In psychotherapy, a dual relationship occurs when a therapist has a second, significantly different relationship with their client in addition to the traditional client-therapist bond. For example, a therapist may find that the person seeking treatment happens to be their neighbor.
Some dual relationships are unavoidable, as may be the case when a therapist is mandated to testify in court. But there are others which are voluntary or coincidental, such as when a therapist and client shop at the same stores in a small community. Regardless of the circumstances in which a dual relationship arose, a therapist should be careful to follow ethical guidelines and maintain healthy boundaries.
TYPES OF DUAL RELATIONSHIPS
According to the Zur Institute, the following are common types of dual relationships:
- Social dual relationship: The therapist is also a friend.
- Professional dual relationship: The therapist doubles as someone’s work colleague or collaborator.
- Business dual relationship: The therapist is also involved with someone in a business capacity.
- Communal dual relationship: Both the therapist and client are members of a small community and will likely run into each other or be involved in the same activities outside of the office.
- Institutional dual relationship: The therapist serves an additional role inherent to a particular institution, such as a prison, hospital, or military base. For example, a therapist could be a prisoner’s counselor and their parole evaluator.
- Forensic dual relationship: The therapist is a counselor as well as a witness in legal trials or hearings involving his or her client.
- Supervisory dual relationship: The therapist is also responsible for overseeing and supervising the client’s development as a professional therapist, as often occurs in educational settings.
- Digital, online, or Internet dual relationship: The therapist is connected with the client on social media sites such as Facebook, Twitter, and LinkedIn.
- Sexual dual relationship: The therapist and client are engaged in a sexual and/or romantic relationship.
SEXUAL DUAL RELATIONSHIPS
The APA Ethics Code forbids therapists from being sexually intimate with current clients due to ethical conflicts of interest. Likewise, therapists should not take on clients with whom they’ve been intimate in the past. The APA does allow therapists to pursue a romantic relationship with a former client, assuming at least two years have passed since the therapy ended. Yet even this kind of relationship is still highly discouraged.
On the surface, sexual dual relationships may appear to occur between two consenting adults. However, the nature of therapy puts a client in a uniquely vulnerable position. Therapy often involves sharing intimate thoughts and emotionally raw experiences. The client may be reluctant to share these things with a romantic partner, leading them to either avoid important issues in therapy or to cross their personal boundaries.
Research suggests most clients who have sex with their therapists ultimately view this intimacy as harmful. Even clients who initially enjoyed the sex generally found it exploitative in hindsight. These feelings may increase the clients’ symptoms of depression, suppressed anger, or suicidal ideation. The client may be more likely to isolate themselves and mistrust others, making it harder for them to receive adequate care in the future.
Therapists who have sex with clients can face severe consequences. They may be sanctioned by licensing boards and professional organizations. Their professional reputation may be damaged to the point that they no longer get new clients or referrals. They could also rack up expensive legal fees. As such, even when a therapist has sexual feelings for a client, it is not recommended that they act on said impulses.
ETHICAL CONCERNS WITH NONSEXUAL DUAL RELATIONSHIPS
Nonsexual dual relationships can be ethical or unethical depending on the circumstances. The distinguishing factor is often the establishment of mutual trust. Can each party rely on the other to respect their boundaries and needs? Or does one party misuse the other’s vulnerability?
In some cases, the dual nature of the relationship may be beneficial from a clinical standpoint. For example, if the therapist and client are colleagues in the mental health field, they may be interested in exploring certain techniques together. This exploration could prove useful for both parties so long as guidelines are agreed upon ahead of time.
In other cases, the dual relationship can be a detriment to the therapeutic relationship. A dual relationship is more likely to be harmful when:
- There is a lack of objectivity.
- Example: A therapist may treat an influencer they follow on social media. Their admiration of the client may skew their clinical judgment.
- The boundary between roles is unclear.
- Example: If a client and therapist are friends, they may inadvertently begin to discuss mental health issues outside the office.
- There aren’t any guidelines for when therapy will end.
- Example: A client may be reluctant to terminate therapy with a close neighbor for fear of awkward encounters later.
- The difference in power makes it easy for the therapist to potentially harm the client.
- Example: The therapist is also the client’s teacher and can give the client a bad grade.
When assessing the ethics of a dual relationship, it is important to ask whether the relationship is truly beneficial for both therapist and client.
