Dual/Multiple Relationships Avoiding client exploitation and unclear boundaries

Dual/multiple relationships are tricky dilemmas. They can be benign or lethal and can pose problems in treatment and possible liability. Often, particularly in rural areas and small towns, and sometimes even in larger cities, people’s lives intersect. This is where multiple relationships can arise…

Definitions Dual/multiple relationships: In the mental health field, a dual relationship is a situation where multiple roles exist between a therapist, or other mental health practitioner, and a client. Dual relationships are also referred to as multiple relationships, and these two terms are used interchangeably in the research literature. Boundary: Boundaries are guidelines that are made to help keep the therapeutic relationship professional and safe. Gutheil and Gabbard, 1993, wrote, “Therapeutic boundaries can relate to the role, time, place and space, money, gifts, services (and related matters), clothing, language, self disclosure (and related matters), physical contact. Power: It refers to the amount or degree of power which a clinician may have in relation to a consumer. Power can vary widely. The clinician who gives a speech at the local PTA on childrearing practices has relatively little power over members of the audience when compared with a therapist's influence over someone in long-term, insight-oriented psychotherapy. (Gottlieb, 1986)

BHCM LPC LMFT LBP LCSW Dual/Multiple Relationships Affect ALL Mental Health Professionals!

BHCM Rules 450: Consumer welfare (b) Certified Behavioral Health Case Managers must be aware of their influential positions with respect to consumers and not exploit the trust and dependency of consumers. Certified Behavioral Health Case Managers shall refrain from dual relationships with consumers because of the potential to impair professional judgment and to increase the risk of harm to consumers. Examples of such relationships include, but are not limited to familial, social, financial, business, and professional or close personal relationships with consumers. (1) Certified Behavioral Health Case Managers shall not have any type of sexual contact with consumers and shall not provide case management services to persons with whom they have had a sexual relationship. (2) Certified Behavioral Health Case Managers shall not engage in sexual contact with former consumers for at least two (2) years after terminating the professional relationship.

LPC Rules 86:1033(c) Dual relationships. LPCs shall not knowingly enter into a dual relationship(s) and shall take any necessary precautions to prevent a dual relationship from occurring. When the LPC reasonably suspects that he or she has inadvertently entered into a dual relationship the LPC shall record that fact in the records of the affected client(s) and take reasonable steps to eliminate the source or agent creating or causing the dual relationship. If the dual relationship cannot be prevented or eliminated and the LPC cannot readily refer the client to another counselor or other professional, the LPC shall complete one or more of the following measures as necessary to prevent the exploitation of the client and/or the impairment of the LPC's professional judgment: (1) Fully disclose the circumstances of the dual relationship to the client and secure the client's written consent to continue providing counseling; (2) Consult with the other professional(s) to understand the potential impairment to the LPC's professional judgment and the risk of harm to the client of continuing the dual relationship.

LMFT Rules 86:1531 Responsibility to Clients (c)LMFTs are cognizant of their potentially influential position with respect to clients, and they shall not exploit the trust and dependency of such persons. LMFTs therefore shall avoid extra therapeutic relationships with clients that could impair their professional judgment or increase the risk of exploitation. When extra-therapeutic relationships cannot be avoided, LMFTs shall take appropriate professional precautions to insure that judgment is not impaired and that no exploitation occurs. Examples of such extra therapeutic relationships include, but are not limited to, business or close personal relationships with clients. Sexual intimacy with clients is prohibited. Sexual intimacy with former clients for two years following the termination of therapy is prohibited.

LADC Rules 38:10-3-3(e) Dual Relationships: LADCs and CADCs shall be aware of their influential positions with respect to clients, and shall not exploit the trust and dependency of clients. Examples of such relationships include, but are not limited to, familial, social, financial, business, professional or close personal relationships with clients. When the possibility that a dual relationship exists, the LADC and CADC shall take appropriate professional precautions such as informed consent, consultation, supervision and documentation to insure judgement is not impaired and no exploitation occurs.

