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1 PREFACEAs helping professionals. we enter into a dual relationship whenever we have another, significantly different relationship with oneof our clients. students, or supervisees. When we play dual roles.the potential exists for a conflict of interest and for exploiting thosewho seek our help. Our profession has become increasingly concerned about dual relationships as an ethical issue. Throughoutthe 1980s. sexual dual relationships received a great deal of atten-iion in both the professional literature and the popular press.Today. there is clear agreement that sexual dual relationships areunethical, and prohibitions against them have been codified intoethical standards and law.Lately, nonsexual dual relationships have been getting more attention. Articles on the topic have been appearing more frequentlyin our professional journals. Recent revisions of the ethical standards of some professional associations have dealt more extensivelywith dual relationship issues. There has also been an increase inlegislative and governing board activity. For example, in Californiathe Board of Behavioral Science Examiners and the Board of Psychology are developing regulatory language that attempts to addresseffectively the issue of nonsexual dual relationships in psychotherapy. The enforcement programs of both boards are faced with manyconsumer complaints and disciplinary cases that involve harm toclients as a result of a variety of dual relationships.Nonsexual dual relationships can be complex. The issues are pervasive and affect counselors and human development specialists inall work settings and in relationships with individual clients, students, or supervisees; in relationships with families: in relationshipswith groups: and in supervision or consultatioa activities. Just afew examples of problematic or potentially problematic situationsare bartering with a client for goods or services, counseling a friend.

xivDUAL RELATIONSHIPS "V COUNSELINGproviding therapy to a student or supervisee, conducting experiential groups as part of a group counseling class, becoming involvedin a discipline matter with a student client, and managing the casebudget for a client in rehabilitation counseling.When conscientious professionals look for guidance regardingdual relationships, they may find conflicting advice. The AACD Eth7teal Standards (1988) state that "dual relationships with clients thatmight impair the member's objectivity and professional judgmentmust be avoided. ." (emphasis ours). Yet, many writers have asserted that not all dual relationships can he avoided nor are theynecessarily harmful.Considerable disagreement exists around some dual relationshipissues. We (Barbara Herlihy and Gerald Corey) have seen this disagreement in our own recent experiences. During the summer of.1990, Gerald Corey proposed to the faculty in his university'shuman services program that a policy statement be created on thesubject of faculty seeing students as clients. His proposal stirredup quite a bit of controversy and evolved tnto a lengthy, two-partposition paper reflecting a diversity of viewpoints. At much the sametime, Barbara Herlihy was asked to consult with the staff of heruniversity's counseling center to help develop a policy on referringstudents to counselors in private practice. The first question raisedwas whether it is ever appropriate for college counselors to referclients to themselves when they also have a private practice. Thisgenerated a host of related questions and led to a series of extendeddiscussions. As each of us began to talk with friends and colleaguesaround the country, it became apparent to us that interest in dualrelationships is widespread and that there is a broad spectrum ofopinion surrounding many issues. This impression was reinforcedduring the 1991 AACD Convention in Reno, when the topic of dualrelationships received a great deal of attention and a number ofissues were heatedly debated.We hope that this book will be useful to others who share ourinterest in dual relationships and who struggle, as we do, to find adear personal stance on the issues involved. We intend it to be aresource that reflects the current thinking of our profession On thetopic. We also want it to represent th t. diversity of opinion thatexists. To that end, we have asked several guest contributors topresent their positions on various specific topics.We have organized the book so that part 1 presents generalintroduction and overview of dual relationships. In chapter 1, wedefine the issues and areas of concern. In chapter 2, we focus onsexual dual relationships, reviewing and discussing the consider.3

Prefacexvable body of existing literature and raising questions about some-gray areas." The remainder of the book focuses primarily on nonsexual dual relationships. In part II (chapters 3. 4. and 5). we ex-amine issues in the preparation and supervision of counselortrainees. Part III (chapters 6 through 11) focuses on how dual relationships affect practitioners in various settings and aspects oftheir work. We discuss issues that confrov.: counselors in privatepractice. college personnel workers. school counselors, rehabilitation counselors, group counselors. and consultants. At the end, inpart IV (chapter 12). we identify key themes. ask questions toencourage integration and reflection. and offer a decision-makingmodel. We make no claim to having discovered answers to complexand difficult questions. Rather, it is our aim to raise issues, presenta range of viewpoints on these issues, and discuss our own positions. We hope that you will use this material as a springboard forfurther reflection and discussion. We invite you to think about theissues that are raised. apply them to your own situation. and discuss them with colleagues.This work focuses on a specialized topic in counselor preparationand counseling practice. Because dual relationships are becominga topic of increased discussion, this book can be used as a supplement to any of the textbooks that are used for courses in ethicaland professional issues. We also expect that counselor educatorswill find this book useful for getting a current view of the potentialproblems and promises that are associated with dual relationships.The book can also be used in practicum. fieldwork. and internshipseminars. Finally, we hope the book will be useful to practitionerswho struggle with dual relationship issues in their work.We anticipate that dual relationshipsespecially nonsexual dualrelationshipswill continue to be discussed and debated well intothe 1990s. As with any complex ethical issue. complete agreementmay never be reached nor would it necessarily be desirable. However, as conscientious professionals. we must strive to clarify ourown stance and develop our own guidelines tor practice. within thelimits of ethical codes, current knowledge. and divergent opinions.

