Respecting Boundaries - Preventing Dual Relationships
Social Work Today
By Kate Jackson
Vol. 4 No. 5 p. 26

On the same church committee as your client, at the same 12-step meeting, or in the same grocery store—the boundaries are sometimes blurred with clients whose personal lives intersect with yours.

In social work, as in geography, boundaries are flexible and constantly shifting. Because social workers and their clients are social creatures, the possibility that they will collide in society—especially in small communities—is great. The temptation to behave in ways that extend the practitioner/client relationship and create multiple roles—known as dual relationships—is around many corners. This risk may be somewhat more prevalent and complex for individuals who work in the addiction and recovery field, particularly for those who are in recovery themselves.

Shadow Roles
Dual relationships can be said to occur any time a social worker has a relationship with a client other than the role of professional. These might include social, business, and other kinds of professional relationships. Among the many actions that may be said to cross the boundary into dual relationships or set the stage for boundary encroachments are accepting a gift from a client, benefitting financially through association with a client, and socializing with the client—which might involve anything from having a cup of coffee to becoming sexually involved.

A Matter of Degree
As Frederic G. Reamer, PhD, professor in the graduate program of the School of Social Work, Rhode Island College, explains, there’s a distinction between so-called boundary violations and boundary crossings. “The former entail unacceptable exploitation of clients by practitioners—severe conflicts of interest where clients’ interests are undermined.” A classic example is when a practitioner becomes sexually involved with a client. “If there’s a mutual attraction and the client and therapist decide to act on that attraction,” says Reamer, “there’s widespread consensus among professionals that that kind of relationship is unethical and unacceptable and would constitute a boundary violation; in fact, it is a violation of the National Association of Social Workers Code of Ethics.” It’s a less clear-cut situation, although still problematic ethically, when the individual with whom the social worker develops an intimate relationship is not a current client but a former client or a client’s relative.

Conversely, explains Reamer, there are boundary crossings that are sometimes unavoidable, inevitable, or even acceptable. A client and social worker may happen to worship at the same church or synagogue and may have a social relationship in that setting that may be very constructive. That, he says, is not inherently unethical but may require careful management and boundary maintenance. But if the practitioner were asked by the clergy to chair a task force for the congregation and invited other congregants to join the task force, a client might view that as an opportunity to get closer to and spend time with the therapist, perhaps even at the therapist’s home with his or her family. “That, to me, would cross a line and concern me a great deal,” says Reamer. “That kind of blending of their lives in an ongoing and somewhat intense way would be counterproductive and would begin to approach a boundary violation rather than a boundary crossing.”

Danger Zones
In his book on boundary issues, Tangled Relationships: Managing Boundary Issues in the Human Services (Columbia University Press, 2001), Reamer delineates a typology of circumstances that may give rise to boundary issues. Having looked at hundreds of cases, he’s determined that they fall into five categories.

Dual relationships that entail some kind of intimate element fall into his intimacy category. “In the most egregious cases, there’s some kind of inappropriate sexual activity, but it’s not always explicit and may be much more subtle,” says Reamer.

A second theme involves social workers’ emotional and dependency needs. “Sometimes social workers get involved in dual relationships because of their efforts to deal with difficult issues in their own lives—for example, the counselor who’s just divorced or separated and is lonely. He may spend excessive amounts of time with clients because he needs to be needed or may share too much information because of his own need to talk,” says Reamer.

A third theme is personal benefit. Examples include when social workers receive gifts from clients, barter for services, or are the beneficiaries of special deals for services, such as when a client who is a mechanic gives a social worker a particularly good deal on car work.

A fourth category comes under the label of altruism. “A lot of social workers are wonderfully educated people who are deeply committed to client welfare and well-being and want to help,” Reamer says. “Sometimes our altruistic instincts can get us into at least warm if not hot water when we make ourselves so available because we care so much.”

Reamer calls his final category unavoidable and unanticipated circumstances. A social worker, for example, finds out that his client is also his child’s fourth-grade teacher. “Maybe it’s in a rural area and there’s no other fourth-grade teacher. You can’t transfer the child to another classroom, so on Monday you’re dealing with your client, and on Tuesday your client is talking to you at a parent-teacher conference about your child’s behavioral issues. It’s messy,” he says.

As in the case above, in small towns and rural areas, the risk can intensify, says Reamer, “when people’s lives overlap in all sorts of ways.” A social worker may be part of a very small ethnic or religious community, he observes, where they are likely to encounter clients in all kinds of unexpected or unavoidable ways. There’s no quick fix for these situations, he says, so the social worker might need to rely on good consultation or supervision.

