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THE MANAGEMENT OF ETHICAL DILEMMAS ASSOCIATED
WITH DUAL RELATIONSHIPS BETWEEN
GAY THERAPISTS AND GAY CLIENTS
AND LESBIAN THERAPISTS AND LESBIAN CLIENTS
INTRODUCTION
A dual relationship exists when a therapeutic relationship extends, either intentionally or unintentionally, to include encounters or activities outwith the client-therapist relationship.
This chapter considers ethical dilemmas associated with dual relationships in lesbian therapist-lesbian client, and gay therapist-gay client work. Although the consequences and complexities of dual relationships can occur in any community, they are more likely to exist in the particular social and cultural contexts of the lesbian and gay communities.
Brief definitions of dilemma, dual relationships and boundary provide a framework for the discussion. Theoretical perspectives are introduced throughout the text where appropriate and aspects related to the management of ethical dilemmas, including boundary management and the use of ethical problem solving models, are noted.
Three case studies are presented to create opportunities for the discussion and consideration of ethical practices in managing what could be termed duality dilemmas .
The authors wish to thank Tim Bond, Alan Jamieson and Charles Neal for their valuable feedback on earlier drafts of this chapter.
The authors note the limitations of existing theory in relation to therapeutic work in the lesbian and gay communities and seek to develop ethical practices for managing duality
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2 and overlap; practices which strive to honour and respect diverse social, political and relational realities.
This chapter does not claim to be exhaustive. It is offered in the spirit of an exploration, for the benefit of the authors as well as the readers; and ultimately, our clients and communities. There is no intention to proscribe or prescribe a definitive set of practitioner beliefs and behaviours. Suggestions and recommendations are given from a philosophical base that values ongoing debate and development in counselling theory and practice.
The terms counsellor and therapist , and counselling and therapy will be interchanged within the text, and are used generically to avoid any ambiguity regarding their meaning and interpretation in the context of this work. The pronouns he and she will be used as appropriate, and for ease of reference, the lesbian therapist-lesbian client and gay therapist-gay client relationship will be referred to as lesbian and gay therapy.
DEFINITIONS AND CONTEXTS
Defining dilemmas, dual relationships and boundaries and placing them in the context of managing dilemmas in the client-therapist relationship
Dilemmas associated with the living experiences and encounters of lesbian and gay therapy take us into largely unexplored territory in counselling theory and practice.
Conflicts of relationships are central to human existence, yet conflict resolution and the management of dilemmas are not areas of human expertise. Perhaps this is why we sometimes shy away from difficult situations or lock horns in destructive ways. Our
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3 dictionary definitions indicate that dilemmas are situations to be avoided. The Concise
Oxford Dictionary defines dilemma as,
`a position that leaves a choice between equally unwelcome possibilities; argument forcing opponent to choose one of two alternatives, both unfavourable; difficult situation’..
(Concise Oxford Dictionary, 1982: p 268)
Given the definition above, it is hardly surprising that counsellors’ therapy dilemmas are not more openly discussed. To do so might make us personally and professionally vulnerable, and may be viewed as challenging the profession’s perceived image of competency and reliability (Bond, 1997). Through avoidance however, we shun opportunities for personal and professional development, since it is possible for seeds of growth to be contained in the midst and aftermath of dilemmas. It may be that we fear rejection or ridicule through the disclosure of dilemmas in our therapy practice; seeking instead peer and professional acceptance through adherence to practices and values that may be alien to our particular culture and community. Perhaps worse, we may consciously or unconsciously engage in unethical behaviours, finding ways to condone and justify our actions.
To see, or seek, the positive in the face of a dilemma is not a typical reaction. It is more likely to be one of anxiety, fear, or panic. Despite the anxiety or concern we may hold about overlap between therapy relationships with our clients, and imagined or actual encounters with them in our shared communities, the potential does exist to
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4 creatively, ethically and respectfully deal with duality, and develop what Clarkson refers to as role fluency (Clarkson, 1995) .
Prior to further discussions however, we offer some definitions of dual relationships, note concepts drawn from the literature and construct a meaning of the term `boundary’ that is appropriate and applicable when considering overlap between therapy and community.
Dual relationships are defined here as those where the therapy relationship extends, either intentionally or unintentionally, to include extra-therapy relationships, encounters or activities (Gabriel, 1996). They have been described as containing the potential for exploitation and the impairment of professional and clinical judgement (Kitchener, 1988) and they have been the subject of a great deal of professional contention and dispute, as well as the cause of civil litigation cases (Borys and Pope, 1989). Professional opinions range from dual relationships always being unethical (Pope, 1991), to, sometimes being unethical (Berman, 1985). Pope (1991) believes that dual relationships seriously distort and impair the therapeutic relationship, and where they are allowed to occur, are engaged in purely to satisfy the therapist’s needs and are often excused on the grounds of prevalence, tradition and necessity. Where dual relationships occur through `necessity’,
Pope states that they are undertaken without recourse to ethical or clinical scrutiny (Pope,
1991). Perhaps the fears, prohibitions and exhortations to avoid dual roles and relationships are based upon deep rooted, irrational fears about intimacy in human relating; perhaps the profession has held a phobia about dual relationships. The weight of protest against dual relationships has been laid upon their inherent potential for client
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5 harm, and it has been suggested that the risk of damage appears to increase where there are corresponding increases in level of intimacy and power differential (Pearson and
Piazza 1997). The concept of intimacy is complex and will not be explored in this work, although aspects of intimacy are implicit in the three case studies. However, the notion that client and therapist may experience therapeutic intimacy , whilst experiencing parallel community intimacy may well warrant future research.
Despite a history of prohibition, there are indications that professional perceptions of dual relationships are shifting. There is growing recognition that in some contexts dual relationships are unavoidable (see for example, Anderson and Kitchener, 1996; Pearson and Piazza, 1997). We may be in the process of a paradigm shift in professional beliefs - taking us from “
Dual relationships must be avoided” to “
Dual relationships exist, therefore how can we best manage them?” Whatever consciously or unconsciously motivates such beliefs, it is reasonable and professionally appropriate to question what approach is relevant to the context and reality of lesbian and gay therapy; a reality whereby convoluted and complex relationship networks can exist. For example, where non-monogamous relationships are common, the client and therapist may share a complex web of interconnected friends, lovers, acquaintances or colleagues.
Whatever the root source of past injunctions and judgements, little account has been taken of the culture and context of the communities in which lesbian and gay therapists and their clients exist. It may not be realistic to expect counsellors to divorce themselves from their communities. Importantly, therapy does not exist in a vacuum or
