| Significance and objective of the studyThe immense demand for, and the country’s increasing emphasis on, psychological service have propelled the professionalization of counseling and psychotherapy in China. The key to further professionalize counseling and psychotherapy lies in professional ethics construction, where the most prominent problem results from acquaintance dual relationship. Statistics has shown frequent interaction between psychotherapists and acquaintances. In fact, over one third of the counselors and therapists have provided counsel and therapy to their acquaintances such as relevant, friends, neighbors, teachers, students, colleagues, classmates and fellow townsmen. However, acquaintance dual relationship should be avoided according to Ethical Principles of Psychologists and Code of Conduct (The First Version) released in2007. If so, nearly1/3of counselors and therapists have violated the professional ethic code, and their service might fail to live up to the rights and benefits of their clients. Meanwhile, some studies have shown that the western ethic values are at odds with the cultural characteristics in our country, and therefore should not be applied as a reference for our ethic codes. Henceforth, it is necessary to explore acquaintance dual relationship against our country’s cultural backdrop and in realistic settings.This study aims to explore acquaintance dual relationship in actual practice of counseling and psychotherapy in the Chinese cultural background and actual working environment. It demonstrated the current situation of such a dual relationship and its influence, analyzed the reasons for its existence and its influential factors, and finally concluded coping strategies for counselors and psychotherapists in our country. The results of the study have interpreted the occurrence and process of acquaintance dual relationship from the angle of Chinese culture. Furthermore, it has also set up a model of coping strategies consistent with our culture, as well as proposed concrete suggestions for the current ethic codes.Subjects and Methods1. Research MethodsThis study adopted qualitative research methods due to the complexity and situationality of acquaintance dual relationship.2. Sampling Methods and Research ObjectsPurpose sampling method was used to recruit counselors and psychotherapists from general hospitals, psychiatric specialist hospitals as well as institutions in secondary schools and universities. Based on the research objectives and previous results, the objects were recruited according to the following standards:(1) With a national psychological counselor qualification level3, or a qualification for registered psychological counselors, or a practice qualification certificate for psychiatrists.(2) With an experience of at least five years in practicing counseling and psychotherapy. The sample size of this study was determined by the most commonly used basic standard in qualitative research---"theoretical saturation", i.e., to stop sampling when there is no new information in new samples. This study stopped sampling when information became saturated by the10th object.3. Research ToolsResearch tools in this study include:(1) the interview outline based on the research objectives and previous literature review. The outline was used for data collection in the semi-structured interview.(2) Informed consent signed by interviewees before the interview.(3) Recording devices used in the whole procedure of interview with consent of the interviewees beforehand.(4) Research notes derived from thinking and reflections during the research, as a reference for data analysis.4. Data AnalysisInterview data were carefully transcribed word by word through repeatedly listening to the recording. Categorization and contextualization were used for interview data analysis.Results1. Counselors and psychotherapists have been exposed to the basic ethic concept of "dual relationship", yet their attitudes diverge widely towards whether to "avoid acquaintance dual relationship", ranged from greatly approving to extremely disapproving. Most interviewees held a contradictory attitude towards acquaintance dual relationship, thinking on the one hand it should be avoided in principle, yet on the other it is unavoidable in practice.2. The vast majority of counselors and psychotherapists had the experience of acquaintances seeking professional psychological help, and had provided counseling and psychotherapy for such acquaintances as students, leaders, colleagues, friends, old schoolmates, relatives, etc.3. Counselors and psychotherapists have a common understanding about the acquaintance dual relationship, and the key reason for that lies in both sides’ emphasis on "relationship" and the multiple roles of the counselors and psychotherapists.4. Among the acquaintance dual relationship between counselors or psychotherapists and acquainted clients, acquaintance relationship can be divided into the direct and indirect types, while the professional relationship into the instructional, authentic and empathetic types. Except for the empathetic professional relationship and the direct acquaintance relationship due to irreconcilable contradictions between professionals’ and acquaintances’ role, all other acquaintance relationships and professional relationships are possible to match with each other on certain conditions.5. The advantages and disadvantages of acquaintance dual relationship have two major features:(1) On the whole, acquaintance dual relationship has both beneficial and harmful effects. On the one hand, acquainted clients can get beneficial psychological help and change from general counseling and psychotherapy (i.e. the one without acquaintance dual relationship), which in turn facilitates the counseling and treatment. On the other hand, however, clients might not get the expected psychological help and might be worried about being manipulated or threatened. For counselors and psychotherapists, they might suffer from the undue energy and time and empathy fatigue. All this is detrimental to the acquaintances relationship.