This document discusses dual and multiple relationships in counseling and psychotherapy. It defines dual and multiple relationships as situations where a professional assumes two or more roles simultaneously or sequentially with a client. This can negatively impact the professional relationship and is generally considered unethical. The document provides examples of different types of dual relationships and boundary violations. It also summarizes the American Psychological Association's code of ethics regarding multiple relationships and discusses strategies for preventing and addressing dual relationship issues.

1. Dual and Multiple
Relationships

2. Name! That! Violation!
Can you spot the:
Boundary Crossing
Boundary Violation
Dual or Multiple Relationship

3. Name! That! Violation!
http://youtu.be/g_RLVWPBq4w

4. What are dual and
multiple relationships?

Dual or multiple relationships occur when a
professional assumes two or more roles at the
same time or sequentially with a client or with
someone who has a significant relationship with
the client

In most cases, having a personal relationship with
someone can affect the professional/business
relationship in a negative way, causing one of the
relationships to suffer

5. Conflict of interest
and why does it matter?
• Dual and multiple relationships are more
commonly understood by the term “Conflict of
Interest.”
• According to the APA:
• 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.

6. What are the differences between
dual and multiple relationships?

Doverspike prefers the term “dual relationship” over
“multiple relationship” because most boundary
crossings involve a duality rather than a multiplicity.
Even when there are multiple roles being taken part in,
the dual relationship is established first.

7. Examples of Dual
Relationship Violations
Relationships that affect professional judgment tend to fall in at least one of nine categories
1. Social or personal
2. Sexual or improper physical contact
3. Business or financial
4. Caretaking
5. Improper gift giving or receiving
6. Interference with personal autonomy or undue influence
7. Self-disclosure
8. Advocacy or enmeshment
9. Employment of patients or interns, monetarily or
otherwise

8. Boundaries and Slippery Slopes
Boundary crossings often involved clinically effective
interventions, such as self-disclosure, home visit, non-sexual
touch, gifts or bartering. Boundary crossings are not unethical.
Not all boundary crossings constitute dual or multiple
relationships.
Boundary violations occur when therapists cross the line of
decency and violate or exploit their clients.
Slippery slopephenomenon claims that minor boundary
crossings can lead to boundary violations and deterioration of
ethical behavior.

9. Significance
In the helping profession, it is absolutely imperative, not
only to keep these relationships separate, but to
prevent the co-existence of personal and professional
relationships altogether!

10. American Psychological
Association

Ethical Principles of Psychologists and Code of
Conduct
 The Ethical Standards set forth enforceable
rules for conduct as psychologists.

11. Multiple Relationships

Ethical Standard 3: Human Relations

3.05 Multiple Relationships
 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.

12. Foreseeable and Unforeseeable
Dual Roles

Foreseeable dual roles are those that the therapist has
time to consider or contemplate before engaging in them.
For example considering whether or not to provide
psychotherapy to someone with whom you have had a
prior social or business relationship.

An unforeseeable dual role is a role that cannot be
reasonably foreseen. Ex. joining a gym and then finding
out one of the fitness instructors is a client of yours.

13. 
Concurrent Vs. Consecutive
Dual Roles
Concurrent dual roles exist when a therapist has two roles at the same time
with the same client, or with a person who is in a significant relationship with
the client. The two roles occur simultaneously.

Consecutive dual roles involve a prior relationship that involves either a
professional or nonprofessional role followed by the development of a second
relationship at a later point in time.

A foreseeable concurrent dualrole might involve considering whether to
provide therapy to your personal trainer or member of the gym.

An unforeseeable concurrent dual relationship might involve one of your
psychotherapy clients is married to your personal trainer or a member of the
gym where you take an exercise class.

A foreseeable consecutive dual relationship might involve considering
whether to provide psychotherapy to your former personal trainer.

An unforeseeable consecutive dual relationship might involve learning that
your personal trainer or member of your gym is one of your former
psychotherapy clients.

14. Can you really prevent multiple
relationships from forming?

Multiple relationships that would not reasonably be expected to
cause impairment or risk exploitation or harm are not unethical.
 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.
 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.

15. Conflicts Check
•
When you are operating in a professional role and you are
contemplating a dual relationship with a patient, client,
employee, supervisee, research participant, or student consider
asking yourself these five questions:
1.Is there a chance of loss of effectiveness of the professional?
2.Is there a chance of loss of objectivity of the professional?
3.Is there a chance of loss of competence of the professional?
4. Is there a chance of risk of exploitation of the client?
5. Is there a risk of harm of the client?
If the answer is “no” to all these questions then proceed with
caution only after consulting with a colleague to determine the
client’s best interests and to identify any ethical blind spots on the
part of the professional.

16. Protection for Therapists
1. Set healthy boundaries from the outset
2. Secure the informed consent of clients and discuss with them
both the potential risks and benefits of dual relationships
3. Remain willing to talk with clients about any unforeseen
problems and conflicts that may arise
4. Consult with other professionals to resolve any dilemmas
5. Seek supervision when dual relationships become particularly
problematic or when the risk for harm is high
6. Document any dual relationship in clinical case notes
7. Examine your own motivations for being involved in dual
relationships
8. When necessary, refer clients to another professional

17. Case Studies

18. The Case of Monica Descamps
• Jill Davis sued her former therapist in May 2006.
• In her lawsuit, Jill Davis said she sought counseling
with Monica Descamps in February 2003, which
lasted until February 2004. At that point the
psychologist ended counseling and initiated a
romantic relationship with Davis, which lasted nine
months.
• In court papers, Descamps acknowledged the
improper conduct.

