TABLE OF CONTENTS Introduction Links to professional organizations codes of ethics Codes of Ethics on Touch APA CAMFT NASW USABP Ethical decision-making and the standard of care Written consent form regarding touch in therapy Codes of Ethics on Sexual Relationships with Clients APA CAMFT NASW USABP Codes of Ethics on Dual Relationships APA CAMFT NASW USABP AAMFT ApA ACA Links California law online sites California Business and Professional Code BOP - CA: Laws and Reg. Relating to the Practice of Psychologists BBS - CA: Laws and Reg. Relating to the Practice of MFTs & LCSWs California Business and Professional Code on sexual exploitation Professional Therapy Never Includes Sex - Brochure The CA Business and Professional Code on sexual exploitation BOP - Laws and Regulations Relating to the Practice of Psychology BBS - Laws and Regulations Relating to the Practice of MFTs & LCSWs INTRODUCTION This article accompanies the more comprehensive article "To Touch or Not to Touch." Together, these two articles provide extensive coverage of the issues of touch in psychotherapy and counseling. This paper is also a part of the "Touch in Psychotherapy" online course. It is the part of the course that is in fulfillment of the Law and Ethics requirement for California Psychologists, MFTs & LCSWs. This article provides general legal and ethical information on the issues of touch in psychotherapy and counseling. It is also designed to ensure that California psychologists, MFTs and LCSWs are provided with the relevant and most current and up-to-date information regarding the applicable California law, professional codes of ethics and ethical decision-making. The focus of the paper is on non-sexual touch that is employed as an adjunct to verbal psychotherapy. In addition to the discussion of California laws and regulations this article discusses the sections of the codes of ethics relevant for psychologists (American Psychological Association (APA) Code of Ethics), MFTs (California Marriage and Family Therapists (CAMFT) Code of Ethics) and LCSWs (National Association of Social Workers (NASW) Code of Ethics). It provides additional information from the Code of Ethics of the United State Association of Body Psychotherapists (USABP). This last section is likely to be mostly relevant to those who use touch primarily as an intervention rather than as an adjunct to verbal psychotherapy. The relevant sections of these codes will be discussed and direct links to the codes online will be provided. State laws vary, and therapists must be informed about their own state laws. This section does not intend to serve in lieu of clinical, ethical and legal consultation. It neither gives legal, ethical nor clinical advise. Each situation, context, therapist and client is different, and, therefore, each situation needs to be evaluated independently. Following are links to the Codes of Ethics that are applied most directly to California Psychologists, MFTs and LCSWs: American Psychological Association (APA): http://www.apa.org/ethics/code2002.html California Association of Marriage and Family Therapists (CAMFT): http://www.camft.org/CamftBenefits/whatiscamft_ethnic1.html National Association of Social Workers (NASW): http://www.ssc.msu.edu/~sw/ethics/nasweth.html Additional ethical guidelines, which may be relevant to therapists who use touch in therapy more extensively, is the code of ethics of: United States Association for Body Psychotherapy (USABP): http://www.usabp.org/associations/1808/files/USABPethics.pdf Codes of Ethics on Therapist-Client Physical Contact or Touch: This section refers to ethical guidelines in regard to touch or physical contact that is intentionally employed as part of or adjunct to verbal psychotherapy. Counter to common belief non-sexual or non-erotic touch, like many other boundary crossings, are not always unethical. Ethics codes of all major psychotherapy professional associations (e.g., AAMFT, ACA, ApA, APA, NASW, NBCC) do not prohibit non-sexual or non-hostile touch in therapy. All of them view sexual or violent touch with current clients as unethical. However, a couple of these codes (i.e., APA, CAMFT) do not even mention the words 'touch" or "physical touch" in their entire codes of ethics. American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct (2002) does not mention specifically any guidelines in regard to touch or physical contact that is intentionally employed as part of therapy. California Association of Marriage and Family Therapists (CAMFT) Ethical Standards for Marriage and Family Therapists (1997), does not mention specifically any guidelines in regard to touch or physical contact that is intentionally employed as part of or adjunct to verbal psychotherapy. The National Association of Social Workers (NASW) Code of Ethics (1999): Standard 1.10 Physical Contact: Social workers should not engage in physical contact with clients when there is a possibility of psychological harm to the client as a result of the contact (such as cradling or caressing clients). Social workers who engage in appropriate physical contact with clients are responsible for setting clear, appropriate, and culturally sensitive boundaries that govern such physical contact. United States Association for Body Psychotherapy (USABP) Ethical Guidelines (2007) Introductory section: Body psychotherapists recognize the intrinsic unity of the human being in our somatic nature. Body psychotherapists, therefore, work in ways that foster the integration of bodily sensation, thought, affect, and movement to promote more integral human functioning and the resolution of psychotherapeutic concerns. Body psychotherapeutic methods, including language, gesture and touch, when used in responsible, ethical and competent ways, make an essential contribution to the psychotherapeutic process by including the missing and often alienated aspects of our being which are rooted in our bodily nature and experience. VIII. Ethics of Touch: The use of touch has a legitimate and valuable role as a body-oriented mode of intervention when used skillfully and with clear boundaries, sensitive application and good clinical judgment. Because use of touch may make clients especially vulnerable, body-oriented therapists pay particular attention to the potential for dependent, infantile or erotic transference and seek healthy containment rather than therapeutically inappropriate accentuation of these states. Genital or other sexual touching by a therapist or client is always inappropriate, never appropriate. Body psychotherapists evaluate the appropriateness of the use of touch for each client. They consider a number of factors