The ethics of multiple relationships: a clinical perspective

By Stephen Behnke
The Monitor on Psychology
July/August 2015, Vol 46, No. 7
Print version: page 84

APA members contact the Ethics Office on a daily basis to discuss the ethical aspects of their work. Receiving these calls is both interesting and gratifying, and educates the office about how psychologists across the country frame the ethical questions they encounter. One of the most frequent topics is multiple relationships. During the Ethics Code revision process that ended in 2002, the Ethics Code revision task force made clear that not all multiple relationships are unethical. The task force wrote a test for determining when a psychologist should refrain from entering a multiple relationship:

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.

The language of ethical standard 3.05 requires the psychologist to determine when a particular relationship would impair the psychologist's objectivity, competence, or effectiveness in doing the work of a psychologist, or would otherwise risk exploitation or harm. The standard thus illustrates clinically driven ethics.

The entire article is here.

Ethics, self-disclosure and our everyday multiple identities

APA’s Ethics Code speaks to our psychologies — and our clients’ psychologies — on many levels.

By Stephen Behnke, JD, PhD, MDiv
March 2015, Vol 46, No. 3
Print version: page 70

Here is an excerpt:

Here our profession's rather rigid history with multiple relationships may get in the way of good ethical thinking. The belief that all multiple relationships are unethical may lead a student to conclude that a rigid demarcation among identities is preferable or necessary. Of course, such demarcations are not possible and attempting to behave as though they are is futile, counterproductive and painfully distracting. Although a psychologist who is a parent is not parenting during psychotherapy, such a psychologist nonetheless remains a parent during the session. Standard 3.05 offers a way to think about this intra-psychic conundrum.

The entire article is here.

Managing Risk When Contemplating Multiple Relationships

By Jeffrey Younggren and Michael C. Gottlieb
Professional Psychology: Research and Practice, Vol 35(3), Jun 2004, 255-260.

Abstract

Entering into dual relationships with psychotherapy patients has been a topic of significant controversy in professional psychology. Although these types of extratherapeutic alliances have generally been considered to be unethical conduct, some authors recently have supported their development as both ethical and, in some cases, even therapeutic (A. Lazarus & O. Zur, 2002). In this article, the authors briefly review the general literature regarding dual relationships and offer the reader guidelines in applying an ethically based, risk-managed, decision-making model that could be helpful when a practitioner is considering entering into such relationships or when such relationships inadvertently develop.

The entire article is here, behind a paywall.

The authors ask many great questions from a risk management perspective.

Not All Multiple Relationships are Created Equal

By Ofer Zur
Independent Practitioner, 34/1, 15-22. 2014.

Introduction

Most mental health professionals have attended risk management and ethics workshops where one of the central messages was the dire warning that multiple relationships are generally unethical, inherently harmful, mostly prohibited, and should be avoided.  While the term "unethical" is thrown about liberally when it comes to multiple relationships, the fact is that none of the major professional organizations' codes of ethics prohibit all forms of dual or multiple relationships.

The entire article is here.

In Bed with our Clients: Should Psychotherapists Play Matchmaker or is this Plain Old Erotic Transference?

By Keely Kolmes, PsyD.
http://drkkolmes.com

Last January, there was an opinion piece in the New York Times, written by Richard Friedman on whether therapists should play Cupid for clients, basically performing as a matchmaker, setting them up on dates. The article focused primarily on the fantasies that some clinicians have about wanting to do this and the potential issues that could come up regarding transference. It did not speak directly to erotic transference, but I think this is a key component of such a question.

Following the article, HuffPost Live did a segment on which I was one of four guests interviewed about our points of view on the issue. As expected, the show included diverse opinions and even had the one clinician, Terah Harrison, who has expanded her practice to include matching services.

Another clinician, Dr. Lazarus, argued passionately that we are "uniquely well positioned" to make such matchmaking recommendations to our clients. Jeff Sumber agreed it was unethical but he admitted to having such strong fantasies about fixing up his clients that he'd deliberately scheduled people in hopes they might meet. (I imagine his clients are now wondering as they arrive for therapy if the person leaving is someone he has chosen for them?)

