What is a Dual Relationship in Counseling?
What to do when you see your therapist outside of session? Usually, the therapist will follow your lead whether you choose to engage with them or not. But sometimes, it can be much more complicated. Maybe you go to a friend’s party and find out your therapist is a close mutual. Or maybe you find out you live in the same apartment building after seeing each other in a resident community event. A therapist-client role is a unique professional alliance that requires navigating expectations within clear, ethical boundaries. Though, there is no easy answer, since relationships themselves are complex and messy.
Situations where therapists and clients have additional social roles overlap are called “Dual relationships”. These overlaps often happen in small-town settings, within niche communities, or among professionals in the same field. These relationships can create ethical dilemmas, challenging the fundamental design for healthy boundaries in therapy. While professional guidelines emphasize maintaining the therapeutic alliance alone, ethical guidelines do not always address the complexity of real-world situations. To start, here is a breakdown of how dual relationships can look like:
Types of Dual Relationships & Examples
Social Dual Relationships
A therapist that discovers mutual acquaintances with a client at a party.
Professional Dual Relationships
The therapist collaborates professionally with the client, such as in academic research or as colleagues within the same organization.
Business Dual Relationships
A therapist becomes a customer for a client’s business, creating a secondary business relationship.
Communal Dual Relationships
Therapists and clients interact as members of the same small-town community or niche group.
Living in the same apartment building.
Institutional Dual Relationships
Institutional multiple relationships can create conflicts, particularly in correctional facilities where therapeutic and security roles intersect (Haag, 2006; Weinberger & Sreenivasan, 1994, as cited in Black, 2017). Educational institutions can have scenarios such as university students having more than one role, such as counseling clients, teaching assistants, and peer supervisors (Sharkin, 1995, as cited in Black, 2017).
Forensic Dual Relationships
A therapist serves as a legal witness for a client during a court case.
Supervisory Dual Relationships
A therapist oversees the professional development of a client who is also a therapist-in-training.
Digital/Online Dual Relationships
A therapist and client connect via social media or interact in other digital spaces.
Intimate Dual Relationships
Romantic or sexual involvement with clients is strictly prohibited. This can harm the therapeutic process, causing emotional, psychological, and legal harm.
Ethical Considerations
Intimate Dual Relationships
The American Psychology Association Ethics Code strictly prohibits any sexual involvement between therapist and client. (American Psychological Association, 2017) Additional organizations, such as the American Association for Marriage and Family Therapy (AAMF), National Association with Social Workers (NASW), and American Art Therapy Association (AATA) also require that no harm is done to clients from dual relationships. Consequences of these relationships compromise trust, create power imbalances, and lead to significant emotional and psychological harm.
Non-Sexual Dual Relationships
Potential Harm:
Blurred boundaries leading to power imbalances.
Difficulties in maintaining objectivity and unclear termination processes.
Potential Benefits:
Building deeper trust and strengthening the therapeutic alliance.
Carefully adjusted boundaries to enhance client care, when done thoughtfully.
Ethical Guidelines and Contextual Factors
Professional Codes of Ethics
Organizations such as NASW, AMFT, and APA acknowledge that dual relationships can be unavoidable in certain situations.
These boundaries should also account for culturally sensitive approaches to ensure professional integrity while keeping the warmth, person-centered aspects of the therapeutic relationship.
Context and Judgment
Strictly following guidelines must be balanced with practical considerations. Therapists should use critical thinking, document decisions, and consult with colleagues to mitigate risks.
Decision-Making in Dual Relationships
Weighing the potential benefits and risks of a dual relationship is essential. Personally, myself (the writer) has struggled with how to navigate professional identities as a practicing artist and an art therapist. For clients and myself, it would be unfair to take away our joys in participating in community art wellness workshops and exhibitions. Therefore, examples of breaking down the ethical process may look like the following:
Benefits: If the therapist is leading a wellness related workshop (e.g., an art therapy-based community workshop), it could give the client additional coping skills and therapeutic insight in a non-clinical setting. Clients might feel inspired or creatively empowered, benefiting from exposure to art as a medium for self-expression. If the therapist’s artwork relates to themes of healing, clients may find indirect therapeutic value in engaging with the work post-therapy.
