Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers.

Abstract

4,800 psychologists, psychiatrists, and social workers were surveyed (return rate = 49%) to examine attitudes and practices regarding dual professional roles, social involvements, financial involvements, and incidental involvements. Half of the Ss rated the degree to which each behavior was ethical; the other half reported how often they engaged in each behavior. A majority believed dual role behaviors to be unethical under most conditions; most reported that they had rarely or never engaged in the behaviors. 10 factors (therapist gender, profession, age, experience, marital status, region of residence, client gender, practice setting, theoretical orientation, and practice locale) were examined for their relation to beliefs and behaviors. A higher proportion of male than of female therapists were perpetrators of sexual and nonsexual dual relationships. The professions did not differ among themselves in terms of (a) sexual intimacies with clients before or after termination, (b) nonsexual dual professional roles, (c) social involvements, or (d) financial involvements with patients. 10 specific training implications are discussed in light of the exploitive and clinically harmful nature of dual relationships.The American Psychological Association (APA) has long recognized the harm and exploitation resulting from dual relationships. The Ethical Principles of Psychologists (APA, 1981) require psychologists to act to avoid impairing their own professional judgment or increasing the risk of exploitation of their clients through dual relationships. "Examples of such dual relationships include, but are not limited to, research with and treatment of employees, students, supervisees, close friends, or relatives. Sexual intimacies with clients are unethical" (Principle 6a; p. 636). However, compliance with this principle has apparently been difficult for many psychologists: Dual relation-DEBRA S. BORYS received her PhD in clinical psychology from the University of California, Los Angeles (UCLA), in 1988 and is currently in independent practice. She and her coauthor were among the founders of the UCLA Post-Therapy Support Program, which provides treatment for clients previously involved in sexualized therapy relationships, as well as conducts research, training, education, and consultation regarding dual relationships in therapy and their consequences. KENNETH S. POPE, PhD, graduated from Harvard and Yale and is an American Psychological Association (APA) Fellow and Diplomate in Clinical Psychology in independent practice. He has served as Chair of the Ethics Committees of the APA and of the American Board of Professional Psychology, and he is a recipient of the Frances Mosseker Award for Fiction and the Belle Mayer Bromberg Award for Literature.

Clients’ experiences giving gifts to therapists.

“…Furthermore, not only were these gifts not discussed (at least according to the client reports), but neither was Emma's admitted use of the gifts as a means of expressing feelings she was uncomfortable verbalizing in the therapy nor her sense of the gifts as a way she could "repair" herself via behavior rather than therapeutic discussion. Echoing earlier theorists' concerns and contradicting other researchers' suggestions about gifts in therapy (Borys & Pope, 1989;Freud, 1917Freud, /1963Gerson & Fox, 1999;Glover, 1955;Hundert, 1998;Knox et al, 2003;Kritzberg, 1980;Langs, 1974;Lewinsky, 1951;Pope et al, 1987;Ruth, 1996;Simon, 1989;Spandler et al, 2000;Talan, 1989), Dr. E reportedly did not address Emma's motivations for giving the gifts, the nature of what they communicated, the prominent role they began to take in her therapy, nor their effect on the therapy process and relationship. Perhaps, following a more intersubjectivist approach (e.g., Atwood & Stolorow, 1984;Hahn, 1998;Stolorow & Atwood, 1996), Dr. E may have sought to affirm and accept Emma by accepting her gifts (although we cannot know this without having talked to the therapist).…”

“…In his study of 29 practicing British psychoanalysts, Glover (1955) found that none of the respondents accepted large gifts or money offerings, most did "not receive gifts gladly" (p. 319), and most analyzed patients' motives for giving gifts, hoping to reduce such behaviors in the future. In a survey of members of the American Psychological Association's Division 29 (Psychotherapy), Pope, Tabachnick, and Keith-Spiegel (1987) and Borys and Pope (1989) found that therapists almost universally accepted gifts of minimal financial value (e.g., less than $5) and rarely accepted those of higher value; they usually considered the former ethical and the latter unethical. Gerson and Fox (1999) surveyed 600 forensic professionals (MA, MD, MSW, PhD, PsyD) whose work demanded familiarity with the law (e.g., civil, competency, criminal, custody, workplace); respondents disapproved either somewhat or absolutely of five types of gifts (e.g., food, tickets to an event) and were neutral toward accepting a cupcake on a patient's birthday.…”

Boundary violation and sexual exploitation in psychiatry and psychotherapy: a review

“…Although psychiatrists are three times as likely as psychotherapists to be sued for this kind of malpractice (Perr, 1989), epidemiological studies tend to suggest that there is no difference in rates between the different types of professional engaged in psychotherapy (Borys & Pope, 1989).…”

Gifts in psychotherapy: Practice review and recommendations.

“…tickets to what type of event and at what value?). In addition, as was the case with Pope et al (1987) and Borys and Pope (1989), we do not know what types of clients these respondents had in mind when answering the questions.…”