Dual relationships dominate the ethical landscape of counseling. They are the leading cause of malpractice lawsuits (Corey, Corey & Callanan, 1993); they are a frequent cause of professional sanction (Carr, 2001; Robinson, 2001) and they have earned the attention of state legislatures who enact laws to protect clients from abuse (General Assembly of North Carolina, 1998). In much of the discourse, “dual relationships” are treated as synonymous with “sex with clients.” Sex with clients is clearly unethical. However, there is a wide variety of more ambiguous multiple relationships the counselor can have with clients. During the last 10 years, these other types of dual relationships have earned increasing interest (Corey, Corey & Callanan, 1993) as recently exemplified by the expansion of the American Psychological Association’s Code of Conduct (American Psychological Association, 2002). This article will articulate the damaging aspects of these dual relationships, present a method for placing the relationships on a continuum of potential for harm, and suggest steps to prevent violations of the boundaries that protect clients and the public.

Examples of dual relationships in the addiction counseling field abound, ranging from the trivial to the deeply troubling (Corey et al., 1993). In general, a dual relationship occurs when a counselor has any relationship with a client or former client other than that of counseling. Counseling close relatives, friends, or neighbors; leading a Johnson-style intervention for an employee; hiring clients to do odd-jobs around the house; being a case manager as well as counselor for the same person; entering into a business partnership with a client; and (more alarmingly) soliciting or engaging in sexual contact with clients are all examples of dual relationships and risk serious boundary violations and harm to the client.

Two types of boundary violations
Dual relationships are boundary violations in two senses of the word “boundaries.” In the first sense, boundaries are the rules that govern counselors’ role-based behavior. As counselors, substance abuse professionals understand relationships. They do not provide blends of friendship, family ties, business partnerships, and clinical roles. The boundaries are the rules that clearly define the therapeutic role. Examples include the professional setting for counseling; the adherence to beginning and ending times of counseling sessions; and the limiting of how the counseling relationship intrudes into the private lives and time of the client and counselor. Some hug clients; some do not; some develop a sense of when and how to use physical touch in a way that is supportive but not inviting.

Some agencies assign duties so that case managers are not also a client’s primary counselor. Some counselors attend but do not speak at 12-Step groups. Clinical chaplains or ministers who are also substance abuse professionals may choose to close their private practices while serving a congregation. They might provide counseling within the ministry of the church, but no longer accept payment from clients.

These rules vary by community and agency standards. For instance, there is no universal dress code. However, a case could be made that sexually provocative clothing, for example, would be outside of that sense of boundary.

The second understanding of boundary is deeper, and relies on understanding psychodynamic ideas about ego. In this sense, there is an abstract understanding of a person’s identity or ego. The ego boundary is the construct containing all of the conscious and unconscious beliefs about oneself. When clients begin therapy, they are opening themselves up to influence. They take the counselor seriously, endowing him or her with important attributes about wisdom and care. This influence can go deeper than knowledge acquisition or skill learning. Clients may learn from the counselor, taking those lessons deeply into the ego. This is real vulnerability, even for those clients who show only a tough exterior. The primary responsibility of the addiction counselor is to protect that vulnerability and exercise careful influence toward health. Dual relationships are at their most damaging when they are an exploitation of the client that violates trust and causes a relationship wound. This relationship wound is the second and more harmful boundary violation.

Dual relationships are everywhere
Luckily, this type of violation is not likely when the dual relationship is of the trivial sort. Trivial dual relationships are more common when one practices within one’s own community. Networks of relationships are the nature of community. On the trivial end of the spectrum are brief encounters, such as unexpectedly finding one’s client is also one’s grocery bagger. Professionals in recovery may routinely see clients and former clients at 12-Step groups, and at gatherings of other recovering people. There is evidence that rural counselors are often faced with these “over-lapping” relationships (Schank & Skovholt, 1997).

