Advocating *for* dual relationships?

[futureapppsy2]

I read a book chapter today where the author writes about her dual, platonic relationship with a client--evolving from client to client-friend over the course of three years of (insurance-covered!) therapy for depression and suicidal ideation and continuing on past termination. I know that self-disclosure and all that can be a matter of opinion and can be quite tricky, but when you're exchanging non-trivial gifts with your client, meeting them weekly for lunch, helping their children find jobs, and having "sessions" that are as much about your issues as your client's, to me, that stops being a gray area and starts being a blatant ethical issue.

It's odd, too, because the author frames it as though there are no negative side effects and this was all so wonderful while also talking about how emotionally draining she found the relationship and how she would spend hours waiting for the client to call so that she could put out the "fires" in the client's marriage (even after the professional relationship had ended) and how she felt like the client knew her so well that she could "crawl into her [the psychologist's] head"... That doesn't strike me as healthy for either one of them, and it doesn't strike me as ethical, either, as I think forming a dual friendship would really mess up therapeutic boundaries for both parties. Furthermore, I wonder why you would want to document this publicly in a book chapter!

Maybe I'm being too strict with boundaries, but I just don't see how establishing even platonic dual relationships with clients is wise--building warmth and rapport, yes, forming all-out friendships within and beyond the professional relationship? Not so much. I know most of the focus is on sexual relationships and dual relationships are allowed if there's no reasonable suspicion of harm, but this seems way over the line of appropriate behavior.

Thoughts?

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[roubs]

Sounds way over the line if this was going on while the client was paying to see the therapist. It might be more murky if they kept everything professional and only started becoming friends after terminating.

As this is published, do you mind saying what book/chapter you're referring to?

 

[PsychPhDone]

Yeah, I think that's inappropriate. Yikes.

 

[futureapppsy2]

Sounds way over the line if this was going on while the client was paying to see the therapist. It might be more murky if they kept everything professional and only started becoming friends after terminating.

As this is published, do you mind saying what book/chapter you're referring to?

Goldin, M. (2002). Authorization to continue: A post-termination friendship evolves. In A. A. Lazarus and O. Zur (Eds.), Dual relationships and psychotherapy. (pp. 409-422). New York, NY, US: Springer Publishing Co.

Also, an error in my first post--it was two years of a therapeutic relationship, not three.

I was indirectly involved in/aware of a somewhat similar ethics issue earlier this year (with very blurred lines between friendship and clinical roles, plus some other potential issues) and was surprised to find that some seasoned professionals totally condoned what I saw as clearly ill-advised, if not outright unethical, behavior, but compared to this, it almost looked tame.

Admittedly, I have pretty conservative/strict view of clinical boundaries, I just don't see how a competent clinician could think this type of concurrent, emotionally loaded dual relationship building is healthy or without the potential for harm. I'd even go as far to say that I think post-termination friendships are ill-advised in a vast majority of cases--admittedly, I'm only a rising second year, but I just don't see how the intimate but very power imbalanced therapist-client relationship can ever be really "undone" or made not to matter. JMHO, though--if you think otherwise, I'd sincerely love to hear your perspective.

 

[deleted106747]

Goldin, M. (2002). Authorization to continue: A post-termination friendship evolves. In A. A. Lazarus and O. Zur (Eds.), Dual relationships and psychotherapy. (pp. 409-422). New York, NY, US: Springer Publishing Co.

Also, an error in my first post--it was two years of a therapeutic relationship, not three.

I was indirectly involved in/aware of a somewhat similar ethics issue earlier this year (with very blurred lines between friendship and clinical roles, plus some other potential issues) and was surprised to find that some seasoned professionals totally condoned what I saw as clearly ill-advised, if not outright unethical, behavior, but compared to this, it almost looked tame.

Admittedly, I have pretty conservative/strict view of clinical boundaries, I just don't see how a competent clinician could think this type of concurrent, emotionally loaded dual relationship building is healthy or without the potential for harm. I'd even go as far to say that I think post-termination friendships are ill-advised in a vast majority of cases--admittedly, I'm only a rising second year, but I just don't see how the intimate but very power imbalanced therapist-client relationship can ever be really "undone" or made not to matter. JMHO, though--if you think otherwise, I'd sincerely love to hear your perspective.

I tend to agree with you. BUT - as good scientist does not go into these things with her mind already made up, I'll defer judgment until I read the piece.

 

[erg923]

This is certainly outside the bounds of what our profesion does or is suppose to do/be, BUT, if you look at the actual behavior, forgetting about the "rule book" for a moment, what has this lady really done? Nothing inherently wrong or malicious at all. We have all probably done this with at least one person in our lives. She has become a "friend" (or so it sounds to me). While in most cases this would certainly be contraindicated and problematic, I see no CLEAR-CUT ethical violation in becoming friends with a former-patient after treatment has terminated. Thus, Im not in too much of a hurry to burn this woman at the proverbial stake.

