Nasrudin Subhi

Pusat Pengajian Psikologi dan Pembangunan Manusia

Fakulti Sains Sosial dan Kemanusiaan
Universiti Kebangsaan Malaysia

Dual and Multiple Relationship in

Perspective

Ethical problems are often raised when counselors

blend their professional relationship with a client
with another kind of relationship.
The ethics codes of most professional organizations
have increasingly paid attention to the potential for
crossing boundaries and not acting in the best
interests of clients when dual or multiple
relationships occur.
Because of the complex nature of combining
various roles and relationships, the term multiple
relationships is often more accurate than dual
relationships in capturing the many forms that can

Dual and Multiple Relationship in

Perspective

Dual or multiple relationships occur when

professionals assume two or more roles at the
same time or sequentially with a client.
This may involve assuming more than one
professional role (such as instructor and therapist)
or blending a professional and nonprofessional
relationship (such as counselor and friend or
counselor and business partner).
Counsellors must learn how to effectively and
ethically manage multiple relationships including
dealing with power differential between counsellor
client.

Dual and Multiple Relationship in

Perspective

Sexual relationships with clients are clearly

unethical and all of the major professional ethics
codes have specific prohibitions against them.
Additionally most states have declared such
relationships to be a violation in law. However non
sexual relationships have also received increase
interest.
The codes of ethics of most professional
organizations warn of the potential hazards of dual
and multiple relationship.

Dual and Multiple Relationship in

Perspective

The ACA Code of Ethics and Standards of Practice (1995)

encourages counselors to avoid dual relationships when
possible:

Counselors are aware of their influential positions with respect

to clients and they avoid exploiting the trust and dependency of
clients. Counselors make every effort to avoid dual relationships
with clients that could impair professional judgment or increase
the risk of harm to clients. (examples of such relationships
include but are not limited to familial, social, financial, business
or close personal relationships with clients.) When a dual
relationship cannot be avoided counselors take appropriate
professional precautions such as informed consent,
consultation, supervision and documentation to ensure that
judgment is not impaired and no exploitation occurs.

Dual and Multiple Relationship in

Perspective

The APA (1992) standard on multiple relationships points to

the potential for impairing a professionals objectivity:

In many communities and situations, it may not be feasible or

reasonable for psychologists to avoid social or other
nonprofessional contacts with persons such as patients, clients,
students, supervisees or research participants. Psychologists
must always be sensitive to the potential harmful effects of other
contacts on their work and on those persons with whom they
deal. A psychologist refrains from entering into or promising
another personal, scientific, professional, financial or other
relationship with such persons if it appears likely that such
relationship reasonably impair the psychologists objectivity or
otherwise interfere with the psychologists effectively performing
his or her functions as a psychologist or might harm or exploit
the other party.

Dual and Multiple Relationship in

Perspective

Dual relationships are inherent in the work of all

helping professionals regardless of work setting or
client population.
Despite certain clinical, ethical and legal risks some
blending of roles is unavoidable and it is not
necessarily unethical or unprofessional.
Although the codes of ethics of most professions
warn against engaging in dual relationships not all
such relationships can be avoided or necessarily
harmful (Herlihy & Corey, 1997).

Dual and Multiple Relationship in

Perspective

It is the responsibility of practitioners to monitor

themselves and to examine their motivations for
engaging in such relationships.
In rural areas for instance, mental health
professionals may find it more difficult to maintain
clear boundaries than do those who work in large
cities.

Designing Safeguard to Protect Clients

Sleek (1994) also describes ethical dilemmas that

plague rural practice. For example, if a therapist
shop for a new tractor, he risks violating the letter of
the ethic code if the only person in town who sells
tractors happens to be a client. However if the
therapist were to buy a tractor elsewhere this could
strain relationships with the client because of the
value rural communities place on loyalty to local
merchants.

Designing Safeguard to Protect Clients

Consider clients who wish to barter goods or

services for counseling services. Some
communities operate substantially on swaps rather
than on a cash economy.
This does not necessarily have to become
problematic yet the potential for conflict exists in the
therapeutic relationship if the bartering agreements
do not work well.

