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Former Clients as Trainees

Trainee Policy Regarding Dual Relationships

Occasionally, students interested in clinical training opportunities at CAPS may have a potential dual relationship with a current member of the CAPS staff. Examples of this may include but not be limited to a family member, a past or present romantic partner, a past or present business associate, or a past or present clinical treatment provider. Since all senior staff are involved in various roles in the training programs, CAPS has established the following policies to prevent dual relationships in its training programs. It is expected that interested applicants will evaluate the potential for a dual relationship in considering a training position at CAPS. Below we have provided guidelines to minimize the likelihood of creating dual relationships.

Policies

PREVENTION OF POTENTIAL DUAL RELATIONSHIPS
  1. Since CAPS is a potential training site for graduate students from various mental health training programs at Penn State and other institutions, any potential applicants for CAPS training programs seeking clinical services at CAPS will be made explicitly aware of the impact that a dual relationship would have on future training opportunities at CAPS. Case management services will be offered to help these students connect with alternative treatment in their best interest.
  2. For the reasons cited above, CAPS staff clinicians in private practice are strongly discouraged from providing treatment to potential CAPS trainees. The same policy will apply for potential applicants in regards to business, romantic or family relationships with CAPS senior staff members.
  3.  As a part of the informed consent for services, all potential clients will be informed that seeking services at CAPS may impact their ability to seek future training opportunities at CAPS for the reasons cited above.
POLICIES REGARDING SPECIFIC RELATIONSHIPS

1.)  FORMER CLIENTS 

a.)        In order the minimize the potential for dual relationships, students who received counseling services at CAPS and who subsequently seek training at CAPS as a clinician will not be considered for a training position (e.g., Extern or Intern or Post Doctoral position) until a period of 3 years has elapsed since their last clinical contact. This does not include a brief screening appointment that resulted in no further treatment. This parallels ethical guidelines of two years following termination of services prior to any possible romantic relationships. We have chosen three years to take a more conservative approach in the hopes that there would be adequate staff turnover and a reasonable interval between the time someone was a client here and known to clinical staff and administrative staff in that context.     

b.)        Students who received counseling services at CAPS more than 3 years ago and who are interested in a training opportunity will submit their materials for the desired position and will be reviewed without consideration of prior clinical treatment. If a former client is accepted as a trainee at CAPS, and they choose to make it known that they are a former client, their electronic mental health record will be locked so it cannot be accessed by anyone but the administrators and system administrators of the electronic medical records.  As is consistent with our Confidentiality Policy, clinical staff should only access electronic records when there is a clinical need.

2.)        FAMILY RELATIONSHIPS

Family members of current CAPS staff will not be eligible for training positions at the Center.

3.)        BUSINESS RELATIONSHIPS 

It is expected that applicants currently in a non-university business relationship with a CAPS staff member will not apply for training positions at CAPS or will terminate their business relationship prior to engaging in training at CAPS. 

4.)        ROMANTIC RELATIONSHIPS 

Due to inevitable likelihood that current or past romantic relationships can complicate a training situation, current or past romantic partners of current CAPS staff should not apply for training positions at the Center. 

Reviewed by: Shannan Smith-Janik, Ph.D., Associate Director, Training, Date: 04/19/2024


Signature: Natalie Hernandez, Ph.D. Senior Director, Date: 04/19/2024
 

CAPS Multiple Role Relationships Policy

Purposes of Statement 

The purposes of this policy statement are (1) to provide a definition of multiple role relationships, (2) to discuss the inevitable, beneficial, and problematic aspects of multiple role relationships, and (3) to provide a process for dealing with both potential and actual multiple role relationships. 

I. Multiple Role Relationships

By the nature of their duties and responsibilities, staff persons at CAPS can become involved in a wide variety of roles. These include supervisor, therapist, group co-therapist, couples co-therapist, committee member, administrator, seminar presenter, colleague, and others. For the purposes of this document, multiple role relationships are defined as those situations in which an individual functions in two or more professional roles, or functions in a professional role and some other non-professional role (Sonne, 1994).

Definition of Terms

Staff Persons – any individual employed full-time or part-time at CAPS, including senior staff, associate staff, trainee staff (post-doctoral fellows, doctoral interns, externs), and support staff.

