(a) in organizational contexts, maintenance of confidentiality depends not only on the consultant, but also on the cooperative efforts of perhaps many organizational members as well; (b) levels of participation by members are often variable and so, too, must access to information be variable; (c) selective access to information in organizational consultation must be ensured even in light of long-term patterns of relationships that existed before consultation began; (d) this selective confidentiality must be maintained in a system that is structured to facilitate open communication flow; (e) because they are selective, parameters of confidentiality are not inherent in given relationships, but must be negotiated; (f) these parameters must be publicly delineated to ensure that all parties know who has access to what information; and (g) while consultants have an ethical responsibility to ensure confidentiality, in reality, they often have very limited control over the information and the participants in consultation. (Newman & Robinson, 1991, p. 27)

Given the practical limits on a consultant's ability to protect the confidentiality of information obtained during consultation, individuals' rights to privacy may be difficult or even impossible to guarantee. At a minimum, ethical responsibility requires the consultant to be sure that participants clearly understand what and how information will be used, by whom, and for what purposes. The limits of confidentiality must be clearly and universally understood by all participants.

The fact that consultation often involves multiple levels of the consultee agency is another important consideration. Subordinates may be hesitant to share sensitive information for fear of penalty or reprisals from superiors. The consultant must be cognizant of the real or perceived risks involved for these individuals and make every effort to protect them from potential harm resulting from their participation in the consultation process. A common ethical dilemma encountered by consultants occurs when a member of the consultee agency wants to share information privately with the consultant (Lippitt, 1983; Newman & Robinson, 1991). The consultant's response to this kind of request may have significant implications for the process and outcome of consultation. Agreeing to accept the information under the conditions of confidentiality may place the consultant in the position of possessing information that is vitally important to the consultation process, but being unable to use the information. Accepting the information may also support norms of secrecy within the agency and erode the trust of other participants. on the other hand, rejecting the individual's offer may cost the consultant information that is critical to the consultation process. Furthermore, the consultant's refusal of the information may temporarily or permanently alienate the individual making the offer. Ideally, the consultant can convince the individual of the importance of sharing the information openly so that it can be used to facilitate consultation goals. Potential consequences to the individual sharing the information, however, must be anticipated. In cases where disclosure may place the individual in some form of jeopardy, anonymity may be a realistic alternative.

Ethical Issues

Few would argue that sexual relationships between practitioners and clients are ethical. Such relationships clearly violate the norms of social work and other helping professions (American Psychiatric Association, 1989; National Federation of Societies for Clinical Social Work, 1988). The NASW Code of Ethics (1993) prohibits sexual relationships with clients: "The social worker should under no circumstances engage in sexual activities with clients" (p. 5). Sexual relationships jeopardize services and injure clients (Bouboutsos, Holroyd, Lerman, Forer, & Greenberg, 1983; Taylor & Wagner, 1976). Clients who have had sexual contact with their therapists may experience profound mistrust and anger, as well as problems of identity and self-esteem (Feldman-Summers & Jones, 1984; Sonne, Meyer, Borys, & Marshall, 1985). Some authors have compared the dynamics and effects of such relationships to those of rape, child abuse, and other forms of violence (Kardener, 1974; Pope, 1988; Zelen, 1985). Those who have previously suffered abuse appear especially vulnerable to exploitation by their therapists (Brown, 1985; Coleman & Schaefer, 1986).

Sexual intimacy with a current or former client may lead to ethics sanctions against the practitioner (Berliner, 1989; Committee on Women in Psychology, 1989). The client or someone acting on the client's behalf may lodge a complaint with the state licensing or regulatory board, and all state boards that license clinical psychologists have found that practitioners have violated professional ethics if they acknowledged having a sexual relationship with a current or former client (Gottlieb, Schoenfeld, & Sell, 1988; Sell, Gottlieb, & Schoenfeld, 1986). The client may also file a complaint with the practitioner's professional association (for example, with the NASW Committee on Inquiry). Such complaints can lead to formal sanctions as well as termination of membership in the professional association (Berliner, 1989; Ethics Committee of the American Psychological Association, 1988).

Nonsexual dual relationships are also potentially exploitive. A practitioner who enters into a personal relationship with a client, provides services to a student or employee, or exchanges goods and services with a client violates professional boundaries. In any dual relationship, the practitioner's influence and the client's vulnerability carry over to the second relationship. Even if no sexual intimacy occurs, the practitioner is in a position to subordinate the client's interests to his or her own. Moreover, a social worker's professional influence on and bond with a client extend well beyond formal termination.