Pitfalls Particular to Addiction Work
“The possibility of boundary issues are present no matter what the social service setting,” says Reamer, “but in the recovery arena, the risk is somewhat higher than in other domains.” “Many professionals in personal recovery themselves are sustaining, maintaining, and supporting their own recovery through involvement in 12-step programs and may run into a client at a 12-step recovery meeting this evening,” explains Lloyd L. Lyter, PhD, professor and director, School of Social Work, Marywood University in Scranton, PA. In this way, 12-step and other such groups are a minefield of potential boundary issues for therapists in recovery. Among the dilemmas practitioners face are whether or not to take a client to a recovery group, whether or not to stay in a meeting at which a client is present, how to handle such a chance encounter, how much information to share if they stay, and whether or not to transfer the client to another social worker’s care.

Disclosure
Among risks of straddling boundaries in such cases is confusion for both clients and therapists. “Self-disclosure at times can be appropriate and constructive, and clients can make great use of having access to some information about the practitioner’s own recovery efforts,” says Reamer. On the other hand, he’s aware of circumstances in which self-disclosure crosses a line and can be destructive and unethical.

According to Lyter, “A lot of recovering professionals who are involved in 12-step programs see self-disclosure as a real benefit to their work. They run the risk, however, of bumping into clients at meetings. The Code of Ethics and laws call for us to maintain confidentiality of clients, but clients are not bound by that code. So there’s a risk in sharing too much information if the client discusses your revelations with others. And too much information about the client can be equally problematic. If my client, with whom I have a confidential relationship within my office, starts speaking about things at a 12-step meeting that he or she hasn’t told me in my office, what do I do with that information? Do I have the right to bring it up in the office later?” Clearly, he says, there are some significant ethical dilemmas and binds there.

Furthermore, when social workers self-disclose, clients can become confused if too much information about their therapists is shared. “A client may not be clear about whether the social worker is functioning primarily as a professional or whether this is now a fellow 12-step group member—a kind of partner in arms in the recovery effort,” says Reamer. The client may not be clear about how to use the practitioner in a helpful way. Furthermore, it could be very detrimental if the client senses that the practitioner is slipping in the recovery effort. “That, for example, could undermine the therapeutic progress the client has made when his or her role model, so to speak, is having difficulty,” he says. Another possible risk in this situation is that the client may have an unhealthy dependence on the practitioner when the relationship becomes complicated and their lives intersect so they’re not only professional and client but partners in recovery supporting each other. In this kind of social relationship, says Reamer, “it may be hard for clients to do the work that needs to be done for their own recovery.”

Judgment, Discretion, and Prevention
Understanding the professional codes of ethics only goes so far in helping social workers who are approaching potentially precarious ethical cliffs.

The issues are not always cut-and-dried. Codes address in strict terms only the most blatant of boundary violations—usually those involving sexual relations with a client. But it doesn’t offer a map to help practitioners avoid the less nefarious breaches of conduct. Even the social issues of daily living can muddy the waters, suggests Lyter. “I hear people struggle all the time with simple things like bumping into a client in the supermarket. Do they say hello? What if someone asks the client who it was that said hello?” Even such small encounters are fraught with choices that, he says, can get uncomfortable for social workers. “Codes of ethics are intended to be guidelines,” explains Lyter, “not absolutes—thou shalts and thou shalt nots.”

“Some of these issues are clear-cut and many of them reduce to professional judgment and discretion,” says Reamer. Suggesting that it’s a matter of common sense, he warns, is problematic. “When it comes to the careful, ethical management of boundaries, the standard ought to be higher than common sense. It ought to entail an assertive attempt to reflect on the nature and genesis of boundary issues.” There is, he says, “a whole host of criteria one ought to reflect on. If a therapist is heading toward a social relationship with a client, for example, an examination of motivations may forestall a boundary crossing.” That social worker, he says, might ask, “Why is the issue emerging at this particular time? Is it because I feel attracted to this client? Do I want to have a friendship with a former client because I’m having difficulty in my personal life? Or are these feelings emerging because I’m a caring, altruistic person and I think it will be helpful to my client?”

