Speaking the Unspeakable

The Ethics of Dual Relationships in Counselling and Psychotherapy

Lynne Gabriel

• Publisher: Routledge
• Year: 2005
• Print ISBN:
  9781583919842
• eBook ISBN:
  9781135443672
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Are dual relationships always detrimental? Speaking the Unspeakable provides an in-depth exploration of client-practitioner dual relationships, offering critical discussion and sustained narrative on thinking about and being in dual relationships.

Lynne Gabriel draws on the experiences of both practitioners and clients to provide a clear summary of the complex and multidimensional nature of dual relationships. The beneficial as well as detrimental potential of such relationships is discussed and illustrated with personal accounts. Subjects covered include:
· roles and boundaries in dual and multiple role relationships
· client experiences and perceptions of being in dual and multiple role relationships
· developing a relational ethic for complex relationships

This book offers an insightful and challenging portrayal of dual relationships that will be welcomed by therapists, trainers, trainees and supervisors.

Chapter 1
Introduction and overview

This book offers a detailed and compelling story of dual and multiple role relationships in counselling and psychotherapy. It breaks new ground in offering sustained narrative on practitioner and client experiences of being in dual and multiple role relationships. At this stage, it is important to clarify what I mean by dual relationship. I define it here as:

a one-to-one contracted therapy relationship between an individual in the role of ‘client’ and one in the role of ‘therapist’ which then overlaps into a non-therapy context or role. The overlapping contact occurs while there is a current therapy relationship, or before the therapy relationship is formed, or beyond its cessation. The non-therapy contact is friendship, social, sexual, collegial, financial or business oriented.

Part of the book’s title – Speaking the unspeakable – arises directly from the accounts of client and practitioner experiences and perceptions of being in dual or multiple role relationships. In order to respect and validate their experiences, I chose to include this phrase in the title. While the unspeakable suggests a taboo and damaging experience, it also symbolizes beneficial and rewarding dual relationship experiences for clients and practitioners. My aim was to make the text an accessible training and practice resource that will be of value to a wide range of individuals involved in the helping professions – including practitioners, clients, trainers, supervisors and service providers.

Dual relationships are a reality for many therapists. Paradoxically, until recently, the majority of counselling texts have tended to ignore the subject, with some taking a rigid prohibitive stance (Pope, 1985, 1988a, 1988b, 1991, 1994; Pope and Bouhoutsos, 1986; Pope and Feldman-Summers, 1992; Pope, Levensen and Schover, 1979; Pope, Tabachnick and Keith-Speigel, 1987; Pope and Vasquez, 1998; Pope and Vetter, 1991). Recent UK and USA contributions to the body of knowledge on the subject offer an alternative understanding and broaden the area to include debates on non-sexual, consensual dual relationships (Gabriel, 2001c; Lazarus and Zur, 2002; Syme, 2003).

Despite prohibitions on unorthodox contact between therapist and patient, historically, eminent practitioners did engage in non-therapy contact with their patients. Jung, Ferenczi and Rank had sexual relationships with their patients (Mann, 2001), Freud regularly met his patients outside the confines of the analytical space and Klein analysed her own children (Masson, 1985). In recent years, Thorne (1987) disclosed his willingness to extend the usual parameters of the client–therapist work and relationship into sexual dimension and contexts. His disclosure sparked a furious row within the profession and led to bitter wranglings and swift reactions from professional bodies through increasing prohibitive codes of ethics and practice (for example, BAC, 1998).

Given the diversity and complexity of contemporary social, cultural and professional contexts, the power and prevalence of a dual relationship taboo might seem a bizarre phenomenon. For instance, there are increasing cases of clients and their therapists encountering one another in numerous non-sexual contexts. Of key significance in any opposition to dual relationships is the association they have with sexual relationships between clients and their therapist. However, this emphasis ignores the domain of non-sexual dual relationships between clients and their current or former therapist. For instance, there are many examples of clients and their therapists successfully living and working in the same locale (Gabriel, 2001c; Gabriel and Davies, 2000; Lazarus and Zur, 2002). There is little published material about this type of relationship, yet assumptions abound about the potential for harm. Significantly, aside from literature by clients about their experience of therapy (see, for example, Heyward, 1993; Sands, 2000, 2002), we know relatively little about the client’s perspective on client–therapist relationships.

