11.4 Dual Relationships

Dual relationships occur when a counselor assumes another role besides a counselor with a current or former client. Many types of dual relationships can occur between counselor and client, each of which will be discussed throughout this chapter. Dual relationships can be professional (supervisor, professor, employer) or non-professional (friend, sexual partner, connection to client’s relative) in nature (Moleski, 2005). Counselors are encouraged to consider the impact of the dual relationship on their clients and act according to best practices. Of note is that the term dual relationships will be used throughout this text, though different ethical codes may also refer to them as multiple relationships.

According to the ACA’s and NAADAC’s best practice guidelines, counselors should take all possible steps to avoid engaging in dual-client relationships. This is because the nature of having dual roles can undermine the fiduciary responsibility counselors hold through their licensure, threaten their objectivity, and increase the chances of harming clients (Moleski, 2005). Counselors may be compromised by other interests when engaging in dual roles, depending on the nature of the relationship- financial, familial, social, professional, etc. (Moleski, 2005).

The NAADAC (2021) Code of Ethics discusses multiple relationships:

Types of Dual Relationships

Dual relationships can occur in various contexts: social, professional, business, institutional, forensic, supervisory, sexual/ romantic, digital, etc. (Zur, 2014). That said, for any dual relationship, there are various factors to consider when assessing the duality and whether to engage in the dual relationship. Zur (2014) created a table to aid in considering different aspects of a dual relationship and their impact (Table 11.2). The counselor is responsible for developing and utilizing clinical judgment to determine when engagement in dual relationships is necessary or unavoidable when it is appropriate, and when it should be avoided (Barnett, 2007). Counselors apply their clinical judgment to analyze sources of harm that could come from engagement and sources of foreseeable risk. Ethical counselors employ risk management practices in ethical decision-making (discussed later in this section) and seek consultation and supervision to flush out their participation in dual relationships further.

Choice	Context	Legal/ Ethical	Timing	Intensity	Helpful/ Harmful
Mandated	Social	Ethical	Concurrent	Low	Helpful
Unavoidable	Professional	Unethical	Sequential	Medium	Neutral
Avoidable	Business	Legal		High	Harmful
Unexpected	Institutional	Illegal			Destructive
	Forensic
	Supervisory
	Sexual
	Digital
	Etc.

Table 11.2. Factors for counselors to consider when evaluating participation in dual relationships with clients (Zur, 2014).

Choice

Dual relationships can emerge in one of two ways: by chance or by choice (Moleski, 2005). In some situations, entering a dual relationship may happen inadvertently or be mandated. This is especially true in rural settings or small communities, which will be discussed later in this section. Chance encounters with clients in social settings may occur, and the counselor can evaluate the other factors in Table 11.2 to help determine how to proceed in the moment. For example, inadvertently passing a client on a walk around a city park is an unexpected, social, ethical, legal, concurrent, low-intensity, neutral dual relationship (Zur, 2014). If an active decision is involved, counselors consider countertransference and risk management practices in addition to the abovementioned factors (Table 11.2; Zur, 2014). They must account for their intentions, feelings, and motivations to participate in the dual relationship and demonstrate ongoing self-reflection to maintain awareness of their own activation (Moleski, 2005). If their professional role becomes overly compromised, the counselor may have to refer the client to another professional (Moleski, 2005). They also honor the ACA code regarding client abandonment in such cases by remaining actively involved in the referral process.

Impact of the Dual Relationship

Counselors perceive the impact of a dual relationship on the client and therapeutic relationship and realize that this impact exists as part of a spectrum, with one end being beneficial and the other being destructive (Moleski, 2005). Some clients have more significant or vulnerable concerns to address in counseling. When clients seek services for severe mental health disorders, safety concerns, and violence, counselors assume a dual relationship with them will involve more risk and potential for harm. The best practice is to avoid dual roles with clients involved in complex cases. The intensity of impact ranges from low to high and is considered in the possible pursuit of a dual relationship.

