Can Psychologists Date Patients or Former Patients?
Love and relationships often form the main issues that patients take to their psychologists. As such these professionals are privy to deepest recesses of their patient’s heart and their keenest personal impulses too. Often in helping their patients, psychologists stand in danger of a developing a personal bond too since in human relationships, the impulses of love and support are closely related and often expressed in the same manner. Also a therapist listens to a patient without being judgmental, may help to solve long-standing problems, and may be kinder to the patient than the latter’s own friends or family. Thus it is quite common for a client to have good feelings about his/her therapist, and see these feelings as the beginning of romance. But how ethical, legal or even practical it is for psychologists to date patients or even former patients for that matter?
Psychologists and current clients
Almost all developed societies prohibit any romantic or sexual relationship between a psychologist and a current patient. The American Association of Psychology is unequivocal about the issue and rule 10.05 of the Ethical Principles of Psychologists and Code of Conduct absolutely forbids Sexual Intimacies With Current Therapy Clients/Patients1. Again section 3.05 of the Ethics Code lays down rules for psychologists on entering into Multiple Relationships; according to this a multiple relationship occurs when a psychologist is in a professional role with a person and at the same time is in another role, for example a lover, with the same person. Multiple relationship can also occur if the psychologist promises to enter into another relationship in the future with the patient or a person closely associated with or related to the patient. Rule 3.05 clearly forbids A psychologist from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists. All these possibilities are strongly present in case of a dating relationship between the psychologist and a patient. However the Ethics Code also mentions that multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
Psychologists and former patients
Apart from prohibiting romantic and sexual relations between psychologists and a current patient, the Ethics Code of American Psychologists Association also has strict rules on psychologists dating former patients. Rule 10.08 deals with Sexual Intimacies with Former Therapy Clients/Patients according to which Psychologists are forbidden to engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. Even after a two-year interval, psychologists can engage in sexual intimacies with former clients/patients only in the “most unusual circumstances”. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the patient's personal history; (5) the patient's current mental status; (6) the likelihood of adverse impact on the patient. Apart from all these factors, if a psychologist of therapist makes any statements or actions during the course of therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the patient, that is also deemed unethical according to the Ethics Code of the APA.
Psychologists are not only prohibited from engaging in romantic or sexual relationship with a current patient and in most cases former patient but it is also unethical for a psychologist to terminate the therapeutic relationship established with a patient in order to pursue a social or sexual relationship with the patient.
Possible Consequences
The Consumer information page of Association of State and Provincial Psychology Boards (ASPPB) – an alliance of state, provincial, and territorial agencies responsible for the licensure and certification of psychologists throughout the United States and Canada – states that sexual contact of any kind between a psychologist and a patient, and in most cases even a former patient, is unethical and grounds for disciplinary sanctions3. Additionally, in some jurisdictions, such activity may constitute a criminal offense. All psychologists are trained and educated to know that this kind of behavior is inappropriate and can result in license revocation.
Why are such relationships considered unethical?
There are several reasons why dating a patient – current or former - is considered unethical on a psychologists’s part. To begin with a sexual involvement makes the work of psychotherapy or analysis impossible. A professional cannot conduct a psychotherapy or analyze a patient with whom he/she is having, or has had, a sexual involvement—there is loss of objectivity and thus the method the psychologist would use to help the patient has been neutralized. For this reason, A sexual involvement is unethical because the psychologist can no longer exercise beneficence in the professional relationship.
Then again, the psychologist is in a position of power over the patient. By virtue of their education and training, mental health professionals are armed with the knowledge of what is wrong with a patient and how to treat him/her. In such a case if a psychologist becomes romantically interested in a patient, he/she may succumb to the temptation of using his/her medical knowledge to advance his/her romantic aspirations and not necessarily in a positive manner. Also when a patient comes to a psychologist, it is because the former is ill and thus vulnerable to whatever the therapist says or tells him/her to do. When a person’s physical and mental faculties are thus compromised, any relationship entered into is usually not from a position of strength and equality but rather weakness and vulnerability. In medico-legal context, the relationship between a psychologist and a patient falls in the ambit of a fiduciary relationship. In a fiduciary relationship, there is an overarching ethical obligation not to derive illegitimate forms of satisfaction that place the patient at risk of harm. A sexual involvement violates the fiduciary nature of the relationship and is therefore unethical.
While all these reasons underlie the prohibition against a romantic relationship between a psychologist and current patient is unethical, certain dangers continue to exist even when a psychologist has ceased treating a patient and become his/her partner. This is because even when the therapist is no longer seeing someone as a patient but as a partner, he/she may continue to have access to the individual’s medical records and medical history. In case the romantic relationship ends acrimoniously, the psychologist goaded by negative feelings may compromise the former patient’s medical records thus breaching the important codes of confidentiality and objectivity. Also if the relationship between a psychologist and his/her now partner continues the emotional dependence of the earlier doctor-patient relationship, then even the current relationships is far from healthy and equal.
In the end, there is no doubt that a dating relationship between a psychologist and patient is fraught with complications that can prove to be damaging to both parties if boundaries are crossed. However once the professional relationships has ceased completely and a considerable time period has elapsed, it may be possible for a doctor and a former patient to date each other provided the new relationship is equal and emotionally healthy.
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