But this is not only a rural issue — even in large cities, there are sub-communities. Often addiction counselors provide services to those in their own ethnic, religious, or cultural group. In fact, this type of outreach is one model of how service is best provided to members of diverse cultural groups. For example, many American cities are served by gay counselors in recovery who provide counseling mainly to other gay and lesbian people (Washington Blade, 2003). Providing service within one’s community helps establish trust and can quickly overcome many cultural barriers to successful therapy. The experienced addiction counselor knows to predict these chance occurrences. They rarely instigate true boundary violations or lead to client complaints, and they are not unethical. Handling them smoothly, warmly, and confidently is a matter of growth and competence.

These situations do pose practical challenges. For example, addiction counselors may find themselves no longer able to share openly within their chosen 12-Step group. Instead they might seek support primarily from a sponsor (or peer helper). Counselors may face choices about where to receive services themselves (even seemingly innocuous services like haircuts, dental cleanings, and banking can be awkward or worse).

There are a variety of creative strategies used to prevent these kinds of dual relationships. Careful therapists are sometimes forced to make intentional decisions about where they get to become “the client,” even if the service is a fairly public one like haircuts. In a different vein, it is not uncommon for a large community to have a few select counselors who regularly provide service to the children of other therapists. These respected counselors must then separate themselves somewhat from the local professional scene. Being a community’s trusted keeper of secrets and vulnerabilities can take some sacrifice. It can take work to prevent the overlap of roles in a community. For example, counselors who also pastor congregations may choose to terminate counseling relationships if their clients become members of their congregations.

What’s not ethical
More serious dual relationships develop when the relationships are the result not of chance but of bad decision-making. Providing counseling to family members, employees, students, supervisees, and co-workers is not ethical (for more on dual relationships in supervision, see p. 28). Establishing a counseling relationship distorts the nature of the previously established relationship. It sets the stage for conflicts of interest and makes issues of family participation, evaluation, promotion, and equality unclear. The counselor becomes more powerful, but not in a way that helps the therapy.

Counselors are powerful. They influence others dramatically, sometimes with the subtlest of expressions or utterances. Therein lies the power of the therapeutic relationship, but also the danger to the client. Peterson (1992) claims “as professionals we clearly have more power than our clients. Yet, we generally do not feel all that powerful” (p. 50). Whether addiction counselors experience their own power, clients often do. And in this situation, perception rules.

The purpose of boundaries
Counselors place boundaries around their work and their clients to protect both from the ambiguity that Marilyn R. Peterson, MSW, details in her book At Personal Risk: Boundary Violations in Professional-Client Relationships (1992). Evaluating the potential for harm to the client is one strategy for separating trivial dual relationships from those that are most troubling. Peterson provides guidance by revealing four aspects of dual relationships that help discriminate the trivial from the troubling:

1. A secret. Is the nature of the dual relationship something the counselor wants to keep a secret (from the client, from colleagues, from others)? Counselors having sex with clients keep their misconduct a secret, and they enlist their client-victims in that secret as well.

2. A reversal of roles. Has the client somehow become the provider of service, or the giver? Examples might include enticing a client to provide financial advice during sessions, or an action as overt as asking the client to help edit an article.

3. An indulgence of professional privilege. Has the goal been changed (typically “the client gets better” transforms into “the counselor’s needs get met”)?

4. A double bind. A situation has been created that the client cannot leave without getting hurt. He or she is in a “lose/lose” situation, where leaving any one of the relationships causes loss. Therapy is not possible at this point.

In trivial examples, such as the client who bags one’s groceries, there is no secret from the client, there is no serious change in the goal, and there is no double bind. Perhaps there is a superficial reversal of roles, but it is fleeting and poses no practical challenge or psychological boundary violation. Enticing a client into friendship, though, is more troubling. It does constitute a change in the goal, does create a double bind, and may have elements of reversal of role and secretiveness.

Understanding and preventing dual relationships
The wise addiction counselor seeks to understand why and how dual relationships develop and takes action to prevent them. Such a process could be guided by these suggestions:

1. Counselors are aware of opportunities for accidental dual relationships that commonly occur in community. They practice explaining why they cannot provide counseling to family members, or parishioners; they refrain from soliciting clients within their personal networks.

2. Counselors establish rules of behavior (a good idea whether in solo practice or within an agency). Specific rules are by no means universally accepted (note disagreement about physical touch). They should fit within the culture of the practice and community.

