Graduate Student Journal of Psychology Copyright 2005 by the Department of Counseling & Clinical Psychology Graduate Student Journal of Psychology Copyright 2007 by the Department of Counseling & Clinical Psychology 2007, Vol. 9 Teachers College, Columbia University ISSN 1088-4661 Proposed Standard for Multiple Relationships in the APA Ethical Principles of Psychologists and the Code of Conduct Veronica Lee Lestina Capella University Cynthia M. Walljasper Family Medicine of Mt. Pleasant, PC This article provides a proposal for new language and a revised standard for multiple relationships to be considered for the APA Ethics Code. The current multiple relationships language in the APA (2002) Ethical Principles of Psychologists and the Code of Conduct was updated in part due to rural American psychologists being involved in a variety of relationships with clients out of necessity. This article explores the differences between the previous APA (1992) Ethics Code and the current APA (2002) Ethics Code, addressing the strengths and weaknesses of the current code and the need for an updated version. The proposed language builds upon the 2002 Ethics Code’s strengths re- garding the definition of multiple relationships and the idea that not all multiple relationships are ethical violations. It then provides a minimum standard for a strategy of assessing multiple relation- ships and informing the client of the dynamics of a multiple relationship. As providers practicing in a rural generalist setting, the authors propose a review of the current standard regarding multiple relationships for psychologists as it is written in APA (2002) Ethical Principles of Psychologists and the Code of Conduct, Standard 3.05. In reviewing this standard, one can determine areas for growth in the language and specificity to assist all psychologists in clarifying multiple relationships, including the rural American psychologist. This article provides a review of the APA (2002) and APA (1992) Standards on multiple relationships as well as a pro- posal for updating this standard. These proposed updated standards aims to help betterfulfill the needs of the profes- sion today in terms of safeguarding and enforcing against potentially harmful multiple relationships. Current and Past Multiple Relationship Standards The current APA (2002) Ethical Principles of Psy- chologists and Code of Conduct for multiple relationships is as follows: 3.05 Multiple Relationships. (a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into an- other relationship in the future with the person or a person closely associated with or related to the person. Correspondence concerning this article should be addressed to Veronica Lestina, Family Medicine of Mt. Pleasant, PC, 501 South White Street, Suite 1, Mt. Pleasant, Iowa 52641; e-mail: veronickins@mchsi.com. A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, compe- tence, 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. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical. (b) If a psychologist finds that, due to unforeseen fac- tors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code. (c) When psychologists are required by law, institu- tional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceed- ings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. (See also Standards 3.04, Avoiding Harm, and 3.07, Third- Party Requests for Services.) (APA, 2002, p.6). The previous APA (1992) Ethical Principles of Psy- chologists and Code of Conduct Standard as it pertains to multiple relationships was as follows: 1.17 Multiple Relationships. (a) In many communities and situations, it may not be feasible or reasonable for psychologists to avoid social or other nonprofessional contacts with persons such as pa- tients, clients, students, supervisees, or research partici- pants. Psychologists must always be sensitive to the poten- tial harmful effects of other contacts on their work and on those persons with whom they deal. A psychologist refrains from entering into or promising another personal, scien- 25 LESTINA AND WALLJASPER 26 tific, professional, financial, or other relationship with such persons if it appears likely that such a relationship rea- sonably might impair the psychologist's objectivity or oth- erwise interfere with the psychologist's effectively perform- ing his or her functions as a psychologist, or might harm or exploit the other party. (b) Likewise, whenever feasible, a psychologist refrains from taking on professional or scientific obligations when pre-existing relationships would create a risk of such harm. (c) If a psychologist finds that, due to unforeseen fac- tors, a potentially harmful multiple relationship has arisen, the psychologist attempts to resolve it with due regard for the best interests of the affected person and maximal com- pliance with the Ethics Code. (APA, 1992, p. 1601) Changes in the Multiple Relationships Standard from 1992 to 2002 The differences between the multiple relationships standards in the 1992 and 2002 Ethical Codes are outlined in Table 1. The 2002 code change allowed for a more ex- plicit definition of a multiple relationship for psychologists, and it stated that not all multiple relationships are unethical (Smith, 2003b). Multiple relationships are viewed as some- thing that the psychologist should refrain from, if possible, especially if it is reasonably “expected to impair the psy- chologists’ professional performance or could exploit or harm the other individual” (Smith, 2003b, p. 65). The changes in the APA (2002) Ethics Code were im- plemented due to a variety of problems in the