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Tuesday, February 1

Ethics Corner: Ethical Considerations with Dual Relationship (1 of 2)

Ruth Lipschutz, LCSW, ACSW


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Ethical issues related to professional boundaries are among the most problematic and challenging. Boundary issues occur when social workers face possible conflicts of interest in the form of what have become known as dual or multiple relationships. “Dual or multiple relationships occur when professionals engage with clients or colleagues in more than one relationship. A professional enters into a dual relationship whenever he or she assumes a second role with a client, becoming social worker and friend, employer, teacher, business associate, family member, or sex partner. A practitioner can engage in a dual relationship whether the second relationship begins before, during, or after the social worker relationship.” (Reamer 2001).
 
Dual relationships can be sexual or nonsexual in nature. Examples may include everything from sexual intimacy to being a customer at the only store in town owned by a client. Not all dual relationships are unethical. Social workers need to distinguish between boundary violations and boundary crossings. “A boundary violation occurs when a social worker engages in a dual relationship with a client or colleague that is exploitive, manipulative, deceptive, or coercive. Examples include social workers who become sexually involved with clients, recruit and collude with clients to bill insurance companies fraudulently, or influence terminally ill clients to include social workers in clients' wills. Boundary violations are inherently unethical” (Reamer 2001).
 
“In contrast, a boundary crossing occurs when a social worker is involved in a dual relationship with a client or colleague in a manner that is not intentionally exploitive, manipulative, deceptive, or coercive. Boundary crossings are not inherently unethical” (Gutheil & Gabbard,1993). Boundary crossings can have a positive, negative or neutral impact on the social worker, client, colleague and social work relationship. In more rural areas and within communities such as LGBTQ, twelve step and recovery, or particular ethnic or cultural populations, boundary crossings are often unavoidable.
 
Social worker relationships are based on unequal power. It is the social workers fiduciary duty to not exploit or abuse that power in any manner. The NASW Code of Ethics includes the core values of service and integrity. Service states that “social workers elevate service to others above self-interest”. Integrity embodies the aspiration that “social workers are continually aware of the profession's mission, values, ethical principles, and ethical standards and practice in a manner consistent with them” and that “social workers act honestly and responsibly and promote ethical practices” (NASW Code of Ethics 2008).
 
The NASW Code of Ethics takes into account the complexity and range of boundary issues that practitioners face. It states that “specific applications of the Code must take into account the context in which it is being considered and the possibility of conflicts among the Code's values, principles, and standards. Social workers' decisions and actions should be consistent with the spirit as well as the letter of this Code” (NASW Code of Ethics 2008). Reamer (2000) recommends that social workers’ emphasis should be on assessment and risk management, rather than on avoiding dual relationships at all costs.
 
Reamer (2001) offers a conceptual framework to help social workers identify, asses and manage dual relationships. He organizes boundary issues into the following five categories:
 
Intimate relationships:
sexual relationships
physical contact
services to former lover
intimate gestures
 
Personal benefit:
monetary gain
goods and services
useful information
 
Emotional and dependency needs:
extending relationship with clients
promoting client dependence
confusing personal and professional lives
reversing roles with clients
 
Altruistic gestures:
performing favors
providing nonprofessional services
giving gifts
being extraordinarily available
 
Unanticipated circumstances:
social and community events
joint affiliations and memberships
mutual acquaintances and friends

Boundary issue assessment presents one of the most common and challenging areas of ethical dilemmas. By definition reasonable social workers may come to different conclusions in managing each situation. Social workers ethical obligation is to engage in a “systemic, deliberate, and comprehensive series of decision-making steps” (Reamer 2001). These steps need to include the use of a sound risk management protocol, accessing needed consultation (clinical, ethical, and/or legal), referencing all applicable codes, laws and policies and appropriate documentation and follow-up. “Social workers also should be aware of the impact on ethical decision making of their clients' and their own personal values and cultural and religious beliefs and practices” (NASW Code of Ethics 2008).
 
Though this article cannot address in depth each aspect of the conceptual framework, we will explore some key factors addressed in the NASW code and offer a thorough risk management protocol developed by Reamer.
 
Ruth Lipschutz, LCSW, ACSW, is a licensed clinical social worker with postgraduate certification in ethics, mediation, Transformational Imagery, hypnotherapy, and Eye Movement Desensitization and Reprocessing (EMDR). She received her MSW from the University of Illinois in 1978 and went on to complete the two-year postgraduate training program of the Institute for Family Studies at Northwestern University. She has extensive experience in the areas of ethics, mental health, addictions, traumatology, program development and implementation, supervision, consultation and Alternative Dispute Resolution. She is the chairperson of NASW’s National Ethics Committee and has served as a panelist, consultant, mediator, and trainer for the NASW Illinois Chapter Ethics Committee. She is currently in private practice.
Posted on 02/01/11 at 11:21 AM

Comments

I went out for two years with my last girlfriend who is a licensed professional counselor. During that time, early on in the relationship, I accepted therapy from her as she was frustrated with some of my issues from growing up in a dysfunctional home. It certainly wasn’t my idea but was pushed by her as she had the intention of “helping” me and at the time I was unable to afford therapy on my own.  She told me that she could get into serious trouble for it and yet persuaded me to let her help me even though I wasn’t crazy about the idea. I went along anyway as a proper co-dependent would be expected to behave yet I protested once she switched the roles and wanted me to assist her while she performed “therapy” on herself. The technique she employed was EMDR and was always with the use of equipment designed for that technique. When she asked me to perform operations on her I objected saying that I’m not a trained psychotherapist and wouldn’t know what to do if something were to arise in the process. She quickly berated me in a loud and demeaning tone protesting that I was out of line for not reciprocating what she’d done for me. At that moment I began to be uneasy more and more and avoided her performing emdr on me unless she pushed me and I caved in as to keep the peace. As you can guess the relationship ended badly after two years, an abortion, and a threat from her to call the police on me if I ever contacted her. I’m not the stalking type and never have been before. She used the threat to attack me for writing a less than cordial letter I left on her porch.  After 6 months passed and working with a therapist I decided to make a formal complaint against her with the regulatory board in our state concerning her licence to practice psychotherapy. This I did after talking with my therapist about the issue and reading every letter written on the subject of dual relationships the internet has to offer. My question is how is a person in need of help, on their own accord, able to easily investigate a potential therapist of violations of their ethical obligation to the public? What are psychotherapists doing to assist the public in researching say databases by local governmental bodies to make a safe choice in hiring a therapist? My guess is the probability of clients researching therapists is very very unlikely as it’s not readily advertised that clients even have the right to investigate therapists with letters of public records. Should this public access knowledge be in print with every disclosure statement? Why or why not?
Thanks for the post.

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