The Truth About The Codes Of Ethics:
Dispelling the Rumors that Dual Relationships are Unethical
By Ofer Zur, Ph.D.
Following are annotated direct quotes from various professional associations’ codes of ethics in regard to dual or multiple relationships.
Table Of Contents
1. American Association of Christian Counselors (AACC)
2. American Association of Marriage and Family Therapists (AAMFT)
3. American Board of Examiners in Clinical Social Work (ABE)
4. American Counseling Association (ACA)
5. American Mental Health Counselors Association (AMHCA)
6. American Psychological Association (APA)
7. Association of State And Provincial Psychology Boards (ASPPB)
8. Australian Ethics Codes for Psychologists, Social Workers
9. California Association of Marriage and Family Therapists (CAMFT)
10. Canadian Counselling and Psychotherapy Association (CCPA)
11. Canadian Psychological Association (CPA)
12. Center for Clinical Social Work (CCSW)
13. National Association for Addiction Professionals (NAADAC)
14. National Association of Social Workers (NASW)
15. National Board for Certified Counselors (NBCC)
The codes of ethics of psychotherapists’ professional associations have evolved through the years to suit the increasing awareness and knowledge of the field in regard to dual relationships and other relevant issues. Most codes during the mid-twentieth century and ensuing decades (i.e., APA, 1953) concentrated on the general points of promoting client welfare and discouraging abuse of power by therapists. The concerns with therapeutic boundaries came to the forefront of the field after Gestalt therapy, with Frederick Perls at the helm, became enormously popular during the sexual revolution of the 1960s. In response to the sexually and other permissive attitudes of the 1960s and 1970s, there was pressure on psychology and counseling to articulate and provide more specific guidelines regarding therapists’ conduct vis-á-vis their clients. As a result, consumer protection agencies, licensing boards, and legislators joined ethicists and psychotherapists in establishing clear restrictions with regard to therapist-client sexual dual relationships. Therapists were instructed not only to resolutely avoid sexual relationships but also to make every effort to avoid any kind of boundary crossing and dual relationship because, as the (unfounded) myth went, it starts them on the slippery slope towards sexual dual relationships and harm.
The increasingly litigious culture of the 1980s and thereafter as well as the increased focus on risk management in medicine, led to more spoken and unspoken injunctions against any deviation from hands-off, only-in-the-office, “no self-disclosure” therapy. Dual relationships, like bartering, gifts, nonsexual touch, and dual were generally viewed as hazards from a risk management standpoint and the first step in the slippery slope towards sexual relationships. The early 1990s witnessed a growing acknowledgment that nonsexual dual relationships were unavoidable under some circumstances, such as in rural areas, small towns, military settings, and among constituents of distinct individual communities, such as churches, the deaf, gay men and lesbians, and other minorities. Partly in response to this growing awareness, several professional associations (i.e., APA, ACA, NASW) revised their codes of ethics, particularly with regard to dual relationships.
A few years into the 21st century we have seen even more profound changes. Many professional associations, such as APA, ACA and ASPPB published codes of ethics that present a non-rigid, flexible and context based approach towards boundaries. As with this document, almost all current major organizations’ codes of ethics clearly acknowledge that sexual relationships with current clients are always unethical, not all (non-sexual) dual relationships are unethical and some dual relationships are not avoidable. Regretfully, there is still a widespread false impression among psychotherapists, ethics committees, “experts,” judges and licensing boards that dual relationships are essentially unethical and harmful.
To circumvent the possibility of contributing to the confusion surrounding the codes of ethics, the next section is composed of exact-direct quotes about dual relationships, lifted verbatim from the codes of ethics of the major professional associations. Because sexual dual relationships with current clients have always been unethical in the codes of ethics of all psychotherapists’ professional associations, the passages that follow contain primarily those principles that directly relate to non-sexual dual relationships.
American Association of Christian Counselors (AACC) Code of Ethics
1-140: Dual and Multiple Relationships: Dual relationships involve the breakdown of proper professional or ministerial boundaries. A dual relationship exists when two or more roles are mixed in a manner that can harm the counseling relationship and/or the therapeutic process. This includes counseling, as well as personal, fraternal, business, financial, or sexual and romantic relationships. Not all dual relationships are necessarily unethical—it is client exploitation that is wrong, not the dual relationship in and of itself. However, it remains the responsibility of the counselor to monitor and evaluate any potential harm to clients.