interpretation and enforcement of the previous 1992 code. In a national survey, multiple relationships were found to be the second most frequent type of unethical conduct in which psycholo- gists had difficulty maintaining clear, reasonable, and therapeutic boundaries with their clients (Pope & Vetter, 1992). This survey underscored the need to more clearly define multiple relationships and delineate when they are therapeutically relevant/acceptable and when they are harm- ful. Based on the survey’s findings, Pope and Vetter (1992) suggested that the standard must be specific enough for all psychologists yet take into account the special circum- stances of those professionals who practice in small towns, rural communities, and other remote locales. These authors requested that a revised code provide direction in terms of multiple relationships that were premeditated and purpose- ful versus accidental or incidental encounters. These sug- gestions were taken into consideration for the changes in the current version of the APA (2002) Ethics Code. The earlier APA (1992) Ethics Code was directed to- ward risk prevention. This is evidenced by the preamble stating the “psychologists’ primary goal is to provide for the welfare and protection of the individuals and groups with whom they work” (Sonne, 1994, p. 339). Bersoff (2003) indicates that the updated APA (2002) Ethics Code took an even greater risk reduction stance by defining a multiple relationship and indicating that not all dual rela- tionships are potentially unethical. This was intended to further protect the welfare of the client and the professional, with the gained clarity of the language in the new code. Table 1 Comparison of the Multiple Relationships Standards in 2002 and 1992 APA Ethics Codes 2002 APA Ethics Code 1992 APA Ethics Code • Explicit definition of multiple relationships • No explicit definition of multiple relationships • Not all multiple relationships are unethical • Not all multiple rela- tionships can be avoided • Enhanced risk prevention stance • Risk prevention stance • If a potentially harmful multi- ple relationship arises, psy- chologist will resolve in com- pliance with Ethics Code • Same as 2002 Ethics Code • Refrain from engaging in mul- tiple relationships if expected to impair psychologists’ objec- tivity or performance, or harm the other individual in the rela- tionship • Same as 2002 Ethics Code • If required by laws, policy, or circumstances to serve in more than one role, then clarify role expectations and confidential- ity limits at outset and over time as needed • Not included in 1992 Ethics Code Problems within the earlier APA (1992) Ethics Code called for more definitive language regarding multiple rela- tionships, given that many psychologists were found “to be dealing with a variety of nonromantic, nonsexual relation- ships with former clients” (Anderson & Kitchener, 1996, p. 65). A problem with the 1992 edition of the code is that a clear definition of a multiple relationship was not provided, nor did the code comment on how one should determine that definition or decide when a multiple relationship might be unethical. With a large number of psychologists in blurry territory and no clear definition of unethical multiple rela- tionships, the profession was at a high level of potential risk as a whole. Therefore, the updated APA (2002) Ethics Code aimed to provide more insight and clarification into this matter. Continued Concerns that Might Suggest Further Change to the 2002 Ethics Code A number of potential complications necessitate re- examination of the current APA (2002) Ethics Code. Namely, the application of the 2002 Standard of multiple relationships in the profession may be inconsistently inter- preted across licensing boards. With the current language, MULTIPLE RELATIONSHIPS AND ETHICS 27 each state may provide its own interpretation on a case-by- case basis. This type of interpretation and utilization allows for a significant amount of subjectivity and possible dis- crimination, which could be viewed as inconsistent, capri- cious, and arbitrary. The civil courts could also use the current multiple re- lationships standard in an inconsistent manner for malprac- tice cases. Some boards continue to operate from the 1992 Standard for multiple relationships, stating that the 2002 change is at odds with the 1992 Standard (Bersoff, 2003; Schank, Slater, Banerjee-Stevens, & Skovholt, 2003). These applications and interpretations present risk man- agement concerns for the profession of psychology. Not only could this lead to poor and inconsistent handling of clinical matters, but the state licensing boards could set themselves up for lawsuits. There continues to be variable interpretation of the 2002 Standard. The authors propose that the language and specificity be revised to encourage more consistent interpretation across all state boards; con- tinue to provide for the best client welfare possible; ensure clear, sound, and just standards for psychologists; and re- flect the ethical theory of the profession of psychology. Pros and Cons of the 2002 Standard for Multiple Relationships Pros The APA (2002) Ethics Code has come farther in clari- fying multiple relationships than any other code of ethical conduct for psychology. It also has developed the profes- sional standard that not all multiple relationships are un- ethical. This is a positive development given that there have been disagreements about whether certain types of multiple relationships are ethical. The clarification helps protect both the psychologist and the client (Fisher, 2003; APA, 2002; APA, 