Eye on Ethics
Managing Boundaries and Dual Relationships
What do the following circumstances have in common?
• A 27-year-old client of a social worker in a community mental health center commits suicide. The client’s parents are devastated but deeply appreciate the social worker’s efforts to help their daughter cope with chronic depression. Shortly after the client’s death, the parents contact the social worker and ask her to deliver a eulogy at the funeral.
• A clinical social worker in private practice receives a telephone call from a former client. The social worker and client terminated their working relationship four months earlier. During the telephone call, the client tells the social worker that she misses the social worker and wants to stop by the office briefly to say hello.
• A hospital-based social worker and her husband are struggling with infertility. The social worker, who works in the pediatric unit of the hospital, contacts a nursing supervisor in the obstetrics department to explore how she and her husband might meet pregnant women who are planning to deliver at the hospital and who may be interested in placing their newborns with adoptive parents.
• A social worker in a residential facility for older adolescents helps one of his clients develop skills to enable her to move to a supervised apartment sponsored by another social service agency. Shortly after the client moves to the apartment, the client invites the social worker to come to her apartment on Saturday evening for an informal open house and to meet some of her friends. The former client is proud of her achievements and independence and is eager for the social worker to see her new home.
• A social worker in a family service agency is a recovering alcoholic. She attends an Alcoholics Anonymous meeting in a local church and encounters one of her clients. The social worker must decide on the spot whether to stay at the meeting or leave.
Each of these situations involves what are commonly called boundary issues. Boundary issues occur when social workers establish more than one relationship with clients or former clients, whether professional, social, or business. These typically involve dual (or multiple) relationships.
Not all dual and multiple relationships are unethical. For example, many social workers have had unanticipated or unavoidable contact with clients in supermarkets, at sporting events, or at the local library; ordinarily, these encounters are brief and fleeting and do not pose any significant ethical challenge.
Some boundary issues, however, raise serious and troubling ethical questions. The most egregious circumstances involve some kind of exploitation of clients, for example, when a social worker becomes sexually involved with a client. A relatively small number of social workers have engaged in sexual relationships with clients, former clients, or clients’ relatives or other individuals with whom clients maintain a close personal relationship—a clear violation of the National Association of Social Workers’ Code of Ethics (standards 1.09[a-c]). Historically, sexual misconduct accounts for a significant percentage of ethics complaints and lawsuits filed against social workers.
Other circumstances involve more subtle boundary issues in which social workers may disagree about the appropriateness of the dual or multiple relationship. For example, to what extent is it appropriate for social workers to share personal information with clients (i.e., religious beliefs or family history)? Is judicious self-disclosure acceptable in some circumstances? What about contact between social workers and clients in social settings? Would it be appropriate for a social worker to serve with a client on a church committee that they both joined coincidentally? How should a social worker handle the news that a client—a teacher—has just been assigned as the new instructor in the social worker’s son’s third-grade class (and this is the only third-grade class in the rural school district)?
Although social workers have been aware of boundary issues for decades, the topic has been addressed systematically in the profession’s literature only recently. Contemporary research on boundary issues suggests that social workers face several major issues, including the following:
• Intimate contact — Many dual relationships in social work involve some element of intimacy. The most extreme cases involve sexual intimacy. However, there are other forms as well. Under what circumstances, for example, is it appropriate for social workers to hug a client? Is there a distinction between a brief good-bye hug at the end of long-term treatment and a more sustained hug with a client who is distraught about a life crisis? Also, what about counseling a former lover who seeks the social worker’s clinical expertise? Or, is it ever appropriate for a social worker to send personal notes to clients, give clients gifts (for example, when a client marries or delivers a baby), or accept gifts from clients?
• Personal gain — Social workers occasionally become involved in dual relationships that produce some kind of personal benefit, such as monetary gain from a business venture. Over the years, I have been involved in ethics cases in which social workers have invested money in a client’s growing business, bartered with clients for goods or services as payment for social work services, referred clients to the social worker’s relative for additional professional services, or sought useful information from clients (as in the previously described case involving the infertile social worker and the obstetrical nurse at a local hospital).
• Emotional and dependency issues — A number of boundary issues arise from personal issues in social workers’ own lives. What many of these circumstances have in common is that they are rooted in the social worker’s emotional needs, such as those stemming from childhood experiences, marital or relationship issues, health problems, aging, career frustrations, or financial and legal problems. These various stressors can impair social workers’ judgment, which may lead to inappropriate dual or multiple relationships and boundary violations.
• Altruistic instincts — Some boundary issues arise because of social workers’ genuinely altruistic inclinations. The vast majority of social workers are dedicated, caring, and principled people who would never knowingly exploit clients. Ironically, social workers who are extraordinarily kind and humane may unwittingly foster challenging dual and multiple relationships by attending clients’ life-cycle events, giving clients home telephone numbers for emergency circumstances, or giving isolated clients gifts at holiday time. On occasion, such altruistic gestures may be misinterpreted by clients and trigger boundary confusion.
It is important to reiterate that not all dual and multiple relationships are unethical. Some are and some are not. The challenge in social work is to use good judgment, consistent with current ethical standards, to distinguish between the two.