Guess which role I played on this segment? Yes, I was the conservative fuddy-duddy talking ethics, dual relationships, and risk management.

The entire story is here.

Why Should We Behave Ethically?

Stephen A. Ragusea, PsyD, ABPP

Guest Blog

Every psychologist must read and know the basic tenets of the American Psychological Association’s Code of Ethics in order to get through graduate school and obtain a license to practice psychology.  We’ve all read it.  We’ve all learned it.  We’ve all tried to apply it.  How many of us have asked the question, “Why bother?”  Obviously, the entire concept of ethical behavior is rooted in our system of morality and, although the word “should” often has a negative connotation in our psychotherapeutic lexicon, any ethics code is all about what we should and should not do.  Codes attempt to answer the question, “What’s the right thing to do in this situation?”

It’s interesting to me that nowhere in the current Ethics Code is this question directly addressed.  The issue is addressed only obliquely.  The Preamble states,

“Psychologists are committed to increasing scientific and professional knowledge of behavior and people’s understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations, and society.  Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching, and publication.  They strive to help the public in developing informed judgments and choices concerning human behavior.  In doing so, they perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist, and expert witness.  This Ethics Code provides a common set of principles and standards upon which psychologists build their professional and scientific work.”

It seems to me, what the preamble does is one thing.  It advises us that this code of shoulds and should nots is intended to guide our behavior to facilitate our work as psychologists.  Essentially, the Ethics Code advises us that we’ll do a better job of being psychologists if we follow the principles articulated there in.  It helps us do our work.

What is our work?  The jobs that psychologists do could fill a book, in fact, they fill many books.  But for most of the membership of this state psychological association, our work consists largely of psychological assessment and psychotherapy.  It’s important work. 

This Christmas, I was reminded of the importance of the work we do via a Christmas card I received from one of my former patients.   Here’s the story.   Almost three decades ago, I was asked to evaluate a family because one of the parents had been found guilty of abusing a child.  In response to a child’s episode of enuresis, the parent placed the child in a bathtub full of ice cubes and cold water for half an hour.  The community’s response was to place all three children in foster care.  When I was asked to evaluate the family, I administered a variety of psychological tests to the entire family.

Through the assessment process, I uncovered important information as I worked with this very poor, rural family. The parents had graduated from high school as Special Education students, with Wechsler IQs near the bottom of the borderline range.  But they also had near perfect handwriting and spelling on the Rotter and WRAT and that told me they were capable of learning.  The father worked as a laborer and the mother, while somewhat disabled, worked as a homemaker caring for her family.  While talking with the parents during interviews, I found them to be loving, devoted people.  I learned that they had treated the enuresis problem using the same disciplinary technique used on them when they were children.  In their minds, they weren’t being abusive; they were being good parents.  I established a good relationship with them during the evaluation and ultimately worked with them in family therapy, which largely consisted of psycho-education – I had them read Dr. Spock’s Baby and Child Care and then we discussed it, section by section.  We worked hard.  These two parents eventually got their kids back and raised them as well as they could given the limits of their intellect, education, and finances.  What would you expect to be the outcome?  Here’s what was in their annual Christmas card to me this year.  Obviously, the information has been disguised to protect identities.  However, the original punctuation is maintained.

“Our son, Tim, is in Columbus going through college at Ohio State, business engineering, our daughter Martha is going through college at Indiana University in Indiana, criminal justice she wants to be a detective and she also works at the grocery store.  Our youngest moved to Erie, PA, in July she works at a Walgreen pharmacy.  John and I are just fine.  Hope all is fine and well where you are.  Take care….”

  

We all have cases like this in our files, don't we?  We do very important work out there and sometimes we forget that reality.

There were a number of significant ethical issues in this case.  For example, all the potential dangers regarding multiple relationships needed to be navigated.  Clarifying the identity of my client or clients at various points was a challenge.  I didn’t always adhere to the letter of the then current Ethics Code,  but I certainly tried to adhere to the spirit of the document.  It helped me to do what I think was good work.  I think our system of ethics helps us all to do good work.  And, I think that’s why we have an Ethics Code and why we should behave ethically.   Maybe you’ve got a better reason, but that’s the best answer I can come up with.  It helps us do good work. And that’s why we’re here, isn’t it? 