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6 hermetically sealed container (Clarkson, 1995), hence the need to question the realism of prohibitions and injunctions. Directives against seeing friends and acquaintances as clients have been almost universally accepted, and almost as universally violated (Roll and Millen, 1981). A number of theorists and practitioners have noted the links between gay and lesbian therapists, clients and their communities
(see for example, Brown, 1984, 1985, 1989a, 1989b, 1990, 1994; Burgess, 1997;
Dworkin, 1992; Dworkin and Gutierrez 1989; Gabriel, 1996; Gartrell, 1992; Lyn, 1995).
The reality of living and practicing within ones community is such that it can resemble a small town or village, where interconnections and overlap, and knowledge of the inhabitants, are shared by the individuals (Brown, 1984). Brown describes living and working in this type of environment as akin to `life in a fishbowl’. Such a situation demands clarity regarding what is available for the `public domain’, and what must be held in the `private domain’. Where overlapping and complex multiple roles exist, (for example, where client and therapist share an interconnected network of friends, lovers, colleagues or acquaintances), it might be necessary to adopt some form of `mind map’ to help process what knowledge and information about the community and its members must remain in the therapy arena and what is available for `public consumption’.
Managing the web of client and community connections can present the counsellor with a myriad of challenges, issues and potential dilemmas. Complex boundary situations may arise where non-monogamous relationships are common within the community
(Browning et al, 1991). Where there are overlapping links between clients, ex-lovers,
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7 current lovers, friends of ex-lovers, friends of clients, and so on, there exists the potential for life and work to become extremely complicated and interwoven. Such a complex matrix of overlapping connections may create difficulties for the counsellor who chooses to openly and actively participate in the community and its events. A therapist may find her/himself in a position where they have to choose between avoiding events held at the only lesbian or gay social venue, or find means of dealing with the overlapping situations that will inevitably arise. Though some may choose to avoid participating in events, such abstention may generate unconscious reactions that impact upon the client-counsellor relationship. Taking evasive action can serve to separate the therapist from the very community in which they live and work.
Whilst all therapists and clients living and working together within a small community experience overlapping roles, encounters or activities, there are undoubtedly some aspects that are unique to lesbian and gay communities. One of the most ethically challenging scenarios, probably unique to the gay community, is that where the gay therapist and one of his clients find themselves together in a `backroom’ scene. One of our case examples later will consider this and suggest ways of dealing with what some consider to be the `worst case scenario’. We now offer a definition of `boundary’ in an attempt to construct a working term for a concept that is often misunderstood or experienced as difficult to define.
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Boundary dilemmas can constitute the most anxiety inducing situations for counsellors
(Gabriel, 1996) yet limited focus is given to the subject during counsellor training; especially to the role that boundaries play in minimising professional boundary mismanagement (Webb, 1997). Practitioners tend to feel that they understand the concept of boundaries almost instinctively and intuitively, yet often encounter problems in bringing it to life and attempting to explain it to others (Gutheil and Gabbard, 1993).
Counsellors’ difficulties with boundaries range from confusions and mismanagements, through mild exploitation, to seriously abusive boundary violation (Webb, 1997). How then, might we define boundary? The Concise Oxford Dictionary (1982) defines it as a limit-line, with additional meanings for boundary layer and a boundary rider . The boundary layer denotes an area of fluid, adjacent to a body moving through it, whilst the boundary rider is defined as an individual who rides a perimeter fence, undertaking any necessary repairs.
From this definition, the boundary in counselling can be perceived as a limit-line, with inherant fluidity and permeability, as well as safety and security. It is a limit that requires the thoughtful actions of the boundary rider , the counsellor , to monitor, check and repair where necessary, in order, as far as is humanly and professionally possible, to ensure security and safety (Gabriel, 1996). This resonates with a definition offered by Peterson
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(1992) whereby boundaries are viewed as limits for protective and holding purposes.
This protection and holding function can be created within an overall therapy frame and constitute a major part in the complex obligations, tasks and components involved in holding and containing the therapeutic relationship (Gabriel, 1996). Appropriate boundary management will also be contextually based, and operate according to different rules within different roles and relationships (Webb, 1997).
Research data and professional literature specific to boundaries in dual relationships is minimal and the majority is derived from an analytical, psychodynamic or feminist perspective (see for example Brown, 1984, 1985, 1989a, 1989b, 1994; Cooper, 1992;
Epstein and Simon, 1990; Gartrell, 1992; Langs, 1976, 1978, 1979; Margolies, 1990;
Milton, 1993; Peterson, 1992; Post and Avery, 1995). From a feminist perspective, theologian Carter Heyward (1993) has offered some interesting notions of mutuality within the therapy relationship and suggests that clients can accurately perceive a therapist’s struggle with boundary issues. Written from a client’s perception of therapy, she offers a poignant reminder that the client’s experience of the boundaries and frame of therapy is crucial to the process and progress of the therapy, and must not be ignored or undermined. Heyward was influenced in her feminist philosophy of helping relationships by a counselling model developed at The Stone Centre, Massachusetts,
USA.
The work of Jordan and Stone Centre colleagues (see Jordan et al, 1991; Jordan, 1995) moves far away from Aristotelian and Kantian logic and objectivity toward an image of a
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10 reality defined by relationship, continuities and probabilities. Both participants in the dynamics of therapy enter into a relationship of mutual empathy and respect, where interpersonal responsiveness and efficacy is encouraged. This is not to imply that the relationship is symmetrical, for client and counsellor are seen to participate in differentiated roles yet share the intention of facilitating the client in resolving particular problems or dilemmas (Jordan, 1995). This form of therapy acknowledges the powerful position of the therapist, though power ought to exist in the service of client empowerment, and never to violate or utilise for therapist self-gratification. It is significant to note that to date, counselling research has paid minimal attention to a client’s perception of boundaries, and importantly, how they experience boundary issues where dual relationships and overlapping connections occur.
The complex power dynamics in client-therapist interactions are central to the issues and dilemmas of dual relationships. For some clients, meeting their therapist outwith therapy will engage both counsellor and client in a delicate exploration and reparation of the therapeutic relationship. Indeed for some, the overlap or duality may lead to the decision to end the therapeutic relationship. Preliminary discussions during the contracting phase at the outset of counselling helps to clarify and `rehearse’ appropriate actions where dual relationships or overlapping connections might arise. Essentially, we are promoting anticipation as a discipline where dual relationships are likely, rather than wisdom after the event (Jamieson, 1998).
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Facilitating a client’s self-empowerment and their capacity for managing duality in a healthy, safe, and respectful way, can become a significant aspect of the work for lesbian and gay therapists and clients who share a community. How the counsellor might manage this process will be considered in the sections on processing dilemmas and case studies. In the following section, we consider some of the mainstream theoretical and philosophical influences upon dual relationships in lesbian and gay therapy.
