Nonsexual relationships between psychotherapists and their former clients: obligations of psychologists

This article examines the issue of nonsexual relationships between psychologists and their former therapy clients. What little research is available concerning nonsexual relationships with former clients suggests that psychologists have clear reservations about some of these relationships, especially personal ones and intentional social interactions. Relationships immediately following termination are seen as particularly suspect. Drawing on the literature dealing with multiple relationships in general, and sexual relationships with former clients in particular, a number of arguments are made outlining why psychologists should avoid significant nonsexual relationships with former clients for at least some period of time following termination.     

Managing Nonsexual Multiple Relationships in University Counseling Centers: Recommendations for Graduate Assistants and Practicum Students

Graduate students typically serve in a wide variety of positions throughout their course of study in an academic setting. Because of the large number of roles assumed, graduate students may encounter several ethical dilemmas unique to the academic setting, particularly dilemmas regarding nonsexual multiple relationships. Although the topic of multiple relationships and psychologists has been extensively discussed in the literature, fewer articles have focused on the potential for nonsexual multiple relationships between graduate assistants, practicum students, and undergraduate students. This article focuses on the unique ethical dilemmas and challenges experienced by graduate assistants completing their practica at University Counseling Centers and provides recommendations for evaluating and managing nonsexual multiple relationships with undergraduate students.     

Sexual Contact Between Psychologists and Patients

Summary

This article discusses sexualized dual relationships between psychologists and patients, including both sexual contacts while treatment is in progress and after its termination. The reported prevalences of sexual contact between psychologists and patients and between psychologists and former patients are discussed as well as practitioners attitudes towards these two types of relationships. The profiles of both psychologists and patients likely to be involved are outlined as are the clinical and professional consequences of these behaviours. Finally, the APA Ethics Code (2002) is examined to determine whether its inclusions in these areas are adequate and to shed more light on clinicians' continued roles and responsibilities even after treatments have concluded.     

Sexual Contact During and After Professional Relationships: Practices and Attitudes of Female Counselors

A national sample of female counselors (N = 377) was surveyed regarding sexual contact in professional relationships. Few respondents reported engaging in sexual contact either during or following professional relationships with clients, supervisees, or students. Individuals with doctoral degrees were more likely to have engaged in sexual contact with their own counselors, supervisors, or teachers. Counselors viewed sexual contact in current professional relationships as less ethical than contact in subsequent relationships, although relationships with former clients were seen as less ethical than relationships with former supervisees or students. Compared with male counselors from a previous study, female counselors were less likely to report sexual contact in their professional roles. Implications for research and training are discussed.     

Sexual intimacies with clients after termination: should a prohibition be explicit?

The Revisions Task Force of the Ethics Committee of the American Psychological Association (APA) has proposed that prohibition of sexual intimacies with clients after termination of therapeutic relationships be made an explicit part of the new code. This decision was based on much careful deliberation and input from various individuals and groups. This article supports the proposed change and provides a rationale based on emerging theoretical positions and research findings regarding risks to clients, risks to professionals, and risks to the various mental health professions. The revision would read, "Psychologists do not engage in sexual intimacies with current or former psychotherapy clients."     

Internet Research: An Opportunity to Revisit Classic Ethical Problems in Behavioral Research

The Revisions Task Force of the Ethics Committee of the American Psychological Association (APA) has proposed that prohibition of sexual intimacies with clients after termination of therapeutic relationships be made an explicit part of the new code. This decision was based on much careful deliberation and input from various individuals and groups. This article supports the proposed change and provides a rationale based on emerging theoretical positions and research findings regarding risks to clients, risks to professionals, and risks to the various mental health professions. The revision would read, "Psychologists do not engage in sexual intimacies with current or former psychotherapy clients" (see "Ethical Principles Revised," 1990).     

Dual Relationships: A Continuum Ranging From the Destructive to the Therapeutic

This article is a review of the literature regarding the nature, scope, and complexity of dual relationships, which range from the destructive to the therapeutic. The dynamics, consequences, standards of practice, and ethical dilemmas regarding sexual and nonsexual counselor–client dual relationships are discussed. Common elements of concern pertaining to both types of relationships are identified, and the potential benefits of some forms of nonsexual dual relationships are explored.     

