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What Films Can Teach Psychotherapists About Dual Relationships in Psychotherapy
By: Ofer Zur, Ph.D. and Birgit Wolz, Ph.D.
Table Of Contents
Dual Relationships in Psychotherapy
Movie Vignettes and Analysis
Basic Instinct
Dressed to Kill
Girl Interrupted
House of Games
Mr. Jones
Prime
Prince of Tides
Stay
What about Bob?
Dual relationships in psychotherapy refer to the existence of an additional role or roles between therapists and clients in addition to the clinical relationships. Examples of dual relationships are when a psychotherapy client is also a student, friend, family member, lover, employee or business associate of the therapist.
Dual relationships are, at the very least, boundary crossings as they involve crossing the lines of the therapeutic frame and adding a secondary relationship. Unavoidable and non-exploitative dual relationships, as often occur in small, rural or military communities, are boundary crossings. Sexual relationships with current clients and other exploitative dual relationships are boundary violations as they are very likely to impair the therapists’ objectivity and clinical judgment (Bersoff, 1999; Gutheil & Gabbard, 1993; Lazarus & Zur, 2002; Koocher & Keith-Spiegel, 1998; Pope & Vasquez, 1998).
It is important to differentiate between boundary crossings, such as therapeutic non-sexual touch, clinically driven self-disclosure, home visits to a bed-ridden client and gift exchanges, which do not entail a secondary relationship and those associations that involve dual relationships. As long as the therapist self-discloses, touches or makes a home visit as part of the treatment plan and no secondary social or other relationships are created, there is no dual relationship. For the same reasons attending a client’s wedding or self-disclosure, when carried out for clinical reasons rather than social ones, do not constitute social or other dual relationships. However, if self-disclosure or attending the client’s wedding takes place in the course of a social relationship or as part of a community relationship between the therapist and client, that constitutes a dual relationship (Lazarus & Zur, 2002). Obviously incidental, chance encounters between therapists and clients outside the therapy room, which are not part of a social connection, do not constitute dual relationships. Unlike most bartering for goods, bartering for services, such as when a client paints a therapist’s home, fixes her car or cleans his office in lieu of payment, inherently creates a secondary business association and, therefore, is a dual relationship (Zur, 2004b).
There are many types of dual relationships.
Dual relationships can be voluntary, unavoidable, mandatory or a normal part of communal living.
Dual relationships can come in many shapes and forms. They can be:
Publications during the 1980’s and early 1990’s focused primarily on the risks of dual relationships and their association with sexual boundary violations (e.g., Borys & Pope, 1989; Epstein, Simon, & Kay, 1992; Gutheil & Gabbard, 1993; Kitchener, 1988; Pope, 1989, 1990; Pope et al., 1993; Simon, 1991, 1992; Sonne & Pope, 1991; Strasburger et al., 1992). A shift took place in the mid 1990’s that has continued through the early years of the 21st millennium. During this period, more publications have reviewed the inevitability and potential clinical utility of dual relationships (e.g., Barnett, 1999; Campbell & Gordon, 2003; Ebert, 1997; Hedges et al., 1977; Kessler & Waehler, 2005; Lazarus, 1994, 1998; Lazarus & Zur, 2002; Tomm, 1993; Williams, 1997; Zur, 2000, 2001a, 2004a, 2005b). Thus, Younggren and Gottlieb (2004) write:
Professional practice abounds with the potential for multiple relationships, and the circumstances under which these types of relationships occur are quite varied. Although psychologists frequently choose to enter into these types of relationship, many may actually be unavoidable, and in some situations one can even conceptualize the avoidance of the dual relationship not only as unethical but also as potentially destructive to treatment itself. (2004, p. 255)
Dual relationships in rural and isolated communities have discussed extensively as these communities present psychotherapists who practice there with a wide range of unavoidable dual relationship situations which are embedded in the social structure and therefore become normal, accepted and expected (e.g., Barnett, & Yutrzenka, 1994; Campbell, & Gordon, 2003; Hargrove, 1986; Schank & Skovholt, 1997; Sleek, 1994; Stamm, 2003; Stockman, 1990). People in such communities are familiar with most of their fellow citizens, including the local therapists. These communities often offer only a limited pool of therapists from which to choose As a result, therapists and clients often know each other prior to the start of therapy and interact with each other in a number of non-clinical capacities before, during and after therapy. Solo practitioners in such small communities often cannot avoid interacting with their clients at the local market, community events or school functions. Avoiding all contacts would require the therapists to lead the life of hermits (Younggren & Gottlieb, 2004) If therapists choose to isolate themselves, they will be looked upon with suspicion by members of such communities who rely on familiarity for the development of trust (Moleski & Kiselica, 2005; Zur, 2000).
