Psychotherapist and Wiccan Clergy:

The Ethics of a Dual Relationship

by Ellen C. Friedman

Abstract

Wiccan clergy psychotherapists encounter complex ethical dilemmas due to dual roles.
In an attempt to understand the extreme complexity of the multiple roles, this discourse
begins with examination of current ethical codes of the professional societies. Recent
literature related to dual relationships in rural and small communities is surveyed, as
well as decision-making models effective in these situations. Common ethical
complexities experienced by clergy psychotherapists are reviewed. Informal
communication with Wiccan clergy psychotherapists confirms the multidimensional
nature of the ethics. Options for Wiccan clergy psychotherapists are considered.

In the course of studying ethics as a candidate for a master's degree in counseling, I

became aware of complex ethical dilemmas when considering the implications of the
fact that in the near future I will practice as both therapist and Wiccan priestess. The
point of this discourse is to identify the current views held by counseling professional
societies and to review recent literature relevant to the dilemmas encountered by
Wiccan clergy psychotherapists in their practice. Since no literature was available on the
specific topic under consideration, I conducted informal research with people currently
fulfilling the dual roles.

Dual Relationship Dilemmas

A dual relationship exists when a psychotherapist serves in the capacity of both therapist
and at least one other role with the same client. Most commonly the second relationship
is social, financial, or professional and may be concurrent or subsequent to the
therapeutic relationship. In 1992, the American Psychological Association published
research on common ethical dilemmas experienced by their members. Dilemmas arising
from "blurred, dual, or conflictual relationships" were the second most frequent ethical
dilemma cited by 679 psychologists (as cited in Pope & Vasquez, 1998, p. 27). "Dual
relationships form the major basis of licensing disciplinary actions, financial losses in
malpractice suits involving psychologists, and ethics complaints against psychologists"
(Pope & Vasquez, 1998, p. 195). The Code of Ethics for the American Counseling
Association (ACA) strongly advises avoidance of harmful dual relationships whenever
possible:

Counselors are aware of their influential positions with respect to clients,

and they avoid exploiting the trust and dependency of clients. Counselors
make every effort to avoid dual relationships with clients that could
impair professional judgment or increase the risk of harm to clients.
When a dual relationship cannot be avoided, counselors take appropriate
professional precautions such as informed consent, consultation,

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 supervision, and documentation to ensure that judgment is not impaired
and no exploitation occurs. (ACA, 1995, Standard A. 6.a.)
The ethics code for the American Psychological Association (1992) states that multiple
relationships may be unavoidable and recommends that therapists remain aware of the
potentially harmful consequences. They recommend refraining from multiple
relationships if harm may occur. The ethics codes of the American Association of
Marriage and Family Therapists (1998), National Association of Social Workers (1998),
and the American Association of Pastoral Counselors (1994) recommend avoidance of
multiple relationships that exploit or harm clients. All of the above codes strictly prohibit
sexual activity between therapist and client. All but the AAPT code warns against
superior/subordinate dual relationships such as when a therapist has an administrative,
supervisory, or evaluative role with a client.

Pope and Vasquez identify common ethical concerns about dual relationships (1998, p.
193-195). Dual relationships can erode and distort the professional nature of the
therapeutic relationship. They may create conflicts of interest that compromise
professional judgment or create situations where the therapist is engaged in meeting his
or her own social, financial, or other personal needs, rather than putting the welfare of
the client foremost. Dual relationships can affect the current and future benefits of
therapy. Pope and Vasquez claim that the power differential between a therapist and
client is one of the main reasons that exploitation and harm can occur. They also
mention the concern that the therapist is held legally liable and may be called to testify
in court regarding the patient's diagnosis, treatment, or prognosis. They admit that not
all dual roles are unavoidable, and caution therapists to take steps to minimize harm
when multiple relationships do occur by utilizing informed consent, negotiation, and
professional consultation.

Pearson and Piazza (1997) classify dual relationships into five categories in order to aid
the decision making process of whether or not a dual relationship will cause harm:
circumstantial roles, structured multiple professional roles, shifts in professional roles,
personal and professional role conflicts, and the predatory professional. Circumstantial
multiple roles are those that occur by pure coincidence, such as running into a client at
their sales job in the mall. Structured multiple professional roles are acceptable if the
nature of all the relationships is professional. Shifts in professional roles include
difficulties that arise when a teacher or supervisor counsels a student. Personal and
professional role conflicts include sexual or romantic, social, and peer-like relationships,
such as occur when collaborating on publications or engaging in a shared pastime. The
predatory professional is a therapist who exploits the therapeutic relationship to meet
personal needs rather than client needs. Pearson and Piazza do not agree that dual
relationships are inherently unethical, "Multiple professional roles such as advisor-
instructor, supervisor-mentor, counselor-advocate, and others enhance our effectiveness
as counselors and educators. However, risk of harm, or the perception of harm, seems
to increase as both level of intimacy and power differential increase. In addition, the
influence of the power differential is not always obvious" (1997).

The ban and demonization of dual relationships has come from an

attempt to protect the public from exploiting therapists. Regretfully, it has
emerged as a simplistic solution to a wide and complex problem. Even

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 worse, the ban on dual relationships and the isolation it imposes on the
therapeutic encounter tends to increase the chance of exploitation and
decrease the effectiveness of treatment. It enables incompetent
therapists, to wield their power without witnesses and accountability. In
addition it buys into the general cultural trend towards isolation and
disconnection (Zur, 2000).
Ofer Zur, one of the most outspoken supporters of the benefits of dual relationships,
states that the term "dual relationship" has been used interchangeably with
"exploitation", "harm", "abuse", "damage", and "sexual abuse" (1999). He cautions us to
remember that neither dual relationships nor any relationship with a differential of
power (i.e., parent-child, teacher-student) are inherently exploitative. (2000). Dr. Zur
states that behavioral, cognitive, humanistic, and existential therapies do not consider
dual relationships harmful, and that some therapies, like Family Systems therapy, rely
on the inherent duality of relationships that exists. He recognizes that for some clients
dual relationships cause anxiety and other difficulties, necessitating the need to consider
each dual relationship on an individual basis. Dr. Zur developed extensive clinical
recommendations to aid therapists in negotiating boundaries prior to entering a dual
relationship, to help in developing treatment plans, and to ensure clinical integrity and
effectiveness (1999). Dr. Zur finds dual relationships frequently aid the therapeutic
relationship and outcome, "for the most part it has significantly increased my
effectiveness, reduced the length of treatment and enhanced my ability to care for my
clients" (2000).
In a healthy society, people not only admit to, but celebrate their
complex mutual reliance on each other. The more multiple relationships,
the richer and more profound the individual experience. In a healthy
society, the witch doctor, the wise elder, and the practical neighbor are
all part of the fabric of advice and guidance, of physical and spiritual
support. In administering to the needs of the members of a healthy
society, therefore, its healers, rabbis, priests, or therapists will not shun
dual relationships, but rather rely on them for the insight and intimate
knowledge that such relationships provide (Zur, 1999).
Dual Relationships in rural and small communities

