In psychology and social work, dual relationships and clinical boundaries are often common. They are often unclear and most times the professional has a difficult time noticing them developing. Ethical dilemmas are found in all professions, but are often different in type and solutions. They are hard to identify and even harder to make a clear decision. Dual relationships and clinical boundaries are one of the biggest ethical dilemmas social workers face because of the difficulties of finding the line between the professional role and the empathetic role a social worker plays.
Social work is a profession that helps to solve complex human problems and create a more just and caring society. One of the foundations of social work is the focus on the strengths, as opposed to the shortcomings, of individuals, families and communities so that creative solutions for complex social problems can be found. The profession is characterized by a steadfast commitment to social justice in the service of empowering individuals, families and communities to meet their needs. Few professions offer many different types of employment opportunities.
Social workers serve as counselors, in adoption, domestic violence, rehabilitation, hospice, mental health, youth, community development workers, public policy analysts, global rights workers; and in juvenile and adult justice systems, just to name a few. However, the main job of a social worker, however, is to help the client to reach a more stable environment, but to go about it a specific way dependent on the job the social worker held. Each job might come with different ethical problems, but social workers have to follow a strict code of ethics that have guidelines to help them make the correct decisions.
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The NASW, National Association of Social Work, is the largest group of professional social workers. It is the group that wrote the NASW code of ethics, which are followed by all social workers across the United States (NASW, 2008). Ethics are the underlying rules put in place to help society better function. Usually, they are hard to identify and can be interpreted in many different ways. Each person has their own ethical standards, which is why it’s necessary to have ethical codes that make it more general and help each professional make his or her own ethical decision.
Ethics play a huge role into social work. Without an ethical background or a code of ethics it could harm not only a client, but also the social worker himself. The biggest struggle that comes along with ethics is the fact that each individual usually interprets them differently. Ethics is two things. First, ethics refers to right and wrong that advise what humans should do, in terms of rights, obligations, benefits to society, fairness, or specific virtues. Ethics can refer to those standards that make humans refrain from rape, stealing, murder, assault, slander, and fraud.
Ethical standards also include ideals relating to rights, such as the right to life, the right to freedom from injury, and the right to privacy. Secondly, ethics refers to the study and development of one's ethical standards. As mentioned above, feelings, laws, and social norms can deviate from what is ethical; therefore it is necessary to constantly examine one's standards to ensure that they are reasonable. The NASW Code of Ethics was written to serve as a guide to the everyday professional conduct of social workers. It includes four sections.
The first section, "Preamble," summarizes the social work profession's mission and core values. The second section, "Purpose of the NASW Code of Ethics," provides an overview of the Code's main functions and a brief guide for dealing with ethical issues or dilemmas in social work practice. The third section, "Ethical Principles," presents broad ethical principles, based on social work's core values, that inform social work practice. The final section, "Ethical Standards," includes specific ethical standards to guide social workers' conduct and to provide a basis for adjudication.
The Code of Ethics, as used today, was approved by the 1996 NASW Delegate Assembly and revised by the 1999 NASW Delegate Assembly. (NASW, 2008) The NASW code of ethics is used to help guide social workers when it comes to making ethical decisions in the field. It is used to help give every therapist and client the same treatment and ethical decisions. Usually, each profession has a different code of ethics due to the fact that each profession has a diverse set of ethical issues that come with it.
Dual relationships or multiple relationships are interactions in which a client is treating a patient, but is also interacting with them in some other way. It can also be if a therapist is in a professional role with a person and promises to enter into another relationship in the future with that person or someone closely related to the individual. Dual roles refer to two different roles and multiple roles are when more than two overlapping roles exist. For example if a therapist is treating their child’s teacher, their child’s friend, having sexual relations with the client, or are close to the client in some way.
Dual relationships are against the APA ethics code and can cause harm to the patient in some cases. A therapist should never work with people who he or she might have to interact with on a causal level instead of a patient-therapist level, not only for the patient’s confidentiality, but also to help keep the therapist from giving preferential treatment (Barnett, Vasquez, Moorehead-Slaughter, Johnson, 2007) Dual relationships can also allow a therapist to misuse their power and influence. The practitioner is in a position to exploit the client for his or her own personal gain.
The problem of the dual relationships and the second relationship, the counselor is now susceptible to other interests (personal, financial, or social) that he or she may put before the best interests of the client. Problems that arise usually occur when the professional boundaries are not clear to begin with. Therefore, boundaries should be included as part of the intake paperwork. The wording should be clear and specifically state the therapist's intentions. The therapist-client relationship is one that does not permit contact in a casual manner outside the therapy session.
