Tag Archives: dual relationships

Why can’t we be friends?

By Allison L. Kramer January 27, 2016

Over the past three decades, researchers have examined multiple relationships between psychotherapists and their current and former clients, and boundary issues have been explored in the ethics literature. In day-to-day practice, multiple relationships (also known as dual-role relationships) with current clients are commonplace for some practitioners. In some instances, these relationships can be unavoidable and even beneficial. For example, it is not uncommon for a school counselor to also be the coach of a sports team, thus filling both a counselor and a coach role for students.

A_KramerDiscussions of multiple relationships with former clients have been relatively scarce until recent years. In the late 1980s and early 1990s, research began regarding the ethics of counselors entering sexual relationships with former clients, culminating with the ACA Code of Ethics prohibiting sexual relationships with former clients for a period of at least five years post-therapy (see Standard A.5.c.). More recently, studies have examined how therapists view nonsexual relationships with former clients. Interestingly, research suggests that therapists feel less ethically conflicted about entering these relationships with former clients than they have in the past. For example, in 1989, Debra Borys and Kenneth Pope reported that 46 percent of therapists thought that becoming friends with former clients was ethical under some conditions. In a 1996 study, William Salisbury and Richard Kinnier found that 70 percent of counselors held this belief. In 2004, Tracey Nigro and Max Uhlemann found that a whopping 83 percent of counselors thought that becoming friends with former clients was ethical at least some of the time.

Research design

So, what about clients’ perspectives of friending a former counselor? My colleagues Sharon Anderson, Jim Banning, Suzan AlDoubi and I took a mixed-methods approach to study former clients’ experiences of nonsexual post-therapy relationships with their therapists (the research was inclusive of psychologists and counselors).

In the first phase, Sharon collected and analyzed data from a questionnaire. The questionnaire asked former clients to provide demographic data (e.g., their gender, the former therapist’s gender, their ethnicity, the former therapist’s ethnicity, age while in therapy, reason for therapy, estimated time between therapy termination and post-therapy contact, and who initiated contact). In addition, participants were asked to:

1) Describe the post-therapy relationship

2) Indicate whether they thought the post-therapy relationship was positive, neutral or negative for them

3) Explain why they thought the relationship was positive, neutral or negative for them

4) Indicate whether they would be willing to be interviewed about the post-therapy relationship and its impact on them

In the second phase, Sharon conducted interviews with nine former clients who responded to the questionnaire. Participants were interviewed one at a time, and the interviews ranged from one hour to 90 minutes each. Prior to beginning the interview, informed consent was discussed and obtained. A debriefing sheet listing referral for counseling was provided. Participants were informed that the research findings might be published but that their names and identifying information would be altered to protect their confidentiality. All interviews were recorded and transcribed.

Of the nine clients interviewed, eight were female. All participants identified themselves as white or Caucasian. Their ages while in therapy ranged from 16 to 56. Reasons for being in therapy included couples work, grief and loss, self-esteem, anorexia, depression, suicide in the family, suicidal ideation, sexual abuse, family-of-origin issues, transitional issues, dissociative identity disorder and posttraumatic stress disorder. Time in therapy ranged from seven months to five years. The estimated time between therapy termination and post-therapy contact ranged from a few weeks to two years.

Former clients and former therapists were almost equally responsible for initiating post-therapy contact, with five clients initiating contact and four therapists initiating contact. Regarding the former therapist’s gender, there were five males and four females. The ethnicities of the former therapists were reported as African American, German, Jewish, Irish and white.

Results

Our findings examined the following five variables:

1) The type of post-therapy contact between the former client and therapist

2) Which party initiated post-therapy contact

3) The transition between therapy and post-therapy relationship

4) Power issues in the post-therapy relationship

5) The impact of the post-therapy relationship on the former client

Quotes from the former clients (using pseudonyms) are included to highlight these results.

Type of post-therapy contact 

We identified three different types of post-therapy contact that participants described with their former therapists.

1) Incidental 

Simon: “I’ve only seen her in class. I think maybe I’ve stopped by her office once or twice just to say hello, but it’s just been in a classroom where she’s like a TA [teaching assistant] now and I’m a student.”

2) Professional

Jewell: “We are in the same field. She had developed some workshops. Then as I moved into private practice, I began wanting something for my clients that I knew she had to offer. So I began to do some training with her, so there was a process of not therapy anymore, but more training and mentoring.”

3) Personal

Lacey: “Me and my husband have done a couple things with her and her husband, like dinner and things like that. I talk to her on the phone maybe once a month. … I call her, she calls me. It’s not just a one-way thing.”

Alice: “So I went to workshops with her, and I think part of us becoming friends was that I cleaned her house to pay for therapy. And so I kind of got to know her a little bit better that way, and then after, we just hung out. She had been friends with my mom some, but then she got to be closer with me, and we talked on the phone and we were like friends and went out quite a bit, and I went to workshops that she did. I also took a psychology class from her later.”