In rural and small communities, multiple relationships are unavoidable and are not
considered inherently unethical. (Brownlee, 1996; Schank and Skovolt, 1997). "Due to
the lack of anonymity, rural psychologists are inherently active participants in the
community. They have a more holistic view of clients and must balance the accepted
and more easily defined single role of an urban setting versus the complexity of
simultaneous relationships in a rural or small-community" (Schank and Skovolt, 1997).
Schank and Skovolt (1997) published qualitative research produced through interviews
with sixteen psychologists who live and practice in rural areas and small communities.
All of the psychologists identify dilemmas involving professional boundaries as a
significant concern. Emerging themes include the reality of overlapping social
relationships, the reality of overlapping business relationships, the effects of overlapping
relationships on members of the psychologist's own family, and the dilemmas of working
with more than one family member as clients or with others who have friendship with
individual clients. All sixteen therapists state that dual relationships are the most
frequent and complicated of all ethical dilemmas that they face in daily practice. Three

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different criteria are cited by the psychologists to make decisions about whether to see a
client when a dual role exists. Some psychologists use their own comfort level to gauge
whether they could successfully manage the overlapping relationship. The type and
severity of the clients' presenting problems is also used as an indicator when deciding to
enter a dual relationship. Therapists are more likely to enter a dual relationship if the
client is seeking problem-solving and would likely avoid a dual relationship with a client
if they suspected a complex issue such as a personality disorder. Other therapists
involve prospective clients in the decision-making process to decide if the benefits of
entering into a dual relationship outweigh the risk. Schank and Skovolt conclude by
suggesting safeguards to minimize the risks when entering into dual relationships which
include ongoing consultation, setting clear expectations and boundaries, informed
consent, documentation.

Keith Brownlee (1996) describes ethical decision making models especially suitable for
rural therapists since the complete avoidance of dual relationships is not a realistic
option. "Pivotal to any decision making based on the codes, are the two central
principles, impaired objectivity, and risk of exploitation. Both of these principles are very
broad and the counselor is left to judge for him or herself what kind of relationship
would qualify as impairing objectivity or increasing risk". He cites Kitchener's ethical
decision making model which is based on role conflict, and three variables associated
with increasing risk of harm. First, the risk of harm increases as the extent of
incompatibility of expectations between roles increase. Second, the risk of divided
loyalties increases and objectivity decreases as the obligations associated with each of
the roles diverge. Third, the risk of exploitation increases as the difference in prestige
and power between the therapist and client increases.

Brownlee (1996) cites Gottleib's ethical decision making model, which is based on three
dimensions: power, duration, and termination. The model recognizes that relationships
have a power differential ranging from low to high (minimal to profound personal
influence). Duration refers to the length of therapy (brief or long-term). Termination
refers to whether a specific time span for therapy can be decided upon or whether the
client is likely to require therapy for an indefinite period. Gottlieb's model involves the
following five steps:

1. Assess the current relationship in relation to power, duration, and

termination.
2. Assess future relationships in relation to power, duration, and
termination.
3. Counselor makes decision upon the role incompatibility of these
relationships. Gottlieb suggests a decision to proceed with the dual
relationships if the relationship between counselor and the client in
question appears to be mid-range to low in power differential and
conflict.
4. Seek professional consultation on decision.
5. Discuss the possible ramifications that could emerge from a dual
relationship with the potential client, utilizing treatment contracts, and
negotiation of boundaries to aid in making ethical decisions.

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Dilemmas special to the practice of clergy psychotherapists

"The legacy of dual training, insufficient attention to professional ethics, as well as

differing role expectations and professional socializations as clergy and counselor make
it imperative for clergy psychotherapists to be particularly thoughtful about boundary
issues in counseling" (Haug, 1999). "A 1994 report by the Maryland state regulatory
board indicated that 40% of the psychologists accused of sexually inappropriate
behavior were also ordained ministers."(as cited in Haug, 1999). Haug states the power
differentials are particularly high for clergy psychotherapists, "Client's vulnerability might
be heightened when they consult clergy psychotherapists. Due to the ministerial
background of clergy therapists, clients may have exaggerated expectations of their
ethical conduct and of the safety, if not 'sacredness', of the counseling relationship".
Haug stresses the importance of setting, communicating and maintaining distinct
boundaries in order to maintain the integrity of both roles,

Clergy psychotherapists who work both as pastors, priests, rabbis, and so

forth, and as therapists, face more complexities negotiating what
constitutes appropriate behavior in which context. It is crucial for
counselors, particularly clergy psychotherapists, to ask themselves these
questions: Who will benefit from this boundary crossing? Who really
needs this hug, this financial advice, this get-together outside the
counseling room? What are the possible negative, unintended
consequences for clients and those close to them, for the public, and for
the profession at large? Am I satisfying personal needs, for instance for
services, social contact, self-revelation, financial stability, and so on, that
might and should be met otherwise? Could this multiple relationship be
avoided? Am I rationalizing away my concerns? Am I comfortable having
this course of action made public?
Haug maintains that clergy are particularly vulnerable to unethical behavior due to their
lack of professional ethics education, gender inequalities in some religions, a tendency
to be idealized by the public, poorly defined job descriptions and expectations, and the
expectation of warm and friendly social interactions. Haug identifies common boundary
dilemmas which include non-sexual multiple relationships, sexual and sexualized multiple
relationships, confidentiality issues, and issues related to client autonomy. Dr. Haug
concludes with recommendations to prevent abuse of power and boundary violations
which include ethics education, professional consultation with other clergy
psychotherapists, and personal therapy. "Awareness of the differences in what is
expected and deemed professional and ethical in the two professions, however, is the
first step toward preventing a lapse in ethical conduct and client harm." (Haug, 1999)

Special problems encountered by Wiccan clergy psychotherapists

Dual relationship dilemmas faced by Wiccan clergy psychotherapists are similar to

dilemmas identified concerning practice in small and rural communities, and by clergy
psychotherapists, but there are concerns and complications specific to practicing in
Wiccan communities. The structure of Wiccan community consists of autonomous clergy
serving and leading autonomous covens. Covens are small worshipping and teaching
congregations (generally three to twenty persons). The larger Wiccan community could

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include as little as a handful to as large as a few thousand members. In some places the
community expands to include the pagan community, which is comprised of countless
magickal traditions, orders, religions, and autonomous individuals with little common
ground.

