● NASW (2011) notes that dual relationships occur when the social worker relates to the client in more than one way, whether professional, social, or business and these relationships can occur simultaneously or consecutively. They should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. If a multiple relationship is unavoidable, the social worker takes steps to protect the client and is responsible for setting clear, appropriate, and culturally sensitive boundaries (Standard 1.06). ● AAMFT (2015) states that multiple relationships include but are not limited to business or close personal relationships with a client or the clients’ immediate family. Therapists make every effort to avoid multiple relationships that could impair professional judgement or increase the risk of exploitation (Standard 1.3). ● NBCC (2023) states that counselors should avoid counseling relationships with individuals with whom they have another relationship with such as a community connection, friendship, or work relationship. They strive to avoid multiple relationships with clients except in cases where it is culturally appropriate or therapeutically relevant. If an unforeseen multiple relationship happens, the counselor is to discuss the potential effects with the client and make attempts to resolve the situation, which may include termination of the therapy relationship and referral to another provider (Standard 22). They should not enter into a non-counseling relationship with a former client for at least 5 years after the last professional contact (Standard 23). ● APA (2017) does not specifically define persons but broadly states that a multiple relationship occurs when the clinician “Is in a professional role with a person and at the same time is in another role with the same person,” “At the same time is in a relationship with a person closely associated with or related to” the client or “Promises to enter into another relationship in the future” with the client or person closely related to the client. Psychologists do not enter into a multiple relationship if it could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness or if it otherwise risks exploitation or harm to the client. If the psychologist finds that a potentially harmful multiple relationship has arisen, they take steps to resolve it keeping the best interests of the client in mind (Standard 3.05).
As implied in these guidelines, there are many types of relationships which fall under the definition of multiple relationships. Examples include social, when the therapist and client are also personal friends; professional, when the therapist and client work together in the same organization; business, when the therapist shops at a store owned by the client; community, when the therapist and client attend the same church or community group; or romantic, when the therapist and client are intimately involved. Despite these guidelines advising against multiple relationships, they may not always be avoidable. Small towns, small communities, or limited-in-size groups may make it nearly impossible to avoid having a relationship with a client outside of the therapy room. For example, in a small community the therapist may attend the same church as the client. In a rural area with one physician, the therapist who is a patient of the physician may provide therapy services to the nurse who works at the doctor’s office. Brownlee and colleagues (2019) surveyed rural social work practitioners and found that 90% of the therapists felt that dual relationships in rural communities are inevitable and common. Szumer and Arnold (2023) note that in rural environments it is inevitable that the healthcare provider’s personal relationships will cross over with their professional relationships either with the client or with persons close to the client. They argue that these encounters are just that— encounters—and are not ongoing involved relationships. They suggest the term “overlapping” relationship rather than dual or multiple relationships to differentiate them. They recommend that the provider reflect on whether the overlapping relationship is harmful to the client in any way, whether it could damage the therapeutic relationship in any way, whether any professional codes or regulations are applicable to the situation, and whether new boundaries need to be put in place to protect the client and the therapy relationship, including potential referral to another provider. The overlapping relationship should be discussed with the client and documented in the chart. These situations highlight that not all encounters outside of the therapy office constitute an ongoing, involved relationship. The central question in any dual or multiple relationship situation to consider is whose needs are being met, the client’s or the therapist’s. Brownlee and colleagues (2019) note that any time a dual relationship has occurred, the therapist should self-reflect and consider the specific circumstances surrounding the boundary crossing, including frequency and intent.
BOUNDARY CROSSING: GIFTING
A boundary crossing situation that is seemingly benign and that is frequently faced by the clinician is the giving and/ or accepting of gifts to or from a current client. Appropriate gift-giving is a boundary crossing that may potentially enhance the therapeutic relationship. Inappropriate gift giving moves into the realm of a boundary violation. Gift-giving is a nearly universal way of showing gratitude, appreciation, respect, and caring toward others. It is not uncommon for clients to offer gifts to providers, especially around traditional holiday times or at the conclusion of treatment. Many providers also choose to give a small gift or token to their client at various times. Any exchange of a gift must be considered in terms of appropriateness due to type of gift, value of the gift, timing in treatment, intent of the gift-giver, and perception by the recipient of the gift’s purpose. How gifts are given or received in the context of a therapeutic relationship requires careful consideration as this seemingly benign act of a boundary crossing may have a significant impact on the provider, client, or both.
Gifting is typically viewed as a boundary crossing and, as such, is addressed directly or indirectly by the ethics codes of many professions. For those fields where the code of ethics does not specifically address the issue of gifts, ethical considerations can be inferred. For example, the APA Ethical Principles (2017) and the NASW Code of Ethics (2021) do not directly discuss gifts but are clear about prohibiting exploitation of the client, they have several sections addressing the issue of multiple relationships, and they also state that the provider must, above all, strive to do no harm. The ACA Code of Ethics (2014) is more specific and states counselors must take into account the monetary value of the gift, the client’s motivation for giving it, and the counselor’s motivation for wanting to accept it. The AAMFT Code of Ethics (2015) states that therapists must consider the potential effects that receiving or giving gifts may have on clients and the efficacy of the therapeutic relationship. The NBCC Code of Ethics (2023) is even more specific by stating “Counselors shall not accept gifts from clients except in cases when it is culturally appropriate or
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Book Code: PYTX1325
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