Associate Staff - degreed and/or licensed staff, or pre-licensure staff who have completed their internships and are receiving supervised hours toward licensure as part of their employment at CAPS. These staff members are employed part-time on a wage payroll basis.  

Senior Staff – degreed and licensed staff who may function in training or supervisory roles at CAPS, or degreed and pre-licensure staff who have completed their internships and who may function in training roles at CAPS.

Training Staff - degreed and licensed staff who function in training or supervisory roles at CAPS, or degreed and pre-licensure staff who have completed their internships and who function in training roles at CAPS. Doctoral interns and post-doctoral fellows are training staff when they are supervisors of externs.

Trainee Staff – post-doctoral fellows, doctoral interns, and externs. Pre-licensure staff, depending on the situation, may also at times function in a trainee staff role.

Support Staff - non-mental health professionals employed by CAPS to perform clerical or other support functions.

Staff Peers – persons who share the same employment category at CAPS.

 

II.  Inevitability and Beneficial Aspects of Multiple Role Relationships 

Although multiple role relationships have the potential to create conflicts of interest and confusion among staff persons, it can nonetheless be argued that they are an inevitable part of the fabric of human relationships and most especially of professional life in the mental health field. This is particularly true for a large training agency, where the varying professional roles each staff person may play are prone to overlap (e.g., a trainee's clinical supervisor may also facilitate a seminar at which the same trainee is in attendance). Further, former clients or current or past friends of staff persons may become a part of CAPS as trainees or senior professional staff.

All of these overlapping relationships can become even more complex in an agency which adopts a humanistic and personal growth approach to training. Such an approach places a premium on the processes of introspection, self-disclosure, and support, all of which may promote a range of emotional responses among staff persons, such as feelings of closeness, warmth, attachment, dependency, idealization, vulnerability and sexual attraction. These feelings in themselves may lead staff persons to develop more personal relationships.

It can also be argued that multiple role relationships can and do have beneficial effects. They may sometimes enhance the variety and depth of experiences at an agency. This is especially true when the multiple roles are linked to the mentoring process, which can be very valuable in enhancing a new professional's sense of identity and career development.

Given the inevitability and potential beneficial aspects of multiple role relationships, this policy statement is not intended to eradicate all multiple role relationships. Recognizing that many trainees come from sites other than Penn State, it is desirable to create an environment that is also warm and hospitable. As a result, this policy statement is intended to serve as a guide to balance multiple roles and manage personal feelings for other staff persons.

 

III.       Problematic Aspects of Multiple Role Relationships

Multiple role relationships can present a number of problems, not just for the participants but also for the environment of the center. The occurrence of multiple relationships between individuals can blur the boundaries between relationships. This can result in confusion on the part of the individuals as to expectations, reactions, and behaviors in their interactions with each other. The confusion that can result from multiple role relationships can jeopardize effective and appropriate maintenance of each role. This is especially problematic when one of the role relationships is characterized by an imbalance of power. In such cases, the party with less power can feel overly vulnerable, especially when an evaluation process is involved.

Multiple role relationships can also have consequences for the agency as a whole, as they engender an environment of indebtedness, favoritism, and inclusion/exclusion. These unfavorable conditions may also have a deleterious impact on the relationships between members of the trainee cohort group.

 

IV.        Guidelines for Dealing with Potential or Actual Multiple Role Situations

In evaluating the possibility for conflict of interest or other difficulties in a potential multiple role relationship, the following guidelines are offered:

   A.        Refer to the guidelines outlined in the Ethical Principles of Psychologists and Code of Conduct published by the American Psychological Association (2017), the National Association of Social Workers Code of Ethics (2017, updated 2021), American Counseling Association Code of Ethics (2014), and the American Psychiatric Association Principles of Medical Ethics (2013).

   B.        Discuss with the other person(s) involved the possible conflicts, consequences, and solutions accompanying the anticipated multiple role relationship(s).

   C.        Consult with other senior staff member colleagues to gain insights which the persons involved might have difficulty ascertaining.

   D.        If the persons involved decide to avoid the anticipated multiple role relationship, no consultation with administrative staff would be required, although this might be sought as a means of soliciting another perspective on the issues raised.