Jeg: “I wouldn’t really call it a friendship like my other friendships in my life. It’s not the kind of friend that I would call and shoot the breeze with and tell the latest news to. It’s a friendship in the sense of … it’s two-sided. I tell her how I am doing now, and she also shares with me what’s going on in her personal life. Again, I don’t think she shares great intimate details like really close friends might. There’s just a real warm regard and mutual interest.”

Lanette: “I think to me the post-treatment contact … has been kind of leveling, kind of humanizing. [It] kind of keeps things for me in perspective, in terms of ‘you’re a person, I’m a person,’ and even though we have had this very intense and sometimes traumatic contact, basically, we’re just people muddling along the best we can. … I guess what I am saying is, to me, it sort of makes them like friends, although they are not friends in the way most of my friends are my friends. They’re something between a friend and an acquaintance.”

Flo: “I knew he loved me … and his wife loved me as well. I was friends with him, and I was friends with his wife. I’m an artist, and he loved my work and he came to all my openings. … We did some neat things together. It was great.”

Initiator of post-therapy contact

We asked participants to recall who initiated the contact after therapy. Was it the former client, or was it the former therapist who made the first move? Four responses came out of the analysis:

1) Former therapist

Leni: “So, I had initiated the termination in February after we had the discussion about it for about six months, and then I didn’t have any contact with him until June. He wrote me a letter saying that he would be willing [to see me] if I needed anything.”

2) Former client 

Lanette: “We moved from _____, which is just so different. We’ve gone back for each vacation, and last summer we saw him … and this summer I expect we will also. I went back by myself in December and arranged to meet with him.”

Jewell: “As I moved into private practice and I began wanting something for my clients that I knew she had to offer, I started calling her to ask her about ‘What do you do in this workshop?’ and ‘What has been helpful?’ and ‘What’s the theory base?’ [and] ‘Whose work have you drawn on for that?’”

3) Both/mutual

Jeg: “When I go to town, we get together and have lunch. We send Christmas cards. … She sends birthday cards, Christmas cards. A couple of times she sent me a short letter with an article or something like that.”

Alice: “She had been friends with my mom some, but then she got to be closer with me, and we talked on the phone and we were like friends and went out quite a bit, and I went to workshops that she did.”

4) Neither/circumstantial 

Simon: “The person I had been in therapy with is a doctoral student here at ___. I’ve only seen her in class.”

Transition between therapy and post-therapy relationship 

We wondered how the therapist handled this transition. In analyzing this part of the interviews, we found two themes: 1) the termination of the therapy relationship was not clear and 2) the termination was clear, with the termination process being clearly discussed.

1) Unclear termination 

Leni: “He had some formula, being psychoanalytically based, that if you were in therapy this number of years, termination equaled that amount of time. And up to a year of termination was the thought. I was feeling like that would be dragging it on, and we discussed the issue … but he said that would not feel like it was a termination. So I had struggled with that sort of wanting to be successful in treatment but yet not being able to afford it and feeling like it just kept going on and on. He wrote me a letter saying that he would be willing [to see me] if I needed anything … and I saw him one or two times. … It was basically that I still had some wish to sort of bring closure more successfully than it had been done.”

Lacey: “I don’t really remember a termination process. I knew when I was going to see her for the last time [that] it would be the last time … but nothing really was said. Actually, I know there wasn’t any [termination process]. I would have remembered that.”

2) Termination process clearly discussed

Simon: “Our schedules were changing. I had kind of gotten to a place where I didn’t feel like I was making any more progress, so I said, ‘Well, this has been real helpful, but I’ve gotten what I needed to get out of this,’ and so we … did go through what felt like a real formal termination.”

Lanette: “There was a winding down. We’d already gone through a winding down emotionally, and he had preferred to see me once a week until the day that I left. … We talked a lot about termination, which was extremely difficult for me, extremely painful.”

Jewell: “It was gradual in that I probably went fairly regularly to her — maybe every other week. Then it got less frequent, sometimes once a month. … And when my family moved, we talked about it, that phase was ending, and that phone contact would be available if I needed it. I’m not sure what to say about termination except that it was pretty clear, pretty gradual: ‘Call me if and when you need to, but you’re doing well and don’t need it.’ So it was seen as an achievement. It actually was not painful. That was really nice.”

Power issues during post-therapy contact

A power differential exists in the therapy relationship. The therapist is there to offer expertise, and the client is there as a customer who pays for the service rendered. Thus, the counselor is seen as having more power in the therapeutic relationship. But what happens to the power differential in the post-therapy relationship? Two participants saw the power within the post-therapy relationship as being more or less equal. The other seven participants described the power differential as remaining unequal, with the therapist continuing to hold more of the power in the relationship and, at times, transference and dependency continuing.

