Research Paper on Dual Relationships: Challenges in Health Services

Introduction

Multiple relationships present a challenge in health services, including substance abuse counselling. Also referred to as dual relationships, multiple relationships refer to situations where many roles exist between a therapist and the client. For instance, multiple relationships arise where the client is friend, student, associate, or a family member of the therapist (Sanders 108). These relationships increase the likelihood of misuse of power by therapists. This can lead to the exploitation of the clients for the therapist's benefit. Therefore, it is necessary for therapists to abstain from engaging in multiple relationships or avoid crossing boundaries. However, this is not usually possible. To become a good therapist and to be able to help clients recover, one must be able to set healthy boundaries to protect themselves as the therapist and to safeguard that client's recovery as well. Therefore, this paper will dwell on managing boundaries and multiple relationships.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Types of Multiple Relationships

There exists different types of dual relationships. A social dual relationship exists where the client and the therapist have some form of social relationship (Barnett 35). These relationship might have occurred physically or online. Professional dual relationship occurs where the client and the therapist are professional colleagues. Where an employee-employer relationship exists between the client and the therapist or the two are business partners, the relationship amounts to a business dual relationship. Communal dual relationship occurs where the client and the therapist live in the same community or belong to the same religious faction. This is the most common type of multiple relationships, especially in small communities. Institutional dual relationships occur in institutional settings such as prisons, military, and police departments (Johnson and Johnson 70). Forensic dual relationships arise where the therapist also serves as a witness or evaluator in hearings or trial. This type of multiple relationship is usually complicated. A sexual dual relationship arises where the therapist and the client are in a sexual relationship. If such a relationship occurs with current clients, it is usually unethical and illegal.

Multiple relationships can be unavoidable, avoidable, or mandated (Younggren and Gottlieb 30). Voluntary-avoidable multiple relationships occur in large cities where there are several therapists. Also, in such settings, there are many worship, shopping, and recreational facilities, and hence, the chances of development of social and communal dual relationships are reduced. Unavoidable multiple relationships usually occur in rural areas, drug and alcohol recovery centres and similar settings. In such settings, development of multiple relationships cannot be avoided. Mandated multiple relationships usually occur settings such as police departments, prisons, and military institutions, among others.

The Ethics of Multiple Relationships

The 1992 Ethics Code implied in its wording that multiple relationships were unethical. The burden of proof was also placed on the therapist by the code. However, the wording of the 2002 Ethics Code Standard has a neutral definition of multiple relationships and does not imply that multiple relationships are unethical (Nardone 1). On the contrary, the code states that as long as multiple relationships are not exploitative or harmful to the client, they are ethical. The code of conduct caution professionals against any involvement or engagement with their clients that might lead to impairment of their objectivity and judgement alter their ability to offer effective services or result in the exploitation of the client (Nardone 1). Different people have different perspectives on multiple relationships. While some focus on problems inherent to multiple relationships, others view multiple relationships as an inevitable part of communal life. However, regardless of the view held, there are some factors that a therapist must consider before getting into a multiple relationship. They include the therapist's motivation, the history and culture of the client, consistency with the treatment plan, among others.

Pros and Cons of Multiple Relationships

Multiple relationships carry various advantages and disadvantages for both the client and the therapist. The major advantage of multiple relationships is that it helps foster a better relationship between the therapist and the client, which in turn improves the outcome. For instance, where the client is familiar with the therapist's personal ethics and spiritual beliefs, they are at a better position to trust the therapist. Dual relationships also helps avoid exacerbation of power dynamic between the client and the therapist, which in turn helps prevent exploitation of the patient. Concern with boundaries is the major disadvantage of multiple relationships. Multiple relationships may lead to deviation from boundaries, which in turn may harm the client as well as the therapist. Multiple relationships can also lead to exploitation of power, which can end up hurting the client and denting the therapist's career (Barnett).