 

[Therapist4Chnge]

Even if it isn't an ethical violation, that doesn't mean it is fair game. There are so many things that could go wrong, and for what benefit? I have seen this in other "helping" professions, and it makes me rather uncomfortable. Whether the provider realizes it or not, they are in a position of influence, and they have a duty to respect and enforce heathly relational boundaries. A patient is a patient is a patient. A patient is not your friend, but they are your responsibility. You do not set up social dates. You provide interventions. As a provider, if you need assistance with something, you seek that out on your time and you do not bring it to work with you.

Bottom line...risk/reward. Even if there was a decent clinical reason, there is no way that outweighs the risk of possible harm to the patient and/or provider.

 

[roubs]

she could put out the "fires" in the client's marriage (even after the professional relationship had ended)

This sounds like the most troubling part, that she continued on and actually reveled in continuing her therapist role off the clock. I wouldn't be so strict as to say "no social contact after termination" but her level of being enmeshed in the clients life seems to be a bit far.

 

[futureapppsy2]

This sounds like the most troubling part, that she continued on and actually reveled in continuing her therapist role off the clock. I wouldn't be so strict as to say "no social contact after termination" but her level of being enmeshed in the clients life seems to be a bit far.

To play devil's advocate, I often get relationship advice from my friends. Which is the problem, I think--when you create a blurred relationship like that, you can wind up not knowing where on part ends and the other begins. The client will always think of the therapist as someone who is/was their therapist and the therapist will, on some level, always think of the client as they first new them--as a client with [problem/dx/etc]. It falls apart, I think, because the therapeutic relationship *is* deeply personal, but it is also needs to have professional definition and boundaries because it's not a "personal", equitable relationship.

 

[roubs]

To play devil's advocate, I often get relationship advice from my friends. Which is the problem, I think--when you create a blurred relationship like that, you can wind up not knowing where on part ends and the other begins. The client will always think of the therapist as someone who is/was their therapist and the therapist will, on some level, always think of the client as they first new them--as a client with [problem/dx/etc]. It falls apart, I think, because the therapeutic relationship *is* deeply personal, but it is also needs to have professional definition and boundaries because it's not a "personal", equitable relationship.

First off, I'm agreed with your points. The main problem is it seems the therapist stopped thinking about boundaries once she stopped billing the client. In some ways every friendship we have his different and unique, and if one of your friendships is stamped with "former client" it's incumbent upon you to tread carefully and make sure you don't slide back into the therapist role. That's why I agree it's generally not a good idea, but since we cannot outlaw it there should be sensible guidelines for "What to do when you have a social relationship with a fmr client"

 

[futureapppsy2]

First off, I'm agreed with your points. The main problem is it seems the therapist stopped thinking about boundaries once she stopped billing the client. In some ways every friendship we have his different and unique, and if one of your friendships is stamped with "former client" it's incumbent upon you to tread carefully and make sure you don't slide back into the therapist role. That's why I agree it's generally not a good idea, but since we cannot outlaw it there should be sensible guidelines for "What to do when you have a social relationship with a fmr client"

I agree, but I think it is even more troubling that the client was still formally her client when she started becoming less of a client and more of a friend.

Alternately, there's the issue of how make boundaries with your friends or students as not to make them your de facto clients. Giving general advice as a friend? Okay-that's a big part of friendship. Suggesting they may want to see someone? Probably okay, or even recommended. Diagnosing your friends (seriously, not in a joking or cavalier manner)? Probably not. Giving a detailed, personalized description of how treat the disorder you think your friend has? Probably not. JMHO. It's an interesting issue, though, and I wish there was more research out there on non-sexual/platonic dual relationship issues.

 

[FadedC]

Alternately, there's the issue of how make boundaries with your friends or students as not to make them your de facto clients. Giving general advice as a friend? Okay-that's a big part of friendship. Suggesting they may want to see someone? Probably okay, or even recommended. Diagnosing your friends (seriously, not in a joking or cavalier manner)? Probably not. Giving a detailed, personalized description of how treat the disorder you think your friend has? Probably not. JMHO. It's an interesting issue, though, and I wish there was more research out there on non-sexual/platonic dual relationship issues.

I've often been curious about some of those questions in non platonic relations as well. I mean it's a normal thing for couples to do to talk to each other about their thoughts and feelings and give advice about what they think the other might be going through. But when one person is a psychologist that adds a whole different layer to that.

 

[PsychPhDone]

Even if it isn't an ethical violation, that doesn't mean it is fair game. There are so many things that could go wrong, and for what benefit? I have seen this in other "helping" professions, and it makes me rather uncomfortable. Whether the provider realizes it or not, they are in a position of influence, and they have a duty to respect and enforce heathly relational boundaries. A patient is a patient is a patient. A patient is not your friend, but they are your responsibility. You do not set up social dates. You provide interventions. As a provider, if you need assistance with something, you seek that out on your time and you do not bring it to work with you.

Bottom line...risk/reward. Even if there was a decent clinical reason, there is no way that outweighs the risk of possible harm to the patient and/or provider.

👍

Once a client, always a client. Doesn't mean we can't empathize for a client or care about them. The most caring thing you can do as a therapist is take your role seriously.