Dual Relationships: Sexual Boundary Violations
Sexual Relationships are generally frowned upon when they are between the counselor and client. There are ethics in place to make sure that the client is protected from this type of boundary violation. These ethics are explained below.
Understanding Dual Relationships: Sexual Boundary Violations
Dual Relationships
Sexual boundary violations. Ethics are standards that counselors follow to ensure the safety of their client's at all times. Sometimes these areas are grey and unclear, so counselors will consider the best interest of their client before acting. Sometimes, counselors make unethical decisions that are harmful to their clients. These unethical decision can range from ending therapy for reasons of race to engaging the client in a sexual relationship. For this paper, there will be a focus on sexual boundary crossing.
To better understand sexual boundary violations, it must first be explained what dual relationships are. Dual relationships are defined as existing, "whenever a counselor has other connections with a client in addition of or in succession to the counselor-client relationship" (Moleski and Kiselica, 2005, p. 3). When applying this to sexual relationships, it's important to remember that not only can counselors not counsel those who they have been inmate with before, but they cannot be inmate with those they counsel past or present. It is specified in A.5.c. that, ". . . Sexual and/or romantic counselor-client interactions or relationships with former clients, their romantic partners, or family members are prohibited for a period of 5 years following their last professional contact" (as citied in Remley and Herlihy, 2016, p. 403). Although the relationship can happen after 5 years, these types of relationships are frowned upon and require documentation that provides this relationship will not be exploitative and will not cause harm to the client. Sexual relationships don't have to be just overt forms (e.g. intercourse) they can also be covert (e.g. trying to seduce the client). Although these relationships may seem like they are never ethical, this does not stop these relationships from happening (Moleski and Kiselica, 2005). Although clients may become attracted to the therapist and make advances in some cases, it is the therapist duty to make sure the boundaries that are initially discussed stay in place. Boundary violations can cause harm to the client and legal ramifications to the therapist.
Although sexual relationships have been frowned upon, therapist still find themselves engaging in sexual relationships with clients. A finding of those who most engage in sexual relationships with clients seems to be more experienced therapist who are males (as cited in McNulty, Ogden, and Warren, 2013). These boundary violations can come about in many different ways. One major way that was looked into was the need to save the patients or to be a hero with the clients. When a therapist takes on the hero role, they may lose sight in the boundaries they have set up and start slightly crossing lines that end up becoming deeper and deeper and the client may not know how to stop it, due to the fact that they feel like they are not in a high enough position to stop these boundary crossings (McNulty, Ogden, and Warren, 2013).
Stopping dual relationships. To better assist therapist from entering these relationships, some researchers and other therapist have given recommendations as to how to handle situations that may lead to boundary crossing. The first thing to do would be to set boundaries from the beginning. The first initial intake session should be used to talk about what confidentiality is and what boundaries are set in place to keep the client safe and to keep the therapist safe. If, for example, the therapist doesn't do hugs, that should be said in the beginning so there is no complications or upsetting of the client in the future.
Next, the therapist should keep conversation ways open so that the clients and the therapist feel comfortable enough to discuss possible complications that may arise. This could be in the form of the client starts to say things that make the counselor uncomfortable. Sometimes, clients may have moments of transference (e.g. seeing the counselor as an ex-boyfriend or someone who can save them) and this may make the client make advances that puts the therapist in an uncomfortable situation. This situation can become uncontrollable if the therapist doesn't address these unwanted advances and the same for the vice versa situation.
Then, there is also the process of talking to other professional when things get too much for the therapist. Consulting with others about to handle things that you, yourself are struggling with. When consulting with other people is beneficial, because counselors are able to get a new perspective on the events that are occurring. It may also give you a way to document the behaviors and refer the client out to someone else who they don't identify emotionally with (as cited in Moleski and Kiselica, 2005).