   E.        In the event that a tentative decision is made to proceed with a multiple role relationship, particularly one involving a personal or non-professional role, consultation is recommended. Concerns can be raised in an Administrative Supervisors Team Meeting with relevant staff present. The Associate Director, Training should be involved in the consultation if the issue concerns a post-doctoral fellow, doctoral intern, or extern. The Externship Coordinator should also be involved in the consultation if the issue concerns an extern. Doctoral interns and post-doctoral fellows supervising externs can raise these concerns in the Supervision of Supervision seminar.

   F.         In some cases (e.g., where an administrator is one of the parties involved in the multiple role relationship), other administrators within the agency or an external consultant might be utilized to provide insight or mediate the issues involved, or these issues could be brought to an Administrative Supervisors Team Meeting.

   G.        In all discussions of an anticipated multiple role relationship, consider the following questions:

  1. Could this situation jeopardize the staff member’s ability to evaluate or supervise a trainee objectively? Conversely, could a trainee’s ability to evaluate a supervisor or program objectively and without fear of reprisal be impaired?
     
  2. Could this situation create a feeling of being exploited by or overly indebted to another staff member?
     
  3. Could this situation make it more difficult for one staff member to maintain appropriate limits and boundaries with another staff member, particularly one who possesses more power in the agency?
     
  4. Could this situation create the perception of favoritism, exclusion, or distrust in other staff members?
     
  5. Could this situation affect the agency in some other negative way (e.g., negative perceptions of the agency as a whole)?

 

V.          Guidelines for Social Relationships 

In considering the types of social interactions that may take place between training staff and trainee staff, the following questions are offered for consideration:

  1. Is the proposed social activity public vs. private?
     
  2. Is the proposed social activity a group activity or an individual activity?
     
  3. Is the proposed social activity time limited vs. open ended?
     
  4. Does the proposed social activity take place during the workday or after working hours?
     
  5. Is the proposed social activity an occasional activity or a regular and expected activity?
     
  6. Does the proposed social activity provide the trainee freedom of choice, or will they feel obligated to engage in the activity?
     
  7. Whose needs are being met by the proposed social activity?  The trainee or the training staff member?

 

VI.         Multiple Role Relationships Involving Sexual or Romantic Feelings

Multiple role relationships which involve sexual or romantic feelings have an added potential to create conflict and impairment. The following relevant laws, policies and principles are offered to shed light on this issue:

 

APA Ethical Principles for Psychologists and Code of Conduct (2017, https://www.apa.org/ethics/code/ethics-code-2017.pdf) states in Section 7. Education and Training:

 7.07: Sexual Relationships with Students and Supervisees.

Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency or training center or over whom the psychologists have or are likely to have evaluative authority.

 

The NASW Code of Ethics (2017, updated 2021, https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English) states in Section 2. Social Workers’ Ethical Responsibilities to Colleagues:

2.06 Sexual Relationships

(a)   Social workers who function as supervisors or educators should not engage in sexual activities or contact (including verbal, written, electronic, or physical contact) with supervisees, students, trainees, or other colleagues over whom they exercise professional authority.

 

American Counseling Association, Code of Ethics (2014, American Counseling Association Code of Ethics.pdfstates in Section F. Supervision, Training and Teaching:

F.3.b. Sexual Relationships. Sexual or romantic interactions or relationships with current supervisees are prohibited. This prohibition applies to both in-person and electronic interactions or relationships.

 

American Psychiatric Association, The Principles of Medical Ethics (2013, American Psychiatric Association_The Principles of Medical Ethics.pdfstates in Section 4. 

14. Sexual involvement between a faculty member or supervisor and a trainee or student, in those situations in which an abuse of power can occur, often takes advantage of inequalities in the working relationship and may be unethical because: a. Any treatment of a patient being supervised may be deleteriously affected. b. It may damage the trust relationship between teacher and student. c. Teachers are important professional role models for their trainees and affect their trainees’ future professional behavior.

 

Commonwealth of Pennsylvania-State Board of Psychology Regulations:

http://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter41/chap41toc.html&d=reduce

41.81      Prohibited conduct.

(b) Sexual intimacies between a psychologist and a psychology trainee, student or research participant are prohibited.

