Ethics of Therapeutic Boundaries and Dual & Multiple Relationships in Recovery, 12 Step, and Substance Abuse Rehabilitation Communities
Resources & References
By Ofer Zur, Ph.D.
This page provides an overview and resources regarding the unavoidable complex therapeutic boundaries and the ethics of unavoidable and not uncommon multiple relationships in recovery, 12 step, and substance abuse rehabilitations communities.
Table Of Contents
Before the term dual relationships became well known, recovering mental health professionals were referred to as “two-hatters” in the AA community because they wore two hats, one as the counselor and one as the person in recovery. Many rehabilitation psychotherapists are actively in recovery for themselves, so it is not uncommon that they encounter current or former clients at 12 step meetings, Rational Recover, or other recovery gatherings. Not only does this often create unavoidable dual relationships between client and therapist, these boundary crossing relationships are reported to have positive effects on clients as therapists model, encourage and support their sobriety via 12 step programs. Bissell and Royce (1987) referred to this form of multiple relationships by saying, “Today’s patient in treatment becomes tomorrow’s peer at A.A.” (p. 35). Consider the following example. A client has a therapist in a residential rehabilitation program. After he has completed his 28 day program he attends outpatient AA meetings and sees the therapist there as a member. The client attends a program to be trained as a therapist and gets a job at the original 28 day program which makes him a professional colleague working side by side with his prior therapist with whom he fellowships at a 12 step meeting. Dual relationships are rooted in treatment recommendations of maintaining involvement in recovery community. Tongue in cheek, we can think of many hat combinations.
- St. Germaine, Jacquelyn, (1993). Dual relationships: A national study of addiction counselors’ beliefs and behaviors . A Dissertation, Univ. of Arizona
- Demask, Dean M., Ethics for Addiction Professionals
- Kaplan, L.E. (2005). Dual Relationships: The Challenges for Social Workers in Recovery, Journal of Social Work Practice in the Addictions, 5/3 (download)
- Nardone, N.A. (2006). Analyzing the Pros and Cons of Multiple Relationships Between Chemical Addiction Therapists and their Clients. Journal of Addictive Disorders.
- Powell, Less J. (ss). Opinions Concerning Unique Dual Relationships among Recovering Substance Abuse Counselors in Rural and Urban Settings. A Dissertation, State Univ. Kansas.
- Alcoholics Anonymous. Understanding Anonymity. Retrieved from http://www.soberrecovery.com.
- Behnke, S. (2004). Multiple relationships and APA’s new Ethics Code: Values and applications. Ethics Rounds, 35(1), 66-66.
- Coleman, P. (2005). Privilege and confidentiality in 12-step self-help programs: Believing the promises could be hazardous to an addict’s freedom. The Journal of Legal Medicine, 26(4), 435-474.
- Jaffee v. Redmond (95-266), 518 U.S. 1 (1996).
- Kaplan, L.E. (2005). Dual Relationships: The Challenges for Social Workers in Recovery. Journal of Social Work Practice in the Addictions, 5/3.
- Nardone, N.A. (2006). Analyzing the Pros and Cons of Multiple Relationships Between Chemical Addiction Therapists and their Clients. Journal of Addictive Disorders. Retrieved from: http://www.breining.edu.
- Remley, T. P., Herlihy, B., & Herlihy, S. B. (1997). The US Supreme Court decision in Jaffee v. Redmond: Implications for counselors. Journal of Counseling & Development, 75(3), 213-218.
- Sex Addicts Anonymous. Group Guide: Handbook for SAA Groups. Retrieved July 05, 2017, from http://saa-recovery.org/Meetings/GroupGuide/SAA_Group_Guide.pdf.
- Sex Addicts Anonymous (2017). Sex Addicts Anonymous, 3rd Edition.
- Silberstein, A, & Lindsey Boone, L. (2017). Multiple Relationships in Recovery Communities.(pp. 130-140) In O. Zur, (Ed.) Multiple Relationships in Psychotherapy and Counseling: Unavoidable, Common and Mandatory Dual Relations in Therapy. New York: Routledge.
- Weiss, R. Does Therapist-Patient Confidentiality and Privilege Extend to 12-Step Programs? Retrieved from https://blogs.psychcentral.com/
- Zur, O. (2014). Not all multiple relationships are created equal: Mapping the Maze of 26 Types of Multiple Relationships. The Independent Practitioner, 34 (1), 15-22.
- Barker, M. (1966).The ethical Two-hater. The Counselor, 14(3),15-16.
- Bissell, L., & Royce, I. (1987). Ethics for addiction professionals. Center City, MN: Hazelden Foundation.
- Demask, M. & Washington, D., Legal and Ethical Issues for Addiction Professionals, Pamphlet published by Hazelden Essentials for Professionals.
- Doyle, K. (1997) Substance Abuse Counselors in Recovery: Implications for the Ethical Issue of Dual Relationships. Journal of Counseling & Development, 75/ 6, pages 428–432.
- Gass, M. A. (1993). Adventure therapy: Therapeutic applications of adventure programming. Dubuque, IA: Kendall/Hunt.
- Hollander J. K., Bauer S, Herlihy B., et al. (2006). Beliefs of board certified substance abuse counselors regarding multiple relationships. J Mental Health Counseling; 28:84-94.
- Kaplan, L. E. (2005). Dual relationships: the challenges for social workers in recovery. Journal of Social Work Practice in the Addictions (accessed July 27, 2016).
- Nardone, N. A. (2006). Analyzing the pros and cons of multiple relationships between chemical addiction therapists and their clients. Journal of Addictive Disorders. Retrieved from: http://www.breining.edu (accessed July 27, 2016).
- Silberstein, A. & Boone, L., (2017). Multiple Relationships in Recovery Communities. In Zur, O. (Ed.) Multiple Relationships in Psychotherapy and Counseling: Unavoidable, Common and Mandatory Dual Relations in Therapy. New York: Routledge.
- St. Germaine, J. (1996) Dual Relationships and Certified Alcohol and Drug Counselors. Alcoholism Treatment Quarterly 14(2): 29-44.
- White, W. (1933). Critical incidents: Ethical issues in substance abuse prevention and treatment. Blomington, IL: Lighthouse Training Institute.