(2) From individual cases, the effects of acquaintance dual relationship can be beneficial, harmful or both.6. Seven risk factors for harmful effects on acquaintance dual relationship are:(1) role conflict;(2) vague role definition of the roles between counselors and clients;(3) irregular and ambiguous boundary between counseling and psychotherapy;(4) counselors’ and psychotherapists’ inadequate emphasis on confidentiality;(5) professional ethical sensitivity of counselors and psychotherapists;(6) deficient professional ethical skills and (7) lack of proficiency.7. Seven coping strategies to deal with the acquaintance dual relationship:(1) to grant the request of acquainted clients to maintain harmonious relationship;(2) to make a comprehensive assessment before deciding to provide which kind of psychological help for the benefits of the clients;(3) to clearly define the roles of both sides;(4) to explain and emphasize confidentiality to clients, yet talk only about common sense of psychological health to acquaintances who have come to make inquiries, instead of going deep into details;(5) to set up and maintain flexible boundary between counseling and psychotherapy;(6) to make neutral and correct judgment during counseling and psychotherapy; and (7) to publicize professional ethics of counseling and psychotherapy, proactively preventing risk factors in acquaintance dual relationship and reducing the ethical dilemma.Conclusions1. The acquaintance dual relationship is controversial issue among counselors and psychotherapists.2. The acquaintance dual relationship is common.3. The common occurrence of the acquaintance dual relationship is associated with traditional Chinese Confucian culture and real working environment.4. There is beneficial acquaintance dual relationship, as well as harmful ones.The acquaintance dual relationship is good or bad depends on the counselors and psychotherapists can effectively cope with risk factors on the development process of the acquaintance dual relationship5. Based on the Chinese cultural and the domestic experience that counselors and psychotherapists provide consultation and treatment for acquaintances, we build an ethical culture adaptive decision making model for the acquaintance dual relationship, which is helpful for the counselor and psychotherapist that is more reasonable to deal with the risk factors in acquaintance dual relationships.6. As to the provisions in the work ethics of clinical and counseling psychology from Chinese Psychological Society, concerning acquaintance dual relationship, it’s necessary to make amendments on them. The specific suggestion for amendments are as the following:①Allow counselors and psychotherapists to provide the following the consultation and treatment for acquaintances (such as students, colleagues, leaders, schoolmates, friends, neighborhoods, relatives and so on):one is diagnostic interview, and the second is the consultation and treatment on the level of consciousness (such as cognitive, behavioral and emotional aspects of the guidance), but on the condition that the highest ethics principles, which is " Respect and contribute to the well-being of acquaintances visitors", and two fundamental ethical value, which are " Benevolence" and "No harm", should be followed, as well as the domestic ethical culture adaptive decision making model for the dual relationship between acquaintances.②Counselors and psychotherapists should be not allowed to provide psychodynamics oriented consultation and treatment for acquaintances who have direct and frequent interactions with them.Characteristics and innovations of the study1. Characteristics and innovations of the research perspective. While previous studies on dual relationship in counseling and psychotherapy explored the topic of acquaintance dual relationship from an external perspective by means of foreign concepts and terms as well as questionnaires, this study took an internal angle by combining our country’s social and cultural factors and the practical experience of the local counselors and psychotherapists. The study refined the term "acquaintance dual relationship" with Chinese characteristics, and probed into the current situation and nature of acquaintance dual relationship, thereby expanding the existent research perspectives on dual relationship in China.2. Characteristics and innovations of the research content. Previous studies focused mainly on dual relationship or the overall professional ethics of counseling and psychotherapy, but seldom on acquaintance dual relationship. This study specifically made a comprehensive and in-depth exploration into acquaintance dual relationship in counseling and psychotherapy in our country. It collected through interview the practical experience of the counselors and psychotherapists who provided services for acquaintances. The materials collected were later carefully analyzed with category analysis and scenario analysis. The study demonstrated the current situation of acquaintance dual relationship, and concluded its effects, risk factors, reasons as well as coping strategies. Furthermore, it interpreted acquaintance dual relationship under the distinctive cultural background of our country, in order to clarify the nature of acquaintance dual relationship in counseling and psychotherapy in the context of Chinese society and culture. Last but not least, the study also set up a model of ethical and cultural coping strategies for acquaintance dual relationship, which is consistent with our culture, thereby greatly enriching the research content.3. Characteristics and innovations of the research methods. This study introduced the quantitative research methods, a breakthrough from the relatively monotonous research techniques (mainly quantitative study at a macro level like questionnaire) on dual relationship in counseling and psychotherapy in our country. Unlike previous quantitative researches, the study collected firsthand materials on acquaintance dual relationship in counseling and psychotherapy through in-depth interview; it made a detailed and dynamic description and analysis on acquaintance dual relationship at a micro level; it drew closer to the actual situation of acquaintance dual relationship in counseling and psychotherapy in our country, revealing its complexity and situationality. As a result, the study compensated for lack of behavior information of previous quantitative studies which could only provide counselors and psychotherapists with ethical concepts detached from concrete context.The limitations of the study and predication of future studies1. The sample size of the counselors and psychotherapists is only10persons for this study, therefore, there are some limitations to extrapolate the conclusions of this study to other counselors and psychotherapists. For this reason, a furthering research with larger sample size of the counselors and psychotherapists is needed, through which to verify and modify the conclusions of this study.2. This study did research into the acquaintance dual relationship only from the perspective of, counselors and psychotherapists, however, visitors are also the important builders, participators and those affected in the acquaintance dual relationship, so there is necessity for future researchers to study on visitors, so as to comprehensively reflect the status quo and nature of the acquaintance dual relationship from multiple perspectives. |
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