"The dual nature of our covens makes the situation even more complex. They are not
simply worshipping congregations, kept small to maintain personal intimacy and spiritual
intensity. They are also, by tradition, the places where we train and develop our future
clergy. This places the coven leader in two roles that are almost directly contradictory:
mentoring and evaluating" (Harrow, 1996). "If you see coven as a support group for the
psycho-spiritual healing and growth of the members, which it is, then the leader serves
as facilitator, mentor and counselor" (Harrow, 1996). Harrow recommends that coven
leaders meet their own needs in other social relationships, not through the coven.
Harrow points out that the matter is further complicated because covens also serve
many Wiccans as families of choice.

Oakwood, a non-clinical psychologist and Witch, commented that "given the hopefully
intimate relationships inherent in covening, there might be a role conflict, as there would
be in counseling one's best friend. However, I do not see a role conflict inherent in
counseling someone the therapist is less intimately related to, for example, a member of
the community at large, or, in some traditions, the outer court." (Oakwood, personal
communication, July 27, 2000). She recommends open discussion of boundaries, "It
should be clear to the client that the counselor may be showing up for rituals, or even
running them. If the client is not comfortable with that from the beginning, then you
should not accept them as a client. You should choose that course rather than choosing
to stay away from a ritual you would normally attend or run." Oakwood stresses that
radically altering your life for the comfort of a client only leads to resentments, which
will negatively impact the therapeutic experience.

"Running into your therapist in the grocery store, a restaurant, or even at the same
political demonstration is not the same as encountering them in a ritual context,"
explains Cat Chapin-Bishop, a psychotherapist and Wiccan priestess (C. Chapin-Bishop,
personal communication, August 2, 2000). "Ritual settings and Pagan gatherings tend to
encourage intimate connection. Therapy too is intimate, but in a very different way: for
one thing, in a therapy session, my clients have my undivided attention. Coming into a
ritual setting where I am present, many of my Pagan clients have brought that
expectation into the new setting--- after all, all around are people hugging, connecting,
telling one another deeply personal stories. The setting (unlike a restaurant) conveys
the legitimacy of pursuing connection, and the therapy has given rise to the expectation
of how that intimacy 'should' feel." She continues, "Undivided attention rarely happens
for anybody, but folks often feel abandoned and rejected when it is suddenly taken
away, and in ways that prove very disruptive to the therapy afterwards." At this time,
she sees Pagans and Wiccans in a pastoral setting but not a psychotherapeutic one.

Chapin-Bishop identified the importance of the type and severity of client presenting
problems in consideration of a dual relationship, "Smoking cessation, behavioral
desensitization, or short-term couples' counseling evoke very different transferential
issues than long-term trauma and grief work." The presence of clients dealing with

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abuse issues at rituals she leads would impede her performance as a priestess. Wiccan
clergy need to be in a safe and controlled space in order to perform the skills required of
their ritual role, which can include trance possession by deity, commonly known in
Wiccan circles as "Drawing Down the Moon". Chapin-Bishop expresses a need to
minimize the role stress, "If I therefore adopt a detached, non-intimate stance toward
my community and my Gods, so that I can manage the transferential issues of any
clients who are present, I cheat myself of my main source of spiritual nourishment."

Chapin-Bishop recognizes that clergy therapists are idealized. "If you are in a dual
wisdom role, both the all-powerful priestess and the all-compassionate therapist, you're
on the pedestal before you even properly begin your work." From her viewpoint:

We are, as Pagan clergy, members of our communities in a way that

Christian pastoral counselors are not. Our community and ritual structure
favors intimacy and connectedness, and while many of our priests are
talented and charismatic, our pews do not face forward. We don't favor
group structures that create the kind of emotional detachment that would
keep transferential issues from becoming noticeable. Quite the reverse:
our drive toward connection, as whole persons, one member with
another as equals, tumbles us together in ways that almost ensure that
people's idealized expectations will meet with disillusionment. It's bad
enough to be a High Priestess who is 'caught' yelling at her child. To be
both Pagan clergy and psychotherapist to the same subject is to be at
ground zero for some positively nuclear pyrotechnics.
Conclusions and Implications

The professional societies of the helping professions agree that sexual dual relationships
between therapists and clients are unethical (AAMFT, 1991; AAPC, 1994; ACA, 1995;
APA, 1992; NASW, 1996). These codes agree that therapists should not meet their own
needs through relationships with clients. The AAMFT, ACA, APA, and the NASW strongly
caution therapists against supervisory and evaluative dual relationships with clients. As
far as non-sexual dual relationships, the codes caution therapists to avoid harmful and
exploitative dual relationships, and when relationships cannot be avoided they obligate
he therapist to employ methods to minimize harm.

Abuse of the power differential and loss of objectivity is at the heart of the risk of harm
(Brownlee, 1996, Haug, 1999; Pearson and Piazza, 1997, Pope & Vasquez, 1998). While
far from suggesting that all dual relationships are beneficial, Ofer Zur (1999, 2000)
strongly supports the use of dual relationships to enhance the effectiveness of the
therapeutic relationship and minimize exploitation. Brownlee (1996) and Schank and
Skovolt (1997) agree that dual relationships are not inherently exploitative and that they
are unavoidable in rural and small communities. Clergy psychotherapists are especially
at risk of unethical behavior and face complicated dilemmas when entering into dual
relationships (Haug, 1999). There is strong agreement in the literature that the therapist
should employ ethical decision making models, professional consultation, informed
consent through open discussion of benefits and ramifications, and case documentation
in order to decide whether or not to enter into a specific dual relationship, and to

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minimize risk when the relationship is avoidable or consensual (Brownlee, 1996; Haug,
1999; Pearson & Piazza, 1997; Schank & Skovolt, 1997, Zur, 1999; Zur 2000).

Wiccan clergy psychotherapists appear particularly vulnerable to ethical dilemmas

caused by dual relationships. Complications unique to Wicca include the intimacy
required of its clergy within the ritual context and within their covens. Covens serve not
only as congregation, but also as seminaries and in some instances as family of choice.
The lack of professional training for Wiccan clergy and the adolescent development of
Wiccan ethics is a considerable problem. Wicca is a young religion and has yet to
develop in these areas to the extent found in older religions. Ethical decision-making
often relies on an intuitive grasp of the "Wiccan Rede", which states "An' it harm none,
do as ye will".

