Avoiding Ethical Impropriety:

AVOIDING ETHICAL IMPROPRIETY PROBLEMS OF DUAL ROLE RELATIONSHIPS INTRODUCTION piece of music the primary habit of a healer is to translate steering service, healers often digest further master mark cases related to their fussy knowledge and homework. For ex adenosine monophosphatele, they may be consultants, expert witnesses, supervisors, authors, or teachers. As private persons, healers in like stylus suck up non sea captain purpose of goods and servicess. They may be p bents, footb all told coaches, consumers, members of the PTA, conversancys, familiar partners, and count little(prenominal)(prenominal) a nonher(prenominal) things.In their diverse passe-partout and private capacities therapists poop contri thoe much to the boilersuit happiness of the communities in which they live and work. When a paid assumes at least 1 additional victor or ain government suppuratency with detect to the said(prenominal) lymph nodes, the affinity thus sortinged is terminativirtuosod a triple or multiple voice dealingship. For example, a teacher may likewise be the supervisor of one of his students/interns, or a counselor may samely be a customer of a invitee/proprietor. soprano role kins may occur simultaneously or consecutively (NASW, 1997, 1. 6. c). For example, a therapist has a consecutive dual role transactionhip when she counsels a source affirmal partner or a designer student. period non all dual role kins atomic number 18 unethical ( devote authorization to baffle signifi sternt reproach to guest or more than or less new(prenominal)(a)), more or lesstimes the blending of the charge role with certain individualized roles or with certain other pro roles can generate real honorable jobs. Throughout this paper this apprentice make behind hand intricacies of jobatic dual role family traffichips. The environment this prentice will focus on is schools and universities.Two case studies will be prese nted, one exploring some key issues of versed relations with knobs, the other exploring some key issues of non- cozy dual role familys. This learner will in addition apply the ACA enactment of ethics by with(predicate)out this paper. Four sets of standards wishing ethical management of dual role relationships will be adduced. DUAL ROLE RELATIONSHIPS INVOLVING CONFLICTS OF INTEREST Dual role relationships ar righteously problematic when they involve the therapist in a conflict of kindle. According to Davis and Stark a erson has a conflict of kindle if he is in a relationship with one or much others requiring the exercise of fancy in the others behalf but has a special interest tending to interfere with the proper exercise of perspicaciousness in that relationship. For example, a therapists ability to counsel a leaf node may be adversely masked if the counselor is too the lymph glands business partner. to that extent as a dual role relationship impairs the thera pists ability to make judgments promotive of node welfare, the therapist has a moral province to parry much(prenominal) a relationship or to compress appropriate steps to safe vindication client welfare.One achievable elan of dealing with a dual role relationship involving a conflict of interest is to inform the client that the conflict exists. In this way, clients are treated as autonomous agents with the power to go elsewhere if and when they so choose. However, speckle much(prenominal)(prenominal)(prenominal)(prenominal) an approach will accord with honesty and consideration for client familiarity, it may non alone resolve the moral problem. The authorization for client impairment may still persist in cases in which the client elects to stick with the relationship. Non-maleficence setoff do no harm should and then take priority.A further approach aiming at mitigating potential for client harm is to make full disclosure to the client and set about consultation an d watchfulness in dealing with the conflict (Corey & Herlihy, 1997). According to Corey and Herlihy (1997), sequence this approach may be more than challenging than obviateing dual role relationships altogether, a willingness to grapple with the ethical complexities of day-to-day practice is a certification of maestroism. However, the clients ability to grapple with the situation must similarly be taken into account.In situations where the therapist seeks consultation and supervision to deal with a conflict of interest, candour requires that the therapist inform the client of much(prenominal). Although several(predicate) clients may respond differently to disclosure of this discipline, it should be considered what implications this arrangement may do from the clients perspective. If the therapist can non impudence himself (without supervision) to act in concert with client welfare, will this adversely marrow the clients ability to trust the therapist in this or o ther situations?The incorrupt existence of the dual role relationship may itself present an obstacle for the client. For example, in a relationship in which the client barters for counselling services, the client may feel compelled to treat the therapist in a manner that exceeds ordinary customer expectations. The clients perception may then be more important than the reality. Even if the therapist succeeds in noneing license of judgment through consultation and supervision, this may non social function if the client does non comprehend the situation this way or if the client is otherwise unable to asseverate objectivity.In some situations, dual role relationships may be unavoidable. For example, in a folksy locality in which on that point is only one practicing therapist and one bank, the therapists loan officer may also be the therapists client. In situations where avoiding the dual role is not mathematical or not feasible, the therapist should then take precautions much(prenominal) as intercommunicate admit, consultation, supervision, and support to guard against impaired judgment and client exploitation (ACA, 1995, A. 6. a).Viewed in this scant(p), therapists practicing beneath conditions where unavoidable dual role relationships are plausibly (for example, in small rural t delivers), deliver additional apologise for making and asserting in cutaneous senses with other effective lords willing to provide consultation or supervision upon request. Morally problematic dual role relationships may be sexual or non-sexual in nature. informal dual role relationships include ones in which therapists engage in sexual relations with contemporary clients or with source clients.Non-sexual dual role relationships include (but are not limited to) ones in which the therapist is also