1) Equal power

Simon: “Toward the end, I felt when I left that she was not like the almighty therapist like when I had originally started therapy a number of years ago. When I first started, I used to think, ‘This person’s like next to God or something.’ [Then I] was able to see her as a real genuine person. I think I still do.”

Flo: “Well, now that I think about it, part of getting healed is getting to feel good about yourself. As the relationship progressed and I got better, that [feeling of being equal] would transpire. … I think it was a combination of his trusting me and my expertise and his openness. He told me … some of the things he was dealing with.”

2) Unequal power

Jeg: “I initially saw her as the person with the answers, a person who was going to tell me what to do so I could make it all better. And a lot of times I was real pissed off at her because she didn’t do that, so in that sense, she was a sort of parent figure for a while. And even now, I think that’s why I would probably say we may not ever be friends in the sense as regular friends are.”

Jewell: “I think power differential in the therapy and supervisory relationship of course are there, though she worked very intentionally on not being the all-knowing, all-powerful person. So I would say there was, in a sense, a power differential, however unintentional, [and] I think it’s been a little tricky … to go into more of a mutual, really truly mutual relationship. I think the fact that I have trouble calling her or taking the initiative has to do with the fact that she is about the age of my mother and some of the difficulty of relating to my mom. I assume that she is not going to be really present, even though she always has been. I sort of think, ‘Well, I don’t want to bother her,’ so I think some of that is still there. Do I mention it to her, set it aside and say, ‘This isn’t my mother’? I think there’s a piece of it that is just there and the relationship is just too big of a trigger for it.”

Lacey: “When I go see my family in the summer, they live in the same town. Should I call her and let her know I’m in town? Should I just wait to see if she calls me before I go? Maybe I should just forget it, but then what does that mean? Can I still call her as a therapist or not? It’s kind of confusing. I don’t sit and ponder those thoughts very often. But you better believe, driving to Texas, I’ll think about that a lot, thinking maybe I should call her. I don’t want her to get mad if I don’t call and she knows I’ve been in town. It’s one of those kind of bitchy friendships a little. It’s just confusing.”

Impact of post-therapy contact 

We were interested to hear participants’ assessment of the impact of the post-therapy relationship. We identified four themes, ranging from harmful to beneficial.

1) Definite harm: To these former clients, post-therapy contact was extremely confusing. Interactions with former therapists were disorienting and harmful, compromising the work accomplished in therapy.

Lacey: “If I was a counselor, I would never do it. I just kind of think … ‘I wonder if she is going to call? Well, should I call her? Well, I’m just kind of confused. This sucks.’”

2) Possible harm: To these former clients, post-therapy contact was conflicting and confusing. Participants were in post-therapy relationships, yet preferred to be completely done with the therapist and on with life. The former therapist continued to encourage connection.

Leni: “When I got the letter, it felt like I was valued and that I was important, and that felt good. At the same time, it felt like I had to read between the lines. … So, I remember carrying the letter around for a long time [because] that gave me some sense of security. But at the same time, [it was] frustrating because it continually sort of challenged me to call him or not call him … call him or not call him … call him or nor call him. Sort of perseverating on that unfinished feeling.”

3) No benefit, no harm: The post-therapy interactions occurred because of external circumstances.

Simon: “I know she works here on campus, and I have stopped in and seen her. It felt real reassuring just to stop in and say hi and touch base. I did that a couple of times and it was like, ‘I can let this go.’”

4) Beneficial, yet confusing: These former clients initiated the post-therapy contact. Participants talked about the good connection with their therapist. At the same time, their statements at times suggested confusion about the relationship.

Lanette: “I always tell them in our Christmas letter when we’re coming out there. … It’s just kind of nice to lay eyes on them again … see that they’re still walking around, kicking, doing the
same stuff.”

Jeg: “The whole experience of working with her I wouldn’t trade for anything. I might put it up there with the most important thing I’ve ever been through. And even now, I think that’s why I would probably say we may not ever be friends in the sense as regular friends are. It is hard for me to completely not have her in that role.”

Jewell: “I don’t want to bother her, and I didn’t know if I would be bothering her or not with that. She said that she wished I would sometimes. That she is an old woman and would welcome it, having that connection. I said, ‘Well, you know you don’t call me.’ She said, ‘I have followed your lead on that part.’ There’s still some of that transition. However, it’s probably been much harder for me than her (laughs). It may sound a little crazy. It is not neat and tidy.”

Discussion

Standard A.6.e., Nonprofessional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships) of the ACA Code of Ethics states: “Counselors avoid entering into nonprofessional relationships with former clients … when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships.”

The central theme inherent in all the interviews we conducted was confusion. Is confusion potentially harmful to former clients? We believe it is. Thus, we suggest if there is the potential for a role change to a nonsexual post-therapeutic relationship, then the potential for confusion should be an ongoing discussion in counseling.