1992). The improved definition of a multiple rela- tionship provided a more realistic understanding of what may or may not be an ethical violation. In the 1992 Ethics Code, there was no explicit definition of a multiple relation- ship; therefore, the licensure bodies had the freedom to con- sider each case uniquely and thus did not provide consistent determinations on ethical violations. This, to some extent, left the psychologists involved in alleged unethical multiple relationships at the mercy of the subjective interpretations of the boards. The current APA (2002) Ethics Code is the first to in- directly support rural and small town psychologists by stat- ing that not all multiple relationships are unethical. In a rural area (not limited to a small town), a psychologist may be called to be a “teacher, administrator, researcher, thera- pist, mediator, entrepreneur, crisis counselor, and referral source all in the course of a day, sometimes changing roles by the hour” (O’Conner, 2001). Due to this potential chang- ing of hats, the psychologist, under the current code, has room to navigate and explore multiple relationships as long as they do not negatively impact client welfare. This more accurately reflects and supports the reality of daily life in rural America. Schank and Skovholt (1997) interviewed 16 psycholo- gists in rural areas and small communities regarding ethical dilemmas the psychologists have dealt with in their prac- tices. The authors found that all 16 psychologists identified significant concerns involving professional boundaries. The concerns included major themes of “overlapping business relationships, the effects of overlapping relationships on members of the psychologist’s own family, and the dilem- mas of working with more than 1 family member as clients or with others who have friendships with individual clients” (Schank & Skovholt, 1997, p. 44). Although all 16 psy- chologists understood the 1992 Ethics Code, each one struggled with how to best apply the multiple relationship standard since it did not allow for the possibility of an ethi- cal multiple relationship. These findings support that rural psychologists in America have a significant interest in ex- amining multiple relationship concerns. Rural psychologists are asked to compartmentalize and deal with blurred boundaries of multiple relationships in day-to-day life (Schank & Skovholt, 1997). Rural psy- chologists must be aware at all times whether or not to ac- cept social invitations for themselves and their family members, as this may introduce even more difficulties with handling multiple relationships in rural practice. Attendance at church, running errands, and shopping at the local gro- cery store become thoughtful encounters rather than the simple daily task that most professionals have the luxury of performing automatically. The effects of multiple relation- ship concerns for rural psychologists and clients are begin- ning to be explored in more depth; however, the effects this may or may not have on the rural psychologists’ families has yet to be explored (Schank & Skovholt, 1997). Com- munity acceptance and trust is of great value for the rural psychologist, so she or he must be aware that each decision she or he makes may impact oneself, one’s family, potential clients, and/or community (Schank & Skovholt, 1997). To elaborate, the following are true-to-life examples of the overlap that occurs daily for the rural psychologist. • Imagine that during a session your client expresses frus- tration about the boy her daughter has begun dating. You realize that the new boyfriend is your client. • Every time you go out for dinner with your family, you are likely to see at least one or two of your clients, either as other diners or as restaurant employees. You find yourself wondering if there are any guidelines about how much to tip the waiter if he is your therapy client. • You need someone to fix your garage door, and there is really only one business in town that does this kind of work. The business owner’s spouse happens to be a pre- vious therapy client. • After developing a relationship with a client, he tells you he is suing his ex-girlfriend for custody of their child. LESTINA AND WALLJASPER 28 You learn the ex-girlfriend is a previous client of yours. Your records could be subpoenaed by both parents. • Your spouse wants to buy a vehicle and has worked out an initial deal with a salesperson who you previously evaluated for ADHD. • Your child wants to play at a friend’s house, and you have done therapy with that friend’s brother. Which of these multiple relationships could be harmful? How does the psychologist know? The current code allows for the recognition of this real- ity for rural and small town psychologists. It does not state that all multiple relationships for rural psychologists are acceptable. It simply implies that all potential and ongoing multiple relationships need to be examined. If there is no foreseen harm to the client, the multiple relationship is likely not to be considered unethical. This does not mean that the decision to have a multiple relationship should be taken lightly nor should it be assumed to be a simple deci- sion process, as the above examples indicate. In sum, the current code provides more leeway for the psychologist to determine if and when a multiple relation- ship is potentially unethical. Assuming the psychologist goes through the determination process with integrity, the APA (2002) Ethics Code is helpful in giving the psycholo- gist this room to operate effectively. Cons As with any code, there are usually areas