Risks: Scenarios where active participation in group activities for wellness workshops may risk confidentiality or shift client perception of the therapist positively or negatively. If the therapist is attending the same wellness event or is participating in an art show, the artwork or personal stories during the wellness event may contain personal themes or self-disclosures that weren’t shared in therapy, it could alter the client’s view of the therapist and create discomfort or power imbalances in sessions. For group therapists, if multiple clients attend the same event, privacy and confidentiality concerns may arise, particularly in settings where others might recognize them as a therapy client. The therapist is required to maintain confidentiality, but it is not guaranteed in some group therapy settings amongst members.
Guidelines for Minimizing Risk
The client’s therapeutic needs and goals take priority, as well as what the therapist is comfortable with. For the scenario above, it would be important for the therapist and client to have a conversation in advance of how to navigate these social scenarios, possible risks, and thoughts and feelings the client may have. For example, a client seeing the therapist outside of session—especially in a setting where the therapist is in a leadership or performance role—could impact their perception of the therapist's authority or emotional availability. The best move in dual relationships would be to refer the client to another therapist as soon as possible to create distance and minimize risk as much as possible. When in doubt, lean towards the side of caution to prevent potential harm.
For clients considering re-engaging with a former therapist with a minimum of 2 years post therapy, it would be important to understand why, the goal of reconnection, and what they envision the interaction to look like. It may be helpful to reach out to your therapist of what to expect if you are thinking to re-engage (for example, buying an art piece from your former therapist). Check in with yourself and take it slow! This is to preserve all the work done in therapy; trust your instincts of what feels like lingering attachment vs. discomfort vs. comfort in re-engaging in a new professional dynamic.
Perspectives on Dual Relationships
There are many academic articles that discuss how dual relationships should be navigated, for example “multiple relationships also include providing therapy to a relative or a friend's relative, socializing with clients, becoming emotionally or sexually involved with a client or former client, combining the roles of supervisor and therapist, having a business relationship with a client, borrowing money from a client, or loaning money to a client”. (Corey, 2019) This risks a higher possibility of power imbalances, violations of HIPPAA, and trust in the therapeutic alliance. Additionally, Moleski and Kiselica (2005) believe multiple relationships range from the destructive to the therapeutic. Although some multiple relationships are harmful, other secondary relationships complement, enable, and enhance the counseling relationship. Moleski and Kiselica encourage counselors to examine the potential positive and negative consequences that a secondary relationship might have. They suggest that counselors consider forming multiple relationships only when it is clear that such relationships are in the best interests of the client (Corey, 2019).
Dual relationships are complex and highly context-dependent. While professional guidelines offer direction, they cannot include every situation therapists face. Overall, enforcing ethical practices requires critical thinking, client centered care, and regular consultation with other practicing professionals to keep the power dynamics in check.
Get some help breaking up with your therapist!
Struggling with how to tell your therapist you no longer want to see them? Are you not quite sure how to do it or what your options are? This guide will walk you through your options from contemplation to completion and feelings that may come up after. The guide also provides templates and scripts that you can use or build on to make the break up process easier.
Citations
American Association for Marriage and Family Therapy. (2015). AAMFT code of ethics.
https://www.aamft.org/AAMFT/Legal_Ethics/Code_of_Ethics.aspx
American Art Therapy Association. (2013). Ethical principles for art therapists.
https://arttherapy.org/wp-content/uploads/2017/06/Ethical-Principles-for-Art-Therapists.pdf
American Psychological Association. (2017). Ethical principles of psychologists and code of
conduct (2002, Amended effective June 1, 2010, and January 1, 2017).
https://www.apa.org/ethics/code
Black, S. C. (2017). To cross or not to cross: Ethical boundaries in psychological practice.
JANZSSA - Journal of the Australian and New Zealand Student Services Association,
25(1). ANZSSA.
Corey, G., Corey, M. S., Corey, C., & Callanan, P. (2019). Managing boundaries and multiple
relationships. In Issues and ethics in the helping professions (10th ed., pp. 254–301).
Cengage Learning.
Moleski, S. M., & Kiselica, M. S. (2005). Dual relationships: A continuum ranging from the
destructive to the therapeutic. Journal of Counseling & Development, 83(1), 3–11.
https://doi.org/10.1002/j.1556-6678.2005.tb00574.x
National Association of Social Workers. (2021). NASW code of ethics: Ethical standards
Social workers' ethical responsibilities to clients. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-to-Clients