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=Dual Relationships in Mental Health=

In the mental health field, the term "dual relationship" refers to any situation where multiple roles exist between a therapist, or other mental health practitioner, and a client. Dual relationships are also referred to as multiple relationships, and these two terms are used interchangeably in the research literature. The American Psychological Association Ethical Principles of Psychologists and Code of Conduct (herein after referred to as the APA ethics code) is a resource that outlines ethical standards and principles to which practitioners are expected to adhere. Standard 3.05 of the APA ethics code outlines the definition of multiple relationships. Dual or multiple relationships occur when:

 (a) a professional and personal relationship take place simultaneously between the psychologist and the client   (b) the psychologist has a relationship with a person closely related to or connected to their client   (c) the psychologist has intentions to enter into a future relationship with the client or someone closely related to the client 

In addition, the standard provides a description of when to avoid multiple relationships (e.g., when the relationship causes harm to the client or impairs the psychologist's competence) and when these relationships are not considered unethical (e.g., when the relationship does not exploit the client or impair competence).

Types of Dual Relationships
There are several different types of dual relationships that can create an ethical dilemma for a mental health practitioner. Zur  outlines five different types of dual relationships:

 (a) Social-Communal: The client is a friend, acquaintance, fellow congregational member, or employee at the store where the therapist shops.   (b) Sexual: The practitioner engages in a romantic/sexual relationship with the client. Sexual relationships are the ultimate boundary violation and have been extensively examined in the literature with the unanimous conclusion that this type of a multiple relationship is never therapeutically appropriate.   (c) Business: The practitioner engages in business deals with the client (e.g., buying goods from the client’s store). Zur noted that bartering for services with a client does not constitute a dual relationship because this act creates a secondary business agreement.   (d) Professional: The client is another professional who is the practitioner's colleague.   (e) Familial: The client is the practitioner's family member. 

How to Address & Avoid Dual Relationships
When dual relationships can be avoided they should. Unfortunately mental health practitioners are frequently faced with situations in which a dual relationship cannot be avoided. Pearson and Piazza reported that dual relationships accounted for 23% of all ethical complaints filed with the APA. Given the prevalence of dual relationships within the mental health field, practitioners need to be prepared to address the issue of the dual relationship as early in the therapeutic relationship as possible. Schank and colleagues suggest talking with clients prior to therapy about how the therapists will handle seeing a client in public. For example, will the therapist acknowledge the client? Further, the therapist and the client need to establish role demands. It is important for clients to understand the power dynamic of the therapeutic relationship. This helps to clarify the relationship for clients so they do not confuse this relationship with a friendship. Friendship is a relationship that is based on equality, has an indefinite time-frame, and is meaningful to both parties; whereas a professional relationship is based on hierarchy with the practitioner acting as the expert and the relationship is designated within a specific time frame. Additionally, acknowledging the power dynamic will help the practitioner keep the boundaries clear.

Safeguards to Effectively Deal with Dual Relationships
There are several safeguards that practitioners can implement to help cope with the stresses of dual relationships. For example, mental health practitioners should consult and discuss cases with colleagues and other professionals when available. For practitioners in rural or isolated areas, e-mail or teleconferencing to communicate with other professionals that are not readily available in the community can help reduce the effects of isolation. Utilizing consultation through e-mail and teleconferencing is a practical option for rural practitioners; however, the practitioner should be cautioned about the elevated risks of breaking confidentiality using these modes of communication. Thorough documentation of all consultations and why they occurred should be included in the client’s file. Finally, practitioners should seek continuing education training and remain connected to professional organizations.