Similar to the isolated rural communities are the close-knit communities that exist within large metropolitan areas. These include church, synagogue and other spiritual communities (Geyer, 1994; Llewellyn, 2002; Montgomery & DeBell, 1997); Hispanic, African-American, American Indian, Chinese and other ethnic communities (Kertész, 2002; Sears, 1990); gay, lesbian and bisexual communities (Kessler & Waehler, 2005; Smith, 1990); deaf (Guthmann & Sandberg, 2002), other disabled communities and the recovery communities. What is unique about these communities is their membership’s strong sense of affiliation and equally strong feelings of interdependence, mutuality and affiliative philosophy. Christian fellowship members may choose their pastors or other church leaders as their psychotherapists because they have heard their Sunday sermons, know their spiritual, communal and familial values, have witnessed them leading prayer groups and have watched them interact with members of the congregation (Geyer, 1994; Llewellyn, 2002; Montgomery & DeBell, 1997). Gay clients often choose gay therapists in their community who are “out” and whom they know share their sub-cultural background or difficult experiences in a generally homophobic and often discriminatory culture (Kessler & Waehler, 2005). Deaf clients often seek deaf therapists in their communities whom they know personally, whom they respect or have seen overcome difficulties related to impairment or discrimination. Additionally, deaf clients are likely to choose therapists who can sign in order to avoid the use of interpreters. These therapists tend to be hearing-impaired themselves, and often involved in the deaf community (Guthmann & Sandberg, 2002). Jewish, African-American or Hispanic clients may seek familiar therapists with similar cultural or ethnic backgrounds from within their own community who share their heritage, values, language or customs (Lazarus & Zur, 2002). A newly ‘clean and sober’ member of the AA fellowship may seek therapy with a therapist who is part of the local fellowship and with a similar cultural and socio-economic background who has been clean and sober for a long period of time (Doyle, 1997; Moleski & Kiselica, 2005; Zur, 2004a).
At college and university counseling centers that are located on campuses, the therapists are very likely to run into their clients frequently, incidental encounters are very common and dual relationships, consequently, may arise. The milieu is in some ways similar to rural, small towns and remote military bases in the sense that dual relationships are often unavoidable. Because many therapists in these counseling centers are graduate students themselves, they may often interact with other students, including their clients, in various capacities. Many scenarios are possible: attending classes, lectures, graduation ceremonies, concerts, parties and sports events, participating in team sports or frequenting the campus health club or pool together; both working part-time at a library or a research center (Hyman, 2002; Hayman & Cover, 1986). More clinically complex, and potentially unethical dual relationships occur when clients attend classes that are being taught or assisted (TA) by their therapists,
Training institutes, such as the psychoanalytic or Jung Institute or family training establishments present unique and complex dual relationship situations. Like supervisors, analysts and instructors in these institutions, trainees and candidates also tend to be licensed professionals with graduate degrees. Naturally, these institutions attract people who share their appreciation of a certain philosophy, theoretical orientation or even worldview. The trainees in these places are neither necessarily young nor necessarily professionally inexperienced. Unlike graduate schools, and due to admission criteria, many of the trainees are seasoned professionals who seek advanced or more focused professional training.