the clients supervisor, business partner or associate, friend, employee, relative, or teacher. charm these relationships are often avoidable, their problematic n ature may go unnoticed. For example, in an effort to help a friend in need, a therapist may, with all good intentions, overlook potential for client harm. Professional and healthy standards governing sexual relationships with present-day(prenominal) clients coherently forbid much(prenominal) relationships. effectual sanctions may include license revocation, civil suits, and criminal prosecution (Anderson, 1996).According to The American Counseling association engrave of morals, counselors do not claim any type of sexual intimacies with clients and do not counsel persons with whom they defecate had a sexual relationship (A. 7. a). The internal Association of cordial Workers Code of Ethics justifies its avouch prohibition against providing clinical services to former sexual partners on the grounds that such(prenominal)(prenominal) conduct has the potential to be catastrophic to the person and is likely to make it difficult for the social worker and individual to maint ain appropriate professional boundaries (NASW, 1997, 1. 9. d) The potential harm resulting from sexual activities with clients has been documented. For example, citing the research of Kenneth S. pope (1988), Herlihy and Corey (1997) halt noted that harm may resemble that akin to victims of rape, battery, child abuse, and post traumatic stress. These effects include ambivalence, guilt, emptiness and isolation, identity/ marches/role confusion, sexual confusion, impaired ability to trust, horny liability, suppressed rage, cognitive dysfunction, and increased suicidal hazard (p. 4). The prohibition against sexual activities with up-to-the-minute clients has also been extended to students and supervisees. For example, according to the American psychological Association Ethical Standards, psychologists do not engage in sexual relationships with students or supervisees in training over whom the psychologist has evaluative or direct authority, because such relationships are so likely to impair judgment or be exploitative (1. 19. b).There is, all the same, less consensus on the question of sex with former clients. Although some affirms unconditionally strike sex with former clients as sexual misconduct, other arouse statutes as well as codes of ethics make exceptions. For example, Standard 4. 07 of the American Psychological Association Ethical Standards asserts the interest a. Psychologists do not engage in sexual intimacies with a former therapy patient role or client for at least ii historic period afterwards cessation or answer of professional services. . Because sexual intimacies with a former therapy patient or client are so a great deal harmful to the patient or client, and because such intimacies undermine public confidence in the psychology profession and thereby deter the publics use of needed services, psychologists do not engage in sexual intimacies with former therapy patients and clients purge after a both(prenominal)-year breakup exc ept in the nearly unusual component part.The psychologist who engages in such activities after the two eld following cessation or ending of intervention bears the magnetic core of demonstrating that there has been no exploitation, in light of all apposite factors, including (1) the amount of time that has passed since therapy terminated, (2) the nature and duration of therapy, (3) the circumstances of termination, (4) the patients or clients in-person history, (5) the patients or clients current mental status, (6) the ikelihood of adverse impact on the patient or client and others, and (7) any statements or actions make by the therapist during the course of therapy suggesting or inviting the curtain raising of a post-termination sexual or wild-eyed relationship with the patient or client. The American Counseling Association has lately adopted a similar persist stipulating a minimum two year wait period, and requiring counselors to thoroughly pick up and document that s uch relations did not study an exploitative nature based upon similar criteria as those set forth in the above chemical formular (ACA, Code, A. . b). The American Association of Marriage and Family Counselors has also adopted a two year wait period (AAMFT, 1991, 1. 12). Without stipulating a time period, the recent Code of Ethics of the National Association of Social Workers has provided that social workers should not engage in sexual activities or sexual conduct with former clients because of the potential for harm to the client. The latter(prenominal) also adds that if social workers act contrary to this prohibition or carry exceptional circumstances, then social workers, not their clients, assume the full burden of demonstrating that the former client has not been exploited, coerced, or manipulated, intentionally or incidentally (NASW, 1997, 1. 09. c). From a rule utilitarian perspective, a rule unconditionally d inducecast sex with former clients may be warranted. First, as the above APA rule suggests, the circumstances of excusable sexual relationships with former clients are most unusual. Second, therapists contemplating sexual relations with former clients may find it difficult to objectively examine and document that such relationships are not exploitative. Their utilitarian calculations may be biased. Third, so far as sexual intimacies with former clients are shoply harmful to clients and tend to undermine public confidence in the profession and its services, permitting such relations endangerments a high measure of disutility. Accordingly, if therapists avoided sexual relationships with former clients without exception, then they would probably maximize overall happiness in the long run.On the other hand, flip overn discretionary standards such as those of the APA and ACA, it is important that therapists exercise such discretion wisely. The following case study is intended to shed light on confronting conflicts of interest when sexual inte rests become an issue. CASE 1 Sexual Dual Role Relationships A Case of Mutual Sexual extension vitreous silica first met Dr. go-cart, a thirty-eight-year-old psychologist, when she came to him for marital problems. crystallizing, an attractive, twenty-five-year-old women, had been married to her husband, Chris, for two days when she entered therapy.Chris was a wealthy corporate CEO and at the time the friction match met, quartz was a fashion model functional between jobs as a waiter in a popular nightclub. When the two were married, Chris insisted that Bethany give up her career goals and