Social Workers in Nonfiduciary Situations
Social workers, as with other professionals who have fiduciary relationships with their clients, also have a “duty to inform” component to their clinical relationships. As best understood, it is necessary to inform others of the possibility of risk and bodily harm to them by a client of ours as gathered in the treatment relationship. It happened to me five times in 35 years of practice. Each time I contacted the person suspected of being in harm, but first told my client of my impending actions and explained it as a function of professional responsibilities.
Out of the five, three terminated immediately, one threatened a lawsuit and then left, and one stayed, expressing relief that someone had taken her seriously. Of the five individuals contacted, all of them dismissed my concerns as “just angry babble, he/she is mouthing off, don’t mean it, what a joke, and they can handle them.”
Each of these five situations involved a client who was in a treatment relationship and understood that I was their therapist. But what if a social worker perceives a problem that is not part of a treatment relationship, but is an observer, or an actual participant in an event the social worker perceives as inappropriate or potentially harmful to oneself and others? For whom is the moral duty owed, or is there even a moral duty since the duty to warn may not cover the situation?
My wife Kathy and I were invited to have lunch with others at a senior center nearby. We joined a group of six people at a table and enjoyed a wonderful meal and conversation. As coffee and dessert were being served, the host, who was a staff member of the agency, picked up a mic and began to come to our table since we were the closest to his table.
He asked each person to take a “walk down memory lane” and share a memory. The six people at the table all talked about their deceased partners. Three of them actually pulled out plastic-covered obituaries and read them. As the host went around the table, he began to interrupt and actually encouraged the last few to take only a few minutes because he had to end the luncheon. All six were tearing and very uncomfortable as the luncheon ended and people filed out of the hall to their charter buses back to their retirement communities. I identified myself as a social worker at our table and asked if they could stay so we as a group could talk; they could not. The room emptied quickly and, as Kathy and I sat there, the sun filled the room with light, seemingly illuminating something that was not right.
I called the host the next day and explained that I was uncomfortable with what happened. He assured me it was one of his after-lunch programs and was a form of “entertainment.” When I suggested that it was not entertainment, but a form of advantage-taking of vulnerable others, he was angry and told me to stay away. A follow-up call to the executive director got no further. She stated that there have been no complaints by the members of the lunch group and that I could not come if I so choose.
Yes, it wasn’t structured as a need to disclose and certainly wasn’t entertainment. There are support groups, grieving groups, and even reminiscing groups—this was none of these.
I began to apply the Three Sufi Gates phenomena to it. They are as follows: “Before you speak, let your words pass through three gates: Is it true? Is it necessary? Is it kind?”
Was it true? No. It wasn’t entertainment.
Was it necessary? No. It was inappropriate.
Was it kind? No. There was little kindness.
Was I overreacting? I believe not. Did the guests know they would be asked such a question? I believe not. While all should retain the right to self-determination, autonomy, and choices of behavior in such circumstances, it appeared the need to talk and share was so great, it overcame a greater sense of personal boundaries and common sense. To make matters worse, the host had no awareness of what he was opening and then no skills in closing. To me, it was a dangerous lack of awareness of others. I sense it now as meaning well, and no more; but we as social workers hold ourselves and are held professionally to a higher ethical and moral responsibility to others.
I sensed three problems with this experience. First, the purpose and intention of the luncheon was mismanaged by adding an exploration of the past for people who did not expect it, but complied. Second was that the host did not understand the implications of his attempt to introduce “entertainment” by asking people to share a memory. Third, the people who complied were left open and vulnerable. All three are unacceptable.
Let me explore a different experience to help illuminate the differences. Some years ago, Jackson Rainer, MD, offered a workshop for social workers and therapists on how their own personal grieving experiences influenced their care of clients who were grieving. I knew right away the purpose and intention of his workshop, and so did each of us who attended. Rainer began by asking the group to write about their first experience of loss that turned to grieving. He asked us to write about it and then appoint a leader from each table of eight who would call on us and monitor our responses. It was painful, grueling, and important. Each person shared their first encounter with loss and grieving, including me.
This workshop was for us and was structured to give us the opportunity to explore—in a safe environment of fellow social workers—the dynamics we brought to our offices when working with a client in a grieving situation. All in all, the workshop was what it intended to be. The luncheon was not.
I look back on the two encounters through the lens of my own past grieving and the care I offered to those who grieved. The first encounter was just wrong and the second was not. What are we to do when we are part of something that is just wrong? For me, it was that I felt I hadn’t done enough only to realize in the light of time that it was all I believed I could have done at that time. … What would you have done?
— Alan S. Wolkenstein, MSW, is a retired clinical professor of family medicine for the University of Wisconsin School of Medicine and Public Health.