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Social Control Theory -Slides and data in this outline are from Adler, Mueller, and Laufer (2007, 2013, 2018, & 2022); Siegel (2015); and modified by Manning (2007, 2013, 2015, 2018, & 2022).
T H E T H E O RY FAVO R E D BY M O S T C R I M I N O LO G I S T
Social Control theory Social control theory focuses on techniques and strategies that regulate human behavior leading to conformity or obedience to society’s rules.
Influences (family & school, religious beliefs, moral values, friends, & beliefs regarding government).
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Theories of Social Control MACROSOCIOLOGICAL STUDIES
Explore the legal system, particularly law environment
Powerful groups
Social & economic government directives
MICROSOCIOLOGICAL STUDIES
Focus on informal systems
Data based on individuals
Examines one’s internal control system
Travis Hirschi Social Bonds
Attachment: to parents, teachers, peers
Commitment: to conventional lines of action ◦ Educational goals
Involvement: with activities that promote the interests of society ◦ Homework or after school programs
Beliefs: acceptance of societies values ◦ Belief that law are fair
Hirshi’s Hypothesis was that Stronger the bonds = less delinquency & weaker bonds = increased risk of delinquency
Scientific Research shows support: ◦ Hirshi conducted a self-report survey on 4,077 high school students in CA.
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Critics of Hirschi’s Bond theory Criticism of social bond theory
◦ The influence of friendship ◦ Drug abuser stick together
◦ Failure to achieve ◦ Failing in school = few legitimate means
◦ Deviant parents and peers ◦ Gang member also create social bonds.
◦ Mistaken causal order ◦ Deviance may brake parental bonds
◦ Hirschi also counters the critics ◦ These bonds are weak and only created out of need – drug abuser will turn on one another.
Gresham Sykes and David Matza Delinquency and Drift Drift
◦ Most deviants also hold value in social norms.
◦ Must use tech. of neutralization to drift in and out of criminality.
Observation of neutralization: ◦ Criminals sometimes voice guilt over their illegal acts.
◦ Offenders frequently respect and admire honest, law abiding people (entertainers, & preachers).
◦ Criminal define whom they can victimize
◦ Criminals are not immune to the demands of conformity. ◦ They go to school, family functions and church.
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Gresham Sykes and David Matza Delinquency and Drift
Techniques of neutralization: ◦ Denial of Responsibility
◦ Not my fault - accident
◦ Denial of Injury - No one hurt
◦ Denial of the Victim - Victim is no saint
◦ Condemnation of the Condemner ◦ Everyone has done worse things
◦ Appeal to Higher Loyalties ◦ Couldn’t let my friends down
◦ Studies show most adolescents know when they deviate ◦ So they use neutralization techniques to justify their behavior.
◦ Critics: Many adolescents have no empathy. ◦ Crimes are most often intraracial and within familiar areas.
Albert J. Reiss Delinquency is the result of
◦ A failure to internalize socially accepted and prescribed norms of behavior.
◦ A breakdown of internal controls
◦ A lack of social rules that prescribe behavior in the family, school, and other important social groups.
Social Disorganization and crime
What if you grew up in the slums with your mother selling heroin out of your apartment ◦ Where would you be?
While slums create more crime some individuals find a greater stake in conformity and embrace laws.
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Walter Reckless Containment Theory
Containment Theory assumes that for every individual there exists a containing external structure and a protective internal structure, both of which provide defense, protection, or insulation against delinquency.
External ◦ Family, laws, and peers
Internal ◦ Self concept, ego and conscience
Walter Reckless Outer Containment
A role that provides a guide for a persons activities (i.e. Teacher/student).
A set of reasonable limits and responsibilities (i.e. Roles defined).
An opportunity for the individual to achieve status. ◦ Promotion or graduation
Cohesion among members of a group including joint activity and togetherness. ◦ Integrated and inclusive
A set of belongingness (i.e. identification with the group).
Identification with one or more persons within the group.
Provisions for supplying alternative ways and means of satisfaction when one or more ways are closed.
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Walter Reckless Inner Containment
A good self-concept
Self control
A strong ego
A well developed conscience
A high frustration tolerance
A high sense of responsibility
General Theory of Crime Travis Hirschi and Michael Gottfredson
Designed General Theory to explain and individuals propensity to commit crime.
Assumes that the offenders have little control over their own behavior and desires.
Crime is a function of poor self-control ◦ Poor child rearing, poor attachments
◦ People with low self control may drink too much, smoke and have unwanted pregnancies.
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Theory Informed Policy Delinquency prevention through teaching values.
Family – role model study habits.
School –bond youth to conventional systems
Neighborhood – federally funded programs can reduce crime ◦ Examples: crisis intervention centers,
◦ and mediation between schools and youth, youth and police and youth and gang intervention.
Article Review Instructions
You will write three article reviews and if you choose, one extra credit article review. You will select the article yourself by searching the UWA Library Databases. The article you choose should be a research article (has a hypothesis that is empirically tested). Pick an article relevant to a topic covered in the weekly readings. Each review is worth 15 points. The review should be 1-2 single-spaced pages in a 12-point font. It is in your best interest to submit your review before it is due so you may check your originality report and correct any spelling and grammatical errors identified by the software program.
The purpose of the review is to provide students knowledge of how research is conducted and reported. The main part of your review needs to include the following information. Please comment on these aspects of the article as part of your review. Provide only the briefest summary of content. What I am most interested in is your critique and connection to weekly readings.
Reference. Listed at the top of the paper in APA style.
Introduction. Read the introduction carefully. The introduction should contain:
· A thorough literature review that establishes the nature of the problem to be addressed in the present study (the literature review is specific to the problem)
· The literature review is current (generally, articles within the past 5 years)
· A logical sequence from what we know (the literature review) to what we don't know (the unanswered questions raised by the review and what this study intended to answer
· The purpose of the present study
· The specific hypotheses/research questions to be addressed.
· State the overall purpose of the paper. What was the main theme of the paper?
