Explore relational ethics with Dr. Carol-Ann Dixon, a important framework for South African psychologists working with couples.
Beyond Autonomy: Why Couples Therapists Need a Relational Ethics
Based on the Calabash talk on Relational Ethics presented by Dr. Carol-Ann Dixon, Counselling Psychologist
If you work with couples, you already know the feeling: you reach for the ethical principles you were trained on, and they don't quite fit. Autonomy, beneficence, non-maleficence, justice; these bioethical pillars, drawn from Kant, Mill, and later Beauchamp and Childress, were built for an individual sitting in front of you. But when there are two people in the room, and the “client” is really the space between them, those principles start to strain at the seams.
This tension is the starting point for relational ethics: a way of thinking about ethical practice that treats the relationship itself, not just the individuals within it, as the unit of care. What follows is a synthesis of the theoretical foundations behind this approach, aimed at helping practitioners recognise where individual-based ethics falls short in dyadic and family work, and what frameworks can fill the gap.
The Problem With Importing Individual Ethics Into Relational Work
Bioethical principles emerged from a medical model that is fundamentally individualistic. They ask: what does this person need, want, and deserve? They don’t have much to say about interdependence, mutuality, or the fact that a relationship is more than the sum of its two participants.
This creates familiar dilemmas for anyone doing couples or family work:
The identified-patient trap. It's tempting to notice that one partner seems to be bringing more of the problem into the room, while the other appears to be the more reasonable, “innocent” party. Following that instinct pulls attention away from the relationship and onto an individual. This often reproduces the very dynamic that brought the couple to therapy in the first place. Confidentiality becomes a minefield. Do you take individual intake forms or a joint one? What happens when one partner corners you after a session to disclose something the other doesn’t know about? Standard confidentiality rules, built for one client, don’t map cleanly onto two people with entangled interests. Coercion and consent get complicated. One partner may feel pressured into attending therapy. Do you see them separately? Together? What does informed consent even mean when a decision by one person inevitably affects the other? Power and difference are everywhere - gender, age, financial standing, neurodivergence, cultural background. Bioethical principles have little built-in machinery for addressing asymmetries within the client system.
None of this means autonomy, beneficence, non-maleficence, and justice should be discarded. It means they need a relational scaffold around them, one that treats the relationship as the client, and the space between two people as a legitimate focus of ethical attention.
Theoretical Foundations of Relational Ethics
Relational ethics isn’t a single theory so much as a constellation of frameworks that each illuminate a different aspect of what it means to be ethical between people rather than only for a person. Six strands are worth knowing well.
1. Martin Buber: I-Thou and the Space Between
Buber’s distinction between I-Thou and I-It relating is foundational. In an I-It encounter, we relate to the other as an object, flattening their subjectivity, especially when they think or experience the world differently from us. In an I-Thou encounter, we meet the other as a full subject in their own right.
The hyphen between “I” and “Thou” matters as much as the words either side of it: Buber calls this the space between, and treats it as a kind of sacred territory that has a dynamic of its own, separate from either individual. For Buber, dialogue is the relationship; verbal or non-verbal ongoing exchanges in the space between two people, that constitutes their connection, and it opens the door to the idea that there isn’t one single truth in a relationship, but multiple, coexisting truths.
Practically, this means training your attention on the interaction itself and helping couples develop what might be called a relational consciousness: an awareness that their relationship is a living, dynamic third thing, not just two people who happen to be in the same room.
2. Feminist Theory: Naming Power and the Relational Self
Feminist theory: from early theorists like Wollstonecraft and de Beauvoir through to contemporary scholarship, brings a direct challenge to gender inequality and entrenched power structures within relationships. Two contributions matter most for clinical work:
The relational self. Rather than treating the self as a bounded, independent unit, feminist theory foregrounds a self that is constituted through relationship. Intersectionality. Gender doesn't operate in isolation but it intersects with race, class, ideology, and ethnicity, and any account of power within a couple needs to hold all of these at once.