1-140-a: The Rule of Dual Relationships: While in a counseling relationship, or when counseling relationships become imminent, or for an appropriate time after the termination of counseling, Christian counselors do not engage in dual relationships with clients. Some dual relationships are always avoided—sexual or romantic relations, and counseling close friends, family members, employees, business partners/associates or supervisees. Other dual relationships should be presumed as potentially troublesome and avoided wherever possible.
1-140-b: Proving an Exception to the Rule: Christian counselors have the primary burden of proof for a justified dual relationship by showing: (1) informed consent, including discussion of how the counseling relationship might be harmed as other aspects of the relationship proceed; and (2) lack of harm or exploitation to the client. As a general rule, all close relationships are unethical if they become counselor-client or formal lay helping relationships. Dual relationships may be allowable, requiring justification by the foregoing rule, if the client is an arms-length acquaintance and/or the relationship is not a close one.
1-140-c: Counseling with Family, Friends, and Acquaintances: Christian counselors do not provide counseling to family members or close friends, as dual relationships with other family members, acquaintances, and fraternal, club, association, or group members, are potentially troublesome and best avoided, otherwise requiring justification.
1-140-d: Business and Economic Relations: Christian counselors avoid partnerships, employment relationships, and close business associations with clients. Barter relationships in exchange for rendered therapeutic services should be avoided as potentially troublesome, and require justification; therefore if done, barter should be considered a rare and uncommon occurrence. Unless justified by compelling necessity, customer relationships with clients are normally avoided.
1-140-e: Receiving Gifts: Christian counselors recognize that sometimes and for certain cultures, a gift, when it is given, is a token of respect and a way of showing gratitude to a counselor. Prior to accepting a gift, counselors consider the cultural narrative of the client, the monetary value of the gift, and any therapeutic implications.
1-140-f: Counseling with Fellow Church Members: Christian counselors do not provide counseling to fellow church members with whom they have close personal, business, or shared ministry relations. Dual relationships with any other church members who are clients are potentially troublesome and best avoided, otherwise requiring justification. Pastors and church staff helpers should take all reasonable precautions to limit the adverse impact of any dual relationships.
1-140-g: Termination to Engage in Dual Relations Prohibited: Christian counselors do not terminate counseling for the purpose of engaging in dual relationships of any kind. Some counselors and their former clients may agree that any future counseling will be done by another provider if, after legitimate termination and no identified risks of potential harm to the client, they decide to pursue another form of relationship.
American Association of Marriage and Family Therapists (AAMFT) Code of Ethics
Section 1.3, states: 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.
American Board of Examiners in Clinical Social Work (ABE) Ethics Code (2006)
Section 1.5. States:
5. Clinical social workers do not use clients for self-interest, do not socialize with clients in a manner detrimental to treatment, and do not exploit clients or engage in sexual harassment or sexual relationships with supervisees, students, employees, research subjects, or current and former clients. The clinician carries the burden of determining that a relationship is appropriate, not detrimental, and does not violate boundaries of roles.
American Counseling Association (ACA) Code of Ethics and Standards for Practice (2014)
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. Sexual and/or Romantic Relationships Prohibited
Sexual and/or romantic counselor–client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. This prohibition applies to both in-person and electronic interactions or relationships.
A.5.b. Previous Sexual and/or Romantic Relationships
Counselors are prohibited from engaging in counseling relationships with persons with whom they have had a previous sexual and/or romantic relationship.
A.5.c. Sexual and/or Romantic Relationships With Former Clients
Sexual and/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. This prohibition applies to both in-person and electronic interactions or relationships. Counselors, before engaging in sexual and/or romantic interactions or relationships with former clients, their romantic partners, or their family members, demonstrate forethought and document (in written form) whether the interaction or relationship can be viewed as exploitive in any 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 into such an interaction or relationship.
A.5.d. Friends or Family Members
Counselors are prohibited from engaging in counseling relationships with friends or family members with whom they have an inability to remain objective.
A.5.e. Personal Virtual Relationships With Current Clients
Counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship (e.g., through social and other media).
A.6. Managing and Maintaining Boundaries and Professional Relationships
A.6.b. Extending Counseling Boundaries
Counselors consider the risks and benefits of extending current counseling relationships beyond conventional parameters. Examples include attending a client’s formal ceremony (e.g., a wedding/commitment ceremony or graduation), purchasing a service or product provided by a client (excepting unrestricted bartering), and visiting a client’s ill family member in the hospital. In extending these boundaries, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no harm occurs.