· What new ideas or information were communicated in the paper?
· Why was it important to publish these ideas?
Methods. The methods section has three subsections. The methods sections should contain:
· The participants and the population they are intended to represent (are they described as well in terms of relevant demographic characteristics such as age, gender, ethnicity, education level, income level, etc?).
· The number of participants and how the participants were selected for the study
· A description of the tools/measures used and research design employed.
· A detailed description of the procedures of the study including participant instructions and whether incentives were given.
Results. The results section should contain a very thorough summary of results of all analyses. This section should include:
· Specific demographic characteristics of the sample
· A thorough narrative description of the results of all statistical tests that addressed specific hypotheses
· If there are tables and figures, are they also described in the text?
· If there are tables and figures, can they be interpreted "stand alone" (this means that they contain sufficient information in the title and footnotes so that a reader can understand what is being presented without having to go back to the text)?
Discussion. The discussion is where the author "wraps up the research". This section should include:
· A simple and easy to understand summary of what was found
· Where the hypotheses supported or refuted?
· A discussion of how the author's findings compares to those found in prior research
· The limitations of the study
· The implications of the findings to basic and applied researchers and to practitioners
Critique.
In your opinion, what were the strengths and weaknesses of the paper or document? Be sure to think about your impressions and the reasons for them. Listing what the author wrote as limitations is not the same thing as forming your own opinions and justifying them to the reader.
· Were the findings important to a reader?
· Were the conclusions valid? Do you agree with the conclusions?
· If the material was technical, was the technical material innovative?
Conclusion.
Once you provide the main critique of the article, you should include a final paragraph that gives me your overall impression of the study. Was the study worthwhile? Was it well-written and clear to those who may not have as much background in the content area? What was the overall contribution of this study to our child development knowledge base?
APA Format Review
If you are unfamiliar or a bit “rusty” on your APA format, you may want to use the tutorial available through the APA website which is listed on your syllabus.
Grading Criteria
I will grade your paper based upon:
· How well you followed directions (as indicated in this page)
· How thoroughly you used examples to support the critique
· How accurately you used APA format
· your organization, grammar, and spelling
· Integration of assigned weekly readings
NAVIGATING DUAL RELATIONSHIPS IN RURAL COMMUNITIES
Jennifer L. J. Gonyea and David W. Wright The University of Georgia
Terri Earl-Kulkosky Fort Valley State University
The literature examining dual relationships in rural communities is limited, and existing ethi- cal guidelines lack guidelines about how to navigate these complex relationships. This study uses grounded theory to explore rural therapists’ perceptions of dual relationship issues, the perceived impact of minority and/or religious affiliation on the likelihood of dual relation- ships, and the ways rural therapists handle inevitable dual relationship situations. All of the therapists who participated in the study practiced in small communities and encountered dual relationship situations with regularity. The overarching theme that emerged from the data was that of using professional judgment in engaging in the relationship, despite the fact that impairment of professional judgment is the main objection to dual relationships. This overall theme contained three areas where participants felt they most needed to use their judgment: the level of benefit or detriment to the client, the context, and the nature of the dual relation- ship. Surprisingly, supervision and/or consultation were not mentioned by the participants as strategies for handling dual relationships. The results of this study are compared with estab- lished ethical decision-making models, and implications for the ethical guidelines and appro- priate ethical training are suggested.
The authors’ collective experiences of practicing in small communities led us to question how therapists in these communities handle the inevitability of dual relationships. As we discussed anecdotes from our respective practices, it became apparent that tension exists between a client’s desire to have a familiar therapist and the ethical standards of our field. We turned to the American Association for Marriage and Family Therapy (AAMFT) Code of Ethics for answers about how to navigate these delicate situations. Couple and family therapists are admonished to “make every effort to avoid [dual relationships] at all costs” (AAMFT, 2001; p. 1); however, no mention is made of how to accomplish this in settings with limited alternatives.
The issue of dual relationships in areas with limited alternatives is complicated by clients’ attempts to self-match. Self-matching occurs when clients select a therapist who shares their atti- tudes, race, education, social class, and/or religion (Jones, Botsco & Gorman, 2003; Whalley & Hyland, 2009; Willging, Salvador & Kano, 2006; Wintersteen, Mesinger & Diamond, 2005). Cli- ents feel more comfortable discussing their lives and presenting issues when they believe their ther- apist holds the same values or shared cultural experience. A large percentage of Americans living in small communities may be able to achieve this owing to homogeneity in small communities, but not without creating ethical challenges for the therapist.
The ethical challenges for rural therapists are compounded when they also belong to a minor- ity group. In addition to the limited number of available therapists in a small community, there are
Jennifer L. J. Gonyea, PhD, is a Lecturer and Undergraduate Coordinator, Department of Child and Family
Development, The University of Georgia and in practice at Samaritan Counseling Center of Northeast Georgia,
Athens Georgia; David W. Wright, PhD, is an Associate Professor, Department of Child & Family Development,
The University of Georgia, Athens, Georgia; Terri Earl-Kulkosky, PhD, is an Assistant Professor, Department of
Behavioral Sciences, Fort Valley State University, Fort Valley, Georgia.
This research was made possible through consultation with Edwin Risler, PhD (Athens, GA) and the Georgia
Association for Marriage and Family Therapy Board and members.
Address correspondence to Jennifer L. J. Gonyea, Department of Child and Family Development, The
University of Georgia, Dawson 123, Athens, Georgia 30602; E-mail: [email protected].
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Journal of Marital and Family Therapy doi: 10.1111/j.1752-0606.2012.00335.x January 2014, Vol. 40, No. 1, 125–136
far fewer minority therapists in general (AAMFT, 2004). Therefore, when minority clients attempt to self-match, there is a strong likelihood that a dual relationship dilemma will be encountered.
Thisstudyaimstoexploreareasnotpreviouslyconsideredintheethicsliterature,payingparticu- lar attention to how therapists practicing in rural areas navigate these complex relationships. The next section provides the foundation for this study by reviewing the unique set of circumstances and community variables that increase the likelihood of dual relationships in rural areas and the ways existingethical decision-makingmodels fail to considerthe challengesof rural practice.
