The rules of ethics of the National Association of Social Workers state that social workers should not engage in dual or multiple relationships with clients or former clients in which there are risks of exploitation or potential harm to clients. Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. When this is not done, the patient may suffer unnecessary exploitation and damage. Here is just one example:
A divorced father of one, living with a domestic partner, begins psychotherapy by the use of internet communication (predominantly emails) with a licensed social worker who is female and located in another state.
The patient had been struggling for years with symptoms of posttraumatic stress due to emotional and sexual abuse from his childhood where the sexual abuse was perpetrated by his father. When his current partner engages in infidelity, the patient begins to question his sexuality. He searches the internet for help and finds a website offering therapy and counseling, via email, with the social worker.
Over the course of two years, the emails between the patient and the social worker blossom into a friendship, where the two share personal and intimate details of their lives; exchange gifts and photographs; and celebrate holidays “together.” The social worker, through therapy, also encourages the patient to be “unforgiving” of his partner’s infidelity and shares her own marital and divorce problems with her husband.
The e-mails turn flirtatious. The patient confesses his love to the social worker.
At this point, the social worker begins to understand why the ethical rules of her profession forbid “dual relationships.” She seeks help and advice from a supervising social worker and is told to end the therapy. When she abruptly sends an email regarding termination, the patient is left with an overwhelming sense of loss, betrayal, and feelings of abandonment. This improper treatment and termination process aggravates a pre-existing condition, such as the symptoms of post traumatic stress disorder.
The patient has paid many thousands of dollars to the social worker for therapy, which turns out to be useless and damaging. The internet therapy has compounded and magnified the problems which drove the patient into therapy in the first place. Over the next few years, the patient becomes isolated and unable to trust other therapists. He is despondent and retreats into an inner world of depression and despair, neglecting his child and his job. He is even suicidal at times.
This patient might have been saved from a world of harm (and the costs of more therapy to attempt to correct that harm), had the social worker explained, early on at the beginning of therapy, that dual relationships are fraught with danger and must be guarded against at all times.
When patients enter therapy, they expect help for the problems that brought them to therapy. Good therapy helps the patient with those problems, without subjecting them to additional traumas. It is the therapist’s responsibility to monitor the relationship at all times to prevent what happened to the patient in this case. There was also negligence because the therapist did not provide the information needed to obtain informed consent from the patient to have this psychotherapy.
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