A guide to violating an injunction in psychotherapy: On seeing acquaintances as patients.

Abstract

After a review of the prohibition against seeing acquaintances in therapy and the frequency with which the prohibition is violated the rationale in favor of the injunction are presented. They include 1) loss of the previous relationship, 2) complication of transference and counter transference, and 3) stimulation of therapist grandiosity. Guidelines are then offered to offset the difficulties in seeing acquaintances as patients. They include, 1) realization of the reality of both the "real" relationship and the transference relationship, 2) acquiring supervision or consultation, 3) becoming more conservative in the observance of rules about time, space, and protocol, 4) thinking through and clarifying values about the dual relationships, 5) being prepared to sacrifice the nontherapeutic relationship, and 6) being prepared to end the therapy and transfer the patient. The problem of seeing acquaintances in therapy is discussed in terms of the profession as a whole and the need for research, training and a more articulated code of ethics.

Dual relationships between clinical psychologists and their clients: A survey of UK clinical psychologists' attitudes

“…Sensitivity to ethical issues is also a career‐long requirement; it is not a discreet body of knowledge to be assimilated in pre‐professional training. There is therefore also a need for continuing professional workshops about ethical dilemmas and their resolution (Roll & Millen, 1981). A better understanding about what it is that makes clinical psychologists who describe their main theoretical orientation as psychodynamic, view dual relationships, as less professionally appropriate.…”

“…Sensitivity to ethical issues is also a career‐long requirement; it is not a discreet body of knowledge to be assimilated in pre‐professional training. There is therefore also a need for continuing professional workshops about ethical dilemmas and their resolution (Roll & Millen, 1981).…”

Avoiding exploitive dual relationships: A decision-making model.

“…Kitchener (1988) assumed that as the risk of harm increased, so should the ethical prohibitions against engaging in the relationships. Roll & Millen (1981) developed guidelines for psychologists who must respond to requests for psychotherapy from acquaintances. They included; avoiding doing so if possible, remaining mindful of possible transference relationships, obtaining consultation, maintaining boundaries, being aware of one's own values, being prepared to lose the friendship, remaining mindful of confidentiality, recognizing when treatment should be terminated, and insuring that the therapist's personal needs are met to avoid abusing the psychotherapy process.…”

“…Unfortunately, their models do not offer the specific assistance that is required. The recommendations of Roll & Millen (1981) are helpful but can be applied only in very specific circumstances. Gonsiorek & Brown (1989) recommend specific actions which apply only to the psychotherapeutic relationship and leave no room for professional judgment.…”

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

“…Third, the models often advocate that psychotherapists consult with other professionals. Fourth, a few of the ethical decision-making models acknowledge the influence of clinicians' personal factors, such as role expectation, professional identity, and personal values in their ethical decisions (e.g., Keith-Spiegel & Koocher, 1998;Roll & Millen, 1981;Woody, 1990). Roll and Millen, accepting that clinicians' personal issues play a significant role in their ethical decisions, advised psychotherapists to ensure that their own needs are met elsewhere so that they do not depend on their clients to meet those needs.…”