19. The Case of Alfonso Bustamante

A lawsuit filed July 19th, 2012, in Orange County
Superior Court
•
Accuses Alfonso Bustamante of repeatedly
abusing his position as a licensed psychologist by
secretly engaging in a “side relationship” with the
female half of a married couple undergoing
counseling with him.

20. The Case of Alan Shulik




The couple, named as John and Jane Doe in the lawsuit to
protect their privacy, list 13 counts against Guilford
psychologist, Alan Shulik in a complaint filed recently in
Superior Court in New Haven.
Shulik allegedly had a sexual relationship with Jane Doe
for more than a year beginning in 2008 after she came with
her husband for marriage counseling to his practice.
Shulik advised the pair that separate sessions would be
more effective, and began an on-off relationship with Jane
Doe.
Jane Doe stated that Shulik makes degrading remarks
about her husband.

21. The Case of James Stewart

James Stewart, Ph.D, was found to have violated
multiple laws and regulations governing the
practice of psychology in Virginia.

22. The Case of James Stewart:
Patient A

Patient A
– From 1999 - 2004, Dr. Stewart provided
therapy to Patient A and her family, during
which time he developed an intimate
knowledge of the family system. Dr. Stewart,
while acting as therapist to Patient A
• Slept in the same bed with her
• Acted amorously toward her
• Used her car.

23. The Case of James Stewart:
Patient B

Patient B
– Shortly after providing ten years of weekly,
individual psychotherapy to Patient B, Dr.
Stewart moved into patient’s B home
approximately the summer of 2002, until
August, 2003.
• He occupied a room in the patient’s home
without paying rent.
• Used said patient’s credit card for his own
purchases.

24. Dual and Multiple Relationship
Scenario #1
I am an activities therapist and one of my clients was
divorced recently. We discuss his marital problems fairly
frequently, and I feel that I understand his former wife
very well. She called me the other day to talk about him
and his treatment, which I told her I couldn’t do. The
conversation turned flirtatious and we made a date for
drinks. Before things go too far, are there any ethical
requirements about how far I can take this?

25. What were the ethical (if any) of
the previous scenario?
•Remember the ethical standards involved with dual and
multiple relationships
•Remember the different types of ethical traps from Ch. 1
•The “Commonsense, Objectivity” Trap
•The “Values” Trap
•The “Circumstantiality” Trap
•The “Who Will Benefit” Trap
•What action should take place, or is the behavior in the
scenario ethically legitimate?
•Could there be any foreseeable consequences from taking
this action or inaction?

26. What were the ethical (if any) of
the previous scenario?
•The ethical standard involved (dual relationships) says that helping
professionals should avoid emotional involvement of any kind with
their clients. By implication, this includes family members and close
friends…and former spouses.
•There is a danger of falling into the “objectivity trap”, because
emotional involvement with a client’s former wife could
substantially distort your objectivity about your client and erode his
confidence in you as a helper
•What should you do?
•Preliminary response: You should cancel your date, explaining
your ethical concerns, (and ask yourself “what was I thinking”?)
•It is important that you find a way to meet y our needs for social
and intimate interactions outside of your client relationships

27. Dual and Multiple Relationships
Scenario #2
I mentioned the fact that I’m gong to be moving to
another apartment in a couple of weeks to a client. Now
he seems to have taken this on as his own move, offering
me a truck and his help in loading and unloading it. He
seems sincere and I really need the help. May I accept it
from him?

28. What were the ethical (if any) of
the previous scenario?
• The ethical standard involved (dual relationships) says
that helping professionals should refrain from “all forms of
dual relationships with clients, including emotional,
sexual, and BUSINESS involvement.”
• Also the possibility of falling into the “objectivity” Trap.
• What should you do?
• Carefully decline, and make sure your client
understands that you are required to do so by your
ethical code. Discuss the issue in a way that is most
beneficial to your client, never demeaning his offer.
(Re-establish Boundaries?)

29. Dual and Multiple Relationships
Scenario #3
The hairdresser I’ve been going to for several years has
been hinting that she has some emotional problems. Now
she’s shown up at my agency and wants to become my
client. May I accept her as a client? If I do, can she still do
my hair?

30. What were the ethical (if any) of
the previous scenario?
• Ethical standard of Dual Relationship
• Once again the “objectivity trap” is the possible ethical trap
• What should you do? Not accept her as a client, explaining
why you may not do so, and make sure she understands the
reasons for this and help her find another counselor in your
agency. (Does it have to be your agency?)
• Circumstantiality: If you found another hairdresser, you could
taker her on as a client, but this abrupt change in your
relationship would not be helpful to her either therapeutically
or financially
• Ethical resolution: Discourage her from discussing her
counseling with you while she is doing your hair.

31. Name! That! Violation!
Can you spot the:
Boundary Crossing
Boundary Violation
Dual or Multiple Relationship

32. Name! That! Violation!
http://youtu.be/jark7NzEf0g

33. References




American Psychological Association (2010). American Psychological Association Ethical Principles of
Psychologists and Code of Conduct. Retrieved October 18, 2013
http://www.apa.org/ethics/code/index.aspx.
Corey, G., & Corey, M. S. (2011). Issues and ethics in the helping professions (8th ed.). Australia:
Brooks/Cole/Cengage Learning.
Jensen, D. (2005, September). Unlawful and/or Unethical Dual Relationships: A Word to the Wise.
Retrieved November 2, 2013, from
http://www.camft.org/ScriptContent/CAMFTarticles/Legal_Issues/DualRelationshipsUnlawful.htm
Zur, O. (2013). Dual Relationships, Multiple Relationships & Boundaries In Psychotherapy,
Counseling & Mental Health. Retrieved November 6, 2013
http://www.zurinstitute.com/dualrelationships.html.