MAINSTREAM PROFESSIONAL INFLUENCES
Attitudes, morals, philosophies and theories
There are certain aspects of lesbian and gay culture and experience which, if made central to all psychological enquiry and debate, would influence and expand our ability to further comprehend both the intrapsychic and interpersonal realms of human existence (Brown,
1989b). In essence, this is a request for the expansion of the boundaries of therapy and counselling research. Since the kernel of the majority of counselling and therapy schools is the comprehension and expansion of our understanding of an individual’s inner world, or intrapsychic realms, and the outer world, or interpersonal realms, this call seems realistic. However, it will necessitate the willingness of mainstream counselling, psychology, and psychotherapy professions to seriously and critically appraise the views of
Brown and others who strive for theoretical and clinical recognition (see for example
Coyle, 1993, 1995; Davies and Neal, 1996; Gonsiorek, 1994; Kitzinger, 1987).
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Despite homosexuality being declassified as a mental illness by the American Psychiatric
Association (APA) in 1973, discrimination and homophobic attitudes continue to exist within the helping professions. The World Health Organisation (WHO) did not declassify homosexuality as a mental disorder until 1992. Section 28 of the UK Local Government
Act, introduced in 1988, has made it illegal for local authorities to intentionally promote homosexuality (Sayce, 1995). Though the APA’s 1973 watershed decision undoubtedly opened the way to professional developments and the promotion of a psychology which understood the experience of lesbians and gays within non-pathological frameworks, there remains a long way to go (Coyle, 1995). Therapists have tended to remain `in the closet’ and therefore invisible in mainstream professional literature. It may be that lesbian and gay therapists elect, for significant reasons, to demarcate what is available for the public domain and, for reasons of privacy and professional status, contain certain aspects of their life and work in a private and personal domain. Very little literature has been published that is of immediate and practical assistance to the lesbian or gay practitioner, and virtually all of the key historical figures in counselling and therapy have been men
(McLeod, 1993) who have made their contributions from what has overtly been a white, heterosexual, middle-class perspective.
This apparent imbalance within the published literature has misrepresented and distorted theoretical and clinical approaches to lesbian and gay therapy. Encouragingly, there are indications of changing perceptions. Anti-discriminatory policy and practice is central to
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13 the recently introduced National Vocational Qualifications (NVQ’s) in counselling, and the British Association for Counselling (BAC) have recently amended their Codes of
Ethics and Practice to incorporate equal opportunities statements and anti-discriminatory clauses (BAC, 1997). Other publications have addressed the need for equal opportunities, and anti-oppressive and multicultural beliefs and practices to be upheld within the helping professions (see for example, Lago and Thompson, 1989; Young,
1995).
A recent MIND survey highlighted how mainstream psychiatric services are failing lesbians, gay men and bisexuals (MIND, 1997), and Health Minister Paul Boateng declared that;
“Gay, lesbian and bisexual people coping with mental health problems ought not to be doubly disadvantaged by having to face yet another unacceptable stigma.
We ought to put clearly behind us the psychiatric stone age that dismissed an individual’s homosexual identity as a pathological one. All people, regardless of sexual orientation, are entitled to respect and affirmation in the NHS”.
(Powell, 1997)
Whilst the above statement was made in reference to NHS and statutory services, it might be applied generally throughout the helping professions. Many lesbian and gay therapists may fear, or actually experience, their work and lifestyles being pathologised. To publicly accept and acknowledge, and conscientiously, professionally and humanely manage the overlap between therapy and community, may invite scorn, discredit and homophobic reactions.
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Challenging discriminatory attitudes may be best dealt with from the outset of the helping professional’s training, with issues related to working with lesbian, gay and bisexual clients integrated throughout the training curriculum, rather than given ad-hoc, token status.
A number of articles have begun to appear, calling for a heightened awareness and sensitivity to lesbian and gay issues in counselling training (see for example, Burhke,
1989;
Crouan, 1996; Iasenza, 1989). Following research which demonstrated how psychoanalytic training establishments were discriminating against lesbian and gay trainees
(Ellis, 1994), organisations such as Pink Therapy and the Association for Lesbian, Gay and Bisexual Psychologies UK (ALGBP (UK)) are working to promote the inclusion of lesbian and gay issues in counselling. This is a welcome move, since training rarely equips us to manage ethical decision making or assist us in developing the ability to theorise and conceptualise about ethical and professional issues, including dilemmas in dual relationships. We may well enter the profession ill-equipped to deal with the intricacies of the day-to-day reality of counselling practice.
In recent years, a greater emphasis has been placed upon moral principles and their relevance to counselling (see Bond, 1993; Henry, 1996; Kitchener, 1984; McGrath,
1994). Where the lives of the client and therapist cross or intertwine, codes of ethics and practice may provide inadequate guides to managing the overlap. In fact, the boundaries
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15 of acceptable behaviour in the view of professional codes may be inappropriate for lesbian and gay communities, since the codes do not account for the web of complex and convoluted relationships often encountered. The development of appropriate and ethical boundary management in dual relationships can benefit from knowledge of the moral principles that inform and underpin counselling theories. They can become significant supports in the process of managing dual relationship issues and dilemmas. The five moral principles which inform most ethical codes of conduct within the helping professions are autonomy (promoting the maximum degree of choice for all involved), justice (ensuring that people are treated with fairness), beneficence (action undertaken for the good of/benefit of the client), non-maleficence (ensuring that no harm is done to anyone), and fidelity (action in good faith). This latter principle of fidelity is closely related to issues of trust, power dynamics and the informed consent of individuals (Meara and Schmidt, 1971) and may be significant to therapy in lesbian and gay communities, where complex relationship dynamics and interconnections can exist. For example, where the client and counsellor have a tacit agreement about attending social/community event, does the practitioner explicitly seek the client’s informed consent on each occasion? How might we know whether a client is merely deferring to what she/he perceives as the more powerful position of the therapist?
Although this chapter does not offer an exploration of moral principles, a number of explanatory texts and articles are available for practitioners to read and form their own opinions and judgements about what is appropriate (see for example, Beauchamp and
Childress, 1979, 1983, 1989, 1994; Bond, 1993; Henry, 1996; Kitchener, 1984; McGrath,
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1994).
Placing moral problem-solving and decision-making within the context of the counselling relationship may be an important step toward ethical and professional practice. As stated earlier, there seems to be a perceptable shift in beliefs from
“Dual relationships are never appropriate”, to,
“Okay, we acknowledge that dual relationships are inevitable in some contexts; given this, how can we best manage the situation?”
Tables 1 and 2 below are offered as generic models for ethical problem-solving and decision making which incorporates the five moral principles outlined above.
Table 1
………………………………………………………………………………………………
PROCESS STEPS FOR ETHICAL PROBLEM-SOLVING AND DECISION
MAKING
………………………………………………………………………………………………

