Professional Organizations' Codes of Ethics on Teacher-Therapist Dual Roles (Student-Patient Dual Roles), Teacher-Supervisor Dual Roles, Boundaries, and Sexual Dual Relationships between Teacher/Supervisors and Students in Educational Institutions and Educational Settings

Complete comparative list of different Codes of Ethics on a variety of topics

By Ofer Zur, Ph.D.

Table Of Contents

Overview
American Association of Marriage and Family Therapists (AAMFT)
American Counseling Association (ACA)
American Mental Health Counselors Association (AMHCA)
American Psychiatric Association (ApA)
American Psychoanalytic Association (APsaA)
American Psychological Association (APA)
California Association of Marriage and Family Therapists (CAMFT)
National Association of Social Workers (NASW)
National Board for Certified Counselors (NBCC)

 
Overview

Traditionally, in graduate and postgraduate educational programs such as Psychoanalytic, Jungian, or Cognitive-Behavioral institutions, it was common for analysts or therapists, who were often on the faculty of the institution, to teach or instruct the institute’s students, as well as serve on committees with students. In earlier years of psychoanalytic training, it was not unusual for students who needed to fulfill the program’s requirement to be in analysis with a faculty member, who was also an instructor at the institute. As a result, multiple roles of teacher-therapist and student-client were very common and often unavoidable in such training institutions and programs. This seems to have changed in the last couple of decades where more training institutions clearly separated the therapist/analysts role from the instructor/teacher role. Trainees are allowed to fulfill the therapy or analysis requirement with therapists or analysts from outside the institutes in order to avoid the dual roles of clients and students. As noted below, most professional associations’ code of ethics state that therapists-teacher dual roles are unethical.

The issues of sexual relationships between faculty and students in training institutions and graduate and post-graduate programs has also been a major concern in recent decades. As noted below, most professional associations’ code of ethics clearly state that sexual relationships between teacher/instructor and current students are unethical. Similarly, the below quotes from different codes of ethics show that the dual role of supervisor and therapists/analysts is also frowned upon by most codes of ethics.

Below is a summary of the relevant sections of the different professional associations’ codes of ethics in regard to dual roles and dual relationships, including therapist-teacher and therapist-supervisor sexual multiple relationships and other dual relationships within post graduate programs and educational institutions.

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The Current Codes of Ethics, Verbatim

American Association of Marriage and Family Therapists (AAMFT) Code of Ethics (2015)

Standard I: RESPONSIBILITY TO CLIENTS
Marriage and family therapists advance the welfare of families and individuals and make reasonable efforts to find the appropriate balance between conflicting goals within the family system.

1.3 Multiple Relationships. 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 document the appropriate precautions taken.

Standard III: PROFESSIONAL COMPETENCE AND INTEGRITY
Marriage and family therapists maintain high standards of professional competence and integrity.

3.7 Harassment. Marriage and family therapists do not engage in sexual or other forms of harassment of clients, students, trainees, supervisees, employees, colleagues, or research subjects.

3.8 Exploitation.Marriage and family therapists do not engage in the exploitation of clients, students, trainees, supervisees, employees, colleagues, or research subjects.

Standard IV: RESPONSIBILITY TO STUDENTS AND SUPERVISEES
Marriage and family therapists do not exploit the trust and dependency of students and supervisees. Marriage and family therapists do not exploit the trust and dependency of students and supervisees.

4.1 Exploitation. Marriage and family therapists who are in a supervisory role are aware of their influential positions with respect to students and supervisees, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships that could impair professional objectivity or increase the risk of exploitation. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists take appropriate precautions.

4.2 Therapy with Students or Supervisees. Marriage and family therapists do not provide therapy to current students or supervisees.

4.3 Sexual Intimacy with Students or Supervisees Marriage and family therapists do not engage in sexual intimacy with students or supervisees during the evaluative or training relationship between the therapist and student or supervisee.

4.6 Existing Relationship with Students or Supervisees. Marriage and family therapists are aware of their influential positions with respect to supervisees, and they avoid exploiting the trust and dependency of such persons. Supervisors, therefore, make every effort to avoid conditions and multiple relationships with supervisees that could impair professional judgment or increase the risk of exploitation. Examples of such relationships include, but are not limited to, business or close personal relationships with supervisees or the supervisee’s immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, supervisors document the appropriate precautions taken.

