There has been a lot written about boundary issues and multiple relationships. Many psychologists think that all multiple relationships are unethical. However, that is not what the APA Ethical Principles and Code of Conduct (APA, 2010) says.
Standard 3.05 states:
A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
Thus, not all multiple relationships are unethical and they are not always unavoidable. This presents a dilemma for psychologists because there are many circumstances where psychologists face entering into multiple relationships and the situations can be quite varied. It is also important to note that therapeutic relationships differ from social and other business relationships. For example, it is a regular part of many other professional relationships to have a meal with a client or to play golf or tennis with clients.
If psychologists were to take a purely risk management perspective then they would never engage in any behavior that could be considered a multiple relationship. However, this may not be the most therapeutic choice in some situations and could even have a negative or harmful effect on treatment.
Experts make the point that good risk management also means providing good care. So if avoiding a multiple relationship or boundary crossing results in harm or is destructive to treatment then it is not good risk management.
There is no reason that a psychologist cannot attend a client’s wedding, funeral, graduation or athletic event or give or receive a gift from a client as long as these relationships would not reasonably be expected to lead to exploitation or harm, and as long as the psychologist acts in a professional manner. However, if there is any possibility that the client could misperceive these situations, it is advisable to document in the client’s record the actions and ethical decision-making process used by the psychologist.
Because engaging in multiple relationships has a high potential for exploitation and harm, there are several questions psychologists should ask themselves. The first question is, “Who is this for?” Is this new role for the benefit of the client or is it for the benefit of the therapist? This can be a difficult question to answer honestly, highlighting the need for consultation. Several additional questions have been suggested, including:
- Is entering into the secondary relationship necessary, or should I avoid it?
- Can the multiple relationship potentially cause harm to the client?
- If harm seems unlikely or unavoidable, would the additional relationship prove beneficial?
- Is there a risk that the secondary relationship could disrupt the therapeutic relationship?
- Can I evaluate this matter objectively?
Another variable that makes it difficult to anticipate whether a boundary crossing will be seen as exploitative or harmful is that an action such as touching a client may be clinically relevant and appropriate for one client, but for another client with a history of abuse, the very same behavior may be an unwelcome boundary violation. Thus, if possible, it is good practice to discuss boundary crossings in advance with clients to ensure their comfort with the plan and to prevent misunderstandings. If a client is not willing to consider the issues, this may be an indication that the boundary crossing or multiple relationship should not proceed.
Therapeutic boundaries are shaped by current opinions about professional behavior and by culture. The decision to cross boundaries to be helpful to culturally diverse clients should be made carefully. Gift giving, personal space, self-disclosure and touch are all issues that practitioners should consider when working with diverse clients.
The importance of consultation cannot be underestimated in the context of boundary crossings or multiple relationships. This is essential because it can be difficult to objectively determine when one is putting the client’s needs above one’s own interests. The consultant should be familiar with the circumstances, the client and the decision maker. For example, the consultant should know if the male internship supervisor is recently divorced, or the trainee is a single female when consulting about accepting a social invitation. Documentation of consultation should not be forgotten or overlooked.
Boundary crossings and multiple relationships are not unethical, but must be in the client’s best interest and consistent with his or her treatment goals. These relationships have risks that need to be thoroughly analyzed and addressed, although not necessarily avoided. It is important to anticipate the worst case scenario and plan how to handle it. When things go wrong, clients feel hurt. It is also important to be aware of red flags such as excitement at seeing certain clients or wishing that a client was not a client. In addition, consult with a trusted colleague to monitor tendencies to use rationalization. However, it is not necessary to place ethical standards and risk management practices above humane considerations.
Linda K. Knauss, Ph.D., ABPP, is a professor at Widener University’s Institute for Graduate Clinical Psychology. In addition, she maintains a private clinical practice where she sees children, adolescents, adults and families. Her email address is: firstname.lastname@example.org.