Write a brief description of the problem or dilemma.

Whose problem or dilemma is it?

Consider all available codes and guidelines.

Consider the moral principles underlying counselling/helping professions.

Identify possible courses of action.

Select the most appropriate course of action.

Evaluate the outcome.
This helps to clarify the situation and minimise confusion. This step is particularly helpful where you are discussing the situation with your supervisor or professional colleague.
The counsellor’s?
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The client’s?
Joint problem?
Agency/organisation problem?
Where joint responsibility exists, then clarification, negotiation, and issues related to the boundaries within the counselling relationship need to be thoroughly discussed between client and counsellor; using the process steps to support the discussion and decision making. Supervisor consultation is advised to facilitate this process.
Consider appropriate sources of guidance, eg., British Association for Counselling
(BAC) codes and guidelines. Consider where appropriate:
 what actions are prohibited/required according to available ethics codes?
 what actions are prohibited by law?
 what actions are required by law?
In the absence of decisive guidelines, consider:
Beneficence: what will achieve the greatest good?
Non-maleficence: what will cause the least harm?
Justice: what will be fairest for all parties involved?
Respect for autonomy: what maximises the opportunies for everyone to implement their own choices?
Fidelity: what actions need to be taken to ensure that the counsellor remains faithful to the counselling relationship? - this is a fiduciary relationship, that is, it is given in trust. Breaking the client’s faith and trust in the counsellor may constitute a serious violation of the therapy relationship, and reparation and redemption of the therapeutic alliance may not be possible.
Brainstorm all possible courses of action. Depending upon circumstances, this step will be carried out with the support and cooperation of the client/supervisor/counselling colleague.
Consider the preferred/chosen course of action from the following perspectives:
Universality: could the chosen action(s) be recommended to others?
Would I condone my proposed action(s) if undertaken by a colleague?
Publicity: Could I explain my chosen action(s) to colleagues? Supervisor?
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Would I be willing to have my action(s) exposed to scrutiny in a court of law, in the media, or other public forum?
Justice: Would I take the same course of action with other clients? If the client were well-known or influential, would my decision(s) have been the same?
Different?
Answering no to any of the above questions indicates that you would be advised to reconsider your chosen course of action. It is advisable that reconsideration is undertaken with your counselling supervisor.
Consider:
Was the outcome as you hoped?
Had you considered all relevant factors with the result that no new factors emerged?
Would you do the same again in similar circumstances?
If you answered no to any of the above three questions, consider what you would do differently should the dilemma/problem arise in the future.
………………………………………………………………………………………………
Source: Gabriel (1996), adapted from Tim Bond (1993) `Standards and Ethics for
Counselling in Action’.
London: Sage.
………………………………………………………………………………………………
Whilst the above model does not claim to be a definitive framework for solving ethical dilemmas, it does offer a guide to the consideration of appropriate courses of action.
Knowledge of ethics, codes and moral principles provides an important background for the decision making process, and can be enhanced through consulting colleagues,
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19 supervisors and available literature. Inevitably, our personal, political and professional morals, beliefs and values will consciously or unconsciously inform our principles, decisions and practices. Where conflict does arise in our personal and professional decision-making, it may provoke actions that widely divert existing codes of ethics and adversely impact upon client-therapist dynamics. In essence, we need to accomplish a fine balancing act between the personal and the professional aspects of our lives, through ongoing assessment, monitoring and reviewing of opposing or competing elements in our boundary management. And each dual relationship or multiple role situation will require us to attend to the psychological, emotional and contextual features unique to that particular situation (Sim, 1997).
It would be sad if decisions regarding the ethical management of dilemmas in our practice were to be taken totally out of our hands and put solely into the hands of ethics committees. It would seem more appropriate for practitioners to develop realistic and reasoned frameworks within which to practice, and from which the dynamics of the client-counsellor relationship and community connections could be monitored and managed.
Table 1 presented a framework for problem-solving in ethical dilemmas, whilst table 2 below offers an overview of the phases involved in working through dilemmas in dual or overlapping relationships. Used in partnership, they provide a complimentary perspective for charting routes through a dilemma, beginning with the moment of
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`impact’, and developing onwards to the longer term directions that the client/counsellor work and relationship may take
Table 2
………………………………………………………………………………………………
WORKING WITH DILEMMAS IN DUAL RELATIONSHIPS AND OVERLAPPING
CONNECTIONS
………………………………………………………………………………………………
Containing shock and impact of situation
Invoking stress/crisis management techniques!
Containing any immediate `fall-out’/ acting-out
impulses
Invoking an `internal supervisor’
Making contact with client; acknowledge situation
Seeking agreement to discuss situation at the next therapy session
Modelling healthy, appropriate behaviour
Acknowledgement of situation at next therapy session
Discuss with client issues of confidentiality, boundaries, future overlapping connections and possible discussion/rehearsal of agreed actions should other situations arise
Begin to address client’s reactions/responses to the situation
Begin to address transference issues
Continue to provide ongoing containment
Redeeming the therapeutic alliance
Discuss countertransference reactions in supervision/personal therapy
Ongoing exploration of transference manifestations
Exploring countertransference in personal therapy and supervision
Ongoing work with issues/themes triggered by or
linked to dual or multiple roles and relationships
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………………………………………………………………………………………………
©
Gabriel, 1998
………………………………………………………………………………………………
Bringing this process model to life requires conjoint consideration of our professional ethics codes. For example, BAC’s Code of Ethics and Practice for Counsellors states that;
“Counsellors must establish and maintain appropriate boundaries around the counselling relationship. Counsellors must take into account the effects of any overlapping or pre-existing relationships”.
(BAC (1997) Code of Ethics and Practice for Counsellors, Section A.5)
This statement implies that, for those clients and counsellors who share the same lesbian or gay community, the counsellor holds a responsibility to delineate and define overlapping connections and boundaries between therapy and community.
The BAC Code also contains a clause stating;
“Counsellors are responsible for setting and monitoring boundaries throughout the counselling sessions and will make explicit to clients that counselling is a formal and contracted relationship and nothing else”.
(BAC, 1997, Code of Ethics and Practice for Counsellors, Section B.5.1)
This clause implies a clear role definition between what behaviour and actions belong within the counselling relationship, and what remain outwith and beyond the realms of the client-therapist dynamic.
In relation to resolving ethical conflicts in our practice, the BAC code offers the following;
“Counsellors may find themselves caught between conflicting ethical principles,
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22 which could involve issues of public interest. In these circumstances, they are urged to consider the particular situation in which they find themselves and to discuss the situation with their counselling supervisor and/or other experienced counsellors. Even after conscientious consideration of the salient issues, some ethical dilemmas cannot be resolved easily or wholly satisfactorily”.
(BAC (1997), Code of Ethics and Practice for Counsellors, Section B.1.6.3.)