Standard V: RESEARCH AND PUBLICATION
Marriage and family therapists respect the dignity and protect the welfare of research participants, and are aware of applicable laws, regulations, and professional standards governing the conduct of research.

5.4 Right to Decline or Withdraw Participation. Marriage and family therapists respect each participant’s freedom to decline participation in or to withdraw from a research study at any time. This obligation requires special thought and consideration when investigators or other members of the research team are in positions of authority or influence over participants. Marriage and family therapists, therefore, make every effort to avoid multiple relationships with research participants that could impair professional judgment or increase the risk of exploitation. When offering inducements for research participation, marriage and family therapists make reasonable efforts to avoid offering inappropriate or excessive inducements when such inducements are likely to coerce participation.

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American Counseling Association (ACA) Code of Ethics and Standards for Practice (2014)

Section F Supervision, Training, and Teaching

Introduction
Counselor supervisors, trainers, and educators aspire to foster meaningful and respectful professional relationships and to maintain appropriate boundaries with supervisees and students in both face-to-face and electronic formats. They have theoretical and pedagogical foundations for their work; have knowledge of supervision models; and aim to be fair, accurate, and honest in their assessments of counselors, students, and supervisees.

F.10. Roles and Relationships Between Counselor Educators and Students

F.10.a. Sexual or Romantic Relationships
Counselor educators are prohibited from sexual or romantic interactions or relationships with students currently enrolled in a counseling or related program and over whom they have power and authority. This prohibition applies to both in-person and electronic interactions or relationships.

F.10.b. Sexual Harassment
Counselor educators do not condone or subject students to sexual harassment.

F.10.c. Relationships With Former Students
Counselor educators are aware of the power differential in the relationship between faculty and students. Faculty members discuss with former students potential risks when they consider engaging in social, sexual, or other intimate relationships.

F.10.d. Nonacademic Relationships
Counselor educators avoid nonacademic relationships with students in which there is a risk of potential harm to the student or which may compromise the training experience or grades assigned. In addition, counselor educators do not accept any form of professional services, fees, commissions, reimbursement, or remuneration from a site for student or supervisor placement.

F.10.e. Counseling Services
Counselor educators do not serve as counselors to students currently enrolled in a counseling or related program and over whom they have power and authority.

F.10.f. Extending Educator– Student Boundaries
Counselor educators are aware of the power differential in the relationship between faculty and students. If they believe that a nonprofessional relationship with a student may be potentially beneficial to the student, they take precautions similar to those taken by counselors when working with clients. Examples of potentially beneficial interactions or relationships include, but are not limited to, attending a formal ceremony; conducting hospital visits; providing support during a stressful event; or maintaining mutual membership in a professional association, organization, or community. Counselor educators discuss with students the rationale for such interactions, the potential benefits and drawbacks, and the anticipated consequences for the student. Educators clarify the specific nature and limitations of the additional role(s) they will have with the student prior to engaging in a nonprofessional relationship. Nonprofessional relationships with students should be time limited and/or context specific and initiated with student consent.

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American Mental Health Counselors Association (AMHCA) AMHCA Code of Ethics (2020)

A. Counselor-Client Relationship
3. Dual/Multiple Relationships

CMHCs are aware of their influential position with respect to their clients. CMHCs do not exploit the trust of their clients, nor do they foster client dependency.

  • a. CMHCs make every effort to avoid dual/multiple relationships with clients that could impair professional judgment or increase the risk of harm. Examples of such relationships may include, but are not limited to, familial, social, financial, business, or close personal relationships with the clients.
  • b. When deciding whether to enter a dual/multiple relationship with a client, former client, or close relationship to the client, CMHCs will seek consultation and adhere to a credible decision making process prior to entering this relationship.
  • c. When a dual/multiple relationship cannot be avoided, CMHCs take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and that exploitation has not occurred.
  • d. CMHCs do not accept as clients any individual with whom they are involved in an administrative, supervisory, or other relationship of an evaluative nature.