CHALLENGES OF RURAL PRACTICE
Rural communities are partially defined by their isolation that forces residents to rely more heavily upon one another. Smaller communities have increased potential for dual relationships, in general, and those between clients and therapists in particular (Erickson, 2001). Although the lack of boundaries may seem natural and is often used as fodder for sitcoms set in small communities, in real-life, it sets the stage for dual relationship dilemmas.
For many residents, this closeness is positive and helps build identity and sense of belonging to that community in terms of Us versus Them. Therefore, residents of rural areas are often hesi- tant to seek services from an outsider (Murry, Heflinger, Suiter & Brody, 2011) because they are not to be trusted, which can lead to multiple levels of personal and professional relationships. Fur- ther, persons from rural areas may resent an outsider offering assistance (Erickson, 2001; Jesse, Dolbier & Blanchard, 2008).
Similarly, those who belong to a religious community or a minority group may prefer profes- sional services from someone within their group or at least from someone who may share familiar values. Research has found that people want a therapist and they believe to be like themselves (Jones et al., 2003; Wintersteen et al., 2005) and when clients’ ethnicity matches that of their thera- pist, they attend more sessions and have a greater likelihood of treatment completion (Erdur, Rude & Baron, 2003).
Competing Ethical Principles The absence of attention to how therapists in rural settings navigate potential dual relation-
ships is compounded by the ambiguous and vague discussion of dual relationships in the AAMFT Code of Ethics, which states:
Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation (American Association for Marriage & Family Therapy, 2001; p. 1).
If one’s interpretation of the code is that when multiple relationship situations arise, MFTs should ensure that these relationships do not impair professional judgment or increase the risk of client exploitation, then the dilemma is not “how to avoid dual relationships,” but “how does one tell when multiple relationships will impair professional judgment” and “what is the obligation of the therapist in warning or explaining the dilemma to the client?”
It quickly becomes clear that the real problem is how to address inevitable dual relationships, rather than how to avoid them. Some suggestions include openly discussing the inevitability and potential of out of session contacts between therapist and client (Faulkner & Faulkner, 1997) or having a preconceived plan to negotiate social contacts with clients and seek immediate consulta- tion if boundaries feel threatened (Jennings, 1992).
Rural clinicians are likely to be professionally isolated, making it difficult to obtain supervi- sion or consultation. These clinicians may be secluded from the mainstream of their profession and may have limited colleagues from whom they can seek support, collaboration, or supervision. Rural therapists’ sense of isolation is also compounded by fewer opportunities for professional development, continuing education, and limited access to support services.
These collegial issues also create a challenge to maintaining client confidentiality (Weigel & Baker, 2002). A client’s confidentiality can be compromised through the “grapevine” in small
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communities when the client is seen leaving the therapist’s office, parked in front of it, or even while sitting in the waiting room. The few therapists in a rural area often have regular contact with one another, and informal conversations between providers can increase threats to client confidential- ity. Rural therapists rely on one another for professional development and resources. Withdrawing from such informal exchanges could alienate close colleagues and leave a rural therapist with even fewer resources. Rural therapists are left with the choice between increased threats to clients’ rights to privacy or alienation of a close colleague.
Models of Ethical Decision-Making Many ethical decision-making models suggest the following for the resolution of ethical dilem-
mas: (a) consulting the ethical guidelines of therapy professions; (b) seeking supervision or consul- tation with peers; (c) creating a pros and cons list to determine the possible consequences and/or alternative courses of action; or (d) some combination thereof (Corey, Corey & Callahan, 1998; Erickson, 2001; Forester-Miller & Davis, 1996; Smith & Smith, 2001; Steinman, Richardson & McEnroe, 1998; Tarvydas, 1998; Welfel, 1998). As noted previously, these guidelines may not pro- vide enlightenment because they are ambiguous and require interpretation, the very foundation of the original dilemma!
Few existing models specifically refer to issues of power and maneuverability, that is, the roles and positions therapists take with clients. The professional guidelines assume therapists hold the position of power when interacting with clients. Yet, depending on the nature of the out-of-session contact, the client may occupy a powerful position in the relationship. In a unique acknowledg- ment of potential limitations to both sides of a dual relationship, Haas and Malouf (1995) suggest therapists ask themselves and their supervisors specific questions prior to engaging in a potential dual relationship. For example, how might engaging in the dual relationship inhibit clients’ ability to make autonomous decisions; how might the therapist acknowledge his or her privileged position in the relationship; will the dual relationship affect the therapist’s ability to intervene effectively and congruently. The suggested questions imply that the therapist is able to conceive a number of alternatives and have insight into multiple perspectives on the situation, yet the inability to do so when interacting with friends and relatives is precisely why dual relationships are discouraged.
Most ethical decision-making models assume that therapists have equal access to professional resources across community types (rural compared to urban). In fact, models ignore the existence of barriers to obtaining supervision and consultation in rural areas even though the limited avail- ability of these in small communities has been well documented (Weigel & Baker, 2002). None of the models reviewed suggest alternatives to supervision or ways of navigating a dual relationship if, indeed, it is unavoidable. The potential consequences to seeking consultation with peers or feed- back from supervisors in rural communities are also not addressed in the ethical decision-making models reviewed for this study.
Clearly, one model or set of ethical standards does not encompass all possible dual relation- ship dilemmas or all the factors contributing to it. Therefore, a more comprehensive exploration of the processes through which clinicians make ethical decisions is called for. To meet that goal, this study specifically examines (a) the ways rural therapists perceive dual relationships and the result- ing impact on clinical practice; (b) the strategies clinicians believe they employ to negotiate dual relationships; and (c) the perceived influence of minority or religious affiliation on dual relation- ship situations.