This includes work relationships, social conversations or any type of romantic or sexual contact. " The therapist can state something about not giving personal information to a client, as there is no need for them to know this kind of thing. If the client signs the consent form, a contract is in effect and should not be breached by either party. Not only does the therapist have to gauge the client and the way he or she processes things, but also what the client could take inappropriate.
Although it may seem appropriate in a therapist’s eyes it could be inappropriate in the client’s eyes and vice versa. (Syme, 2003) The therapist has to keep a close eye on their actions and make sure their client is not seeing it differently than they are. There are three factors that counselors should consider. First, there is a greater risk of harm when the expectations of client and counselor are mismatched. When clients have one set of assumptions about the ground rules of the relationship, and the professional has a different set of assumptions, there is an increased chance of susceptibility.
Another factor is that there is potential for divided loyalties and an associated loss of objectivity. Counselors who have personal, social or business relationships with their clients, are at risk because their self-interest may be involved and thus compromise the client's best interest. Finally, by the very nature of the counselor/client relationship, clients are more dependent, have less authority and are vulnerable. Due to this power differential, it is the responsibility of the professional to ensure that the client in the relationship is not harmed.
One key feature of boundary issues is a conflict of interest that harms clients. Conflicts of interest occur when professionals find themselves in a relationship that could prejudice or give the appearance of prejudicing their decision-making. Thus a counselor who provides services to a client with whom he would like to develop a sexual relationship faces a conflict of interest; the professional’s personal interests collide with his or her professional duty to avoid harming his or her client. Zur, American Psychological Association, 2007) Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should also inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients’ interests primary and protects clients’ interests to the greatest extent possible. In some cases, protecting clients’ interests may require termination of the professional relationship with proper referral of the client (standard 1. 6[a]), NASW, 2008). The code goes on to say that "social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client" (standard 1. 06[c], NASW, 2008). While treating someone in therapy, a counselor has to be careful about how their patient is going to interpret their actions and words. When a patient is in therapy, a lot of times they don’t have anyone around to support them and help them overcome their obstacles.
That being said, it’s the job of the therapist to be that person for their client and help them to succeed. As a client gets closer to his or her therapist, sometimes the slightest of things can be taken in the wrong way. For example, as trust is built the slightest of things can trigger a client to see their therapist in a different light. As a counselor, a pat on the back, hand touch, ect can seem like nothing to you, but to the client can seem like a sexual advance. This an be detrimental to a client and can break all the trust the therapist had built up, putting the patient back to the beginning of the process (Smith, Fitzpatrick, 1995) When the psychologist and the patient develop an extracurricular relationship, this dual relationship can threaten the psychologist's ability to act impartially as a therapist and the patient's ability to receive proper treatment in their vulnerable state. If psychologists are not held accountable to prevent this type of behavior, they can harm the reputation of all clinical psychologists.
Personal relationships imply a bias and the private relationship can cross over into therapy and treatment. The term "conflict of interest" applies to dual relationships because no matter how objective a psychologist tries to be, their own emotions may taint their trained perceptions. Conflict of interest can be applied to a variety of situations, such as the psychologist should not treat a family member or close friend due to the possibility of favoritism or being non-objective, and could interfere with the treatment being given and received.
The psychological ethical codes clearly prohibit the interaction of a personal relationship between the psychologist and the client. Dual relationships and clinical boundaries are one of the biggest ethical dilemmas social workers are faced with; trying to find the line between the professional role and the empathetic role a social worker plays. This being said, as a social worker it is important to distance the client, but also to build trust. It takes time to learn the boundaries and how to avoid crossing them.
This is just one of the biggest challenges social workers have to overcome in their field. Reference Page: Barnett J, Lazarus A, Vasquez M, Moorehead-Slaughter O, Johnson W (2007) Boundary Issues and Multiple Relationships: Fantasy and Reality; Professional Psychology: Research and Practice, 38 (4) 401-410 doi: 10. 1037/0735-7028. 38. 4. 401 Herlihy, B and Corey G. (1992) Dual Relationships in Counseling. Alexandria, VA: American Association for Counseling Development Reamer, G. F. PhD (2011, October 13). Eye on Ethics Social Work Today, retrieved from http://www. socialworktoday. om/news/eoe_101311. shtml Smith, D. and Fitzpatrick, M. (1995) Patent-Therapist Boundary Issues: An Integrative Review of Theory and Research, Professional Psychology: Research and Practice, 26 (5), 499-506 doi: 10. 1037/0735-7028. 26. 5. 499 Syme, G (2003) Dual Relationships in Counseling and Psychotherapy: Exploring the Limits, London: Sage Publications Zur, O and American Psychological Association (2007) Boundaries in Psychotherapy Ethical and Clinical Explorations. Washington, DC : American Psychological Association http://www. socialworkers. org/pubs/code/code. asp
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