The horns of ethical and professional dilemmas may be sharp, and undoubtedly possess the potential to inflict damage, yet they can become powerful allies to aid us in excising inappropriate or redundant theoretical debris. In our counselling practice, we may need to conscientiously discard theoretical or conceptual aspects that hinder realistic and reasoned solutions to dual relationships in lesbian and gay therapy. Imagine a counsellor placing herself between the horns of a dilemma, thus providing a creative conceptual space. She has now entered a space in which to craft a reasoned and intentional exploration of all the salient issues. If we now consider a dual relationship, whereby the counsellor and a client encounter one another at a social gathering, we can begin to raise some of the issues or questions that may result. For instance, in not contracting for the possibility of overlapping situations between counselling and community at the outset of therapy, does the counsellor breach the ethical principles noted above? In striving to ensure that responses to dual or overlapping situations are based upon BAC’s stated counsellor values of integrity, impartiality and respect (BAC, 1997), the counsellor can uphold these notions whilst monitoring and evaluating her decisions and actions.
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Through empathic management of the initial impact and subsequent containment phases of the overlapping situation, the client-counsellor relationship and work can begin to move on. Reaching mutually agreed strategies for subsequent overlapping situations needs to be an important focus of subsequent work, and will aid redemption and repair of the therapeutic alliance. Not all alliances will be retrievable, and termination or referral on to other sources of therapy may be more appropriate in some situations. Utilising ethical and moral principles (for example as depicted in table 1) in the process of decision-making, the counsellor can consider ways of working through impact upon the client, the goals and task focused aspsects of the therapy relationship, and the transference and countertransference dynamics (where these phenomenon are acknowledged and explicitly worked with).
Clarity of role definition and boundary demarcations will be crucial, and can model containment, relationship limits, and the importance of being able to relate as separate, autonomous individuals (principle of autonomy) across a range of roles and relationships.
The potential for achieving this will be influenced by the client’s state of emotional and psychological well-being, and will demand considerable attention to all aspects of the relationship and work. Ensuring clarity of roles between the relationship of client- therapist and that of being lesbian or gay community members who may encounter one
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24 another at future social gatherings, will be crucial to subsequent `damage limitation’ work in the therapy relationship (this encorporates the principles of non-maleficence and beneficence). How this is managed within the therapeutic relationship will be influenced by the counsellor’s theoretical perspective. For example, from a psychodynamic object-relations position, the therapist may be concerned about the client’s stage of ego development and their capacity to withstand the complexities of dual roles.
It will be important to remain faithful to the spirit of the relationship through being actively aware of the power dynamics generated by the situation, and through striving not to abuse the client’s trust and faith in the therapy work (principle of fidelity). Ensuring the principle of justice may be especially challenging. For example, is it just , that is fair , for the counsellor to deny themselves access to community social events, especially where there is only one major meeting place? Might it be possible to seek an agreement with the client to attend the venue on a rota basis, whereby they attend one event, the counsellor the next? Whilst there may be some instances where this type of agreement may be appropriate, if a substantial number of the counsellor’s clients are from the lesbian or gay community, it may become complicated to manage an agreeable, realistic, and fair rota system that honours the confidentiality of each individual. If the counsellor should decide to withdraw from the only regular lesbian or gay social event, might she or he not become resentful of this? How might this impact upon the therapy relationship? What type of behaviour is this modelling for clients? Modelling is
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25 extremely powerful (Vasquez, 1988), and will undoubtedly influence the client’s perceptions and beliefs about the counsellor and the therapy work. Should a rota be reasoned through and agreed between counsellor and client, it will be important that as far as is humanly and professionally possible, the client has agreed to any decisions from a position of informed consent. Achieving this can be complex, since client and therapist do not share equal power in the therapy relationship; the client may defer to the more powerful position of the counsellor, unable or unwilling to challenge decisions, or may accede from a transferential position.
It will now be evident from the above sections, that the counsellor needs to strive toward achieving emotional, intellectual, and conceptional literacy in order to feel confident and competent in processing ethical and professional dilemmas. This clearly places an expectation and responsibility upon the individual to pursue ongoing learning, and personal and professional development. Of significance in managing dilemmas will be the counsellor’s intentionality; that is, the conscious or unconscious forces underpinning their motives and actions.
The use of self as a `therapeutic tool’ in decision-making invokes our uniquely personal set of ethics and beliefs, informed by our life experiences. Whilst our personal, intuitive set of ethics and values may be an important component in processing dilemmas and reaching decisions, it needs to be counterbalanced and complimented by professional codes and moral principles. In isolation it may produce a distorted or inappropriate response to the situation we are dealing with (Kitchener, 1984).
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Further aspects which will influence the problem-solving and decision-making processes, and inform how the situation is dealt with personally and professionally, include:
 finding respectful and confidential ways of checking-out social situations, whilst withholding client identity;
 fostering and encouraging, in non-counsellor friends, the need for boundary clarity, containment, and confidentiality;
 considering therapeutic issues and themes relevant to counsellor’s theoretical and clinical frame of reference; for example, working with attachment and loss; intimacy; envy and jealousy; locus of control, and issues of power and control;
 working with transference/countertransference; under-involvement or overinvolvement in the therapy relationship;
 the counsellor’s, as well as the client’s, capacity to manage and withstand conflict and dissonance in the therapeutic relationship;
Ultimately, how we come to understand and contextualise that which is beneficent, just, or respectful of autonomy, is based upon integrating our professional and personal experience and knowledge with our vision of human life (Betan, 1997). Essentially, an holistic approach can be adopted, with the framework for problem-solving shown at table
1 underpinning choices and actions, and the process model in table 2 supporting a route through the dilemma. In effect, the models are offered as maps to guide one across the tricky and challenging terrain of ethical and professional dilemmas.
CASE STUDIES
By exploring challenging, and even `worst case’ scenarios, we are able to rehearse and model effective and ethical behaviour which will help therapists if they should encounter
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27 a dual relationship dilemma. This may reduce the possibility of unethical acting out and be supportive of therapists who might encounter similar situations, but whose fear prevents the working out of ethical behaviour in advance, or the discussion of dilemmas in training and supervision contexts.
Case One
You are attending the annual conference of a lesbian and gay counsellors professional organisation. You are a regular attender and this year you are presenting a workshop on short-term psychodynamic therapy which is scheduled for the following morning. It is late on the first evening; you have drunk more alcohol than you would normally and you are thoroughly enjoying yourself. This includes being `loud’, extremely flirtatious, and the centre of attention of the group you are with when at all possible. You suddenly notice one of your clients is sitting on the other side of the room watching you, and it dawns on you that they have been there for some time.
From the therapeutic relationship, you know that this client is themselves a counsellor in training; that their training is psychodynamic, as was your own; and that at this point in their training they are heavily invested in the values embodied in traditional psychodynamic theory.
What are the issues and what actions do you take?
ISSUES
A number of personal and professional issues are likely to be raised by the situation:
Personal Issues and Immediate Reactions

