Psychologists and psychotherapists of various stripes learn things academically from books, go through training, and learn things experientially from supervised practice as interns or residents and then they seek licensure.

In the licensing process there are various matters to be checked on. Does the therapist have a clinical grasp of what is going on in therapy? Is the therapist able to conceptualise a case from beginning to end, including a reasonable course of treatment? Does the therapist understand the legal parameters in the jurisdiction in which he or she is practising? Does the therapist know and abide by the ethics code binding on his or her profession?

Tucked inside most ethics codes for psychologists, psychiatrists, and psychotherapists is a subject called ?dual relationships.? A dual relationship is one in which the client and the psychotherapist know one another, relate to one another in at least two different contexts. For example, if I were to play poker each Saturday night with a group of guys, and we were to usually sit around a table telling stories and joking with one another, that would be one context.

Then, if one of those guys were to come to me and say, ?Can I see you for therapy? Cause I?ve been depressed and I want to kill myself,? that would be another context. Dual relationships have been frowned upon in the mental health field, because it?s been recognised that they dilute what used to be called a ?professional distance?.

Professional distance means a kind of scientific objectivity. It was thought that if a therapist knew someone under separate circumstances, that that would automatically colour the process of therapy and undermine its value for the client.

The classic example of a dual relationship is when a woman client starts out seeing a male therapist because she has emotional or psychological issues, and ends up sleeping with her male therapist. It has happened the other way around as well.

The problem is that they would know one another as client and therapist, but they would also know one another as lovers. When people are related romantically, or related by blood, having been living with one another, the therapist?s own interests, needs, sensitivities and blind spots interfere with the needs of the client.

The kind of scientific objectivity that used to be contemplated when people would use the term ?professional distance? is a fiction. Those who study and think about therapeutic process have long since realised that when two human beings interact, there is no actual objectivity; there is really only inter-subjectivity. That is, two people who are each experiencing life influence one another ? they experience being with one another, and it?s a mutual thing.

The trick for a therapist is to be aware of this and to watch out that his or her ability to set aside personal interests and needs doesn?t obscure the client?s process.

In more recent years, then, the ethics codes for psychotherapists acknowledged that all dual relationships are not necessarily unethical. Some cannot be avoided. In a small town, for instance, a therapist might see and relate to clients at the grocery store, the church, the local school, or even the filling station. Not all such relationships unduly influence a therapist?s ability to put the client first or be so clouded with self-interest in regard to that client that the therapist cannot actually help.

However, some dual relationships do present such problems. It is up to the therapist to know the difference and to refer people who pose such a distracting presence. One of the ways I learn for myself if I?m able to work with someone whom I know under different circumstances is to name the fact that we do know one another that way. That includes me disclosing any uneasiness I might have. If, for instance, I know someone well, and I think highly of them and have wanted to be accepted by them, and then they come to see me professionally, I have to name these things. I have to put them out on the table and see what happens when they are right there for both me and the client to see. If things settle down, and I notice I can pay more attention to the client than to my own anxiety about how I?m doing in the client?s eyes, then we can proceed. If I cannot, I will have to refer that person to someone else. Not to do so, would be unethical.