stay at home. crystal cooperated with Chris, resigning from her job and rupture all ties with her modeling agency. During the first few weeks of her marriage, after returning from a week-long honeymoon in Europe, she felt passably contented. However, as the weeks went on, she began to baffle increase dis pleasure with her new life, which she subsequently described as totally empty.Althou gh she was frequently visited by friends, she still felt very much alone. Chris was often apart on business and the couples relationship began to feel strained when the two were together. While they had previously enjoyed an active sex life, the couple gradually became sexually estranged. crystallizing thought that their relationship might improve if she resumed her modeling career, but when watch glass tried to discuss the matter with Chris, he refused to listen to her, stating I will not suffer the humiliation of having any wife of mine parading close like a piece of meat. When she suggested that they go to marriage focusing, Chris refused, saying that there was nothing that the two couldnt resolve on their own. However, a close friend convinced crystallisation to seek centering, even though her husband would not agree to come on. The friend recommended Dr. baby buggy. In therapy with Dr. pedestrian, vitreous silica often evince a desire to leave her husband but also verbalized fears of being by herself and of not making it on her own without p guide oner from her husband.On the one hand, she complained of boredom, loneliness, and desperation on the other, she expressed reluctance to give up what she now had to return to the precariousness of her former existence. It was a lot easier and less risky, she said, just to stay right where I am. Dr. pushcart knew from person-to-person view how difficult it could be to stand up to the fear of making changes in ones life without any guarantees. Having been through a divorce (three years ago) with a woman whom he had been married to for thirteen years, Dr. carriage felt a individualised bond with Crystal. He too had struggled with similar issues and felt the force of inactiveness as he mustered up enough inner strength to leave a wife whom he had lived unhappily with for over a decade. Hence, when Crystal began to make romantic overtures toward him (telling him that she rear him extremely attrac tive, that she was falling in roll in the hay with him, and asking him if he felt the same about her), Dr. perambulator base himself in a more perplexing situation. In receipt to Crystals interrogative about his feelings toward her, Dr. pedestrian responded by stating query about his feelings toward her, Dr. pushchair responded by stating I think you are a very attractive woman but as your therapist it would be inappropriate and definitely not in your silk hat interest if I were to become in the flesh(predicate)ly involved with you. Although he considered Crystals overtures to be a result of transference, he began to question the appropriateness of rede a women who awakened so much of his own in the flesh(predicate) turmoil, and he worried about the possibility of his own countertransference. Dr.Walker was indeed also sexually attracted to Crystal. While he was awake of other occasions in which he was sexually attracted to egg-producing(prenominal) clients whom he manag ed to successfully counsel, Dr. Walker felt less confident in the present case. Crystal had at this juncture been in therapy for six months. Although he believed that she had made significant progress in this period, he also believed that it would be in her best interest if she were referred to another therapist. He thus decided to terminate therapy and to refer her. Dr.Walker explained to Crystal that he had personalised problems of his own that made it inappropriate for him to continue as her therapist, and that it was in her best interest if she accorded his referral. Notwithstanding Crystals repeated pleas to know more, Dr. Walker refused to remark on what exactly those personal problems were except to emphasize that they were his, not her, problems. Crystal declined the referral and, in tears, left his office, neither seeking nor receiving therapy from anyone else again. Dr. Walker did not himself seek professional counseling for his personal problems. However. s a result o f his experience with Crystal, he did subsequently avoid practicing marriage counseling, especially with young, attractive female clients. About two years after ending their professional relationship, Dr. Walker met Crystal while shopping at a supermarket and they began to talk. Crystal explained that she had dissociate Chris a year ago and that she was presently efforting to get thorn into fashion modeling but was finding it difficult to make headway. The two changed phone numbers. A week later Dr. Walker called Crystal and asked her out on a date. They subsequently began a sexual relationship.As we conduct seen, the primary purpose of a therapist is to promote the welfare of the client. In the present case, Dr. Walkers decision to terminate Crystals counseling was a rational response to the problem of how best to fulfill this primary counseling mission. Dr. Walker was aware that his personal emotions were potentially harmful to Crystals continued therapeutic advancement. In p articular, he was aware that his sexual attractor for this client bring together with his homelyly opened feelings about his former marriage and divorce provided a climate for countertransference. In this regard, Dr.Walkers decision to terminate was in concert with the precept of Loyalty insofar as his personal conflict prevented him from maintaining license of judgment in the homework of treatment. As provided by APA Standard 1. 