The current American Psychological Association Ethical Principles of Psychologists and Code of Conduct (APA Ethics Code) states that a multiple relationship is established between a psychotherapist and a client when they engage in a relationship (personal or professional) in addition to the therapeutic relationship (AP A, 2002). Evidence that psychologists do become involved in such relationships, sometimes resulting in harm to the client, comes from examination of complaints to professional organizations and licensing boards, and of scant existing research. Remarkably, however, there has been no research to date regarding the ethical decision-making process in which a psychologist engages regarding whether to become involved in a potential nonsexual multiple relationships. This study empirically tests a proposed new model of ethical decision-making regarding nonsexual multiple relationships. The new model is derived from existing general models, behavioral guidelines specific to nonsexual multiple relationships and the limited research on the topic. As such, the study explored the role of therapist factors, client factors, and secondary relationship factors in participants' (acting as therapists) willingness to expend cognitive energy and subsequent recognition of a potential nonsexual multiple relationship. The findings pointed out that the participants' empathic capacity and affective responses to the ethical dilemmas appeared to act as stronger predictors of participants' willingness to expend cognitive effort than their characteristic tendency to engage in cognitive tasks. Furthermore, the results indicated that higher cognitive expenditure predicted lower recognition of the ethical dilemma. Additionally, the findings in this study indicated that there may be a complex relationship among determining factors and recognition of an ethical dilemma. Overall, the best predictors of recognition of a potential nonsexual multiple relationship was positive affect and ethics training, as well as the interaction of client gender with participant (therapist) gender. An additional element shown to be of importance was the moral intensity of ethical dilemma. The findings of this study also highlight the importance of ethics training in the therapist's recognition of a potential nonsexual multiple relationship. Ethics training may lower the level of anxiety experienced by the practitioner in training thereby improving the nature of the cognitive processing and resulting in greater likelihood in recognition of the ethical dilemma. As suggested by Street and colleagues (2001), it may be that such education is particularly important for new clinicians, and certainly worthy of further empirical testing. The findings of this study also suggested that it may be imperative that therapists during their training learn to consider the role of the therapist factors (particularly their affective response to a potential ethical dilemma), client factors (particularly the interaction of their gender with client gender), primary (therapy) relationship factors and secondary (other) relationship factors (particularly the perceived moral intensity of the dilemma) in their decision-making process when facing ethical dilemmas.

LLU Discipline

Clinical Psychology




School of Science and Technology

First Advisor

Vermeersch, David A.

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded

January 2010

Date (Title Page)




Library of Congress/MESH Subject Headings

Psychology; Decision Making -- Moral and ethical aspects; Decision Making -- ethics



Page Count

143 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses & Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives