A Survivor's Perspective: 
Understanding Therapy Exploitation
Resources to Help You Through Your Recovery From Exploitation and Negligence by Your Therapist 

BIBLIOGRAPHY OF RESEARCH ARTICLES 
(including case testimony from a victim/survivor of therapy exploitation)

by Kay C. 
(see disclaimer at bottom of page)

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DUAL RELATIONSHIPS
RESEARCH

When a therapist has another relationship with a patient -- called a "dual relationship" -- there really is no therapy. Dr. "X" continued an ongoing relationship with me outside of our therapy -- a major violation which caused multiple boundary violations in and away from therapy with him and contributed to the negligence and complications of all other areas of our therapy together, particularly "transference" and "countertransference." It never occurred to me, and he never mentioned, that he should not be my friend away from therapy.

As time went on, I began having severe problems in therapy and away from therapy with Dr. "X", and he never attempted to explain to me why I was getting so upset. The boundaries were so blurred that I stayed in a maze of confusion for a long time. His "acting out" and my "acting out" occurred within both relationships and, though enjoyable in the beginning, over time it became very destructive. Eventually, Dr. "X" began rejecting me as both my therapist and friend away from therapy and he became even more hurtful and confusing in his "treatment" with me. He ignored my attempts to discuss and resolve the problem and merely told me that he "couldn't be my special friend anymore" and he "had to bring it back to therapy" -- with no explanation other than "the personal and professional collided."

A "dual relationship" is prohibited by the state licensing boards and associations. It seriously confuses and compromises the therapy and harms the patient emotionally and mentally. Dr. "X's" own expert stated that Dr. "X's" "willingness to allow her to interact with him in any manner outside the therapy sessions became a problem in itself, and one from which the therapy was unable to recover." (Expert Report, June 1997). Please -- I urge you -- if your therapist is allowing you to engage in any kind of relationship other than therapist-patient, whether sexual or non-sexual, run as fast as you can to someone who can help you before you end up in a state of emotional and mental trauma that will take several years for you to work through. I learned a lot from my subsequent therapist and expert witness about the complications of a "dual relationship" and did my own research. These articles were also helpful in understanding the confusion and harm that occurs in a "dual relationship" with your therapist.

Kay C.
Comments, questions or add an article to this research list, please e-mail me at MKC1kaysie@aol.com