Identifying Boundary Violation

Certain behaviours of professionals have the

potential for creating a dual relationship but they are
not inherently considered to be dual relationships.
Examples of these behaviours include accepting a
clients invitation to a special event such as a
graduation; bartering goods or services for
professional services; accepting a small gift from a
clent; attending the same social, cultural or religious
activities as a client or giving a supportive hug after
a difficult session.

Identifying Boundary Violation

Gutheil and Gabbard (1993) distinguish between

boundary crossing (changes in role) and boundary
violations (exploitation of the client at some level).

A boundary crossing is a departure from commonly

accepted practices that could potentially benefit clients.
Boundary violation is a serious breach that results in harm
to clients.

Identifying Boundary Violation

Note that not all boundary crossings should be

considered boundary violations.
Interpersonal boundaries are fluid; they may
change over time and may be redefined as
therapists and clients continue to work together.
Yet behaviours that stretch boundaries can become
problematic if boundary crossings lead to a pattern
of blurring of professional boundaries.
When this occurs there is a real potential for harm.

Identifying Boundary Violation

The key is to take measures to prevent

boundary crossings from becoming boundary
violations.
The prevention of boundary violations by
practitioners should be based on early
detection and thorough individual assessment
(Twemlow, 1997).

Role Blending

Role blending = a concept

related to that of
maintaining appropriate
boundaries.
For example, counselor
educators serve as
instructors but they also
act as therapeutic agent,
mentor, evaluator or
supervisor.
Role blending is not
necessarily unethical but
does call for vigilance on
the part of the professional
to ensure that exploitation
does not occur.

Role Blending

Functioning in more than

one role involves thinking
through potential problems
before they occur and
building safeguards into
practice.
Whenever a potential for
negative outcomes exists,
professionals have a
responsibility to design
safeguards to reduce the
potential for harm.

Role Blending

Herlihy and Corey (1997) identify the following

measures aimed at minimizing the risks of dual or
multiple relationships:

Maintain healthy boundaries from the outset.

Secure the informed consent of clients and discuss with
them both the potential risks and benefits of dual
relationships or any kind of blending of roles.
Remain willing to talk with clients about any potential
problems and conflicts that my arise.
Consult with other professional to resolve any dilemmas.
Seek supervision when dual relationships become
particularly problematic or when the risk for harm is high.
Document any dual relationships in clinical case notes.
When necessary refer clients to another professional.

Bartering for Bartering for Professional

ServiceProfessional Services

Bartering is not prohibited by ethics or law.

Most ethical codes now address the complexities
of bartering, however undeniable in some cultures
and in certain communities bartering is an
acceptable practice.
Before bartering is entered into, both parties
should talk about the arrangement, gain a clear
understanding of the exchange and come to an
agreement.
It is also important that problems that might
develop be discussed and that alternatives be

Bartering for Professional Services

The AAMFT ethics code (2001) offers this guideline

on bartering:

Marriage and family therapists ordinarily refrain from

accepting goods and services from clients in return for
services rendered. Bartering for professional services
may be conducted only if: (a) the supervisee or client
requests it, (b) the relationship is not exploitative, (c) the
professional relationship is not distorted and (d) a clear
written contract is established.

Bartering for Professional Services

ACA (1995):

Counselors ordinarily refrain from accepting goods or

services from clients in return fro counseling services
because such arrangements create inherent potential for
conflicts, exploitation and distortion of the professional
relationship. Counselors may participate in bartering only
if the relationship is not exploitive, if the client request it, if
a clear written contract is established and if such
arrangements are an accepted practice among
professionals in the community.

Bartering for Professional Services

Forester-Miller (1997) writes about the difficulties

involved in avoiding dual relationships in rural
communities. She reminds counselors that values
and beliefs may vary significantly between urban
dwellers and their rural counterparts and suggests
that counsellors need to work to ensure that they
are not imposing values that come from a cultural
perspective different from that of their clients. E.g.,
Appalachian culture.

Giving or Receiving Gifts

A number of factors need to be considered in

making a decision of whether or not to accept gifts
from clients:

What is the monetary value of the gift?