METHOD
Design of the Study This study used a naturalistic paradigm to explore the experiences of therapists in rural set-
tings. Among Lincoln and Guba’s (1985) naturalistic paradigm axioms, several were relevant here: (a) realities are multiple, constructed, and holistic; (b) the knower and the known are inseparable; therefore, the participant and researcher influence one another; (c) generalization is only possible through the formulation of working hypotheses that are context and time specific; and (d) unlike traditional inquiry that is value-free, the naturalist paradigm states that inquiry is value-bound by the choice of the problem, theory, and context.
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This study sought to explore how rural therapists interpreted the AAMFT ethical guidelines as they made decisions about whether to have dual relationships with the clients they served. Their experiences then constituted multiple realities and, while tied professionally to the ethical guide- lines, their interpretation of the guidelines allowed the therapist to construct their understanding and approaches to ethical dilemmas of dual relationships. This qualitative approach allowed for an emphasis on the participant’s view (Creswell, 1998) of their experience of dual relationships in rural areas and how they navigate such situations. Specifically, the present study questions how the experience of dual relationships decision-making is handled when the therapist’s professional supports are limited.
Description of Participants and Selection Process Participants were Clinical and Associate members of an AAMFT Division in the Southeast
practicing in rural areas. Rural areas were selected using the categories of urbanicity established by Bachtel (2004) at the county level: Urban, Suburban, Rural Growth, and Rural Decline. Approxi- mately, 50 members were in the pool of potential participants.
Once the purposive sample was drawn from the current listing of active members of the Divi- sion, participants were contacted via telephone based on information provided in the Division directory. After providing verbal consent, telephone interviews were conducted. Multiple research- ers were involved in gathering the data through phone interviews, and this served as one of the forms of investigator triangulation (Denzin, 1978). Attempts to contact the 50 members were made, and six therapists participated in the phone interviews. Some participants expressed a desire to have more time to reflect on the questions. The researchers experience confirmed that additional data collection methods could provide more respondents and richer data. Therefore, researchers decided on an additional data collection method, which would be to collect data at the annual Division Spring Conference.
Conference attendees self-selected to participate in the study after hearing it described and announced. An additional screening by the authors was used to ensure that participants met the criteria established at the outset of the study. Attendees were provided consent forms and study questions on the first day of the conference and asked to return both by noon on the last day. This ensured that participants were able to reflect on their experiences and practices to give as detailed explanations as possible. Participants provided information about the population size in their practicing area and completed survey forms where they provided demographic information such as age, race, type of practice, and length of practice. In addition, participants provided their perception of the degree to which their minority or religious affiliation influenced requests for therapeutic services from acquaintances in other settings, and how they make decisions in response to these requests.
Between telephone interviews and the annual Division conference, fifteen therapists pro- vided data for this study. Of these, five self-identified as African American, one self-identified as racially mixed (Caucasian and Phillipina), and the remaining nine participants self-identified as Caucasian. Participant ages ranged from 29 to 60; however, most participants reported having been in practice for over 20 years. All practiced in areas designated as rural according to Bachtel (2004). Participants practiced in either private (N = 6) or public settings (N = 6), while three practiced in both types of settings. Seven participants practiced in catchment areas whose populations were 20,000–50,000, six practiced in catchment areas whose populations were 50,000–100,000, and two of the participant’s catchment areas were over 100,000 people. Some worked in communities that served more than one county, or in counties that served multiple cities.
A detailed description of participant demographics is provided to illustrate several consider- ations regarding the results. First, the participants in this study represent very experienced clini- cians, the majority having practiced more than 20 years. The perception of one’s ability to navigate complex dual relationships may be related to a sense of clinical competency evident in an experienced sample. Second, how long clinicians had lived in their rural community is unknown, a factor that may influence the likelihood of dual relationships. And lastly, most of the participants worked at least part time in public settings where they may or may not have control over the decision to see the a client known in another setting.
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Data Analysis An interview guide (see Appendix A) was developed with open-ended questions that invited
the participants to convey their experiences with dual relationships in rural communities. This interview guide provided a common set of questions for all participants, and left room to explore new areas that might emerge. Data were analyzed using a sorting procedure that calls for searching for what Wolcott (1994) terms patterned regularities in the data. We looked for common themes and patterns of behavior that would give an understanding of the experiences of the participants. Participant responses were then compared with the suggested procedures for ethical decision- making reported earlier.
Our analysis process was guided by grounded theory (Charmaz, 2002; Glaser & Strauss, 1967); a qualitative methodology used with the goal of finding new theory or emerging themes in phenomena studied. This method seemed most appropriate to the limited understanding of how dual relationship dilemmas are handled by clinicians when such dilemmas are frequent or inevita- ble. Consistent with a grounded theory approach, data collected from the first interview were compared with data from the second interview, and this process of comparison was repeated with each data collection (Strauss & Corbin, 1998).
Each phone interview was transcribed by the research interviewer, and non-phone written interviews were reviewed. The interviewers (J.G. and T.K.) recorded notes immediately following the data collection. These process notes included clarification questions asked, information on the date and type of contact, insights, questions, and connections to other responses.
The research investigators then carefully examined the data and completed the task of com- parison, developing new categories relative to the answers. Open coding methods (Charmaz, 2002) were used to organize the data, and initial categories were developed. Themes emerged from the categories and subcategories as data analysis continued. These themes are discussed in detail in the results section that follows.
Trustworthiness and Credibility To ensure trustworthiness (Merriam, 1998) and credibility, qualitative terms that are similar
to reliability and external validity, we used detailed descriptions of the research methods and credi- bility audits to review the research methods, interviews, and findings. A licensed marital and family therapy (MFT), who has practiced for more than 20 years, served as an internal auditor of the data to open code the data from the interviews and written responses. In addition, an external auditor (2nd author) reviewed all drafts of the results to verify that the categories and themes were consis- tent with the interviews.
Transferability, the degree to which a study can be applied to other contexts by different researchers, was established by providing detailed information about the participants and contex- tual factors that may be relevant to future research efforts. For example, the Appendix A reports the guiding questions used and the demographic information, such as practice setting, catchment population, and years in practice are reported in the following section.
