiration of the client may skew their clinical judgment.
• The boundary between roles is unclear.
  • Example: If a client and therapist are friends, they may inadvertently begin to discuss mental health issues outside the office.
• There aren’t any guidelines for when therapy will end.
  • Example: A client may be reluctant to terminate therapy with a close neighbor for fear of awkward encounters later.
• The difference in power makes it easy for the therapist to potentially harm the client.
  • Example: The therapist is also the client’s teacher and can give the client a bad grade.

When assessing the ethics of a dual relationship, it is important to ask whether the relationship is truly beneficial for both therapist and client.