such as the capacity of the client for genuine informed consent; the client's developmental capacity and diagnosis; the transferential potential of the client's personal history in relation to touch; the client's ability to usefully integrate touch experiences; and the interaction of the practitioner's particular style of touch work with the client’s. They record their evaluations and consultation in the client's record. Body psychotherapists obtain informed consent prior to using touch-related techniques in the therapeutic relationship. They make every attempt to ensure that consent for the use of touch is genuine and that the client adequately understands the nature and purposes of its use. As in all informed consent, written documentation of the consent is strongly recommended. Body psychotherapists recognize that the client's conscious verbal and even written consent for touch, while apparently genuine, may not accurately reflect objections or problems with touch of which the client is currently unaware. Knowing this, body psychotherapists strive to be sensitive to the client's spoken and unspoken cues regarding touch, taking into account the particular client's capacity for authentic and full consent. Body psychotherapists continue to monitor for ongoing informed consent to ensure the continued appropriateness of touch-based interventions. They maintain periodic written records of ongoing consent and consultation regarding any questions they or a client may have. Body psychotherapists recognize and respect the right of the client to refuse or terminate any touch on the part of the therapist at any point, and they inform the client of this right. Body psychotherapists recognize that, as with all aspects of the therapy, touch is only used when it can reasonably be predicted and/or determined to benefit the client. Touch may never be utilized to gratify the personal needs of the therapist, nor because it is seen as required by the therapist's theoretical viewpoint in disregard of the client's needs or wishes. The application of touch techniques requires a high degree of internal clarity and integration on the part of the therapist. body psychotherapists prepare themselves for the use of therapeutic touch through thorough training and supervision in the use of touch, receiving therapy that includes touch, and appropriate supervision or consultation should any issues arise in the course of treatment. Body psychotherapists do not engage in genital or other sexual touching nor do they knowingly use touch to sexually stimulate a client. Therapists are responsible to maintain clear sexual boundaries in terms of their own behavior and to set limits on the client's behavior towards them which prohibits any sexual touching. Information about the therapeutic value of clear sexual boundaries in the use of touch is conveyed to the client prior to and during the use of touch in a manner that is not shaming or derogatory. Ethical Decision-Making and Standard of Care For ethical guidelines, general considerations about touch in therapy and ethical decision-making for the use of touch in psychotherapy, click here. For more general ethical guidelines, general considerations and ethical decision-making for boundaries and boundary crossing in psychotherapy, click here. Touch, like any other conduct or intervention by therapists, must fall within the standard of care. For a general description of the standard of care in psychotherapy, click here. Consent form for use of touch in therapy: Informed consent is one of the most important aspects of psychotherapy and counseling. Generally, like any consent, consent to touch can be implicit or explicit, written, verbal or non-verbal, or expressed or implied.  Obviously, handshake and a client initiated ritual hug at the end of a session are considered implied consents to touch.  Client can give  non-verbal consent by responding with an approving nod to the therapist question whether s/he can touch the client's hand or shoulder.  Verbal consent is simple statement by clients that they have been informed and have consented to the proposed form of touch.  Having clients sign a specific-additional consent form prior to the employment of extensive or systematically physical touch in therapy, as in some forms of body-psychotherapy, has been suggested by some experts and professional organizations.  (For a sample of such informed consent, go to http://www.traumahealing.com/Members/SE_InformedConsent _11052007.doc.)  While verbal informed consent is always important, such a written consent is only optional when touch is used as an adjunct to verbal psychotherapy, i.e., when psychotherapists use touch to greet, depart, comfort, consol, model, etc. (For descriptions of different types of touch in therapy and counseling, go to http://www.zurinstitute.com/touchintherapy.html#types.) As with all consent forms, an additional special-consent-form for the use of touch in therapy must be written in simple language that an average person with average education and intelligence may easily understand. It should not include legalese or sophisticated professional jargon. Therapists should take into consideration the patient's mental state, intelligence, cognitive functioning, level of acculturation and comprehension of English before they give the consent to a client. Of course clients are entitled to a copy of the consent. While separate consent is a valid option, a simple way of dealing with the consent issue is by adding a section to the standard informed consent that all clients should read and sign before the onset of therapy. Such a paragraph may include some of the following sentences: Dr./Ms./Mr. xx may also incorporate non-sexual touch as part of psychotherapy. Sexual touch of clients by therapists is unethical and illegal. Dr./Ms./Mr. xx will ask your permission before touching you, and you have the right to decline or refuse to be touched without any fear or concern about reprisal. Touch can be very beneficial but can also unexpectedly evoke emotions, thoughts, physical reactions or memories that may be upsetting, depressing, evoke anger, etc. Sharing and processing such feelings with the therapist, if they arise, may be a helpful part of therapy. You may request not to be touched at any time during therapy without needing to explain it, if you choose not to, and without fear of punishment. When psychotherapists use touch more extensively, such as in body psychotherapies, they may consider using a separate consent form. For more information, review a sample consent at  http://www.traumahealing.com/Members/SE_InformedConsent _11052007.doc. Also  contact United States Association for Body Psychotherapists (USABP) or any of the individual organizations, institutions or schools that employ somatic or bodypsychotherapy therapy or training. Codes of Ethics on Therapist-Client Sexual Relationships (which are always unethical): American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct (2002): 10.05 Sexual Intimacies With Current Therapy Clients/Patients: Psychologists do not engage in sexual intimacies with current therapy clients/patients. 