Standard A.6.d., Role Changes in the Professional Relationship, states: “When counselors change a role from the original or most recent contracted relationship … clients must be fully informed of any anticipated consequences … of counselor role changes.” Again, we believe the potential for confusion as a result of changing roles should be a part of this conversation.dogLaptop

Finally, we suggest that all nonclinical, post-therapy contact should be initiated by the client. Standard A.4.b., Personal Values, says, “Counselors are aware of — and avoid imposing — their own values, attitudes, beliefs and behaviors … onto clients, especially when the counselor’s values are inconsistent with the client’s goals …”

If clients want to return to counseling, or to transition from a therapeutic relationship to a friendship, the right and responsibility to renew or reinvent the relationship should be theirs alone. Overcoming the power differential inherent in therapy is tricky. Giving clients the power to decide if and when to pursue a post-therapeutic relationship is but one step in acknowledging their autonomy and effort in becoming happier, healthier people.

We believe counselors seeking therapy would expect nothing less from their own therapists.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Allison L. Kramer is associate professor and program lead at Johnson & Wales University in Denver. She is a licensed professional counselor and a level-two certified addiction counselor in Colorado. Contact her at akramer@jwu.edu.

Letters to the editor: ct@counseling.org

Behind the book: Boundary Issues in Counseling

By Bethany Bray January 7, 2015

There are lots of “what ifs” that come with being a professional counselor.

What if a client invites you to his or her wedding or graduation party? Should you go?

What if you’re one of only a few counselors in a rural area, and a client turns out to be your child’s schoolteacher? What if a client wants to hug at the conclusion of a particularly emotional session?

“Multiple relationship issues exist throughout our profession and affect virtually all counselors, regardless of their work setting or the client populations they serve,” write Barbara Herlihy and Gerald Corey in the third edition of their book Boundary Issues in Counseling. “No professional remains untouched by the potential difficulties inherent in dual or multiple relationships.”

When it comes to relationship boundary issues, there is never a definitive or one-size-fits-all answer, say Herlihy and Corey. The solution will vary with each client and each situation. For counselors, the Boundry-issues-branding-boxkey is to have a method of thinking through each decision, from reading the latest professional literature to brainstorming with colleagues.

“We make no claim to having discovered the answers to many complex and difficult questions,” Herlihy and Corey write in the book’s preface. “Rather, it is our aim to raise issues, present a range of viewpoints and discuss our own position. Our hope is that you will use this material as a springboard for further reflection and discussion. We invite you to think about the issues that are raised, apply them to your own work and discuss them with colleagues.”

 

 

Q+A: Boundary Issues in Counseling

Responses written by co-authors Barbara Herlihy and Gerald Corey

 

In the book, you mention that multiple relationship issues “affect virtually all counselors, regardless of their work setting or the client populations they serve.” With this in mind, what are some key takeaways you feel counselors should be aware of?

We expect that ethically conscientious professionals will continue to struggle with the multiple relationship dilemmas that they face and the multiple roles they will be expected to balance in their work. Because there are often not clear answers to questions about personal and professional boundaries, we must rely on our reasoned professional judgment, openness to discussing issues with clients who are equally affected by the decisions made, and consultation with colleagues. Rather than searching for definitive answers to many of the multiple roles and responsibilities associated with counseling practice, the real challenge is for counselors to learn a process of thinking about such dilemmas and to have a rationale for the decisions they make.

 

What advice would you give to a newly graduated counselor who is starting out in the profession?

Students and new professionals would do well to err on the side of caution when they think about crossing a boundary with a client and to consult with seasoned colleagues before making exceptions to their customary boundaries. Newly graduated counselors can realize that they do not have to make ethical decisions about boundaries by themselves. They can always seek consultation with peers, colleagues and supervisors. Involving the client in a discussion about establishing and managing boundaries is a good idea since this fosters a collaborative spirit. Rather than making decisions about the client and for the client, counselors can promote dialogue with their clients about how boundaries are important and how best to manage them.

 

Do you feel this topic is covered enough in counseling graduate programs and continuing education?

We recognize the constraints of trying to teach a wide range of issues, including those related to boundaries, in a single ethics course. Yet some of the topics that we address in our book are probably not covered as fully as they could be if time were not so limited. A few of these topics that we suspect may be given short shrift include:

  • Deciding when to accept or refuse a gift from a client
  • Learning how to engage in appropriate and timely self-disclosure
  • Managing sexual attractions in the counseling relationship
  • Determining when touching might be appropriate (and even therapeutic)
  • Learning how to keep boundary crossings from becoming boundary violations
  • Considering the culture of clients in deciding when to cross boundaries
  • Learning when it is appropriate to engage in multiple roles and relationships
  • Acquiring a personal ethical decision-making model that can be applied to addressing boundary and relationship considerations
  • Establishing guidelines for effectively managing multiple roles and relationships

Although most counseling professionals are required to participate in continuing education in law and ethics as a part of the licensure renewal process, it seems that many of these continuing education workshops focus on legal matters and do not give a great deal of attention to ethics. On matters such as accepting gifts, meeting clients outside of the office, engaging in nonerotic touching and going to a special event of a client, the advice is typically to use a risk management approach and avoid deviating from a strictly professional context. We hope our book will invite readers to reflect on matters such as these and examine what might be the best practice for clients.