RESULTS
Although interviews varied somewhat, participant responses reflected the inevitability of dual relationships in rural areas, consistent with the existing literature. As expected, a common experience among participants was receiving referrals for persons that they knew in other settings on a frequent or occasional basis. Also as expected, participants received referrals based on religious and minority affiliation,althoughmostof these were basedonreligious as opposedto minority affiliation.
Similar themes emerged across clinicians in terms of how they handled potential dual relation- ship situations. The therapists who participated in this study universally referred the potential client elsewhere when the referral was well known. Among those that made referrals to avoid the dual relationship, they took care to explain the dual relationship dilemma to clients in order to preserve the existing relationship and ease the transition to a trusted colleague. For example:
The most common type of referral comes from my church. I usually refer them on and explain the problem inherent in dual relationships. Generally, people are clueless about
January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 129
this [dual relationships] issue and appear disappointed but do okay once they get started with a colleague.
Even among those who reported engaging in the relationship initially, all stressed the impor- tance of evaluation and assessment at the beginning of therapy. For example, several participants engaged in two to four sessions during which they assessed the clients’ needs, their own ability to meet those needs, and the likelihood that the therapeutic relationship might violate the ethical guidelines by potentially “exploiting the trust and dependency of such persons” or “impair profes- sional judgment or increase the risk of exploitation” (American Association for Marriage & Family Therapy, 2001; p. 1). One participant reported engaging in the relationship:
depending on my conversation with the referral, for a 3 or 4 session evaluation with the clear understanding that I may make a referral, continue to see the client myself, or have a professional consultant in the fourth session to help us decide the appropriate next phase.
Strategies for Handling Dual Relationships During the open coding procedure, responses developed into the overarching theme of profes-
sional judgment which contained three areas where participants felt they most needed to use this judgment: (a) level of benefit or detriment to the client; (b) the context; and (c) the nature of the dual relationship.
Professional judgment. Whether explicit or implied, participants’ approach suggested they had used professional guidelines as the source of their decision-making. One participant discussed the “limits of therapy,” while another came to an agreement that “boundaries will be kept” with the clients with whom he or she entered into a dual relationship. Elaborating on how boundaries were kept, one participant stated:
NOT discussing client info with staff. When necessary for support, speak vaguely to the school counselor. Make it clear to students and any others I see in community that I do not/will not identify them seek them out in public social settings. I also make it clear that I do not/will not identify other clients—or talk about them any professional relationship to anyone. Clarity around boundaries is extremely important in maintaining them.
Several participants appeared to use a strict interpretation of the AAMFT ethical guidelines concerning therapy with persons known from other contexts, unequivocally stating that they would refer the client elsewhere based on their understanding of “making every effort to avoid . . . multiple relationships” (American Association for Marriage & Family Therapy, 2001; p. 1). These participants did not disclose any conditions under which they would agree to conduct therapy with persons known from other contexts.
Professional judgment is a broad category and precisely the aspect of navigating complex rela- tionships that this study was undertaken to explore. When prompted about how they used their pro- fessional judgment, participants elaborated on how they make the decision to refer the client or engage in the dual relationship. Participants were aware of the people or groups with whom they are mostexperiencedor thosethetherapist feltmostcompetent inhelpingand with whomtheyweremost likely to engage in therapy: one partipant reported, “I know I work best with couples, single adults of adolescents, not children and not addictive adults.” Several noted the client’s need for treatment, the severity of the presenting issue, intake information, or expertise in couples versus family work as issues to consider when deciding to take the case. For example, when participants felt that the client needed immediate intervention and making a referral might delay treatment, they were more willing to engage in a dual relationship. In this case, ensuring that the client received timely therapy was tem- porarilyprioritized over the admonishment to avoidadual relationship.
The remaining three emergent themes reflect specific aspects of the dual relationships decision- making articulated by participants. Although participants used their professional judgment in each of these areas, they were specific enough to warrant separate elements.
Level of benefit or detriment to client. Promoting clients’ well-being was a factor in most deci- sions therapists’ decision-making in their clinical practice. Specifically, they used their judgment
130 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014
about the degree of benefit to the client when deciding whether or not to engage in a dual relationship: one stated “professional judgment and instinct regarding my ability to be helpful to the client.” In the words of one participant, he or she was aware of the potential “negative impact of a dual relationship” on the clients well-being and the existing relationship. Despite this senti- ment, many participants specifically mentioned that the dual relationship was a lesser concern than promoting client safety. For example, one therapist would “suggest another referral unless an emergency or crisis is presented.”
Another aspect of benefit to the client used as a deciding factor in engaging in the dual rela- tionship was whether or not the client would not have sought therapy. A participant provided an example of such a circumstance:
I have made one exception and accepted a client who told me she checked me out care- fully at church and would otherwise not go to another therapist. She disclosed a ritual abuse history and indicated a need to feel safe first since some of her abusers were trusted people in positions of authority.
For this therapist, engaging in the relationship meant the particular client was able to receive services. Other participants’ responses suggest that they use their judgment about what the client needs and what they can offer at that time as means of determining whether or not to pursue the dual relationship.
Context. Participants indicated concerns about the context within which they knew the potential client. One participant differentiated between contexts such as “church affiliate versus friend,” while another made the distinction between “whether I know them personally or profes- sionally” as influential factors in their decision to pursue a therapeutic relationship or refer a client to another therapist. Participants were more willing to conduct therapy with a professional associ- ate than with a personal associate. A few were very specific in their understanding of a need to keep personal and professional relationships separate, responding “I would not see someone with whom I have a personal relationship” or “I don’t see family members of friends or acquaintances.” Others made decisions based on a more graduated sense of the personal acquaintance. One participant considered taking the case of someone with whom he or she had a professional relationship to be unlikely to impair professional judgment or exploit clients and therefore upholding the ethical standards of the field. Another participant noted receiving referrals from a sister program and would engage in the dual relationship in the interest of “continuum of care.”
