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This way of thinking is intended to be protective of clients and can help prevent various kinds of abuses, up to and including taking advantage of clients sexually. Among students, senior clinicians, and many faculty, this is a near universal opinion. To challenge it can bring some negative reactions from peers. Before you read further, let me be absolutely clear. In no way am I supporting or encouraging any activity with a client or former client that would be exploitive. This includes sexual relations with clients, as well as any situation in which we exert undue influence over a client for our own benefit.
And if so, what are the logical ramifications or consequences? In small rural communities, this situation would be more acute, but the principle would be the same in big cities, too. You are interested in politics in your community and decide to run for school board. You find out a former client has also announced his or her candidacy. Do you campaign against your former client, or withdraw because it would be a conflict? Our clients are often free to join many, if not most, of the organizations where we are members. Do we withdraw if they join our groups? Do we bar their membership if we can?
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This could include online networks, as well. You provide therapy to a child. Ten, fifteen, or more years later, that patient becomes a prominent, top in their field, attorney, surgeon, or other highly specialized professional.
Why Your Therapist Can’t Be Your Friend
You discover that you need someone with those highly specialized qualifications. If the client is still a client even after all those years of no contact, is that a conflict of interest and a prohibited dual relationship? If it is an issue of power, who is in the position of power? Is power in any relationship always static, or is it variable and subject to change based on the circumstances?
When a therapist and client enter into a relationship that is outside of or in addition to the therapeutic relationship, it is generally referred to as a dual relationship. Dual relationships are discouraged by most professional organizations. However, not all experts in the field believe that all dual relationships are necessarily harmful. It would depend on the context. However, when a therapist and long past patient enter into a relationship separate from the therapeutic one, is that actually a dual relationship? Would it be more accurate to call it a sequential or serial relationship?
Is there a difference? If one believes that our patients grow mature and sometimes surpass us in knowledge, wisdom, and power, then it is a significant difference.
Can My Therapist Also Be My Friend?
Of course, of all the dual or sequential relationships that are potentially possible with patients and former patients, when the issue of sex comes up, most all therapists of all disciplines react forcefully. Having sex with a current patient or even a recently discharged patient is not only unethical—it is illegal. It is truly a betrayal of the trust the patient places in us.
However, over time as in years , can that change in some very special circumstances to allow exceptions to the rule? If a therapist and former patient meet some 10 or 15 years after the last therapeutic session and develop a personal relationship, get married, and have children, can we say that an ethical violation or a crime has been committed? In most all states, laws prohibiting sex with clients are limited to current or recent clients. Washington State is one exception.
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However, assuming the former client does not file any complaint, how enforceable would such laws be? For example, what if the former therapist and patient got married, were in a committed relationship, and had children? Would or should an ethics committee have the authority to interfere with a marriage or union among consenting adults? What about our belief in the right to free association? What is the rationale for the prohibition against sex with patients? Many believe it is the power differential. Behnke points out that many relationships have significant power differentials, including partnerships and marriages, and that we often do in fact put our own interests above those of clients when we charge fees, for example.
So, neither a power differential nor putting our own needs first is in and of itself unethical. Rather, Behnke says, it is because we have a fiduciary relationship that is compromised and creates additional risks that are not a necessary part of the therapeutic relationship, making psychotherapy impossible.
But fiduciary relationships are not static and change with time and circumstances. Some would argue it is based on psychodynamic theory, and perhaps those who practice psychoanalytically have a higher standard. But interestingly, there is nothing in psychodynamic theory or psychoanalysis that would state such.
This would include taking patients on vacation and conducting analysis in hotel room beds. Psychologists and current clients Almost all developed societies prohibit any romantic or sexual relationship between a psychologist and a current patient. The American Association of Psychology is unequivocal about the issue and rule All these possibilities are strongly present in case of a dating relationship between the psychologist and a patient. However the Ethics Code also mentions that multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
Psychologists and former patients Apart from prohibiting romantic and sexual relations between psychologists and a current patient, the Ethics Code of American Psychologists Association also has strict rules on psychologists dating former patients.
Apart from all these factors, if a psychologist of therapist makes any statements or actions during the course of therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the patient, that is also deemed unethical according to the Ethics Code of the APA. Psychologists are not only prohibited from engaging in romantic or sexual relationship with a current patient and in most cases former patient but it is also unethical for a psychologist to terminate the therapeutic relationship established with a patient in order to pursue a social or sexual relationship with the patient.
Possible Consequences The Consumer information page of Association of State and Provincial Psychology Boards ASPPB — an alliance of state, provincial, and territorial agencies responsible for the licensure and certification of psychologists throughout the United States and Canada — states that sexual contact of any kind between a psychologist and a patient, and in most cases even a former patient, is unethical and grounds for disciplinary sanctions3.
Additionally, in some jurisdictions, such activity may constitute a criminal offense. All psychologists are trained and educated to know that this kind of behavior is inappropriate and can result in license revocation.
Can Psychologists Date Patients or Former Patients?
Why are such relationships considered unethical? To begin with a sexual involvement makes the work of psychotherapy or analysis impossible. For this reason, A sexual involvement is unethical because the psychologist can no longer exercise beneficence in the professional relationship.