A.6.c. Documenting Boundary Extensions
If counselors extend boundaries as described in A.6.a. and A.6.b., they must officially document, 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. When unintentional harm occurs to the client or former client, or to an individual significantly involved with the client or former client, the counselor must show evidence of an attempt to remedy such harm.
A.6.d. Role Changes in the Professional Relationship
When counselors change a role from the original or most recent contracted relationship, they obtain informed consent from the client and explain the client’s right to refuse services related to the change. Examples of role changes include, but are not limited to
- 1. changing from individual to relationship or family counseling, or vice versa;
- 2. changing from an evaluative role to a therapeutic role, or vice versa; and
- 3. 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, therapeutic) of counselor role changes.
A.6.e. Nonprofessional Interactions or Relationships (Other Than Sexual or Romantic Interactions or Relationships)
Counselors avoid entering into nonprofessional relationships with former clients, their romantic partners, or their family members when the interaction is potentially harmful to the client. This applies to both in-person and electronic interactions or relationships.
American Mental Health Counselors Association (AMHCA) Codes 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.
B. Counseling Process
6. The Use of Technology Supported Counseling and Communications (TSCC)
CMHCs recognize that technology has become culturally normative worldwide and may employ modern technology communications judiciously, attentive to both the benefits and risks to clients and to the therapeutic process of using technologies to arrange, deliver, or support counseling.
- j. CMHCs may maintain professional profiles that are kept separate from personal profiles. CMHCs need to be aware of their impact on clients should personal information or opinions be disclosed in a public platform. When applicable, CMHCs educate clients on confidentiality, implications for client activity on these pages, and appropriate channels for contacting CMHCs.
C. Counselor Responsibility and Integrity
- 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
- f. CMHCs avoid conflicts of interest in selecting consultation clients.
F. Other Roles
- 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.
American Psychological Association (APA) [Section 3.05] Ethical Principles of Psychologists and Code of Conduct (2016)
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 maximal 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.
The Association of State and Provincial Psychology Boards (ASPPB) Code of Conduct (2018)
RULES OF CONDUCT. B. Multiple Relationships
- Definition of multiple relationships.Psychologists recognize that multiple relationships may occur because of the psychologist’s present or previous familial, social, emotional, financial, supervisory, political, administrative or legal relationship with the client or a relevant person associated with or related to the client. Psychologists take reasonable steps to ensure that if such a multiple relationship occurs, it is not exploitative of the client or a relevant person associated with or related to the client.
- Prohibited Multiple Relationships.
- a. A multiple relationship that is exploitative of the client or a relevant person associated with or related to the client is prohibited.
- b. Psychologists take all reasonable steps to ensure that any multiple relationships do not impair the psychologist’s professional judgment or objectivity or result in a conflict of interest with the client or a relevant person associated with or related to the client.
- c. Multiple relationships that would not reasonably be expected to impair a psychologist’s judgment or objectivity or risk harm to the client or relevant person associated with or related to the client are not expressly prohibited.
Australian Ethics Codes for Psychologists, Social Workers
The Australian Psychological Society (APS) Code of Ethics (2007), Principle B.7.b states: Psychologists who use interpreters take reasonable steps to ensure that the interpreter is not in a multiple relationship with the client that may impair the interpreter’s judgement. Principle C.3.1 states: Psychologists refrain from engaging in multiple relationships that may: (a) impair their competence, effectiveness, objectivity, or ability to render a psychological service; (b) harm clients or other parties to a psychological service; or (c) lead to the exploitation of clients or other parties to a psychological service. Principle C.3.3 states: When entering into a multiple relationship is unavoidable due to over-riding ethical considerations, organisational requirements, or by law, psychologists at the outset of the professional relationship, and thereafter when it is reasonably necessary, adhere to the provisions of standard A.3. (Informed consent).
Australian Association of Social Workers (AASW) Code of Ethics (2002) section 4.1.4 g. states: recognising that conflicts of interest can arise from engaging in dual or multiple relationships with clients, former clients, research participants, students, supervisees or colleagues, social workers will set and enforce explicit, appropriate professional boundaries to minimise the risk of conflict, exploitation or harm.
Australian Institute of Welfare and Community Workers (AIWCW) Code of Ethics (1999) does not mention specific prohibition of dual or multiple relationships. It simply outlines the general principles that appear in all other codes, of the mandate to treat clients with respect.
