Dual Roles and Resistance
Clifton Mitchell, Ph.D.
Dual roles with clients can have significant impact on resistance. Sometimes dual roles decrease resistance; however, this is not typically the case. Mental health professionals placed in dual roles by the bureaucratic system in which they work usually find that the result is an increase in resistance. In my travels throughout the country, I have frequently encountered mental health professionals who are placed in dual roles with their clients and then must deal with the subsequent resistance that emerges.
Even though this is a frequent problem, little guidance has been offered for managing the resistance created when one is placed in dual roles. This article is written in an attempt to begin filling this void. Below, I would like to offer some ideas from seminar participants, colleagues, as well as a few of my own with regards to understanding and managing the resistance that comes from dual roles.
Before I address the impact and management of dual roles with regards to resistance, I want to clarify the specific category of dual roles to which I am referring. This article is not about dual roles that have direct legal and ethical implications. Rather, this article will address accepted dual roles that are a regrettable component of many bureaucratic systems. These dual roles occur, for example, when a therapist is required to be a disciplinarian or informant to the courts as well as a counselor. I refer to this category of dual roles as bureaucratically-created or system-created dual roles. Such dual roles are not considered unethical or illegal, but frequently increase resistance. In order to be comprehensive a very brief review of dual relationships that have legal or ethical implications will first be presented. This review is followed by a discussion of the resistance issues resulting from dual roles created by bureaucratic systems.
Legal and Ethical Dual Roles
Dual roles are common in mental health work. The implications and pitfalls of dual roles are regularly addressed in legal and ethical trainings. Most ethical codes caution against entering into dual relationships and provide guidance when they cannot be avoided. Dual relationships most frequently addressed in ethical codes included bartering, social relations, and sexual relations. Some of these dual relationships are unethical and illegal and should be avoided. Other dual roles are potentially harmful and should be avoided or managed carefully with a keen awareness of the potential consequences. Bartering for services and social relationships outside of therapy would fall into this category.
Therapists are also placed in dual roles when clients threaten harm to self, harm to others, or report child abuse. In these instances, the codes and laws require that we take on additional roles that include being an informant for the state. Our mandates may also include participating in removing clients’ rights as would be the case with an involuntary commitment. Sometimes therapists are required to testify in court about information they have regarding clients’ lives. In all of these situations, the counselor is mandated by the codes and laws to move out of a pure counseling role and into additional roles that typically involve being a watchdog for society. Recognizing that such additional duties may be required of therapists, these duties are always discussed in informed consent procedures.
Therapeutic Dual Roles That Foster Resistance
Counselors frequently encounter dual roles that are not of a legal or ethical nature, but that possess pitfalls with regards to resistance, nonetheless. Examples of such dual roles include being responsible for discipline in a juvenile inpatient unit as well as being a counselor; or being an employee of the Department of Child Services who must report to the courts as well as being a counselor; or being a parole officer whose job includes counseling parolees about personal problems. Whenever a mental health professional is placed in such dual roles, resistance is inevitable. The therapeutic implications of such dual roles are quite significant and should be acknowledged and studied by our profession.
It is easy to understand why such dual roles result in resistance. If you were an adolescent in an inpatient facility and you knew that your counselor was also responsible for disciplining you, would you be forthcoming? I doubt it. I wouldn’t. If you knew your counselor was obligated to report information that may result in your children being taken away, would you reveal all of your parenting flaws? It is ridiculous to expect this. Thus, resistance is created by bureaucratic structures that place counselors in incompatible roles. Let’s further examine the dynamics at play here.
Counseling is influential in promoting change, in part, because of the unique nature of the counseling relationship. A vital, critical component of this relationship is confidentiality. Except for the limited legal and ethical situations addressed above, counseling conversations are held in strict confidence. Confidentiality is only broken with a release from the client. Thus, clients are provided an environment where they can discuss their deepest emotions, thoughts, inadequacies, fears, faults, etc. Many times the things said are not socially acceptable. For example, clients may admit that they don’t love their parents, they don’t like their own children, they are not happily married, they have deviant sexual thoughts, they use drugs, etc.
Because counselors provide an environment where difficult issues can safely be discussed and processed, clients address and move beyond their psychological roadblocks. Creating and using this environment is the job of the counselor. Anything that compromises clients’ feelings of safety and security diminishes the counseling relationship and results in resistance. This is precisely what happens when mental health professions are placed in the system-created dual roles mentioned above.