When it comes to boundary considerations, it is essential that counselors are able to live with some ambiguity. There are often no single best answers, and the best course of action could vary with circumstances, client needs and counselors’ styles and preferences. We hope that readers will see the importance of reaching out to colleagues and supervisors when they have any doubts about how to address situations involving boundaries.

 

What prompted you to release a third edition of this book? Please talk about the updates and changes readers will see in the new edition.

The third edition of Boundary Issues in Counseling is based on the assumption that counseling professionals must learn how to manage multiple roles and responsibilities effectively, rather than always attempting to avoid them. We wanted to update the book to capture how the thinking of our profession has evolved over the decades — particularly over the past few years.

At one time, practitioners were advised to avoid dual relationships and be wary of any kind of boundary crossing. This rigid stance has been replaced by a more nuanced understanding of the complexities of dual relationship issues. Most professionals now realize that they must balance and carry out multiple roles in various situations. In this edition, as co-authors we still maintain our personal voice and express our views in most of the chapters. We have invited even more colleagues with various specializations, and also graduate students and new professionals, to express their perspectives on a wide range of topics that fall within the scope of boundary concerns. There are now 40 contributors who offer essays and examples from their practices, most of which (30) are new to this edition.

A number of new topic areas address various specializations. For example, Chapter 10 focuses on disaster mental health, private practice, addictions counseling and rehabilitation counseling. In Chapter 11, there is a focus on unique boundary issues that arise in rural practice, counseling in the military, working with clients with end-of-life concerns, in-home service provision and working in forensic settings. Boundary issues impact not only the counseling relationship but also pervade supervision and consultation, counselor education, training of group counselors and couples and family counselors. All these areas are addressed in this new edition.

 

As a whole, do you feel the counseling profession handles boundary and relationship issues well, or it something that could be improved on?

Although it is difficult to make generalizations about such a broad area, we believe the vast majority of counseling professionals take boundary issues very seriously and strive to maintain the integrity of the therapeutic relationship. That said, however, we think that even the most competent counselors could probably find ways to improve when it comes to making decisions about boundaries and managing roles in the counseling process. The complexities can be difficult to sort through, particularly when cultural differences are taken into account. As the counseling profession continues to become more global, this will be an ongoing challenge. Also, counselors seem to blur boundaries in inappropriate ways when their own needs get mixed into situations. Some counselors could be more diligent in practicing self-monitoring and self-care, and counselor education programs could emphasize more strongly the importance of these practices.

Finally, we urge counselors to invite their clients to provide them with ongoing feedback about how they are experiencing their counseling. To increase their effectiveness, counselors must be willing to take risks of listening carefully to what their clients tell them and be willing to modify their practices based on what clients say they need. Perhaps the best way for counselors to improve is to be open to feedback on a systematic basis from their clients and to engage in personal reflection. The process of reflection is vital to producing positive outcomes, which means that counselors must be willing to spend time thinking about what they are doing, why they are doing it and how they can be functioning more effectively in meeting their clients’ needs.

 

In addition to your book and the ACA Code of Ethics, what resources do you recommend counselors turn to with questions about relationship and boundary issues?

Most professional organizations have consultants who are available for discussion on ethical, legal and professional matters. In addition to guidance provided by one’s professional organization, reading can be a useful adjunct to developing an ethical perspective. Keeping up to date with the professional journals is an excellent practice for staying current.

Here are a few books that can be of value in keeping abreast of the changes in ethics and professional practice:

 

  • Herlihy, B., & Corey, G. (2015). ACA ethical standards casebook (7th ed.). Alexandria, VA: American Counseling Association.
  • Barnett, J. E., & Johnson, W. B. (2015). Ethics desk reference for counselors (2nd ed.). Alexandria, VA: American Counseling Association.
  • Remley, T. P., & Herlihy, B. (2014). Ethical, legal, and professional issues in counseling (4th ed.). Upper Saddle River, NJ: Pearson.
  • Corey, G., Corey, M. S., Corey, C., & Callanan, P. (2015). Issues and ethics in the helping professions (9th ed.). San Francisco, CA: Cengage Learning.
  • Zur, O. (2007). Boundaries in psychotherapy: Ethical and clinical explorations. Washington, DC: American Psychological Association.
  • Yalom, I. D. (1997). Lying on the couch: A novel. New York: Perennial.