10.06 Sexual Intimacies With Relatives or Significant Others of Current Therapy Clients/Patients: Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard. 10.07 Therapy With Former Sexual Partners: Psychologists do not accept as therapy clients/patients persons with whom they have engaged in sexual intimacies. 10.08 Sexual Intimacies With Former Therapy Clients/Patients: (a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. (b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client's/patient's personal history; (5) the client's/patient's current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic relationship with the client/patient. California Association of Marriage and Family Therapists (CAMFT) Ethical Standards for Marriage and Family Therapists (1997): Section 4.1: Marriage and family therapists are aware of their influential position with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid dual relationships that are reasonably likely to impair professional judgment or lead to exploitation. Provision of therapy to students or supervisees is unethical. Provision of marriage and family therapy supervision to clients is unethical. Sexual intercourse, sexual contact or sexual intimacy and/or harassment of any kind with students or supervisees is unethical. Section 1.2.1: Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient's spouse or partner, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical. Section 1.2.3: Marriage and family therapists do not enter into therapeutic relationships with persons with whom they have had sexual relationships. Section 3.9: Marriage and family therapists do not engage in sexual or other harassment or exploitation of patients, students, interns, trainees, supervisees, employees or colleagues. The National Association of Social Workers (NASW) Code of Ethics (1999), Standard 1.09 Sexual Relationships: (a) Social workers should under no circumstances engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced. (b) Social workers should not engage in sexual activities or sexual contact with clients' relatives or other individuals with whom clients maintain a close personal relationship when there is a risk of exploitation or potential harm to the client. Sexual activity or sexual contact with clients' relatives or other individuals with whom clients maintain a personal relationship has the potential to be harmful to the client and may make it difficult for the social worker and client to maintain appropriate professional boundaries. Social workers -- not their clients, their clients' relatives, or other individuals with whom the client maintains a personal relationship -- assume the full burden for setting clear, appropriate, and culturally sensitive boundaries. (c) Social workers should not engage in sexual activities or sexual contact with former clients because of the potential for harm to the client. If social workers engage in conduct contrary to this prohibition or claim that an exception to this prohibition is warranted because of extraordinary circumstances, it is social workers -- not their clients -- who assume the full burden of demonstrating that the former client has not been exploited, coerced, or manipulated, intentionally or unintentionally. (d) Social workers should not provide clinical services to individuals with whom they have had a prior sexual relationship. Providing clinical services to a former sexual partner has the potential to be harmful to the individual and is likely to make it difficult for the social worker and individual to maintain appropriate professional boundaries. Section 1.11 Sexual Harassment: Social workers should not sexually harass clients. Sexual harassment includes advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature. United States Association for Body Psychotherapy (USABP) Ethical Guidelines (2007) Section IV, Avoiding Harm 2. Sexual relationships between body psychotherapists and their clients are prohibited during the therapeutic relationship and for a minimum of 2 years following the termination of that professional relationship. A body psychotherapist who considers engaging in sexual intimacy with a former client after the 2 years following cessation or termination of treatment bears the burden of demonstrating that there has been no exploitation, in light of all relevant factors that would influence the client's ability to freely enter such a relationship. 3. Body psychotherapists do not engage in sexual intimacies with individuals they know to be the parents, guardians, spouses, partners, offspring, or siblings of current clients. Body psychotherapists do not terminate therapy to circumvent this rule. 4. Body psychotherapists do not accept as therapy clients persons with whom they have engaged in sexual intimacies. 5. Body psychotherapists refrain from engaging in any behavior which could reasonably be interpreted as harassment, sexual or non-sexual. They monitor their therapeutic relationships to ascertain if clients perceive any harassment and address that concern promptly. Section VIII, Ethics of touch, subsection 8: 8. Body psychotherapists do not engage in genital or other sexual touching nor do they knowingly use touch to sexually stimulate a client. Therapists are responsible to maintain clear sexual boundaries in terms of their own behavior and to set limits on the client's behavior towards them which prohibits any sexual touching. Information about the therapeutic value of clear sexual boundaries in the use of touch is conveyed to the client prior to and during the use of touch in a manner that is not shaming or derogatory. Codes of Ethics on Dual Relationships: Unlike the commonly held belief, non-sexual touch, when employed as an adjunct to verbal psychotherapy, does not constitute dual relationships. Sexual relationships with clients constitute dual relationships, and all sexual relationships with current clients are unethical and, in most states, illegal. Due to the fact that all forms of boundary crossing, including non-sexual touch, have been associated with dual relationships, following is a detailed description of the sections of the professional