- Capawana, M. R. (2016, June 9). Intimate attractions and sexual misconduct in the therapeutic relationship: Implications for socially just practice. Cogent Psychology, 3(1). Retrieved from https://www.tandfonline.com/doi/full/10.1080/23311908.2016.1194176
- Ethical principles of psychologists and code of conduct. (2017). American Psychological Association. Retrieved from https://www.apa.org/ethics/code/index?item=13#1005
- Herlihy, B., and Corey, G. (1992). Dual relationships in counseling. Alexandria, VA: American Association for Counseling and Development. Retrieved from http://files.eric.ed.gov/fulltext/ED340985.pdf
- Miller, J. (2014, January 30). Utah therapist admits to sexual relationship with teen client. The Salt Lake Tribune. Retrieved from http://www.sltrib.com/sltrib/news/57473599-78/peterson-police-abuse-girl.html.csp
- Zur, O. (2013). Dual relationships, multiple relationships & boundaries in psychotherapy, counseling & mental health. Retrieved from http://www.zurinstitute.com/dualrelationships.html
Last Updated: 09-19-2019
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Ofer ZurDecember 27th, 2014 at 1:59 PM
A recent summary chart of different types of multiple relationships (or dual relationships) is available at zurinstitute.com/DualRelationships2.pdf
GiaFebruary 13th, 2017 at 11:35 PM
I have known my therapist for 20 years, 10 years through church and then 10 years now as her patient. My probation officer just told me it is considered a boundary issue and I can no longer see my therapist of 10 years and must be getting an entirely new therapy with an outside agency. I have dissociative identity disorder and my therapist and I have established a mutual trusting and respectful relationship that do not cross any ethical boundaries. Does anyone have any feedback on this? I’m falling into a deep depression because I am being severed from my therapy and isolated away from my therapist of 10 years. I’m being re traumatized by a new therapist because I have to discuss issues that trigger my trauma and are tearing me apart. Please I would really appreciate someone’s feedback on this. Thank you very much.
AlisonFebruary 7th, 2018 at 3:09 PM
I agree with your probation officer. It’s about the issue of being in therapy. The therapist/client relationship is a power relationship. In other words, the client often views the therapist as the one with the most power. While therapists may not view that to be true, it just is. If a therapist says something with regard to the client making changes and the rapport has been built, the client would be more likely to take the therapist’s advice. The therapy relationship is supposed to be separate from other relationships. If you see one another in church, that is not a big deal, but if you see one another in church and other people see you and you have multiple conversations and share life with one another, that’s what you want to avoid. If the current new therapist is not working for you, I would encourage you to find one who does. In addition, it hurts my heart that your previous therapist did not try to end this sooner. I’m sorry you’re hurting, but your probation officer is correct. Even in DID, 10 years is too long. There comes a time when you terminate therapy. That’s healthy and the way we are trained. At some point after a few years of therapy, the therapist should have transferred you to a new therapist. It’s called a soft transfer. It’s when the therapist introduces the client to the new therapist in the last couple of sessions before the new therapist takes over the therapy process.
AngelaJune 11th, 2019 at 6:36 PM
I don’t see how this is a problem. Yes there is a dual relationship but not all dual relationships are bad. I am not sure why your probation officer can chose who you see as long as you are complying by your terms of probation. As long as you and your counselor are not having a romantic relationship I really do not see a problem with this and I personally would talk with your probation officers supervisor and make a complaint. Unless there is something that is specifically said in your court papers about who you can not see. This situation is odd. I was given a list of providers that I could see that they would pay for. If I went to any others I had to pay out of my pocket. Don’t give up!!
KymnkimJanuary 15th, 2020 at 5:28 PM
I have to agree with you. I was wondering why the probation officer was not commenting on an area not within his scope of practice. Like you said not all dual relationships are bad, dual relationships occur in rural areas all the time. Like the article said, as long as
the client can benefit from the dual relationship in a way that is healthy I do not necessarily see an issue here. Maintaining continuity of care with this doctor and the ongoing diagnosis of Dissociative Identity Disorder is actually crucial for the client. I am sure this client has a possible team consisting of a Psychiatrist, Therapist, and Neurologist. Transitioning this client to a different doctor after 10 years can be detrimental and set her back. Associate Identity Disorder is unique in nature and requires trained Psychiatrists and therapists who specialize in these areas. If you are not trained to work with individuals who have this disorder than you should not take them as clients as they are in a category of their own as far as being treated. As long as her therapist maintains an appropriate relationship there should be no issue.
Understanding Dissociative Identity Disorder may also be an issue her probation officer may not understand. Dissociative Identity Disorder is generally diagnosed by a Psychiatrist or Therapist and followed sometimes for years.
CVFebruary 27th, 2017 at 9:44 AM
Ethics question: If a School Psychologist and a School Principal in the same district have an affair (both are married with kids) should something be said and if yes to whom?
GiaFebruary 27th, 2017 at 11:55 AM
First should be reported to district administrator. Secondly, board of education.
CVFebruary 27th, 2017 at 1:41 PM
Thank you for responding.