Wiccan clergy psychotherapists will need to ask themselves many questions in order to
find their own boundaries concerning dual relationships. What type of relationship does
the clergy therapist have the with Wiccan community? What type of therapy does the
clergy therapist practice? Does the clergy therapist meet personal needs through their
community membership or are they isolated from social contact with the community?
How will the therapeutic relationship affect their family or coven members who also live
in the community? Options for Wiccan clergy psychotherapists include:

1. Avoid dilemmas as much as possible by not seeing clients who are also Wiccan
or Pagan. Cease any therapeutic relationship if client becomes as member of the
Wiccan and Pagan community.
2. Practice low power, short-term, advice-oriented, solution-focused or pastoral
counseling within community. Avoid high power, long-term psychotherapeutic
relationships.
3. Practice deep psychotherapy with community members and negotiate each
relationship on a case-by-case basis. This may necessitate that the therapist has
less socially intimate relationships within the community. There may be a need
for therapists to practice within their religion since some prospective clients seek
out therapists of the same faith. I recommend that Wiccan clergy therapists
avoid counseling coveners. The role conflicts encountered in this situation include
existing teacher-student relationships, and possible familial relationships since
covens foster reliance and intimacy in order to facilitate deep personal spiritual
work.
4. When consciously entering into a multiple relationship, use the ethical decision
making models and guidelines available (Brownlee, 1996; Zur, 1999). Employ
consultation and supervision with other Wiccan clergy psychotherapists, and with
other psychotherapists who are not also Wiccan clergy. Openly discuss role
boundaries with clients, obtain informed consent, and document the agreements.
Be aware of the reasons why you choose to enter a dual relationship.

I do not believe that dual relationships are inherently harmful. Personal experience has
proven a wealth of opportunities for growth to exist within consensual dual
relationships. As both clergy and future therapist, I am aware that these waters can be
muddy and require careful navigation. For nineteen years, I have lived my life openly in
the local Wiccan community. I will not deny myself the nourishment and intimacy I

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receive from my spiritual family and home. Due to the fact that I meet personal needs in
the Wiccan community, and that I prefer to err on the side of caution as I embark on
my career as a therapist, at this time I will continue to function as a priestess and
pastoral counselor and in the future will likely avoid most psychotherapeutic
relationships in the Wiccan community. As counselor and clergy, my primary
responsibility is to respect the dignity and promote the welfare of those that I serve. As
a human being, I also have responsibilities to my own welfare. Occasionally, these
obligations may conflict. I am thankful that my dual training provides me with
exceptional resources and tools with which to navigate these waters.

One Client: Many Provider Roles - Dual Relationships in Human Service

Settings

Debra Guthmann, Ed.D, Wendy Heines. LCSW, Marcia Kolvitz, M.S.

Abstract

Unlike professionals who work with hearing consumers, those of us working with Deaf
and Hard of Hearing individuals invariably will encounter our consumers outside of the
work environment. Should professionals who work with Deaf and Hard of Hearing clients
in vocational rehabilitation, social work, mental health, post-secondary settings or other
human service agencies socialize with their clients? How should professionals deal with
the number of dual relationship issues that arise on a regular basis? Is the significance
of dual relationships different for hearing and Deaf professionals? Whenever we as
professionals are operating in more than one role, and when there is potential for
negative consequences, it is our responsibility to develop safeguards and measures to
reduce (if not eliminate) the potential for harm.

Introduction

Dual or multiple relationships are rarely a clear-cut matter. There is an ongoing debate
over the risks and benefits of dual relationships. Some dual relationships are
unavoidable and in these cases, professionals need to take appropriate precautions.
Herlihy and Corey (1992) describe dual relationships as occurring when professionals
assume two roles simultaneously or sequentially with a person seeking help. The dual
relationship may exist at the beginning of the counseling relationship, it may occur
during the time services are provided, or it may develop after the termination of
counseling. Ethical codes vary in their statements about the length of time that must
pass for another A significantly different@ relationship, especially a sexual one, to be
permissible. Often, professionals need to make judgement calls and to apply the codes
of ethics carefully to specific situations. Dual relationships are filled with complexities

9
and ambiguities. Pope and Vasquez (1991) indicate that dual relationships are
problematic because some dual relationships are clearly exploitative and do serious
harm to the helper and professional involved, while others do not cause harm. Dual
relationships are not always obvious. It can be difficult to anticipate situations which are
not currently conflicts in role, but may become so at a later time. Dual relationships are
also the subject of conflicting views and not always avoidable.

How does one assess the potential for harm? Kirtchener and Harding (1990) identified
three factors that counselors should consider. First, there is a greater risk of harm when
the expectations of client and counselor are incompatible. When clients have one set of
assumptions about the ground rules of the relationship, and the professional has a
dissimilar set of assumptions, there is an increased likelihood of vulnerability. Another
principle is that when the responsibilities inherent in the dual roles are divergent, there
is potential for divided loyalties and a concomitant loss of objectivity. Counselors who
also have personal, political, social or business relationships with their clients, are at risk
because their self-interest may be involved and thus compromise the client's best
interest. Finally, by the very nature of the counselor/client relationship, clients are more
dependent, have less authority and are vulnerable. Due to this power differential, it is
the responsibility of the professional to ensure that the client in the relationship is not
harmed..

Pope and Vasquez (1991) asserted that counselors who engage in dual relationships are
often skillful at rationalizing their behavior thereby, evading their professional
responsibility to find acceptable alternatives to dual relationships. Entering into dual
relationships with clients, or even considering entering into them can drastically change
the nature of therapy. Counselors could begin using their practices unconsciously to
screen clients for their likelihood of meeting the counselor's social, financial or
professionals needs. It can also distort the professional nature of the therapeutic
relationship, which needs to rest on a reliable set of boundaries on which both client and
counselor can depend. Dual relationships affect the cognitive processes that benefit
clients during therapy and help them maintain these benefits after termination. Dual
relationships create conflicts of interest, and thus compromise the objectivity needed for
sound professional judgement. If a counselor were required to give testimony in court
regarding a client, the integrity of the testimony would be suspect if a dual relationship
existed.

Sexual Relationships

There is clear consensus among the professional associations (counselors, psychologists,

social workers, etc.) that concurrent sexual and professional relationships are unethical.
Many of the associations agree that a sexual relationship cannot later be converted into
a therapeutic relationship.