 

Penn State Administrative Policy:

Policy AD85: Title IX Sexual Harassment (https://policy.psu.edu/policies/ad85)

 

CONSENSUAL RELATIONSHIPS

While not expressly prohibited, romantic and/or sexual relationships between faculty and students, staff and students or supervisors and subordinate employees are strongly discouraged. Such relationships have the potential for adverse consequences, including the filing of charges of sexual harassment. Given the fundamentally asymmetric nature of the relationship where one party has the power to give grades, thesis advice, evaluations, recommendations, promotions, salary increases or performance evaluations, the consensual nature of the relationship is inherently suspect.

Even when both parties have consented to the relationship, there may be perceptions of conflicts of interest or unfair treatment of others. Such perceptions undermine the atmosphere of trust essential to the educational process or the employment relationship. Accordingly, the person in the position of supervision or academic responsibility must promptly report the relationship to his or her immediate supervisor. Once the consensual relationship is reported, the immediate supervisor is responsible for eliminating or mitigating the conflict of interest to the fullest feasible extent and ensuring that fair and objective processes are in place for decisions relative to grading, thesis advice, evaluations, recommendations, promotions, salary increases, or performance evaluations. The new supervisory or academic arrangement should be documented.

 

For these reasons it is the expectation that the senior staff and training staff will not engage in romantic and/or sexual relationships during the time that the staff member and trainee are at CAPS.

Because of the added potential for harm where romantic or sexual feelings are involved, the following additional guidelines are offered to deal with such situations:

 

  1. Acknowledge romantic/sexual feelings in yourself and discuss them with a non-involved colleague or supervisor.

     
  2. If you are a supervisor or other senior staff member feeling attraction towards a trainee, discuss your feelings with the Associate Director, Training, Externship Coordinator, Senior Director, or an Administrative Supervisor. This will serve as a safeguard against acting out of your feelings and will afford an opportunity to evaluate your ability to provide objective feedback and evaluation.

     
  3. If you are a supervisee or trainee experiencing romantic/sexual feelings towards a supervisor or other senior staff member, consult with the Associate Director, Training, Externship Coordinator, Senior Director, or another senior staff member.

     
  4. If you are a supervisee or trainee experiencing sexual advances from a senior staff member, consult with the Associate Director, Training or Externship Coordinator or the Senior Director.  

     

VII.       Relationships Involving Sexual or Romantic Feelings Following a Trainee’s Time at CAPS or Relationships Between Staff Peers

Romantic or sexual relationships which occur after a trainee has completed training at CAPS should be initiated only after careful and thoughtful consideration. Romantic or sexual relationships between staff peers, whether initiated during their tenure at the agency or thereafter, should also be initiated with careful and thoughtful consideration as to the impact on the professional functioning of the persons involved and of the rest of the staff. Please refer to the guidelines above.

 

Summary

Awareness of the effects of multiple role relationships continues to evolve in the mental health professions. The issue is a controversial and complex one. This document acknowledges the complexity of multiple relationships as well as their prevalence in training and agency environments. It calls for careful and thoughtful responses to actual and potential multiple role relationships. These responses will often involve consultation with a colleague or administrator at CAPS.

The ultimate aim of this document is to assure that CAPS provides a positive learning environment for the persons who choose to train with us, as well as for all staff. Such an environment must be free of any harmful multiple relationships so that trainees and other staff feel safe enough to risk themselves in the process of becoming and growing as therapists and professionals.

 

REFERENCE:

Sonne, J.L. (1994). Multiple relationships: Does the new ethics code answer the right questions? Professional Psychology: Research and Practice, 25 (4), 336-343.

 

ACKNOWLEDGEMENTS:

            In preparing this document, policy statements from numerous college counseling centers were examined and used as points of departure for discussion and actual composition. We are particularly indebted to policy statements from the Ohio State University.

            This document was originally written as a project of a CAPS committee in the Summer of 2001, consisting of Drs. Kurt Gehlert, Joyce Illfelder-Kaye, Mary McClanahan, Jill Morgan, and Ken Nafziger. Input was also provided by Alan Baehr.

Reviewed by: Shannan Smith-Janik, Associate Director, Training, Date: 04/30/2024

Signature: Natalie Hernandez, Ph.D., Senior Director, Date: 8/2/2023

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