that can be further developed within the framework of the current stan- dard. The profession is not stagnant. There continue to be changes, interpretations, ideals, and other variables that allow for the profession of psychology to evolve. These changes have led to revisions of the APA Ethics Code a number of times. In examining the current APA (2002) Ethics Code as it pertains to multiple relationships, one can find a number of potential pitfalls or areas of confusion. The added statement that not all multiple relationships are unethical is a positive development, yet it has its own set of drawbacks. Schank and Skovholt (1997) remind the reader that, “psychologists must maintain a balance of flexibility in overlapping rela- tionships” (p. 48), yet the psychologist must also have clear expectations and boundaries in each relationship. This is a tricky area for the psychologist to navigate. The updated APA (2002) Ethics Code does not provide a clear step-by-step process of how the professional should determine whether or not the potential multiple relationship might be unethical. Therefore, a psychologist can easily and unintentionally be led into poorly defined or overlapping relationships. It does not take much for an ethical multiple relationship to fall into an unethical one. Holub and Lee (1990) note that “blurring of boundaries may become prob- lematic for the therapist who becomes a compassionate friend to a client or acts as professional for a friend” (p. 107). In most cases of multiple relationships that become unethical, “the relationships began insidiously” (Hamilton & Spruill, p. 318). Another potential pitfall for the current ethics code is that regardless of the clear definition of a multiple relation- ship, there may still be difficulty in carrying out the stan- dard. For instance, Smith, McGuire, Abbott, and Blau (1991) note that there is “often a discrepancy between what clinicians know to be the ethically preferred course of ac- tion in dealing with professional-ethical dilemmas, and their stated willingness to implement this ideal” (p. 238). The idea that the professional can be aware of the problematic and potentially unethical situation and not be able to steer clear of this dangerous situation is frightening, especially considering that the psychologist has the responsibility to determine whether or not the multiple relationship could negatively impact the client’s welfare. The professional is responsible for judging conduct in relationships outside of therapy and how such conduct could potentially result in harm to the client (Schank et al., 2003). If the psychologist who is responsible for examining the multiple relationship for potential harm to the client has impaired objectivity, then there is definitely a problem ac- cording to the current APA (2002) Ethics Code (Schank et al., 2003). Due to the complex and often ambiguous nature of multiple relationships, Schank and colleagues (2003) caution the professional to stay away from developing mul- tiple relationships at all. Ultimately, the psychologist is responsible for making the judgment regarding the multiple relationship and puts him/herself on the line if something goes awry. Since the APA (2002) Ethics Code does not describe in detail how to examine potential multiple relationships for harm, the psy- chologist has no basic template from which to operate a checks and balances system. The APA (2002) Ethics Code is assuming that the psychologist will have the integrity and capacity to make this determination professionally. Given that we have the code for a reason (i.e., there have been problems with some psychologists’ integrity), outlining the process of evaluating multiple relationships more specifi- cally may help to keep the professional accountable as well as provide some protection for the psychologist who does go through a specific evaluation process. There are three main areas that the psychologist must seriously consider when examining a potential multiple relationship, according to Smith (2003a): issues of power, length of treatment, and termination. First, the psychologist needs to gain a clear awareness of how much power he or she has in the relationship (Smith, 2003a), as this will help determine the likelihood for harm. In making an informed decision, the psychologist must also be aware of the vulnerability the client may ex- perience (Schank et al., 2003). “This power continues even after the therapy relationship ends” (Schank et al., 2003, p. 183). Typically, a client allows the psychologist to be in an elevated hierarchical position. The client looks to the thera- pist for advice, approval, and even worth, at times. Fur- thermore, the client discloses very difficult personal mate- MULTIPLE RELATIONSHIPS AND ETHICS 29 rial, widening the power differential between client and psychologist. The psychologist who does not handle oneself professionally and properly can harm the client psychologi- cally. The impaired judgment of a professional may allow for a lingering problem that could potentially have lasting ef- fects upon the client or other individual involved in the multiple relationship; this highlights the importance of be- ing as specific as possible in the language that covers mul- tiple relationships. It is not easy to accurately predict the potential risks and benefits of a multiple relationship even if the professional has unimpaired judgment (Schank, Slater, Benerjee-Stevens, & Skovholt, 2003). Second, what will be the duration of the contact or rela- tionship? The longer the duration; the more concern. As mentioned by Smith (2003a), it is important