Psychotherapy and Counselling Federation of Australia (PACFA) Ethical Guidelines section on Exploitation states:
– Counsellors must not exploit clients, past or present, in financial, sexual, emotional or any other way.
– Counsellors should consider that the deeper the involvement with the client’s emotional life during Counselling, the less likely is the possibility of a subsequent equal relationship following termination of therapy. Counsellors must seek professional supervision should any attempt to build a relationship with a former client be considered.
California Association of Marriage and Family Therapists (CAMFT)
Ethical Standards for Marriage and Family Therapists (2019)
4. DUAL/MULTIPLE RELATIONSHIPS
Marriage and family therapists establish and maintain professional relationship boundaries that prioritize therapeutic benefit and safeguard the best interest of their clients/patients against exploitation. Marriage and family therapists engage in ethical multiple relationships with caution and in a manner that is congruent with their therapeutic role.
4.1 DUAL/MULTIPLE RELATIONSHIPS:
Dual /multiple relationships occur when a therapist and his/her client/patient concurrently engage in one or more separate and distinct relationships. Not all dual/multiple relationships are unethical, and some need not be avoided, including those that are due to geographic proximity, diverse communities, recognized marriage and family therapy treatment models, community activities, or that fall within the context of culturally congruent relationships. Marriage and family therapists are aware of their influential position with respect to clients/patients, and avoid relationships that are reasonably likely to exploit the trust and/or dependence of clients/patients, or which may impair the therapist’s professional judgment.
4.2 ASSESSMENT REGARDING DUAL/MULTIPLE RELATIONSHIPS:
Prior to engaging in a dual/multiple relationship, marriage and family therapists take appropriate professional precautions which may include, but are not limited to the following: obtaining the informed consent of the client/patient, consultation or supervision, documentation of relevant factors, appraisal of the benefits and risks involved in the context of the specific situation, determination of the feasibility of alternatives, and the setting of clear and appropriate therapeutic boundaries to avoid exploitation or harm.
4.3 UNETHICAL DUAL/MULTIPLE RELATIONSHIPS:
Acts that could result in unethical dual relationships include, but are not limited to, borrowing money from a client/patient, hiring a client/patient, or engaging in a business venture with a patient, or engaging in a close personal relationship with a client/patient. Such acts with a client’s/patient’s spouse, partner or immediate family member are likely to be considered unethical dual relationships.
4.4 NON-PROFESSIONAL RELATIONSHIPS WITH FORMER CLIENTS/PATIENTS:
Prior to engaging in a non-sexual relationship with former clients/patients, marriage and family therapists take care to avoid engaging in interactions which may be exploitive or harmful to the former client/patient. Marriage and family therapists consider factors which include, but are not limited to, the potential continued emotional vulnerability of the former client/patient, the anticipated consequences of involvement with that person, and the elimination of the possibility that the former client/patient resumes therapy in the future with that therapist.
4.5 SEXUAL CONTACT:
Sexual contact includes, but is not limited to sexual intercourse, sexual intimacy, and sexually explicit communications without a sound clinical basis and rationale for treatment. Sexual contact with a client/patient, or a client’s/patient’s spouse or partner, or a client’s/patient’s immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical. Prior to engaging in sexual contact with a former client/patient or a client’s/ patient’s spouse or partner, or a client’s/patient’s immediate family member, following the two years after termination or last professional contact, the therapist shall consider factors which include, but are not limited to, the potential harm to or exploitation of the former client/patient or to the client’s/patient’s family, the potential continued emotional vulnerability of the former client/patient, and the anticipated consequences of involvement with that person.
4.6 PRIOR SEXUAL RELATIONSHIP:
A marriage and family therapist does not enter into a therapeutic relationship with a person with whom the therapist has had a sexual relationship or knowingly enter into a therapeutic relationship with a partner or immediate family member of a person with whom the therapist has had a sexual relationship.
Marriage and family therapists do not use their professional relationships with clients/patients to further their own interests and do not exert undue influence on patients.
4.8 NON-THERAPIST ROLES:
Marriage and family therapists when engaged in professional roles other than treatment or supervision (including, but not limited to, managed care utilization review, consultation, coaching, adoption service, child custody evaluation, or behavior analysis), act solely within that role and clarify as necessary, in order to avoid confusion with consumers and employers, how that role is distinguished from the practice of marriage and family therapy.
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.
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.
