L. 7 Multiple relationships

Multiple relationships

Definition

• when a psychologist is in a professional role and at the same time is in another role with the same person, at the same time is i’m a relationship with a person closely associated with or related to the client, or promises to enter into another relationship in the future with the person or a person closely associated with or related to the client

• APA

  • a psychologist refrains from entering a multiple relationship if the multiple relationship could reasonably be expected to impair

  • 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 interest of the affected person and maximal compliance with the Ethics Code

  • no other relationship, just the professional one; past, present, future; work, financial, emotional, sexual, other

Examples

• friends, friend-of-a-friend, being a client of ur client

Are all multiple relationships unethical?

• boundary crossings can be an integral part of well-formulated treatment plans or evidence-based treatment plans

  • examples are: flying in an airplane with a patient who suffers from a fear of flying, having lunch with an anorexic patient, making a home visit to a bed-ridden depressed patient, or accompanying a patient to a dreaded but medically essential doctor’s appointment to which he/she wouldn’t go on their own

Why not?

• impaired objectivity

• poor judgement

• diminished competence

• declined efficiency

• nonprofessional relationships are unlikely to be truly mutual

Dilemmas and conflicts

• less training and experience - difficulty with keeping boundaries

• careful consideration of boundary crossing: are they really necessary?

• assess the client’s boundaries: personality disorders, history of exploitation

Boundary crossing ≠ boundary violation

• potentially helpful BCs also include going on a hike, giving a non-sexual hug, sending cards, exchanging appropriate (not too expensive) gifts, lending a book, attending a wedding, confirmation, Bar Mitzwah or a funeral, or going to see a client performing in a show

• boundary crossings are not unethical. ethics code of all major psychotherapy professional associations (APA, ApA, NASW, ACA, NBCC) don’t prohibit

• BUT: debates

Elements of contract of psychotherapy/counseling

• goal setting (in a language accessible to the client)

  • who is the client (individual/family/group)

  • what is the aim

  • how will we work together, what technique (s) will be used

  • risks of the intervention, alternative treatment

  • frequency, duration, and number of sessions

  • keeping contact in between sessions

  • legal aspects (e.g., underage client, obligatory treatment)

  • confidentiality : to family members, colleagues, friends

  • limits of confidentiality : potentially life-threatening, supervision

  • aims and ways of documentation : who can have access

  • financial issues: fee, method of paying, frequency and timing of payment, what to do if payment is hindered

  Functions of the contract

  • information

  • setting the frames: protection for both parties

  • sets a basis for safety

  • facilitates cooperation

  • makes a clear distinction between professional relationship and other relationships

  • helps recognizing he boundaries

Risky therapy examples

• heated topic of interest: some hold the position that therapists should share only professionally related information. But, most mental health professionals apparently do knowingly self-disclose, at least occasionally

• the question is, then: how, when, why, what?

• self-disclosure can be benign and helpful: can increase the connection, affords marginalized clients more power in the relationship,

• BUT: greater risk for problematic relationship with clients

• well-considered illustrations may help make a point or signal empathy,

• BUT: absorbing therapy time with extended renditions of one’s own personal history and family issues isn’t typically justifiable