Eye on Ethics
The Cultivation of Ethics Expertise: The Impact of ‘Deliberate Practice’
In my ongoing efforts to strengthen the quality of my skills as a social worker and social work educator, I have been reading the pioneering research of renowned cognitive psychologist Anders Ericsson, PhD. Ericsson is best known for his theoretical and experimental research on the concept of expertise. For many years he has studied the cognitive structure of expert performance in domains as diverse as chess, music, and sports. Put simply, Ericsson has sought to understand what enables exceptional teachers, practitioners, artists, authors, and athletes to become experts in their field.
This is a critically important question for social workers who want to be expert in their efforts to help clients. Reading Ericsson, it dawned on me that his ideas also apply to expertise in social work ethics.
During the course of a social work career, one will encounter remarkably complex ethical challenges that defy easy solution. That’s not to say that all ethical issues in the profession rise to the level of difficult; indeed, many ethical issues in social work are easy to manage. Every practitioner knows that it is unethical to engage in a sexual relationship with a client, falsify records, and disclose clients’ confidential information during casual conversations in an elevator, restaurant, or with the social worker’s own family.
But once we move beyond the easy cases—the low-hanging fruit on the ethics tree—social workers need highly developed expertise in order to conceptualize and manage complex ethical dilemmas where practitioners’ duties and obligations clash. These are the cases where a coterie of thoughtful, principled, wise, and experienced social workers may reach different conclusions about the “right” course of action. Here are several examples:
• A clinical social worker employed in a community mental health center provided services to adolescents who were enrolled in the agency’s high school for teens with challenging mental health and behavioral issues. A 15-year-old boy diagnosed with bipolar disorder disclosed to the school social worker that he and several new friends were using crystal methamphetamine, ecstasy, and blunts (cigars stuffed with marijuana). The client confided to the social worker, “I’m in over my head with the drugs and need help. I don’t want to use so often, but I can’t stop.”
The social worker told her client about a federal grant the agency recently received to provide services to adolescents with co-occurring disorders (mental illness and substance abuse). The teen said he was eager to participate but refused to provide informed consent for the social worker to disclose his drug-related problems or treatment to his parents; the teen said he was terribly afraid of his parents’ reaction. The social worker felt torn between her wish to respect her client’s confidentiality and her belief that the parents may have a right to know about their son’s substance abuse challenges and treatment.
• A social worker at a large urban hospital was notified by the social work department’s director that the union representing hospital nurses was about to go on strike. For several months the union and hospital representatives had been negotiating a new contract, but negotiations had broken down. The strike was scheduled to begin the following day.
The hospital’s social workers met to discuss the situation. Some of the social workers felt strongly that they should not cross the picket line in order to support the nurses, whose wages and benefits lagged behind those in other area hospitals. Other social workers on staff argued vehemently that the social workers should not abandon the hospital’s patients and had an ethical duty to report for work.
• A social worker in a small town provided crisis intervention and counseling services to area residents. One client was the local school’s fourth-grade teacher, who was coping with challenging marital issues. Shortly before the start of the new school year, the teacher was informed that she would be responsible for a combined third- and fourth-grade classroom because the school’s third-grade teacher had died suddenly and the school’s principal decided to combine the two classes, both of which had low enrollments.
Coincidentally, the social worker’s son was enrolled in the school’s third grade and struggling with serious behavioral issues. The social worker was not sure how to sort through the complex boundary issues involving her relationship with her client, who was also her child’s new teacher. The school was so small that the child could not be transferred to another classroom.
The Importance of Deliberate Practice
Deliberate Practice and Ethics
But in my experience such mastery is merely a necessary—not a sufficient—component of ethics expertise. True expertise requires deliberate practice. For social workers to grasp the nature of ethical issues in the profession and cultivate the ability to manage challenging ethical dilemmas, it is important to practice, practice, practice—deliberately.
Deliberate ethical practice includes several components: Take a hard look at challenging ethical circumstances in your particular area of social work practice. Identify the conflicting duties and obligations. Learn how to engage in meaningful dialogue with clients about ethical dilemmas that involve them. Sort out the options, factoring in relevant professional and personal values, ethical theories, ethical standards, social work practice theory and, when they pertain, laws. Consult with colleagues and compare and contrast differing perspectives. Anticipate the possible consequences of different options for clients, third parties, colleagues, employers, and yourself. Recognize that, in the final analysis, reasonable, thoughtful, and principled practitioners may disagree.
We know that ethical competence is a vital component of being a professional. Experience tells me that focused, sustained, thoughtful, purposeful—deliberate—practice applied to challenging ethical dilemmas is the path to real expertise.
Ericsson got it right: The apex of professionalism is not reached easily. It involves hard intellectual work and a great deal of practice. This is as true of social work ethics as it is of every other component of the profession’s domain.
— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work, Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, healthcare, criminal justice, and professional ethics.