 

 Your book mentions that dual relationships can be positive, even furthering the therapeutic alliance in some cases. Do you think counselors have misconceptions about this and end up avoiding dual relationships?

It is certainly possible that some counselors, particularly those who received their training decades ago, have the misconception that dual relationships should be avoided in all circumstances. Not all multiple relationships (and boundary crossings) can be avoided, nor are they necessarily always harmful, and they can be beneficial. The challenge is to determine when crossing boundaries can be beneficial. A few suggestions we offer in our book include:

  • Decisions whether to enter into dual or multiple relationships should be for the benefit of our clients (or others served) rather than to protect ourselves from censure.
  • In determining whether to proceed with a dual or multiple relationship, or to cross a boundary, consider whether the potential benefit of the relationship outweighs the potential for harm. A good question to ask is “What could go wrong?”
  • Whenever we consider becoming involved in a dual or multiple relationship, it is wise to seek consultation from trusted colleagues or a supervisor.
  • Boundary issues must be considered within their cultural contexts.
  • Recognize that the problem is not engaging in multiple relationships, but is rather abusing power and thus exploiting and harming clients. Consultation and supervision are routes to monitoring our motivations and reducing the risk of abusing power and harming clients.

 

 

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About the authors

Barbara Herlihy is a licensed professional counselor and university research professor in the counselor education graduate program at the University of New Orleans.

Gerald Corey is a national certified counselor (NCC) and professor emeritus of human services and counseling at California State University at Fullerton.

 

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Boundary Issues in Counseling is available from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222.

Published this year, the new edition updates previous editions published in 1992 and 1997.

 

 

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Herlihy and Corey will be at the 2015 ACA Conference & Expo in Orlando to give a talk on both Boundary Issues in Counseling and the ACA Ethical Standards Casebook, another that they co-authored for ACA.

They will be speaking Friday, March 13, at 4 p.m. and signing books Thursday, March 12, at 4:30 p.m. For more information, see counseling.org/conference

 

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Interested in learning more? ACA recently produced a webinar with Herlihy and Corey about boundary issues, ethics and their two books, Boundary Issues in Counseling and the ACA Ethical Standards Casebook. More information here: counseling.org/continuing-education/webinars

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

 

New guidelines on dual relationships

Mary A. Hermann and Sharon Robinson-Kurpius December 9, 2006

The recent revision of the ACA Code of Ethics significantly changes the ethical guidelines related to dual relationships. Careful review of the specific ethics code language addressing dual relationships is imperative in order to navigate this prevalent ethical issue. Though the 1995 code offered guidance on the topic of dual relationships, the 2005 ACA Code of Ethics provides more explicit guidelines about which dual relationships are ethically acceptable and which are strictly prohibited.

Dual relationships exist on a continuum ranging from potentially beneficial interactions to harmful interactions. One dual relationship that is always considered harmful is a sexual relationship with a client. The 2005 revision of the ACA Code of Ethics reiterates and expands the ban on sexual relationships with clients. Under the new code, counselors are ethically prohibited from engaging in sexual relationships not only with clients but also clients’ partners or family members (Standard A.5.a.).

Another substantive revision is the extension of the time ban on sexual relationships with former clients. In the 1995 code, the specified period of waiting was two years, with extensive justification after two years that such a relationship would not be harmful to the former client. The 2005 code extends this period to five years. Echoing the previous code, the 2005 code states in Standard A.5.b. that “Counselors, before engaging in sexual or romantic interactions or relationships with clients, their romantic partners or client family members after 5 years following the last professional contact, demonstrate forethought and document (in written form) whether the interactions or relationship can be viewed as exploitive in some way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids entering such an interaction or relationship.”

Though sexual relationships with clients are clearly prohibited, nonsexual relationships are ethically permissible under certain circumstances. Like a dual relationship that is sexual, a nonprofessional dual relationship has the potential to blur the boundaries between a counselor and a client, create a conflict of interest, enhance the potential for exploitation and abuse of power, and/or cause the counselor and client to have different expectations of therapy. The 1995 code instructed counselors to avoid nonsexual dual relationships when it was possible to do so. The Ethical Code Revision Task Force felt that this instruction was being interpreted as a prohibition on all dual relationships, including relationships that could be beneficial to the client (see “Ethics Update” in the March 2006 issue of Counseling Today). Thus, the 2005 code revisions clarify that certain nonsexual interactions with clients can be beneficial, and therefore, those relationships are not banned (Standard A.5.c.).

The 2005 code also provides examples of potentially beneficial interactions, including “attending a formal ceremony (e.g., a wedding/commitment ceremony or graduation); purchasing a service or product provided by a client (excepting unrestricted bartering); hospital visits to an ill family member; mutual membership in a professional association, organization or community” (Standard A.5.d.). When engaging in a potentially beneficial relationship with a client or former client, however, the counselor is expected to “document in case records, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client.” Standard A.5.d., “Potentially Beneficial Interactions,” further clarifies that “Such interactions should be initiated with appropriate client consent,” and if harm occurs because of the nonprofessional interactions, counselors are expected to “show evidence of an attempt to remedy such harm.”