3. Counselors must see how their own humanness contributes to the success of their counseling. Corey, Corey, and Callanan (1992) consider this a primary issue for the counselor — the role of the counselor as a person in the therapeutic relationship.

4. Counselors are aware of the intense dynamic between counselor and client, which could be fleshed out in several statements:

a. Counseling is about intimacy; and intimacy engages everyone’s (even counselors’) deepest needs as people. This is particularly relevant for counselors in recovery, who may have a deep allegiance to the particular therapeutic path that is their own recovery. It can be hard to encourage clients who are choosing a different path.

b. Counseling is about influence (also known as power); and being open to counseling is about vulnerability.

c. And though we are told to avoid dual relationships, living in community sets one up to face that opportunity.

5. Counselors understand the issue of power. They develop insight and sensitivity to the presence of power in their work.

6. Counselors are sensitive to the vulnerabilities of their substance-abusing clients. They appreciate that clients with long histories of substance abuse may be cognitively impaired. Those with current or even historical addiction may need very clear relationship boundaries to be sure of the nature and scope of the therapeutic relationship. For example, having counseling group outside on a beautiful day might seem like a refreshing change of venue to the counselor, but could be perceived as an invitation toward friendship by clients.

7. Counselors notice the erosion of helpful boundaries before they become boundary violations. They notice when they are minimizing the power differential with the client; they notice when they attempt to equalize the power differential. They notice when they are unconsciously preparing to step over the line. They notice concrete signs such as:

a. Scheduling more frequent or late night appointments with a client.

b. Avoiding clinical supervision of work with a particular client.

c. Attending more to small talk or mutual interests than client issues.

d. Steering conversation toward the counselor’s needs.

e. Counselor disclosures that are excessive or not linked directly to the goal of furthering the client’s self-expression.

f. Feeling upset about how things are going in a client’s life, possibly indicating a degree of countertransference.

8. Counselors seek the highest quality clinical supervision. They provide tapes and video for review. They make supervision an integral part of their practice.

And lastly, ethical counselors make two commitments: to the honorable role of the addiction counselor who never exploits his or her position and to their own needs as human beings. If counselors are aware of their needs and how those needs play out through relationships, it is hoped they will not be motivated to step over the line, violating the very important boundaries that protect clients (Strean, 1993). As counselors cultivate their skills of self-awareness, deeply heal their own wounds, and create well-rounded and satisfying lives, everyone wins: the profession of addiction counseling is elevated; counselors will have more enjoyable and lasting careers; and clients will be both safe and challenged to grow toward health.

Adam Robinson, MA, CSAPC ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) is associate director of Program Services at Wake AHEC in Raleigh, NC, and former chair of the NC Substance Abuse Professional Certification Board Ethics Committee.

References
American Psychological Association. (2002). Ethical Principles of Psychologists and Code of Conduct. Retrieved August 8, 2003, from http://www.apa.org/
ethics/code2002.html The Washington Blade (2003). Classifieds. Retrieved September 5, 2003, from http://
www.washblade.com/classifieds
Carr, F. A. (2001, Winter). Message from the Chair, Update of North Carolina Social Work Certification and Licensure Board.
Corey, G., Corey, M. S., & Callanan, P. (1993). Issues and ethics in the helping professions. (4th ed.). Pacific Grove: Brooks/Cole Publishing Company.
General Assembly of North Carolina. (1998). Psychotherapy Patient/Client Sexual Exploitation Act. Retrieved August 8, 2003, from http://www.ncleg.
net/statutes/generalstatutes/HTML/byarticle/chapter _90/Article_1F.html
Peterson, M. (1992). At Personal Risk: violations in professional-client relationships. New York: W. W. Norton & Company.
Robinson, A. (2001). Annual report from the ethics committee. North Carolina Substance Abuse Professional Certification Board.
Strean, H. S. (1993). Therapists who have sex with their patients: treatment and recovery. New York: Brunner/Mazel Publishers.

This article is published in Counselor,The Magazine for Addiction Professionals, December 2003, v.4, n.6, pp. 24-27.

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