From a legal perspective, non-sexual dual relationships are less likely to produce
sanctions than are sexual dual relationships. For instance Healy and Herlihy (1992)
found that sexual dual relationships comprised 20% and other dual relationships
comprised 7% of complaints made to state counselor licensure boards. However, in

10
recent years state licensing boards seem to be addressing the issue of nonsexual dual
relationships more vigorously.

Most ethical codes draw strong distinctions between sexual and non-sexual dual
relationships. Ethical codes vary in their requirements about the length of time that must
pass for another "significantly different" relationship, especially a sexual one, to be
permissible (Herlihy & Corey, 1992, p.3). Although the codes considered here prohibit
the counselor from having a sexual relationship with a current client, variation occurs in
the prohibition of such a relationship with former clients and the length of time that
must pass for such a relationship to be permissible (American Counseling Association,
1995; National Association of Alcoholism and Drug Abuse Counselors, 1995).

All the major professional associations agree that sexual contact less than two years
after termination of the professional relationship is unethical. If a sexual relationship
occurs after a two-year interval, the burden rests with the therapist to demonstrate that
there has been no exploitation. Considerations include: amount of time that has passed
since termination; nature and duration of therapy; circumstances surrounding
termination; client's personal history; client's mental status; and any statements or
actions by the therapist suggesting a romantic relationship after terminating the
professional relationship.

There is disagreement among practitioners about whether a sexual relationship initiated

after termination is ever ethical. Some maintain that "once a client, always a client." One
must also consider that given the fact that there are so few professionals working in the
Deaf community, chances are that former clients may have few, if any, other options,
than to return to the same practitioner for services when the need arises again. The
transference elements of the therapeutic relationship persist forever, and therefore,
romantic relationships with former clients are considered unethical by many
professionals.

Social Relationships

The roles of friend and clinician are not compatible. Friends do not pay their friends a
fee for listening and caring. It will be difficult for a counselor who is also a friend to
avoid crossing the line between empathy and sympathy. Because a dual relationship will
be created, there is always the possibility that one of the relationships -- professional or
personal -- will be compromised. It may be difficult for the counselor to confront the
client in therapy for fear of damaging the friendship. It will also be problematic for
clients, who may hesitate to talk about deeper struggles for fear that their
counselor/friend will lose respect for them. It can be very difficult when a professional
has to report to authorities about a client who is homicidal or suicidal, or in regard to a
child abuse/neglect report. Imagine the turmoil faced by a professional who is also
friends with that client.

Is it ethical to counsel a mere acquaintance? A friend of a friend? A relative of a friend?

It is going to extreme measures to insist that counselors should have no other
relationship, prior or simultaneous, with their clients. Often clients seek us out for the
very reason that we are not complete strangers. We need to ask ourselves if the

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nonprofessional relationship is likely to interfere, at some point, with the professional
relationship.

For Deaf professionals working with Deaf clients, the issue of social relationships can
frequently conflict with their professional roles. This may be impossible to avoid. For
example, often Deaf professionals receive their elementary and high school educations
in the same mainstream programs and residential schools as their Deaf clients. When
former schoolmates become counselor and client, there are many potential conflicts.
Some Deaf professionals choose to minimize this quandary by moving to a different
state or at least a distance from where they spent their school years.

Deaf professionals, like humans everywhere, have their own social needs. It is natural to
seek friendships with others who share the same language, culture and values as
themselves... in other words, within the Deaf community. Even when one takes care not
to accept friends, or former classmates into their caseload, conflicts may still occur. It is
not only how the Deaf professional perceives the relationships he/she has with others,
but how those relationships are perceived by others as well. Consider a situation in
which Jack, who had been thinking about starting counseling, attends a Deaf event, and
observes the Deaf counselor, Janet, chatting and laughing with Sue, from whom Jack
has had a stormy and ugly divorce.

In addition, the partners of Deaf professionals often are Deaf as well. Clients frequently
and understandably are concerned about what the spouses share with one another.
Again, even when the counselor maintains scrupulous boundaries regarding
confidentiality with their mate, how it is perceived by the client remains an issue.
Morever, the partner's social relationships can sometimes cause a conflict with the
counselor's professional relationships. As an example, a therapist begins counseling with
a new client. During the third session, the client brings in photos of her new boyfriend.
To the counselor's chagrin, she realizes that the new boyfriend is a close friend of her
husband's. This presents a challenge that could develop when the counselor's husband
wants to go out socially with his friend and his friend's new girlfriend. How will the
counselor explain to her husband why she won't go out?

Hearing professionals working with the Deaf community, often feel discomfort when
attempting to maintain a professional boundary which is meant to provide their clients
with privacy and respect. Often, a hearing professional=s attempts to respect the Deaf
community are misinterpreted as being aloof and the perception could be that they view
themselves as better than the Deaf community member(s). For some, the perception is
that the hearing professional is only working with the Deaf community as a means to
fulfill their own needs whether financial or professional. The perceptions of some Deaf
community members do not necessarily match the true intent of the hearing
professional. Professional interpreters for the Deaf often identify the need to categorize
their lives and actively avoid allowing the different arenas of their lives to overlap. Some
interpreters may attempt to be friendly and supportive with clients, but do not get
involved with most Deaf community social activities. This may help with dual relationship
issues, but can be viewed negatively by some Deaf people. Interpreters try to socialize
with those Deaf individuals who understand their role, but it may be difficult to
determine who does and does not understand their role. Some individuals are often put

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in a position of crossing roles by uninformed hearing community members, but also by
individuals from the Deaf community as well. Interpreters who interpret personal
situations may also inadvertently find themselves in the role as a counselor, someone
who helps hearing members of their families. At times, it is very difficult to block out
information known about an individual, such as physical/sexual abuse , substance abuse
problems, etc.

Hearing professionals need to establish trust and often do this through becoming
actively involved in the Deaf community. People get to know these professionals and
develop a comfort level with them. An individual may have been well trained in the field
s/he is practicing in, received education on Deaf culture and interacted with Deaf
students while in college or graduate school, actively participated in Deaf community
activities while in school and developed fluent sign skills. If, however, when the
individual moves from college to professional practice, the person remains apart from
the Deaf community s/he is likely to be rejected by the very community in which s/he
hopes to work. And yet, because of the close nature of the Deaf community, remaining
active in this community can potentially violate the ethical standards set by the work
environments

For both Deaf and hearing professionals, it is a common occurrence that a Deaf person
at a social gathering will begin talking openly about what is normally considered
confidential. This is commonly dealt with by quickly encouraging the client not to discuss
personal issues with them outside the office. Another problem encountered is when a
client invites the counselor to a social function such as their wedding. When asked,
several professional=s indicated that if they had terminated with the client, they might
attend. The nature of the social function is also an important consideration. It might be
more acceptable to attend a client's wedding than to invite a client to a party at the
counselor's home. A similar problem occurs when the clinician attends a wedding of a
colleague, and a Deaf client is also attending the same event.