In view of the extent of opposition to dual relationships and the lack of pragmatic texts and resources, the prospects for naϊve or inexperienced practitioners who encounter them is likely to be poor. Consequences for clients in dual relationships with ineffective or unintentionally abusive practitioners are probably grim. The consequences for clients in relationships with intentionally abusive practitioners are bleak. Paradoxically, the potential for the practitioner to be harmed in a dual relationship is rarely considered. If dual relationships were on a spectrum that ranged from unacceptable to acceptable and their current status was firmly located at the ‘unacceptable’ end, I sense we are about to witness a shift towards the acceptable end and see a concurrent increase in texts on nonsexual, non-abusive relationships. With this in mind then, a key aim here is to offer insight into and understanding of harmful and helpful dual relationships and broaden the debate on ethical duality and diversity in helping relationships.

The book’s conception

My interest in dual relationships grew from a small-scale qualitative project I conducted in the early 1990s as part of an MEd. in counselling (Gabriel, 1996). On that occasion, I researched therapists’ experiences of boundaries in lesbian therapist–lesbian client relationships. Findings revealed that most were concerned about how to manage therapy relationships that overlapped into non-therapy contact and contexts. Throughout the early and mid-1990s I also personally experienced a number of overlapping social and professional contacts with former and current clients. Looking for resources to help me deal with these situations, I discovered that few supportive or advisory texts were available. Dual relationship literature at that time was virtually non-existent in the UK, although some texts and articles existed in the US field. Paradoxically, however, there seemed to be an unspoken convention, condoning those relationships that did occur. Essentially, it was a case of learning through trial and error how best to respond to the relational issues that arose. Fortunately, I had good supervision, as well as several colleagues who had experience of dealing with dual relationships and were willing to discuss and share ‘good practice’.

My curiosity led me to want to hear from others who had engaged in a dual relationship, to find out how they had dealt with these relationships and to discover what could be learned from their experiences. The lack of pragmatic and accessible material for clients and therapists currently in a dual relationship, for those contemplating entering one, those who anticipate or expect to be in one, or anyone wanting to explore them at a conceptual and theoretical level, is problematic. However, recent publications in the UK and USA (Lazarus and Zur, 2002; Syme, 2003) have gone some way to redress this.

My research, practice and writing are informed and influenced by a range of philosophies and theories. My core practitioner training was based on humanistic psychology. Although I have no formal psychodynamic training, I spent several years in psychodynamic therapy and supervision and draw on psychodynamic thinking to inform my helping work. In recent years, I have been increasingly drawn towards social constructionist ideas and welcome a view of the world that embraces diversity and difference, recognizes multiple realities and acknowledges the role our social history and context play in human experience and perception.

In addition to the personal and professional influences outlined above, there are other professional matters that impact on the existence and timing of this text. In particular, I refer to the rapidly developing identity of the counselling and psychotherapy field. In relation to the status and identity of ‘counselling’ and ‘psychotherapy’ as a unified helping ‘profession’ within the UK, it is likely that a more corporate and cohesive identity will arise through the anticipated compulsory regulation and registration for counselling and psychotherapy practitioners. However, the categories and clauses of a system for regulating practitioners and their services have yet to evolve. Nevertheless, despite the uncertainty around the future of compulsory regulation, or questions about a cohesive identity for counselling and psychotherapy, principles of ethical practice and a degree of professional status and identity already exist, promoted by the codes of ethics and practice and the registration schemes of professional organizations such as the British Association for Counselling and Psychotherapy (BACP) and the United Kingdom Council for Psychotherapy (UKCP). For ease of reference, I refer to ‘the counselling and psychotherapy field’ as ‘the profession’.

Overview of the chapters

Key areas covered across the chapters include:

• the complex, multidimensional nature of dual and multiple role relationships;
• client and practitioner experiences of being in dual or multiple role relationships;
• client and therapist thinking on how to/how not to respond in different roles;
• client and therapist capacity to sustain self in complex relational situations;
• relational intimacy in client–therapist relationships;
• the individual’s intentionality in the relationship;
• the notion of the client’s and therapist’s relational responsibilities;
• the idea of forming a relational ethic for helping work and relationships.