10.4 DUAL ROLES:
Marriage and family therapists avoid providing both court evaluations and treatment concurrently or sequentially for the same clients/patients or treatment units in legal proceedings such as child custody, visitation, dependency, or guardianship proceedings, unless otherwise required by law or initially appointed pursuant to court order. When pre-existing clients/patients become involved in a legal proceeding and the marriage and family therapist continues to provide treatment, they should discuss the potential effects of legal involvement with their clients/patients, including clarifying the potential role conflicts, clients’/patients’ expectations, and possible requests to release treatment information.
11.3 RESEARCH PARTICIPANTS:
Researchers respect participants’ freedom to decline participation in or to withdraw from a research study at any time. This obligation requires special thought and consideration when researchers 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 dual/multiple relationships with research participants that could impair professional judgment or increase the risk of exploitation.
Marriage and family therapists ordinarily refrain from accepting goods or services from clients/ patients 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 client/patient requests it, the bartering is not otherwise exploitive or detrimental to the therapeutic 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.
Canadian Counselling and Psychotherapy Association (CCPA) Code of Ethics (2007)
Section B, Counseling Relationships, subsection B8, Dual Relationships, states:
Counselors make every effort to avoid dual relationships with clients that could impair professional judgment or increase the risk of harm to clients. Examples of dual relationships include, but are not limited to, familial, social, financial, business, or close personal relationships. When a dual relationship cannot be avoided, counselors take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs.
Canadian Psychological Association (CPA) Code of Ethics for Psychologists (2000)
Section III.33, states:
Avoid dual or multiple relationships (e.g. with clients, research participants, employees, supervisees, students, or trainees) and other situations that might present a conflict of interest or that might reduce their ability to be objective and unbiased in their determinations of what might be in the best interests of others (Avoidance of Conflict of Interest Section, para. 3) (Emphasis added).
Section III.34, states:
Manage dual or multiple relationships that are unavoidable due to cultural norms or other circumstances in such a manner that bias, lack of objectivity, and risk of exploitation are minimized. This might include obtaining ongoing supervision or consultation for the duration of the dual or multiple relationship, or involving a third party in obtaining consent (e.g., approaching a client or employee about becoming a research participant). (Avoidance of Conflict of Interest section, para. 4)
Center for Clinical Social Work (CCSW) Ethics Code
Section 1.5. States:
Clinical social workers do not use clients for self-interest, do not socialize with clients in a manner detrimental to treatment, and do not exploit clients or engage in sexual harassment or sexual relationships with supervisees, students, employees, research subjects, or current and former clients. The clinician carries the burden of determining that a relationship is appropriate, not detrimental, and does not violate boundaries of roles.
National Association for Addiction Professionals (NAADAC)
Code of Ethics (2011)
Standard 3: Dual Relationships, states:
The addiction professional understands that the goal of treatment services is to nurture and support the development of a relationship of equals of individuals to ensure protection and fairness of all parties.
Addiction professionals will provide services to clients only in the context of a professional setting. In rural settings and in small communities, dual relationships are evaluated carefully and avoided as much as possible.
- 1. Because a relationship begins with a power differential, the addiction professional will not exploit relationships with current or former clients, current or former supervisees or colleagues for personal gain, including social or business relationships.
- 2. The addiction professional avoids situations that might appear to be or could be interpreted as a conflict of interest. Gifts from clients, other treatment organizations or the providers of materials or services used in the addiction professional’s practice will not be accepted, except when refusal of such gift would cause irreparable harm to the client relationship. Gifts of value over $25 will not be accepted under any circumstances.
- 3. The addiction professional will not engage in professional relationships or commitments that conflict with family members, friends, close associates or others whose welfare might be jeopardized by such a dual relationship.
- 4. The addiction professional will not, under any circumstances, engage in sexual behavior with current or former clients.
- 5. The addiction professional will not accept as clients anyone with whom they have engaged in romantic or sexual relationships.
- 6. The addiction professional makes no request of clients that does not directly pertain to treatment (giving testimonials about the program or participating in interviews with reporters or students).
- 7. The addiction professional recognizes that there are situations in which dual relationships are difficult to avoid. Rural areas, small communities and other situations necessitate discussion of the counseling relationship and take steps to distinguish the counseling relationship from other interactions.
- 8. When the addiction professional works for an agency such as department of corrections, military, an HMO or as an employee of the client’s employer, the obligations to external individuals and organizations are disclosed prior to delivering any services.
- 9. The addiction professional recognizes the challenges resulting from increased role of the criminal justice system in making referrals for addiction treatment. Consequently he/she strives to remove coercive elements of such referrals as quickly as possible to encourage engagement in the treatment and recovery process.