to examine the length of a professional relationship before making a deci- sion on a dual role. This could seemingly apply to both short-term and long-term relationships, in either a positive or negative manner. A psychologist could have worked with an individual for a long time, developed substantial trust and rapport, and have significant risk of harm if a mul- tiple relationship developed. On the other hand, some indi- viduals may only work with a psychologist for a brief time and not be appropriate for a multiple relationship. If possible, multiple relationships should be avoided, as a general rule. If it is not possible, then the professional must implement a strategy to determine whether or not to engage in the multiple relationship. Simply having a time frame of how long a client/therapist relationship has been established is not sufficient because each case is unique. All situations must be weighed as carefully and objectively as possible, with peer consultation periodically. Additionally, the professional is urged to consider other consultations, such as with a supervisor, attorney, state psychological as- sociation, ethics panel, or state ethics board. Third, in the case of a therapeutic relationship, has it been terminated? If so, how long ago and what was the out- come (i.e., positive or negative)? Termination is the last area that Smith (2003a) emphasizes as a key factor in evaluating multiple relationships. A client treated for mild depression 25 years ago, for example, is different from a client with Borderline Personality Disorder who finished treatment (for now) three weeks ago. Some clients who have terminated three or four years prior would not be ap- propriate for a multiple relationship, whereas others would be appropriate. The APA (2002) Ethics Code indicates that a sexual relationship (i.e., an intimate and physical relation- ship) should not occur prior to two years following termina- tion. This is simply a minimum. Some professionals believe that a sexual relationship should not occur with a previous, current, or future client—this is the easiest and perhaps best answer to the question of whether a sexual relationship be- tween psychologist and client is ever ethical. Once again, the power and hierarchical differences could be severely damaging to the client even if a few years have passed. The disclosure was one-sided, and it is difficult to transform that into a two-way relationship. It does not appear that a sexual relationship could be an equal two-way relationship be- tween a psychologist and a previous, current, or future cli- ent. Smith (2003a) reported that these three areas must be examined carefully to make an informed decision about the foreseeable risk of a multiple relationship. The more in- formed the psychologist is, the more likely he or she will be able to make an objective judgment about the multiple rela- tionship. Therefore, although there are many positive as- pects of the current APA (2002) Ethics Code in regard to multiple relationships, continued concerns need to be ad- dressed to better protect psychologists and the people with whom they work. New Language Proposed for the Multiple Relationships Standard Most of the APA (2002) Ethics Code Standard 3.05 that covers multiple relationships is important to keep in the new proposed standard offered here. Several clarifications and additions are recommended. The proposed revision is as follows: Multiple Relationships Proposed Standard. (a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person. A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, compe- tence, 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. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical. (b) If a psychologist finds that there is a possibility of a multiple relationship prior to the multiple relationship oc- curring, then the psychologist is obligated to go through a number of steps in order to assess objectively if the rela- tionship could potentially impair his or her functions as a psychologist or otherwise risk harm or exploitation to the client or person with whom the professional relationship exists. The assessment process should begin by a self- assessment of the nature of the multiple relationship. The psychologist should outline the type of relationship and the actual or projected expectations, length, and roles (includ- ing power differences) for both the professional relation- ship and the other relationship. At this point, if the psy- chologist believes the multiple relationship is not ethical, LESTINA AND WALLJASPER 30 then s/he does not allow the multiple relationship to de- velop. However, if the psychologist believes that the multiple relationship is still potentially ethical, then the psychologist should consult with another psychological or legal profes- sional with documentation of this consultation, at a mini- mum. The other professional should assist in an objective assessment and provide the psychologist with a documented opinion. The original psychologist ultimately makes the decision and would be held responsible for continuing or not continuing in the development of the multiple relation- ship. (c) If a psychologist finds that, due to unforeseen fac- tors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code. (d) An assessment process should also be done if the psychologist has found him/herself in the position of (c) as listed directly above. This should begin with the same self- assessment as listed in (b) above. The psychologist should outline the professional relationship, expectations, length, and roles and outline the type of multiple