Therapist participants were more likely to engage in the dual relationship if he or she has expertise with a particular population or presenting issue that was otherwise unavailable in the area, in part out of the belief that the particular treatment the therapist offers is unique and that it would be an undue hardship to the client to pursue this unique help elsewhere. For example:
Trauma using Eye Movement Desensitization and Reprocessing (EMDR) is my specialty —if it is a very slight acquaintance (i.e., plumber, workman, etc) I would have to think about it as I am, to the best of my knowledge, the only one using EMDR.
Nature of relationship. The nature of the relationship was considered a separate theme from that of context and was based on a distinction between type of relationship (context) and the level of intimacy or closeness in the relationship with a client (nature of the relationship). Examples from responses include the influence of “the degree of interaction outside therapy,” “if I do not have an intimate relationship with them I will see them,” and “if I know we will socialize I will refer” as more intimate levels of contact with potential clients that would preclude a therapeutic relationship. Participants distinguished between a high level of intimacy (personal relationships) and low levels of intimacy (professional relationships) and considered high levels of intimacy to be a barrier to a successful therapeutic relationship. Participants defined knowing someone “well” in one or more of the following ways: (a) persons with whom they socialized; (b) persons with whom their children played; (c) friends; (d) family members/acquaintances of friends; (e) students where a spouse works; and (f) sharing a specific activity.
Participants might engage in a professional relationship with someone known from the gym or an exercise class owing to the low levels of intimacy involved, but they were aware of their influ- ential positions and potential likelihood of their impaired professional judgment when the current
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relationship was one where there was a high frequency of contact and a high degree of intimacy, such as a through a Bible study group or book club.
DISCUSSION
The strategies participants used to determine whether or not to refer a potential client reflect several aspects of the ethical decision-making models reviewed, although they did not use any model in its entirety. The four strategy themes derived from participant responses are present in some of the ethical decision-making models previously outlined. Conversely, seemingly, important aspects of the models are absent from participant responses and discussed below.
Professional Judgment Despite the underlying assumptions about the inherent risks to judgment in a dual relation-
ship, the primary tool for navigating the complexity of a dual relationship among our participants was the use of their professional judgment. Consistent with the question posed in the conceptuali- zation of this study, therapists practicing in small communities appear to be aware of this integral conflict and ask themselves, “How do I tell when multiple relationships will impair my professional judgment?” These results indicate that therapists are intentional in handling potential dual rela- tionships to minimize the impact on their ability to effectively manage the therapy process.
Although not explicitly stated in any of the models reviewed for this study, virtually all of them imply using professional judgment. Several advise generating a list of potential courses of action along with the possible consequences of these actions (Corey et al., 1998; Forester-Miller & Davis, 1996; Smith & Smith, 2001; Steinman et al., 1998; Tarvydas, 1998; Welfel, 1998). The results of this study add to the ethical decision-making literature and supplement the AAMFT Code of Ethics by indicating specific aspects of the therapeutic relationship therapists in practice should consider when exploring courses of action and their consequences, for example, judgments about client motivation, the therapists’ ability to be helpful to the client, the potential for triangu- lation, and the three specific themes discussed below.
Level of Benefit or Detriment It is clear that dual relationships are discouraged, yet therapists may engage in them anyway if
they believe it will yield more benefit than harm for the client. A therapists’ main goal is for clients to grow, improve, and heal. Toward this end, therapists were intentional in assessing the potential harm to the client and the probable benefits.
Thisthemereflectsthemodelsthatsuggesttherapistsweighthepotentialrisksandbenefitstosee- ing the client. Only Gottlieb (1993) proposes discussing with the client the potential consequences or what their relationship posttherapy might entail should they engage in the dual relationship. The majority of attention is focused on how contact outside of sessions prior to and during therapy might impede the therapeutic process. Posttherapy contact is particularly important for those practicing in asmall communitywhere thelikelihood of suchcontactsin the communityisvery high.
Haas and Malouf (1995) suggest therapists ask themselves to reflect on their ability to be help- ful. It is a therapist’s obligation to best meet the needs of their client, but also their prerogative to refuse cases when they are not able to meet those needs. For example, if a therapist realizes that she would be limited in what issues she can address and how she can address them, she might not be able to provide quality therapy and would consider discussing that with the clients. An impor- tant point for consideration is that the results of this study indicate that therapists practicing in small communities may not feel they have the same latitude to refuse a case when the assessment of the situation suggests that the client would be more harmed by their refusal.
Kitchener’s (1988) model also addresses power, but through the understanding of the different roles, one might have in dual relationships. For example, one partner in a couple’s session is the principal of the school the therapist’s child attends. In session, the therapist may be perceived as having power. During interactions with the school, the principal is clearly in a position of power, not only with the therapist, but also her or his child. Therapists who practice in small communities are well aware of these types of power dynamics and considered them in assessing the level of bene- fit or detriment to the client as well as the context and nature of the relationship discussed below.
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Context and Nature of the Relationship The models reviewed herein do not attend to contexts in which decisions are made about
ethical dilemmas. The lack of distinction between contexts may lead to the assumption that all out of session contacts between client and therapist are equally problematic to the process and outcome of therapy. The therapists in this study felt that there are differences between types of relationships (context) and the levels of intimacy (nature of the relationship) inherent in the different types.
Most therapists have encountered a client outside of therapy, either at the grocery store, the dry cleaners, or a physician’s office. Usually these meetings are unexpected and spontaneous. In the case of a dual relationship, the assumption is that meetings outside of therapy are expected and at times may even be regular, as in the case of a fellow parishioner. A consistent theme in the responses of the participants reflected an attempt to understand the context and the nature of the relationship between therapist and client outside of the therapy room, or in other words, attempt to determine the regularity with which they might see one another and the quality of their out of session relation- ship, consistent with the models proposed by Smith and Smith (2001) and Gottlieb (1993).
