AAMFT’s legal and ethics consultation service frequently fields calls from members confronted with situations involving concerns about dual roles/multiple relationships. Over the years, various scenarios have been presented including questions about buying or selling items to or from clients, hiring clients, entering into platonic friendships with clients, and entering into some kind of business relationship with clients. You’ll notice the word “clients” was used in the previous examples—later in the post we’ll discuss matters of timing (e.g. current client vs. former client).
Regardless of the scenario presented, these situations are nuanced and require careful considerations of the facts of the specific scenario, the AAMFT Code of Ethics, and applicable statutes and regulations that govern the therapist’s practice. This post, of course, will focus on the AAMFT Code of Ethics.
In these situations, members are guided to Standard 1.3 in the AAMFT Code of Ethics, which states:
Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client’s immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists document the appropriate precautions taken.
Taking guidance from Standard 1.3, therapists presented with the possibility of a dual role or multiple relationship are called upon to make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. This portion of Standard 1.3 is consistent with the risk management approach to dual roles/multiple relationships, which generally states that therapists should avoid scenarios that give rise to concerns about dual roles and multiple relationships, whenever possible.
If a therapist makes the decision to move forward in the face of concerns about dual roles and multiple relationships, therapists are called upon to assess the situation in question for any increased risk of exploitation of the client, as well as any increased risk of impaired professional judgment on the part of the therapist. When assessing for an increased risk of exploitation, it may be helpful to turn to a dictionary definition of “exploit.” Merriam-Webster defines “exploit” as “[making use] of meanly or unfairly for one’s own advantage.” Assessing for an increased risk of impaired professional judgment should be relatively straightforward, but therapists would likely benefit from consultation so as to achieve an objective perspective of the situation.
The last sentence of Standard 1.3 hints that there may be appropriate precautions that could be taken if the risk of impairment or exploitation exists. If, after assessing the risks and all relevant factors, a therapist chose to move forward in a situation presenting the possibility of dual roles/multiple relationships, Standard 1.3 advises the therapist to document the appropriate precautions taken. Examples of appropriate precautions may include, but are not limited to, discussing the risks with the client and planning for how to handle issues that may arise, seeking peer consultation or supervision, and being prepared to assess and reassess the situation as it evolves.
Standard 1.3 also provides a non-exhaustive list of examples of relationships that could impair professional judgment or increase the risk of exploitation. That non-exhaustive list includes business or close personal relationships with a client or the client’s immediate family.
Dual roles/multiple relationships can be thought of as landing somewhere on a spectrum of possibly workable to more clearly problematic. On the possibly workable side you’d find situations that may be objectively and reasonably managed (e.g. therapist and client have children that attend the same school and may see each other at school events from time to time). On the more clearly problematic side of the spectrum you’d find situations that are more objectively risky and likely to be problematic (e.g. therapist borrows money from client).
Many members ask about how much time needs to pass between the end of the therapeutic relationship and the beginning of the new relationship in question. Standard 1.3 does not mention a specific time frame. Rather, any questions of timing would simply be one of many factors to consider when assessing the situation for risk. If the therapist/client relationship is current and active, the risk levels may be higher. If the therapist/client relationship has ended, the risk levels may be lower. The greater amount of time that has passed since the end of the therapeutic relationship, the lower the risk levels may drop.
So, while not all dual roles/multiple relationships are automatically problematic, these are not risk free scenarios. Peer consultation, consultation with AAMFT’s legal and ethics staff, and consultation with your professional liability insurer may be helpful resources. And, remember, from a risk management standpoint, the advice given tends to be to avoid scenarios that give rise to concerns about dual roles and multiple relationships, whenever possible.
For further discussion on dual roles/multiple relationships, you can look to the September/October 2016 issue of FTM, which includes an informative article on managing multiple relationships.
Exploit [Def. 2]. (n.d.) In Merriam Webster Online, Retrieved November 23, 2016, from http://www.merriam-webster.com/dictionary/exploit.