Would it be more accurate to call it a sequential or serial relationship? If one believes that our patients grow mature and sometimes surpass us in knowledge, wisdom, and power, then it is a significant difference.However, if one truly believes “once a client, always a client” and that clients are always dependent on us, then “former clients” would mean a distinction without a difference.Would or should an ethics committee have the authority to interfere with a marriage or union among consenting adults?What about our belief in the right to free association? Stephen Behnke, APA Ethics Director (2006), says otherwise.Dual or Sequential Relationship When a therapist and client enter into a relationship that is outside of or in addition to the therapeutic relationship, it is generally referred to as a dual relationship.Dual relationships are discouraged by most professional organizations.This includes sexual relations with clients, as well as any situation in which we exert undue influence over a client for our own benefit.
If, in fact, “once a client, always a client,” then we would run into some interesting situations that create ethical dilemmas with no easy solutions.Rather, Behnke says, it is because we have a fiduciary relationship that is compromised and creates additional risks that are not a necessary part of the therapeutic relationship, making psychotherapy impossible.But fiduciary relationships are not static and change with time and circumstances.Our clients are often free to join many, if not most, of the organizations where we are members. If it is an issue of power, who is in the position of power?Is power in any relationship always static, or is it variable and subject to change based on the circumstances?Of course, of all the dual or sequential relationships that are potentially possible with patients and former patients, when the issue of sex comes up, most all therapists of all disciplines react forcefully.Having sex with a current patient or even a recently discharged patient is not only unethical—it is illegal.You find out a former client has also announced his or her candidacy. You discover that you need someone with those highly specialized qualifications.Do you campaign against your former client, or withdraw because it would be a conflict? If the client is still a client even after all those years of no contact, is that a conflict of interest and a prohibited dual relationship?Nonetheless, it leaves open the possibility, as rare as it may be, and does not claim that “once a client, always a client.” In most all states, laws prohibiting sex with clients are limited to current or recent clients. However, assuming the former client does not file any complaint, how enforceable would such laws be?For example, what if the former therapist and patient got married, were in a committed relationship, and had children?