Boundary Crossings versus Boundary Violations

There exists boundaries that define therapeutic frame or therapeutic-fiduciary relationships. These boundaries help make the distinction between sexual, familial, and social relationships from psychotherapy. Some of these boundaries are drawn around therapeutic relationships and are meant to address concerns of fees, confidentiality, as well as the time and places where sessions take place. Other types of boundaries are drawn between, rather than around, therapists and clients. They include therapist's self-disclosure, giving and receiving gifts, physical contact, language use, contact outside sessions, proximity during sessions, among others (Amis 56). A boundary crossing can be described as a deviation from the commonly accepted practices that is intentionally done to help the client. It includes clinically effective interventions like home visits, gifts or bartering, self-disclosure, non-sexual touch, among others. For instance, a therapist may choose to go for a walk with a depressed client to foster a positive relationship.

On the other hand, boundary violation is a situation where the therapist engages in a serious breach that ultimately harms the client. It is considered highly unethical. An example of such a situation is where a therapist gets sexually involved with a client. Engaging in exploitative business relationships with the client also amounts to boundary violation. It is important to note that not all boundary crossings amount to dual relationships. For instance, while making a home visit to a client is a boundary crossing, it does not necessarily constitute a dual relationship. However, all dual relationships such as bartering, going to the same church and using the same recreational facilities constitute boundary crossings. While boundary violation is harmful, boundary crossing is neither harmful nor unethical (Barnett 40). Various professional associations do not give any prohibitions against boundary crossing. Moreover, various forms of therapy call for the incorporation of boundary crossings in the treatment plan.

Some professionals argue that the view of various institutions on multiple relationships is skewed. Resultantly, therapists have fallen victims of inconsistent and unfair decisions by licensing boards in various states. Sanctions have also been brought against therapists who did not do any harm. Such stands imped the ability of the therapists to perform optimally with their clients. These issues have led to the prevalence of the "slippery slope" belief. This paranoid approach is founded on snow ball effect where a minor boundary crossing is believed to lead in boundary violations later. For instance, it is believed that giving a gift will inevitably lead to a business relationship or self-disclosure may bloom into a social relationship. These beliefs lead to a rigid attitude regarding boundary crossings. However, though beneficial, boundary crossings should be approached with great caution, especially among clients suffering from borderline personality disorders (McCarthy and Taylor). Boundary crossings, just like with multiple relationships, must be implemented in accordance with the unique needs and specific situation of the client. It is recommended that the rationale behind boundary crossings must be articulated clearly and preferably included in treatment plan. As stated by the New Ethics Code, maintaining healthy boundaries does not necessarily require a therapist to have detached objectivity. On the contrary, it calls for therapists to apply professional judgement and remain committed to the best interests of the client at all times (Nardone 2).

Moreover, the issue of boundary crossing and violation is divisive and controversial not only in therapy but also in social work (Reamer 130). Looking at it from one theoretical orientation, what makes up harmful boundary violation may be seen as helpful, which might not necessarily be the case using other theoretical orientations. Also, different cultures place different expectations on therapists and are guided by different values and customs. Thus, different cultures judge boundary crossings differently. For instance, communally oriented cultures may embrace boundary crossings more as opposed to rigid boundary implementation.

Various studies have revealed that crossing boundary influences the progress of the therapy (Barnett 38). Dual relationships and crossing boundaries promote the working relationship between the client and therapist, enhances therapy, and helps in the treatment strategy. However, it also has the potential to weaken the treatment process, hamper cooperation between the therapist and the client, and may lead to instant or lasting damage to the client. Therefore, therapists must be cognizant of the professional and individual needs. They must also strive to achieve the needs without hurting the relationship between the client and therapist. Therapists must come up with a strategy focussed on general attitude to ethical requirements. They must also put effort to stay up-to-date with the evolving legal and ethical requirements (Afolabi 10).

Meaning of Boundaries and Appropriate Application

The meaning of boundaries, as well as their appropriate application, can only be assessed and understood in the context of therapy. The context of therapy is made up of four components; setting, clients, therapy, and therapist (Barnett 35).

Client Factors

The client factors that influence the understanding and application of boundaries are majorly concern with the culture and history of the client. Factors such as history of trauma, mental state and the severity of mental disturbances, personality type or disorder, religious beliefs and practices and experience with therapy must be clearly evaluated before boundary crossings are applied (Barnett 35).

Setting Factors

This involves factors such as outpatient versus inpatient setting, solo practice versus group practice, privately owned clinic versus hospital-based clinic, presence and proximity of other staff, among others (Barnett 36). These factors must also be considered before boundary crossings are applie...