organizations codes of ethics on dual relationships. American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct (2002), Section 3.05 on Multiple Relationships: (a) 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. (c) When psychologists are required by law, institutional policy, extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. California Association of Marriage and Family Therapists (CAMFT) Ethical Standards for Marriage and Family Therapists (1997): Section 1.2: Marriage and family therapists are aware of their influential position with respect to patients, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid dual relationships with patients that are reasonably likely to impair professional judgment or lead to exploitation. A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship either simultaneously with the therapeutic relationship, or during a reasonable period of time following the termination of the therapeutic relationship. Not all dual relationships are unethical, and some dual relationships cannot be avoided. When a dual relationship cannot be avoided, therapists take appropriate professional precautions to insure that judgment is not impaired and that no exploitation occurs. Section 1.2.2: Other acts which would result in unethical dual relationships include, but are not limited to, borrowing money from a patient, hiring a patient, engaging in a business venture with a patient, or engaging in a close personal relationship with a patient. The National Association of Social Workers (NASW) Code of Ethics (1999): Standard 1.06.c: Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.) United States Association for Body Psychotherapy (USAB) Ethical Guidelines (2007) Section V, Multiple Relationships: Body Psychotherapists avoid exploitive multiple relationships. A multiple relationship occurs when a Body Psychotherapist is in a psychotherapeutic relationship with a person and is at the same time, or sequentially, in another relationship with the same person. Body Psychotherapists make a distinction between normally occurring community interactions and multiple relationships. Body Psychotherapists do not accept as a client anyone with whom they have had a sexual, close personal. or financial relationship or family or relatives of such persons. The boundaries of the therapeutic relationship should be clearly defined otherwise they have the potential to impair judgment, cause damage and undermine the purpose of the therapy. 1. Considerations about potential exploitation include the: nature and intensity of the professional relationship and of the secondary relationship, stage of therapy, amount of transference, degree of the role conflict, level of communication skills, and existence of an evaluative role. 2. Body Psychotherapists are aware of the differences in power that may exist in their relationships with clients, students and supervisees. Body Psychotherapists will be sensitive to the real and ascribed differences in power, be responsible for bringing potential issues into the awareness of those involved, and be available for reasonable processing with those involved. 3. In some situations, for example in small geographical or modality communities, a multiple relationship that is nonexploitive may be undertaken. In these cases, the Body Psychotherapist takes precautions to protect the client from exploitation and damage. Such precautions may include, but are not limited to, acknowledgment of the multiple relationship and its inherent risk to the client, ongoing dialogue, informed consent, documentation, and case consultation and/or supervision. 4. In the event that a Body Psychotherapist is providing services to several persons who have a relationship (partners, parents and children, siblings, families) the therapist attempts to clarify at the onset of the therapy, the relationship they will have with each individual. At any time, if it becomes apparent that the Body Psychotherapist is in multiple relationships which compromise the treatment situation or threaten to impair the objectivity or judgment of the therapist in any way, they clarify, adjust or withdraw from conflicting roles. 5. Barter is the acceptance of goods or services from clients in return for psychological services. Body Psychotherapists do not barter (including work exchange) unless the bartering arrangements are appropriate in the context of the therapeutic relationship, indicated by the needs of the client, and for the welfare of the client. Where bartering is used, the therapist and client make agreements in writing related to the exchange of goods or services to ensure that both understand the scope and limitations of the agreement. Body Psychotherapists consult or obtain supervision to ensure that the bartering arrangement is not harmful to the client, that the client is being given fair value in the exchange, and that no exploitation of and/or damage to the client is involved. 6. As teachers, Body Psychotherapists acknowledge that their relationships with students and/or supervises include factors which often make avoiding multiple relationships difficult. They monitor their teaching and supervision relationships to ensure that they do not become exploitive and/or damaging. Body Psychotherapists do not have sexual relations with students or supervisees and do not subject them to sexual harassment. American Association of Marriage and Family Therapists (AAMFT) Code of Ethics (2001): Section1.3: Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client's immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions. American Psychiatric Association (ApA) Principles of Medical Ethics. with Annotations Especially Applicable to Psychiatry (2001) does not mention dual or multiple relationships. It simply outlines the general principles that appear in all other codes of the mandate to avoid exploitation and harm to patients. American Counseling Association (ACA) Code of Ethics and Standards for Practice (2005): A.1.d. Support Network Involvement Counselors recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/spiritual/community leaders, family members, friends) as positive resources, when appropriate, with client consent. A.5.a. Current Clients Sexual or romantic counselor–client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. A.5.b. Former Clients Sexual or romantic counselor–client interactions or relationships with former clients, their romantic partners, or their family members are prohibited for a period of 5 years following the last professional contact. Counselors, before engaging in sexual or romantic interactions or relationships with clients, their