Guidelines: Dual Relationships

Treatment plans:

1. Develop a clear treatment plan for clinical interventions which are based on the context of therapy. As indicated above, the context includes client, therapy, setting and therapy factors. Client’s personality, culture, DX, gender, etc., are of the highest importance in determining the TP.
2. Intervene with your clients according to their needs, as outlined in each of their treatment plans, and not according to any graduate school professor’s or supervisor’s dogma or even your own beloved theoretical orientation.
3. Some treatment plans may necessitate dual relationships however, in other situations dual relationships should be ruled out. Make sure you know the difference.
4. If planning on entering a dual relationship you must take into consideration the welfare of the client, effectiveness of treatment, avoidance of harm and exploitation, conflict of interest, and the impairment of clinical judgment. These are the paramount and appropriate concerns.
5. Do not let fear of lawsuits, licensing boards or attorneys determine your treatment plans or clinical interventions. Do not let dogmatic thinking affect your critical thinking. Act with competence and integrity while minimizing risk by following these guidelines.
6. Incorporate dual relationships into your treatment plans only when they are not likely to impair your clinical judgment, or create a conflict of interest.
7. Do not enter into sexual relations with a client because it is likely to impair your judgment and nullify your clinical effectiveness.
8. Remember that treatment planning is an essential and irreplaceable part of your clinical records and your first line of defense.
9. Consult with clinical, ethical or legal experts in very complex cases and document the consultations well.

 

Prior to and during therapy which includes dual relationships:

10. Study the clinical, ethical, legal and spiritual complexities and potential ramifications of entering into dual relationships.
11. Attend to and be aware of your own needs through personal therapy, consultations with colleagues, supervision or self-analysis. Awareness of your own conscious and unconscious needs and biases helps avoid cluttering the dual relationship.
12. Before entering into complex dual relationships, consult with well-informed and non-dogmatic peers, consultants, and supervisors.
13. When you consult with attorneys, ethics experts and other non-clinical consultants make sure that you use the information to educate and inform yourself rather than as clinical guidelines. Separate knowledge of law and ethics from care, integrity, decency and above all effectiveness. Remember you are paid to help and heal, not to protect yourself.
14. Discuss with your clients the complexity, richness, potential benefits, drawbacks and likely risks that may arise due to dual relationships.
15. Make sure that your office policies include the risks and benefits of dual relationships and that they are fully explained, read and signed by your clients before you implement them.
16. Make sure your clinical records document clearly all consultations, substantiations of your conclusion, potential risks and benefits of intervention, theoretical and empirical support of your conclusion, when available, and the discussion of these issues with your client.

 

Clinical integrity and effectiveness:

17. Remember you are setting an example. Model civility, integrity, emotionality, humanity, courage, and, when appropriate, duality.
18. As a role model, telling your own stories can be an important part of therapy. Make sure that the stories are told in order to help the client and not to satisfy your own needs.
19. Remember that you are being paid to provide help. At the heart of all ethical guidelines is the mandate that you act on your clients’ behalf and avoid harm. That means you must do what is helpful, including dual relationships when appropriate.
20. Answer clients’ basic and legitimate questions about your values and beliefs, including your thoughts on dual relationships.
21. Continue to keep excellent written records throughout treatment. Keep records of all your clinical interventions, including dual relationships, additional consultations and your own and your clients’ assessment of treatment and its progress.
22. Evaluate and update your approach, attitudes, treatment plans and above all effectiveness regularly.
23. If you find yourself in a dual relationship which either is not benefiting the client or is causing distress and harm, or has unexpectedly brought about conflict of interest, consult and, if necessary, stop or ease out of the dual relationship in a way that preserves the client’s welfare in the best possible way.