In settings such as rural communities and schools, nonsexual dual relationships are often impossible to avoid. The 1995 code provided guidance on managing unavoidable dual relationships, stating that the counselor was expected to “take appropriate professional precautions such as informed consent, consultation, supervision and documentation to ensure that judgment is not impaired and no exploitation occurs.” Though this language is no longer explicitly stated, such precautions still seem warranted.

The 2005 ACA Code of Ethics also provides guidelines for supervisory relationships, stating that “Sexual or romantic interactions or relationships with current supervisees are prohibited” (Standard F.3.b.). Furthermore, the ethics code clearly states that “Counseling supervisors do not condone or subject supervisees to sexual harassment” (Standard F.3.c.). It should be noted that not only is sexual harassment unethical, it is also illegal.

Counseling supervisors are expected to “clearly define and maintain ethical professional, personal and social relationships with their supervisees” (Standard F.3.a., “Relationship Boundaries With Supervisees”). The standard goes on to say that “If supervisors must assume other professional roles (e.g., clinical and administrative supervisor, instructor) with supervisees, they work to minimize potential conflicts and explain to supervisees the expectations and responsibilities associated with each role.” The 2005 ACA Code of Ethics also cautions counseling supervisors to remain aware of “the power differential in their relationships with supervisees” (Standard F.3.e.). The code further clarifies that “Counseling supervisors avoid accepting close relatives, romantic partners or friends as supervisees” (Standard F.3.d.).

Standard F.3.a. also advises counseling supervisors not to engage in “any form of nonprofessional interaction that may compromise the supervisory relationship.” If a counseling supervisor believes a nonprofessional relationship with a supervisee has the potential to benefit the supervisee, Standard F.3.e. provides that supervisors take precautions similar to those taken by counselors who engage in potentially beneficial dual relationships with clients. It goes on to say that “Before engaging in nonprofessional relationships, supervisors discuss with supervisees and document the rationale for such interactions, potential benefits or drawbacks, and anticipated consequences for the supervisee.”

The 2005 ethics code addresses other dual relationships as well, including relationships between counselor educators and students and relationships between researchers and research participants. Standard F.10. sets guidelines for counselor educators and students that are similar to the ethical guidelines for supervisors and supervisees. Standard G.3. virtually mirrors these rules for researchers and their research participants.

The 2005 ACA Code of Ethics clarifies that nonsexual dual relationships are not prohibited; however, navigating dual relationships can be challenging. Counselors are ethically mandated to approach dual relationships with care and caution. Informed consent is a critical component of engaging in nonsexual dual relationships with clients, and this includes specifying the potential negative consequences of such a relationship. It is wise for counselors to consult when faced with a dual relationship to ensure that clients are not harmed. Though the standards related to dual relationships in the ACA Code of Ethics have undergone significant changes, the spirit of their intent can still be summarized in one sentence: Do what is in the best interest of the client.

Mary A. Hermann, a professor of counselor education at Virginia Commonwealth University, and Sharon Robinson-Kurpius, a professor of counseling and counseling psychology at Arizona State University, are members of the ACA Ethics Committee.

Letters to the editor: ct@counseling.org

Allowing dual relationships

By David Kaplan March 27, 2006

Editor’s note: American Counseling Association members received the 2005 ACA Code of Ethics bundled with the December 2005 issue of Counseling Today. Completed over a three-year period, this revision of the ethical code is the first in a decade and includes major updates in areas such as confidentiality, dual relationships, the use of technology in counseling, selecting interventions, record keeping, end-of-life issues and cultural sensitivity.

All ACA members are required to abide by the ACA Code of Ethics, and 21 state licensing boards use it as the basis for adjudicating complaints of ethical violations. As a service to members, Counseling Today is publishing a monthly column focusing on new or updated aspects of the ACA Code of Ethics (the ethics code is also available online at www.counseling.org/ethics). ACA Chief Professional Officer David Kaplan conducted the following interview with Rocco Cottone and Michael Kocet, two members of the ACA Ethical Code Revision Task Force.

 

David Kaplan: Two months ago we discussed a major change in the recent revision of the ACA Code of Ethics — changing the criterion for breaking confidentiality from “clear and imminent danger” to “serious and foreseeable harm.” This month we will be talking about another critical change in a core area of counseling ethics: allowing a dual relationship when it is beneficial to the client, supervisee, student or research participant (Editor’s note: See Standards A.5.d, F.3.e, F.10.f and G.3.d). It is interesting to note that the new 2005 Code of Ethics does not even mention the term “dual relationship.”

