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UnavoidableDualRelationships

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UnavoidableDualRelationships
ClinicalUpdateNovember2014
ByZurInstitute
ViewacompletelistofClinicalUpdates.

Asmentalhealthprofessionals,mostofushaveattendedriskmanagementorethicsworkshopswherewehearthecentralmessage
anddirewarningthatallormostmultiplerelationshipsareunethical,prohibited,harmful,andshouldbeavoided.Itisshockingfor
metohearhowsocalledexpertsandethicistscanbesouninformed.Thisisitsownkindofunethicalbehavior:instructorsand
ethicists,likeallclinicians,haveadutytobewellinformed.Whilesomerelationships,suchassexualandexploitativedual
relationships,areclearlyunethicalandillegal,somemultiplerelationshipsareunavoidableandattimesmandated.ThisClinical
Updatefocusesonunavoidablemultipleordualrelationships.

MultipleRelationshipsareStandard,MandatedandUnavoidableintheFollowingSettings:
Militarysettings,wheremilitarypsychologistshavemultiloyaltiestotheDepartmentofDefense,tothefightingunit,and
totheindividualsoldierpatient.Eventhoughthesemultiplerelationshipscancreateaconflictofinterests,theyareoften
mandatedandrequiredbythemilitary.
Prison,jailsanddetentionsettingswhere,attimes,forensicpsychologistsarerequiredtoprovidereportsregardingtheir
psychotherapypatients'competencyorfitnesstostandtrialandmayalsobemandatedtoprovidesanityreports.Theyalso
haveprimaryloyaltyandlegalresponsibilitytotheinstitutionabovetheirloyaltytothepatientprisoner.

DualRelationshipsareCommon,UnavoidableandStandardintheFollowingSettings:
Ruralandsmallcommunities,wheretherearefewavailablecliniciansandmultiplerelationshipsare,infact,anormaland
healthyaspectoflivingandanimportantingredientofhowsuchcommunitiessurviveandthrive.
Rehabilitationanddrugprograms,suchasAAorother12stepprograms,wheremanytherapistsarethemselvesin
recoveryandclientsandtherapistsregularlymeetinAAmeetingsandotherrecoveryorientedgatherings.
SportPsychology,wheresocialdualrelationshipsareaninherentpartofthemilieusuchaswhensportpsychologiststravel
withtheteam(andtheirpatients),spendinglonghourswiththemonbusesandinairports,airplanes,dininghalls,hotels,
and...bars.
SpiritualandFaithCommunities,suchaschurches,synagogues,ashrams,temples,mosques,etc.,whichofteninvolve
primarilysocialmultiplerelationshipsbetweenthetherapistswhobelongtothecongregationsandfellowcongregational
clientswhochosethemtobetheirtherapistsbecausetheyknewtheminthecongregation.Asaresult,therapistsandclients
interactsociallyandinotherwayswitheachotherinmanycongregationalactivitiesandfunctions.Additionaldualroles
mayexistwiththespiritualleadersoffaithcommunitieswhoprovidespiritualorpastoralbasedclinicalcounseling.
EducationalandTrainingInstitutions,wheretherapistsandclientsmaybeinvolvedinsocialandothertypesofactivities
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UnavoidableDualRelationships

oncampuswithinthedepartmentortheeducationalinstitution.
Isolatedmilitarybasesoraircraftcarriers,wheremilitarypsychologiststrain,dine,playsports,areentertainedandlive
alongsidetheirpatients.
LinkedInandFacebook:Moderndayconsumersexpecttransparencyandconnectivity.Havingclientsasfollowersona
therapist'sFBPage(notasfriendsonthetherapist'sFBprofile)isanimportantaspectofmoderndaymarketing.Similarly,
clientswhoarefellowmentalhealthprofessionalswillhaveprofessionaldualrelationshipswhentheyinteractwiththeir
therapistsonLI.
SupervisoryRelationshipsareuniquesituationswhichinvolveinherentmultiroles,functions,andresponsibilities.Tensionsmay
existbetweenthesupervisor'sethical,legal,andgatekeepingroles,whichinclude:
1. enhancingsupervisees'growthandprofessionaldevelopment
2. protectingtheirclients
3. protectingfutureclientswhomaybetreatedbythesuperviseesand
4. likemostotherpsychotherapists,protectingthepublicincertaincases,suchasthosewherethereisadanger(i.e.,Tarasoff)
orchild/elderabuse/neglect.

TheCodesofEthicsonDualRelationshipsofallmajorprofessionalassociationsareclearthatnotalldualrelationshipsare
unethical.Forexample,theAPAcodestates:"Multiplerelationshipsthatwouldnotreasonablybeexpectedtocauseimpairment
orriskexploitationorharmarenotunethical."TheACA'scodestatesthatmultiplerelationships"maybepotentiallybeneficial."
CAMFT'scodestatesthat,"Notalldualrelationshipsareunethical,andsomedualrelationshipscannotbeavoided"andNASW's
codestates,"Ininstanceswhendualormultiplerelationshipsareunavoidable,socialworkersshouldtakestepstoprotectclients
andareresponsibleforsettingclear,appropriate,andculturallysensitiveboundaries."

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