- 10. The addiction professional encourages self-sufficiency among clients in making daily choices related to the recovery process and self care.
- 11. The addiction professional shall avoid any action that might appear to impose on others’ acceptance of their religious/spiritual, political or other personal beliefs while also encouraging and supporting participation in recovery support groups.
The National Association of Social Workers (NASW) Code of Ethics (2017)
1.06 Conflicts of Interest:
(a) Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients’ interests primary and protects clients’ interests to the greatest extent possible. In some cases, protecting clients’ interests may require termination of the professional relationship with proper referral of the client.
(b) Social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests.
(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.)
(d) When social workers provide services to two or more people who have a relationship with each other (for example, couples, family members), social workers should clarify with all parties which individuals will be considered clients and the nature of social workers’ professional obligations to the various individuals who are receiving services. Social workers who anticipate a conflict of interest among the individuals receiving services or who anticipate having to perform in potentially conflicting roles (for example, when a social worker is asked to testify in a child custody dispute or divorce proceedings involving clients) should clarify their role with the parties involved and take appropriate action to minimize any conflict of interest.
(e) Social workers should avoid communication with clients using technology (such as social networking sites, online chat, e-mail, text messages, telephone, and video) for personal or non-work-related purposes.
(f) Social workers should be aware that posting personal information on professional Web sites or other media might cause boundary confusion, inappropriate dual relationships, or harm to clients.
(g) Social workers should be aware that personal affiliations may increase the likelihood that clients may discover the social worker’s presence on Web sites, social media, and other forms of technology. Social workers should be aware that involvement in electronic communication with groups based on race, ethnicity, language, sexual orientation, gender identity or expression, mental or physical ability, religion, immigration status, and other personal affiliations may affect their ability to work effectively with particular clients.
(h) Social workers should avoid accepting requests from or engaging in personal relationships with clients on social networking sites or other electronic media to prevent boundary confusion, inappropriate dual relationships, or harm to clients.
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.
National Board for Certified Counselors (NBCC) Code of Ethics (2016)
5. NCCs shall not engage in harmful multiple relationships with clients. In the event that a harmful multiple relationship develops in an unforeseen manner, the NCC shall discuss the potential effects with the client and shall take reasonable steps to resolve the situation, including the provision of referrals. This discussion shall be documented in the client’s record.
14. NCCs who provide clinical supervision services shall not have multiple relationships with supervisees that may interfere with supervisors’ professional judgment or exploit supervisees. Supervisors shall not supervise relatives.
19. NCCs shall recognize the potential harm of informal uses of social media and other related technology with clients, former clients and their families and personal friends. After carefully considering all of the ethical implications, including confidentiality, privacy and multiple relationships, NCCs shall develop written practice procedures in regard to social media and digital technology, and these shall be incorporated with the information provided to clients before or during the initial session. At a minimum, these social media procedures shall specify that personal accounts will be separate and isolated from any used for professional counseling purposes including those used with prospective or current clients. These procedures shall also address “friending” and responding to material posted.
21. NCCs who use digital technology (e.g., social media) for professional purposes shall limit information posted to that which does not create multiple relationships or which may threaten client confidentiality.
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.
The Ethics Codes in Solidarity
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:
- a. Sexual dual relationships with present clients are always unethical.
- b. Non-sexual dual relationships are not always avoidable.
- c. Non-sexual dual relationships are not always unethical.
- d. 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.
In contrast to the widespread belief that non-sexual dual relationships are inherently unethical, the codes of ethics of all major professional organizations place no ban on non-sexual dual relationships and in fact acknowledge dual relationships as sometimes unavoidable. Instead of supporting the opinion that dual relationships are unethical under any circumstances, the codes dictate that only those relationships likely to impair judgment and objectivity, interfere with the therapeutic work, or harm or exploit patients ought to be avoided.
Understanding the ethics codes is imperative in order to make informed decisions about dual relationships. Blind trust in other practitioners’ interpretations of these codes does not constitute a thorough process of gathering information. Therapists familiar with the ethics codes will realize that non-sexual dual relationships are neither always unethical nor always avoidable, and thus will be better prepared to make choices about dual relationships that attend to the needs of the client. When the propensity to practice based on fear of litigation or licensing boards is set aside and replaced by first-hand knowledge of the ethics codes themselves, dual relationships can be accurately regarded as yet another opportunity to help clients.