When a client’s actions mirror their intentions, an ethical dilemma will rarely present itself in the social work context. Someone who blatantly abuses their family members without remorse, for example, will be quickly reported by a social worker without much internal conflict on the reporter’s part. When a well-intentioned client makes a misguided decision, however, as part of the effort to improve their situation based on the social worker’s advice, an ethical conflict can occur.

Especially when mental health and/or addictive tendencies are involved, social workers are very conscious of the fragility of recovery for their clients. For this reason, they may feel compelled to stay silent when a well-meaning client crosses an ethical boundary. In order to skillfully navigate this recurring issue, social workers must first recognize the most common forms of ethical problems in their field. Then, they can establish a method for gently guiding clients to a more productive course of action in a way that minimizes impact on morale.

Confidentiality

Social workers are of course bound to confidentiality, meaning they cannot discuss client business with anyone else. Like healthcare providers and HIPAA, this is a very serious matter that people lose their jobs over, even in the case of accidental breaches.

There is only one scenario that justifies a breach of confidentiality, and reasonably so: unlawful and harmful acts. If a client tells you that they are hurting themselves, hurting anyone else, or being hurt by someone else, that’s grounds for the release of private information.

When social workers are in school, this may seem like a relatively straightforward requirement, but they often feel very conflicted when they first encounter it in the field. If a case is blatant, as mentioned, as with severe harm or abuse, then the reporter is not so conflicted. If a client shows up to a session with a small bruise that is consistent with abusive handling, however, and they insist strongly that they aren’t being abused, the social worker may struggle ethically – especially if the spousal or parental relationship is fragile enough to be damaged by an investigation.

The best way to resolve this dilemma – or at least make it easier – is to pre-empt it. At the start of a social worker’s relationship with a client, the social worker should disclaim to the client that all information is private except for reports of self-harm, harm of others, etc. This will help to preserve trust, even in the case of a report. In either case, social workers should always remember that their state’s NASW guidelines (Connecticut linked as an example) will help outline the circumstances required for a mandated report.

Client Requests for Independent Living

This issue most prominently affects clients with mental health and behavioral concerns. When a client with mental health issues requests their own housing, the social worker may feel conflicted. They want to encourage the client’s self-sufficiency, but they aren’t entirely sure if the client is prepared to make that transition – especially the client has been in an inpatient environment for a significant amount of time. Similarly, a social worker may be hesitant to place a client with severe depression and suicidal tendencies in their own home for obvious reasons.

The more assessment data a social worker can obtain in this case, the more evidence (and confidence) they will have to reinforce their ultimate decision. Assessment data varies per client, but the following can act as a very general framework in most cases:

  • What services does the client currently need throughout the day?
  • What services will they have access to if they move to this home/apartment?
  • How long has it been since the client lived on their own?
  • What is the client’s current level and quality of social interaction with fellow tenants/caregivers?
  • What do the client’s family members say about his or her independence level prior to community/institutionalized living?

Assessment is absolutely critical in this event, as it will lessen the social worker’s hesitation in making a decision either way. Even if a social worker decides not to endorse a client’s appeal for independent housing based on this data, they can use it to create an action plan for the client so they can strive to make the transition in the future.

Moral Dilemmas

Moral and religious qualms are a two-way street when it comes to the social work environment. If a client is seeking assistance in having an abortion, for example, and their social worker is firmly against abortion in general, a moral conflict may affect that case. On the other hand, a social worker may refer a client to healthcare or mental health specialists who practice treatments that violate certain religious beliefs (drawing blood or taking certain medications, for example).

In the first scenario, it’s important for the social worker to prioritize the client’s welfare over their own beliefs. To deny or discourage the abortion on any grounds not related to the patient’s functional needs is an abuse of the social worker’s oversight.

The second scenario can be prevented with a mindful approach to intervention planning. Even if the social worker has never worked with someone of a certain religious or moral ideology before, they can still prevent problems by simply asking everyone what they’re comfortable with prior to recommending certain services.

The Self-Determination vs Security Paradox

Encouraging self-determination is usually high on the list of a social worker’s objectives for any given client, but the freedom to direct oneself is fundamentally related to a greater risk of harm. Consider the post-9/11 crackdown on airport security, to illustrate a much broader case. Before 9/11, passengers had much more freedom to bring certain items on board airplanes, but for security reasons, that freedom was restricted.

The social worker must promote a sensible balance between autonomy and security for clients who are invested in their own growth, and they should establish this precedent early on in the relationship. If a client wants to appeal for custody of their children, for example, but have not taken sufficient strides to remedy their substance abuse and behavioral problems as mandated by the court, it’s the social workers job to shift the focus towards these critical steps before jumping back into the legal process.

It’s important that, when guiding a client to a safer (and less autonomous) choice, the social worker clearly and reasonably justifies their decision, always prioritizing the client’s:

  • Safety and well-being
  • Legal standing
  • Motivation to continue their efforts
  • Promises to family and friends
  • Self-established goals

Sometimes, clients need to be nudged towards self-reliance, not away from it. Instead of recommending a particular course of action for hesitant clients, it’s more important to the client’s self-reliance to keep the conversation open-ended so that they can choose (within defined parameters). “What do you think we should do?” or “Which of these options sounds best to you?”

Dual Relationships

When a social worker and client interface with each other outside of the boundaries of their professional relationship, they are often said to have a “dual relationship.” Especially in the era of social media, this issue has become very convoluted and confusing for social workers across the country.

Sometimes, after a social worker and client have finished working with each other, the client or a family member may reach out to thank the social worker. In many of these cases, nothing unethical occurs. Similarly, if a social worker encounters a former client in the community, there’s nothing wrong with polite conversation.

Professional relationships that turn into sexual relationships are an obvious violation of the National Association of Social Workers’ Code of Ethics. This is example is straightforward, but what about a hug? What if a former spouse or partner seeks counsel from a social worker? Many of these cases exist in the “gray area” as far as state guidelines are concerned, and social workers are strongly advised to familiarize themselves with the hard boundaries. As always, the more informed a social worker is on the thresholds of appropriate behavior, the less conflicted they will be when a tough decision comes.

Tim Kalantjankos

B.S. Sociology | University of Nebraska at Omaha

A.S. Physical Therapy | Clarkson College

September 2019

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