Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers.

TLDR

A national survey of 4,800 psychologists, psychiatrists, and social workers (49% response) assessed attitudes and self‑reported behaviors toward dual professional, social, financial, and incidental relationships, with half of respondents rating ethical acceptability and the other half reporting frequency, and examined ten therapist and client characteristics for their influence on beliefs and practices. Most clinicians deemed dual relationships unethical and reported infrequent engagement, yet male therapists were more likely to perpetrate sexual and nonsexual dual relationships, while the three professions did not differ in other dual‑relationship domains, leading to ten training implications for preventing exploitation and harm.

Abstract

4,800 psychologists, psychiatrists, and social workers were surveyed (return rate = 49%) to examine attitudes and practices regarding dual professional roles, social involvements, financial involvements, and incidental involvements. Half of the Ss rated the degree to which each behavior was ethical; the other half reported how often they engaged in each behavior. A majority believed dual role behaviors to be unethical under most conditions; most reported that they had rarely or never engaged in the behaviors. 10 factors (therapist gender, profession, age, experience, marital status, region of residence, client gender, practice setting, theoretical orientation, and practice locale) were examined for their relation to beliefs and behaviors. A higher proportion of male than of female therapists were perpetrators of sexual and nonsexual dual relationships. The professions did not differ among themselves in terms of (a) sexual intimacies with clients before or after termination, (b) nonsexual dual professional roles, (c) social involvements, or (d) financial involvements with patients. 10 specific training implications are discussed in light of the exploitive and clinically harmful nature of dual relationships.