13c, a therapist who becomes aware of a personal problem that has potential for interfering with the provision of professional services should take appropriate measures, which may include terminating therapy. In making a referral upon termination, Dr. Walker further sought to safeguard client welfare. There was, of course, the risk that Crystal might refuse Dr.Walkers referral and never again seek counseling, a possibility that did in fact come to pass. Dr. Walker was therefore confronted with the problem of deciding which optionreferral versus contin ued therapyran the greatest chance of minimizing harm and maximise welfare for this client. In making this utilitarian determination, Dr. Walker could not, however, mechanically and dispassionately calculate the risks of each available option. On the one hand, he had to try to transcend his own subjective feelings in order to rationally judge the situation.Yet, on the other hand, he had to stay in touch with those very same feelings which he sought to transcend in the change of deciding. Were the emotions he was now experiencing more of an impediment to successful counseling than previous experiences he had when he chose not to refer? Was the present case really different than the previous ones? To answer these questions, Dr. Walker could not merely be an cold-eyed and objective observer applying a rational standard as Kantian ethics. Nevertheless, while he had to live his feelings in order to adequately typify them, he also had to attain some measure of rational outer space f rom them.According to Martin (1997) such professional outmatch can be defined as a well-founded response in pursuing professional set by avoiding inappropriate personal involvements while maintaining a sense of personal engagement and righteousness. Under-distancing is the undesirable interference of personal values with professional standards. Over-distancing is the evenly undesirable issue of personal involvement, whether in the form of denying ones responsibility for ones actions or in the form of lacking desirable forms of caring about clients and community.How can a professional determine whether client engagement avoids the above extremes and is therefore proper? Such determination, according to Martin (1997), constitutes an Aristotelian mean between these extremes. As such it must rest with perception and sound judgment enlighten by experience. As a general rule, this mean appears to be reached in therapy when the therapist gets as close to the clients situation as po ssible without losing her ability to rationally assess it, for it is at this point that the therapists powers of empathetic caring and apprehensiveness are at their highest rational level.The point at which a therapist has attained this mean and has therefore stretched her rational capacities to their limits appears to be relative to both situation and individual therapist and May not always be attainable. Thus, while Dr. Walker has successfully treated clients to whom he was sexually attracted, at least some therapists might not be able to successfully work with such clients and had best refer them. On the other hand, Dr. Walker was not sanguine about his ability to work with Crystal without under-distancing himself. In deciding whether or not to refer, Dr.Walker needed to remain personally busy yet detached enough to make a rational judgment about what would best promote his clients welfare. Paradoxically, he had to attain proper distance in order to decide whether, in counselin g Crystal, he would be able to maintain proper distance. Martin (1997) claims that maintaining such distance indoors a professional relationship serves at least three important functions. First, it can help professionals to efficiently manage with difficult situations by keeping them from bonnie emotionally overwhelmed.Second, proper distance can help in promoting a professionals obligingness for clients autonomy. Third, it can help a professional to maintain objectivity. Insofar as liberation of professional distance militates against these three functions, stern potential for loss of proper professional distance in counseling Crystal would acquire afforded Dr. Walker sufficient reason for termination. In the first place, loss of professional distance, in particular under-distancing himself from Crystal, could devour destroyed his ability to cope with Crystals crisis by resulting in countertransference. In such an instance, Dr.Walkers inability to keep personal interests d ivide from those of client could well engender clouded and distorted his professional judgment regarding client welfare and thereby preempted the provision of equal counseling services. With loss of proper professional distance, Dr. Walker would accordingly have also suffered loss of objectivity, that iscritical detachment, guilelessity, the absence of distorting biases and blinders (Martin (1997). Had Dr. Walker allowed his personal interests and emotions to seep into the professional relationship, his perception would have been biased and as such not objective.For example, in overidentifying with Crystals plight as an extension of his own negative marital experience, he would no chronic have been impartial. He would have had blinders on, interpreting Crystals circumstances in terms of his own values and interests, seeking resolution not of Crystals crisis but of his own. In Dr. Walkers case, loss of proper professional distance could also have unnatural client autonomy by imp airing his powers of empathy. We have seen that empathy can be an important autonomy facilitating virtue.This virtue, however, entails proper professional distance by requiring a therapist to feel as if he were in the clients subjective world without ever losing the as if quality. Dr. Walkers failure to keep his own subjectivity separate from that of his client would have precluded the possibility of his accurately sensing the feelings and meanings being undergo by the client, for these experiences would have been filtered through Dr. Walkers own overwhelm of self-interest and personal emotions. As a result Dr.Walker would not have been able to competently help his client accurately clarify the feelings and meanings she was sensing. It is, however, through such increased self-understanding that Crystal could reasonably hope to gain great control over her own behavior and life circumstances. Given serious potential for loss of proper professional distance, any attempt by Dr. Walk er to continue counseling Crystal might therefore have been carried out behind a veil of self-interest and misguided ideas, impede client progress toward greater autonomy and well-being, countering the primary counseling mission.Under such conditions, Crystals own state of dependency would have rendered her vulnerable to the exploitation and use of goods and services that easily arises when a counselor does not clearly separate personal welfare, interests, or call for from that of the client. Dr. Walkers decision to terminate was accordingly in concert with his moral responsibility not to apply the power and authority of his professional role in a manner that might exploit client dependency and vulnerability.In keeping with the Principle of Vulnerability, the heightened vulnerability of this client due to the therapists lowly capacity for objectivity provided an occasion for exercising special care in guarding against infliction of client harm. This additional moral responsibili ty to take special care was discharged by Dr. Walker when, in consideration of his personal