Finally, counseling for the counselor may be a way to deal with these conflicting feelings if one feels as though they want to enter into a sexual dual relationship with their clients. Since past trauma is a possible factor in those who engage in unethical relationships, personal therapy may provide a way to work through these issues (McNulty, Ogden, and Warren, 2013). Counseling can be emotionally draining when considering the emotional strain it can put on a counselor in regular session. When adding the conflict of romantic interest from transference and countertransference, a counselor may feel additional stress, because they may not know how to handle these boundary violations appropriately. Also, when consulting others it may help counselors become more aware of the lines they are blurring. Some relationships can start out from just accepting a gift to dinner to a connection. When a counselor allows boundary lines to become fluid that's when crossing these lines becomes to prevalent and easy. This is why it's important to be clear and honest with oneself and one's clients (Barnett, 2013).
Application of Dual Relationships
Sexual relationships with counselors and clients is highly frowned upon even though there is an acceptable time limit if not harm is occurring. To better understand the lengths of harm this type of violation takes a case study will be presented and examined.
Case Study. Sometimes, time best way to understand the harm is to look at real-life accusations and cases. The first is one that is more on the extreme end. In 2004 a relationship began between Glatt, the psychologist and the client, who is referred to as Mary Jane. This relationship developed out of client seeking therapy for the after her newborn sons death. It came about during therapy that there had been some sexual trauma in her past and more major losses of family in her current life. The therapist, Glatt, introduced Mary Jane into a BDSM or as the article refers to it, a sadomasochistic relationship. There were comments made by Mary Jane that she entered into the relationship because she trusted Glatt. Since she felt lost in her life, she felt like following Glatt may have provided some since of clarity in what to do next. This relationship continued for 5 years until eventually something occurred that brought their relationship to an end. It should be noted that Mary Jane nor Glatt reported this relationship. The complaint was filed by an outside source who Mary was seeing for help.
The following information after the complaint was filed followed as the therapist wasn't brought up on charges (e.g. in Florida were the complaint happened, there is a law prohibiting these types of relationships). Furthermore, Glatt moved to Virginia and opened up a practice. It wasn't until over a year later, that the charges came about and Glatt ended up giving up this Tampa license. After the license was invalid, Virginia took action and suspended Glatt's license as well (Douglas, 2014).
This cause helps identify some of the harmful things that occur to people who enter into sexual relationships with clients. Upon looking at the facts presented to us, there is already a use of the counselors power against the client. The client came in, in a very vulnerable state. She had lost everything and was seeking out how to gain back herself and direction in her life. The therapist, sought this as a chance to enter into a relationship of power with the client. The particular type of relationship that was chosen may be viewed as a power display. Also, the fact that the client stated she felt lost and Glatt would provide her with direction. This is clearly an abuse of power. As a therapist, one is to do no harm to the client. When Glatt pursued this relationship, he was doing harm to Mary Jane. The harm comes from one, never treated the issues that were presented when she entered into counseling. Two, ignoring the ramifications of the relationship they were having. Finally, the third harm was to the emotional well-being of the client. He took her need for control and direction and entered into a power play relationship with her. He knew her weaknesses and he played on them to begin a relationship with her.
Glatt also harmed himself. Since he was brought up on legal charges in the state of Florida, he lost his license. Although he was able to move and get a new license, he still managed to lost that license as well. Furthermore, the skeptical clients he would encounter on the daily bases would affect his livelihood. A client in need of help may not want to subject themselves to someone who is willing to take advantage of them in a vulnerable place. There's also the fact that the ACA may not choose to reinstate him. If this is the board's decision, then Glatt has no choice, but to seek out other means of making a living.
After reviewing was went wrong, lets apply some of the tips discussed earlier so that this situation may be avoided for other counselors. The boundaries that were set up should have been solid and not fluid. Although, we do not know exactly what lead up to Glatt suggesting a relationship with Mary Jane, we may be correct in assuming some minor boundary crossing occurred. When these boundary violations occurred, Glatt should have first addressed these crossings and then decided to either continue with sought out help from another professional or referred Mary Jane. Due to the fact that Glatt may have still wanted to treat Mary Jane after these minor boundary crossings, Glatt should have talked to another professional, asked for peer supervision, and/or sought out professional counseling for himself. Glatt may be wanted to be the hero in Mary Janes world, but that may have been his down fall. This need to save her, may have been the deciding factor in his decision to date Mary Jane. If Glatt had sought out outside opinions on this matter and possibly referred her out, Mary Jane could have sought out the help she needed to heal from the pain she was experiencing and Glatt would have been doing harm to his client. Attraction to patient or the need to save a patient may stem from personal issues. If these personal issues are addressed, the counselor may be more effective in providing treatment.