Posttermination Friendship Between Counselors and Clients

This study examined counselors' behaviors and attitudes regarding friendships and sexual relationships with former clients. A random sample of 96 members of the American Mental Health Counselors Association responded to our survey. Although a minority of counselors (33%) believed that posttermination sexual relationships might be acceptable 5 years after termination, only 4% admitted to engaging in such relationships. In contrast, 70% of the counselors believed that posttermination friendships were acceptable 2 years (on average) after termination and 33% acknowledged that they had engaged in such friendships. Potential harm to the client was the most important concern expressed by the counselors. Ethical and research implications are discussed.     

Working in Indigenous Contexts: Self‐Reported Experiences of Non‐Indigenous Australian Psychologists

Despite assertions in the literature that psychologists adopt culturally inappropriate strategies for working with Indigenous clients, there is little empirical evidence about this. The aim of this study was to document the self‐reported experiences of non‐Indigenous psychologists working with Indigenous clients, the factors that they felt constrain these interactions, and the clinical, assessment and communication strategies they perceived as effective in Indigenous contexts. Structured interviews were held with 23 psychologists, 18 females and five males, with age groups ranging from 20–30 to 50+. Thematic analysis of the data revealed that participants experienced contradictions between the typical Western white psychologists' ways of interacting with clients, which they had been taught and the typical ways in which relationships are structured in Indigenous communities. The results suggest that the Western model of psychological training does not work very well in Indigenous contexts, and that psychologists working in Indigenous contexts have to work out their own methods on a trial‐and‐error basis. This points to the need for more systematic cultural competence training. However, there is a lack of research into the effectiveness of psychological intervention from the viewpoints of Indigenous clients themselves.     

Treatment of Deaf Clients: Ethical Considerations for Professionals in Psychology

Providing therapy to deaf clients raises important ethical considerations for psychologists related to competence; multiple relationships and boundary issues; confidentiality; assessment, diagnosis, and evaluation; and communication and using interpreters. In evaluating and addressing these, psychologists must consider the American Psychological Association’s Ethics Code and other relevant issues (e.g., Americans with Disabilities Act) necessary to provide ethical treatment. The current article provides background, ethical considerations, principles and standards relevant to the treatment of deaf clients, and recommendations to support psychologists, training programs, and the field. Psychologists have the responsibility to guarantee that the benefits of mental health treatment are fairly and justly provided to this traditionally underserved population.     

Counseling Regulations Regarding Sexual Misconduct: A Comparison Across States

Sexual relationships with clients, former clients, and supervisees are some of the most powerful and difficult clinical issues for counselors. These issues force counselors to examine the heart of the therapeutic process: the counseling relationship. The purpose of this study was to gather and analyze different approaches used by state counseling boards to deal with sexual relationships in counseling and supervision. This information affords counselors and state licensure board members a broader view of options and issues involved in this difficult area of ethical decision making.     

'No-show': therapist racial/ethnic disparities in client unilateral termination

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.     

Therapeutic Practices and Ethical Beliefs of Professionals Working With Adolescents in Residential Treatment

The authors investigated dual relationships between 2 groups of staff (direct care and professional) and adolescent clients in 2 residential treatment programs. Staff were surveyed on their behavior and corresponding ethical beliefs regarding interactions they believed to be acceptable with minor clients specifically at termination of the treatment program. Direct care staff were more likely than were professional staff to have inconsistencies in behaviors and ethical beliefs. The American Counseling Association's (1995) Code of Ethics would prohibit some of the staff beliefs regarding acceptable behavior. Both groups were uncertain about the ethical appropriateness of certain interactions with adolescent clients. Implications are discussed.     

Dual relationships in psychotherapy

A dual relationship in psychotherapy occurs when the therapist engages in another, significantly different relationship with the patient. The two relationships may be concurrent or sequential. For both sexual and nonsexual dual relationships, men are typically the perpetrators and women are typically the victims. This article presents examples of dual relationships, notes the attention that licensing boards and other agencies devote to this topic, reviews the meager research concerning nonsexual dual relationships, and discusses common strategies that promote both sexual and nonsexual dual relationships.     