In Chapter 2, I examine attitudes towards and beliefs about dual relationships. First, I construct a working definition of ‘dual relationship’, then go on to briefly discuss dual relationship classifications and consider questions of relationship type, including whether they are intentional or unintentional. I note several conflicts and confusions about dual relationship status and identity that are conveyed by the question, ‘just what is a dual relationship?’ Chapter 3 addresses the taboo on dual relationships and shows how prohibitions on sexual dual relationships have influenced attitudes towards all non-sexual and non-therapy relations between clients and therapists (here the terms ‘client’ and ‘therapist’ refer to individuals either currently or previously in the roles of client and therapist). Issues of whether, and how, to break the taboo on speaking out about dual relationships are considered. I examine claims about the harmful nature of dual relationships between clients and their therapists and review evidence on the type of damage that can occur. I consider relevant US and UK theoretical and empirical work, discuss how it informs dual relationship conventions, attitudes and practices and suggest that traditional psychotherapy theory is invoked to support prohibition, rather than used to critically conceptualize or pragmatically inform the complex relational situations that are likely to arise in dual relationships. In Chapter 4, I consider non-sexual dual relationships and dominant discourses that influence our thinking about these relationships.

In Chapter 5, I discuss specific opposition to client–therapist dual relationships that is based on the belief that dual relationships create role and boundary problems. To inform the discussions, I draw on concepts and insights from a number of psychosocial and relational approaches to therapy, including humanistic, psychodynamic and role theory. Chapter 6 identifies and examines significant ethical and moral dimensions of dual relationships, including professional beliefs, expectations and ethics in relation to client autonomy, therapist fidelity and relational integrity.

Ideas and developments from biomedical and nursing ethics (Beauchamp and Childress, 1994; Parker, 1991; Sim, 1997), feminist critiques and representations of ethics (Chase, 1996; Gilligan, 1982; Koehn, 1998; Sherwin, 2001), as well as narrative-informed ethics (Almond, 1998; Josselson, 1996; Widdershoven and Smits, 1996) inform my discussions. I consider principles, virtues and rights in the context of relational issues that are thought to occur in dual relationships. Client and practitioner experiences of dual relationships are represented in Chapters 7, 8 and 9. Chapter 7 provides an overview, while Chapters 8 and 9 give detailed client and practitioner experiences of being in dual and multiple role relationships. In Chapter 10, I posit a relational ethic for dual relationships and Chapter 11 concludes the text.

While the book represents a comprehensive review of the issues of dual relationships in counselling and psychotherapy, it nevertheless is a partial representation, set as it is against the contemporary UK counselling and psychotherapy field and informed by contributions from the literature and research. I offer it as a thought-provoking contribution that will stimulate further debates.

Although I have chosen to define terms used infrequently in the text in the context in which they arise, commonly used terms are clarified here. Throughout, the pronouns ‘she’ and ‘he’ are used as and where appropriate. The terms ‘counselling’ and ‘counsellor’, as well as ‘psychotherapy’ and ‘psychotherapist’, are used at various points. Usually the inclusive terms ‘therapy’ and ‘therapist’ or ‘practitioner’ are substituted.

This terminology does not aim to exclude particular theoretical orientations, practices or practitioners, but instead seeks to move away from any divisive stance associated with disagreements and divergent thinking about these professional titles. The terms used here represent those who identify as counsellors who counsel their clients, those who identify as psychotherapists who engage in psychotherapy, as well as those who lay claim to both.

Chapter 2
Dual and multiple role relationships in counselling and psychotherapy

we need to come to terms with the fact that some of the psychotherapeutic profession is in a state of denial around dual relationships, role confusion and the inadvertent and unintentional interpenetration of role boundaries.

(Clarkson, 1994: 37)

WHAT DO WE MEAN BY THE TERM DUAL RELATIONSHIP?