LBP Rules 86: Non-professional relations with clients (a)Dual relationships. LBPs shall not knowingly enter into a dual relationship(s) and shall take any necessary precautions to prevent a dual relationship from occurring. When the LBP reasonably suspects that he or she has inadvertently entered into a dual relationship the LBP shall record that fact in the records of the affected client(s) and take reasonable steps to eliminate the source or agent creating or causing the dual relationship. If the dual relationship cannot be prevented or eliminated and the LBP cannot readily refer the client to another counselor or other professional, the LBP shall complete one or more of the following measures as necessary to prevent the exploitation of the client and/or the impairment of the LBP’s professional judgment: (1) Fully disclose the circumstances of the dual relationship to the client and secure the client's written consent to continue providing counseling; (2) Consult with other professional(s) to understand the potential impairment to the LBP’s professional judgment and the risk of harm to the client of continuing the dual relationship; (b)Sexual contact. The following restrictions apply to sexual contacts between LBPs and clients, students or supervisees.(1)Current clients. LBPs shall not engage in sexual contact with clients and shall not counsel persons with whom they have had a sexual relationship. (2) Students and supervisees. LBPs shall not engage in sexual contact with students or supervisees and shall not teach or supervise persons with whom they have had a sexual relationship. (c) Providing counseling to persons of prior association. LBPs shall not undertake to provide counseling to any person with whom the LBP has had any close personal relationship within the previous five (5) years. (d) Interaction with former clients. LBPs shall not knowingly enter into a close personal relationship, or engage in any business or financial dealings with a former client for two (2) years after the termination of the counseling relationship. LBPs shall not engage in any activity that is or may be sexual in nature with a former client for at least five (5) years after the termination of the counseling relationship. LBPs shall not exploit or obtain an advantage over a former client by the use of information or trust gained during the counseling relationship.

LCSW Rules 675: Social worker’s ethical responsibility to clients a. Social workers shall not exploit their professional relationships with clients (or former clients), supervisees, students, employees, or research participants, sexually or otherwise for personal or business advantage. Social workers shall not condone or engage in sexual harassment. Sexual harassment is defined as deliberate or repeated comments, gestures, or physical contacts of a sexual nature that are unwanted by the recipient. d. A social worker shall not engage in any sexual act with a client or with a person who has been a client within the past twelve months.

Beware and Be Aware of Social Overlap Community (i.e. Church, School, Civic Organizations, the Gym, etc) Spouses, Children, Family (school, sports, extra- curricular activities, workplace, etc) Social Media (Facebook, Twitter, Instagram, etc)

Considerations Remember: unnecessary multiple relationships can contain unnecessary risk. As a rule, it is likely to be in the best interests of the clinician, regardless of location or any other factors, to avoid multiple relationships if at all possible. Here are some things to consider: Informed Consent Confidentiality Discussions Consult Refer to another agency

Informed Consent Make sure client understands the issues at hand, possible, risks and dilemmas Document in writing that client has been presented the risks and issues involved and consents to treatment, sign and date document. Send to office for file, leave a copy with client.

Confidentiality It is important to remind clients about client confidentiality, and to have dialog about how situations in the community will be handled (i.e. running into client in public, etc)

Consultation If you are uncertain or have questions, consultation is a must. Consultation is important whether you have been working in the field for 30 years or 30 minutes. Always take the opportunity to process with your Clinical Director, supervisor, or licensure board.

Refer If necessary, to avoid potential harm, litigation, exploitation, boundary problems, and risk, refer client to another in-agency professional or another agency.

Examples of Dual/Multiple Relationships (issues that have come up in consultation) Teacher providing services for his/her students Coach providing services for team members Sunday school teacher providing services for those in class Pastor or youth minister providing and billing services for those in congregation (although this may occur as part of a church counseling program, typically this doesn't involve billing, it is a job duty) Providing services for a relative (by blood or marriage) Providing services for a friend or friend’s family member Hiring or paying a client for something Having client as a “friend” or “follower” on social media Too much self disclosure; talking about your issues or your past, etc.

Bottom Line, No- No's No relatives (by blood or by marriage) as clients No friends as clients No business with clients, including your family members or client’s family (i.e. don’t hire clients to do things for you and don’t hire your family to do things for clients) No financial involvement with clients No sex or intimate or close personal relationships with clients (this seems obvious but it is a frequent complaint to licensure boards)

And When in Doubt… Consult

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