Human rights and applied psychology

Applied and community psychology necessarily involves the consideration of human rights issues. The problems experienced by many of the clients of applied psychologists result from human rights abuses, the provisions of the Human Rights Act (1998) relate to the everyday practice of applied and community psychologists, and psychologists have a distinctive perspective on human rights. For psychologists, human rights reflect formalized systems for ensuring that people's basic needs are satisfied. Declarations of human rights and legal provisions therefore represent, for psychologists, codifications of how we collectively understand our relationships and social obligations. It is therefore argued that psychologists should positively advocate for the application of psychological science to these issues. Copyright © 2007 John Wiley & Sons, Ltd.     

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.     

Advertised Australian counselling psychologists: A descriptive survey of their practice details and self perceived competence in six counselling psychology practice areas

This survey research in a field setting aimed to describe psychologists who advertised themselves in the Australian Yellow Pages as counsellors, thus providing a snapshot of advertised counselling psychologists in Australia. Data was collected using a multiple mailing survey method and resulted in a 62.2% return rate. The psychologists’ (a) demographic characteristics, (b) training and development, (c) provision of services, (d) professional involvement, and (e) their self perceived competence in working with (i) depression, (ii) anxiety, (iii) substance use, (iv) clients from non English speaking backgrounds and Indigenous and Torres Strait Islander individuals, (v) clients who are same sex attracted (gay, lesbian, and bisexual individuals), and (vi) clients using electronic mail and instant messaging were assessed. Advertised Australian counselling psychologists tend to be female, mature and Caucasian. The majority of the psychologists surveyed live in urban areas. Master and Bachelor level degrees were most often reported, a minority held doctoral degrees. The average psychologist charged $96.32 per hour, less than the Australian Psychological Society (APS) recommended fee for an hour of service. Eclectic and cognitive behaviour therapy were indicated most often as the theoretical orientations guiding psychological work. Psychologists belonged almost exclusively to the Australian Psychological Society as a professional association. Surprisingly, 2.9% of psychologists indicate not following an ethical code in their work and 3.9% failed to ensure that their work was covered by professional indemnity insurance. Advertised psychologists are thus described and suggestions are given for the further development of the profession. Regarding their self perceived competence, Australian advertised psychologists present as having self perceived strengths and areas of weakness regarding their counselling competence. This indicates that they are aware of their varying ability to work with various issues and populations. The self perceived competence of Australian psychologists in six specific counselling practice areas and suggestions for future training and development are provided.     

Sanctions for ethics violations: does licensure of socioeconomic status matter?

Although sexual relationships between therapists and their clients are unethical, such beahviors still occur. This study investigated whether psychologists with applied versus nonapplied training differed in the severity of sanctions advocated for psychologists charged with sexual ethical violations toward high- or low-socioeconomic status victims. Licensed and Nonlicensed psychologists (N=48) viewed a 15-min videotape simulating the adjudication process about an alleged sexual involvement between client and psychologist, then prescribed either: Dismissal of Charges, Educative Advisory, Educative Warning, Reprimand, Censure, Stipulated Resignation, Permitted Resignation, or Expulsion. The alleged victim was described as a college professor of home economics or a hairdresser. Licensed psychologists chose more severe sanctions ("Stipulated or Permitted Resignation") than did Nonlicensed psychologists ("Censure"). Socioeconomic status made no significant difference in sanctions. Apparently, applied therapy training results in more severe judgements toward those who violate American Psychological Association ethical guidelines than other types of psychology training.     

Sexual Attraction and Religious Therapists: Survey Findings and Implications

Five hundred Christian therapists returned surveys describing their beliefs and behaviors regarding sexual attraction and sexual expression toward their clients. Four groups of Christian therapists responded: psychologists, licensed therapists, nonlicensed therapists, and lay counselors. Christian therapists' responses are compared with those from a similar survey of 456 psychologists selected without regard to religious values. Most groups of Christian therapists are less likely than previously surveyed psychologists to report sexual attraction and fantasy toward clients, but the differences between Christian psychologists and other psychologists are minimal. Religious factors that may increase the stigma of admitting sexual attraction are considered.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.