This is an important point because the limited number of couple and family therapists who represent cultural or religious minorities is likely to present an increased potential for dual rela- tionships as clients attempt to self-match. This is underscored by a survey of AAMFT membership (2004), which reported that the overwhelming majority of their members reported being White/ NonHispanic (93%: n = 2236) with approximately only 2% of respondents falling in each of the following groups: African American, Hispanic/Latino, Asian, American Indian, and Other/Prefer not to answer.
The energy and attention necessary for handling a dual relationship is usually greater than that of another client. The therapist participants acknowledged this additional investment by considering whether or not they actually have enough time to handle such a case and its unique circumstances. This very specific, and practical consideration is not present in the reviewed models. In fact, a number of everyday impediments to rural practice are not mentioned in the models, but should be added to the list of practical obstacles to rural practice.
Supervision and/or Consultation The literature on ethical dilemmas in rural areas notes the increased likelihood of encounter-
ing dual relationships and limited access to supervision. Two points strongly reflected in the results of this study; one through its prominence and the other through its absence. The rural therapists in this study generated the same concerns and issues that are represented in the literature regarding the increased potential for dual relationships. Study participants received referrals or were sought out by persons known to them in other settings and that these referrals came from a number of community sources: fellow church members, family members of friends, parents of children’s class- mates, persons with whom spouse has a professional relationship, and persons with whom the therapist has a professional relationship (e.g., dentist, plumber, other therapist).
Notably, absent in participants’ responses was mention of bringing these dual relationship issues to supervision to reflect on the potential consequences; however, it is unclear whether the availability of supervision is limited in the areas where participants practice or whether the partici- pants do not consider supervision as one of the tools useful in navigating dual relationships. As noted earlier, one participant did report using a consultant “in the fourth session to help us decide the appropriate next phase.” This participant used consultation as part of the therapeutic decision- making process rather than as a means of determining, a priori, potential problems associated with the dual relationship or as feedback in maintaining healthy boundaries in an ongoing dual rela- tionship. Although intended to clarify the dual relationship, it is equally likely that the use of a consultant, a role different from a supervisor, may create an additional dual relationship that rural therapists must navigate.
A lack of supervision and consultation opportunities may possibly contribute to ethical con- cerns resulting from limited access to clinical resources. Suggestions for therapists to remedy this concern and obtain supervision have included group, telephone, and Internet supervision, yet each presents problems (Kanz, 2001; Weigel & Baker, 2002). For group supervision, practitioners from rural areas may have to drive several hundred miles to receive supervision or risk discussing a client
January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 133
with whom someone else in the group has a relationship. Telephone supervision provides one option for supervisees who may be geographically isolated, but there are still some ethical consid- erations. Sending recorded sessions in the mail increases threats to confidentiality; cell phones are an insecure method of discussing client information that could potentially be intercepted, and the amount of time and expense to send recordings via postal service may be prohibitive. The availabil- ity of Internet supervision is alluring, yet presents concerns about (a) divulging confidential infor- mation over an insecure mode of communication; (b) the difficulty in obtaining informed consent from clients for this type of supervision; (c) the importance of nonverbal cues of the therapist, supervisor, and client; and (d) liability and licensure issues when Internet supervision takes place across state lines (Kanz, 2001).
CONCLUSION
An objective of this study was to gather data to illustrate the complexities of dual relationships in rural areas. The overwhelming majority of the rural therapists who participated in this study did face the dilemmas of dual relationships. Indeed, most had fairly well-established strategies for han- dling these relationships both before and during treatment.
The hope is that this research will foster a better understanding of the complexities of dual relationships in rural areas as well as support further research in this area. The results of this study may serve to clarify ethical guidelines around dual relationships in both the literature and practice. The qualitative exploration utilized in this study allowed the researchers to begin to understand the way therapists think about their process for ethical decision-making. Follow-up interviews with therapists who are in the process of evaluating a dual relationship situation in their rural communi- ties would greatly enhance our understanding of the practice of ethical decision-making. Also, interviews focusing on the themes derived from this study would address the multiple obstacles to confidentiality and maintaining therapeutic boundaries in small communities.
The implications of this study are significant: it seems clear that the nature of these relation- ships is more than duality. Participants noted that whether a relationship is personal or profes- sional, the types of boundaries regulating it, and the context of out-of-session contacts as important factors in making ethical decisions. The consideration of these factors in decision-mak- ing reflects the reality that dual relationships are inevitable in small communities and places more emphasis on evaluating the process of therapy than on the duality. In the words of one participant, “I live in a community of 5,000—if I am going to work, I must navigate these crossovers.”
This has implications for MFT training programs’ curriculum regarding AAMFT ethical guidelines and the ethical guidelines in general. The current guidelines do not address the process for decision-making with regard to dual relationships. Programs can help therapists in training develop a more introspective and less legalistic decision-making process, which would address the complexity of mitigating factors and provide an opportunity for them to explore their own biases in a supportive environment.
Clients want to be in relationships with people like themselves and often look for therapists that they believe have similar values or experience. Unfortunately, in rural communities where the pool of available therapists is often limited, practicing therapists have little guidance in how to make an ethical decision because of the ambiguity of the ethical guidelines and the neglect of the challenges to rural practice in existing ethical decision-making models. These therapists may also have difficulty navigating complex dual relationships because there are few opportunities for super- vision in their communities. Instead, they learn to rely on their professional judgment about the level of benefit or detriment to the client and therapeutic relationship and the context and the nature of the relationship as they make their decisions about engaging in it.
REFERENCES
American Association for Marriage and Family Therapy. (2001). Code of ethical principles for marriage and family
therapists. Washington, DC: American Association for Marriage and Family Therapy.
American Association for Marriage and Family Therapy. (2004). 2004 Member survey results. Washington, DC:
American Association for Marriage and Family Therapy.
134 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014
Bachtel, D. (2004). Georgia facts and figures. Retrieved February 8, 2011, from http://www.fcs.uga.edu/hace/gafacts/.
