Dual Relationships: Ethical Considerations in Rural Settings

This essay delves into the complex ethical considerations surrounding dual relationships between therapists and clients, particularly within rural and remote settings. It begins by defining dual relationships and exploring the ethical guidelines that typically advise against them, while acknowledging their inevitability in certain contexts. The discussion examines the frequency of dual roles in small communities, the potential drawbacks and benefits, and the implications for therapists practicing in these environments. The essay emphasizes the importance of understanding the potential for harm to clients, the role of professional boundaries, and the impact on therapists' personal and professional lives. It also highlights the need for appropriate training and ethical considerations to navigate these complex situations, offering insights into managing dual relationships effectively to ensure ethical practice and client well-being. The assignment also offers a discussion on the role of formal training as well as education and the professional guidelines.

Running head: DUAL RELATIONSHIPS IN RURAL AND REMOTE SETTINGS
Dual Relationships in Rural and Remote Settings
Name of the Student:
Name of the University:
Author’s Note:

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Table of Contents
INTRODUCTION...........................................................................................................................2
DISCUSSION..................................................................................................................................2
Dual Role and Multiple Relationship..........................................................................................2
Dual Roles and Multiple Relationship are more frequent in some contexts...............................3
Drawbacks as well as Benefits of Dual Roles and Multiple Relationships.................................4
Dual Roles and Multiple Relationships in Small and Remote Settings.......................................5
Implication for therapists who practices in rural/minor communities.........................................6
CONCLUSION................................................................................................................................8
REFERENCE LIST.......................................................................................................................10

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INTRODUCTION
Dual relationships between the therapist and the client are more often than not considered
inappropriate when it comes to mental health line of work. However upon considering the
context of remote and rural settings, it is an inevitable part of daily practice (Gonyea, Wright &
Earl‐Kulkosky, 2014). The aim of this assignment is to understand as well provide a detailed
outline on the ethics of dual relationship. A dual relationship exists only when a social service
worker, along with the professional relationship, has one or more than one relationships with a
client. Initially, dual relationships were seen to be a situation where coercion, boundary
violations, and exploitation might occur amongst other issues (Gonyea, Wright & Earl‐Kulkosky,
2014). The ethical guiding principle for social work usually suggests avoiding dual relationships.
In a lot of communities, dual relationship was not only seen as inevitable but it was also seen as
ubiquitous. The formal decision making models were over looked in the favour of an enduring
analysis of the satisfying relationship (Edwards & Sullivan, 2014). Moreover, the assignment
also offers a discussion on the role of formal training as well as education and the professional
guidelines.
DISCUSSION
Dual Role and Multiple Relationship
Whenever a client initiates a relationship apart from the one that has already been
preconditioned by the therapy setting, he or she enters the domain of dual role and multiple
relationships (Edwards & Sullivan, 2014). Here, it becomes necessary to identify the fact that
this beginning or initiation could take place during, before, or even after the therapeutic session
(Gonyea, Wright & Earl‐Kulkosky, 2014). Traditionally, dual role and multiple relationships

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were considered to have a negative implication and were more often than not associated with
client mistreatment as well as with sexual misbehaviours (Edwards & Sullivan, 2014).
Nonetheless, definitions of relationships exterior to the obligatory therapeutic association are
rather broad. It often reports to the non – professional relationships that includes sharing
worshipers or having kids at the same educational centre (McNichols, Witt & Gatewood, 2016).
In addition to this, the phrase, dual role and multiple relationship can also be referred to as a
situation where there prevails more than one role between the therapist and the client. For
instance, dual relationships are when the client is perhaps also a student, relative, friend,
employee or a business associate of the therapist. The relation can be deemed as sexual or non-
sexual depending on the bonding that the two of them share.
Dual Roles and Multiple Relationship are more frequent in some contexts
The usual approach towards the dual roles and multiple relationship, as has been depicted
by the ethical guidelines and the standards of the mental health professional associates has been
about minimization (Herlihy & Corey, 2014). However, there have been a lot of circumstances
wherein it was completely impossible to bypass the dual role and multiple relationships. When it
comes to the rural as well as the remote settings of any country, there seems to be a common
issue as social overlap is difficult to eliminate and avoid (Gonyea, Wright & Earl‐Kulkosky,
2014). In the rural communities, a mental health professional, even though being a part of the
local community, will perhaps be the only option for treatment of the individuals. Other
situations tend to create dual and multiple relationships out of the matched minorities (Humble,
2013). For instance, the deaf and dumb clients will relatively have lesser options available to
them in order to find a therapist who will be able to communicate with them in their language
and signs. At the very same given point of time, the chances of a therapist being a part of the