Ethical Issues

Although far less information on nonsexual dual relationships is available, such relationships are not only exploitive but can also precede and lead to sexual intimacy between practitioners and clients (Coleman & Schaefer, 1986; Pope & Bouhoutsos, 1986).

The NASW Code of Ethics (1993) states that "the social worker should not condone or engage in any dual or multiple relationships with clients or former clients in which there is a risk of exploitation of or potential harm to the client" (p. 5). In addition, the National Federation of Societies for Clinical Social Work's Code of Ethics (1988) recognizes that nonsexual dual relationships pose risks to clients and enjoins practitioners from engaging in such relationships with current or former clients. Unfortunately, nonsexual dual relationships have received little attention elsewhere.

Perhaps the subject of nonsexual dual relationships has not captured more attention because social workers assume that members of their profession would not enter into such relationships with clients. However, the findings of a recent large-scale study of sexual and nonsexual dual relationships using a nationwide sample of 4,800 practitioners (including an equal number of male and female psychiatrists, psychologists, and social workers) found that whereas few admitted being sexually intimate with a current client, many admitted engaging in nonsexual dual relationships. The authors found no statistically significant differences among the professions; however, they did find gender differences. Male practitioners reported having had sexual and nonsexual dual relationships more often than their female counterparts; female clients were the most likely target of such relationships. The study also revealed considerable confusion as to whether certain behaviors were ethical. Whereas almost all the respondents (98.3 percent) recognized that sexual relationships with current clients were always unethical, only 68.4 percent rated sexual intimacy with a former client, 49.9 percent rated employing a client, 39.0 percent rated allowing a current client to become one's student, and 14.8 percent rated becoming friends with a former client as "never ethical." overall, social workers and psychologists rated nonsexual dual relationships as more ethical than did psychiatrists (Borys & Pope, 1989). Clearly, practitioners could benefit from an analysis of the dynamics of exploitation in any dual relationship.

There is much that social work professional associations, social services agencies, and social work practitioners can do to prevent boundary violations and respond to the problem of dual relationships.

More information on dual relationships should be included in undergraduate, graduate, and continuing education programs. Many practitioners fail to recognize and understand the dynamics and risks of exploitation in dual relationships (Borys & Pope, 1989).

More attention to dual relationships should be given in supervision. Practitioners should be encouraged to use supervision to explore their personal responses to clients. Many practitioners, especially those who have experienced boundary violations in their own personal relationships, should consider undergoing their own therapy. All practitioners should be discouraged from entering independent practice until they can demonstrate competence in dealing with boundary issues and transference counter transference processes.

A flier on client rights and professional ethics should be distributed to clients. This flier would define and give examples of ethical and unethical practice and outline the actions clients could take if they have been subject to ethics violations. The sanctions against dual relationships could be highlighted. NASW could distribute the flier and encourage social services organizations and social work practitioners to display it prominently in their offices. The Committee on Women in Psychology of the American Psychological Association (1989) has developed a brochure on sexual dual relationships that might serve as a model.

Reporting of dual relationships to state licensing and regulatory boards and professional associations should be encouraged. Practitioners who discover that their clients have been exploited in a dual relationship with any professional should initiate a report or encourage the client to do so. Although some clients may be reluctant to take action (Bouhoutsos, 1985), many not only wish to act but benefit from the experience (Vinson, 1987). Practitioners found to have engaged in any dual relationships should have their licenses or certifications revoked and their memberships in professional associations terminated.

Clients who have been sexually exploited should be encouraged to take legal action against the practitioner. In some jurisdictions the practitioner may be subject to criminal sanctions; in others, the client may need to initiate a civil action (Jorgenson et al., 1991).

Practitioners who have engaged in dual relationships or who are at risk for such behavior should be encouraged to seek help. Some practitioners will recognize and seek help on their own; many, a however, will need to be confronted with the problem. As soon as the problem is identified, the practitioner should seek intensive supervision or consultation and enter therapy. Some practitioners would be well advised to take leave from practice while working through their problem.

A resource file and referral network should be developed. Practitioners and social services agencies could benefit from knowing who in their community has expertise and experience in providing therapy, supervision, consultation, and continuing education on the topic of dual relationship--s. NASW could take a leadership role in gathering and disseminating this information.