How Dual Relationships In Counseling Affect Your Outcomes
Updated June 12, 2019
Dual relationships can be somewhat difficult to understand. In counseling, dual relationships can be unethical and harmful to your therapy outcomes. It is important to understand what dual relationships in counseling are and how they affect you. It is generally a good idea to have clear boundaries between you and your therapist.
Dual Relationship Definition
A dual relationship in counseling occurs when the therapist and patient have a relationship outside of the counseling sessions. This relationship could be that they are family, friends, members of the same church, professional colleagues, or some other type of relationship. There are both sexual and nonsexual dual relationships in counseling. While some dual relationships are ethical and can work well for therapy, most dual relationships undermine outcomes. Sexual dual relationships are unethical and often illegal.
Types Of Dual Relationships
There are several different types of dual relationships. Some types of dual relationships can be ethical in counseling, provided that both parties have clear boundaries and trust between them. However, some types of dual relationships can be harmful to the patient.
Social Dual Relationship
This type of dual relationship occurs when the therapist is also a friend. Your friends may know a lot about you, but they often don't know the types of things that can come out in therapy. If you have a friend you can trust to keep your affairs private and not judge you based on your sessions, then this type of dual relationship can work for therapy.
Professional Dual Relationship
This type of dual relationship happens when the counselor is also a work colleague of the patient. Colleagues often act as therapists for each other, and this can be healthy in some cases.
Business Dual Relationship
In this type of dual relationship, the therapist has a relationship with the patient in a business capacity. They may be partners of the same business, or they may be customers of the patient's business. Sometimes a barter of goods and services can be helpful in a business dual relationship.
Communal Dual Relationship
A communal dual relationship occurs when the patient and therapist both belong to a small community in which they might frequently run into one another. A communal dual relationship can be problematic, particularly in very small communities.
Institutional Dual Relationship
In an institutional dual relationship, the therapist has worked in an institution such as a prison or hospital in which the patient also was a patient or inmate. This type of dual relationship can be ethical in counseling but only when the therapist can separate the therapy sessions from what they know about the patient in the institution.
Forensic Dual Relationship
A forensic dual relationship is when the therapist is involved in hearings or legal trials as a witness in matters concerning the patient. This is another type of dual relationship that is frequently outlawed.
Supervisory Dual Relationship
A supervisory dual relationship is when the therapist is also the patient's supervisor in their professional duties. This sometimes happens when new therapists seek therapy from their more experienced counterparts within the same practice.
Digital Or Online Dual Relationship
This type of dual relationship is more common than ever with the explosion of social media. With this type of dual relationship, the therapist and patient are friends or follow each other on social media and online. While this may help your therapist to know what is going on in your life, it can be detrimental to your counseling relationship.
Sexual Dual Relationship
In this type of dual relationship, the patient and the therapist are in a sexual relationship. Sexual dual relationships are almost always unethical and sometimes illegal in different states.
Ethics Of Dual Relationships
Dual relationships are not necessarily unethical. The most unethical type of dual relationship is a sexual dual relationship. In many cases, dual relationships are created by people who already know each other in some capacity but choose to also be in a therapist-client relationship. Most of the time the personal relationship exists before the therapy relationship, and in these cases, it is not necessarily unethical.
It is important however that the therapist respect boundaries, and that the patient maintains and fully expresses those boundaries. It is very easy for a therapist to use the information they have of a person from outside the session to influence their therapeutic methods. This is one reason why dual relationships are discouraged.
Sexual dual relationships are almost always unethical, and in many cases may pose legal implications. In therapy, the patient discusses intimate thoughts and feelings and may get into some raw emotions. Although the sexual dual relationship may be by consent, the patient often ultimately feels victimized by the therapist, because the therapist inadvertently has control over the situation. Even in cases where it is not intentional, sexual dual relationships can cause serious problems that must be addressed by another therapist and in some cases the law.
Setting Boundaries In Dual Relationships
If you do have a dual relationship with your therapist, there are some boundaries that you will need to establish. Establishing boundaries is important for the success of the relationship, both in and outside of the counseling sessions.
For example, when setting boundaries in a dual relationship, you may need to make sure that the therapist is not going to use outside knowledge about your life in their treatment plan. Make sure that the therapist is only treating you based on your problems that come out in therapy. If the therapist begins using outside knowledge, especially if it is second-hand knowledge, to change their opinions or treatment plans, then it is time to look for another therapist.
It is important that both you and the therapist have trust that can be easily maintained. Maintaining trust in a dual relationship in counseling is difficult. There must be trust that the two relationships will not influence each other. Since this is very difficult for most people to do, it is a good idea to avoid dual relationships entirely.
However, if you are determined to use a therapist with whom you have a dual relationship, it is important to discuss your concerns with them before starting therapy. Lay down the ground rules and determine if the therapist can help you give your preexisting relationship.
How Dual Relationships Affect Outcomes
While some dual relationships cannot be avoided or may even be mandated, such as institutional dual relationships, most of the time dual relationships should be avoided. Dual relationships can affect the outcomes of therapy in several ways. Some therapists are unable to separate what they know of a patient in the real world with what they learn about the patient in therapy sessions. These therapists can often change their treatment plans or methods, or even gain a negative opinion about the patient based on outside knowledge.
In the case of communal dual relationships, a therapist may have difficulty separating what they learn of the patient through community gossip and what they need from therapy. In business relationships, the therapist may only be interested in what they can get out of the situation.
If a therapist is ethical and responsible and can separate the personal relationship from the therapeutic one, dual relationships may not affect your outcomes adversely. In some cases, a dual relationship can be helpful because the therapist may already have a good background history of the patient before therapy ever begins, which does save some time and effort and allows you to get down to business immediately rather than going through history and current situations.
However, for the most part, dual relationships should be avoided. While some therapists may have the best intentions, it is too easy for them to cross boundaries and change roles in the middle of a session. After all, therapists are only human, and they are just as prone to making judgments as everyone else.
What to Do
If you are having a hard time finding a therapist without a dual relationship, you do have some options. One of the best options is to look for a therapist on a telehealth network. Telehealth allows you to have sessions with a therapist in your state without the need to live or work near the location of the therapist. For those living in small communities, this can be a great way to avoid dual relationships.
There are several services out there that offer this type of therapy. One of the best is BetterHelp. BetterHelp is affordable and offers therapists in every state. You can easily find a therapist with whom you have no other relationship, regardless of where you live or how small your community might be.
With telehealth, you also have some very good options for how you undergo therapy. You can do everything online through chat or video, or you can have phone call sessions. Your therapist is available when you need them, and you will be able to get the treatment you need without worrying about the rest of your community and their opinions.
- Is what is being communicated clinically accepted? NO
- Is the content factual? YES
- Are you comfortable with what is being communicated? NO
- As a therapist, and based on the code of ethics, you cannot have a Dual Relationship with your patient. It completely goes against morals/ values and should not be promoted. Please consider not posting this article.