romantic partners, or client family members after 5 years following the last professional contact, demonstrate forethought and document (in written form) whether the interactions or relationship can be viewed as exploitive in some way and/or whether there is still potential to harm the former client; in cases of potential exploitation and/or harm, the counselor avoids entering such an interaction or relationship. A.5.c. Nonprofessional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships) Counselor–client nonprofessional relationships with clients, former clients, their romantic partners, or their family members should be avoided, except when the interaction is potentially beneficial to the client. (See A.5.d.) A.5.d. Potentially Beneficial Interactions When a counselor–client nonprofessional interaction with a client or former client may be potentially beneficial to the client or former client, the counselor must document in case records, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. Such interactions should be initiated with appropriate client consent. Where unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, due to the nonprofessional interaction, the counselor must show evidence of an attempt to remedy such harm. Examples of potentially beneficial interactions include, but are not limited to, attending a formal ceremony (e.g., a wedding/commitment ceremony or graduation); purchasing a service or product provided by a client or former client (excepting unrestricted bartering); hospital visits to an ill family member; mutual membership in a professional association, organization, or community. (See A.5.c.) A.5.e. Role Changes in the Professional Relationship When a counselor changes a role from the original or most recent contracted relationship, he or she obtains informed consent from the client and explains the right of the client to refuse services related to the change. Examples of role changes include 1. changing from individual to relationship or family counseling, or vice versa; 2. changing from a nonforensic evaluative role to a therapeutic role, or vice versa; 3. changing from a counselor to a researcher role (i.e., enlisting clients as research participants), or vice versa; and 4. changing from a counselor to a mediator role, or vice versa. Clients must be fully informed of any anticipated consequences (e.g., financial, legal, personal, or therapeutic) of counselor role changes. Summary of The Ethics Codes on Dual Relationships: Among the Codes of all major psychotherapists' organizations there is no blanket prohibition of non-sexual dual relationships. These Codes appropriately concentrate on preventing harm and exploitation of patients by therapists, as opposed to dictating a uniform course of action for therapists about dual relationships. There are unified principles among the codes of ethics of all major professional organizations concerning dual relationships in psychotherapy. Once the hindering factors of misinformation and prejudice are discarded, the platform of these Codes is clear: Sexual dual relationships with present clients are always unethical. Non-sexual dual relationships are not always avoidable. Non-sexual dual relationships are not always unethical. Therapists must avoid only the dual relationships that might: Impair their judgment and objectivity. Interfere with performing therapy or supervision effectively. Harm or exploit patients. Links to California Law and Regulations Those parts of California Law most relevant to the topics of law and dual relationships, sexual relationships and boundaries in psychotherapy and counseling are in the following sections of the Business and Professional Code of California. Psychologists: Chapter 6.6 MFTs: Division 2, Chapter 13, Articles 1-7, Sections 4980 - 4989. LCSWs: Division 2, Chapter 14, Articles 1-4, Sections 4990 - 4998.7. For complete regulations online: Business and Professional Code of California at: http://www.leginfo.ca.gov/calaw.html Psychologists, BOP: http://www.psychboard.ca.gov/laws_regs/index.htm MFTs and LCSWs, BBS: http://www.bbs.ca.gov/pdf/lawsregs.pdf California Law and Regulations on Therapist-Client Sexual Relationships The California Department of Consumer Affairs published the brochure, Professional Therapy Never Includes Sex, which states, click here. The brochure states that according to California laws: "Touching" means physical contact with another person, either through the person's clothes or directly with the person's skin (Business and Professions Code section 728) (p. 7) Any kind of sexual contact, asking for sexual contact, or sexual misconduct by a therapist with a patient is illegal, as well as unethical, as set forth in Business and Professions Code sections 726, 729, 2960(o), 4982(k) and 4992.3(k). "Sexual contact" means the touching of an intimate part of another person, including sexual intercourse (p. 7). Sexual contact can include sexual intercourse, sodomy, oral copulation, fondling and any other kind of sexual touching. Sexual misconduct also covers a broader range of activity, including nudity, kissing, spanking, verbal suggestions, innuendoes or advances. This kind of sexual behavior by a therapist with a patient is sexual exploitation. It is unethical, unprofessional and illegal (p. 7) Sexual exploitation of patients by therapists is wrong. The law makes it a crime for a therapist to have sexual contact with a patient. For a first offense with only one victim, an offender would probably be charged with a misdemeanor. For this charge, the penalty may be a sentence of up to one year in county jail, or up to $1,000 in fines, or both. Second and following offenses, or offenses with more than one victim, may be misdemeanors or felonies. The penalty in such felony cases can be up to three years in prison, or up to $10,000 in fines, or both. This law applies to two situations: The therapist has sexual contact with a patient during therapy, or The therapist ends therapy primarily to start having sexual contact with the patient (unless the therapist has referred the patient to an independent and objective therapist who has been recommended by a third-party therapist) (p. 19). Provide brochure for clients who allege sexual relationships with former therapist/s. BBS and BOP both mandate that any psychotherapist who becomes aware through a patient that the patient had alleged sexual relationships (notices the term "alleged") with a previous psychotherapist during the course of a prior treatment, shall provide to the patient a brochure Professional Therapy Never Includes Sex. Further, the psychotherapist or employer shall discuss with the