Timing

It is essential to consider when the dual relationship begins and is maintained. Options include before the counseling relationship is established, during active counseling work, or after the formal termination of services. The duration of time after termination is also necessary, as State statutes and ACA ethical codes govern the length of time between formal termination of services and officially considering the person served as a “former client.” Counselors must consult state statutes, and in MN, counselors are legally unable to engage in a social relationship with former clients until two years after the official termination of services (Office of the Revisor of Statutes, code 5300.0350, subpart 5E). For example, a counselor engaging in non-professional, social relationships with clients not engaged in services for one year would be unethical and illegal in Minnesota. Experts have different viewpoints on the ethics around fostering a role outside of counseling, even after the two-year mark or whatever period is outlined in state law. Many professionals believe that “once a client, always a client” and advise against establishing a dual relationship at any point in the future if it is possible to avoid it (Zur, 2009, pg. 161). They apply ethical codes to all people they have worked with at any given time. Counselors engage in thoughtful, ethical decision-making processes to evaluate options and consider best practices, which may not necessarily align with the professional codes. Additionally, counselors remain open to the fact that the impact or consequences of a dual relationship can evolve, and what may seem like no harm in the present can result in direct harm to clients at different points in time. They also consider the nature of ending services, as the circumstances and nature of termination differ among clients.

Ethical vs. Unethical

Ethical dual relationships abide by the virtue ethics guiding counseling, including autonomy, non-maleficence, beneficence, justice, fidelity, and veracity (discussed in Chapter 1). Ethical dual relationships also follow best practices in the ACA and NAADAC codes of ethical conduct. Unethical dual relationships impair counselor objectivity, inflict harm on clients, exploit clients, or dilute the effectiveness of counseling practices (Zur, 2014). These should be avoided. Counselors must apply ethical decision-making frameworks for each case as each client and situation is evaluated within the specific context of the client’s needs and the therapeutic relationship (Zur, 2014). When counselors decide to refer to other providers, they assist with the referral process and do not abandon their clients.

Legal vs. Illegal

As mentioned above, state laws govern legal practices for counselors in engaging in different types of dual relationships (Zur, 2014). Ethically speaking, sexual relationships with current clients and former clients for at least 5 years is unethical practice and subject to professional consequences. In some states, dual sexual relationships with current or former clients are criminalized, subject to tort law, and subject to malpractice lawsuits (Zur, 2014). Because of the fiduciary responsibility of counselors, engaging in dual sexual relationships can put their licensure in jeopardy as well (Zur, 2014). Dual sexual relationships are discussed further in section 11.10.

Risk Management Considerations and Strategies

With any ethical decision-making process, counselors are invited to evaluate various aspects to conclude with action steps. Multiple ethical decision-making frameworks exist to aid counselors in thinking through different situations. In assessing participation in dual relationships, counselors should incorporate risk management strategies into decision-making. In doing so, they can demonstrate careful consideration of risks, benefits, and potential harm done to clients in concluding. Here, we outline several risk management strategies proposed by different authors to equip counselors with various tools.

Working in Rural Communities

The ways of thinking about dual relationships outlined above are most applicable to counselors working in urban settings where it is easier to maintain physical distance with clients, role differentiations are more precise, more options exist to meet daily needs, and often, people act more independently. In rural communities, dual relationships are likely to be unavoidable and more a matter of when than if they will occur (Woody, 1998). Rural communities’ cultural landscape is also different from that of metropolitan areas. People are generally interdependent, interconnected, and more community-oriented, and place greater emphasis on familiarity and visibility in the community. Often, these values are needed for collective economic, physical, and emotional survival. Attitudes toward counselors in these settings are often more suspicious, guarded, or evasive (Woody, 1998). Therefore, a counselor integrated into the rural community participates in social and professional events and connects with more approachable and trusted people. Engaging in dual relationships in rural settings is likely necessary for counselors to effectively serve this population and address community needs. Counselor anonymity is adaptive in urban settings and potentially harmful in rural ones.

Additionally, one may naively assume that avoiding a dual relationship automatically equals client non-maleficence. Strict adherence to boundaries around dual relationships can also cause harm and constitute avoidance of essential factors in the therapeutic relationship (Woody, 1998). There are no ethics robots! Ethical codes cannot be automatically applied, as there are nuances to working with different populations that require clinical judgment and careful ethical consideration with decision-making models (Woody, 1998). Location and access to services are important factors in considering and justifying dual client relationships. To mitigate some of the risks that dual relationships in rural locales bring, counselors are encouraged to set clear boundaries around time, confidentiality, and expectations in versus out of treatment through ongoing informed consent (Woody, 1998). They also clearly document their risk management practices, thought processes, and informed consent practices with clients.