conflict, he decided to terminate. From a Kantian perspective, the rationale for termination is also manifest(a). As Crystals therapist, Dr. Walkers role was to facilitate her increased personal autonomy.However, by inveterate therapy instead of terminating, he risked treating her as a mere means to the satisfaction of his own confused interests and desires sort of than treating her as an autonomous agent. Dr. Walkers motive for terminating Crystals therapy, namely to safeguard her welfare, could also consistently be willed to be a universal law of nature inasmuch as such a law would be consistent with and supportive of the primary counseling mission. It is noteworthy, however, that not all motives for termination could meet this Kantian standard. For example, had Dr.Walker terminated Crystals therapy for the express purpose of ancestor a sexual relationship with her, such a motive woul d not have been universalizable. This is because, if therapists consistently and universally sacrificed their clients welfare whenever it suited their personal interests or needs, clients would not trust their therapists and therefore counseling would not effectively work. Furthermore, to take on to a universal law of such betrayal would be to consent to being treated as a mere means rather than as an autonomous agent, which no rational person would do.It is thus apparent why the ACA now requires therapists who intend to have sexual relationships with former clients to tell that they did not terminate therapy as part of a plan to tiro a sexual relationship with the client (ACA, 1995, A. 7. b). More generally the ACA also provides that counselors should avoid actions that seek to meet their personal needs at the disbursal of clients (ACA, 1995, A. 5. a). It might, however, be suggested that no violation of client autonomy occurs when a client consents to termination of therapy f or purposes of beginning a sexual relationship.After all, it might be said, is this not to respect the clients will rather than to engage in any form of betrayal? Thus, supposing that Crystal were willing to discontinue therapy for purposes of pursuing sex with Dr. Walker, would Dr. Walker not have respected her autonomy (self-determination) by obliging her? Crystals attraction to Dr. Walker was a case of transference, carrying out a sexual relationship with her would have been to exploit and manipulate her dependency, not to foster her autonomy.Given Crystals vulnerable state of mind, it is far from clear, however, that her consent could have been considered free and uncoerced. In the least, precondition Dr. Walkers own impaired capacity for objectivity, and the potential to cause serious client harm, such conduct would have been a blatant violation of Dr. Walkers moral responsibility to safeguard the welfare of a vulnerable client. In terminating the counseling relationship, shou ld Dr. Walker have told Crystal why he was terminating her therapy? It is arguable that in not fully informing Crystal of the grounds of termination, Dr.Walker had failed to act in a manner be assignment a candid and congruent therapist. In support of the Principle of Candor, the APA provides that psychologists make reasonable efforts to answer patients questions and to avoid apparent misunderstandings about therapy(APA, 1992, 4. 01. d). In further support, the ACA provides that whenever counseling is initiated, and throughout the counseling process as necessary, counselors inform clients of the purposes, goals, techniques, procedures, limitations, potential risks and benefits of services to be performed, and other apt(p) knowledge (ACA, 1995, A. . a). In still further support, the ACA provides that in terminating counseling, counselors should aim at securing agreement when possible (A. 11. c). Unfortunately, Crystal was not afforded the chance to provide informed consent to term ination in a much as she was denied information material to termination, and which any client in similar circumstances would reasonably want to know. Thereby, she was not treated as an end in herself, that is, as a self-determining agent. Additionally, Dr.Walker left Crystal in a state of frustration and bewilderment. Was she to blame for Dr. Walkers decision to terminate despite his insistence that it was due to his problem? Since Dr. Walker had already admitted that he found Crystal to be attractive, was termination a result of his feelings toward her? Did he really love her? On the other hand, was he just offended by her having come on to him? In refusing to disclose his grounds for termination, Dr. Walker failed to achieve adequate closure to therapy, and Crystal was simply left hanging. While Dr.Walker did previously state that he found Crystal to be a very attractive woman, this had been at Crystals own prompting. As such, this statement of his could well have been construed by Crystal as merely an attempt to appease her. As far as Dr. Walker did not follow through with an explicit, candid disclosure as pertinent to termination, therapy ended on an inauthentic note. In failing to own his own feelings, Dr. Walker missed a final and hence important opportunity to model congruence and so to advance Crystal to take similar responsibility for her own future life decisions.What, then, might Dr. Walker have said to Crystal in response to her request for further information about why he was terminating and referring her? The truth as presented along the following lines would probably have been sufficient I have not in all worked through my own divorce, which, coupled with my own sexual attraction for you, has made it difficult for me to remain professionally objective and to provide you with the competent counseling services to which you are entitled.In cases like this, it is my professional responsibility to refer you to soul who will afford you such servic es. In making disclosure along these lines, Dr. Walker would have responded in a manner befitting a candid and congruent therapist, and accordingly in such a manner consistent with the primary counseling mission. Dr. Walkers experience with Crystal appropriately alerted him to the possibility that his own unfinished business surrounding his divorce justified refraining from pass judgment clients whose profiles were similar to Crystals.In this regard, in concert with the Principle of Loyalty, the APA (1992) provides that psychologists refrain from undertaking an bodily function when they know or should know that their personal problems are likely to lead to harm to patent, client . . . or other person to whom they may owe a professional or scientific obligation (1. 