Avoidable Relationships

Professionals serving the Deaf community face a challenge in managing dual roles since
it may not be feasible for professionals to avoid social or other non-professional contacts
with persons such as patients, clients, students, supervisees or research participants.
Within the Deaf community, particularly in more rural communities, professionals may
play several roles and are likely to find it more difficult to maintain clear boundaries than
do their colleagues who practice in urban or suburban areas. There are situations in
which refusing to provide counseling to individuals with whom one has another
relationship, would prevent people in need from receiving assistance, which would raise
other ethical concerns. For example, a Deaf professional with whom you have occasional
professional contact, requests your services because there are no other nearby
professionals who are fluent in sign language. Situations occur in which professionals
are asked to provide individual services to Deaf consumers who have close associations
with each other (e.g. husband/wife, members of the same extended family, business
associates, close friends or enemies) which could likely result in a conflict of roles. When
there are no other referral sources with the necessary communication skills, sensitivity
to and awareness of Deaf culture issues, professionals are faced with the dilemma of

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deciding between treating both, or deciding which client will be referred to a hearing
professional via an interpreter. In certain communities, shortages of interpreters raise
other difficult dilemmas for a clinician who is trying to set clear boundaries.

With the proliferation of the internet, e-mail, and instant messaging, there are other
circumstances which are exposing professionals to boundary dilemmas. It has become a
relatively simple matter for clients to obtain personal e-mail addresses. Clients may
contact their counselors via e-mail on a variety of matters from the innocent
Aforwards@ to emergency situations requiring immediate intervention. It is wise for
counselors to set clear and consistent boundaries with clients regarding internet
communication which takes into consideration not only the current situation, but
anticipating how it could be abused as well. For example, a client may begin by sending
Aforwards@ to you on Deaf community related issues. Then the client sends an e-mail
to change an appointment after several days of playing phone tag. Finally the client
sends an e-mail informing you that her husband gave her a black eye and asks you what
to do because she doesn=t feel safe staying at home, and has no where to go. Some
professionals feel comfortable with the forwards, but draw the line at two-way
communication. However, even the innocent Aforwards@ may cause concern for the
professional, from an off-color joke to forwards containing religious proselytization.
Many agencies are beginning to develop policies with regard to using the internet, not
only directly with consumers, but for sending client-related information within the
agency. It may be sufficient to replace the clients name with a code or record number
before sending confidential information. However, keep in mind that the Deaf
community is small, and it may be possible for others to identify the client from the
description given even with the name encoded.

Exploitation of Relationships

There is a danger of exploiting the client because the counselor holds a more powerful
position since they are paid to provide a service. The greatest potential for harm from a
dual relationship may result from the power held, or perceived as being held by the
professional. Whereas the counseling relationship will eventually come to an end, the
power differential may remain indefinitely, adversely affecting any future, non-
therapeutic relationship between counselor and client (Haas & Malouf, 1989).
Counselors may hold a great deal of power over clients that can potentially lead to
exploitation. When exploitation appears in the personal interaction between counselor
and client, serious dual relationship problems quickly arise.

Power issues between Deaf and hearing members of the Deaf community, or between
Deaf clients and hearing therapists call for even more careful examination.

Another area that may cause potential exploitation involves bartering practices. In the
most recent revisions of the ethics codes of mental health professionals, the standards
pertaining to bartering have been refined and expanded. Although bartering practices
are not encouraged, the codes do recognize that there are circumstances in which
bartering may be acceptable, and that it is important to take into consideration cultural
factors and community standards. Bartering can open up a number of problems. As an
example, consider a client who pays for therapy by working on the counselor's car. If

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the mechanical service is less than desirable, the chances are good that the counselor
will begin to resent the client for having been taken advantage of, for being the
recipient of inferior service, and for not being appreciated. The client, too, can begin to
feel exploited and resentful if it takes many hours of work to pay for a 50-minute
therapy session, or if the client believes the therapy is of poor quality. In some cultures
or communities, bartering is a standard practice, and the problems just mentioned may
not be as evident. For instance, rural communities may lend themselves to barter
arrangements such as with one practitioner who worked with farmers in rural Alabama
who paid for services with a bushel of corn or apples. Within their cultural group, this
was a normal way of doing business.

Dual Professional Relationships

Most professionals who work with Deaf and hard of hearing individuals have faced
dilemmas related to dual relationships. Conflict has been evidenced on several fronts.
Individuals often felt an obligation to interpret for consumers or Deaf friends when no
interpreter is available and the need for an interpreter was crucial. Individuals try to do
their best to define their role and limitations while assuring that those involved
understood why they were choosing to accept the role of interpreter. These individuals
also use this kind of opportunity to educate those who are unfamiliar working with Deaf
individuals of the legal and preferred method of acquiring interpreting services.
Professionals encounter times when it would be unethical to choose not to interpret.

Many professionals work in jobs that include multiple roles. Sometimes, people define
and clarify their roles categorically and their constituents are able to understand when
an individual is working in one role versus another. In a recent survey of professionals
asked to respond to a number of ethical issues(Guthmann, 1999). One respondent
indicated, "As a hearing professional working with Deaf people, one is often required to
wear several different hats, i.e. administrator, counselor, interpreter. All have different
roles, functions and responsibilities and keeping these hats straight is very
challenging.@

Deaf professionals who have another position in the Deaf community (e.g. committee
member of their state NAD chapter, A.A.A.D. team member for softball, basketball,
bowling, etc.) face similar challenges. Does the Deaf professional have to resign their
committee or team membership when a client joins? Under what circumstances should
the professional remain?

Confidentiality

Given that the Deaf community is so small, we may learn something about a client
outside of the counseling setting. One example might be when a clinician sees a client at
a Deaf event and s/he appears to be drinking alcohol. In the office, the individual
reports continued sobriety. Another example might be a social worker who realizes that
the client recently referred is in a relationship with an individual who s/he knew from
another state and was rumored to be HIV positive. The dilemma is that since the
information was not obtained within the agency, is it still confidential? Can the counselor
confront the client and tell him he was observed at the Deaf event drinking?

