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Ethics of Dual and Multiple Relationships &
Therapeutic Boundaries in Rural Communities

Ethical, Clinical and Standard of Care Considerations


By Ofer Zur, Ph.D.

This page provides resources regarding the ethics of often unavoidable multiple relationships in rural communities. Such social, professional and, at times, business dual relationships are often a healthy and integral part of these rural communities, which helps them survive and thrive.

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Summary Article

Therapeutic Boundaries and Dual Relationships in Rural Practice

Online Resources

Additional Resources

  • Barbopoulos, A. & Clark, J. M (2003). Practicing psychology in rural settings: Issues and guidelines. Canadian Psychology, 44/4, 410-424.
  • Barnett, J. E., (In Press). Unavoidable Incidental Contacts and Multiple Relationships in Rural Practice. In Zur, O. (Ed.) Multiple Relationships in Psychotherapy and Counseling: Unavoidable, Common and Mandatory Dual Relations in Therapy. New York: Routledge.
  • Barnett, J. E., & Yutrzenka, B. A. (1994). Non-sexual dual relationships in professional practice, with special applications to rural and military communities. The Independent Practitioner, 14 (5), 243-248.
  • Brownlee, K. (2010). Managing ethical considerations around dual relationships in small rural and remote Canadian communities. International Social Work, March 2010 vol. 53 no. 2, 247-260.
  • Brownlee, K. (1996). The ethics of non-sexual dual relationships: A dilemma for the rural mental health professional. Community Mental Health Journal, 32(5), 497-503.
  • Brownlee, K. & Taylor, S. (1995). The Canadian Association of Social Workers Code of Ethics and non-sexual dual relationships. The Social Worker, 63, 133-136.
  • Campbell, C. D. & Gordon, M. C. (2003). Acknowledging the inevitable: Understanding multiple relationships in rural practice. Professional Psychology: Research and Practice, 34(4): 430-434.
  • Catalano, S. (1997). The challenges of clinical practice in small or rural communities: Case studies in managing dual relationships in and outside of therapy. Journal of Contemporary Psychotherapy, 27(1), 23-35.
  • DeLeon, P. H., Wakefield, M., & Hagglund K. (2003). The behavioral health care needs of rural communities. In B. H. Stamm (Ed.), Rural Behavioral Health Care: An Interdisciplinary Guide. Washington, DC: American Psychological Association.
  • Endacott, R., Wood, A., Judd, F., Hulbert, C., Thomas, B., Grigg, M.t (2006). Impact and management of dual relationships in metropolitan, regional and rural mental health practice. Australian and New Zealand Journal of Psychiatry, 40(11-12), 987-994.
  • Fronek, P., Kendall, M., Ungerer, G., Malt, J., Eugarde, E., Geraghty, T. (2009). Too hot to handle: reflections on professional boundaries in practice. Reflective Practice, 10(2), 161-171.
  • Halverson, G., & Brownlee, K. (2010). Managing ethical considerations around dual relationships in small rural and remote Canadian communities. International Social Work, 53(2), 247-260.
  • Hargrove, D. S. (1986). Ethical issues in rural mental health practice. Professional Psychology: Research and Practice, 17, 20-23.
  • Hastings, S. L., & Cohn, T. J. (2013). Challenges and opportunities associated with rural mental health practice. Journal of Rural Mental Health, 37, 37–49.
  • Helbok, C. M. (2003). The practice of psychology in rural communities: Potential ethical dilemmas. Ethics & Behavior, 13(4), 376-384.
  • Helbok, C. M., Marinelli, R. P., & Walls, R. T. (2006). National survey of ethical practices across rural and urban communities. Professional Psychology: Research and Practice, 37, 36–44.
  • Holzer, C. E., III, Goldsmith, H. F., & Ciarlo, J. A. (2000). The availability of health and mental health providers by population density. Journal of the Washington Academy of Sciences, 86, 25–33.
  • Jennings, F. L. (1992). Ethics of rural practice. Psychotherapy in Private Practice (Special Issue: Psychological Practice in Small Towns and Rural Areas), 10 (3), 85-104.
  • Murray, J. D., & Keller, P. A. (1991). Psychology and rural America: current status and future directions. American Psychologist, 46, 220–231.
  • Nickel, M. (2004). Professional boundaries: The dilemma of dual and multiple relationships in rural clinical practice. Consulting and Clinical Psychology Journal, 1(1), 17-22.
  • Osborn, L. (2012). Juggling personal life and professionalism: ethical implications for rural school psychologists. Psychology in the Schools, 49, 876–882.
  • Pugh, R. (2007). Personal and professional boundaries in rural social work. British Journal of Social Work, 37(8), 1405-1423.
  • Schank, J. A., Helbok, C. M., Haldeman, D. C., & Gallardo, M. E. (2010). Challenges and benefits of ethical small-community practice. Professional Psychology: Research and Practice, 41, 502–510.
  • Schank, A. J., & Skovholt, T. M. (2006). Ethical Practice in Small Communities: Challenges and Rewards for Psychologist. Washington DC: APA Books.
  • Schank, J. A., & Skovholt, T. M. (1997). Dual-relationship dilemmas of rural and small-community psychologists. Professional Psychology: Research and Practice, 28 (1), 44-49.
  • Scopelliti, J., Judd, F., Grigg, M., Hodgins, G., Fraser, C., Hulbert, C., Endacott, R., & Wood, A. (2004). Dual relationships in mental health practice: Issues for clinicians in rural settings. Australian and New Zealand Journal of Psychiatry, 38, 953–959.
  • Sidell, N. (2007). An exploration of nonsexual dual relationships in rural public child welfare settings. Journal of Public Child Welfare, 1(4), 91-104.
  • Sterling, D. L. (1992). Practicing rural psychotherapy: Complexity of role and boundary. Psychotherapy in Private Practice, 10(3), 105-127.
  • Stockman, A. F. (1990). Dual relationships in rural mental health practice: An ethical dilemma. Journal of Rural Community Psychology, 11 (2), 31-45.
  • Taylor, S. & Brownlee, K. (2000). Non-sexual dual relationships: Challenging professional accountability. Ontario Association of Social Workers: Newsmagazine, 27(2), 1-2.
  • Wheeler, L. C. (1994). Dual relationships in rural practice: No easy answers. Libraries Worldwide, 17(6), 100-129.
  • Zur, O. (2006). Therapeutic boundaries and dual relationships in rural practice: ethical, clinical and standard of care considerations. Journal of Rural Community Psychology. V. E9/1. Retrieved from (accessed July 27, 2016).

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