I may experience panic in that I find myself in a situation where I do not immediately know what to do and therefore experience the impulse to run away

I may experience shock that my client has seen me behaving in a way that I would not choose them to see

I perhaps experience shame that they have seen some of the less praiseworthy parts of me

Possible resentment of the client for being there, invading my space and putting me in this difficult position

Likely irritation with myself for not having forseen the possibility of this and for being drunk and not able to think clearly at a time when it is important that I do so
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
I may consider unhelpful courses of action based on the above feelings

I am likely to wonder about the clients feelings about me, about themselves and about the therapeutic relationship and how to deal with them both now and in the therapy

I may consider seeking out a quiet and discreet moment with the client to acknowledge the situation
Professional Issues and Responses

I take a few moments to think about Containment.

It is important to contain my feelings and gut reactions and to manage the situation in the here and now in a way that re-establishes a boundary between myself as therapist and them as client, but also acknowledges and respects us both as human beings.
This may mean establishing a different but no less ethical boundary. It is crucial that I remember my role as boundary rider (Gabriel, 1996).

I probably note with regret that I could have forseen this or a similar situation occurring and prepared for it in the therapy.

I resolve to discuss the dilemma in supervision.
PROCESSING THE CASE: process steps for ethical problem solving and decision making (see Table 1)
1) What is the problem or dilemma?
Meeting a client in a social situation poses a dual relationship dilemma.
2) Whose problem or dilemma is it?
It is a joint problem in that both counsellor and client need to discuss the issues raised and negotiate future plans to maintain boundaries. For me as the counsellor it is a personal as well as a professional dilemma, and for the client there may be a loss of trust in the therapist and the therapeutic alliance as a result of a shift in perspective.
3) Codes, Principles, & Guidelines
I consider the BAC Code of Ethics (and any others that apply, eg, BPS) and appropriate moral and ethical principles in line with the model outlined in Table 1. In this case the law
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29 has nothing to say with reference to the situation under consideration, nor specifically do the BAC Code of Ethics and Practice. However, the ethical principle contained in
Section
A.5 squarely places responsibility on me to take account of overlapping or pre-existing relationships, and therefore it could be argued with validity that I should have negotiated for possible contact outside therapy when negotiating the initial therapeutic contract.
4) Identify possible courses of action
 leave
 ignore the situation and continue to behave in the same way
 ignore the client and modify my behaviour
 acknowledge the situation with the client, propose discussion of the issues at our next session, and negotiate a `here and now’ resolution acceptable to both of us.
5) Select the most appropriate course of action
The chosen course of action should be one which can be considered from the perspectives detailed in Table 1, and should not contain elements of acting out as a result of the aforementioned fears and anxieties.
My chosen course of action in this case is to seek a discreet and private moment with the client to acknowledge both our presences. Acknowledging the situation might involve a conversation about social time and being `off duty’. I suggest that the issues raised be considered at our next session and consider how my behaviour may have impacted upon the client. This might include positive as well as negative aspects. Negotiating a `here and now’ resolution might involve introducing the client to some other people as someone met at the bar or perhaps to your own group if you were intending to leave, if they were new
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30 and feeling a bit lonely, or perhaps returning to your own separate tables, perhaps having agreed to treat each other as slight acquaintances for the duration of the conference.
It is important to consider the importance of modelling functioning as an emotionally well individual in society and thus by extension the gay and lesbian community, in the therapeutic relationship, as well as my responsibility to maintain and contain the therapeutic relationship. I would thus need to explore ways of negotiating or avoiding future possible contact outside therapy with this and other clients, bearing in mind the five principles outlined in Table 1 and the dynamics of the therapeutic relationship which might mitigate against them.
6) Evaluate the outcome
The principles underlying the questions detailed under this heading in Table 1 should be considered with the client in both the long and the short term, in supervision, in private reflection and in one’s own therapy if possible. If the answer to any of them is `no’, it is important to consider what I would do differently should a similar problem/dilemma arise in the future. It is perhaps also important to remember that therapists and counsellors are human beings and that ` to err is human
’. However, we cannot too strongly emphasise the responsibility we have to learn from our mistakes.
Case Two
You are invited to an intimate dinner party, being held in honour of your 40 th
birthday.
The hostess tells you there will be eight people at the party, but is keeping their identities secret! When you arrive, you notice Sarah, a current client, deep in conversation with
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Naomi, your ex-lover, with whom you were in a relationship for three years. Jean, the hostess, and one of your closest friends, notices the look of shock on your face. She tells you that Sarah is Naomi’s new lover, and is present at Naomi’s request. You and Naomi parted on amicable terms six months ago, and have had little contact following her move abroad. She recently returned to the UK to be able to attend your surprise birthday celebrations.
From the client-therapist relationship you have with Sarah, you are aware that she’d very recently begun a sexual relationship with a new lover, who was unaware that she was seeing a counsellor. You know from the therapy work that Sarah had previously felt socially isolated and found making new relationships and friendships difficult. You are also aware of her developing an erotic transference towards you.
What are the issues, and what action do you take?
ISSUES
There are a number of personal and professional issues in the above situation and these are listed below:
Personal issues and immediate r e a c t i o n s

Despite my initial shock and immediate wish to want to leave the party, it would seem ill-mannered to do so, since the party was being held in my honour

My friend (unaware that Sarah is a client of mine) is curious about my reaction to seeing my client and ex-lover

My personal and social space has been intruded upon by a client

Why should I feel it necessary to leave the party?

Will Sarah disclose that I am her therapist?

Will Naomi disclose that I am her ex-lover?

Will they discuss me, or share details with other friends?

Will Naomi share intimate details of our past relationship with her new lover, my client?

Now that Sarah and Naomi know I have arrived at the party, what are their reactions?

Should I immediately approach them? Wait for one of them to approach me?

Should I seek a private moment with Sarah to briefly acknowledge the situation?
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Professional issues and r e s p o n s e s
 Following a few minutes `thinking, stress management, and composure time’, I would begin to consider the next steps and what actions to take to contain the situation;

Regret that there had been little rehearsal/preparation in the therapy relationship regarding potential social overlap

Concern about the effects of the erotic transference and working through the dynamics of this and the client’s relational difficulties in a positive and `healthy’ way

Concern about the therapy boundaries, and subsequent redemption and repair

Questioning the overall impact upon the therapy relationship

Explore the dilemma in supervision
PROCESSING THE CASE: process steps for ethical problem-solving and decision making
1) What is the dilemma?
The meeting of a current client at an intimate party. The client is now in a relationship with a recent (ex) lover of mine.
2) Whose dilemma is it?
It is both the therapist’s and client’s dilemma. As indicated above
, I experience it as a personal, as well as a professional, dilemma. In both respects I may feel compromised.
I may feel that it would be untenable to continue client work with Sarah. For the client, the impact of discovering that her current lover and therapist are actually ex-lovers may present a personal dilemma and raise issues regarding the integrity of the therapy relationship. She may decide that she is unable to continue with the therapy work and relationship.
3) Professional Codes
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As a member of BAC, I would scrutinise the ethics code, in particular reviewing any guidance that seemed applicable to the party situation. The code however, offers only general, non-specific information. It does not incorporate guidance specific to my personal and professional situation, hence I would also consider the dilemma against the established moral principles noted in table 1. Also significant would be my own personal beliefs, morals and ethics, and I would consider how they might inform and support any decisions and actions. Where my personal `inner codes’ were discordant with
BAC’s I would consult with supervisor and peers to seek feedback on my perspective, as well as facilitative support in my decision making.
4) Consider Moral Principles
I would consider the situation against the moral principles outlined in table 1. For example, would it be just (that is fair ) for either Sarah or myself to have to leave the party? (principle of justice ); would my leaving the party cause the least harm to all concerned? (principle of non-maleficence ); should the counselling relationship survive intact and continue beyond the original dilemma, how might I ensure that the principle of fidelity is upheld? This aspect of processing the dilemma would also be informed by my own unique set of personal ethics, as noted above . These ethics will have grown and been nurtured throughout my training and development as a counsellor; as well as shaped in the valuable arena of supervision.
5) Identify possible courses of action
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
Leave the party