3. Systemic Theory: The Whole Is More Than Its Parts
Drawing on systemic thinking, this strand emphasises interconnectedness, interdependence, and feedback loops. The couple isn't just “two individuals plus their interaction”. Understanding the relationship between the parts is essential to understanding the system as a whole. Many of us trained in systemic approaches early on, and it's worth noticing if practice has quietly drifted back toward individualistic thinking since.
4. Care Ethics: Interdependence as a Human Condition
Building on the work of Nel Noddings and Carol Gilligan, care ethics treats caring itself, not just the people doing the caring, as fundamentally relational. Key ideas:
No one is an island. Interdependence is simply a feature of being human, not a deficiency. A give-and-take dynamic. Trust grows out of a workable balance between giving and taking, rights and responsibilities. When that balance tips too far in one direction, trust erodes. Inherent asymmetry. Because people differ, relationships are never perfectly symmetrical. The ethical task isn’t to eliminate difference but to keep working toward balance despite it, while staying alert to how broader social ideologies can amplify inequality within the relationship. Dialogue and negotiation over monologue and control. Healthy relationships require an ongoing “both/and”, not a fight over whose reality wins.
5. Contextual Theory: Fairness, Trust, and Multi-directed Partiality
Contextual theory (associated with the work of Ivan Boszormenyi-Nagy, and drawing on writers like Sandalowsky) contributes some of the most clinically useful concepts in this whole area:
Context and situatedness. Meaning is obscured when context is unclear. For example: a reaction that makes perfect sense in light of someone’s childhood can look wildly disproportionate in the present-day relationship, because the partner triggering it has no idea they’re touching an old wound. Situatedness extends this further: couples are shaped by their physical setting, extended family, and broader socio-political and economic circumstances, not just their internal dynamics. Ignoring this sets up unrealistic expectations of what partners can actually control or provide for each other. Equivalence rather than equality. Couples often want things to be equal and fair, but perfect equality is frequently unrealistic given real differences in experience, ability, age, or neurodivergence. Equivalence: the idea that every person carries equal value, even amid unavoidable inequalities, is often a more workable and honest frame than insisting on strict equality. Trustworthiness. Built from congruence (alignment between what someone says and what they do) and mutual empathy; the far harder task of empathising with two people who hold conflicting accounts of the same event. Multi-directed partiality. The clinical skill of holding more than one person’s reality in mind simultaneously, validating both perspectives as legitimate without collapsing into “there's only one truth here.” Rejunctive vs. disjunctive action. Rejunctive action addresses intergenerational wounds and contextual injustices with an eye toward healing and reconnection. Disjunctive action, by contrast, pathologises a partner’s family of origin and drives a wedge between them and their new relationship. There's a real contemporary pull toward cutting off family of origin entirely, sometimes genuinely necessary (for example, where there's been abuse), but it’s worth distinguishing that from situations where partners could instead help each other heal those relationships. Differentiation vs. fusion. Blurred partner identity (“we love going on holiday”) can look like closeness but often masks a failure to see the other as a distinct, equivalent person. Helping partners speak from “I”: “I love going on holiday, is it the same for you?” supports healthier differentiation without sacrificing intimacy.
6. Non-Western and Communitarian Ethics: Ubuntu
Non-Western ethical traditions widen the lens further, emphasising the common good, shared responsibility, and belonging over individual benefit. Communitarian ethics holds that there is no “I” without a “we.”
Ubuntu, the South African philosophy captured in the phrase “Umuntu ngumuntu ngabantu”; a person is a person through other persons; is a powerful example. Humanness, in this view, is inseparable from relationship: we cannot be fully human except in connection and community with others. Ubuntu foregrounds respect (for people, for the environment, for animals, for life itself) and consensus-based decision-making.
This gives rise to the concept of relational consent - something larger than individual informed consent. A useful illustrative example: a person's individual choice about disclosing an HIV status doesn't sit in isolation when they're in an intimate, committed relationship and the decision inevitably affects their partner too. Ubuntu-informed practice asks us to recognise that some decisions require consent at the level of the relationship, which in turn raises hard questions about where individual confidentiality ends and relational confidentiality begins.