Resistance is created because it is difficult, if not impossible, for clients to view someone as their therapist while knowing that he/she is also potentially going to discipline them or report to a court. In such instances, we are asking the client to view the counselor as purely a counselor and, at the same time, to forget that the counselor has another incompatible job to do. When you think about it, this is an unrealistic expectation to place on clients. From the client’s perspective, we are asking them to be a chump to the system.
Another instance related to the above dual roles occurs when the therapist has been seeing a client for a considerable period of time and is then asked to include an additional family member in the counseling sessions. This most commonly occurs when a partner in a relationship requests that their spouse or companion join the counseling process after many individual sessions have already occurred. In such cases, two therapeutic complications emerge.
First, when the additional client is brought into the conversation, the relationship with the original client is changed. The therapist has moved from individual counseling to couples counseling and now has to take a new therapeutic position and attitude. In essence, the therapist now has dual roles relative to the original client: individual therapist and couples therapist. With two clients, the therapist’s responses will have to be adjusted accordingly. Unexpected responses from the therapist may arouse resistance in the long-standing client who has been receiving individual counseling. In order for the new therapeutic environment to work, the current client must be willing to give up some of his/her established counseling relationship presumptions. Adjusting to the therapist’s new stance may not be as easy as the long-standing client might imagine.
Second, the therapist must find a way to effectively merge the new client into a well-established counseling relationship. It is only fair that the new client enters into the relationship on equal ground with the current client. Yet, the new client realizes that he/she is entering into a well-established, ongoing conversation. Thus, the new client is at a disadvantage because issues have already been presented from the perspective of the original client only. To successfully manage such a merger is difficult. How can someone entering into an established relationship be expected to respond openly and without some caution and defensiveness? In such instances, it is only realistic to expect and receive resistance from the newly added party. The wise therapist must be cognizant of these dynamics and be willing to address them. Suggestions for managing such situations are offered below.
In general it is my sense that the impact of such system created dual roles is underestimated. We tend to not recognize that such dual roles run contrary to what we commonly explain our purpose and benefit to be for clients. Thus, these dual roles run contrary to clients’ image of who we are. Clients do not want to have to view their therapist as a changing entity. Clients are seeking stability and we are in essence switching jobs on them in the middle of the process. Further, such dual role conflicts put pressure on the most vulnerable components of the relationship.
Consequently, system created dual roles are most likely to negatively influence the most vulnerable clients.
I am certain that other dual relation complications exist that have not been discussed here. However, the purpose here is to provide a few examples that highlight the impact on resistance that is likely to occur when dual roles are a reality of bureaucratic structures.
Managing Resistance Which Stems From Dual Roles Imposed by Bureaucratic Systems
Even though I have a number of suggestions for managing the resistance that stems from dual roles, I will be the first to admit that most of these ideas are inadequate. These ideas fall short of the mark because, once the dynamics of the dual roles are in place, the ultimate reality is that mental health professionals may have to implement procedures that the client does not want. Thus, the best that can be expected is to lessen the impact and manage around the dynamics at hand.
It is also important to point out that dual roles are not completely negative. Rather, they are a very common part of life, and learning to manage them is one of life’s many challenges. All parents are in dual or multiple roles. They must discipline, support, teach, love, and take responsibility for their children throughout their early lives. It might be stated that the great difficulty of parenting is choosing the most appropriate role for the situation. Other relationships that require multiple roles include bosses, friends, colleagues, and lovers. All of these relationships require multiple roles if they are to be successful.
The counseling relationship, however, is predicated on maintaining a singular role. The counselor is the unique person with whom the client can talk in confidence and who has no vested interest in the other aspects of the client’s life. This is why it is unethical to counsel your friends, lovers, employees, family members, etc. When the singularity of the counseling role is compromised, resistance is likely to result.
From the above discussion it becomes apparent that dual roles both contaminate the counseling relationship as well as mimic the real world dynamics we all must face. Hence, clients and therapists learn from navigating the dynamics that come with dual roles. In many ways the dual roles of therapy prepare clients for managing one of the many complications inherent in all relationships. From this perspective, it would be beneficial to view dual roles as a tool rather than a problem. Having pointed out some of the many dynamics at play in the world of dual roles, I will now offer a few suggestions toward managing them.
As is so often case, the first tool for managing dual roles is a healthy working relationship. Although the complications inherent to dual roles should be directly addressed early in informed consent explanations, when possible, counselors should establish rapport before moving into a position where conflicting duties must be implemented. Rapport conquers all and it will be rapport that ultimately determines the success with which dual roles are managed and resistance is circumvented.
