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Ethics of Therapeutic Boundaries and Dual & Multiple Relationships in Recovery, 12 Step, and Substance Abuse Rehabilitation Communities

Resources & References

By Ofer Zur, Ph.D.

This page provides an overview and resources regarding the unavoidable complex therapeutic boundaries and the ethics of unavoidable and not uncommon multiple relationships in recovery, 12 step, and substance abuse rehabilitations communities.


Overview on Dual Relationships in Recovery Programs

Before the term dual relationships became well known, recovering mental health professionals were referred to as "two-hatters" in the AA community because they wore two hats, one as the counselor and one as the person in recovery. Many rehabilitation psychotherapists are actively in recovery for themselves, so it is not uncommon that they encounter current or former clients at 12 step meetings, Rational Recover, or other recovery gatherings. Not only does this often create unavoidable dual relationships between client and therapist, these boundary crossing relationships are reported to have positive effects on clients as therapists model, encourage and support their sobriety via 12 step programs. Bissell and Royce (1987) referred to this form of multiple relationships by saying, "Today's patient in treatment becomes tomorrow's peer at A.A." (p. 35). Consider the following example. A client has a therapist in a residential rehabilitation program. After he has completed his 28 day program he attends outpatient AA meetings and sees the therapist there as a member. The client attends a program to be trained as a therapist and gets a job at the original 28 day program which makes him a professional colleague working side by side with his prior therapist with whom he fellowships at a 12 step meeting. Dual relationships are rooted in treatment recommendations of maintaining involvement in recovery community. Tongue in cheek, we can think of many hat combinations.


Online Resources for Multiple Relationships in Recovery Programs

  • Association for Addiction Professionals NAADAC/NCC Code of Ethics (2011)
    Standard 3: Dual Relationships
    • The addiction professional understands that the goal of treatment services is to nurture and support the development of a relationship of equals of individuals to ensure protection and fairness of all parties.
    • Addiction professionals will provide services to clients only in the context of a professional setting. In rural settings and in small communities, dual relationships are evaluated carefully and avoided as much as possible.
    • Because a relationship begins with a power differential, the addiction professional will not exploit relationships with current or former clients, current or former supervisees or colleagues for personal gain, including social or business relationships.
    • The addiction professional avoids situations that might appear to be or could be interpreted as a conflict of interest. Gifts from clients, other treatment organizations or the providers of materials or services used in the addiction professional's practice will not be accepted, except when refusal of such gift would cause irreparable harm to the client relationship. Gifts of value over $25 will not be accepted under any circumstances.
    • The addiction professional will not engage in professional relationships or commitments that conflict with family members, friends, close associates or others whose welfare might be jeopardized by such a dual relationship.
    • The addiction professional will not, under any circumstances, engage in sexual behavior with current or former clients.
    • The addiction professional will not accept as clients anyone with whom they have engaged in romantic or sexual relationships.
    • The addiction professional makes no request of clients that does not directly pertain to treatment (giving testimonials about the program or participating in interviews with reporters or students).
    • The addiction professional recognizes that there are situations in which dual relationships are difficult to avoid. Rural areas, small communities and other situations necessitate discussion of the counseling relationship and take steps to distinguish the counseling relationship from other interactions.
    • When the addiction professional works for an agency such as department of corrections, military, an HMO or as an employee of the client's employer, the obligations to external individuals and organizations are disclosed prior to delivering any services.
    • The addiction professional recognizes the challenges resulting from increased role of the criminal justice system in making referrals for addiction treatment. Consequently he/she strives to remove coercive elements of such referrals as quickly as possible to encourage engagement in the treatment and recovery process.
    • The addiction professional encourages self-sufficiency among clients in making daily choices related to the recovery process and self care.
    • The addiction professional shall avoid any action that might appear to impose on others' acceptance of their religious/spiritual, political or other personal beliefs while also encouraging and supporting participation in recovery support groups.
  • St. Germaine, Jacquelyn, (1993). Dual relationships: A national study of addiction counselors' beliefs and behaviors . A Dissertation, Univ. of Arizona
  • Demask, Dean M., Ethics for Addiction Professionals
  • Kaplan, L.E. (2005). Dual Relationships: The Challenges for Social Workers in Recovery, Journal of Social Work Practice in the Addictions, 5/3 (download)
  • Nardone, N.A. (2006). Analyzing the Pros and Cons of Multiple Relationships Between Chemical Addiction Therapists and their Clients. Journal of Addictive Disorders.
  • Powell, Less J. (ss). Opinions Concerning Unique Dual Relationships among Recovering Substance Abuse Counselors in Rural and Urban Settings. A Dissertation, State Univ. Kansas.

