11.13 Case Study

Alex, a licensed substance use disorder counselor, has been in recovery from opioid addiction for over fifteen years. As part of his ongoing recovery, Alex regularly attends a local 12-step self-help group. He has always found this group to be a crucial part of his support system. However, during one of the meetings, Alex is surprised to see one of his new clients, Jessica, walk through the door. Jessica, who recently began counseling with Alex for opioid dependency, also joined the same 12-step group as part of her recovery efforts.

The encounter creates an immediate ethical dilemma for Alex. He now finds himself in a situation where he is both Jessica’s counselor and a fellow member of her self-help group, resulting in a dual relationship. In the group setting, Alex is expected to participate as a peer, sharing personal experiences and supporting others, including Jessica, in her recovery. However, as Jessica’s counselor, he is bound by professional ethics that emphasize maintaining boundaries and preventing conflicts of interest. Alex worries that his participation in the group could compromise Jessica’s confidentiality and blur the lines between their counselor-client relationship.

Alex is now faced with several difficult decisions. Should he continue attending the group, knowing that Jessica will be there? Should he discuss the situation with Jessica and explore whether she feels comfortable with the dual relationship, or should he immediately transfer her to another counselor to avoid any potential conflicts? He must also consider how his participation in the group could affect his recovery and whether discontinuing his involvement might have personal consequences.

Discussion Questions

1. What are the potential risks of continuing the counselor-client relationship if both Alex and Jessica remain in the same self-help group?
2. How might Alex’s participation in the group affect the power dynamic in his therapeutic relationship with Jessica?
3. Should Alex immediately disclose this situation to Jessica, and if so, how can he do so in a way that respects her autonomy and confidentiality?
4. What are Alex’s options if he feels that stepping away from the 12-step group might negatively impact his recovery?
5. How should Alex address this issue in supervision, and what guidance might he seek from ethical guidelines (e.g., ACA or NAADAC) regarding dual relationships and self-disclosure in a recovery context?
6. Could the 12-step group offer alternative solutions, such as attending a different meeting or setting ground rules for interactions in the group, while maintaining professional boundaries?