Ignore the situation

Acknowledge the situation with the client, seeking a brief and private moment, and suggest that we explore the situation at our next therapy session

Remain at the party and consider how my emotional state may influence my behaviour; eg., I probably would moderate my alcohol intake in order to remain in control and consciously aware of my intentions/actions; my preference would be not to be inebriate in the client’s presence, although I acknowledge that this choice is open to question and may depend upon theoretical/clinical perspectives and beliefs
6) Select the most appropriate course of action
It would be important not to act-out from my fears and anxieties. My immediate action would be to seek a brief and private moment with the client to acknowledge our both being present at the party. I would seek agreement with the client to discuss the situation at our next therapy session. I would consider my behaviour at the party, and how it might impact upon the client. Modelling the significance for emotional well-being of participating in one’s community, and the development and containment of healthy relationships, can trigger responses and issues for therapeutic exploration (when/where appropriate). Therapist modelling of social isolation and estrangement from one’s community is questionable, and communicates a way of being that may promote emotional ill-health rather than well-being.
Although supervision will be important throughout the whole process of dilemma management, it will be especially helpful to me at this stage when I may be struggling to select the most appropriate course of action. I will be aware of BAC’s directive;
“Counsellors must establish and maintain appropriate boundaries around the counselling relationship . Counsellors must take into account the effects of any overlapping or pre-existing relationship”.
(BAC (1997) Code of Ethics and Practice for Counsellors, Section A.5)
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35 and strive to maintain appropriate boundaries, as well as considering the effects of the overlapping relationship. I would see it as my responsibility, as counsellor, to remain the boundary rider; checking and instigating repair of boundaries, as well as facilitating ongoing boundary management. I will also recall BAC’s comments on resolving ethical conflicts in counselling practice, and their recognition that;
“Even after conscientious consideration of the salient issues, some ethical dilemmas cannot be resolved easily or wholly satisfactorily”.
(BAC (1997), Code of Ethics and Practice for Counsellor, Section B.1.6.3)
This statement reminds me that things cannot always be resolved `neatly’ or simply. By aiming to conscientiously work through the processing of the dilemma, fulfilling my role as boundary rider, and exploring and containing my reactions in personal therapy and supervision, I would endeavour to facilitate the `best possible’ course(s) of action.
7) Evaluate the situation
The process of evaluating the situation would take place in the therapy relationship and in supervision. There may also be exploration of a more deeply personal nature in my own therapy. Where the counselling relationship continues, it is important that the client had a voice and active presence in monitoring the immediate, intermediate and longer term working through of the situation.
Case Three
You are participating in an exciting group sex scene in the dark room of a gay sauna.
The lighting is dim, but you can make out details once you get a couple of feet away from someone. You have been kissing one person, another has been fellating you, your right
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36 hand is masturbing someone else. As you look to your side to see who is attached to your right hand, your eyes meet with a client’s.
The client is someone who is in ongoing therapy with you. He is someone who holds highly ambivalent attitudes to sex; mostly he is fairly sex negative (erotophobic). The root of this are a strong religious upbringing. He has previously described his encounters with casual sex as `compulsive’, and about which he feels he has little control. He usually feels extremely guilty about his experiences with casual sex, but `finds himself’ returning time after time. You didn’t know that he used this sauna; he did not know that you use it. Your own attitude to saunas and cruising is sex positive and you see nothing
`pathological’ in celebrating casual, uncomplicated sexual expression.
What are the issues, and what actions do you take?
ISSUES
Personal Issues and Immediate Reaction

I may feel guilt - buried shame about my sexual needs could have been triggered off as I am feeling caught out (caught by my parents)

Concern about possible psychological damage to the client

Worry about implications of this event on my career
 I may feel angry that I can’t have time `off-duty’

I may experience frustation at not being able to remain part of the group scene
Professional Issues and Responses

After some composure time I can begin to think more clearly. I would consider how best to contain the situation

I may feel anxious over trying to remember how well I managed the contracting and negotiation of boundaries at the beginning of the relationship. I would resolve to check my notes and ensure in future I am clear with clients in exploring likelihood of social contact

I would be concerned whether I have irrevocably damaged the client-therapist relationship. I would want to reassure the client that I am concerned to work this through with them

I would be concerned about whether I breached ethical codes and how many codes have I breached? I would need to review the codes and discuss the situation with my supervisor

