When Can Professionals Work with People They Know?

For many professionals, it is perfectly normal to have a relationship with a client or patient outside of the office environment.

In my own case, my brother-in-law is my dentist. I recently socialized with the lawyer who represented me in a real estate closing. I also see a physician who is my sister’s good friend, etc. And, I know I’m not alone.

When a professional has a relationship with their client/patient outside the context of the professional services they are providing to that person we call that a “dual relationship” or “multiple relationship”. While dual/multiple relationships might be common, in some professions, if not all, they always bring about ethical risks related to boundaries.

While dual relationships are sometimes unavoidable or even necessary, they should always be approached with caution and a clear understanding of the ethical implications. For example, when professionals work with someone they know personally, they must be vigilant about maintaining professional boundaries.

It’s crucial that the professional can separate their personal feelings from their professional responsibilities to ensure that the client receives the highest standard of care. This is especially important in situations where the professional might feel a strong sense of loyalty or obligation to the person they know, which can cloud their judgment.

When a professional has a dual relationship with a client, there is a chance that their non-professional relationship with that person will impact their ability to focus on their professional duty. The feelings that a professional has for that client that are not focused on the professional goals can influence the decisions that the professional makes. 

Lack of Fairness

The professional might provide more attention to a client they have a dual relationship with, compared to other clients. That’s not fair to clients who don’t have a dual relationship with the professional. 

Moreover, the presence of a dual relationship can impact the perception of other clients and colleagues. If others perceive that the professional is giving preferential treatment to someone they know personally, it can damage the professional’s reputation and undermine trust in their practice.

Transparency is key in these situations. The professional should openly discuss the dual relationship with the client and, if appropriate, with colleagues or supervisors to ensure that everyone is aware of the situation and that steps are taken to mitigate any potential risks.

Miss Important Information

The professional might miss important factors in their evaluation and treatment of a client they have a dual relationship with because they make assumptions about what they know, or need to know, about the client. This isn’t fair to the client in the dual relationship with the professional.

Unwillingness to Share

The client in the dual relationship with their professional might not be as willing to share intimate or embarrassing details. Clients are concerned this information might change the way the professional thinks about them personally. Although difficult, these details are necessary for the professional to provide them with the best level of care. This limitation in particular puts the client at great risk from the dual relationship.

In cases like this, it is important to discuss Client Confidentiality to help ease the client's concerns in this dual relationship.

The person receiving services might feel pressured to agree with the professional’s recommendations or be hesitant to voice concerns because of their personal connection. This can lead to an imbalance in the professional-client relationship, where the client does not feel fully empowered to make decisions about their care or legal representation.

See how this imbalance could affect your dual relationships in Am I a Mandated Reporter When I'm Not Working?

For these reasons, and many more, professionals in general, are discouraged from knowingly entering into dual relationships with clients. This is particularly true for mental health professionals. This means that mental health professionals, and especially in roles as psychotherapists, should avoid whenever possible starting a professional relationship with someone they already know. This also means that a professional should avoid whenever possible developing a non-professional relationship with a client they have become acquainted with in their professional role. 

This is especially true about avoiding romantic and sexual relationships with clients. Psychotherapists, in particular, are never allowed to have a sexual relationship with a current client. In such situations, the psychotherapist is subject to penalties such as losing their license and in most states, they can be convicted of a crime and sentenced to jail time in addition to incurring a financial penalty. 

General dual relationships, even in mental health professions, are not explicitly prohibited. A dual relationship might be ethically appropriate to meet the needs of a client when the client would otherwise not be able to access the services of that particular type of professional.

For instance, in rural communities there might not be many professionals to choose from. There might be one attorney, one physician and one therapist appropriate to address a particular issue for many miles. It would not be ethical or fair if members of that small community would not be able to access those services because of the limitations provided by their location. So, sometimes dual relationships are more acceptable than in other situations. 

Dual relationships might also be seen as appropriate, if not necessary, in insular communities. Some clients in tight knit religious or ethnic communities, for example, might not feel comfortable receiving particular services from someone outside of their community. However, the nature of their community might be that they will likely have a dual relationship with the professional as a result. In these situations, a dual relationship might be necessary in order for the client to receive the services that they need.

When a dual relationship is determined to be necessary to provide a client with the services they need, the professional still needs to be careful. The professional should make it clear to the client that they are entering into a dual relationship. The professional needs to emphasize that there are risks to a dual relationship. The client needs to be able to understand and appreciate those risks, and then accept those risks, in order to move forward in the professional relationship.

Making the role of the professional clear is important. Find out more on this in How to Discuss Mandated Reporting with Clients & Patients

By being proactive and thoughtful, professionals can navigate dual relationships in a way that respects both the client and the ethical standards of their profession.

Do you have a hypothetical dual relationship question that you’d like explore? Drop it in the comments, and let’s see what people think.

To find great live continuing education trainings on boundaries, including dual relationships, check out the training calendar for Kathryn Krase, PhD, JD, MSW HERE. To schedule a training on boundaries for your organization’s staff, contact Kathryn directly at kathryn@kraseconsulting.com