Eye on Ethics
Elastic Boundaries in Social Work — Proceed With Caution
Two days ago, I received an e-mail message from a social worker that dripped with relief. “It’s over,” the message said. “I finally heard from the licensing board. I can’t believe it’s really over. I got my license back!”
I had been corresponding with this social worker, Adam, for nearly four years. My involvement began when I received a telephone call from the attorney he had retained to represent him in response to a licensing board complaint that a former client had filed against him. During that lengthy conversation, the attorney explained to me that Adam had provided counseling to a couple that was struggling with relationship issues. After participating in counseling with Adam for about seven months, the couple decided to terminate their long-term relationship. One member of the couple, Anna, told Adam she would like to continue seeing him for individual counseling. With the consent of Anna’s former partner, Wayne, Anna and Adam began individual counseling, which continued for three months. The counseling ended when Anna reported that she had addressed several lingering issues satisfactorily.
Approximately one year later, Adam and Anna met coincidentally while standing in line at a popular coffee shop near Adam’s office. After receiving their coffee, Adam and Anna sat at a table and chatted for about 20 minutes. Anna gave Adam a brief update about her life since their counseling relationship terminated.
One week later, Adam received a voice mail message from Anna, who told him how much she enjoyed talking with him at the coffee shop. In her message, Anna told Adam that while she no longer felt the need for counseling, she wondered whether he would be willing to have lunch with her. Adam, who was single, found Anna appealing and agreed to have lunch. During the next few months, Anna and Adam met four times for lunch. Before long, they acknowledged that they found each other attractive and began dating. Eight months later, they decided to live together as a couple.
Because Adam, Anna, and Anna’s former partner, Wayne, lived in a relatively small city, it did not take long for word to reach Wayne that Anna and Adam were living together. Wayne was incensed and filed a formal licensing board complaint against Adam, alleging that Adam violated ethical standards adopted by the licensing board prohibiting inappropriate dual relationships and conflicts of interest. In his complaint, Wayne highlighted his feeling of betrayal.
After a lengthy process, which included a formal hearing, the licensing board concluded that Adam violated its ethical standards and suspended his license for two years. The board told Adam that he could apply for license reinstatement after he completed 15 hours of continuing education related to boundary issues (beyond the minimum number of required continuing education hours), obtained monthly ethics consultation during the probationary period concerning management of professional boundaries, received a satisfactory report from the ethics consultant, read extensive literature on professional ethics and boundary issues, and wrote a lengthy paper discussing boundary issues in social work and analyzing the boundary issues in his particular case.
Boundary Issues and the Slippery Slope
Boundary challenges are among the most difficult ethical issues in social work. Some boundary issues are clear and uncomplicated. For example, there is no room for debate about whether it is appropriate for social workers to engage in sexual relationships, business partnerships, or vacations with current clients. These activities would clearly violate social workers’ fiduciary duty to avoid conflicts of interest that are likely to harm clients.
But beyond obvious black-and-white circumstances are many others that leave considerable room for discussion and debate about boundaries management. For example, many social workers choose to share limited personal information with clients for therapeutic purposes. A social worker who is counseling a distraught child who is struggling with behavior issues and who is upset that his beloved dog just died may choose to tell the child that she, the social worker, also lost a beloved dog at about the same age and may use this modest self-disclosure to enhance the therapeutic alliance and demonstrate empathy. Or a social worker employed in an addictions program may choose to share with a client that he, too, is in recovery. Many addictions programs employ practitioners who are in recovery and permit them to share limited information about their recovery with clients as part of the programs’ treatment model.
In some instances, it is virtually impossible for social workers to avoid dual relationships with current and former clients. Social workers who live and work in small communities, such as a military base in a remote location, or rural areas know how difficult it is to avoid dual relationships. It is common for social workers in these communities to encounter clients in stores, at houses of worship, and at social events. Their children may be school friends and neighborhood playmates, and their spouses or partners may be colleagues.
Management of Avoidable Dual Relationships
Social workers who face boundary challenges can take several steps to protect clients and minimize risk to their careers, including the following:
• Set unambiguous boundaries at the beginning of the professional-client relationship.
• Evaluate possible dual relationships, considering the duration of the professional relationship, conditions surrounding termination, the client’s clinical profile, and prevailing ethical standards.
• Consider whether a dual relationship in any form is warranted or justifiable.
• Assess whether the relationship is exploitative and likely to harm the client.
• Ask yourself if the dual relationship would be self-serving.
• Pay special attention to incompatible roles (e.g., providing professional services to an office employee or neighborhood acquaintance).
• In ambiguous circumstances, consult with colleagues and relevant ethical standards, agency policies, regulations, and statutes.
• Discuss relevant issues with all relevant parties, especially clients.
• Work under supervision, if available, whenever boundary issues are complex and risk is significant.
• If necessary and feasible, refer the client to another professional to minimize risk and prevent harm.
• Document key aspects of the decision-making process and consultation. (For additional discussion, see my book Boundary Issues and Dual Relationships in the Human Services.)
— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He’s the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.