Dual Relationships

I decided to write this blog after receiving a comment recently by somebody who became romantically involved with their therapist and was seeking advice for how to handle the outcome.

In my own experience as a client, it’s definitely a huge bonus if the therapist is friendly, warm and caring. But the ethical guidelines that govern therapeutic relationships, no matter what type of therapist you are, always maintain strict rules around what are known as dual relationships. Therapy relationships are one-sided for very good reason. As much as your therapist loves you and/or you come to love your therapist, they will never and, in my opinion, should never be your friend or romantic partner.

Clients take a huge risk in opening up to a therapist. Most people coming to therapy usually start from a place of extreme vulnerability and unease in their lives. Maybe they are in a shaky marriage. Perhaps they are beginning to look at their sexual orientation. They may recently have begun to work on their sexual abuse history. They may have just lost a significant relationship in their life. Or perhaps they have had a miscarriage or a child has just died. Whatever the presenting issue, people rarely come to therapy because they are so gosh-darned happy, that they need to sit down with a complete stranger and talk about it. The nature of this relationship automatically creates an imbalance of power and it is the therapist’s job and professional duty to uphold the boundaries between him/herself and the client. Any time your relationship with a therapist is anything but a therapist and a client, that is considered a dual relationships.

One important perspective that all therapists need to maintain is the ability to put their clients needs above their own. If I have a clear and vested interest in having some of my important emotional, physical and psychological needs met from my client in the context of a friendship and/or sexual relationship, how can I remain committed to putting them first? Any time a therapist is in a position where they cannot put their client’s needs above their own, they are on shaky ethical ground and it is their responsibility to make the decision about whether the therapeutic relationship is moving (or has moved) into dual relationship territory. Many dual relationships have innocent beginnings, (for example, you find yourself in the same book club as your therapist, or he/she is on the PTA, or n your local community watch group, etc.) but can quickly become exploitative and harmful to the client.

When data from national studies were measured, it was shown that 4.4% of therapists (7% of male therapists; 1.5% of female therapists) have had sexual relationships with their clients. The ethics codes of ALL mental health professions prohibits sexual relationships between clients and therapists, precisely because there is a recognition of the potential for psychological damage from these relationships developing. The most common emotional outcomes for clients who have become involved in a sexual relationship with their therapist are feelings of emptiness and loneliness, difficulty trusting in relationships, confusion over boundaries and the nature of helping relationships, an increased risk of suicidality, anger, feelings of guilt, hesitance and indecision in making life choices. On top of this people often find that their feelings fluctuate wildly, and report feeling out of control and an increased feeling of unpredictability in their lives. When research has been carried out on the outcomes for therapeutic relationships that became sexual in nature, in almost all cases the experience of the former client is predominantly negative. In addition, therapists who engage in sexual relationships with their clients rarely stop at just one client – they have often had multiple other sexual relationships and often choose the most vulnerable clients to initiate sexual contact with.

If your therapist has initiated sexual contact with you, or has offered to terminate therapy so that you can become involved in a relationship outside of the therapeutic context, I suggest that you seriously consider contacting another therapist. If the therapist is licensed or affiliated with a nationally recognized mental health association, consider contacting the association to ask them what action they suggest you taking. Clients frequently get “crushes” and/or fall in love with their therapists. These are complicated feelings to navigate and it is imperative that the therapist remain professional, impartial and maintain strict physical boundaries in order for clients to safely explore these feelings. The power imbalance in a therapy relationship rarely goes away, after either friendship or a sexual relationship has been established, and the power is nearly always in the therapist’s favor.