The Family as Ecosystem: Vertical and Horizontal Dimensions
Couples don’t exist in isolation from their families of origin. It's worth holding both dimensions in mind:
Vertical - the family of origin above, and children (or the next generation) below. Horizontal - the space between the couple themselves.
Clinicians have historically been quick to locate the vertical dimension as a source of intergenerational wounding’ trauma passed down through generations. That's often true. But it’s only half the picture: the vertical relationship is frequently also a source of substantial emotional and material resources eg. help buying a first home, childcare support from grandparents, and so on. Part of ethical practice here is helping couples recognise both the wounding and the resourcefulness in their family systems, rather than only reinforcing a deficit narrative.
Loyalty conflict: involves a stronger pull toward one’s family of origin than toward one’s partner and new family shows up again and again in this work. The space between partners, and between each partner and their own parents, has been described (by therapist Hedy Schleifer) as “the playground of the child”, a phrase worth sitting with, because it reframes that space as sacred territory that shapes the next generation, not just the current couple.
Core Principles of Relational Ethics: A Summary
Pulling these strands together, a relational ethics stance holds that:
The relationship, not the individual, is the client. The space between (Buber) deserves as much clinical attention as either individual. Value is equivalent, horizontally between partners and vertically across generations, even where equality isn't possible. People are interdependent, not merely autonomous. Relating well with others matters as much as functioning well alone. Growth is mutual: each person in the relationship is always becoming, not fixed. The whole is more than the sum of its parts. Attention belongs on interactional patterns and feedback loops, not just on individual presentations. Context, situatedness, intersectionality, and diversity all shape what’s playing out between two people. Practice should aim to foster dialogue over monologue, cooperation over control, and trustworthiness as an ongoing achievement rather than a given.
An Ethical Checklist for Practice
A few questions worth returning to regularly when working relationally:
Role clarity. Are you functioning as an individual therapist, a relationship therapist, or both and have you made that explicit to your clients? Training adequacy. Does your therapeutic modality actually equip you for relational ethics? Many don’t. Have you sought continuing development on emerging issues: neurodivergence, polyamory, and other social realities that shape the couples in front of you and do you know when to refer out? Informed consent as a couple. Do partners complete intake forms jointly, with full transparency, or separately and have you thought through what that choice means for confidentiality later on? Confidentiality boundaries, including the limits (mandatory reporting of abuse or domestic violence) spelled out clearly to both partners in advance. Positioning the relationship as client. Seating arrangements, whether you wait for both partners before starting, how you handle one partner arriving early on video calls. These small logistics that carry ethical weight. Multiple alliances and conflicts of interest including the awkward possibility of having previously seen one partner’s ex, or a family member, in your practice. Guarding against pathologising one partner as “the identified patient,” which creates bias and an unspoken triangulation. A protocol for disclosures: abuse, domestic violence, affairs includes what you do when one partner discloses something in front of, or instead of, the other. Attending to power dynamics and subtle bids for control, emotional manipulation, and moments when one partner tries to recruit you as an ally (“What do you think, Doc?”). Cultural and situational competence, matched to the specific context each couple lives in. Regular supervision and consultation, and ongoing self-reflection on your own biases, assumptions, and transference/countertransference.
Where This Leaves Us
None of this is simple, and it isn’t meant to be. Relational ethics doesn’t discard the bioethical principles most of us trained in: autonomy, beneficence, non-maleficence, justice all still matter. What it adds is a second lens: one that takes the relationship itself seriously as a living thing with its own needs, its own history, and its own claim on our ethical attention. Holding both lenses at once - the individual and the relational - is, perhaps, the central ethical skill this work demands.
This article covers the theoretical foundations of relational ethics. More in-depth coverage of this content is available in the two talks on Calabash: Part 1 and Part 2: Relational Ethics.
Confidentiality and Consent when working with Adolescents