PART I:INTRODUCTION

1 CIMPTER 1DUAL RELATIONSHIPSIN PERSPECTIVEDual relationships occur when professionals assume two rolessimultaneously or sequentially with a person seeking help. Thismay mean two professional roles, such as counselor and teacher,or combining a professional and a nonprofessional role, such ascounselor and friend or counselor and lover. Dual relationship issues, both sexual and nonsexual, affect virtually all counselors andhuman development specialists regardless of their work setting orclientele.We assume that you, the reader of this book, havestruggled with some complex and difficult dual relationship issues in your work as a helping professional. Wehope that as you read the book, you will take time toreflect and consider how the material applies to you andyour situation. Questions that may be useful to ask atthe outset include the following:What are some of the dual relationship strugglesyou have faced in the past or are now facing?flow have you dealt, or how are you coping now,with these issues?What information do you hope to find in this bookthat will help you resolve your questions and con.cerns about the issues you cont.ront in your work?Over the past decade, much has been written about the harmthat can be done when helping professionals enter into sexual re-

4DUAL RELATIONSHIPS IN COUNSELINGlationships with their clients. The dangers of sexual dual relationships between counselor and client, supervisor and supervisee. andfaculty member and student have been well documented. Chapter2 will examine sexual dual relationships in detail.In this chapter. we focus on nonsexual dual relationships. Welook at general issues that arise in all settings. These questionsguide our discussion:What guidance do our codes of ethics offer about dualrelationships?What makes dual relationships so problematic forpractitioners?What factors create the potential for harm?What are the risks inherent in dual relationships, for all parties directly or indirectly involved?What are some possible benefits in dual relationships?What safeguards can be built in to minimize risks?ETHICAL STANDARDSMost professional codes of ethics address the issue of dual relationships. as the following excerpts of standards from ethical codesfor counselors, psychologists, and social workers that speak to nonsexual dual relationships illustrate:When the member has other relationships. partksularly of anadministrative, and/or evaluative nature with an individualseeking counseling services, the member must not serve as thecounselor but should refer the individual to another professional. Only in instances where such an alternative is unavailable and where the individual's condition warrants counselingintervention should the member enter into and/or maintain acounseling relationship. Dual relationships with clients thatmight impair the member's objectivity and professional judgment (e.g., as with dose friends or relatives) must be avoidedand/or the counseling relationship terminated through referralto another competent professional. (American Association forCounseling and Development (AACD), 1988)Psychologists are continually cognizant of their own needs andof their potentially influential position vis-A-vis persons suchas clients, students, and subordinates. They avoid exploitingthe trust and dependency of such persons. Psychologists make17

Dual Relationships in Perspective5every effort to avoid dual relationships that could impair theirprofessional judgment or increase the risk of exploitation. Examples of such dual relationships include, but are not limitedto, research with and treatment of employees, students, supervisees. close friends, or relatives. (American Psychological Association IAPAI, 1989)Clinical social workers use care to prevent the intrusion of theirown personal needs into relationships with clients. They recognize that the private and personal nature of the therapeuticrelationship may unrealistically intensify clients' feelings toward them, thus increasing their obligation to maintain professional objectivity. Therefore, specifically:Clinical social workers avoid entering treatment relationshipsin which their professional judgment will be compromised byprior association with or knowledge of a client. Examples mightinclude treatment of one's family members, close friends, associates, employees, or others whose welfare could be jeopardized by such a dual relationship.Clinical social workers do not initiate, and should avoid whenpossible, personal relationships or dual roles with current clients, or with any former clients whose feelings toward themmay still be derived from or influenced by the former profes.sional relationship. (National Federation of Societies for ClinicalSocial Work INFSCSWI, 1985)As we noted in the preface. nonsexual dual relationships are receMng increased attention. One example of this increased scrutinyis a set of proposed draft regulations regarding dual relationshipsthat would impact the work of helping professionals in California.These draft regulations were the subject of a joint hearing of theBoard of Behavioral Science Examiners and the Board of Psychologyheld in December 1990. The proposed draft, which made a comprehensive attempt to address the issues involved in dual relationships, includes these statements:(a) Psychologists, psychological assistants. registered psychologists, and psychological interns shall avoid dual relationshipswhich could impair their professional judgment or increase therisk of exploitation and/or harm to the patient. Involvement insuch dual relationships is prohibited and constitutes unprofessional conduct and grounds for disciplinary action.(b) A dual relationship exists when a psychologist, psychologicalassistant, registered psychologist, or psychological intern has arelationship which is in addition to, or outside of, the primaryrelationship of providing professional psychological services. InS