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same deaf community is relatively high even in the major metropolitan settings. An instance of
such can be, a client coming from a specific cultural or ethnic background, say Hmonog which is
an Asian group that migrated to the United States after the war that took place in Vietnam in
large number, might perhaps be more at ease or comfortable at getting help from an individual of
their ethnicity or cultural group (McNichols, Witt & Gatewood, 2016). So, it can be deduced that
the same conditions are applicable to various linguistic, ethnic and other minorities. A client
could even find it easier to relate to someone who comes from the same cultural background and
communicates in their native language. Although, ethnicity and cultural diversity between the
mental health professional associations is limited that gain tends to raise a completely new set of
challenges.
Drawbacks as well as Benefits of Dual Roles and Multiple Relationships
As it has already been discussed that a lot of the mental health professional associations
address dual roles and multiple relationships in their ethnic guidelines that seems to be readily
available on their websites (Brocious et al., 2013). The same is likely due because of the fact that
nearly half of the issues and the lawsuits are being filed against the therapist which mostly caters
to complaints such as dual relationships (Brocious et al., 2013). Here, the main concern seems to
be that the dual and multiple relationships could possibly harm a client. It can be noted that this
concern appears to be a grave issue considering the fact that high percentage of issues relate to
this particular matter. Now, there exists two ways through which fitting in dual and multiple
relationships can cause harm to the client. The first reason being, it can cause a loss in terms of
professionalism by a therapist which would eventually result in poor decision making as well as
judgement capability (Barnett, 2017). Coming to the second reason, harm is more often than not
related to some type of exploitation or mistreatment of power, or it could even be sexual

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transgression (Zur, 2014). The latter, over here, is addressed and prohibited in the ethical
guidelines of the mental health professional association, also by the law (Barnett, 2017).
Engaging in any sort of sexual act or behaviour, from physical as well as verbal intimation to
actual sexual relations, is looked upon as unethical where the clients along with the formal
clients are in trouble. The concept of intimacy or sexual relation with a therapist will eventually
harm a client and is backed up by the research (Ameh et al., 2017). When considering the
position on non-sexual relationship between a client and therapist, it seems to be unclear (Chory
& Offstein, 2018). Although it would be easy as well as unambiguous to hold a ban on all sorts
of dual role and multiple relationships, in actual world it will neither be neither desirable nor
practical (McNichols, Witt & Gatewood, 2016). When thinking about the big urban
developmental setting, the therapists as well as the clients can possibly meet in a non-therapeutic
environment. More often than not it is also seen that a therapists are forced to opine to the
intuition or the experience rather than the evidence which is based on the practical codes and
guidelines (Barnett, 2017). Half of these intuitive techniques appears to be standing on two
crucial aspects that is, quality of the dual and multiple relationships or the level of intimacy
along with the severity of the issue of the client.
Dual Roles and Multiple Relationships in Small and Remote Settings
Even though some of the above discussed examples of dual roles and multiple
relationships take place in any sort of urban setting, small as well as the rural communities
generate multifaceted relationships (Ameh et al., 2017). Taking into consideration a hypothetical
yet realistic situation, a local mental health professional who as parent is part of a small
community educational setting while at the very same time could be treating an employee of that
very institutional centre who could perhaps become the child’s class teacher or subject teacher

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(Ameh et al., 2017). Although this is unlikely to take place in an urban environment as a lot of
institutional centres and health professionals are available, different ethical norms and guidelines
will be applicable in such settings (Barnett, 2017). A threefold model has been proposed by
Ameh, who focussed on role expectations which might arise (Mullin & Stenger, 2013). The first
level consists of any sort of harm that could be identified by the grade of discordancy or
inharmoniousness of the expectations which both the therapist as well as the client has towards
the individual roles that they hold (Mullin & Stenger, 2013). This is where the expectations
diverge and the more the dual and complex relation between the client and the therapist, the
more it will tend to cause harm. To specify, the more a client looks up to their therapist as a
friend, the more likely it will be for the therapist to dismiss the expectation of the client. In the
second step, the problem of plural obligations has been addressed (Warren et al., 2014). Here, an
issue might arise where the role obligations might perhaps collide. For instance, according to the
above mentioned example, if the mental health professional is a part of the institution’s boards
and treating a teacher of the same school, conflicts are bound to take place. Lastly, the third
stage, power imbalance that could take place within the dual and multiple relationship is
disturbed by transferring the focus on the therapist as the risk of exploitation would be relatively
higher (Warren et al., 2014).
Implication for therapists who practices in rural/minor communities
There are certain possibilities of potential harm to the clients as a result of the dual
relationship. In some cases it may also affect the therapist, and they feel as if they are at work 24
hours a day. Moreover, it leaves the therapist with exhaustion due to handling of former as well
as the current patients. According to (Edwards & Addae, 2015), there are cases when there arise
certain complexities due to the maintenance of dual relationship that even harm the personal