patient the brochure prepared by the department. The California Business and Professional Code on Sexual Exploitation: Sexual Relations with Patients 726. The commission of any act of sexual abuse, misconduct, or relations with a patient, client, or customer constitutes unprofessional conduct and grounds for disciplinary action for any person licensed under this division, under any initiative act referred to in this division and under Chapter 17 (commencing with Section 9000) of Division 3. This section shall not apply to sexual contact between a physician and surgeon and his or her spouse or person in an equivalent domestic relationship when that physician and surgeon provides medical treatment, other than psychotherapeutic treatment, to his or her spouse or person in an equivalent domestic relationship. Subdivision (2) of Section 1103 of Evidence Code Applies 727. The provisions of subdivision (2) of Section 1103 of the Evidence Code shall apply in disciplinary proceedings brought against a licensee for acts in violation of Section 726. Provision of Brochure by Psychotherapist to Patient Alleging Sexual Intercourse or Contact With Previous Psychotherapist During Course of Prior Treatment 728. (a) Any psychotherapist or employer of a psychotherapist who becomes aware through a patient that the patient had alleged sexual intercourse or alleged sexual contact with a previous psychotherapist during the course of a prior treatment, shall provide to the patient a brochure promulgated by the department that delineates the rights of, and remedies for, patients who have been involved sexually with their psychotherapist. Further, the psychotherapist or employer shall discuss with the patient the brochure prepared by the department. (b) Failure to comply with this section constitutes unprofessional conduct. (c) For the purpose of this section, the following definitions apply: (1) ''Psychotherapist'' means a physician and surgeon specializing in the practice of psychiatry or practicing psychotherapy, a psychologist, a clinical social worker, a marriage and family therapist, a psychological assistant, marriage and family therapist registered intern or trainee, or associate clinical social worker. (2) ''Sexual contact'' means the touching of an intimate part of another person. (3) ''Intimate part'' and ''touching'' have the same meaning as defined in subdivisions (f) and (d), respectively, of Section 243.4 of the Penal Code. (4) ''The course of a prior treatment'' means the period of time during which a patient first commences treatment for services that a psychotherapist is authorized to provide under his or her scope of practice, or that the psychotherapist represents to the patient as being within his or her scope of practice, until the psychotherapist-patient relationship is terminated. Sexual Exploitation-Penalties 729. (a) Any physician and surgeon, psychotherapist, alcohol and drug abuse counselor or any person holding himself or herself out to be a physician and surgeon, psychotherapist, or alcohol and drug abuse counselor, who engages in an act of sexual intercourse, sodomy, oral copulation, or sexual contact with a patient or client, or with a former patient or client when the relationship was terminated primarily for the purpose of engaging in those acts, unless the physician and surgeon, psychotherapist, or alcohol and drug abuse counselor has referred the patient or client to an independent and objective physician and surgeon, psychotherapist, or alcohol and drug abuse counselor recommended by a third-party physician and surgeon, psychotherapist, or alcohol and drug abuse counselor for treatment, is guilty of sexual exploitation by a physician and surgeon, psychotherapist, or alcohol and drug abuse counselor. (b) Sexual exploitation by a physician and surgeon, psychotherapist, or alcohol and drug abuse counselor is a public offense: (1) An act in violation of subdivision (a) shall be punishable by imprisonment in a county jail for a period of not more than six months, or a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine. (2) Multiple acts in violation of subdivision (a) with a single victim, when the offender has no prior conviction for sexual exploitation, shall be punishable by imprisonment in a county jail for a period of not more than six months, or a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine. (3) An act or acts in violation of subdivision (a) with two or more victims shall be punishable by imprisonment in the state prison for a period of 16 months, two years, or three years, and a fine not exceeding ten thousand dollars ($10,000); or the act or acts shall be punishable by imprisonment in a county jail for a period of not more than one year, or a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine. (4) Two or more acts in violation of subdivision (a) with a single victim, when the offender has at least one prior conviction for sexual exploitation, shall be punishable by imprisonment in the state prison for a period of 16 months, two years, or three years, and a fine not exceeding ten thousand dollars ($10,000); or the act or acts shall be punishable by imprisonment in a county jail for a period of not more than one year, or a fine not exceeding one thousand dollars ($1,000) or by both that imprisonment and fine. (5) An act or acts in violation of subdivision (a) with two or more victims, and the offender has at least one prior conviction for sexual exploitation, shall be punishable by imprisonment in the state prison for a period of 16 months, two years, or three years, and a fine not exceeding ten thousand dollars ($10,000). For purposes of subdivision (a), in no instance shall consent of the patient or client be a defense. However, physicians and surgeons shall not be guilty of sexual exploitation for touching any intimate part of a patient or client unless the touching is outside the scope of medical examination and treatment, or the touching is done for sexual gratification. (c) For purposes of this section: (1) ''Psychotherapist'' has the same meaning as defined in Section 728. (2) ''Alcohol and drug abuse counselor'' means an individual who holds himself or herself out to be an alcohol or drug abuse professional or paraprofessional. (3) ''Sexual contact'' means sexual intercourse or the touching of an intimate part of a patient for the purpose of sexual arousal, gratification, or abuse. (4) ''Intimate part'' and ''touching'' have the same meanings as defined in Section 243.4 of the Penal Code. (d) In the investigation and prosecution of a violation of this section, no person shall seek to obtain disclosure of any confidential files