13. a). Dr. Walker failed to have worked through his own marital issues affected his ability to provide competent counseling services, Dr. Walker also had a professional responsibility to rule competent counseling for himself.Thus, in concert with the Principle of Non-Maleficence, the ACA provides that counselors refrain from offer or accepting professional services when their physical, mental or emotional problems are likely to harm a client or others. They are alert to the signs of impairment, seek assistance for problems, and, if necessary, limit, suspend, or terminate their professional responsibilities(ACA, 1995, C. 2. g). In the present case neither Dr. Walker nor Crystal sought therapy for their personal problems after their professional relationship ceased.It was under these circumstances, about two years later, that Dr. Walker and Crystal began a sexual relationship. It was therefore quite possible that Crystals sexual attraction and willingness to begin a sexual relationship with Dr. Walker was a result of the same transference problem that led Dr. Walker to terminate therapy in the first place. Similarly, it is also quite possible that Dr. Walkers own sexual attraction and willingness to begin a sexual relationship with Crystal were themselves an veritableization of his previously perceived tendency to countertransfer.If so, then the possibility for client manipulation and harm which existed in therapy could be hypothesized to continue to exist in the personal relationship. Furthermore, since in his personal relationship with Crystal Dr. Walker was no longer expected to maintain professional distance or to be objective, the potential for even greater client manipulation and harm could be hypothesized to exist. In keeping with the Principle of Non-Maleficence, Dr. Walker had a professional responsibility to avoid harming others, which clearly included former clients.Dr. Walker entry into a personal relationship with Crystal placed her at significant risk of harmand arguably at even greater risk than in their previous professional relationshipDr. Walker had a professional responsibility to avoid such a relationship with Crystal. In addition, since this potential for harm may be traced to the exercise of power and authority open in the therapeutic context, Dr. Walker may be viewed as having used his professional powers and authorities in a manner inconsistent with Crystals welfare.Furthermore, a rule of once a client, always a client would seem to gain ground force from the implausibility of supposing that a clients welfare matters only within the professional context but subsequently becomes expendable as soon as therapy is (formally) ended. Further, presumptuousness that professional safeguards were no longer expected in the personal relationship, all knowledge previously acquired in the therapeutic context was no longer insulated from personal use. Thus, by virtue of his personal relation with Crystal, Dr.Walker was no longer expected to remain objective and professionally distanced, yet he was still privy to information previously protected by such professional responsibilities. Given the emotional dynamics of personal relationships, the potential for revilement of such knowledge will have accordingly increased. For example, in the throws of an emotionally heated disagreement, Dr. Walker might allow his perception to be modify by his intimate knowledge of Crystals former marriage. This could in turn affect the manner of his own verbal, behavioral and emotional responses to Crystal.Insofar as knowledge acquired under a bond of professional privateity, is subsequently used for personal purposes, the Principle of Discretion will also be breached. As the APA (1992) states, Psychologists discuss confidential information obtained in clinical or consulting relationships only for appropriate professional and scientific purposes (5. 03. b) and it is clear use of private client information for personal, self-interested reasons go outside the purview of such legitimate purposes. It is possible. of course, that Dr. Walker could manage to keep such private information out of his personal life.Nevertheless, therapists a re forgiving beings who have emotions and do not always perform at their best. Therefore, expecting therapists to avoid at all times being influenced by prior clinical knowledge of a person with whom they are intimately relating may be asking too much of the most well-adjusted. In Dr. Walkers case, however, there were already reasons for supposing that he had capable problems that would make such expectations all the more unrealistic. Furthermore, maintaining such a stature is tantamount to expecting the therapist to fulfill his professional esponsibilities within the context of a personal relationship. Role expectations between professional and personal relationships, are however, notoriously inconsistent. Thus, in personal relationships, there is an expectation that the needs of both parties will be met in a more or less reciprocal manner. It is difficult to consistently put the consumers needs first if one is also invested in meeting ones own needs. And, accordingly, as the r epugnance of expectations increases between roles, so will the potential for misunderstanding and harm (Kitchener, 1988).On analysis, it is therefore clear that, in starting a sexual relation with a former client, Dr. Walker acted contrary to the primary counseling mission by taking substantial, unwarranted risks. Even though Dr. Walker waited two years before starting a sexual relation as some standards (for example, APA and ACA) require, there were strong reasons militating against starting the relationship. Furthermore, had Dr. Walker attempted to document that this relationship did not have an exploitative basis, it is questionable that Dr. Walker himself would have been in a situation to objectively assess the matter.Under the circumstances, it would have been more fitting had he called in a consultant to help him to decide the matter (ACA, 1995, C. 2. e). Such unbiased ethics assessment would probably have been more reliable than Dr. Walkers own determination. It is evident th at a two year waiting period is not itself a reliable index of warranted sexual relations with former clients. As the APA has suggested, warrant for sexual relations with former clients is most unusual. Had Dr. Walker seen Crystal on a single occasion without having established an ongoing professional relation with her, such warrant would have been arguable.Here, however, there is still danger of the appearance of conflict of interestor even worse, of exploitation of clients. A profession cannot afford to have its