Further, the social worker should consider what kind of consultation is necessary to manage these boundary issues. “Social workers need to figure out if they can sort these issues out on their own or whether they need to raise them with a supervisor or in a peer consultation group and ask themselves what ethical standards in their profession they can rely upon for guidance. In cases that may raise complicated legal issues or risks, social workers may consider reviewing the situation with an attorney,” says Reamer. “There are a number of risk management steps one ought to take, involving consultation, supervision, examining codes of ethics, reviewing legal issues, and looking at relevant literature. This takes one well beyond what is ordinarily thought of as common sense.”

Reamer invokes the concept of “use of self” as a tool with which social workers can reflect upon thorny issues. “Essentially it means thinking about what you’re doing and why you’re doing it,” he says. Ask whether disclosing information is judicious self-disclosure or whether it’s attached to an ulterior motive. Ask whether you accept a gift from a client because it would be clinically counterproductive or insulting to refuse or because you’re signaling to the client an openness to a personal relationship. If you give a client in crisis your home phone number, is it because you’re being an altruistic professional or because there’s something self-serving in the gesture? “It may be good for you in the short run, but not for the client,” observes Reamer. “So the use of self concept is to put yourself under your own microscope and take a close look at what you’re doing and why you’re doing it.”

These concepts can help social workers avoid stepping of their own volition into an ethical pit. A powerful way, however, to avoid being enticed into dual relationships by clients, suggests Lyter, is to be clear with them up front about the therapeutic relationship’s nature. “I might want at the beginning to talk about my role here as a professional and the nature of this setting and tell the client, ‘You need to understand that I will respect your culture and the way you lead your life, but you also have to be aware that these are the guidelines that I work under here.’ If we try to establish as concretely as possible these types of things up front, it can be very helpful. And even if we’ve not addressed each of the possible areas of conflict in advance, if we’ve developed a good trusting working relationship with the client, my hope is that when one of those comes up and I make my explanation, I will have a sense of credibility so that the client will understand why I’m taking or not taking the action that they’ve asked me to take.” The key, he says, is setting reasonable and respectful limits.

Carrying the Burden
Ultimately, social workers must shoulder the responsibility for making sure they do not develop damaging dual relationships with clients and determining when such relationships may or may not be damaging. “It’s like being guilty until you prove yourself innocent,” explains Donna DeAngelis, LICSW, ACSW, executive director of the Association of Social Work Boards. “The burden of proof is always on the social workers because they are the professionals and it’s their judgment that must be relied upon.” The social worker/client relationship, she observes, is a power relationship. “You’re a professional and the client is seeking treatment. Clients often look at their social workers as authority figures and take seriously what they say.” It’s difficult, DeAngelis observes, to predict who is going to err in a dual relationship. “People can have the hard-core knowledge, take an ethics course and think they understand it, but something happens that can make them go astray, even if they know better. So knowing better and doing better are not always the same thing.”

— Kate Jackson is a staff writer for Social Work Today.

When in Doubt
In instances where boundary issues are not clear-cut, Frederic Reamer, PhD, professor in the graduate program of the School of Social Work, Rhode Island College, offers a seven-element decision-making protocol.

1. When being self-reflective, social workers should try to recognize that their reflection involves bias. Therefore, it may be useful to consult with supervisors and colleagues. Choose your confidants wisely, he advises, selecting individuals who are likely to be thoughtful about these issues and courageous enough to give constructive and even constructively critical feedback.

2. Take a look at the prevailing ethical standards in every relevant code of ethics, primarily the codes for social workers but also those of any allied professions.

3. Learn about any of the statutes, regulations, or agency policies that address boundary issues. Take a look at the language in licensing regulations in state laws, he insists. Some states, he notes, have ratified laws that address boundary issues explicitly.

4. “A thoughtful, competent social worker would take the time to read relevant professional literature.” In recent years, he notes, insightful publications have emerged to address the concept of boundaries and dual relationships and provide conceptual frameworks that might be helpful to practitioners struggling with these issues.

5. Take advantage of ethics committees that exist in many agencies to provide consultation and help staff think through how to handle situations.

6. There’s a potential for litigation if boundary issues are not managed well, Reamer cautions, so social workers are well-advised to consult a lawyer if there appear to be legal issues involved in a particular situation.

7. Be careful to document all the steps taken in the process of examining a potential boundary issue. It’s important to be able to show a paper trail of ernest and good faith effort to handle a situation in a responsible and professional way in the event that one questions your judgment or discretion. Another key reason to document such an effort is that when a social worker moves on and a client is seen by another social worker, the new practitioner will have access to all information about any boundary issues that emerged and may be relevant to future delivery and continuity of care.

— KJ