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Not All Dual Relationships Are Created Equal

Clinical Update
By Zur Institute

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For a detailed article on the topic of different types of multiple relationships: Zur, O. (2014). Not All Multiple Relationships Are Created Equal: Mapping the Maze of 26 Types of Multiple Relationships. Independent Practitioner, 34/1, 15-22.



Choice: Mandated, Unavoidable, Healthy/Normal, Avoidable, Unexpected

Context: Social, Professional, Business, Institutional, Forensic, Supervisory, Sexual, Digital, Addition

Legal/Ethical: Ethical, Unethical, Legal, Illegal

Timing/Sequence: Concurrent, Sequential

Intensity: Low, Medium, High

Normal/Common: Normal/common for certain settings, not common/normal for settings/situations

Dual Relationships

Dispelling the Myths that All Multiple Relationships are Unethical and/or Harmful

As mental health professionals, most of us have had the experience of attending risk management or ethics workshops where we hear the central message, and dire warning, that multiple relationships are generally prohibited, inherently harmful and should be avoided. We, understandably but falsely, assume these messages are based on prohibitions in the codes of ethics. In fact, not one professional code of ethics prohibits all forms of dual or multiple relationships. Of course, sexual dual relationships between psychotherapists and current or recently terminated clients are always unethical. However, other forms of dual relationships are, in fact, mandated or required and, in certain situations, they can be unavoidable. Furthermore, there are types of multiple relationships which are, in fact, a normal part of healthy, interconnected and interdependent small communities. (Generally, the terms 'dual relationship' and 'multiple relationship' are used interchangeably.)

Multiple relationships take place when, in addition to the professional role of a psychotherapist or counselor, the professional is also involved in an additional role with the client or with a person closely associated with the client.

The Codes of Ethics of NASW, ACA, CAMFT, etc. provide statements that are basically similar to that of the APA: "Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical." ACA's code states that multiple relationships "may be potentially beneficial", and CAMFT's code states that, "Not all dual relationships are unethical, and some dual relationships cannot be avoided." In summary, none of the major professional organizations' codes of ethics prohibits all forms of dual or multiple relationships.



Dual Relationships Can Be:

  • Mandated: As in military, jail, and prison settings and at times in law enforcement settings
  • Unavoidable: In small rural communities, sport psychology, rehabilitation and drug program and AA or other 12 step programs, remote army bases, aircraft carriers, and some training institutions and educational settings
  • Healthy & Normal: Part of small interdependent and interconnected communities and spiritual and faith communities
  • Ethical/Legal: Multiple relationships can be legal or illegal (i.e., sexual relationships with current clients) and can be ethical or unethical (i.e, harmful or exploitative multiple relationships)
  • Avoidable: In large communities and metropolitan areas
  • Unexpected: As in the movie "Prime" (Imagine finding that the "boyfriend" your client refers to is...your son.)

Contexts of Multiple Relationships

  • Social
  • Professional
  • Business
  • Institutional
  • Communal
  • Forensic
  • Supervisory
  • Sexual
  • Digital

Ethical & Legal Multiple Relationships

  • Ethical
  • Unethical
  • Legal
  • Illegal

Timing/Sequence of Dual Relationships

  • Concurrent
  • Sequential

Intensity Level of Involvement

  • Low
  • Medium
  • Intense

Common or Normal

  • Common and normal for certain settings or communities
  • Healthy aspects of certain communities
  • Unusual or uncommon for certain settings or communities

Situations That Generally DO NOT Constitute Dual Relationships

  • Making a home visit for clinical reasons
  • Accompanying a client to a dreaded but important medical appointment
  • Conducting a session on a walk with a client
  • Attending a wedding, confirmation, bar-mitzvah, or school play
  • 'Friends' on professional social networks, such as LinkedIn
  • Having a meal with a client for clinical reasons
  • Conducting sessions outside the office with a client with a clear clinical rationale

The Main Types of Multiple Relationships to AVOID

  • Always avoid sexual dual relationships with current and recently terminated clients
  • Avoid dual relationships that can reasonably be expected to cause impairment, or risk exploitation or harm
  • Avoid serving as a treater/clinician and an expert in child custody and other situations (i.e., avoid forensic dual relationships)
  • If you are not sure, consult with experts



Free Resources by the Zur Institute on Dual Relationships

Consult on Dual Relationships Cases

  • Consultation with experts can help you figure out how to proceed and can add a layer of protection.
  • Consult with Dr. Zur



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