Multiple relationships and simultaneous services in Positive Behaviour Support

Dr Lee Cubis

Clinical Psychologist/Specialist Positive Behaviour Support Practitioner

Note: This is a work-in-progress, and based the interpretation of my research. It is not intended to be legal advice or replace supervision. I welcome discussion on these interpretations.

Question: I am a Psychologist and I have received a PBS referral for a family where there are multiple siblings requiring input. I'm concerned about multiple and simultaneous relationships here.

Can I work with these siblings, or does the new PsychBA code mean that each sibling needs a separate PBS Practitioner?

It depends...

The code does not create a blanket rule that siblings must always have separate practitioners, but it does require psychologists to start from caution, justify any departure from avoiding multiple relationships, and document why simultaneous work is appropriate and safe for each client.

Multiple relationships is the broader risk concept. It is about overlapping roles or relationships that may compromise, or be seen to compromise, your objectivity, safety, effectiveness, or create a risk of exploitation. The code says psychologists must avoid or discontinue multiple relationships unless they reasonably believe they are ethically, legally or organisationally obliged to continue or enter into them. If they do proceed, they need to document the justification, explain potential conflicts where possible, and actively monitor and protect the interests of those involved.

Simultaneous services is a service format. It means providing the same service to two or more clients together, for example in a couple, family, group, or other system. The code does not say this is automatically prohibited. It says you must consider and record why this mode is appropriate to all clients, ensure consent is free from undue influence, ensure the arrangement does not compromise safety or effectiveness for any client, and maintain privacy and confidentiality.

How they fit together Simultaneous services will often create a multiple relationship issue, because the definitions section says multiple relationships include providing a service to a client together with one or more other clients, or together with associated parties. So simultaneous service delivery is often one type of multiple relationship. But not all multiple relationships are simultaneous services. For example, treating one sibling while also separately treating the parent would be a multiple relationship even if the sessions are never joint. 

For sibling work

If you work with siblings together, the code is not simply asking, “Is family or systems work allowed?”

It is asking:

• does this arrangement create overlapping duties or risks to objectivity?

• is seeing them together actually appropriate to each sibling?

• can you protect each sibling’s interests, privacy, consent and voice?

• have you documented why this is justified and how you will manage risk?

Things to consider (and consult with a supervisor about) whether the following conditions can be met: 

These safeguards (in my opinion) line up with the PsyBA requirements around informed consent, privacy/confidentiality, multiple relationships, simultaneous services, and conflicts of interest, and with the NDIS Code’s requirements for safe, competent and transparent practice. 

• each sibling is clearly a distinct client, with separate goals, formulation, consent, records, billing and review

• any joint component is explicitly justified as beneficial to each sibling, not just cheaper or easier for the service. In PBS, joint components can be beneficial because environments (e.g., home) are more likely to be shared

• there is no present pattern of competing needs, scapegoating, blame, differential parental alliance, or resourcing tension that would predict divided loyalties

• there is a clear capacity for private, separate contact with each sibling and/or substitute decision-maker, so one is not easily pressured by the other or by the family system

• you can keep disclosures compartmentalised and are not relying on open family sessions as the main container for clinically sensitive material

• you have a written conflict-of-interest and confidentiality discussion up front, including what happens if interests diverge

• you set review triggers for referral out, rather than waiting until things are badly tangled.

I would lean toward separate clinicians if any of the following are present:

• one sibling’s plan, funding, risk management or restrictive-practice issues are likely to affect the other

• school or family are implicitly using you to adjudicate between siblings

• one sibling is frequently conceptualised as the "trigger, victim, comparator, or 'problem context" in the other’s work

• information from one case would materially alter your stance in the other, creating unavoidable partiality

• there's any element of triangulation (e.g., from the school or family)

• one sibling needs advocacy against the interests, narrative or support arrangements of the other

• one or both siblings need space for materially different disclosures, trauma material, family complaints, or allegations involving the other sibling.

So, the new PsyBA code does not automatically prevent psychologists from working with siblings within the same family, but it does require a cautious, well-documented, case-by-case judgement about whether doing so is genuinely appropriate, manageable and in each client’s best interests.

Next Blog: Can I work with multiple clients in the same shared living arrangement?