C. Counselor Responsibility and Integrity
1. Competence

  • l. [CMHCs] are aware of the intimacy of the counseling relationship, maintain a healthy respect for the integrity of the client, and avoid engaging in activities that seek to meet the CMHC’s personal needs at the expense of the client.

F. Other Roles
1. Consultant

CMHCs, when in a consulting role, have a high degree of self-awareness of their own values, knowledge, skills, and needs in entering a helping relationship that involves human and/or organizational change.

  • f. CMHCs avoid conflicts of interest in selecting consultation clients.

F. Other Roles
2. Advocate

  • a. CMHCs are aware of and make every effort to avoid pitfalls of advocacy including conflicts of interest, inappropriate relationships, and other negative consequences. CMHCs remain sensitive to the potential personal and cultural impact on clients of their advocacy efforts.
  • b. CMHCs may encourage clients to challenge familial, institutional, and societal obstacles to their growth and development and they may advocate on the clients’ behalf. CMHCs remain aware of the potential dangers of becoming overly involved as an advocate.

III. Commitment to Students, Supervisees, and Employee Relationships
A. Relationships with Students, Interns, and Employees

CMHCs respect the integrity and welfare of supervisees, students, and employees. These relationships typically include an evaluative component and therefore need to be maintained on a professional and confidential basis. For more information about supervision disclosure, please see Appendix E, Clinical Supervision Disclosure Template, in “Essentials of the Clinical Mental Health Counseling Profession.”

1. CMHCs recognize the influential position they have with regard to both current and former supervisees, students, and employees and avoid exploiting their trust and dependency.

2. CMHCs do not engage in ongoing counseling relationships with current supervisees, students, and employees.

3. Sexual behavior with supervisees, students, and employees is unethical.

4. CMHCs do not engage in harassment of supervisees, students, employees, or colleagues.

5. CMHC supervisors ensure that their supervisees, students, and employees accurately represent their training, experience, and credentials.

6. In the informed consent statement, students and supervisees notify the client that they are in supervision and provide their clients with the name and credentials of their supervisor.

7. Students and supervisees have the same ethical obligations to clients as those required of CMHCs.

8. Supervisors should provide written informed consent prior to beginning a supervision relationship.

American Psychiatric Association (ApA)
Principles of Medical Ethics. With Annotations Especially Applicable to Psychiatry
(2013)

14. Sexual involvement between a faculty member or supervisor and a trainee or student, in those situations in which an abuse of power can occur, often takes advantage of inequalities in the working relationship and may be unethical because:

  • b. It may damage the trust relationship between teacher and student.
  • c. Teachers are important professional role models for their trainees and affect their trainees’ future professional behavior.


American Psychoanalytic Association (APsaA)
Principles and Standards of Ethics for Psychoanalysts
(2008)

III. Mutuality and Informed Consent
2. It is not ethical for a psychoanalyst to take advantage of the power of the transference relationship to aggressively solicit patients, students or supervisees into treatment or to prompt testimonials from current or former patients. Neither is it ethical to take such advantage in relation to parent(s) or guardian(s) of current or former minor patients.

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American Psychological Association (APA)
Ethical Principles of Psychologists and Code of Conduct
(2016)

3.04 Avoiding harm
Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.

3.05 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 maxi- mal compliance with the Ethics Code.
(c) When psychologists are required by law, institutional policy, or 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.

3.08 Exploitative relationships
Psychologists do not exploit persons over whom they have supervisory, evaluative, or other authority such as clients/patients, students, supervisees, research participants, and employees.

7.05 Mandatory individual or group Therapy
(a) When individual or group therapy is a program or course requirement, psychologists responsible for that program allow students in undergraduate and graduate programs the option of selecting such therapy from practitioners unaffiliated with the program.
(b) Faculty who are or are likely to be responsible for evaluating students’ academic performance do not themselves provide that therapy.