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lives. For instance, a therapist’s daughter had dated several boys who were the former’s client.
The therapist, also, could not reveal the names of the clients due to confidential purpose. In most
of the cases, the clients tried to establish a contact with the family of the therapists which seemed
to have an effect on the personal lives (Edwards & Addae, 2015). Another example portrayed the
failure of the psychoanalyst to effectively bargain with the client thereby resulting in the
cancellation of YMCA membership which, in turn, resulted in awkward confrontation of the
therapists with that of the client.
The therapist may also feel anxious in order to pretend and hide the personal life from
social life. The anxiety may also cause fear of losing respect from the clients, as well as the
feeling of social abandonment (Sugimoto, et al., 2015). This has also resulted in further
implications that had a great effect on the lives of the therapists as well. In light ofd these4 type
of incviudents it is imperative for the therapists to follow some guidelines and ethical
consideration that can help in both the parties’ lives (Sugimoto, et al., 2015).
According to (Sugimoto, et al., 2015), the client and therapists dual relationship should
not have any implication as long as they learn how to distinguish between their personal and
social lives. Therefore, appropriate training should be given that would implement the strategies
in an effective manner (Zur, 2016). In addition to that, the therapist’s personal and social lives
may come at stake due to acknowledgement of the personal lives in the rural communities. In
order to have a balance in the lives of both the client and therapists, it is imperative to practice it
less often, which can also protect the authenticity of the therapists. The beneficial sides of the act
is however many. It can be used for effective role modelling and therefore, help the client to
recover from the mental illness. Moreover, it can also invoke positive attitude on part of the
client when they see the handling of different situations by the therapist (Norcross & Lambert,

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2019). However, the therapists may face more troubles than that of the one belonging from the
urban sphere. In relation to the environmental factor that have an effect on the therapy, the rural
settings might experience some limitations than that of the urban one (Stiles & Horvath, 2017).
In the essence of confidentiality, it has been noted that the rural settings face lesser
breach of information than urban settings. This is quite contradictory to that of the previous
statement mentioned where it is difficult to preserve confidentiality in the rural setting due to the
small geographical location (Hay-Smith, 2016). However, it has been found that the therapists
are more prone to share the incident with friends, colleagues and other medical practitioners,
whereas, in the rural settings, the therapists do not reveal the confidentiality considering the
limited geographical area, which revealed can have other effect on the personal lives of both the
parties (Sugimoto, et al., 2015).
Again, it can also be noted an increased amount of anxiousness in the minds of the rural
therapists due to the concealment of the confidentiality of the situation (Rolvsjord, 2016).
Therefore, it can have adverse effect on the health of the practitioner thereby, having a potential
mental health issues in the therapists. Therefore, the dual relationship practiced in the rural
communities can also affect the therapists in many ways.
CONCLUSION
In essence of the entire discussion on the dual relationship in the rural sphere, it can be
said that the matter is of high importance in respect to the potentiality of damage it can cause to a
client’s life. Sexual relationship has also been banned and ethically considered incorrect, which
has a least implications especially in the rural or small communities. Moreover, the therapists are
less likely to re-refer their clients to their friends or colleagues for treatment, therefore, reducing
the possibility to reveal of the confidentiality. However, most of the times, they face various

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ethical issues regarding dual relationships that ultimately have an effect on the personal lives.
This type of relationship should be more strategic that requires proper boundaries and proper
addressal which otherwise can cause a misbalance between the professionalism and personal
lives of the therapists. The urban environmental guidelines have come into force, however,
having the least effect in the rural communities. It is dire need to integrate ethical guidelines and
restrictions related to the professionalism of the therapists before indulging in dual relationships
with any clients. The implication of the dual relationship is quite beneficial, however, the matter
of the harm that it can cause needs to be seriously looked in to. Moreover, further improvements
and researches are needed in this context which would enable both the therapists and the clients
to be more careful in the process in order to save themselves from the ethical considerations
surrounding sexual relationships. In addition to that, proper and effective guidelines should be
provided that would help the medical health practitioners deal professionally and effectively that
would both safeguard the health issues and personal lives of the clients. The research should also
be extended including the rural communities that would be able to help the researchers to explore
more ways to reduce the dual relationships.

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