Most mental health professional would agree that
accepting a very expensive gift would be inappropriate
and unethical. It would also be problematic if a client
offered tickets to the theater or a sporting event and
wanted you to accompany him or her to this event.

Giving or Receiving Gifts

What are the clinical implications of accepting or

rejecting the gift?
Certainly knowing the motivation for a clients
proposal is critical to making a decision. For
example, a client may be seeking your approval
and the main motivation for giving you a gift is to
please you. Accepting the gift without adequate
discussion would not be helping your client in the
long run.

Giving or Receiving Gifts

When in the therapy process is

the offering of a gift occurring?
Is it at the beginning of the
therapy process? Is it at the
termination of the professional
relationship? It is more
problematic to accept a gift at
an early stage of a counseling
relationship because doing so
may be a forerunner to creating
sloppy boundaries.

Giving or Receiving Gifts

What are your own

motivations for accepting or
rejecting a clients gift?
Some cousellors will accept
a gift simply because they
do not want to hurt a clients
feelings, even though they
are not personally
comfortable doing so.
Counsellors may accept gift
because they are unable to
establish firm and clear
boundaries. Other
counsellors may accept a
gift because they actually
want what a client is offering.

Giving or Receiving Gifts

What are the culture implications

of offering a gift?
The cultural context does play a
role in evaluating the
appropriateness of accepting a
gift from a client. D. W. Sue
(1997) points out that in Asian
cultures gift giving is a common
practice to show gratitude and
respect and to seal a relationship.
If the therapist were to refuse the
gift, it is likely that this client
would feel insulted.

Social Relationships With Clients

Do social relationships with clients necessarily

interfere with therapeutic relationships?

Some would say no, contending that counsellors and

clients are able to handle such relationships as long as
the priorities are clear.
They see social contacts as particularly appropriate with
clients who are not deeply disturbed and who are
seeking personal growth.
Other counsellors take the position that counselling and
friendship should not be mixed.

Social Relationships With Clients

They argue that attempting to manage a social and

professional relationship simultaneously can have a
negative effect on the therapeutic process, the
friendship or both.
Reasons for discouraging the practice of accepting
friends as clients or of becoming socially involved with
clients: (1) counsellors may not be as confrontive as
they need to be with clients they know socially; (2)
counsellors own needs to be liked and accepted may
lead them to be less challenging, (3) counsellors own
needs may be entangled with those of their clients to the
point that objectivity is lost and (4) counsellors are at
greater risk of exploiting clients because of the power
differential in the therapeutic relationship.

Social Relationships With Clients

Cultural considerations:

In some Asian cultures it is believed that personal matters

are best dissucssed with a relative or a friend. Selfdisclosing to a stranger (the counsellor) is considered
taboo and a violation of familial and cultural values. Thus
some Asian clients may prefer to have the traditional
counselling role evolve into a more personal one.

Social Relationships With Clients

Cultural considerations:

Clients from many cultural groups prefer to receive advice

and suggestions from an expert. They perceive the
counsellor to be an expert, having higher status and
possessing superior knowledge. To work effectively with
these clients, the counsellor may have to play a number
of different roles such as advocate, adviser, facilitator etc.

Sexual Attractions in the Client-Therapist

Relationship

Bennett et al., (1990) and Gill-Wigal and Heaton

(1996) offer suggestions on how therapists can deal
with powerful attractions to clients:

Acknowledge the feelings of attraction to yourself.

Explore the reasons you are attracted to a client. Ask if
there is something about this person that meets some of
your needs.
Never act out feelings of attractions. Be careful of
actions that might foster the attraction, such as sitting
close to the client, hugging the client or prolonging the
sessions.

Sexual Attractions in the Client-Therapist

Relationship

Seek out an experienced colleague, supervisor or

personal therapist who might be able to help you decide
on a course of action.
Seek personal counselling if necessary to help you
understand your feelings about this client and to uncover
the issues in your life that may be triggering them.
Monitor boundaries by setting clear limits on physical
contact, self-disclosure and client request for personal
information.
If you are unable to resolve your feelings appropriately
terminate the professional relationship and refer the
client to another therapist.