I may worry about the client making a complaint. Since this is a possibility, I would take advice from BAC, and inform my Professional Indemnity Insurers about a possible risk, as well as seek advice from them
PROCESSING THE CASE
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1) What is the dilemma?
Effectively, I have been having sex with a client. This is a clear breach of the Code of
Ethics. Contact outside of the therapeutic client-therapist relationship should be explored, preferably at the contracting stage. It is important to monitor boundaries and dual roles and relationships, and minimise them where possible.
2) Whose dilemma is it?
It is my dilemma, in that I am engaged in sexual activity with a client. My face would register my shock, and I would cease immediately and indicate to the client that I am going outside, hoping that he would follow. I suspect that the client is as shocked as I am. I am assuming that the client did not know they were joining in a group in which their therapist was present. My primary concern is the client’s well-being, especially in the light of their feelings around sex. The client may feel unable to continue in their therapy with me; it is therefore also a dilemma for the client.
3) Codes and Principles
In addition to sex with a client, have I also broken contracting codes, as well as dual relationships, if I had not raised at the outset, how we’d deal with meeting outside?
4) Identify possible courses of action
 leave the sauna immediately
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 remain at the sauna but move to other spaces within the sauna which are better lit, and avoid further sexual contact with the client
 indicate to the client you are leaving the room, and that they are welcome to come outside and discuss this
5) Select the most appropriate course of action
As I am aware of the client’s conflicts about sex, I would seek to reassure them that I didn’t know that it was them; that I am somewhat shocked and need time to collect myself. I would let them know that I would be going home (in order to reflect on this) and that I hope that they would feel free to remain at the sauna. I would also indicate that
I would like us to be able to discuss this at our next session. In acknowledging that they too may be surprised to see me here, and in case they might want to discuss this before our next appointment, I would encourage them to telephone me. I would want my tone to indicate that I saw nothing wrong with being at the sauna, or at having casual sex, and that I am leaving as I want some time out.
6) Evaluate the situation
In my reflections afterwards I would no doubt wonder if my behaviour breached the BAC
Code of Ethics. Did we in the spirit of the code, engage in sexual activity? I think this would depend on who was judging it! If the `judge’ were heterosexual, my fear would be that they would automatically say “ yes, you did engage in sexual activity”.
However, casual anonymous sex is a feature of gay mens’ sub-culture. Many gay men use casual sex as a legitimate way of meeting people. This and other cultural differences need to be borne in my mind when considering ethical dilemmas.
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I am uncertain whether our encounter in the dark room would be seen as unethical if, as I have indicated, neither of us knew the other was involved, and as soon as we realised this we stopped immediately. The BAC Codes are particularly concerned with exploitation of clients by counsellors. I think it unlikely that I would be seen as exploiting a client in the circumstances outlined above. If I had followed a client into a room and knowingly joined in, then clearly that would be exploitative, but that wasn’t how the case was presented.
Did the client know I was part of the scene when they joined in? If they did, then we have some issues to work out about our boundaries, that’s for sure! It would be important to reflect on the positive or erotic transference that might exist between us. If there was a strong transference, I’d be wondering whether they had planned to be there. The place to sort this out would the therapy room and I would want to discuss the matter with the client in their next session, after having some supervision on the case.
If they didn’t know I was there with them, how do they feel about what occurred? If they are fairly open-minded and familiar with the context, then they may not be troubled by it and we’d just need to be clear it wouldn’t happen again and take steps to ensure that it didn’t. This isn’t the case with this client. However, it would provide us with a rich vein of material to work with in the therapy.
What of the therapist’s own attitudes to sex in saunas? It is possible their own internalised shame about sex will be triggered by this experience. Many therapists would I suspect feel
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40 they had let the profession down, and I think in part this reflects society’s negative messages about sex. These negative attitudes might be reinforced by some therapeutic modalities. Casual sex may be seen as pathological, avoidant of mature adult intimacy, commitment and fidelity. Others might describe these as heterosexist assumptions, and not consistent with gay mens’ sub-cultural and psychosocial context.
In the situation I outlined, one of my reactions to it was a surfacing of shame about my sexual needs, and feeling `caught out’. This is an example of an issue that would need to be explored in therapy and an indication of how I can feel comfortable about something and not realise I am in denial until an event triggers dormant feelings.
I do feel closer attention to my exploration of the codes around contracting with clients would be essential, as I had clearly breached this code and could have perhaps anticipated this situation better. In this current situation, I think it would depend on how comfortable the client would be in continuing with me as his therapist. The possibility of working through the experience at the sauna holds great potential for understanding his conflicts about sex. However, it is possible the client would feel the relationship has been irrevocably damaged by this intimacy, and would prefer to continue his therapy with someone else.
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WHEN CONSIDERING DILEMMAS IN DUAL
RELATIONSHIPS IN LESBIAN THERAPIST-LESBIAN CLIENT,AND GAY
THERAPIST-GAY CLIENT RELATIONSHIPS
Theoretical and Conceptual Influences: Key Points

Mainstream counselling theory has offered inadequate concepts, theories and frames of reference for lesbian and gay client work.

The decision-making and process models illustrated in this chapter can transcend theoretical perspectives and offer a generic frame for therapeutic work with counselling dilemmas.

Lesbian, gay and bisexual psychology and therapeutic practice needs to be developed - and be appropriate to client work within a community context.

Practitioners can utilise decision-making and process models and integrate them into their own practice.

Practitioners can consider how their own theoretical perspective would encounter and perceive the three case studies, and `rehearse’ (particularly within a training or supervision arena) ethical, professional and realistic means of resolving each case.
Client - Counsellor Dialogues: Key Points

Potential overlap between therapy and community can be discussed in contract building at the outset of the therapy relationship; initial agreements can be negotiated/re-negotiated as and when appropriate throughout the life of the therapy relationship;

Agreements on acceptable/appropriate behaviours where overlap occurs needs to be negotiated eg.,
“ what is appropriate outside the therapy relationship?”

Client and therapist can rehearse and work through possible scenarios.
 Client and therapist can consider ways of becoming `fluent’ in a range of dual and overlapping roles - supervision can serve as an important `facilitator’ for this process.

Client and therapist may agree a form of rota for participating in social or community events.

Ongoing work at the boundaries - regularly monitoring the boundaries of the relationship and work, especially where overlap occurs, or is likely to occur.

The counsellor, the boundary rider, remains the guardian of the boundaries - and ultimately responsible for the ethical and professional handling of boundary overlap where dilemmas or conflicts arise.

The ending of the therapeutic relationship may be necessary in some situations; where this is the case, the process will be negotiated and managed sensitively and humanely.
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
Decisions need to be reached about ethical obligations to former clients eg., at the end of therapy, what decisions are made about future opportunities for further counselling work? What preparation is taken for possible future dual roles and relationships?
The overlapping situations noted in the case studies have raised a number of questions and concerns. Those explicitly stated are drawn from the myriad of possible questions and issues. Grounding our anxiety and concern through utilising a process model to work through the dilemma can help us to deal with the personal and professional issues that arise. Reasoned, relevant and ethical actions are possible, despite any initial shock or concern we may experience when encountering our clients in situations outwith therapy. Witnessing and welcoming one another in a range of roles need not be inappropriate or unmanageable. Where the counselling relationship is to continue beyond the initial dual role situation, and where further dual and overlapping connections are anticipated or agreed, then an appropriate, realistic and respectful way of developing what Petruska Clarkson terms role fluency (Clarkson, 1995) must be developed.
Although this is new territory for lesbian and gay counselling theory, it is possible that we can positively mediate between therapy and community and become fluent in a range of situations; the intricacies and endeavours of becoming fluent are yet to be explored and articulated, and represented in the professional literature.
Above all, we must remember that the counsellor and client are human beings who will at times fall short of imagined ideals. Humans make mistakes, regret things spoken or acted upon; even wish they could be the perfect therapist or client. Yet by reason of the
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43 fact that the therapist is human, not a perfected machine, they will struggle at times in the counselling work. Where conflicts and dilemmas are encountered, we need not set ourselves up to be perfect counsellors; instead, we can draw upon our personal strengths and skills and permit ourselves to learn from our anxieties and concerns. We need to recall too, that our personal and professional skills do not desert us the moment we encounter a dilemma. We may be challenged to remain aware of them however, as we struggle to engage with conflicts or dilemmas, without resorting to acting-out or denial.
Dialogues about dilemmas need to continue, and be brought into mainstream literature.
Counsellor training needs to address the issues discussed in this chapter and ensure that trainee counsellors are equipped to deal with the management of crises and dilemmas in therapy work. We need to explore how to develop and manage role fluency. Importantly, we need to determine how our clients perceive and experience dual and overlapping roles.
One of the authors is pursuing research into dual relationships at PhD level, and all are keen to see the issue openly and actively debated - watch this space!
August 1998
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