Ethics of Dual Relationships & Therapeutic Boundaries in
Resources & References
By Ofer Zur, Ph.D.
This page provides resources regarding the ethics of often mandated and unavoidable multiple relationships in military settings.
Military psychologists often practice in an environment in which multiple relationships are ubiquitous, unavoidable and ethically complex. Military psychologists often experience mixed-agency ethical tensions because their “clients” include the Department of Defense (DOD), the local commanding officer, and the individual service member whom they face in the consulting room. In many situations, when military psychologists evaluate clients, they have an obligation to consider both the unit’s combat readiness and the person they are treating. Helping a client overcome psychiatric impairment, including symptoms of trauma, may result in them being declared fit to re-join their unit, which may mean that they would engage in combat where they may be wounded or even killed. At times, military psychologists are required to evaluate fellow officers and even their own commanders for fitness for duty/combat; such evaluations may provoke complex multiple relationship tensions. Finally, military psychologists may practice in remote or specialized settings as a solo mental health practitioner (e.g., aircraft carrier, combat theatre hospital). Such isolated duty may increase the frequency of ethical tensions related to boundaries, self-care, and competence.
- Howe, E. G. (2003). Mixed agency in military medicine: Ethical roles in conflict, In D. E. Lounsbury & R. F. Bellamy (Eds.), Military medical ethics: Volume I (pp. 331–365). Falls Church, VA: Office of the Surgeon General, U.S. Department of the Army.
- Johnson, W. B., Bacho, E. B., Heim, M., & Ralph, J. (2006). Multiple role dilemmas for military mental health care providers, Military Medicine, 171, 311-315.
- Johnson, W. B., Grasso, I., & Maslowski, K. (2010). Conflicts between ethics and law for military mental health providers, Military Medicine, 175, 148-153
- Reamer, Frederic G., PhD, Novel Boundary Challenges – Military Social Workers, Social Work Today, September 2014
- Staal, M. A., & King, R. E. (2000). Managing a Multiple Relationship Environment: The Ethics of Military Psychology. Professional Psychology: Research and Practice, 31 (6), 698-705.
- Zur, O., & Gonzalez, S. (2002). Multiple relationships in military psychology. In A. A. Lazarus & O. Zur (Eds.), Dual relationships and psychotherapy (pp. 315-328). New York: Springer.
- Barnett, J. E., Lazarus, A. A., Vasquez, M. J. T., Moorehead-Slaughter, O., & Johnson, W. B. (2007). Boundary issues and multiple relationships: Fantasy and reality. Professional Psychology: Research and Practice, 38, 401-410.
- Barnett, J. E., & Yutrzenka, B. A. (1994). Non-sexual dual relationships in professional practice, with special applications to rural and military communities. The Independent Practitioner, 14 (5), 243-248.
- Hines, A. H., Ader, D. N., Chang, A. S., & Rundell, J. R. (1998). Dual agency, dual relationships, boundary crossings, and associated boundary violations: A survey of military and civilian psychiatrists. Military Medicine, 163, 826-833.
- Howe, E. G. (1986). Ethical issues regarding mixed agency of military physicians. Social Science and Medicine, 23, 803–815.
- Johnson, W. B. (1995). Perennial ethical quandaries in military psychology: Toward American Psychological Association and Department of Defense collaboration. Professional Psychology: Research and Practice, 26, 281-287.
- Johnson, W. B & Johnson, S. J., (2017). Unavoidable and Mandated Multiple Relationships in Military Settings. In Zur, O. (Ed.) Multiple Relationships in Psychotherapy and Counseling: Unavoidable, Common and Mandatory Dual Relations in Therapy. New York: Routledge.
- Johnson, W. B., Ralph, J., & Johnson, S. J. (2005). Managing multiple roles in embedded environments: The case of aircraft carrier psychology. Professional Psychology: Research and Practice, 36, 73-81.
- Johnson, W. B. (2011). “I’ve got this friend:” Multiple roles, informed consent, and friendship in the military. In W. B. Johnson & G. P. Koocher (Eds.), Ethical conundrums, quandaries, and predicaments in mental health practice: A casebook from the files of experts (pp. 175-182). New York: Oxford University Press.
- Orme, D. R., & Doerman, A. L. (2001). Ethical dilemmas and U.S. Air Force clinical psychologists: A survey. Professional Psychology: Research and Practice,32 (3),305-311.
- Stone (2008). Dual agency for VA clinicians: Defining an evolving ethical question. Military Psychology, 20, 37–48.