7.07 Sexual relationships with students and supervisees
Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority.

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California Association of Marriage and Family Therapists (CAMFT)
Ethical Standards for Marriage and Family Therapists
(2019)

7. SUPERVISOR, SUPERVISEE, EDUCATOR, AND STUDENT RESPONSIBILITIES
Marriage and family therapists, supervisees and students employ effective and respectful communication when fulfilling their professional responsibilities. Marriage and family therapists, when acting as supervisors and educators, are cognizant of their impact on the professional development of supervisees and students; they do not exploit the trust and dependence of students and supervisees and whenever possible they appropriately safeguard the best interests of the clients/patients of supervisees.

7.1 MAINTAINING PROFESSIONAL BOUNDARIES WITH SUPERVISEES AND STUDENTS:
Marriage and family therapists are aware of their influential position with respect to their students and supervisees, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid engaging in relationships with supervisees and students (over whom they exercise professional authority) that are reasonably likely to impair professional judgment or lead to exploitation. Provision of therapy to students or supervisees over whom the supervisor or educator exercise professional authority is unethical and provision of marriage and family therapy supervision to clients/patients is also unethical. Other acts which are likely to be unethical include, but are not limited to, borrowing money from a supervisee, engaging in a business venture with a supervisee, or engaging in a close personal relationship with a supervisee or student. Such acts with a supervisee’s spouse, partner or immediate family member may also be considered unethical dual relationships.

7.2 SEXUAL CONTACT WITH SUPERVISEES AND STUDENTS:
Marriage and family therapists do not engage in sexual contact with supervisees or students with whom they exercise professional authority. Sexual contact includes, but is not limited to, sexual intercourse, sexual intimacy, and sexually explicit communications without a sound clinical, supervisory, or educational basis. Such acts with the spouse, partner, or immediate family member of a supervisee or student are likely to be unethical and exploitive. (See also section 4.5 Sexual Contact.)

7.3 SEXUAL HARASSMENT OF SUPERVISEES OR STUDENTS:
Marriage and family therapists do not engage in sexual harassment of supervisees or students.

7.12 BARTERING WITH SUPERVISEES:
Marriage and family therapists ordinarily refrain from accepting goods or services from supervisees in return for services rendered due to the potential for conflicts, exploitation, and/ or distortion of the professional relationship. Bartering should only be considered and conducted if the supervisee requests it, the bartering is not otherwise exploitive or detrimental to the supervisory relationship, and it is negotiated without coercion. Marriage and family therapists are responsible to ensure that such arrangements are not exploitive and that a clear written agreement is created. Marriage and family therapists are encouraged to consider relevant social and/or cultural implications of bartering including whether it is an accepted practice among professionals within the community.

12. FINANCIAL ARRANGEMENTS
Marriage and family therapists make financial arrangements with clients/patients and supervisees that are understandable, and conform to accepted professional practices and legal requirements.

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The National Association of Social Workers (NASW) Code of Ethics (2017)

2.06 Sexual Relationships
(a) Social workers who function as supervisors or educators should not engage in sexual activities or contact with supervisees, students, trainees, or other colleagues over whom they exercise professional authority.
(b) Social workers should avoid engaging in sexual relationships with colleagues when there is potential for a conflict of interest. Social workers who become involved in, or anticipate becoming involved in, a sexual relationship with a colleague have a duty to transfer professional responsibilities, when necessary, to avoid a conflict of interest.

2.07 Sexual Harassment
Social workers should not sexually harass supervisees, students, trainees, or colleagues. Sexual harassment includes sexual advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature.

3.02 Education and Training
(d) Social workers who function as educators or field instructors for students should not engage in any dual or multiple relationships with students in which there is a risk of exploitation or potential harm to the student. Social work educators and field instructors are responsible for setting clear, appropriate, and culturally sensitive boundaries.

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National Board for Certified Counselors (NBCC) Code of Ethics (2016)

11. NCCs who act as counselor educators, field placement or clinical supervisors shall not engage in sexual or romantic intimacy with current students or supervisees. They shall not engage in any form of sexual or romantic intimacy with former students or supervisees for two years from the date of last supervision contact.

84. NCCs shall carefully consider ethical implications, including confidentiality and multiple relationships, prior to conducting research with students, supervisees or clients. NCCs shall not convey that participation is required or will otherwise negatively affect academic standing, supervision or counseling services.

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