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Multiple Relationships and the New APA Ethics Code

Professional Practice

Celia B. Fisher, Ph.D.

In August 2002, the Council of Representatives of the American Psychological Association (APA) voted unanimously to adopt the 9th revision of the APA Ethical Principles of Psychologists and Code of Conduct (APA, 2002). The 2002 APA Ethics Code is the product of an extraordinary 5-year revision process built on APA’s 50-year tradition of involving the APA membership in the process of creating a living code of conduct with which psychologists can identify with and use in their everyday professional decisions. I was privileged to chair the APA Ethics Code Task Force (ECTF) composed of individuals dedicated to seeking member input through critical incident surveys, calls for member comments, and open meetings encouraging lively exchange among the ECTF, APA members, and observers from APA constituencies. During this process, the need to distinguish ethical from unethical multiple relationships was one of the primary issues raised by the Division 42 Ethics Code Committee. The Division 42 committee’s helpful comments contributed significantly to the final version of this standard. These excerpts from Fisher (2003) briefly explain the application of Standard 3.05, Multiple Relationships, to psychologists in independent practice and provide case examples of multiple relationship “do’s” and “don’ts” .

3.05 Multiple Relationships

(a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical (APA, 2002).

Not All Multiple Relationships Are Unethical

Individual psychologists perform a variety of roles and work with a variety of individuals. Standard 3.05 was crafted to define multiple relationships and to help psychologists distinguish between those that are ethical and those that are unethical.

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical. Standard 3.05 does not prohibit attendance at a client’s/patient’s, student’s, employee’s, or employer’s family funeral, wedding, or graduation; the participation of a psychologist’s child in an athletic team coached by a client/patient; gift giving or receiving with those with whom one has a professional role; or from entering into a social relationship with a colleague as long as these relationships would not reasonably be expected to lead to role impairment, exploitation, or harm. Incidental encounters with clients/patients at religious services, school events, restaurants, health clubs, or similar places are not unethical. Nonetheless, psychologists should always consider whether the particular nature of a professional relationship might lead to misperceptions regarding the encounter. If so, it may be wise to keep a record of such encounters. For example,

A client with a fluctuating sense of reality coupled with strong romantic transference feelings for a treating psychologist misinterpreted two incidental encounters with his psychologist as planned romantic meetings. The client subsequently raised these incidents in a sexual misconduct complaint against the psychologist. The psychologist’s recorded notes made immediately following these encounters were effective evidence against the invalid accusations.

Post-termination nonsexual relationships. The standard does not have an absolute prohibition against post-termination nonsexual relationships with persons with whom psychologists have had a previous professional relationship. However, such relationships are prohibited if the post-termination relationship was promised during the course of the original relationship or if the individual was exploited or harmed by the intent to have the post-termination relationship or when personal knowledge acquired during psychotherapy becomes relevant to the new relationship.

A psychologist in independent practice abruptly terminated therapy with a patient who was an editor at a large publishing company so that the patient could review a book manuscript the psychologist had submitted to the company.

Clients in individual and group therapy. In most instances, treating clients/patients concurrently in individual and group therapy does not represent a multiple relationship because the practitioner is working in a therapeutic role in both contexts (Taylor & Gazda, 1991), and Standard 3.05 does not prohibit such practice. Psychologists providing individual and group therapy to the same clients/patients should consider instituting special protections against inadvertently revealing to a therapy group information shared by a client/patient in individual sessions. As in all types of professional practice, psychologists should avoid recommending an additional form of therapy based on the psychologist’s financial interests rather than the client’s/patient’s mental health needs.

Potentially Unethical Multiple Relationships

Entering into another role. Psychologists may encounter situations in which the opportunity to enter a new relationship emerges with a person with whom they already have an established professional role. The following examples illustrate multiple relationships that with rare exception would be prohibited by Standard 3.05a because each situation could reasonably be expected to impair psychologists’ ability to competently and objectively perform their roles or lead to exploitation or harm.

A company hired a psychologist for consultation on how to prepare employees for a shift in management anticipated by the failing mental health of the chief executive officer (CEO). A few months later, the psychologist agreed to a request by the board of directors to counsel the CEO about retiring. The CEO did not want to retire and told the psychologist about the coercive tactics used by the board. The psychologist realized too late that this second role undermined both treatment and consultation effectiveness because the counseling role played by the psychologist would be viewed as either exploitative by the CEO or as disloyal by the board of directors.

Relationships with others. Psychologists may also encounter situations in which a person closely associated with someone with whom they have a professional role seeks to enter into a similar professional relationship. For example, the roommate of a psychotherapy client/patient might ask the psychologist for an appointment to begin psychotherapy. With few exceptions, entering into such relationships would risk a violation of Standard 3.05a because it could reasonably be expected that the psychologist’s ability to make appropriate and objective judgments would be impaired, which in turn would jeopardize the effectiveness of services provided and result in harm.

