As funny as Dr. John is, we all know that he has issues. Other than sexual relations, though, what constitutes a “dual relationship,” and why is it so bad?
Yes, we all love Dr. John, despite his quirks and propensity to sleep with your mother, so let’s talk about other problematic arrangements in therapy. Consider a dual relationship to be any involvement between therapist and client that is not part of the traditionally understood treatment agreement. In other words, when you see a therapist, she is offering you a very specific service: treatment of a psychological/emotional difficulty in exchange for payment, via your health insurance or directly from you. Anything that occurs beyond or in addition to that is essentially a dual relationship. This is almost invariably bad, and it is ultimately the therapist’s responsibility to ensure that this does not occur.
Generally speaking, the worst kind of infraction occurs when the therapist asks the client to perform a specific act that is not part of the client’s treatment. This could range from something as seemingly benign as asking the client to bring her a cup of coffee from Starbucks to the more egregious sexual advances. As a recent example, a reader sent an email reporting that a therapist asks his clients to purchase marijuana for him. This is problematic on multiple levels. In this case, the therapist is asking clients to not only commit a crime (i.e., sell or distribute drugs) but commit one that directly serves the therapist’s personal interests. While none of us should be naïve enough to not realize that countless people use and sell pot to both friends and colleagues, the therapeutic relationship is a unique one. By asking clients to do this the therapy is compromised.
Clients are often very dependent on their treatment and their therapist, as therapy can involve experiencing and discussing very painful emotions. Some clients have told me that their psychological pain is far worse than any physical discomfort they’ve endured. In many cases, the therapist becomes a vital person in clients’ lives, helping them to navigate through this emotional pain. Imagine, then, that the client wants to reject a request an “out of bounds” question from this extremely important person, whether it be to buy coffee, drugs, or have sex. Now consider the thoughts that might run through the client’s head: If I say no, will my therapist be mad at me? Will he think poorly of me? Will I stop getting ‘good’ treatment? What if my therapist outright refuses to see me anymore if I don’t comply? Who will help me then?
Suppose, however, that the client doesn’t mind bringing the therapist a cup of coffee (or drugs or sex for that matter). Is he now obligated to bring it every week? What if he forgets? What if the therapist decides he wants coffee and a donut? Does the client have to comply with that too?
In essence, the therapist is creating a potential and unnecessary whirlwind of questions and emotions by asking this of his clients.
Therapist Rule: Do NOT solicit from clients. Ever. For anything.
During graduate training, we often videotaped our sessions with clients as part of our education. Clients were fully aware of this and agreed to it as part of being seen in a low-fee (and sometimes no-fee) setting. One student, a particularly pompous and arrogant woman in her final year of training, was doing particularly well as a therapist that year. Clients were reporting feeling significantly better in a very reasonable number of sessions with her, which made me secretly want to punch her in the neck for being better than me.
During one particular session, a client was saying how thankful she was for all of the student’s help so far. The therapist responded with “You are so welcome. Would you mind giving a testimonial for my business card? Something like, ‘__________ is the best therapist I’ve ever seen,’ maybe? That would really help me start off my practice.”
The client blanched. “Um, well sure, I guess I could say something along those lines.”
Our professor stopped the tape that he and about five students were watching. “Tell me…what the hell is the matter with you?”
“What? What’s wrong?” the student asked, clearly confused.
“You asked a client to give a written testimonial that you are the best therapist?”
“No,” she corrected, “just the best that she has personally seen. Is that wrong?”
“Yes it’s wrong!” the professor snapped. “Do you realize that you are putting this client in a horrible position? This person now has to write that you’re the best therapist she’s ever seen! How do you even know she thinks that?”
“Because she agreed to it,” countered the student.
“Maybe she agreed to it because she is so thankful for your help, maybe she’s afraid that you’ll withhold that help if she says no, maybe she doesn’t want to hurt your feelings. Do you see how many ‘maybes’ we can come up with?”
“I didn’t know it was wrong,” the student said, dejectedly.
“Well it is. And by the way, if you’re the best she’s ever met, she’s seen some bad therapists.”
I was later told that the student cried that night over some cheap scotch.
Feel free to comment on any experiences with dual relationships, or bring this piece to your next therapy session. Just so your therapist knows not to mess with you.