Charmaz, K. (2002). Qualitative interviewing and grounded theory analysis. In J. F. Grubrium & J. A. Holstein
(Eds.), Handbook of interview research: context and method (pp. 675–693). Thousand Oaks, CA: Sage. Corey, G., Corey, M., & Callahan, P. (1998). Issues and ethics in the helping professions (5th ed.). Pacific Grove, CA:
Brooks/Cole.
Creswell, J. W. (1998). Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks, CA:
Sage Publications.
Denzin, N. K. (1978). The research act (2nd ed.). New York: McGraw-Hill.
Erdur, O., Rude, S., & Baron, A. (2003). Symptom improvement and length of treatment in ethnically similar and dis-
similar clients-therapist pairings. Journal of Counseling Psychology, 50(1), 52–58.
Erickson, S. H. (2001). Multiple relationships in rural counseling. The Family Journal, 9(3), 302–304. Faulkner, I. K., & Faulkner, T. A. (1997). Managing multiple relationships in rural communities: Neutrality and
boundary violations. Clinical Psychology: Science and Practice, 4, 1–16. Forester-Miller, H., & Davis, T. (1996). A practitioner’s guide to ethical decision making. American Counseling
Association. Retrieved March 13, 2012, from: http://counseling.org/Counselors/Practitioners Guide.aspx?
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory. Chicago, IL: Aldine Publishing Company.
Gottlieb, M. C. (1993). Avoiding exploitative dual relationships: A decision-making model. Psychotherapy, 30,
41–48.
Haas, L., & Malouf, J. (1995). Keeping up the good work: A practitioner’s guide to mental health ethics. Sarasota, FL:
Professional Resource Press.
Jennings, F. (1992). Ethics of rural practice. In R. D. Weitz (Ed.), Psychological practice in small towns and rural areas
(pp. 85–104). New York: Haworth.
Jesse, D. E., Dolbier, C. L., & Blanchard, A. (2008). Barriers to seeking help and treatment suggestions for prenatal
depressive symptoms: Focus groups with rural low income women. Issues in Mental Health Nursing, 29, 3–19.
Jones, M. A., Botsco, M., & Gorman, B. S. (2003). Predictors of psychotherapeutic benefit of lesbian, gay, and
bisexual clients: The effects of sexual orientation matching and other factors. Psychotherapy: Theory, Research,
Practice, Training, 40(4), 289–301.
Kanz, J. (2001). Clinical-Supervision.com: Issues in the provision of online supervision. Professional Psychology:
Research & Practice, 32(4), 415–421.
Kitchener, K. (1988). Dual role relationships: What makes them so problematic? Journal of Counseling and Develop-
ment, 67, 217–221.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage Publications.
Merriam, S. B. (1998). Qualitative research and case study applications in education. San Francisco, CA: Jossey-Bass
Publishers.
Murry, V. M., Heflinger, C. A., Suiter, S. V., & Brody, G. H. (2011). Examining perceptions about mental health care
and help-seeking among rural African American families with adolescents. Journal of Youth & Adolescence, 40,
1118–1131.
Smith, J., & Smith, A. (2001). Dual relationships and professional integrity: An ethical dilemma case of a family
counselor. The Family Journal, 9(4), 438–443.
Steinman, S., Richardson, N., & McEnroe, T. (1998). The ethical decision making manual for helping professionals.
Pacific Grove, CA: Brooks/Cole.
Strauss, A., & Corbin, J. (1998). The basics of qualitative research (2nd ed.). Thousand Oaks, CA: Sage.
Tarvydas, V. (1998). Ethical decision making processes. In R. R. Cottone & V. M. Tarvydas (Eds.), Ethical and
professional issues in counseling (pp. 144–155). Upper Saddle River, NJ: Prentice-Hall. Weigel, D., & Baker, B. (2002). Unique issues in rural couple and family counseling. The Family Journal, 10(1),
61–69. Welfel, E. (1998). Ethics in counseling and psychotherapy: Standards, research, and emerging issues. Pacific Grove,
CA: Brooks/Cole.
Whalley, B., & Hyland, M. E. (2009). One size does not fit all: Motivational predictors of contextual benefits of
therapy. Psychology and Psychotherapy: Theory, Research & Practice, 82, 291–303. Willging, C. E., Salvador, M., & Kano, M. (2006). Pragmatic help-seeking: How sexual and gender minority groups
access mental health care in a rural state. Psychiatric Services, 57(6), 871–874. Wintersteen, M. B., Mesinger, J. L., & Diamond, G. S. (2005). Do gender and racial differences between patient and
therapist affect therapeutic alliance and treatment retention in adolescents? Professional Psychology: Research &
Practice, 36(4), 400–408.
Wolcott, H. F. (1994). Transforming qualitative data: Description, analysis and interpretation. Thousand Oaks, CA:
Sage Publications.
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AAPPENDIX
GUIDING INTERVIEW QUESTIONS FOR CLINICIANS
The following questions were used as a guideline during phone interviews and distributed to partici- pants at the annual Division Spring Conference for review. The researchers gave a brief description of the purpose of the study and a consent script, either at the beginning of the interview or in writing for those recruited at the Division Conference.
1. I am interested in knowing more about your experiences as a family therapist practicing in a small community. Do you receive referrals for clients that you already know from another setting? a. (If yes) Help us understand how you think about these referrals? (factors you con-
sider, type of relationships, specific examples). 2. What are the settings that you might know some of these referrals from? 3. Describe how you respond to these requests for therapy from people you already know?
(Appropriate follow-up questions as needed to understand the factors.) 4. What influences your decision to see the client? (Appropriate follow-up questions as
needed to understand the factors.) 5. What influences your decision to refer the client? (Appropriate follow-up questions as
needed to understand the factors.) 6. Tell us about a time you received a referral from your religious or minority community?
a. Which affiliation? b. How do you think knowing the person/family impacts your ability to conduct ther-
apy with the person or family? 7. What is your perception of how often you get referrals based on this affiliation?
136 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014
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