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist,Vol. 57, 1060-1073. 

If you have specific suggestions for topics to be covered in The Ethics Corner, please e-mail me with your suggestions.  My e-mail address is ragusea@aol.com. 

Psychologist Kristina Nana Killam Duangpatra banned for six months for inappropriate relationship with prisoner

By Tony Keim
The Courier-Mail
Originally published November 5, 2012


A FEMALE psychologist who had a "personal and intimate relationship" with a Brisbane prisoner - including offering to have his child - has been banned for six months.

The Queensland Civil and Administrative Tribunal was told psychologist Kristina Nana Killam Duangpatra had an improper relationship with a prisoner over a two-year period.

QCAT acting Deputy President Kerrie O'Callaghan, in a just published eight-page decision, said Duagnpatra first met the prisoner, identified only as Mr Cougan, at Wacol's Wolston Correctional Centre when she began treating him on August 3, 2009.

The tribunal became involved after a disciplinary referral from the Psychology Board of Australia indicated Duangpatra was having an improper relationship with a former patient.

The entire story is here.

Los Angeles-Area Psychologist Surrenders License

Psychiatric Crime Database
A Public Service of the Citizens Commission on Human Rights
Originally Published May 10, 2012

On March 6, 2012, psychologist Ross U. Porter surrendered his license to the California Board of Psychology in lieu of facing a hearing on twelve counts of negligence.

According to the Board’s document which laid out the accusations against him, Porter engaged in multiple relationships with the daughter of a family to whom he provided individual and family therapy. The family, described in the state’s documents as “The ‘A’ Family,” consisted of a mother, father and six children.

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Porter encouraged Angela to interact socially with his family and to do volunteer work in conjunction with a fundraiser for Porter’s non-profit organization he ran called Stillpoint. Porter also hired and paid her to baby sit and house sit for him. When a health care practitioner engages a patient in his or her business or social activities, it is considered potentially harmful to the patient and is a violation of the American Psychological Association’s ethical principles, as well as a violation of sections of the California Business and Professions Code.

(cut)

In late 2008, during a therapy session with Angela and her parents, Porter recommended that Angela be allowed to move into his home for an indefinite period of time. It was agreed and she moved in.

The whole story is here.

Vignette 10: Multiple Relationships Revealed

A female psychologist works with a male patient for about one year in a suburban area.  They agreed to meet weekly for the first four months of psychotherapy, and then they agreed to meet twice per month.  They developed a good therapeutic alliance.  During the course of their work, he discussed significant facts about his troubled past, numerous details about failed past relationships, and sexual fantasies.  The main therapeutic issues are depression and loneliness.

During the current session, the patient related having made a new female friend.  As social isolation, loneliness and depression are regular themes in treatment; the psychologist frames this as positive progress.

As the conversation continues, the psychologist is surprised to learn that the patient’s new friend is the ex-wife of the psychologist’s husband.  The patient reveals that he became aware of that information after several dates and recently felt comfortable revealing this to the psychologist.  He also indicated that the relationship is taking on a more serious tone.

The ex-wife moved back to the area about six months ago.  The psychologist knows that the ex-wife had been struggling with isolation and loneliness as well.  The psychologist, her husband, and his ex-wife are on good terms.  They see her regularly for informal family events and do holidays together with their adult children and grandchildren.

After the session is over, the psychologist has time to reflect on her concerns.  The psychologist feels stuck and overwhelmed by her present situation.  She calls you for an ethics consult.

What are the ethical issues involved?

What would you suggest that she does?

With whom does the psychologist discuss the multiple roles? 

With only the patient?

With the patient and the ex-wife?

With her husband, the patient and the ex-wife?

Can the psychologist continue the treatment relationship with the patient?

Even if they terminate therapy, how does the psychologist cope with family gatherings since she knows significant details about her patient’s life?

Diversity Based Psychology: What Practitioners and Trainers Need to Know

Diversity Based

This document was found in the public domain here.