NielJuly 5th, 2017 at 3:18 PM
The principal is not their client, and their affair isn’t your business. Don’t meddle.
GiaJuly 5th, 2017 at 6:34 PM
My reply had nothing to do with minding another person’s business. The fact that it’s a school and a principal basically sets the bar for everyone else’s Behavior. If the principal is going to cheat with the psychologist then everybody in leadership in that school will feel it is okay to have affairs behind husbands and wives backs. It’s disgusting and slutty. Just going to sit there about an individual’s personal code of ethics. Apparently the principal and the psychologist are battling with their own deep insecurities and their own sense of inadequacy so they have to step outside of their marriages to suffice their need for self-esteem and ego-stroking. So let’s say we don’t report it to the school district will the office of the professionals… Husbands and wives order know when their partners are slutting around with other sluts. I rest my case.
Ofer ZurFebruary 27th, 2017 at 2:53 PM
The idea that sex between two consenting adults (married or not) who, as far as I can tell, have not broken any law, code of ethics or violated any official regulations should be reported to “district administrator and board of education” seems like a classic example of what I have referred to many times that, we therapists, are own worst enemies when we act as the ‘moral police’. I have written on the topic of how we, therapists, at times, are our worst enemies in several places, including zurinstitute.com/subsequenttherapist_clinicalupdate.html . However, if they have broken any laws or violated establish regulations , then, one must consider whose responsibility it is to report it and to whom.
Mr ConfuseMarch 11th, 2017 at 10:35 AM
I’m all about, therapists helping and showing genue concern. My question is, is it wrong for the therapist and patient to exchange numbers when it’s regarding if patient can come in earlier then there assigned time? Even though at times there are exchanges of personal things, like how are you feeling? Or how is your day going? Or even exchanges of funny videos. The therapist and I have form a dual relationship, and there are boundaries in place. Which is fine, problem is now she doesn’t want to be texting because something happen at the job with another therapist and patient and now she is thinking she violated some protocol. Advice is needed, ever since she told me not to text her I feel sad ,because she led me to believe that she was Genuine and enjoyed our trust and the fact that she was helping me in some way. How can I go back after all we have shared with each other… See her once a week and pretend she cares when she really doesn’t and she is just seeing me as a number and problem to fix….. Advice welcome
coyMay 17th, 2017 at 8:02 AM
im being informed to transport male clients 50 miles to counseling services. i informed supervisor duty safety reason and ethics i will not take that change transporting. would you have something in writing.
LisaMay 1st, 2018 at 7:05 PM
A psychologist saw my son for two sessions . Then we decided he wasn’t a good fit . Is it unethical at that point for mom and psychologist to start a relationship?
The GoodTherapy.org TeamMay 2nd, 2018 at 6:45 AM
Thank you for your comment. GoodTherapy.org is not a licensing or regulatory board, and is not able to file complaints or investigate ethical concerns. If you have ethical concerns regarding a therapist who has treated you, we encourage you to contact your state’s licensing board. If you need help contacting the board, please let me know what state you are in and I would be happy to try to direct you to the proper channel.
If you have any questions about this or anything else, please don’t hesitate to give us a call. We are in the office Monday through Friday from 8:00 a.m. to 4:00 p.m. Pacific Time; our phone number is 888-563-2112 ext. 2.
The GoodTherapy.org Team
HeatherMay 3rd, 2018 at 5:30 PM
My client is an artist and I recently fell in love with a piece of original artwork in his home. He has offered to sell me this piece of work, but this would obviously constitute a dual relationship, but I’m in a very rural area and am counseling a separate individual that I attended church with a few years back. So in the scheme of things, buying a piece of art doesn’t seem like it would really be so harmful, but I want to make sure I’m ethical. Any opinions?
JoeSeptember 7th, 2018 at 8:41 PM
My wife and I are separated. We began seeing a couple for marriage counseling. My wife and her friend have been good friends for 15 years. The husband and I became friends after they got married a few years ago but not overly close. The counseling seems to be very subjective and I have since been advised that they should not have taken my wife and I on as clients due to the length and nature of my wife’s friendship with the counselor. Should we seek different counselors or am I reading something into this that isn’t there?We seem to be getting very inconsistent counsel between the two of us. For quick example, they told me that separation would be devastating to our marriage and then later advised my wife to kick me out of the house, clean out our bank accounts and file for legal separation. Thank you for any input.
The GoodTherapy.org TeamSeptember 8th, 2018 at 9:31 AM
I am sorry to hear you have had a concerning experience with a therapist. GoodTherapy is not a licensing or regulatory board and is not able to file complaints or investigate ethical concerns. If you have ethical concerns regarding a therapist who has treated you, we encourage you to file a formal complaint with your state’s licensing board. If you need help contacting the board, please let me know what state you are in and I would be happy to try to direct you to the proper channel.
