Reaching back to Aristotle and the Oath of Hippocrates, the medical field has worked from guidelines that direct moral principles of behavior (Schoener, 1999). Corey at al. (2003) and Remley and Herlihy (2005) astutely identified these moral principles as important parts of building counseling practices and protecting the consumers from harm. When referring to ethics and codes of ethics, counselors practice within a model of moral principles that includes do no harm, do good work, and be fair, honest, and loyal (Walden et al. , 2003).
Interpretation and application of these moral principles varies from person to person and from situation to situation. Theoretical orientation, therapist personality, and client type greatly influence ethical decision-making regarding issues of dual relationships (Lazarus & Zur, 2002). Psychoanalytic and psychodynamic modalities encourage detachment, whereas humanistic approaches support empowerment and relationships (Lazarus & Zur). Counselor biases, values, and morals, along with client type, impact ethical decision-making (Borys & Pope).
For example, if the therapist has a linear way of thinking, seeking right and wrong tends to be more prevalent, leading to a structured decision-making model. If the client type or diagnosis interferes with the ability to think abstractly, again, a structured model would be deemed appropriate. Lazarus and Zur (2002) explain that counselors fall into two views of ethical decision-making: narrow and broad. The narrow view of decision-making is a more traditional model in which the counselor sets appointments for a specific place and time.
Within the session, there is no touch, self-disclosure, or other boundary crossing, and the general focus is professional, objective, and non-personally involved. The counseling modality typically employs a psychodynamic or psychoanalytical approach. The broader view recognizes the value of the therapeutic relationship and is regarded as a more humanistic approach. Nonsexual touch is permitted, and out-of-office relationships with current and former clients are seen as potentially beneficial.
For example, a current or former client might attend a workshop or class that the counselor is teaching. The therapist is with the client as a full and genuine person, and the counselor acts as an interpersonally healthy role model (Lazarus & Zur, 2002). Lazarus and Zur (2002) presented several arguments for avoiding dual relationships. Entering into a dual relationship can position a clinician on a “slippery slope,” making future boundary crossings and violations more likely to occur or more difficult to avoid (Lazarus & Zur; Reamer, 2003; Remley & Herlihy, 2005).
The mission of licensure boards to protect the consumer from harm is identified from the perception of the client; it is difficult to know just when the dual relationship may have changed from benefit to harm. From a litigation point of view, it is safer to remain free of dual relationships, as there is then no risk of crossing into gray areas. Many earlier mental health training programs had an underpinning philosophy grounded in psychoanalysis or psychodynamics that promoted detachment and neutrality, eliminating the risks of dual relationships.
Finally, many counselors have a bias toward traditional psychotherapies, which encourage a more narrow view of ethical decision-making. Models of decision-making can be taught, but use of the skills is closely related to an individual’s ability to process at a critical thinking level (Remley & Herlihy, 2001). It is through ethical decision-making that a professional evaluates whether to venture into a boundary crossing.
Examples of boundary crossings include receiving or giving gifts, dual relationships, self-disclosure, and bartering. According to Herlihy and Corey (1997), boundary crossing is for the benefit of the client, whereas a boundary violation meets the needs of the counselor and is harmful. Reamer (2003) added to this definition that boundary crossings are not intentionally harmful. According to Lazarus and Zur (2002), Reamer, and Remley and Herlihy, the “slippery slope” is often subtle and the clinician is often unsuspecting.