Preexisting personal relationships. Psychologists may also encounter situations in which they are asked to be in a professional role with someone with whom they have a preexisting personal relationship. These multiple relationships are frequently unethical because the preexisting relationship would reasonably be expected to impair the psychologist’s objectivity and effectiveness. The phrase “could reasonably be expected” indicates that violations of Standard 3.05a may be judged not only on the basis of whether actual impairment, harm, or exploitation has occurred but whether most psychologists engaged in similar activities in similar circumstances would determine that entering into the multiple relationship would be expected to lead to such harms.

Relatives asked a psychologist to help his nephew overcome anxiety about going to school.

A colleague asked a psychologist to administer a battery of tests to assess whether she had adult attention deficit disorder.

Unavoidable Multiple Relationships

In some situations, it may not be possible or reasonable to avoid multiple relationships. Psychologists working in rural communities, small towns, military bases, or American Indian reservations, or who are qualified to provide services to members of unique ethnic or language groups for which alternative psychological services are not available, would not be in violation of this standard if they took reasonable steps to protect their objectivity and effectiveness and the possibility of exploitation and harm. Such steps might include seeking consultation by phone from a colleague to help ensure objectivity; taking extra precautions to protect the confidentiality of each individual with whom the psychologist works; or explaining to individuals involved the ethical challenges of the multiple relationships, the steps the psychologist will take to mitigate these risks, and encouraging individuals to alert the psychologist to relational situations of which the psychologist might not be aware and that might place his or her effectiveness at risk.

(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code (APA, 2002).

Unforeseen Multiple Relationships

There will be instances in which psychologists discover they are involved in a potentially harmful multiple relationship of which they had been unaware. Standard 3.05b requires that psychologists take reasonable steps to resolve the potential harms that might arise from such relationships, recognizing that in some instances the best interests of the affected person and maximal compliance with other standards in the Ethics Code may require psychologists to remain in the multiple roles.

A psychologist in independent practice became aware that his neighbor had begun dating one of the psychologist’s psychotherapy patients. The psychologist could not reveal to his neighbor that the patient was in therapy. Although telling the patient about the social relationship could cause some distress, it was likely the patient would find out about the relationship during conversations with the neighbor. The psychologist considered reducing his social exchanges with the neighbor but this proved infeasible. After seeking consultation from a colleague, the psychologist decided that he could not ensure therapeutic objectivity or effectiveness if the situation continued. He decided to explain the situation to the patient, provide a referral, and assist the transition to a new therapist during pre-termination counseling.

(c) When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. (See also Standards 3.04, Avoiding Harm, and 3.07, Third-Party Requests for Services.) (APA, 2002)

Standard 3.05c applies to instances when psychologists are required to serve in more than one role in judicial or administrative proceedings or because of extraordinary circumstances. This standard does not permit psychologists to take on these multiple roles if such a situation can be avoided. Standard 3.05c requires that when such multiple roles cannot be avoided as soon as possible and thereafter as changes occur, psychologists clarify to all parties involved the roles the psychologist is expected to perform and the extent and limits of confidentiality that can be anticipated by taking on these multiple roles.

In most situations, psychologists are expected to avoid entering multiple relationships in forensically relevant situations or to resolve such relationships when they unexpectedly occur (Standards 3.05 a and b). When such circumstances arise (e.g., such as performing a custody evaluation and then providing court-mandated family therapy for the couple involved), the conflict may sometimes be resolved by explaining to a judge or institutional administrator the problematic nature of the multiple relationship.

A judge asked a psychologist who had conducted a custody evaluation to provide 6-month mandated family counseling for the couple involved followed by a reevaluation for custody. The psychologist explained to the judge that providing family counseling to individuals whose parenting skills the psychologist would later have to evaluate could reasonably be expected to impair her ability to form an objective opinion independent of knowledge gained and the professional investment made in the counseling sessions. She also explained that such a multiple relationship would likely impair her effectiveness as a counselor if the parents refrained from honest engagement in the counseling sessions out of fear that comments made would be used against them during the custody assessment. The judge agreed to assign the family to another psychologist for counseling.

References

American Psychological Association. (2002). Ethical Principles of Psychologists and Code of Conduct. American Psychologist, 57, 1060 – 1073.

Fisher, C. B. (2003), Decoding the Ethics Code: A Practical Guide for Psychologists. Thousand Oaks, CA: Sage Publication Company.

Taylor, R. E., & Gazda, G. M. (1991). Concurrent individual and group therapy: The ethical iissues. J. of Group Psychotherapy, Psychodrama, & Sociometry, 44, 51-59.

Celia Fisher served as Chair of the APA Ethics Code Task Force. Her comments reflect her own opinion and not those of APA or other members of the task force. This article is excerpted from Fisher, C. B. (2003), Decoding the Ethics Code: A Practical Guide for Psychologists. Thousand Oaks, CA: Sage Publication Company

She is Professor of Psychology and Director, Center for Ethics Education Fordham University, Bronx, NY.

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