The military and the prison systems are two such examples of mandatory dual relationships. What is unique about these two governmental structures is the fact that the psychotherapists’ primary allegiance is to the institutions rather than to their clients. Military law mandates that military psychologists give higher priority to national defense, unit integrity and unit combat readiness than to concerns with the welfare of the individual psychotherapy patient (Johnson, 1995; Staal & King, 2000). Similarly, forensic psychotherapists who work in prisons and jails must give higher priority to matters of security and safety than to concerns with the welfare of their individual clients. Police psychology also presents a complex and often unavoidable multiple relationships situation where the psychologists may be concurrently involved in training, fitness-to-duty evaluations, consultation, hostage negotiation and other roles (Zelig, 1988). These psychotherapists are employed by a city, county, state or federal government, so needless to say, these mandated priorities very often put them in difficult conflict of interest situations where they may need to act in a way that may harm the client but serve the institution. Like military therapists, prison therapists also have this dual loyalty both to the institution and to the client, but again with first importance always being the institution’s concern with safety and security. Psychotherapists in prisons are part of the prison staff and, as such, are first and foremost concerned with issues of security. Any information that is revealed during psychotherapy sessions that may have bearing on security and safety must be reported to the prison authority. As members of the prison staff, therapists may be mandated to serve also as guards or even armed guards. As in the military, these dual roles can lead to ethical and clinical convolutions and conflict of interest, which therapists in the conventional therapeutic world seldom encounter.
In summary, dual relationships take place when therapists have additional relationships with their clients in addition to the therapeutic one. Dual relationships can be avoidable or unavoidable, common or rare, harmful or helpful, unusual or normal, very involved or minimally involved, all depending on the patient, setting, location and culture of therapists and their clients. Dual relationships can involve a secondary professional, social, business or sexual relationship. These relationships can be simultaneous or sequential. Appropriate and ethical dual relationships are boundary crossings and exploitative and harming dual relationships are boundary violations. Dual relationships are a normal part of many small, isolated or highly cohesive communities and are legally mandated in the military and prisons. As such, they clearly fall within the standard of care. Appropriate, non-exploitative dual relationships are neither unethical nor constitute boundary violations. The therapist’s involvement in any type of dual relationship must be determined, if possible, by the client’s well-being and personal data, therapist’s orientation and culture, and, what often is the determining factor, the setting and culture in which therapy takes place.
Dual Relationships In the Movies
Basic Instinct
Detective Nick Curran and his colleague, Gus Moran, investigate a murder. Nick gets sexually involved with one of the suspects, Catherine Tramell. He is in psychotherapy with police psychologist, Dr. Beth Garner, who had also become his lover. In order to protect Curran, Garner gives Lt. Marty Nilsen access to the therapy notes about Nick.
Dual Relationships in Special Settings
Because they are colleagues at the police department, Beth knows that Curran discusses his cases with other officers sometimes in a bar. In one scene she is angry, finds Nick at the bar, and gets into an argument with him in front of the other officers.
Because both the therapist and the client are employees at the police department, this kind of social encounter might be more common than in other therapeutic relationships.
As the police department’s forensic psychologist, Beth Garner is part of the team that tries to solve murder cases. In one team meeting, Garner, Curran, and their colleagues discuss the murder of the former rock and roll star who was found brutally murdered.
At this police department, the client and the therapist interact with each other in their roles as colleagues in a team that collaborates in a murder investigation.
Sexual Dual Relationships
At the beginning of the movie, we learn that, a while ago, Internal Affairs had ordered detective Nick Curra to see police psychologist Beth Garner for psychotherapy, because he killed four people in five years on duty and struggled with an addiction to alcohol and cocaine. During their last therapy session, it becomes obvious that they had a romance that is over now. As he leaves her office, Beth says to him, “I still miss you, Nick”. Referring to Curran and Garner, one of his colleagues tells another one in a later scene, “Sometimes I think that he started banging her just to get off the hook with Internal Affairs.”
What is rarely discussed in the literature is the fact that some clients in some situations gain significant power over their therapists, with whom they have sexual relationships. In this case, starting an affair with Beth, Nick gains power over her. As a result of her attraction to him, she decides and acts in his favor and even lie on his behalf.
Sequential Sexual Dual Relationships
Nick feels sexually teased and provoked by the murder suspect, Catherine Tramell. Shortly after this encounter with Catherine, he visits his ex-therapist, Beth Garner, to have passionate sex with her. She reveals that she knew Catherine when they were both psychology students at UC Berkeley. Beth gets jealous of Catherine when she understands that Nick has fallen for her, and throws the detective out of her apartment.