Attitudes have not changed much in the years since Clarkson (1994) argued that the therapy profession was in a state of denial and confusion about dual relationships. Many of us might continue to be uncertain about what we actually mean by the term dual relationship. Interpreting it is a helpful starting point. According to the British Association for Counselling and Psychotherapy (BACP, 2002), dual relationships ‘arise when the practitioner has two or more kinds of relationship concurrently with a client, for example, client and trainee, friend and client, colleague and supervisee’. On the other hand, the British Psychological Society (BPS) have regarded dual relationships as those ‘in which individuals engage in a personal loving and/or sexual relationship with someone to whom they also have professional responsibilities’ (BPS, 1997: 36) as well as those ‘in which the psychologist is acting in at least one other role besides a professional one’ (BPS, 1997: 39).

For example, a dual relationship exists where a client and her/his therapist also share supervisee and supervisor contact. It exists where a client–therapist relationship (a current or previous relationship) develops into an intimate and loving friendship or a sexual relationship. This raises questions regarding what constitutes sexual and non-sexual dual relationships; an area that until recently received little attention (Gabriel, 2001c; Gabriel and Davies, 2000; Lazarus and Zur, 2002; Syme, 2003). How might we distinguish between the qualities or characteristics of a sexual or a non-sexual dual relationship? A sexual dual relationship could appear relatively simple to identify, whereas a non-sexual one might seem a more complex phenomenon to interpret. Pope and Vasquez (1998) believe that non-sexual dual relationships occur when:

the therapist is in another, significantly different relationship with one of his or her patients. Most commonly, the second role is social, financial, or professional. In some cases, one relationship follows the other. The mere fact that the two roles are apparently sequential rather than clearly concurrent does not, in and of itself, mean that the two relationships do not constitute a dual relationship.

(1998: 190–1)

We can also distinguish between non-therapy and therapy contact, as in Gabriel’s (2001c) definition, suggesting that a dual relationship occurs when:

a one-to-one contracted therapy relationship between an individual in the role of ‘client’ and one in the role of ‘therapist’ overlaps into a non-therapy context or role. The overlapping contact occurs whilst there is a current therapy relationship, or before the therapy relationship is formed, or beyond its cessation. The non-therapy contact might be friendship, social, sexual, collegial, financial or business oriented.

(Gabriel, 2001c)

A wide-ranging definition of dual relationship phenomena is offered by Lazarus and Zur (2002: xxvii) who suggest that these relationships are ‘virtually any association outside the “boundaries” of the standard client–therap...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• ACKNOWLEDGEMENTS
• CHAPTER 1: INTRODUCTION AND OVERVIEW
• CHAPTER 2: DUAL AND MULTIPLE ROLE RELATIONSHIPS IN COUNSELLING AND PSYCHOTHERAPY
• CHAPTER 3: SEXUAL DUAL RELATIONSHIPS
• CHAPTER 4: NON-SEXUAL DUAL OR MULTIPLE ROLE RELATIONSHIPS
• CHAPTER 5: ROLES AND BOUNDARIES IN DUAL AND MULTIPLE ROLE RELATIONSHIPS
• CHAPTER 6: DUAL RELATIONSHIPS AND RELATIONAL ETHICS
• CHAPTER 7: CLIENT AND PRACTITIONER DUAL AND MULTIPLE ROLE RELATIONSHIPS
• CHAPTER 8: CLIENT EXPERIENCES OF BEING IN NON-SEXUAL DUAL AND MULTIPLE ROLE RELATIONSHIPS
• CHAPTER 9: PRACTITIONER EXPERIENCES OF BEING IN NON-SEXUAL DUAL AND MULTIPLE ROLE RELATIONSHIPS
• CHAPTER 10: DEVELOPING A RELATIONAL ETHIC FOR COMPLEX RELATIONSHIPS
• CHAPTER 11: CONCLUDING COMMENTS
• APPENDIX 1: SAMPLE QUESTIONS FOR ASSESSING DUAL AND MULTIPLE ROLE RELATIONSHIP SITUATIONS
• APPENDIX 2: GUIDANCE FOR ETHICAL DECISION-MAKING: A SUGGESTED MODEL FOR PRACTITIONERS
• APPENDIX 3: USEFUL CONTACTS
• BIBLIOGRAPHY