5. Responses to unanticipated circumstances : Unplanned situations over which the social worker has little or no control.
For example: Jake was uncomfortable when his mother was admitted to the same mental health hospital where he was on staff.
Intimate relationships As discussed earlier, boundary issues involving intimate relationships are the most common violations. Those involving sexual misconduct are clearly prohibited and will be further explored in this course. While most professionals might agree that having other, non- sexual, relationships, such as a friendship with a current clinical client is inappropriate, the rules are not as clear regarding ex- clients and even less so for those clients in case management, community action, or other non-clinical relationships. When a dual relationship results in personal benefit to the practitioner, it also undermines the trusting relationship. Some of the scenarios mentioned earlier (getting property below market value, becoming the executor of the client’s will, and referring clients to a relative) are examples. There are very respectful, sound, and appropriate reasons for encouraging clients to share what they know and to listen to their strengths. Benefiting from information the client has (e.g., stock tips and leads on jobs) is another matter. It is important to remember that this can apply both ways, i.e., the mental health professional needs to avoid offering assistance in areas outside his or her role. According to Reid, 1999: Your usefulness to your patients lies in your clinical skills and separation of your professional role from other roles which would be better filled elsewhere in their lives. Do not suggest, recommend, or even inform the patient about such things as investments, and be cautious about giving direct advice on such topics as employment and relationships. There is a difference between eliciting thoughts and feelings to encourage good decision making and inappropriately influencing those decisions. Another tricky area involves bartering arrangements, particularly involving the exchange of services. These should be considered carefully and, according to Reamer (2003), limited to the following circumstances when they are: ● An accepted practice among community professionals.
There are also times when the intent of the professional is truly to be helpful – for example, buying merchandise from a client whose business is struggling or inviting a divorce recovery group client to a community function in order to help her broaden her social network. While some types of situations may not be considered unethical or illegal, the worker needs to carefully review his or her motivation and the potential consequences of each decision. Some helpful questions to ask are: ● Would I do this for all my clients? ● Am I doing this because I feel uncomfortable (e.g., saying no)? ● Am I feeling at a loss to help the client any other way and thus feeling “I must do something” to feel competent? ● How might the client interpret my gesture? ● Am I doing this just for the client’s interest or also for my own interest? ● What are all the potential negative outcomes? There will be occasions when you incidentally come into contact with a client, such as finding your client’s daughter is on the same soccer team as your child. Some practitioners go out of their way to live in a different community so the chances are minimal that this could happen. Others see that as over managing a potential situation that is unlikely to lead to harm for the client or colleague (as in the case of supervisees). The appropriateness of relationships with clients is often debated across the profession. The unique service settings and roles assumed by workers often contrast with the traditional clinical approach to human service. Applying strict rules around relationships can appear excessive and/or contradictory with sound mental health practice. A worker, for example, may work in a small, isolated community that would expect its community members to share in social customs such as family meals and weddings. Ethical guidelines recommend giving students and supervisees guidelines to guarantee client protection instead of blanket advice to avoid dual relationships altogether (Boland-Prom & Anderson, 2005). Freud and Krug (2002b) also feel that “overcorrecting a problem, as is a frequent tendency in our society, sometimes escalates the very transgressions against which the new rules are to protect us.” While necessary and healthy debate continues, practitioners must, no matter what their scope of practice, seek guidance and input from a variety of sources to make good decisions around boundary issues. There are some areas where clear rules about dual relationships are essential and include: 1. Protection of the therapeutic process : In the context of current clinical practice, “even minor boundary trespasses can create unwarranted expectations.” Transference and countertransference issues are present and cannot be underestimated. According to Freud and Krug (2002b), “The mystique of the tightly boundaried, hierarchical therapeutic relationship heightens transference phenomena.” For example: Mark, a mental health counselor, suspected that his therapeutic alliance with a depressed young woman had turned a corner when she reported feeling less hopeless and more energized. She gratefully acknowledged his assistance and stated that she was planning to return to college and become a therapist. Mark was careful to point out that it was his client’s own work that facilitated her recovery.
● Essential to service provision. ● Negotiated without coercion.
● Entered into at the client’s initiative, and ● Done with the client’s informed consent.
Again, the professional is in the unenviable position of determining whether an action presents the possibility of psychological harm to the client. Kissing on the cheek, for example, may be perfectly correct, and clearly non-sexual, in certain cultures and contexts, but may confuse or intimidate a client in other contexts. Another area fraught with peril is when workers engage in behavior arising from their own emotional needs. Most mental health practitioners are more familiar with examples of intentional and even more egregious examples such as the practitioner who uses undue influence to “convert” the client or takes sides in a custody case in order to foster a relationship with one of the spouses. Many times boundaries are crossed unintentionally, as when a practitioner becomes overly involved in a case with which she personally identifies. Or the worker may be experiencing life issues that make him or her more vulnerable to the attentions of a client. Mental health professionals have a responsibility to maintain competence in both the professional and emotional arenas. Regardless of the circumstances, the worker’s first responsibility is always to the client.
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Book Code: SWUS1524
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