APA members contact the Ethics Office on a daily basis to discuss the ethical aspects of their work. Receiving these calls is both interesting and gratifying, and educates the office about how psychologists across the country frame the ethical questions they encounter. One of the most frequent topics is multiple relationships. During the Ethics Code revision process that ended in 2002, the Ethics Code revision task force made clear that not all multiple relationships are unethical. The task force wrote a test for determining when a psychologist should refrain from entering a multiple relationship:
A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.
The language of ethical standard 3.05 requires the psychologist to determine when a particular relationship would impair the psychologist's objectivity, competence, or effectiveness in doing the work of a psychologist, or would otherwise risk exploitation or harm. The standard thus illustrates clinically driven ethics. Consider how this manner of thinking about ethics might be applied to a request for consultation that came to the Ethics Office:
A little over a year ago, Dr. Parks, a talented psychotherapist, began seeing Jessica and David in a couples treatment. David is tenured in a comparative literature department, while Jessica is an attorney. The couple, in their mid-30s, married young, had a child and have done well in their professional lives. When Jessica discovered David was having an affair with a graduate student — she suspected it was not his first — she threatened to leave the marriage. Beginning couples treatment was a condition for her to stay. David agreed.
Jessica's father, an academic, had carried on numerous affairs with his students, and her mother had turned what Jessica describes as a "blind eye" to his philandering, despite evidence that Jessica says "no one could have missed." Jessica grew up despising "the secrets everyone knew," and she developed an intensive, positive transference toward Dr. Parks when, at the beginning of treatment, Dr. Parks made clear that she would not agree to keep "secrets" that either Jessica or David chose to share in individual sessions that might take place during the treatment. More present issues have also been part of the treatment, naturally. As an example, David's refusal to wear a wedding ring — "a vestige of a bourgeois society," in his words — has been a long-standing point of contention.
Andrea, in her late 20s, has also been a psychotherapy patient of Dr. Parks for about a year and a half. The treatment has focused on Andrea's ambivalence about commitment, ambivalence that is evidenced as an uncanny ability to find unsuitable men who appear eminently suitable, or, in Andrea's words, as "snatching Mr. Wrong from the jaws of Mr. Right." Andrea discusses with some insight how enticing she finds her "Mr. Wrongs," as well as her fantasy that she can "turn Mr. Wrong into Mr. Right," fantasies that have resulted in Andrea spending a good deal of time with a "Mr. Wrong" before leaving the relationship. Dr. Parks believes that Andrea could probably benefit from another year of treatment, but this may or may not be possible. Andrea is working to complete her dissertation in the next two months, and will soon be looking for academic jobs in her field, that of viewing political events through the lens of comparative literature.
One week in late fall, Andrea excitedly begins her session by telling Dr. Parks about an event in her job search. The previous weekend she had attended an out-of-town meeting sponsored by the American Humanities Association for graduate students looking for academic positions. There, Andrea had met a charming, charismatic man, whom she was so taken with that she ended up spending Saturday night with him. Andrea explains that he lives in this area. She says he was very honest about being in a relationship, but that he does not envision the relationship lasting more than a few months longer, enough time, in his words, "to allow things to come to a civil end."
As Andrea continues, Dr. Parks realizes that Andrea is talking about David. As this realization slowly comes over Dr. Parks, Andrea pauses from her rather exuberant description of the weekend and says, "Dr. Parks, what's wrong — you seem very distracted?"
Dr. Parks faces a dilemma, perhaps several, although it is not entirely clear at this point whether her choices will be based primarily on her clinical or ethical thinking. Her first decision arises at the very end of the vignette: How will she respond to Andrea's question? Dr. Parks will need to decide — in that very moment — what, if anything, to disclose. Also, she will need to decide whether to acknowledge the reality of Andrea's perception, perhaps by simply responding, "Yes, you're right, I was distracted for a moment," and hope that Andrea does not press further.
More challenging for Dr. Parks will be how she addresses the multiplicity of relationships that have now arisen. There will be important ethical considerations. As an example, Dr. Parks cannot disclose to either Andrea or David that she has a treatment relationship with the other. More deeply, Dr. Parks must attend to her wish that she could disclose this information. The language in the ethical standard on multiple relationships focuses on whether Dr. Parks's objectivity, competence or effectiveness will likely be impaired. It would be reasonable to ask: How could they not be? And will Dr. Parks herself be able to assess how much her work is affected? It would be entirely appropriate, if not necessary, for Dr. Parks to seek a consultation.
If Dr. Parks determines that her objectivity, competence or effectiveness will be impaired, she will explore whether she is able to continue both treatments. A decision not to continue both treatments will be complex, since it will entail two important considerations. First, Dr. Parks will need to decide which treatment to terminate, and second, Dr. Parks will need to address the harm from terminating a therapy for reasons that she cannot disclose to the client(s). A decision to terminate the treatment is thus not cost free, insofar as the termination presents a risk of harm. Solving one problem creates another.
If Dr. Parks decides to continue both treatments, she will need to consider how she will manage to keep information from each treatment separate in her mind as she listens to the clinical material. She will also need to think through how she will manage Jessica's feelings of betrayal, when Jessica learns — as she inevitably will, at some point — that Dr. Parks knew of the affair and did not disclose it to her. Also, Dr. Parks now has confirming evidence that David is less committed to the marriage than he has presented himself to be. Thus, the understanding upon which the couples treatment is based is questionable, and Dr. Parks will need to decide what implications this information has for continuing to offer Jessica and David therapy.
The Ethics Code gives no clear answer to Dr. Parks. She may decide that continuing both treatments is untenable. On the other hand, she may decide that although managing the countertransference will present clinical challenges, her discovery that David and Andrea are having an affair merely continues the long established psychological dynamics of all three individuals involved. If Dr. Parks decides that she will continue both treatments, she may begin by asking herself: On what basis do I believe that these individuals are benefiting from the treatments I am offering them?
Stephen Behnke, JD, PhD, MDiv, is director of APA's Ethics Office.