characterization tarnished. A therapist concerned for the welfare of potential clients cannot afford to neglect professional image. A professional known to have had sex with former clientsno matter how well the relation might have been documenteddoes nothing to promote an image of a trustworthy and virtuous therapist in the public eye. Finally, good requirements need not always be in harmony with professional standards.While some causes may sometimes be chastely obli ge enough to override obedience to law, it is unlikely that violation of a state statute in order to engage in a sexual relation with a former client would qualify. If sexual relations with former clients were legally regarded as sexual misconduct in the state in which Dr. Walker practiced, there would have been further reason, an overriding and compelling reason, for his not engaging in such a relation with Crystal. In the absence of such a state statute, there would also have been a compelling case against it.ETHICAL STANDARDS FOR ADDRESSING DUAL ROLE RELATIONSHIPS The following rules of dual role relationships may be gathered from the case study. While they are not intended to be exhaustive of all such possible rules, they are intended to supplement ones provided under Principles of Loyalty and Non-Maleficence. General Rules Regarding Dual Role Relationships GR 1 In considering whether a dual role relationship is morally problematic and should be avoided or terminated therapists considers the potential for loss of the clients independence of judgment as well as that of their own.GR 2 Therapists consider the adverse effects that pursuing certain types of dual role relationships (for instance, sexual relations with former clients) might have on the public image of their profession, and avoid apparent conflicts of interest as well as actual ones. GR 3 Therapists avoid any dual role relationship in which a serious potential for misappropriation of confidential information exists (for instance, the use of such information for malicious or self-serving purposes).GR 4 Therapists who have institutional affiliations (for instance, teach at colleges or universities or work in agencies) avoid provision of therapy to other employees with whom they have or are likely to have on the job(p) relations. GR 5 Therapists establish and maintain contact with other dependant professionals available to render competent, independent ethics consultation or supervision in case con flicts of interest make the therapists own judgment questionable.GRs 1 through 4 are based upon the premise that therapists should take reasonable measures to avoid all dual role relationships for which there exists serious potential for loss of independence of judgmentthe clients as well as the therapistsand conflicts of interestapparent and actual. The aforementioned rules provide some key considerations for avoiding such relationships. When therapists cannot feasibly avoid a conflict of interest, then they should fully inform the affected clients about the conflict, and, with the clients consent, seek consultation and/or supervision from other qualify professionals (ACA, 1995, A. . a). GR 5 has been advanced in support of the latter premise. In congenial GR 5, therapists who work in agencies should establish and maintain contact with other competent professionals who practice outside their agencies and are therefore more likely to provide independent, nonbiased consultation or supervision. Therapists who practice in isolated rural areas have an especially compelling interest in establishing and maintaining such contacts.As is true with respect to other rules, the present ones are intended to help in head therapists decisions regarding dual role relationships, but are not intended as a substitute for careful ethical reflection. For instance, while avoidance of apparent conflicts of interest is important for maintaining professional image, GR 2 must be employ with regard for the welfare, interests, and needs of particular clients. For example, a therapist might right on tolerate public appearance of a conflict of interest in order to prevent serious harm to an identifiable client while such involvement purely for personal gain would be unacceptable.GR 1 underscores that morally problematic dual role relationships can arise not only when the therapist encounters a conflict of interest but also when the clients independence of judgment is impaired. Since e ither case can result in ineffective or self-defeating therapy, a therapist may have compelling reason for avoiding or terminating a dual role relationship even when it is only the clients judgment that is adversely affected. The use of the term qualified professional in GR 5 refers to another competent therapist as well as to a competent professional in a related area such as a professional ethicist.The term working relations in GR 4 means direct employee relations arising out of the cooperative performance of specific job-related tasks. Such tasks include secretarial, administrative, custodial, maintenance, committee, and departmental functions. Working relations must involve direct contact, which means exchange of information by face-to-face contact or other convey such as e-mail, phone or interoffice memo. In general, the more frequent and intimate the job-related ontact between therapist and client, the greater the potential for loss of independence of judgment by both parties . Thus, an occasional interoffice memo may not be as risky as on-going face-to-face contact. The term working relation does not apply simply because two individuals have the same employer. In a very large institution such as a state university, it is possible that two employees have no working relation, but this is less likely to be true in small institutions such as counseling agencies.Rules Regarding Sexual Relations with Former Clients SF 1 Therapists do not engage in sexual relations with current clients and generally avoid sexual relations with former clients. In high-minded cases in which therapists are considering the warrant for sexual relations with former clients (for instance, in cases where no ongoing therapeutic relationship has been established), they consult with other competent, impartial professionals in documenting the non-exploitative nature of the considered relations.SF 2 Therapists recognize that their former clients like current clients can still be vulnerab le to sexual manipulation, and therefore avoid taking undue sexual wages of these individuals Therapists do not assume that their former clients agreement to enter into sexual relations with them constitutes freely given consent. SF 3 If the state in which a therapist practices regards all sexual relations with former clients as sexual misconduct, then therapists do not engage in any such relations even where warrant for the relation might otherwise exist.In SF 2, the term undue sexual advantage refers to the exploitation of any client weakness related to the prior therapist-client relationship, for example, an unresolved client transference issue, persistent client dependency on the therapist, or the therapists position of power and authority over the client. Insofar as such client weaknesses may persist after therapy has been terminated, the burden of proof resides with the therapist to show that the clients consent to a sexual relation with the therapist is not a result of such factors but rather constitutes the clients autonomous, uncoerced consent (NASW, 1997, 1. 