A commenter to one of the recent posts on termination mentioned dual relationships so it seems a good time to look at this issue.
The APA (American Psychological Association) has this to say in its code of ethics:
A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.
A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.
Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.
Note that dual relationships are not forbidden, though caution is urged. So those who advocate a very rigid policy prohibiting such relationships are not more ethical, they are just more rigid. For some this seems the best way to go. But such rigidity assumes that patients are capable of functioning only at the lowest level for relatedness and that any dual relationship is necessarily exploitive and harmful. It shouldn't be necessary, but I want to make it clear that I am talking only about non-sexual dual relationships. It certainly makes sense for example not to play tennis with a patient who suffers from borderline traits as such a person’s difficulty making sense sense of multiple roles going to cause problems. And one of our roles as therapists is to work to understand the context, purpose and meaning of behavior.
There is a trend in our culture toward attempting to codify ethical behavior through an ever more detailed set of rules and guidelines. But this comes at the dangerous expense of ignoring the fundamental component of ethics, that of setting one's own ethical compass by holding to a clear sense of what is right, what is good and what is moral and ethical. This only comes from being challenged to think critically, good clinical supervision, and strong focus on inculcating the ethical values of the profession. The ethical life is not simply the result of rigidly following rules. The ethical life is a matter of trying to determine the kind of person I should be and of attending to the development of character within myself and my community.
So, an acquaintance, someone I know slightly socially, calls and wants to see me in therapy. What do I say? My stance is that I agree to an initial appointment and within that session we look at possible complications arising from our other relationship and new limits and boundaries that therapy will create. And make it clear that these issues may arise again at different points in our work and when they do, we can and will work through them. In a large city, this issue could be handled by referring the acquaintance to another therapist but in rural areas, this is not always possible or desirable.
Aware of the power issues in a therapy relationship, issues which make any request I make inevitably create conflict, however minor, I try to avoid initiating any dual relationships with my patients. Were I working with a patient who is a plumber, I would not call that person if I needed plumbing services. It just gets too complicated. Nor would I ask a patient to edit a paper I wrote or collaborate on a project. Only when the other can feel free to refuse can such requests work. At least that is how I see it.
But what if my landlord wanted to see me in therapy? Is that okay? Or my physician? Is it all right for a student to seek therapy from a therapist who is also her instructor?
The only way I know to decide such cases is to keep in mind the best interests of the patient and the therapy. Anything which threatens either the patient or the therapy at the very least needs to be thoroughly explored and discussed, if not avoided altogether. What does a request like one of those above mean to the prospective patient? What are the potential complications? How willing is the prospective patient to look at these issues and explore them? What are the possible negative consequences if the therapy is agreed to?