Confidentiality and Privilege in Recovery Programs

  • Alcoholics Anonymous. Understanding Anonymity. Retrieved from http://www.soberrecovery.com.
  • Behnke, S. (2004). Multiple relationships and APA's new Ethics Code: Values and applications. Ethics Rounds, 35(1), 66-66.
  • Coleman, P. (2005). Privilege and confidentiality in 12-step self-help programs: Believing the promises could be hazardous to an addict's freedom. The Journal of Legal Medicine, 26(4), 435-474.
  • Jaffee v. Redmond (95-266), 518 U.S. 1 (1996).
  • Kaplan, L.E. (2005). Dual Relationships: The Challenges for Social Workers in Recovery. Journal of Social Work Practice in the Addictions, 5/3.
  • Nardone, N.A. (2006). Analyzing the Pros and Cons of Multiple Relationships Between Chemical Addiction Therapists and their Clients. Journal of Addictive Disorders. Retrieved from: http://www.breining.edu.
  • Remley, T. P., Herlihy, B., & Herlihy, S. B. (1997). The US Supreme Court decision in Jaffee v. Redmond: Implications for counselors. Journal of Counseling & Development, 75(3), 213-218.
  • Sex Addicts Anonymous. Group Guide: Handbook for SAA Groups. Retrieved July 05, 2017, from http://saa-recovery.org/Meetings/GroupGuide/SAA_Group_Guide.pdf.
  • Sex Addicts Anonymous (2017). Sex Addicts Anonymous, 3rd Edition.
  • Silberstein, A, & Lindsey Boone, L. (2017). Multiple Relationships in Recovery Communities.(pp. 130-140) In O. Zur, (Ed.) Multiple Relationships in Psychotherapy and Counseling: Unavoidable, Common and Mandatory Dual Relations in Therapy. New York: Routledge.
  • Weiss, R. Does Therapist-Patient Confidentiality and Privilege Extend to 12-Step Programs? Retrieved from https://blogs.psychcentral.com/
  • Zur, O. (2014). Not all multiple relationships are created equal: Mapping the Maze of 26 Types of Multiple Relationships. The Independent Practitioner, 34 (1), 15-22.

References on Multiple/Dual Relationships in Recovery Programs

  • Barker, M. (1966).The ethical Two-hater. The Counselor, 14(3),15-16.
  • Bissell, L., & Royce, I. (1987). Ethics for addiction professionals. Center City, MN: Hazelden Foundation.
  • Demask, M. & Washington, D., Legal and Ethical Issues for Addiction Professionals, Pamphlet published by Hazelden Essentials for Professionals.
  • Doyle, K. (1997) Substance Abuse Counselors in Recovery: Implications for the Ethical Issue of Dual Relationships. Journal of Counseling & Development, 75/ 6, pages 428–432.
  • Gass, M. A. (1993). Adventure therapy: Therapeutic applications of adventure programming. Dubuque, IA: Kendall/Hunt.
  • Hollander J. K., Bauer S, Herlihy B., et al. (2006). Beliefs of board certified substance abuse counselors regarding multiple relationships. J Mental Health Counseling; 28:84-94.
  • Kaplan, L. E. (2005). Dual relationships: the challenges for social workers in recovery. Journal of Social Work Practice in the Addictions (accessed July 27, 2016).
  • Nardone, N. A. (2006). Analyzing the pros and cons of multiple relationships between chemical addiction therapists and their clients. Journal of Addictive Disorders. Retrieved from: http://www.breining.edu (accessed July 27, 2016).
  • Silberstein, A. & Boone, L., (2017). Multiple Relationships in Recovery Communities. In Zur, O. (Ed.) Multiple Relationships in Psychotherapy and Counseling: Unavoidable, Common and Mandatory Dual Relations in Therapy. New York: Routledge.
  • St. Germaine, J. (1996) Dual Relationships and Certified Alcohol and Drug Counselors. Alcoholism Treatment Quarterly 14(2): 29-44.
  • White, W. (1933). Critical incidents: Ethical issues in substance abuse prevention and treatment. Blomington, IL: Lighthouse Training Institute.

Extensive Reference List on Dual and Multiple Relationships in Psychotherapy & Counseling

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