AlisonSeptember 8th, 2018 at 11:34 AM
Hi Joe, no, we are trained not to ever counsel friends or family for that very reason. We can’t remain objective. I’m sorry you’re in this predicament. Good Therapy gave good advice above.
JoanneDecember 5th, 2018 at 7:20 AM
My partner had a client who he has done counselling for about 8 years.
That therapy ended about 3 years ago and she is now coming to some social meetings where we are as well.
She is behaving like the best friend of my partner. There were instances of them exchanging gifts, him helping her in her business providing some appliances, they would also both share personal details about what goes on in their lives and they talk a lot.
This is looks like dual relationship. It feels for me that there is a kind of emotional intimacy between them.
I am finding this hurtful to our relationship and it feels very uncomfortable to witness this, sometimes feels inappropriate. Myself and my partner end up arguing a lot about it and it causes us a lot of pain.
Is it possible that dual relationship with former client can affect personal relationships of a therapist and what would be advised in that situation?
AlisonDecember 5th, 2018 at 12:06 PM
Maybe discuss with him the issues of boundaries. I recommend the book, Boundaries, by Cloud and Townsend. Even if he’d never counseled the person, the boundaries are the issue. You wouldn’t want him to have this relationship with any other woman because it’s a one-on-one relationship excluding you just as I’m sure he wouldn’t want you to have this kind of relationship with any man excluding him. Ultimately, he has to make the decision to choose health, but I will say this regarding him having counseled her in the past. It is the responsibility of the counselor to protect the client, so he should remember the unhealthiness that led the client to receive counseling from him for 8 yrs anyway and he should step back and release her, even if that means leaving the social groups. But again, he has to make that choice and if he doesn’t, then, you’re going to have to decide if you want to continue being in a relationship with him.
Ofer ZurDecember 5th, 2018 at 1:39 PM
think that you and your partner need to do some hearty work about the relationships. Of course, have good friend outside the main relationships can be healthy and enriching. We cannot be everything for each other. Some intimate relationships with other people can, in fact, strengthen the primary relationships. The fact that that your partner friend used to be her client means that they are engaged in what we call ‘sequential multiple relationships’. In general non-sexual and non-exploitative sequential multiple relationships are not necessary unethical or below the standard of care.
If you want to read more on multiple relationships you can go to zurinstitute.com/dualrelationships.html#key
I hope this is helpful.
Ofer Zur, Ph.D.
AnonApril 2nd, 2019 at 3:53 PM
Client is referred to therapist for domestic violence therapy. The clients husband is sent to prison, but she remains in the family home. Concerned for the clients well being, said therapist moves said client into their home, and discontinues treatment. Is this a problem?
What if said therapist resumes seeing the client?
Please note, although both the therapist and client are single adults of opposite genders, there is no sexual conduct.
OferJune 12th, 2019 at 10:19 AM
Anon: What you describe is called sequential dual relationships. The situation that your describe of a client stopping therapy and moving in with the therapists is considered unethical and below the standard of care. If the husband in in prison the wife can stay home for a while and there is enough time for the therapists to find other options for the client, besides moving in with the therapist. The therapist should be able to refer the client to a shelter or to many other resources that support battered women.
SSeptember 28th, 2019 at 9:08 PM
I met a therapist at a networking event rare both members. I really like her information and have followed up with her for an appointment. She said she wasn’t sure she could see me because of both of our membership in this group. This group meets quarterly and share information about our businesses. Why can’t she give me Counseling?
BarbDecember 18th, 2019 at 6:31 PM
I want to leave instructions in my will for my psychotherapist to receive my ashes so she can disperse them and I’d like to leave expense money for the trip out of the country. but I don’t want her to have any problems with ethical or legal regulations. I would be grateful for any feedback to this.
Ofer Zur, Ph.DDecember 19th, 2019 at 6:57 PM
What you are proposing is sequential dual relationships. From the limited info I have, it seems like your proposal is initiated by you and will fulfill or serve your wishes and hopes. It does not seem to be exploitative or unethical. It may be advisable for you and your therapist to discuss the details of your proposal fully and for her to document these discussions. I also would recommend that your therapist consult with a expert on ethics and standard of care. She should choose a true expert on these issues rather than an expert who is focused on ‘risk management’ rather.
Ofer ZurDecember 19th, 2019 at 7:06 PM
I think it is neither appropriate nor helpful to have 2 of the 4 references (listed above) on the topic are focused on sexual dual relationships. These kind of presentation perpetuates the old wrong/false myth or view or misperception that dual or multiple relationships are closely associated with unethical sexual dual relationships. As noted above many multiple relationships are unavoidable and normal in many communities and settings.
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