 | Arnold Lazarus and Ofer Zur, Editors (2002)
|||
|
Book Review |
Reviewed by Ed Lundeen, Ph.D. |
||
 |
|
||
|
In a classic movie line, Jack Nicholson, in his role as the psychopathic (but aptly named) ‘Joker’ opined, “This town needs an enema!”. In his own scatological way, the Joker is implying that the complacency and acceptance of the status quo in Gotham City must be challenged and perhaps even flushed (pun intended) from the system. Though I doubt Drs. Lazarus or Zur were influenced by the psychotic bellicosity of the Joker, they have clearly attempted to follow his spirit of agent provocateur in their fine edited volume “Dual Relationships and Psychotherapy”. Intrepidly taking on the sacred cow of the sacrosanct “doctor-patient” relationship, they and their contributors attempt to dismantle notions based on rigid ethical dogma that look out for the best interests of no one. With a rousing, well written Foreword (Grad schools should add this to their regular Ethics curriculum) by Patrick DeLeon (“Meaningful Change Always Takes Time”), the banner is raised that the time for re-examining prevailing notions has come, though we can expect many road blocks and strong objection by entrenched thinkers. Lazarus and Zur note in their introduction “…few people tend to read a book such as this from cover to cover.” (except that is for obsessive book reviewers), and indeed their observation is likely true. This is a reference book, to be read for the value of specific articles. Since the topic of dual relationships is limited in its writings, as the editors note, there is indeed much overlap between chapters, and it is clear the editors looked only for apologists on the subject. This book is NOT a critical overview of the topic; it is meant as a summation of many like-minded thinkers. And uniformly, these thinkers are in favor of relaxing our strictures on dual relationships, citing the damage done by over-zealous lawyers, judges, Licensing Boards, and Ethics Committees to colleagues whose sole desire was to further the healing of the wounded. As this volume well reminds us, the APA Ethics Code (as do those of most other professional associations) does not forbid dual relationships. However, despite the official position, the de facto stance of most professionals is that dual relationships are to be avoided because they have a strong potential for harm to those we serve. Several of the authors point out how the inclusion of multiple roles and relationships between therapist and patient/client can not only NOT cause harm, but significantly aid the development of therapeutic alliance and help patients grow in ways not possible in the context of treatment taking place solely in an office. It is unlikely that most of us will ever play tennis with a patient, or have dinner with them. But this book demonstrates often how doing so may be beneficial. One can then posit that perhaps it is unethical to NOT use multiple relationships, given their potential for extra-therapeutic healing. The seeming delight taken by too many in the rigid interpretation and application of the cautions against dual relationships should alarm us all. Have we forgotten our role as those who work to understand the context, purpose and meaning of behavior? Too long has our field acted as though we professionals were generally incapable of controlling our behavior or executing wise decisions, filled as we are with “jejunosity” (see Woody Allen’s “Love and Death” for explication of this neologism). It is certainly sensible for example not to play tennis with a patient who suffers from clear Borderline traits -- such a person’s inability to make sense of multiple roles is well documented. But most patients do not suffer from such pathology, and to paint our thoughts with brushes tinged by the lowest levels of human capacity for relatedness is atavistic. Many patients are in fact bright, understanding persons, capable of making informed choices and of protecting themselves from potential exploitation. The near constant refusal to consider this facet when discussing dual relationships is noted by the authors, who challenge us to see that our quasi-paternalistic views are perhaps at times grandiose inflations of our own value, power and wisdom. This book notes however the wise maxim that therapists must be judged based on their own capacity as well. In sum, wiser, healthier therapists seem better prepared to make broader and more expansive judgments -- such therapists seem well poised to know when expansion of the boundaries of therapy can be to the best interest of the patient. As one author in the book suggests, perhaps we would do better to invest more money and energy in screening and training students than in retroactively trying to punish those few outlyers who do real harm by crossing clinical lines. “Dual Relationships and Psychotherapy” serves its purpose well. As I read it, I thought that perhaps the authors were at times erecting straw man arguments to prove points -- surely most professionals were a bit more open-minded. But as I have watched in the several months I have been digesting this book, I have felt more confident that the straw men are in fact real life embodiments of Pogo’s aphorism “we have met the enemy (and he is us)”. It is time for us to ease up on ourselves, relax some of the neurotic guilt that has plagued our profession so long. Yes, bad apples exist and we should guard against them. But the institutionalized paranoia that makes even the authoring of a book on dual relationships controversial should end. Thanks go to Lazarus, Zur and their brave contributors for opening Pandora’s Box, and allowing us to timidly look inside to find not the danger expected but riches unexplored. If Drs Lazarus and Zur will lead the revolution I know I will follow (as long as Dr Lazarus lets me beat him at tennis and Dr Zur takes me out to dinner). |
|||