Garner’s unethical roles as Nick’s therapist, lover, colleague, and possible witness in a murder case become increasingly intermingled, complex and unmanageable.
Dressed to Kill
After Kate Miller is brutally murdered, Dr. Elliot, her psychiatrist, and Detective Marino try to find her killer. Kate’s teenage son teams up with the prostitute, Liz Blake, who witnessed the murder, to do an investigation of their own.
What Does Constitute Social Dual Relationships?
Elliott serves coffee to his patient and himself.
If this was part of Elliot’s normal practice that he does with other clients or if it was a planned intervention, possibly to establish a therapeutic alliance, this would not constitute a dual relationship. It would not constitute a dual relationship because the therapist is not involved in additional social or other relationships with his client. However, if the coffee is part of a social relationship rather than a therapeutic one, this would constitute a dual relationship.
Sequential Dual Relationships
Dr. Elliott tries to track the killer of his patient, Kate Miller.
Since the patient is dead, the psychiatrist, acting in a role of an investigator, constitutes sequential dual relationships. Needless to say the new role cannot interfere with the therapist-patient relationship between Elliott and Kate Miller any more.
Girl, Interrupted
After a half-hearted suicide attempt and being evaluated by psychiatrist Dr. Crumble, Susanna Kaysen spends one year at Claymoore. In this psychiatric hospital, she receives treatment from Dr. Melvin Protts and Dr. Sonia Wick, while nurse Valerie looks after her. Susanna befriends the other patients, Lisa, Daisy, Janet, and Georgina.
Social Dual Relationships
Susanna resist and cries when a psychiatrist, Dr. Crumble, wants to admit her to Claymoore hospital. The psychiatrist doesn’t believe that she didn’t plan to kill herself. Crumble tries to convince her by saying, “Susanna, your father is a friend of mine. He is a colleague. He asked me to see you. I don’t do this any more. You’re hurting everyone around you. Claymoore is a top-notch place. A lot of people go there, even writers, like you.” When he calls for a cab, Susanna says, “My mother is here.” Dr. Crumble explains, “It will be less emotional if we do it this way. Your parents and I have talked about it”. He accompanies her to a taxi while Susanna’s mother is watching everything from inside her car. Humble tells the taxi driver not to stop on the way to Claymoore.
The psychiatrist, who is a friend of Susanna’s father, evaluates the daughter of his friend after talking to the father and admits her to psychiatric hospital against her wishes. The social dual relationships with the father may interfere with his capacity to evaluate the daughter objectively.
Sexual Dual Relationships
One night Susanna and Lisa play music to cheer up Polly. In order to distract a male nurse from his attempt to stop Susanna’s guitar playing, she seduces him to kiss her.
There are many reports how clients attempt to cross sexual and other boundaries. It is the therapists’ responsibility to do their best to maintain appropriate therapeutic boundaries regardless of patients’ actions.
House of Games
Margaret Ford, a repressed psychiatrist, tries to help her patient, Billy, with his gambling addiction. Her patient is laying a trap for Margaret when she allows the con artist, Mike, to become her guide through this underworld of confidence games.
Therapist takes on additional role to help client
In her attempt to help her patient, Billy, and to understand and resolve his gambling addiction, Margaret takes on the savior role and embarks on a mission that seems to be geared to help her client. But Billy is laying a trap for Margaret and she falls right into it. Convinced that desperate action is required, Margaret goes to a poolroom called the House of Games, and in doing so is plunged into a shady nighttime world of con men and bunko artists that couldn’t be more different from the professional milieu she’s used to. This mission is also personal as she is intrigued by the world of con man and in fact even competitive with them. In her new role she allows a con artist, Mike, to become her guide through this underworld of confidence games and Byzantine stings. He offers her a deal: If she will help him fleece a high-roller Texan in a big-stakes poker game, he will tear up Billy’s marker. She does so. The psychiatrist becomes fascinated by the backroom reality of these gamblers who have reduced life to knowledge of the odds. She comes back the next day and tells Mike that she wants to learn more about what kind of man he is and about gamblers and con men in general. By the end of this movie, she has become completely caught up in the underworld of professional trickery.
