Case Study: Dual Relationships

Rogers worked with many others in developing the idea that clients could heal themselves, if only the therapist provided ‘facilitative’ or core conditions of, ‘empathy, congruence and unconditional positive regard.’

    In many ways Cloud and Townsend’s (1999) approach to developing and maintaining healthy relationships is comparable to the model of change proposed in Dr. Wilson’s book Hurt people hurt people. Although Dr. Wilson (2001) takes a much etiological approach to addressing

Kitchener, K. (1988). Dual role relationships: What makes them so problematic?. Journal of Counseling and Development.

There are a multitude of reasons why an individual may need or want therapy; whether it’s due to learning how to cope with a mental disorder or disability, life happenings such as traumas or abuse, addictions, or even PTSD. Anybody can receive it – individual persons, families, or groups. It isn’t hard to argue that most therapists and psychologists will agree that the therapeutic alliance is one of the most beneficial foundations of a therapy session. Also referred to as the working alliance or working relationship, it represents the bond between therapist and

Counseling takes many different roads in the direction of improving a client’s mental health. These roads all lead to a common goal, but the therapist must be diligent in the direction chosen. A code of ethics provides the parameters for proper and effective treatment and boundaries protect the process of healing. Understanding how these two critical components interweave into this process aids in the conceptual framework of therapy. It may become necessary to expand upon and even cross the theoretical aspect of a boundary in order to stimulate the process of helping the client, but by no means shall these boundaries be violated. The Royal College of Psychologists (2013) compare professional boundaries to that of guardrails at the Grand Canyon, providing the visitor a safe area to enjoy the view with minimal risk of harm. Though the therapist’s boundaries can be much more flexible than a guardrail as it involves the process of therapy, some aspects such as sexual contact as an example are just as unyielding. Utilization of ethical treatment keeps the counselor on the path with clear direction and out of harm’s way for both the client and the therapist. The substance abuse therapist must become intimately familiar with the definition and application appearance of boundary crossing versus boundary violation and how a code of ethics model successful treatment for the substance user.

Seeing information about a healthcare user in such terms makes me realise that some information is not necessarily in the public domain and therefore I have a privilege and responsibility to not only care for the patient but also for the knowledge about them that I am privy to. I realise that, although I have a duty to retain confidentiality, I may be placed in a position where the confidence has to also include other healthcare professionals and I need to involve the patient in such a situation (ibid).

Certain modalities of therapeutic treatments are linked to ethical dilemmas as well; these modalities affect treatment outcomes as well. Dyadic therapists may misuse the intimate nature of the sessions by pushing their values on the client or clients, or by allowing therapy to extend beyond its efficiency. Confidentiality can be broken much easier with the group setting; therapists need to be highly guarded on this topic. (Amato, 2000)

In conclusion there are ways to maintain the healthy relationship with your client. No matter when the dual relationship may occur, before during or after, it should be avoided at all cost if it jeopardizes the

The guidelines also assert to maintain boundaries, beware my own values, be prepared to lose a friendship, remain mindful of confidentiality, and to recognize when treatment should be terminated (Gottlieb, 1993). However, concerning the dual relationship at hand, these guidelines give me ideas to ponder on when dealing with a close acquaintance.

In today’s psychology profession, a therapist and even the client can cross many boundaries if immediate boundaries are not put into place during the initial visit. Some boundaries that are crossed are not a problem at first and then the problem progresses. Leonard L. Glass called these, “the gray areas of boundary crossing and violation” (429). However, there is further description, “Boundary issues mostly refer to the therapist's self-disclosure, touch, an exchange of gifts, bartering and fees, length and location of sessions and contact outside the office” (Guthiel & Gabbard). This statement by Thomas G. Gutheil, M.D. & Glen O. Gabbard, M.D explains the meaning of boundary

Dual relationships and the ethical behavior that revolves around boundaries with clients present a multitude of very complicated situations to counselors where a clearly defined course of action is not always evident. Aside from no accord amongst mental health professionals and boundary issues being unavoidable at times, recognition and prediction of potential benefits or pitfalls correlated with dual relationships can prove to be troublesome as well (Remley & Herlihy, 2010). For most cases, it is best if an outline is used to discern when it is appropriate for a counselor to breach the client-counselor boundary.

For that reason, in the mental health professions, dual relationships are generally not recommended. Thus, if your friend who’s a psychologist assumes two more roles consecutively with a client, this is considered a dual relationship. For instance, if an individual held a role as a counselor and business partner, or client and friend, this is a considered a dual relationship. Common examples of dual relationships include: bartering therapy for goods or services; providing

Privacy and confidentiality are basic rights in our society. Safeguarding those rights, with respect to an individual’s personal health information, is our ethical and legal obligation as health care providers. Doing so in today’s health care environment is increasingly challenging (OJIN, 2005).

If the client feels “safe” in the session, this can be very powerful for them. As sessions occur, the client will feel more comfortable in trusting the clinician with their feelings, attitudes and emotions. The client is able to present their needs and problems in ways that only they can express. Another factor that may resonate in the sessions may include transference and counter-transference. Transference is when the client’s attitudes, feelings and emotional conflicts from past events begin to be directed to the therapist, while Countertransference is exactly the opposite, when the therapist’s attitudes, feelings, and emotional conflicts from the past are directed towards the client (Transference and Countertransference, 2011). There are not too many positive factors with Countertransference, except being able to recognize it, when it exists, and be able to work out any conflict. A client’s experiences can affect their feelings, emotions, and behaviors towards their therapist. If the therapist remains their professionalism, and sets the proper limits and boundaries, a client can work through past experiences that are affecting their functioning. In a lecture, it is the role of the counselor to recognize the client’s experience; reflect and process the client’s emotional state, as well as process their own emotional reactions to clients and their issues. When clients can work through their problems from past

There has been some recent argument against the current understanding of the place of relationships in psychotherapy. While most theories argue that relationships are important or even essential to good mental health, other theorists claim that the way relationships are conceptualized in these theories is insufficient (Slife & Wiggins, 2009). Most of these theories conceptualize the individuals first, and then talk about the way these individuals relate. Relationships are often understood as two or more independent self-contained individuals interacting (Slife & Wiggins, 2009). An alternative way to look at relationships is offered by relational psychoanalysts and other theorists, though again it should be noted that