Guide Dual Relationships And Psychotherapy

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Ethical Decision-making and Dual Relationships

Be the first. Add a review and share your thoughts with other readers. Similar Items Related Subjects: 12 Psychotherapist and patient. Therapeutic alliance. Professional-Patient Relations. Ethics, Medical. Sociale relaties. User lists with this item 2 deaf community items by AmandaChu updated Linked Data More info about Linked Data. DeLeon -- 1.

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Hyman -- Lawrence Thomas -- Walker -- Cummings -- App. Guidelines to Nonsexual Dual Relationships in Psychotherapy.

Lazarus " ;. All rights reserved. Remember me on this computer. Boundary crossings can be an integral part of well formulated treatment plans or evidence-based treatment plans. Examples are, flying in an airplane with a patient who suffers from a fear of flying, having lunch with an anorexic patient, making a home visit to a bed ridden elderly patient, going for a vigorous walk with a depressed patient, or accompanying a patient to a dreaded but medically essential doctor's appointment to which he or she would not go on their own. Potentially helpful boundary crossings also include going on a hike, giving a non-sexual hug, sending cards, exchanging appropriate not too expensive gifts, lending a book, attending a wedding, confirmation, Bar Mitzvah or funeral, or going to see a client performing in a show.

Boundary crossings are not unethical. Ethics code of all major psychotherapy professional associations e.

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Ethics Codes for therapy. Therapeutic orientations, such as humanistic, behavioral, cognitive, behavioral, family systems, feminist or group therapy are more likely to endorse boundary crossings as part of effective treatment than analytically or dynamically oriented therapies. As with dual relationships, what constitutes harmful boundary violations according to one theoretical orientation may be considered helpful boundary crossings according to another orientation.

Like dual relationships, boundary crossings are normal, unavoidable and expected in small communities such as rural, military, universities and interdependent communities such as the deaf, ethnic, gays, etc. Different cultures have different expectations, customs and values and therefore judge the appropriateness of boundary crossings differently.

More communally oriented cultures, such as the Latino, African American or Native Americans, are more likely to expect boundary crossings, and frown upon the rigid implementation of boundaries in therapy. Not all boundary crossings constitute dual relationships. Making a home visit, going on a hike, or attending a wedding with a client and many other 'out-of-office' experiences are boundary crossings which do not necessary constitute dual relationships.

Similarly, exchanging gifts, hugging, or sharing a meal are also boundary crossings but not dual relationships. However, all dual relationships, including attending the same church, bartering, playing in the same recreational league, constitute boundary crossings. There is a prevalent erroneous and unfounded belief about the 'slippery slope' that claims that minor boundary crossings inevitably lead to boundary violations and sexual relationships. This somewhat paranoid approach is based on the 'snow ball' effect.


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It predicts that the giving of a simple gift likely ends up in a business relationship. A therapist's self disclosure becomes an intricate social relationship. A non-sexual hug turns into a sexual relationship. A rigid attitude towards boundary crossings stems, in part, from what has been called 'sexualizing boundaries. Boundary crossings with certain clients, such as those with borderline personality disorder, must be approached with caution.

Effective therapy with some clients may require a clearly structured and well-defined therapeutic environment. As with dual relationships, boundary crossings should be implemented according to the client's unique needs and the specific situation. It is recommended that the rationale for boundary crossings be clearly articulated and, when appropriate, included in the treatment plan.

The meaning of boundaries and their appropriate application can only be understood and assessed within the context of therapy. The context of therapy consists of four main components: clients, setting, therapy and therapists. Setting factors include: Outpatient vs. It also includes Locality: Large, metropolitan area vs. Indian reservation; Affluent, suburban setting vs. Therapy factors include: Therapeutic factors , such as modality: Individual vs. Therapeutic relationship factors : Quality and nature of therapeutic alliance, i.

Intense and involved vs. Therapist factors include: Culture, age, gender, sexual orientation; Scope of practice i. Non-sexual dual relationships are not necessarily unethical or illegal. Only sexual dual relationships with current clients are always unethical and sometimes illegal. Non-sexual dual relationships do not necessarily lead to exploitation, sex, or harm.

Dual Relationship

The opposite is often true. Dual relationships are more likely to prevent exploitation and sex rather than lead to it.

The Dont's of Dual Relationships

Almost all ethical guidelines do not mandate a blanket avoidance of dual relationships. All guidelines do prohibit exploitation and harm of clients. A social dual relationship is where therapist and client are also friends or have some other type of social relationship. Social multiple relationships can be in person or online. Having a client as a Facebook 'friend' on a personal, rather than strictly professional basis, may also constitute social dual relationships. Other types of therapist-client online relationships on social networking sites may also constitute social dual or multiple relationships.

A professional dual relationship or multiple relationship is where psychotherapist or counselor and client are also professional colleagues in colleges, training institutions, presenters in professional conferences, co-authoring a book, or other situations that create professional multiple relationships. A special treatment-professional dual relationship may take place if a professional is, in addition to psychotherapy and counseling, also providing additional medical services, such as progressive muscle relaxation, nutrition or dietary consultation, Reiki, etc.

A business dual relationship is where therapist and client are also business partners or have an employer-employee relationship. Communal dual relationships are where therapist and client live in the same small community, belong to the same church or synagogue and where the therapist shops in a store that is owned by the client or where the client works. Communal multiple relationships are common in small communities when clients know each other within the community.

Institutional dual relationships take place in the military, prisons, some police department settings and mental hospitals where dual relationships are an inherent part of the institutional settings. Some institutions, such as state hospitals or detention facilities, mandate that clinicians serve simultaneously or sequentially as therapists and evaluators. Forensic dual relationships involve clinicians who serve as treating therapists, evaluators and witnesses in trials or hearings. Serving as a treating psychotherapist or counselor as well as an expert witness, rather than fact witness, is considered a very complicated and often ill-advised dual relationship.

Supervisory relationships inherently involve multiple roles, loyalties, responsibilities and functions. A supervisor has professional relationships and duty not only to the supervisee, but also to the supervisee's clients, as well as to the profession and the public.