of other patients, clients, or former patients or clients of the physician and surgeon, psychotherapist, or alcohol and drug abuse counselor. (e) This section does not apply to sexual contact between a physician and surgeon and his or her spouse or person in an equivalent domestic relationship when that physician and surgeon provides medical treatment, other than psychotherapeutic treatment, to his or her spouse or person in an equivalent domestic relationship. (f) If a physician and surgeon, psychotherapist, or alcohol and drug abuse counselor in a professional partnership or similar group has sexual contact with a patient in violation of this section, another physician and surgeon, psychotherapist, or alcohol and drug abuse counselor in the partnership or group shall not be subject to action under this section solely because of the occurrence of that sexual contact. Board of Psychology (BOP), CA: Laws and Regulations Relating to the Practice of Psychology Causes for Disciplinary Action 2960, (o) Any act of sexual abuse, or sexual relations with a patient or former patient within two years following termination of therapy, or sexual misconduct that is substantially related to the qualifications, functions or duties of a psychologist or psychological assistant or registered psychologist. Limitation Period 2960.05., (e) An accusation filed against a licensee pursuant to Section 11503 of the Government Code alleging sexual misconduct shall be filed within three years after the board discovers the act or omission alleged as the ground for disciplinary action, or within 10 years after the act or omission alleged as the ground for disciplinary action occurs, whichever occurs first. This subdivision shall apply to a complaint alleging sexual misconduct received by the board on and after January 1, 2002. Decision Containing Finding That Licensee or Registrant Engaged in Sexual Contact With Patient or Former Patient; Order of Revocation 2960.1. Notwithstanding Section 2960, any proposed decision or decision issued under this chapter in accordance with the procedures set forth in Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, that contains any finding of fact that the licensee or registrant engaged in any act of sexual contact, as defined in Section 728, when that act is with a patient, or with a former patient within two years following termination of therapy, shall contain an order of revocation. The revocation shall not be stayed by the administrative law judge. Sexual Relations with Patients 726. The commission of any act of sexual abuse, misconduct, or relations with a patient, client, or customer constitutes unprofessional conduct and grounds for disciplinary action for any person licensed under this division, under any initiative act referred to in this division and under Chapter 17 (commencing with Section 9000) of Division 3. Provision of Brochure by Psychotherapist to Patient Alleging Sexual Intercourse or Contact With Previous Psychotherapist During Course of Prior Treatment 728. (a) Any psychotherapist or employer of a psychotherapist who becomes aware through a patient that the patient had alleged sexual intercourse or alleged sexual contact with a previous psychotherapist during the course of a prior treatment, shall provide to the patient a brochure promulgated by the department that delineates the rights of, and remedies for, patients who have been involved sexually with their psychotherapist. Further, the psychotherapist or employer shall discuss with the patient the brochure prepared by the department. (b) Failure to comply with this section constitutes unprofessional conduct. (c) For the purpose of this section, the following definitions apply: (1) ''Psychotherapist'' means a physician and surgeon specializing in the practice of psychiatry or practicing psychotherapy, a psychologist, a clinical social worker, a marriage and family therapist, a psychological assistant, marriage and family therapist registered intern or trainee, or associate clinical social worker. (2) ''Sexual contact'' means the touching of an intimate part of another person. (3) ''Intimate part'' and ''touching'' have the same meaning as defined in subdivisions (f) and (d), respectively, of Section 243.4 of the Penal Code. (4) ''The course of a prior treatment'' means the period of time during which a patient first commences treatment for services that a psychotherapist is authorized to provide under his or her scope of practice, or that the psychotherapist represents to the patient as being within his or her scope of practice, until the psychotherapist-patient relationship is terminated. Sexual Exploitation-Penalties 729. (a) Any physician and surgeon, psychotherapist, alcohol and drug abuse counselor or any person holding himself or herself out to be a physician and surgeon, psychotherapist, or alcohol and drug abuse counselor, who engages in an act of sexual intercourse, sodomy, oral copulation, or sexual contact with a patient or client, or with a former patient or client when the relationship was terminated primarily for the purpose of engaging in those acts, unless the physician and surgeon, psychotherapist, or alcohol and drug abuse counselor has referred the patient or client to an independent and objective physician and surgeon, psychotherapist, or alcohol and drug abuse counselor recommended by a third-party physician and surgeon, psychotherapist, or alcohol and drug abuse counselor for treatment, is guilty of sexual exploitation by a physician and surgeon, psychotherapist, or alcohol and drug abuse counselor. (b) Sexual exploitation by a physician and surgeon, psychotherapist, or alcohol and drug abuse counselor is a public offense: (1) An act in violation of subdivision (a) shall be punishable by imprisonment in a county jail for a period of not more than six months, or a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine. (2) Multiple acts in violation of subdivision (a) with a single victim, when the offender has no prior conviction for sexual exploitation, shall be punishable by imprisonment in a county jail for a period of not more than six months, or a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine. (3) An act or acts in violation of subdivision (a) with two or more victims shall be punishable by imprisonment in the state prison for a period of 16 months, two years, or three years, and a fine not exceeding ten thousand dollars ($10,000); or the act or acts shall be punishable by imprisonment in a county jail for a period of not more than one year, or a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine. (4) Two or more acts in violation of