6DUAL RELATIONSHIPS IN COUNSELINGaddition to personal. social, and business relationships, dual relationships include secondary financial relationships.(c) When a psychologist, psychological assistant, registered psychologist, or psychological intern reasonably should know that adual relationship is developing, the provider shall determinewhether the dual relationship can be prevented and the primaryprofessional relationship protected. At a mininmm, this shall indude consultation by the provider with another psychologist forthe specific purpose of objectively assessing the situation.(d) When the psychologist, psychological assistant, registered psychologist, or psychological intern reasonably should know that aprohibited dual relationship cannot be prevented, appropriatesteps shall be taken to termiliate all relationships to ensure thatthe professional relationship has been adequately resolved to bestprotect the interests of the patient. (Board of Behavioral ScienceExaminers. 1989)As can be seen. these proposed regulations address dual relationships quite extensively. Dual relationships include personal. social,business, and secondary financial relationships. Practitioners areexpected to "reasonably know" that a dual relationship is developingand to consult with a colleague to see whether it can be prevented.If it cannot be prevented then the relationship should be terminated.During the hearing held to discuss these proposed regulations.differing reactions were voiced. One attendee suggested t hat avoidance of all dual relationships should be encouraged. whereas otherswere concerned that written regulations might end up prohibitinginnocent conduct. A middle-ground suggestion was that "insteadof trying to ban every conceivable dual relationship that might causeharm.the boards try to ban specific conduct that is clearly improper and upon which there is consensus" (Leslie, 1991, p. 18).A second example of increased attention to nonsexual dual rela.tionships can be found in the draft of proposed revisions to theAmerican Psychological Association (APA) ('ode of ethics. This draftcontained a section on "potentially harmful dual relationships":(a) Psychologists who have a professional rdationship with il pa-tient. client. student, supervism, reear b subject. or organiza-tion refrain from becoming involved in aimtlwr concurrentpersonal, professional. financial, or other relationship with suchpartv if it k reasonably foreseeable that doing so inight interferewith I heir effectively rendering professional psychological set-viersor might harm or exploit that party.I9

Dual Relationships in Perspective7(b) Likewise, whenever feasible, psychologists refrain from takingon professional obligations in which preexisting relationshipswould create such risks.(c) Minimal or remote relationships are unlikely to violate thisstandard.(d) When a psychologist knows or should know that a potentiallyharmful dual relationship has arisen, the psychologist promptlyattempts to resolve it with due regard for the best interest of theaffected person and with maximum feasible compliance with theEthics Code. ("Draft." 1991)At this time, we do not know whether regulations like those proposed in California and by the APA represent the wave of the future,or whether it will eventually be decided that it is best left to profes-sionals' judgment to distinguish between harmful nonsexual dualrelationships and those that are benign. In the absence of specificguidance, we are left with many areas of uncertainty.Although ethical codes generally prohibit or warn against enteringinto dual relationships, most practitioners agree that not all dualrelationships can be avoided. Recent attention to nonsexual dualrelationships in our profession has highlighted this dilemma andhas left conscientious practitioners wondering how they are supposed to avoid the unavoidable.WHAT MAKES DUAL RELATIONSHIPSSO PROBLEMATIC?Dual relationships are rarely a dear-cut matter. Often, judgmentcalls and the careful application of ethical codes to specific situations are needed. Dual relationships are fraught with complexitiesand ambiguities. They can be problematic along a number of dimensions: (1) they are pervasive. (2) they can be difficult to recog-nize. (3) they are sometimes unavoidable, (4) they can be veryharmful but are not always harmful, and (5) they are the subjectof conflicting advice from expert sources.Dual relationships are pervasive. Dual role relationship issuesexist throughout our profession. A broad array of issues presentthemselvesfor example. bartering with a client for goods or services, counseling a friend or social acquaintance, the counseloreducator's dual role as educator and therapeutic agent with students, or the propriety of dating a former client. Dual relationship

8DUAL RELATIONSHIPS IN COUNSELINGissues confront counselors and human development specialists indiverse roles, including counselor educator, supervisor, privatepractitioner, school counselor, college student personnel specialist,and rehabilitation counselor. They affect the dyadic relationshipbetween counselor and client, and they also emerge in complexways when relationships are tripartite (as in client/supervisee/supervisor or client/consultee/consultant) or involve families or groupwork. No professional remains untouched by the potential difficulties inherent in dual relationships. In later chapters, we will focuson concerns that are specific to various settings and formats.Dual relationships can be difficult to recognize. Pope and Vasquez(1991) have noted that dual relationships are relatively easy todefine but much

Our guest contributors have enriched this book immensely. By sharing their thoughts and opinions. they have provided a diversity. ofviewpoints and have raised issues that are well worth considering. Following is a list of these individuals, their institutional affiliatio