15
Another challenge occurs when a Deaf individual shares a problem with a friend and
also shares the fact that they are seeing a professional therapist. In these situations, the
friend may say something to the effect of, "Oh, I know you are seeing Joe, and he said,
>blah, blah, blah.@ What Joe told the person may or may not be true or could be
misinterpreted or confused in some way. Professionals question if they should
acknowledge "Yes, I am seeing Joe." Does the therapist attempt to provide an accurate
interpretation of the facts? Most frequently professionals agree that they cannot engage
in this conversation, but still the challenge is there and the risk for misinformation to be
spread by silence could be imminent. Because the Deaf community is so small, it is
important to make sure that roles are clear.

Recommendations

Current ethical standards do not include specific references to potentially difficult

situations that face counselors, especially in the area of dual relationships. The
standards do, however, give general guidelines that the counselor may use to draw
conclusions about his or her particular situation or ethical dilemma. Whenever we as
professionals are operating in more than one role, and when there is potential for
negative consequences, it is our responsibility to develop safeguards and measures to
reduce (if not eliminate) the potential for harm. These include the following:

1.) Set healthy boundaries from the onset. Have disclosure statements or informed
consent documents that include a description of the agency's policy pertaining to
professional versus personal, social or business relationships. This written statement can
serve as a springboard for discussion and clarification. If your agency does not have a
specific policy referring to dual relationships, it is suggested that supervisors and
supervisees have a clear and shared understanding of the kind of professional
boundaries expected from employees of the agency.

2.) Involve the client in setting the boundaries of the professional relationship. Although
the ultimate responsibility for avoiding problematic dual relationships rests with the
professional, clients can be active partners in discussing and clarifying the nature of the
relationship. It is helpful to discuss with clients what you expect of them and what they
might expect of you. Professionals working within the Deaf community must scrutinize
their motivations when entering into dual relationships. It is not difficult to imagine that
some clients may not object or may even be pleased to see their counselors in a setting
outside of the office. Deaf and hard hearing professionals also enjoy membership in
Deaf clubs, teams, and other organizations. It would be very easy to rationalize by
thinking " It's okay with the client" or "I can keep my roles separate." The onus is on the
Deaf professional to anticipate problem areas. One way to do this is by talking with
other Deaf professionals in your region, who have more experience, to brainstorm areas
of potential conflicts.

3.) Informed consent needs to occur at the beginning and throughout the relationship.
If potential dual relationship problems arise during the counseling relationship, these
should be discussed in a frank and open manner. Clients have a right to be informed
about any possible risks. This is particularly important for Deaf and hard of hearing
professionals. Clients should be encouraged to raise any concerns they might have

16
about, for example, the professional's partner and other social or professional roles they
may have outside of the counselor's role. Professionals are advised to react to such
inquiries without defensiveness, which could short-circuit such openness. Many
professionals prefer to maintain impermeable boundaries around their private lives.
Therefore, they should consider how they will respond to common questions such as
AWhere do you go to school?@ and AAre you married?@ When such information is
being requested for the purpose of determining if a dual relationship exists, as opposed
to just for the purpose of idle curiosity, professionals working with Deaf and hard of
hearing people may have a greater obligation for self disclosure than professionals in
other fields.

4.) Discussion and clarification may need to be an ongoing process. Practitioners who
are involved in unavoidable dual relationships need to keep in mind that, despite
informed consent and discussion of potential risks at the outset, unforeseen problems
and conflicts can arise.

5.) Consultation from other professionals can be useful in getting an objective

perspective and identifying unanticipated difficulties. We encourage periodic consultation
as a routine practice for professionals who are engaged in dual relationships. We also
want to emphasize the importance of consulting with colleagues who hold divergent
views, not just those who tend to support our own perspectives.

6.) Practitioners should work under supervision. When working with Deaf and hard of
hearing individuals in certain areas of the country, there may be a lack of trained
personnel. When dual relationships are particularly problematic, or when the risk for
harm is high, supervision is critical. Often, professionals working with Deaf and hard of
hearing individuals, are working alone within a larger agency which is providing similar
services to hearing people (e.g. a single vocational rehabilitation counselor serving the
Deaf/Hard of Hearing community, while the rest of the staff in the office work with
hearing people). The supervisor may be someone with limited experience and
knowledge of the Deaf community, although s/he may have expertise regarding other
professional issues. In these situations, counselors may want to consider seeking out
other professionals working with Deaf/hard of hearing in their area, even if they work
outside their discipline. Your agency could also utilize a paid consultant to provide
supervision who has knowledge of issues related to the Deaf community. This consultant
may come from outside your region, so supervision could be arranged on an as needed
basis.

7.) Education and supervision is essential. Talk with students and supervisees about
balance of power issues, boundary concerns, appropriate limits, purposes of the
relationship, potential for abusing power, and subtle ways that harm can result from
engaging in different and sometimes conflicting roles. Encourage your agency to have a
policy that addresses these issues as it pertains to the Deaf and hard of hearing clients
that you serve.

8.) Documentation is an important ethical precaution. It is a good idea to keep a record

of any actions taken to minimize the risk of harm.

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9.) If necessary (and an option), refer the client to another professional. When a dual
relationship cannot be avoided, professionals take appropriate professional precautions
such as informed consent, consultation, supervision, and documentation to ensure that
judgment is not impaired and no exploitation occurs. This often creates a dilemma for
professionals who work with Deaf and hard of hearing clients, since there aren't always
appropriate individuals to refer a client to in all areas of the country. It is important to
recognize your limitations, and provide the kinds of service for which you are qualified

References

American Counseling Association. (1995). Code of ethics and standards of practice.

Alexandria, VA: Author.

American Psychological Association (1981). Ethical principles of psychologists. American

Psychologist, 36(6), 633-638.

Guthmann, D. (1999). Ethical Issues for Hearing Professionals working with Deaf
Individuals. (Unpublished article).

Haas, L. & Malouf, J. (1989). Keeping up the good work: A practitioner's guide to mental
health ethics. Sarasota, FL: Professional Resource Exchange.

Herlihy, B., & Corey, G. (1992). Dual relationships in counseling. Alexandria, VA:
American Association for Counseling and Development.

Kirtchener, K.S., & Harding, S.S. (1990). Dual role relationships. In B. Herlihy & L.
Golden (Eds.), Ethical standards casebook (4th ed., pp. 146-154). Alexandria, VA:
American Association for Counseling and Development.

National Association of Alcoholism and Drug Abuse Counselors (1995). Ethical standards
of alcoholism and drug abuse counselors. Arlington, VA: Author.