relationship, ex- pectations, length to date, projected length, and current and future roles. The psychologist makes an initial assessment. If the psychologist deems that the multiple relationship should cease, then the psychologist should move forward with this making certain that the professional relationship is intact and did not suffer. If the professional relationship suffered, then the psychologist should provide appropriate referrals for the individual. If the psychologist deems that the current multiple rela- tionship is not causing undue harm or exploitation to the individual with whom s/he is in the professional relation- ship, then the psychologist should receive written docu- mented consultation for additional objective assessment by another psychologist or legal professional. The psycholo- gist makes his/her decision and is responsible for his/her actions. (e) When psychologists are required by law, institu- tional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceed- ings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. (f) If a multiple relationship is occurring within a pro- fessional relationship, then the psychologist is obligated to discuss the dynamic of the multiple relationship with the individual who is also in the professional relationship with the psychologist. The psychologist must inform the individ- ual that s/he has the right to inform the psychologist if an unforeseen harmful or exploitative event occurs. The psy- chologist must also inform the individual that s/he is agree- ing to the multiple relationship under the assumption that there are no foreseen exploitative or harmful events that will come of the dual venture. The psychologist must also include in an informed consent the expectations and roles of himself/herself as well as the expectations and roles of the individual. This informed consent discussion of multiple roles should be documented within the client’s record. If, however, the situation or characteristics of the client lead the psychologist to believe that open discussions and in- formed consent of the multiple relationship would be harm- ful to the client’s welfare, then the psychologist should re- frain from this discussion with the client and document the rationale. The above language in the proposed revised standard for multiple relationships in the APA Ethics Code better addresses the evolvement of the profession and current con- cerns in this area (see Table 2). Part A maintained the same definition of a multiple relationship. This definition is spe- cific enough to include all possible multiple relationships, including those that are ethical violations and those that are not. Making this definition any more specific or limiting it to only relationships that are ethical violations would not be taking into account the often necessary and viable multiple relationships that present in some situations, such as rural practice. Part B of the proposed standard would be new to the Ethics Code. It specifies the process of assessment for the psychologist if a potential multiple relationship arises. The steps for risk-management provide a clear understanding of a minimum standard. This proposed section also makes it clear that consultation with another professional is needed in addition to one’s own assessment. An objective opinion should be sought, documented, and utilized in the decision of whether to engage in or continue a multiple relationship. This section will hopefully lead professionals to seek more input and hence reduce the risk of an ethical violation. This assessment process will provide a clear indication of a po- tential ethical violation if the consultant’s documented ob- jective opinion was not in congruence with the decision the professional made about the relationship. If the consultant and psychologist cannot agree, a third opinion could be sought and documented. At that point, an ethics panel or licensing board may be the most appropriate consultation. One potential concern is what to do if the consulting psychologist or other professional is impaired, biased, or under-trained in the area of multiple relationships. For in- stance, an urban ethics board reviewer without experience in rural practice may not be the best consultant in some situations. In this case, the urban psychologist may have very different expectations regarding roles given his/her different cultural perspective. Thus, the consultant needs to be chosen carefully. Overall, the assessment procedure should provide a clearer evaluation of potential impairment or risk of harm. Part B in the APA (2002) Ethics Code was not altered and as presented in Part C of the proposed standard. Part D is similar to the assessment process in Part B of the proposed standard; however, Part D is applied to situa- tions in which the psychologist finds him/herself in a multi- ple relationship without prior time to examine the potential harm of this relationship. Because the multiple relationship MULTIPLE RELATIONSHIPS AND ETHICS 31 Table 2 Comparison of the Proposed Multiple Relationships Stan- dard and Current 2002 APA Multiple Relationships Stan- dard Proposed Multiple Relationships Standard 2002 APA Ethics Code Standard • Explicit definition of multiple relationships • Same as proposed • Not all multiple relationships are unethical • Same as proposed • Enhanced risk prevention stance • Risk prevention • If a potentially harmful multiple relationship arises, psychologist will resolve in compliance with Ethics Code • Same as proposed • Refrain from engaging in multiple relationships if expected to impair psychologists’ objectivity or