Dual Relationships and Attachment Therapy

by Liz Sikora, M.A., C.A.G.S., C.P.C., N.C.C.

Do we really have to discuss, think about, consider dual relationships? Yes, as professionals in this field this issue must be considered. Although the ATTACh professional standards do not address dual relationships we are called upon to meet state and other ethical guidelines. Given the unique situation the attachment therapist often finds her/himslf in when dealing with children or adults with attachment difficulties, a review of the guidelines regarding dual relationships is appropriate. The American Association of Marriage and Family Therapists (AAMFT), American Counselors Association (ACA), American Association for Counseling and Development (AACD), American Psychological Association (APA), and National Association of Social Workers (NASW) all have clear guidelines about dual relationships. In general Corey, Corey and Callanan (1993) summarize these guidelines to include "blending a professional relationship with a client with another kind of relationship" (p.141). They go on to note that specifically the standards include limitations in the following areas:
teaching and providing therapy, bartering, providing therapy to family and friends,
socializing outside of therapy, and given the nature of intensive therapeutic interventions over extended periods of time, the limited number of trainers in the field of holding therapy, the requirement in some programs that a trainee participate as a client in a holding, the travel often required with a client to a treatment facility as well as the individual and family therapeutic interventions there are frequent times in the therapeutic process we must assess and limit the development of dual relationships. Cory, Cory and Callanan (1993) offer professionals the following when considering dual relationship situations:

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1. Consider whose needs are being met. In evaluating this consider the following questions: Whose needs are being met, the client and trainee or the therapist and trainer? Is there any covert manipulation by the therapist or trainer? Would you feel comfortable addressing an ethics panel or state board to explain how the client or trainees needs were being met?

2. Have you considered through an honest self-searching, the impact of a dual relationship on the client/trainee? Is there a personal gain or motive behind the dual relationship for you? Could there be a detrimental impact upon the client or trainee? Although they may be approaching you for the expansion of the relationship it is incumbent upon the therapist to evaluate these issues.

3. Is it possible your clinical judgment will be affected by the dual relationship? Can you state in all honesty your judgment will not be affected by this relationship? For instance, if you are the trainer and require a trainee be held by you during the training, are you clear that your role as therapist will not affect how you treat the client later as a trainee. Are you clear the trainee is participating willingly and with full awareness of the potential negative implications of combining roles?

As therapists, it is extremely critical we continue to be aware of and address the area of dual relationships with clients. The fact we work with children and adults who have already suffered major distress from a lack of safe and trustworthy relationships makes it that much more important we act to protect our clients in every6 way in this regard. We must strive to review our interactions with clients and their families on a regular basis to ascertain our client is best being served. And as trainers we must be clear we are always acting in ways that benefit our students. Dual relationship boundary violations are often secrets that don't get reported. Don't add to the burden of your clients or trainees--keep it clean and simple. And keep the flow of healthy, secure attachment growing!

References: Corey, G., Corey, M., and Callanan, P. (1993). Issues and ethics in the helping professions. Pacific Grove, CA: Brooks/Cole Publishing Company.