Application and understanding is highly important when trying to verbalize the harmful actions that will occur to the counselor/therapist and more importantly, the client. For the state of Wisconsin, a sexual relationship is seen as a class F Felony. This means that engaging on a sexual relationship with one's client can result in a maximum fine of twenty-five thousand dollars or imprisonment for a maximum of twelve years and six months. Let's look at a case that was filed as a criminal offense. Kristin E. Marchese was charged with entering into a relationship with a client. Although, the client had confessed his feelings to the director of the facility he was receiving treatment in and went on to get a new therapist, he still ended up back in Kristin's office. A relationship was formed during therapy sessions and social networks. This relationship eventually took on qualities of a sexual and romantic type. This lead to a letter that was discovered by the clients wife, which was turned into the supervisor. The counselor then was terminated, lost her license, and was taken to court on criminal charges (Wisconsin v. Marchese, 2014).
Although counselor's tend to not stop treatment for clients just because they express feelings for them, the way a counselor may handle the expression of the clients feelings may involve boundary conversations. In Kristin's case, she choose to enter into a relationship with the client. Upon further reading of the case, it was discovered that Kristin and the client both struggled with relationships, communication, and a loveless life with their spouses. As the therapist, Kristin should have address the boundaries that were put and place at the beginning of their counselor/client relationship. If Kristin was experiencing some transference or countertransference in the form of romantic feelings, she should have consulted with her supervisor. The client had removed himself from therapy with Kristin due to his feelings for her. The supervisor should have noticed that his feelings for Kristin were impeding his progression in therapy and continued to keep him with a different therapist instead of allowing him to go back into therapy with Kristin. This is not to assign blame to the client in anyway, it is to understand that preventative measure can come from different people at different times. For instance, had the client not requested to go back into a counselor/client relationship with Kristin, this relationship may have never formed.
What could Kristin have done differently? Kristin should have addressed these boundaries that were being talked about. When a client develops feelings for the therapist it could a result of the client projecting what they are missing onto the counselor. If the client is in a loveless marriage or perceives that women never understand him, the counselor may be seen as different. The reason for this may steam from the fact that the counselor listens and seeks to understand the client. As a counselor, it's important to know where your clients may project onto you and assign qualities that they feel fit to assign. Kristin could have acknowledge the clients feelings and followed up by try to understand where these feelings stem from. If clarity is not found and the client insist on trying to cross the boundaries in place, then it is the counselors duty to remind the client of the boundaries they have established. Being gentle, but firm is important. If boundaries are fluid, the relationship becomes blurry and harm will occur. Rather it is international or not.
When considering the legal aspect of dual relationships, it's important to realize that different states have legal ramifications about dual relationships. When thinking about changing states to practice, being aware of the law's in the state where someone is choosing to practice will make one more aware of their limitations. Although, the law isn't the only violation, it is the minimum violation that counselors should strive not to cross. In California, there are legal ramifications as well. For instance, if a therapist/counselor engages in a sexual relationship with a client, then there is the punishment of jail time (e.g. up to six months) and a fine (e.g. up to one-thousand dollars). A violation can assume the punishment of both, if the state deems it. If the counselor/therapist continues to act unlawfully or ethically, then the amount of jail time continues to increase as well as the amount of the fine. There is also the expectation that the ACA with take action against one's license (Zur, 2014). When considering the laws and ethics surrounding sexual dual relationships, it's important to remember that the counselor as power and using that power intentionally or non-intentionally is harmful to the progression of the client. A counselor/therapist is held to the standard of providing help and care without imposing their values or causing harm. Sexual relationships with a client are always, always negatively impactful. Being aware of one's emotional and personal baggage is import when dealing with clients. Always seek to advocate for the client and if, as a therapist feelings or interest develop, seek out outside counsel.
 
Summary
Sexual dual relationships are frowned upon and in most states legally and ethically wrong. The ACA has ethical codes that a counselor/therapist must adhere to, while the law has legal ramifications for professional's must follow. Taking advantage of clients harmful and a therapist/counselor should take steps in order to keep boundaries clear and their client's psychological and behavioral needs front and center.