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The Dual Relationship in Therapy: It’s Never Good

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Dr. Rob,

As you’ve discussed, we all know therapists have issues. Other than sexual relations, though, what constitutes a “dual relationship,” and why is it so bad?

Ricky

Consider a dual relationship to be any involvement between therapist and client that is not part of the traditionally understood treatment agreement. In other words, when you see a therapist, she is offering you a very specific service: treatment of a psychological/emotional difficulty in exchange for payment, via your health insurance or directly from you.

Anything that occurs beyond or in addition to that is essentially a dual relationship. This is almost invariably bad, and it is ultimately the therapist’s responsibility to ensure that this does not occur.

Generally speaking, the worst kind of infraction occurs when the therapist asks the client to perform a specific act that is not part of the client’s treatment. This could range from something as seemingly benign as asking the client to bring her a cup of coffee from Starbucks to the more egregious sexual advances.

As a recent example, a reader sent an email reporting that a therapist asks his clients to purchase marijuana for him. This is problematic on multiple levels. In this case, the therapist is asking clients to not only commit a crime (i.e., sell or distribute drugs), but also commit one that directly serves the therapist’s personal interests.

While none of us should be naïve enough to not realize that countless people use and sell pot to both friends and colleagues, the therapeutic relationship is a unique one. By asking clients to do this, the therapy is compromised.

Clients are often very dependent on their treatment and their therapist, as therapy can involve experiencing and discussing very painful emotions. Some clients have told me their psychological pain is far worse than any physical discomfort they’ve endured in their lives.

In many cases, the therapist becomes a vital person in clients’ lives, helping them to navigate through this pain. Imagine, then, that the client wants to reject a request, an “out of bounds” question from this extremely important person, whether it be to buy coffee, drugs, or have sex. Now consider the thoughts that might run through the client’s head: If I say no, will my therapist be mad at me? Will he think poorly of me? Will I stop getting ‘good’ treatment? What if my therapist outright refuses to see me anymore if I don’t comply? Who will help me then?

Suppose, however, that the client doesn’t mind bringing the therapist a cup of coffee (or drugs or sex for that matter). Is he now obligated to bring it every week? What if he forgets? What if the therapist decides he wants coffee and a donut? Does the client have to comply with that too? In essence, the therapist is creating a potential and unnecessary whirlwind of questions and emotions by asking this of his clients.

Therapist Rule: Do not solicit from clients. Ever. For anything.

During graduate training, we often videotaped our sessions with clients as part of our education. Clients were fully aware of this and agreed to it as part of being seen in a low-fee (and sometimes no-fee) setting.

One student, a particularly pompous and arrogant woman in her final year of training, was doing particularly well as a therapist that year. Clients were reporting feeling significantly better in a very reasonable number of sessions with her, which made me secretly want to punch her in the neck for being better than me.

During one particular session, a client was saying how thankful she was for all of the student’s help so far. The therapist responded with “You are so welcome. Would you mind giving a testimonial for my business card? Something like, ‘__________ is the best therapist I’ve ever seen,’ maybe? That would really help me start off my practice.”

The client blanched. “Um, well sure, I guess I could say something along those lines.”

Our professor stopped the tape he and about five students were watching.

“Tell me. What the hell is the matter with you?”

“What? What’s wrong?” the student asked, clearly confused.

“You asked a client to give a written testimonial that you are the best therapist?”

“No,” she corrected, “just the best that she has personally seen. Is that wrong?”

“Yes it’s wrong!” the professor snapped. “Do you realize that you are putting this client in a horrible position? This person now has to write that you’re the best therapist she’s ever seen! How do you even know she thinks that?”

“Because she agreed to it,” countered the student.

“Maybe she agreed to it because she is so thankful for your help. Maybe she’s afraid that you’ll withhold that help if she says no. Maybe she doesn’t want to hurt your feelings. Do you see how many ‘maybes’ we can come up with?”

“I didn’t know it was wrong,” the student said, dejectedly.

“Well it is, and by the way, if you’re the best she’s ever met, she’s seen some bad therapists.”

I was later told the student cried that night over some cheap scotch.

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  • begoodtoyourself

    I’ve read quite a bit on “dual relationships” at this point — and I’ve learned the following:

    1) The range of “dual relationships” is infinite — the character of “dual relationships” can be complex

    2) There is no consensus among psychologists, counselors, psycho-therapists, social workers, etc., on the goodness or badness of non-sexual “dual relationships”

    Your article/essay was very helpful to me.

    While I agree that the “arrogant” student’s behavior needed to be addressed by the instructor, it seems as though his response — though unforgettable for her — was not entirely appropriate as a professional (even “professionals” are human). He yelled at her — seems uncool to me.

    I really like my therapist a lot. I find myself, lately, wondering if my interest in her, my affection for her, is entirely positive. I wonder if there is something “wrong” with me since I want to know more about her — I’m curious about who she is a person.

    I used to think my therapist and I were similar people. Now, I think I was/have been projecting. I have said this to her on more than one occasion. She just smiles:) She provides no response beyond that.

    As a result of my reading on “dual relationships,” I’ve learned that I am supposed to like my therapist.

    I’ve learned that some therapists share personal information with their clients — and some therapists do not.

    Whether or not a therapist should share personal information about themselves depends on their motivation for doing so, and whether doing so is helpful to the client in some way.

    So far, I feel good about the things my therapist has shared with me. I feel as though I’ve benefitted from her sharing things about herself — for many reasons — the most clear reason, the one easiest to articulate — is that her “shares” permit me to build trust for her. That feels very good.

    But then, I start to question whether I am capable of identifying a good boundary at all.

    Why do I do this to myself?

    (My therapist would say that there is important information in these feelings and questions:)

    I am tired of questioning the things that make me happy.

    I am tired of feeling bad about feeling good about my therapist.

    Why do I feel so guilty for liking her so much?

    It is important to note that I am not in love with my therapist; nor am I sexually attracted to my therapist (though I do believe she is a physically attractive person).

    Sometimes, I just want to hang out with her.

    I wonder if she feels the same way about me. I hope she does.

    And then I feel guilty about that.

    I deal with this by being open with my significant other about the feelings I have for my therapist. My significant other is supportive & understanding, and for the most part, non-judgmental.

    Maybe the person I should be talking to about my feelings — is my therapist.