Directly Address the Complications of Dual Roles
When you find yourself in a position where you are supposed to be a counselor and disciplinarian, one approach is to fully disclose the dual roles with which you are charged. In other words, tell it like it is to clients. Be forthcoming with the complications of the dual roles and directly discuss the ramifications that may follow. Tell clients that you realize and recognize that they are going to have a hard time viewing you as a counselor while knowing that you are required to make disciplinary or court related decisions. Honesty and frankness are usually appreciated. Further, you will display understanding of clients’ struggles to view you as a counselor. By directly discussing these issues, you are dealing with the resistance that will likely occur in advance. Any time you can circumvent impending resistance by directly addressing it, you are increasing the chances of having a beneficial impact.
After directly addressing the complications of your dual roles, invite clients to express any concerns they have regarding the dual roles. This is a critical component for resolving resistance. Explain that you want them to feel free to express and discuss their concerns regarding the dual roles when they arise. This shows respect for clients and brings them into the process. It also gives clients responsibility for voicing uncomfortable feelings that may arise as a result of dual roles. In this way, you convey and promote the counseling process as a joint effort even when dealing with the incompatible roles in which you have been placed. The honest and open discussion on the part of the therapist also models the problem solving process. More specifically, it models to clients that problems are dealt with by directly addressing them and negotiating, rather than avoiding them.
When concerns are expressed by clients, take the time to listen to and honor clients’ perspectives. This helps to maintain rapport in the midst of a dysfunctional mental health bureaucracy. Do not deny the incompatibility of the roles. Rather, praise clients for their insights and frankness regarding the difficulties inherent in the relationship as it is expected to work. It is likely that the conflicts inherent to your incompatible roles are similar to the conflicts clients are facing in their lives. Discuss the mutual difficulties you both face. Through this approach the entire discussion becomes a rapport-building therapeutic endeavor.
Label Yourself from the Client's Perspective
In many cases, the role of disciplinarian or informant to the court is primary in clients’ minds and it is very difficult for them to genuinely view you as a counselor. In such instances, I suggest that you do not label yourself as a counselor. Labeling yourself as a counselor may simply be too disingenuous to clients. Instead, label yourself relative to the bureaucratic role and let the counseling occur serendipitously. Take the position that counseling is a secondary job that may or may not occur. This is a more realistic approach that will more likely align with clients’ perceptions. Overall, you will be viewed as less deceptive and more honest.
It should be noted that the above process is similar to the informed consent process we already do. We directly address our dual roles with regards to child abuse, suicide, and harm to others in our informed consent and remind clients of our legal and ethical duties anytime they arise. Informed consent is not a one time procedure. Dual roles created by bureaucratic structures can be dealt with in a similar manner, but may require a more detailed discussion.
Separate Dual Roles
When, as a therapist, you must also impose discipline, try to put space and time between the disciplining role and counseling. Thus, do not perform disciplinary actions and counseling actions in the same setting. If possible use a different room for each action. This way the client will be cued as to which role you are representing. Also, do not perform disciplinary actions at the same time as counseling. Carry out disciplinary actions at one time and counseling at another. If both roles are required of you, discharge disciplinary duties first. This way there will be no impending disciplinary sanctions overshadowing the counseling conversation. If you try to counsel before an impending disciplinary action, the client will only see you as a disciplinarian. When you are viewed as a disciplinarian, it is likely that all responses from clients will be focused on lessening the impending sanctions and not on the counseling process. The theory here is that the more you separate roles, the less they will interfere with each other. However, please recognize that these steps alone may be of limited benefit.
My colleague, Dr. Graham Disque, offered an idea of how to dramatize and utilize the reality of dual roles. Depending on the context and the work situation, the fact that you are required to wear “two hats,” so to speak, could be played out literally. That is, you could have two chairs and/or two hats that you switch between when interacting with clients. When you are in one role, you wear one hat and/or sit in one chair. When you are in another role, you wear a different hat and/or sit in a different chair. In this way you clearly depict the dual components of your job and let the client know from which role you are speaking at any point in time. Thus, you are symbolically representing the perspective from which you speak. For the client, there is no confusion regarding the position from which you are speaking. You switch seats and/or hats as you state opposing perspectives. The struggle between your roles could be related to the clients’ struggles between roles as well. Because it brings the reality of dual roles clearly into focus, this approach also removes elements of confusion which arise when such roles remain ambiguous and obscure. Depending on the context, the therapist’s skills, and the clients, this could be a powerful therapeutic tool in approaching issues to which clients and therapists must wrestle.