Pope, K.S., & Vasquez, M.J.T. (1991). Ethics in psychotherapy and counseling. San
Francisco: Jossey-Bass.

Solomon, R.S. (1984). Ethics: A brief introduction. New York: McGraw Hill.

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 The Dangers of Dual Relationships and EAP.
By Stephanie Dvorak, MA., EAP I

Printed in EAGALA News, Summer 2004 issue

A fundamental aspect of mental health training is to develop an understanding of

the dangers of dual relationships with clients and to avoid such relationships when
possible. Mental health providers must be aware of the influential position they
maintain with clients to avoid exploiting the client’s trust and dependency. They must
make every effort to avoid dual relationships with clients that could impair professional
judgment and increase the risk of harm to the client. If a dual relationship cannot be
avoided, the professional must take precautions such as informed consent, consultation,
supervision and documentation to ensure that judgment is not impaired and exploitation
does not occur (American Counseling Association {ACA}, 1995).
The development of multiple relationships between service providers and clients
creates several problems. Clients who are involved in multiple relationships with service
providers may not be aware that the standards and guidelines for one relationship do
not apply to another. This may leave them open to unprotected disclosure, exploitation
and violation of their rights as a mental health client. Engaging in multiple relationships
with mental health clients also challenges the provider’s ability to develop and maintain
multiple relationships that have different boundaries associated with each. It is
important for mental health service providers to understand the level of influence they
have over a client and to understand their own limits.
When an EAP team, therapist and equine specialist, enter into a counseling or
other mental health relationship with a client, they enter it together. The horse
specialist agrees to facilitate mental health services while in partnership with a therapist
or other mental health professional. While mental health professionals are obligated to
abide by a code of ethics and maintain standards of practice, so should a horse
professional. The horse professional, by nature of the EAP partnership, also develops a
therapeutic relationship with clients. Most therapeutic relationships are regulated by
state law and ethical standards that outline client rights, confidentiality, continuing
education and avoidance of dual relationships. It is in horse specialists’ best interests
to be familiar with the professional guidelines that are relevant to the EAP relationship in
order to avoid uncomfortable and unethical situations.
Avoiding multiple relationships with mental health clients poses a greater
dilemma for the equine specialist than the therapist. The realm of equine-related
activities is rather diverse and includes, but is not limited to therapeutic riding, riding
lessons, equine-centered camps and equine assisted learning. There seems to be a
growing trend among EAP horse professionals to offer additional equine related services,
like therapeutic riding or camp, to clients during and after treatment. The financial
benefits of such an endeavor are probably a large motivator for this business as is the
desire to maintain relationships, keep a client safe and to continue supporting healthy
decision-making. Having experienced this business, the risks outweigh the benefits for
the client.
For example, let us say that a young teenage girl is attending EAP sessions for
depression and is demonstrating sexualized behavior. She is making slow progress in
sessions and is struggling to trust the EAP team. This same client is also offered
therapeutic riding lessons and a chance to attend a camp this summer. During a

19
therapeutic riding lesson, she pulls the horse professional aside and tells him/her that
she has a secret to share, but they have to promise not to share it with anyone. In a
good intentioned, but misguided attempt to build trust with the young girl, the horse
professional agrees. The client proceeds to tell the horse professional about sexual
abuse she is currently enduring at the hands of her father. The horse professional
suddenly finds themselves in a position of having to deal with a serious mental health
situation of which they are not trained to do and they made a promise to a frightened
girl who does not know or understand that their communications are not privileged in a
therapeutic riding lesson or that any report of child abuse must be reported by law. The
horse professional is forced to decide whether or not to violate this young girl’s fragile
trust and confidence in order to seek outside help and report the abuse to authorities.
There also seems to be a trend among horse professionals to allow previous
clients to volunteer in their stables or other equine related programming. This also
creates a tenuous relationship between the client and the horse professional. In one
relationship, the horse professional knows a lot of personal and sensitive information
about the person and in another they are supervising their volunteer work. This
situation sets the stage for client exploitation and risks harm to the client. It may also
foster the development of a personal relationship with an individual that previously
received mental health services. Both situations are considered unethical in the mental
health field and should be avoided at all costs.
What’s the solution? Standards of practice in the mental health field would
dictate that the provider refer the client out to receive services from another
professional when it is in their best interests. This is also stated in the EAGALA code of
ethics, which each EAP certified professional, must agree to uphold and maintain in
order to be certified (Kersten and Thomas, 2004). For a horse professional, this means
teaming up with another horse professional or EAP team in order to refer clients to each
other. In other words, if a client is being seen by one EAP team for mental health
services, they would refer the client to another horse professional for riding lessons. If
another person is participating in riding lessons with a horse professional that is EAP
certified, the horse professional would also refer that person to another team in order to
receive mental health services. As stated above, if dual relationships cannot be avoided,
the professional must take steps (informed consent, supervision, consultation and/or
documentation) to ensure that professional judgment remains clear and exploitation
does not occur. This may look like creating an informed consent, with the help of a
mental health professional that outlines the different relationships and what the
boundaries are within each. It then becomes the horse professional’s responsibility to
uphold and maintain those boundaries at the right time and circumstance, reminding the
client of the limits of each relationship with regards to their rights and confidentiality.
Equine Assisted Psychotherapy is still a developing field and if it is to maintain a
solid reputation and receive acknowledgement for the benefits that are demonstrated by
research and known by all EAP professionals, professional integrity must be upheld.
Professional integrity is upheld by a commitment to the EAGALA code of ethics and to
the standards of practice and ethical guidelines outlined by the mental health profession
and state law.

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References

American Counseling Association (1995). Code of Ethics and Standards of Practice

(Section A.6). Retrieved from www.counseling.org/Content/NavigationMenu/
RESOURCES/ETHICS/ACA_ethics.pdf.

Kersten, G. and Thomas L. (2004). Equine Assisted Psychotherapy and Learning

Untraining Manual: Level I. Equine Assisted Growth and Learning Association.

Biography

Stephanie Dvorak is a treatment coordinator and member of the leadership team

at Hand Up Homes for Youth, Inc. She is a graduate of the University of Denver with a
Masters degree in Forensic Psychology. She is trained to work with high risk and
criminal behavior, within the criminal justice system. She has worked with adolescent
and adult sex offenders for three years. She has also worked in secure settings with
high-risk adolescent females. She is involved in the Western North Carolina chapter of
SAIN and NCAMTSO. She moved to Western North Carolina from Colorado in July of
2003 after working with veteran clinicians and developers of the Colorado Sex Offender
Management Board. She currently lives in Asheville with her husband.

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