This is an example of a therapist who is both intrigued by the client’s world and also takes on the roles of investigator and savior to satisfy her need to help her clients and her intrigue with this world. She is naïve and has no experience in the world of gambling and with con-men. She got sucked in by this world and has abandoned her clinical role altogether.
Mr. Jones
Mr. Jones gets treated for Bipolar Disorder in a mental hospital by Dr. Libbie Bowen. They fall in love with each other and start a romantic relationship.
Unethical Sexual Dual Relationships with Current Client
Dr. Bowen has serious problems in her marriage. Early in the movie we see her husband moving his things out of their house as he embarks on an affair with another woman. The rejection by her husband and her attraction to Jones makes Libbie vulnerable to disregard professional boundaries. She puts her hand on her patient’s shoulder when she first talks to him. Later she gives Jones a ride home, and takes him out for something to eat. They keep getting closer, fall in love, and end up in a romantic relationship.
This is a “classic” unethical sexual relationship tale. The psychiatrist finds herself falling for Jones, a bipolar hospitalized patient, with her eyes wide open. She knows it is wrong for a psychiatrist to get romantically involved with a patient, and confesses to a superior and states “But he’s so charming.” An outraged male colleague threatens to report her if she doesn’t end the relationship immediately. But Libbie claims that she has already gone too far and cannot stop it. The unethical behavior of therapists having sex with current clients is clear as APA Code of Ethics, section 10.05 clearly states: “Psychologists do not engage in sexual intimacies with current therapy clients/patients.” NASW Code of Ethics similarly states in section 1.09 “Social workers should under no circumstances engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced.” Similarly, CAMFT Code of Ethics states in 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.”
The focus of the story changes as the patient’s suicide, by jumping from a steep rooftop, is narrowly avoided. As often depicted in movies, boundary violations, such as this, are viewed positively. It is not his psychotherapy and lithium, according to the movie, but the therapist’s love that transforms the patient. As a result of the sexual dual relationships, the wildly manic Jones transforms the rigid psychiatrist by loosening her up. In many movies psychotherapy operates on different principles than real-life treatment. This is especially true around the subject of sexual dual relationships in therapy.
Prime
Rafi Gardet dates a younger man, David Bloomberg. After hearing about this relationship in their sessions for some time, her therapist, Dr. Lisa Metzger, finds out that Rafi’s boyfriend is her own son.
Unavoidable Simultaneous Social Dual Relationships
This is an example of a very complex unavoidable dual relationship. The therapist and client must face a situation that neither one of them anticipated or was prepared for. As soon as Metzger realized that her client was dating her son, she appropriately sought consultation from what seems like a confident and competent consultant. Such consultation is likely not only to help her arrive at the best ethical and clinical decision but also increase the possibility that her actions are within the standard of care regarding this complex situation. Dual relationships, especially in small communities, are often inevitable and at times surprising to all parties. Therapists and clients in rural, spiritual, disabled or military communities, like on college campuses, often end up in a variety of dual relationship situations. These include serving on the same committee, school field trip, playing on the same recreation league or in the same community theatre. As Metzger did in the movie, therapists should seek consultation, consider the client’s welfare and assess whether the therapist can effectively help the client.
Unavoidable Sequential Social Dual Relationships
After Metzger and Rafi discontinue therapy, and against his mother’s initial resistance, David brings his girlfriend home for a family dinner. The therapist and her ex-client tell each other that they missed each other. Rafi gets to know her therapist’s husband, parents, and parents in law. To welcome her and thank her for a present, Lisa gives her ex-client a kiss. Rafi observes her therapist now in the roles of a cook with an apron, and a host. Lisa and Rafi sit next to each other at the dinner table and talk to each other as they clean up together after dinner. When the tension between them reaches a peak, Rafi tells Lisa how “very strange” this new situation is for her, while Metzger pretends that she doesn’t have any problems with the visit.