subdivision (a) with a single victim, when the offender has at least one prior conviction for sexual exploitation, shall be punishable by imprisonment in the state prison for a period of 16 months, two years, or three years, and a fine not exceeding ten thousand dollars ($10,000); or the act or acts shall be punishable by imprisonment in a county jail for a period of not more than one year, or a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine. (5) An act or acts in violation of subdivision (a) with two or more victims, and the offender has at least one prior conviction for sexual exploitation, shall be punishable by imprisonment in the state prison for a period of 16 months, two years, or three years, and a fine not exceeding ten thousand dollars ($10,000). For purposes of subdivision (a), in no instance shall consent of the patient or client be a defense. However, physicians and surgeons shall not be guilty of sexual exploitation for touching any intimate part of a patient or client unless the touching is outside the scope of medical examination and treatment, or the touching is done for sexual gratification. (c) For purposes of this section: (1) ''Psychotherapist'' has the same meaning as defined in Section 728. (2) ''Alcohol and drug abuse counselor'' means an individual who holds himself or herself out to be an alcohol or drug abuse professional or paraprofessional. (3) ''Sexual contact'' means sexual intercourse or the touching of an intimate part of a patient for the purpose of sexual arousal, gratification, or abuse. (4) ''Intimate part'' and ''touching'' have the same meanings as defined in Section 243.4 of the Penal Code. (d) In the investigation and prosecution of a violation of this section, no person shall seek to obtain disclosure of any confidential files of other patients, clients, or former patients or clients of the physician and surgeon, psychotherapist, or alcohol and drug abuse counselor. (e) This section does not apply to sexual contact between a physician and surgeon and his or her spouse or person in an equivalent domestic relationship when that physician and surgeon provides medical treatment, other than psychotherapeutic treatment, to his or her spouse or person in an equivalent domestic relationship. (f) If a physician and surgeon, psychotherapist, or alcohol and drug abuse counselor in a professional partnership or similar group has sexual contact with a patient in violation of this section, another physician and surgeon, psychotherapist, or alcohol and drug abuse counselor in the partnership or group shall not be subject to action under this section solely because of the occurrence of that sexual contact. Board of Behavioral Sciences (BBS) CA, 1/2004: Laws and Regulations Relating to the Practice of Marriage and Family Therapists, Licensed Clinical Social Workers, and Licensed Educational Psychologists. ARTICLE 2. DENIAL, SUSPENSION, AND REVOCATION §4982. UNPROFESSIONAL CONDUCT (k) Engaging in sexual relations with a client, or a former client within two years following termination of therapy, soliciting sexual relations with a client, or committing an act of sexual abuse, or sexual misconduct with a client, or committing an act punishable as a sexually related crime, if that act or solicitation is substantially related to the qualifications, functions, or duties of a marriage and family therapist. §4982.05. ENFORCEMENT STATUTE OF LIMITATIONS (e) An accusation filed against a licensee pursuant to Section 11503 of the Government Code alleging sexual misconduct shall be filed within three years after the board discovers the act or omission alleged as the ground for disciplinary action, or within 10 years after the act of omission alleged as the grounds for disciplinary action occurs, whichever occurs first. This subdivision shall apply to a complaint alleging sexual misconduct received by the board on and after January 1, 2002. §4982.26. DECISION CONTAINING FINDING THAT LICENSEE OR REGISTRANT ENGAGED IN SEXUAL CONTACT WITH PATIENT OR FORMER PATIENT; ORDER OF REVOCATION Notwithstanding Section 4982, any proposed decision or decision issued under this chapter in accordance with the procedures set forth in Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, that contains any finding of fact that the licensee or registrant engaged in any act of sexual contact, as defined in Section 729, when that act is with a patient, or with a former patient when the relationship was terminated primarily for the purpose of engaging in that act, shall contain an order of revocation. The revocation shall not be stayed by the administrative law judge. §4986.71. DECISION CONTAINING FINDING THAT LICENSEE OR REGISTRANT ENGAGED IN SEXUAL CONTACT WITH PATIENT OR FORMER PATIENT; ORDER OF REVOCATION The board shall revoke any license issued under this chapter upon a decision made in accordance forth in Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government any finding of fact that the licensee engaged in any act of sexual contact, as defined in Section 729, patient, or with a former patient when the relationship was terminated primarily for the purpose of engaging contain an order of revocation. The revocation shall not be stayed by the administrative law judge. California Law, Summary: The California Business and Professional Code and the Civil Code (Section 43.93) discuss sexual exploitation of clients by therapists. In California it is illegal for a psychotherapist to engage in sexual contact with a patient or former patient under any of the following circumstances: a. during therapy; b. within two years of termination of therapy and c. by means of therapeutic deception. (Psychotherapist-patient sexual contact by means of therapeutic deception is illegal.) Any therapist in California who becomes aware, from a patient, that the patient had a sexual relationship with a psychotherapist during the course of treatment has the legal obligation to give the patient the brochure entitled "Professional Therapy Never Includes Sex" and to discuss the brochure with the patient. California law also covers the issue of Psychological Assistants and MFT or LCSW interns. The California Business and Professional Codes 2910/11/13 and 1387 cover the regulations for psychological assistants and 4980 discusses the intern status of MFTI. The codes clearly mandate the supervisor's responsibility for the welfare of the supervisee's clients and their responsibility in the case of sexual relationships between the interns or psychological assistants and their clients. For the full article "To Touch or Not to Touch" click here

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