per- formance or harm the other indi- vidual in the relationship • Same as proposed • If required by laws, policy, or circumstances to serve in more than one role, then clarify role ex- pectations and confidentiality lim- its at outset and over time as needed • Same as proposed • Explicit assessment process to determine whether multiple rela- tionship is potentially harmful • Not addressed • Explicit resolution process for ending multiple relationship • Not addressed • Explicit description of need for consultation • Not addressed • Explicit description of need for discussion and informed consent of multiple relationship with other individual • Not addressed has occurred or is ongoing, the psychologist needs to do an assessment to determine if there are any unforeseen factors that could be harmful to the client as well as determine if the multiple relationship should continue or terminate. Part E consists of the same language that was utilized in the APA (2002) Ethics Code in Part C. Finally, Part F is a new addition that addresses the need to inform and discuss the ethical issues of the multiple rela- tionship with the individual with whom the psychologist has the professional relationship. This informed consent and discussion will better safeguard the welfare of the client or other individual in the multiple relationship. The client can be made aware of the expectations and roles for him- self/herself as well as the professional in each of the rela- tionships. This allows for the client to be a part of the dis- cussion in terms of potential consequences of the multiple relationship. It also provides a clear understanding from the beginning so that neither party is making assumptions about what the dual relationship means at present or in the future. Risk management and protection for the client as well as the professional is an important piece of this new addition. Having this informed consent discussion documented in the client’s file allows for more consistent interpretation and evaluation of potential ethical violations due to multiple relationships. This proposed standard allows for exceptions in which it may be harmful to the client to discuss and ob- tain informed consent regarding the multiple relationship. Examples of this type of situation include a client who is psychotic, who is not competent to provide informed con- sent, or who is so low functioning that he or she may not understand the relevant issues. However, it is the authors’ belief that at least a simplistic acknowledgment of the mul- tiple role is possible for most clients. The changes proposed to the APA Ethics Code offer a number of positive benefits. The first is that the process of assessment for potential and current multiple relationships is better defined and established. A standard allows for more consistent interpretation and evaluation of potential ethical violations with multiple relationships. Better protec- tion is offered to the client and the professional with a stan- dardized minimum of assessing a potential problem or risk. The professional is required to document as well as consult with others in order to comply with ethical guidelines and standards. This allows for a better system of documentation and objectivity. The second area that is new in this revised language is the directive to engage the client in an informed consent discussion regarding the multiple relationship. This final section allows for the continued enhancement of client wel- fare as well as providing a better map for the psychologist for a clear, clinically sound, and minimum standard. Conclusion The purpose of this article was to address the need to update the current standard for psychologists regarding po- tential multiple relationships. Although the current APA (2002) Ethics Code provides a clearer definition and more leeway for the psychologist to make an objective decision regarding the ethical possibilities of a multiple relationship, there continues to be the potential for complications, par- ticularly for rural and small-community psychologists. The proposed standard upholds the strengths of the APA (2002) Ethics Code in terms of the definition of a multiple relationship and the possibility that not all multiple relationships are ethical violations. Building on those strengths, the proposed revisions to this standard provide a minimum guideline for evaluating potential and current multiple relationships to encourage more consistent inter- pretations. The new language also provides guidance to the psychologist that the client needs to be fully informed of the dynamics of a multiple relationship. The new language proposed is designed to meet the needs of the current profession as it has evolved to require a more specific multiple relationship standard. It is hoped that a more specific strategy for assessing multiple relationships LESTINA AND WALLJASPER 32 and the call to inform and discuss this issue with clients will provide a better platform to decrease the incidents of ethical violations with multiple relationships for psychologists. References American Psychological Association. (2002). Ethical prin- ciples of psychologists and code of conduct 2002. Re- trieved on March 21, 2002, from http://www.apa.org/ethics. American Psychological Association. (1992). Ethical prin- ciples of psychologists and code of conduct. American Psychologist, 47, 1597-1611. Anderson, S. K., & Kitchener, K. S. (1996). Nonromantic, nonsexual posttherapy relationships between psycholo- gists and former clients: An exploratory study of critical incidents. 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