1. A Guide to Violating an Injunction in Psychotherapy: On Seeing Acquaintances as Patients, Samuel Roll, Leverett Millen, Psychotherapy: Theory, Research and Practice, Vol. 18, No. 2, Summer, 1981.
2. Avoiding Exploitive Dual Relationships: A Decision-Making Model, Michael C. Gottlieb, Psychotherapy, Vol. 30, No. 1, Spring, 1993.
3. Boundary Issues and Dual Relationships: Where to Draw the Line?, Jeffrey E. Barnett, Psy.D.
4. Dealing With Unethical Behavior in Dual Relationships, Chapter 7 ("Managing Boundaries and Multiple Relationships"), pp. 260-262 from Issues and Ethics in the Helping Professions, Gerald Corey, Marianne Schneider Corey, Patrick Callanan, Brooks/Cole Publishing Company, 1997.
5. Dealing with Unethical Dual Relationships, Chapter 7, pp. 261-262 from Issues and Ethics in the Helping Professions, Gerald Corey, Marianne Schneider Corey, Patrick Callanan, Brooks/Cole Publishing Company, 1997.
6. Dual Agency, Dual Relationships, Boundary Crossings, and Associated Boundary Violations, A.H. Hines, D.N. Adler, A.S. Chang, U.R. Rundell, Military Med, Vol. 163, pp. 826-833, Dec. 1998.
   http://www.allhealth.com/medline/0,4260,6601_124714,00.html  
7. Dual and Multiple Relationships in Perspective, pp. 226-231 from Book Keeping Boundaries: Maintaining Safety and Integrity in the Psychotherapeutic Process, Richard S. Epstein, M.D., American Psychiatric Press, 1994.
8. Dual Relationships and Professional Boundaries, J.D. Kagle, P.N. Giebelhausen, Social Work, Vol. 39, No. 2, pp. 213-220, March 1994.
   http://www.allhealth.com/medline/0,4260,6601_124814,00.html  
9. Dual Relationships Between Therapist and Client, Debra S. Borys, Kenneth S. Pope, Professional Psychology: Research and Practice, Vol. 20, No. 5, pp. 283-293, Oct. 1989.
   http://idealist.com/memories/research2.shtml  
10. Dual Relationships: Client Perceptions of the Effect of Client-Counselor Relationship on the Therapeutic Process, Penny S. Ramsdell, Earle R. Ramsdell, Clinical-Social Work Journal, Vol. 21, No. 2, pp. 195-212, Summer 1993.
11. Dual Relationships, State of Arizona, Board of Behavioral Heath Examiners, Spring 1996.
    http://www.aspin.asu.edu/~azbbhe/newsletter/spring96/dual.html  
12. Dual Relationships, State of Arizona, Board of Behavioral Heath Examiners, Summer 1995.
    http://www.aspin.asu.edu/~azbbhe/newsletter/summer95/dual.html  
13. Dual Relationships, State of Arizona, Board of Behavioral Heath Examiners, Winter 1994.
    http://www.aspin.asu.edu/~azbbhe/newsletter/winter94/dual.html  
14. Dual Relationships Between Therapist and Client: A National Study of Psychologists, Psychiatrists and Social Workers, Debra S. Borys, Kenneth S. Pope, Professional Psychology: Research and Practice, Vol. 20, No. 5, pp. 283-293, 1989.
    http://idealist.com/memories/research2.shtml
15. Dual Relationships in Psychotherapy, Kenneth S. Pope, Ethics & Behavior, Vol. 1, No. 1, pp. 21-34, 1991.
16. Dual Role Relationships: What Makes Them So Problematic?, Karen Strohm Kitchener, Journal of Counseling and Development, Vol. 67, No. 4, Dec. 1998.
17. Ethical Considerations of Social/Romantic Relationships with Present and Former Clients, Michael C. Gottlieb, John M. Sell, Lawrence Schoenfeld, Professional Psychology: Research and Practice, Vol. 17, No. 6, 1986.
18. Ethical Principles of Psychologists and Code of Conduct, Section 1.17, American Psychological Association.
19. Inappropriate Personal Involvement Between Doctors and Their Patients, J.J. Bradley, Journal of Social Medicine, 87 Suppl. 22: 40-1, 1994.
20. Managing Boundaries and Multiple Relationships, Chapter 7 from Keeping Boundaries: Maintaining Safety and Integrity in the Psychotherapeutic Process, Richard S. Epstein, M.D., American Psychiatric Press, 1994.
21. Multiple Relationships, Chapter 5 from Ethical Conflicts in Psychology, Donald N. Bersoff, published by American Psychological Association, 1995.
22. Non-Sexual Dual Relationships, Chapter 10, pp. 112-129 from Ethics in Psychotherapy and Counseling, Kenneth S. Pope, Melba J.T. Vasquez, Josey-Bass Publishers, 1991.
23. Non-Sexual Dual Relationships, Debra S. Borys, from Innovations in Clinical Practice, Vol. 11, pp. 443-454, 1992.
24. Personality Characteristics of Mental Health Professionals Who Have Engaged in Sexualized Dual Relationships: A Rorschach Investigation, A. Celenza, M. Hilsenroth, Bulletin of Menninger Clinic, Vol. 61, No. 1, pp. 90-107, Winter 1997.
25. Rules and Regulations of the Texas State Board of Examiners of Psychologists, Rules 465.36(c)(1)(Q)(i)(ii)(iii), 1995.
26. Social Relationships with Clients, Chapter 7 ("Managing Boundaries and Multiple Relationships"), pp. 238-241 from Issues and Ethics in the Helping Professions, Gerald Corey, Marianne Schneider Corey, Patrick Callanan, Brooks/Cole Publishing Company, 1997.
27. Social/Romantic Relationships with Present and Former Clients: State Licensing Board Actions, Michael C. Gottlieb, John M. Sell, Professional Psychology: Research and Practice, Vol. 19, No. 4, 1988.
28. The Development of Dual Relationships: Power and Professional Responsibility, V.J. Rinella, Jr., A.I. Gerstein, International Journal of Law Psychiatry, Vol. 17, No. 3, pp. 225-237, Summer 1994.

• "Boundaries"
• "Sexual (And Other) Exploitation"
• "Legal/Ethical"

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Copyright © 2000 Kay C.  All rights reserved.  Names have been changed to protect identities.  "Dr. X" is a fictitious name.  The views of the author do not necessarily reflect the views of AdvocateWeb.  This is not mental health or legal advice. See our full disclaimer for more details.

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