Types of Dual Relationships in Rural Settings

Due to the range of dual relationships and connections that one can encounter in rural settings, we will explore some possibilities in this section.

Social

For example, counselors working in remote areas may face the possibility of treating their friend’s child, a friend of their child, or family/ friends of former clients (Woody, 1998). As discussed in Chapter 9 (family counseling), working with multiple family members or having extra information about specific family members can threaten a counselor’s objectivity and cause harm (Woody, 1998). Overall, they have a greater chance of social encounters as they can reasonably expect to run into clients at the town grocery store, local restaurant, church, school activities, etc. (Woody, 1998). Professionals may have to turn down social events if they believe mutual attendance with a client could damage the counseling relationship. A special consideration is being in a mutual space with a client and witnessing them (or them witnessing you) using substances or acting under the influence. They could be at the same wedding, restaurant, or local bar. Counselors develop their boundaries, assess personal comfort levels in navigating these unavoidable situations, and communicate them with clients as part of informed consent (Woody, 1998). Counselors may share something along the lines of ‘It is possible we could see each other at our single gas station in town; if that happens, I will not approach or address you to respect your privacy and confidentiality and will minimally engage by saying hello if you approach me’. They consider factors from Table 11.2, such as the intensity of the dual relationship, the severity of the client’s concerns/ diagnosis, treatment goals, client adjustment level, and vulnerability in determining how to proceed (Woody, 1998; Zur, 2014).

Additionally, dual social relationships can arise if supervisors are privy to information from their supervisees about clients who are also community members (Woody, 1998). The supervisee may not have an explicit dual relationship with this client, but the supervisor may develop one if they know the client in another context. The same applies to colleagues you contact for consultation, and you may consider de-identifying clients in those cases or calling another clinician who lives in another area.

Business

Counselors can enter dual business or financial relationships with clients if they shop in a client’s local store, pay dues to their homeowner’s association, which a client leads, hire an electrician who is your client, begin services with people who work for the counselor’s spouse, see your lawyer’s child for counseling, etc. (Woody, 1998). Counselors engage in ethical decision-making processes to determine appropriate actions and consider multiple ethical codes and virtue ethics (Woody, 1998).

In rural settings, there are often fewer options for client services. For this population, counselors must consider options and the reality of client access. It could be unethical to deny a potential client due to a prior connection if it results in that person receiving no services. Counselors consider harm to clients in multi-faceted ways. There are risks and benefits in the actions they are interested in evaluating, and they think about client risks and benefits of reasonable alternatives. In these cases, counselors balance multiple ethical codes, including dual relationships (NAADAC code I-11) and client abandonment (ACA code A.12; NAADAC code I-26), to arrive at a sound ethical decision that abides by virtues, including client beneficence and fidelity.

Just as in urban settings, counselors in rural settings work to engage in ongoing self-monitoring, compartmentalize dual relationships, and maintain a healthy balance in their professional and social/ community involvements (Woody, 1998). A healthy balance helps to ensure that they are taking care of themselves and not exploiting or mishandling the complicated dual relationships they navigate (Woody, 1998). They are aware of who they are outside of counseling, as this impacts how community members work with them. They also realize that addressing community needs and establishing roles within the community may be necessary for their work. They can benefit from a systems-oriented approach to understanding complex power dynamics and politics in these settings (Woody, 1998).

Working in Small Communities

Parallels exist in addressing ethical concerns in rural locations and small communities regardless of physical location. Small communities identify with a shared identity, beliefs, values, and sense of shared experiences. Typically, small communities are oppressed groups (Woody, 1998). Examples include the LGBTQIA2S+ community, the deaf community, people who suffer from chemical dependence, or spiritual or ethnic minority groups (Woody, 1998). Another somewhat different example is sports psychology. These small community groups can exist anywhere and may have a strong online presence or base to promote connections between members.

In many cases, people with specific small communities may prefer to see a counselor who identifies with that group out of shared beliefs and understanding. They must then be aware of outside contact and develop a dual relationship. When and if that happens, they engage in ethical decision-making processes to balance various ethical codes and mitigate client risk and harm. They document each step of the way.