Rocco Cottone: The dual relationship term is really nondescript and does not give good guidance to the profession or to clients who have an ethical concern or complaint.

Michael Kocet: And over time our professional culture had developed the notion that you had to back away from any circumstance that might present a dual relationship, even if there was a potential for benefit to the client.

RC: When you sit down and analyze the concept of dual relationships, you will find that it relates to three different types of relationships: sexual/romantic relationships, nonprofessional relationships and professional role change. The first category, sexual and romantic relationships with current clients, is banned by the code of ethics because we have evidence of the damage that results. The second type of relationship, nonprofessional relationships, encompasses those activities where you might have contact or active involvement with a client outside of the counseling context. The third type of relationship that the old dual relationship term encompassed is a professional role change. An example is when you shift from individual counseling to couples counseling. Moving from one type of counseling to another with one client can be really confusing and ethically compromising.

So, in the end, moving away from the concept of dual relationships was really about the analysis of what the dual relationship term meant and the confusion it caused because of multiple meanings. The new ethics code addresses all three types of roles and relationships with clients.

DK: So instead of banning dual relationships across the board, the recent revision of the ethical code now allows professional counselors to interact with clients outside of a counseling session under certain conditions.

RC: Counselors may now interact with a client in a nonprofessional activity as long as the interaction is potentially beneficial and is not of a romantic or sexual nature. Even if it is a potentially beneficial relationship, counselors must use caution, forethought and proceed with client consent whenever feasible.

MK: Focusing on assessing beneficial versus harmful interactions allows the counselor to really partner with the client to determine whether a potential relationship will help or hurt.

DK: Can you give some examples of potentially beneficial interactions that may now be allowed?

MK: One example is a wedding. Let’s say a long-term client announces that he or she is getting married. The counselor is then asked to the wedding because the client feels that the counseling was instrumental in working through issues that blocked the client from considering new relationships. From the client’s perspective, the counselor’s attendance at the wedding would be very meaningful.

A second example involves a counselor who lives in an extremely rural area, needs to get her car fixed and has a client who is the only mechanic in town. A discussion with the client may lead to the clear conclusion that it is appropriate for the client to service the counselor’s car.

RC: Other examples include attending a graduation ceremony to honor a client’s academic accomplishment or attending a funeral to show respect to a client. It could be as simple as buying cookies from a Girl Scout or as complex as being actively involved in a shared community (e.g., a political party or a disability community) where you are working hand-in-hand with clients, students, supervisees or research participants. Counselors should not feel guilty for engaging in more than one role as long as it is potentially beneficial to the client.

DK: How does bartering fit into this new concept? What if a client would like to do yard work, carpentry, home repair, etc., in return for your services?

RC: Well, the standard we are talking about ( A.5.d, “Potentially Beneficial Interactions”) doesn’t in any way supersede the longstanding standard on bartering (A.10.d).

DK: One of the impressive things about Standard  A.5.d, “Potentially Beneficial Interactions,” is that it gives a very nice road map for how to ensure that the focus is on the client’s best interest when the issue of an interaction outside of counseling, supervision, teaching or research arises.

MK: Right. The counselor needs to have a thorough discussion with the client, supervisee, student or research participant about both the potential benefits and the potential harm that could occur. It is then critical that the counselor document this discussion in case records along with the rationale for engaging in the interaction.

DK: As we have pointed out in previous columns, a major theme through the new ACA Code of Ethics is consult, consult, consult! Is the issue of a potentially beneficial interaction with a client, student, supervisee or research participant an area that comes under this theme?

MK: Absolutely. If the counselor has any reservations, it is very useful to consult with a supervisor or colleague, search the literature, etc. There are many ways to consult.

DK: Dr. Cottone, you were the member of the Ethical Code Revision Task Force who spearheaded the change from banning dual relationships to evaluating beneficial versus harmful interactions. Why was this important to you?

RC: From a personal perspective, I have a son who has muscular dystrophy. I am very active in the community here in St. Louis, and at the same time I have a practice that focuses on counseling individuals affected by muscular dystrophy. So the people I counsel are the people in the same community where I am an active volunteer. I sit side by side my clients at the MDA telethons trying to raise money to save people’s lives. I go to parties with my son where my clients are present and we socialize. I began to realize there was nothing wrong with that. In fact, if I hadn’t been involved in that kind of activity, my clients would have looked at me as if I really was not sincerely interested in helping people with their condition.

I want to thank my colleagues on the task force because they were very receptive to the idea of evaluating beneficial versus harmful interactions rather than an across the board ban on dual relationships. The ideas I brought to the ethics task force were significantly different than those in the prior code, so I applaud my colleagues for letting me express my view and improving on some of the ideas I had.

DK: Thanks for giving a very human touch to the new ethical code.

 

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Next month: New ethical code statements about end-of-life issues.

Letters to the editor: ct@counseling.org