9. c). In the rare cases in which this can be shown, SF 1 requires that documentation include the favorable outcome of consultation with at least one other independent, competent professional (as defined above) in addition to such documentation specified in other pertinent standards addressed in this chapter (APA, 1992, 4. 07 ACA, 1995, A. 7. b). While a virtuous therapist would ordinarily have regard for law, we have noted that some causes such as prevention of serious harm to a client may sometimes militate against shape with law.Rule SF 3, however, is intended to make clear that satisfaction of the therapists sexual interests even when coupled with that of the former clientdoes not warrant or mitigate the legal transgression. Rules Regarding Sexual Attraction to Clients AC 1 Therapists are not unfit from counseling clients to whom they are sexually attracted so long as they are able to prov ide these clients with competent, professional services.However, if they have or, in the course of therapy, come apart sexual attractions for clients which impair or are likely to impair the therapists independence of judgment, then they terminate therapy and make appropriate referrals. AC 2 Therapists do not accept as clients individuals from certain populations (for instance, certain gender and age categories) for whom sexual feelings are likely to impair independence of judgment. In such cases therapists take appropriate steps to overcome their personal problems, such as seeking therapy for themselves, before taking on such individuals as clients.AC 3 In cases where therapists terminate therapy due to mutual sexual attraction, therapists inform clients as to the nature of termination, and do not misrepresent or mislead clients as to the cause of termination. .AC 1 assumes that sexual attraction for at least some clients is frequent occurrence and is not in itself a reason for te rminating therapy. AC 1 affords therapists the autonomy to decide whether such attraction is of such a quality as to impair professional judgment. Therapists sexual attractions for clients may however sometimes be related to therapists own unfinished business. In such cases AC 2 recognizing the need to address such personal problems therapeutically before counseling groups of clients to whom the sexual attraction may be generalized. AC 3 is supported by both Principles of Honesty and Candor in requiring therapists with sexual attractions for clients to avoid deception in informing these clients of the grounds for termination. Rules Regarding Therapy with Students TS 1 Therapists do not engage in therapy with current students or those with whom current students have intimate relationships.Consistent with client welfare, therapists may engage in therapy with former students. TS 2 while therapists may not solicit students for referrals, they may accept unsolicited referrals from studen ts. TS 3 If, during the course of therapy, therapists clients also become their students, therapists take reasonable steps to terminate the ensuing dual role relationships, including terminating therapy and providing appropriate referrals. Therapists inform their clients of all significant risks related to maintaining such dual role relationships and, consistent with client welfare, decline to remain in both roles.Therapists support and encourage their clients own informed, autonomous choices in resolving the conflict. TS 4 Therapists who ascertain that prospective clients are likely to become their students decline to accept such individuals as clients. As part of their clients informed consent to therapy, therapists who teach inform potential students (clients whose profiles suggest that they might become students) of a professional responsibility not to engage in therapy with their students. In TS 1, the term intimate relationships includes family members such as parents, step pa rents, grandparents, and siblings.The term also includes significant others such as boyfriends or girlfriends, fiancees, and sexual partners. While an individual may not have a close relationship with all family members, the probability that the family bond will embroil the student is substantial enough to justify a strict rule against counseling family members of students. Although TS 2 permits therapists to accept as clients the unsolicited referrals from students, it is noteworthy that, in concert with TS 1, such permissible, unsolicited referrals do not include individuals with whom students have intimate relationships.TS 3 provides that therapists should take reasonable measures to terminate non-elective dual role relationships with students. In the context of therapy this means measures which are consistent with client welfare, and which accordingly promote client trust and autonomy. The rule provides that clients be afforded maximal autonomy in deciding how the dual role rel ationship will be resolved for example, whether the student-teacher relationship will be preserved and the therapist-client relationship erminated, or conversely. TS 4 recognizes the utility of taking preventative measures to increase the likelihood that a non-elective dual role relationship with students is avoided before it is established by the student. It also conforms with the Principle of Candor in making clear, from the start, the Therapists professional responsibility not to counsel students. In this way, the therapists move to discontinue such a relationship (should one later be established) comes as no surprise to the client.REFERENCES American Association for Marriage and Family Therapy (1991). Code of ethics. Washington, DC AAMFT American Association of University Professors (1990). description on professional ethics. AAUP Policy Documents and Reports, 75-76. 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