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Abstract

The literature examining dual relationships in rural communities is limited, and existing ethical guidelines lack guidelines about how to navigate these complex relationships. This study uses grounded theory to explore rural therapists’ perceptions of dual relationship issues, the perceived impact of minority and/or religious affiliation on the likelihood of dual relationships, and the ways rural therapists handle inevitable dual relationship situations. All of the therapists who participated in the study practiced in small communities and encountered dual relationship situations with regularity. The overarching theme that emerged from the data was that of using professional judgment in engaging in the relationship, despite the fact that impairment of professional judgment is the main objection to dual relationships. This overall theme contained three areas where participants felt they most needed to use their judgment: the level of benefit or detriment to the client, the context, and the nature of the dual relationship. Surprisingly, supervision and/or consultation were not mentioned by the participants as strategies for handling dual relationships. The results of this study are compared with established ethical decision- making models, and implications for the ethical guidelines and appropriate ethical training are suggested. [PUBLICATION ABSTRACT]

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Headnote The literature examining dual relationships in rural communities is limited, and existing ethical guidelines lack guidelines about how to navigate these complex relationships. This study uses grounded theory to explore rural therapists’ perceptions of dual relationship issues, the perceived impact of minority and/or religious affiliation on the likelihood of dual relationships, and the ways rural therapists handle inevitable dual relationship situations. All of the therapists who participated in the study practiced in small communities and encountered dual relationship situations with regularity. The overarching theme that emerged from the data was that of using professional judgment in engaging in the relationship, despite the fact that impairment of professional judgment is the main objection to dual relationships. This overall theme contained three areas where participants felt they most needed to use their judgment: the level of benefit or detriment to the client, the context, and the nature of the dual relationship. Surprisingly, supervision and/or consultation were not mentioned by the participants as strategies for handling dual relationships. The results of this study are compared with established ethical decision- making models, and implications for the ethical guidelines and appropriate ethical training are suggested.

The authors’ collective experiences of practicing in small communities led us to question how therapists in these communities handle the inevitability of dual relationships. As we discussed anecdotes from our respective practices, it became apparent that tension exists between a client’s desire to have a familiar therapist and the ethical standards of our field. We turned to the American Association for Marriage and Family Therapy (AAMFT) Code of Ethics for answers about how to navigate these delicate situations. Couple and family therapists are admonished to “make every effort to avoid [dual relationships] at all costs” (AAMFT, 2001; p. 1); however, no mention is made of how to accomplish this in settings with limited alternatives.

The issue of dual relationships in areas with limited alternatives is complicated by clients’ attempts to self-match. Self-matching occurs when clients select a therapist who shares their attitudes, race, education, social class, and/or religion (Jones, Botsco & Gorman, 2003; Whalley & Hyland, 2009; Willging, Salvador & Kano, 2006; Wintersteen, Mesinger & Diamond, 2005). Clients feel more comfortable discussing their lives and presenting issues when they believe their therapist holds the same values or shared cultural experience. A large percentage of Americans living in small communities may be able to achieve this owing to homogeneity in small communities, but not without creating ethical challenges for the therapist.

The ethical challenges for rural therapists are compounded when they also belong to a minority group. In addition to the limited number of available therapists in a small community, there are far fewer minority therapists in general (AAMFT, 2004). Therefore, when minority clients attempt to self-match, there is a strong likelihood that a dual relationship dilemma will be encountered.

This study aims to explore areas not previously considered in the ethics literature, paying particular attention to how therapists practicing in rural areas navigate these complex relationships. The next section provides the foundation for this study by reviewing the unique set of circumstances and community variables that increase the likelihood of dual relationships in rural areas and the ways existing ethical decision-making models fail to consider the challenges of rural practice.

2/23/23, 11:37 AM

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CHALLENGES OF RURAL PRACTICE

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5320: U7 D1: Dual Relationships

The dilemma of dual relationships, particularly in rural communities, can present significant ethical challenges. Review the articles by Gonyea, Wright, and Earl-Kulkosky (2014) and by Witt and McNichols (2014) in the studies for this unit.

In your initial post, discuss some of the methods used to manage potential dual relationships from the perspective of a provider and from the perspective of a supervisor. Describe at least one similarity and one difference in the ways a provider and a supervisor address dual relationship situations.

NOTE: 250-300 Words and at least 1 scholarly journal

SOLUTION