Once the therapeutic relationship ended, Metzger and Rafi continued to be in relationship through David. This is an unavoidable sequential dual relationship, as Metzger does not have a say whether her son and ex-patient continue to date each other or not. Both therapist and client clearly and appropriately acknowledge the awkwardness of the situation. This is an example of a therapist who is confronted with difficult unexpected dual relationships and uses consultation and flexibility to honor her seemingly incompatible professional and maternal commitments.
Prince of Tides
Tom, an unemployed, aimless ex-high school football coach from the South meets his sister’s psychiatrist, Dr. Susan Lowenstein, who wants him to shed light on their family life. The movie depicts several types of sexual and non-sexual dual relationships.
Social Dual Relationships
Dr. Lowenstein has a teenage son, Bernard, who acts out against his parents. Because he is clumsy at sports, has low self-esteem, and his father acts distant and unavailable, Susan hires Tom as a football coach for her son. After strong initial resistance, Bernard opens up to Tom. They get to like each other in the process of throwing the football around. Both Tom, who was deprived of fatherly guidance himself, and Susan’s son benefit greatly from this friendship.
This non-sexual dual relationship seems to be harmless, possibly even supportive for Tom and therefore indirectly his sister, Lowenstein’s patient. Even though the psychiatrist and her son benefit from Tom’s engagement as a football coach, the primary clinical relationship does not appear compromised. Before entering into such dual relationships, therapists must weight the risk and benefit for such relationships to their clients and to other people.
What Constitute Therapeutic Relationships
Although he first doesn’t want to talk about his problems, Tom is in need of healing. Dr. Lowenstein takes on the task. As Tom meets her with the intention to help his sister, he enters into an uncharted territory where it is not clear where clinical exchange ends and social relationships start. Their conversation started with Susan seemingly having her clinical hat on to Tom, who did not sign up for therapy with her.
Some people may argue that Tom’s relationships with Susan resemble therapeutic relationships. If Tom were involved in therapy with Susan, that would constitute a dual relationship, as Susan has a dual role as a therapist for Tom and his sister. It is important to clarify that when psychotherapists help their own family members or friends deal with life issues, such as phobia or grief that does not automatically constitute a psychotherapeutic relationship. The fact that therapists use existential or behavioral techniques to help their loved ones does mean they enter into a contractual, legally defined, therapeutic relationship.
Sexual Dual Relationships
Tom’s and Susan’s conversations turn from a friendly and therapeutic mode to the personal. They fall in love with each other during Tom’s cathartic recall of traumatic early life memories. Tom and Susan have a brief love affair that seems to rescue the psychiatrist from her marital misery and help her regain self-respect. Both consider a more permanent arrangement, but part when Tom’s wife asks him to come home to his family.
From an ethical point of view the therapist’s sexual relationships with the current client’s brother is clearly unethical. APA code of ethics states in section 10.06 “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.” Similarly, NASW Code of Ethics in section 1.09 states “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.” Similarly, CAMFT Code of Ethics states in 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.” As often depicted in movies the sexual relationship between the therapist and client’s brother do not compromise the primary clinical relationship, a fact that neither justify it nor make it ethical, legal or within the standard of care.
Stay
A Psychiatrist, Sam Foster, treats art student and painter, Henry Letham. Foster tries to do everything to figure out why and where his patient wants to kill himself in order to prevent the suicide.
Sexual Dual Relationships
Sam Foster lives with his girlfriend, Lila, who is an ex-patient. The script does not give an indication if the romantic relationships started during therapy, right after termination or long after therapy ended.
Almost all code of ethics are concerned about sexual relationships between therapists and clients even after termination. APA Code of Ethics, section 10.08 states: (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 post-termination sexual or romantic relationship with the client/patient.” Similarly NASW Code of Ethics section 1.09 states “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.” Similarly, CAMFT Code of Ethics states in 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.”
What About Bob
After one therapy session, Bob Wiley follows his psychiatrist, Dr. Leo Marvin, to his lakeside summer home in order to further discuss his problems. There, Bob befriends Marvin’s son Sigmund, daughter Anna, and wife Fay.
Social Dual Relationships
The social dual relationships in the case were initiated and pursued by the client against the will and efforts of the therapist. The client engages the therapist’s family in complex social relationships against the therapist’s wishes. This is a classic case of clients crossing therapeutic boundaries against their therapists’ will.
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