Utilize the Resistance
As I have noted many times, the ideal approach to resistance is to utilize it as a therapeutic tool and motivator. In such instances, we redirect the energy clients are putting into resisting and use it to guide clients toward insight or to motivate clients toward a needed action. Dr. Disque also presented an approach to dealing with dual roles based on this concept. The idea here is to join with clients against the bureaucratic system that has placed them in counseling. Stated more accurately, join with clients in a manner that appears to be in opposition to the bureaucracy in which you are both situated.
To do this you make statements that acknowledge and reframe clients’ plights against the system that is making demands upon them. For example, if poor parenting is potentially going to have children removed from parent’s custody, then you might make a statement such as, “These people want to take your children from you because they are not able to recognize the difficulties with which you must deal and your current efforts to manage.” In cases where a juvenile is being punished in a long-term detention facility you might say, for example, “They do not understand the pressure that you are under to prove yourself and they want to keep you here longer than you may deserve under the circumstances.” Such statements join with clients by demonstrating understanding for their situation. These responses are also phrased in a manner that places you more on the side of clients and outside of the bureaucratic system they feel they are fighting. As I have noted many times, the easiest approach for dealing with resistance is to first join with clients in their world and then make baby steps in a therapeutic direction. If you begin in opposition to clients, you run the risk of increasing resistance.
After making such statements you should then try to parlay the conversation into a discussion of how the client can prove to the system that the system’s perceptions are incorrect. The key is not to move into a position of opposition where you are fighting with the client. Ideally, the energy being used to resist the system will be utilized to prove the system wrong. It is important to note that, from clients’ perspectives, they are resisting to improve their quality of life. Clients feel as if their resistance is necessary to maintain some essential component that is important to them. Although their actions may appear absurd from our perspective, clients have a reason for doing what they are doing.
This approach is paradoxical in nature and it should be noted that there is an additional complication of which you need to be aware when using it. When the approach works, clients sometimes feel in a bind with themselves because it indirectly aligns clients’ values with the system’s values. When clients see their values aligning with the system they may again resist. Be prepared for this conflict to arise and try to manage it by framing the fact that clients’ values are similar to the systems as just coincidence. Explain that you are not as concerned about the system as you are the benefits to the client. And, if adjustments just happen to get the system off the client’s back, that is just a secondary gain.
Although much skill is needed to manage this approach, it can be quite effective. The key is to place yourself in a neutral to slightly negative position relative to the system. If you get too negative toward the system, it could come back to sting you because you are, in reality, a part of the system and will have to respond accordingly. However, depending on the context and the client, this approach can save a lot of headaches. Those in private practice may have a more ideal environment for maximizing this approach. Yet, I have seen it used with great impact in community mental health settings.
Approaches for Merging Clients Into Ongoing Therapy
In cases where clients desire that a new party be merged into ongoing counseling, there are two general approaches. The first is to not allow it. Instead, refer the couple or family to another therapist who will begin anew and on even ground with all involved. The reason for this is that the newly added party will likely view the current therapist as biased by the information previously presented. By referring the couple or family, you circumvent the feelings of triangulation that may be felt by all parties, including yourself. Referral establishes equality among clients and avoids placing you in a no-win position relative to the clients. I know of many therapists with whom this is their standing policy. They have tried to coalesce clients late in the process and found that it just makes matters too difficult.
The second approach is to merge the additional party after direct and frank discussions of the implications. This is most likely done when the ongoing counseling has been brief, the problems appear solvable, and the people involved are amenable and prepared to deal with the ramifications. In such instances, I recommend a direct discussion of the relationship and resistance dynamics that must be faced. Most of these were discussed above and include issues surrounding the therapist’s role change, the one sidedness of the information presented thus far, the clients’ responsibility to express concerns because of the dual roles, and, of course, the resistance that may be felt. Adding a third party late in the process can create powerful shifts in relationship dynamics. Direct discussion of these dynamics is a must if resistance is to be averted. This approach depicts the concept and model I consistently advocate: When possible, do what you can to prepare for resistance before it is encountered.
Summary
System created resistance is often not discussed openly and can be difficult to overcome. I sincerely hope that the ideas presented here will help those mental health professionals placed in the binds discussed. Please use this article and the ideas presented to promote discussion of the complications mental health professionals face with regards to this type of resistance. This topic would make an excellent discussion in staff meetings and trainings. If from these discussions more ideas emerge for resistance management, please email me. I welcome any viable input. In the end, we do what works, and many times we need to be reminded of the multitude of approaches available to us.
I would like to thank Cassandra Fenner for her help in editing this article.
July, 2007
