It is common for social workers and case managers to have some amount of firsthand experience with the problems their clients face, but what happens when that level of understanding impacts one’s work in a negative way? A case manager recently shared her experience of working with a teen client who is experiencing confusion with her gender identity. Because the case manager has a personal history of transitioning and subsequently de-transitioning, she worries that her own gender identity experiences might cause problems in her relationship with the client. This issue is complicated by the fact that the case manager has not shared her personal transition history with her agency.
In this instance, the client spoke with the case manager about her interest in seeing a therapist who specializes in gender issues. Now, the case manager is unsure of the right way to approach the provision of services and the referral to a new provider. As she explained, the therapist would be providing a different service, meaning the client would continue seeing both of them. She came up with two options for herself: speak with her supervisor about her history and why she believes a transfer would be a good idea, or wait and see if her lived experience does cause any problems in her work with the client.
In this type of situation, consulting the National Association of Social Workers (NASW)’s Code of Ethics is extremely helpful. The Code of Ethics establishes ethical principles standards that must be followed by those working within the social work profession. The first ethical standard – Social Workers’ Ethical Responsibilities to Clients – has quite a few useful subsections. This scenario highlights the importance of subsections 1.15 and 1.16.
1.15 – Interruption of Services
In section 1.15, the Code of Ethics establishes that social workers must do everything in their power, within reason, to ensure that their clients receive services. Even in the face of personal challenges, social workers should strive to provide continuous services. To adhere to the Code of Ethics in the dilemma above, the case manager should continue to provide services while a transfer to a new case manager is in process.
It is important to acknowledge the case manager’s worries regarding her personal history conflicting with the client’s current feelings. In requesting a transfer to a new case manager, she does not have to disclose her history of transitioning to her supervisor. This is her private information and if it is determined that she would not be the most effective case manager, regardless of the reason, it would be in the client’s best interest to be transferred.
1.16 – Referral for Services
This section establishes that social workers should refer clients to other professionals who are better suited to serve the client’s needs. This should be done in a timely fashion, with the service coordination facilitated by the social worker. Because there is no established definition of service coordination, this can be ambiguous and difficult to navigate. Without a universal guideline of how service coordination and the transfer of services should look, social workers may find themselves in a grey area when trying to ensure their clients are receiving the proper services.
Applying the Code of Ethics in Practice
Therapeutic relationships do not always run their course perfectly, a recent study of therapy practitioners showed that 90% of participants had to terminate a therapeutic relationship before its natural end. The top reasons for termination were facilitating a referral to a practitioner who could better serve the client, and to identify other resources that may be more beneficial. This is in line with the Code of Ethics, which can and should be used as a guiding force behind the decisions social work professionals make, making it a worthwhile tool to refer back to when in doubt about tough situations.
The case manager discussed at the beginning of this article has valid personal concerns but also wants to ensure the client is working with someone who is a good fit for her. Because the case manager understands that she may not be the best fit for this particular client, a transfer to a new case manager may be in order. In this scenario, the Code of Ethics functions as a guide by laying out the path a social work professional should follow. The transfer of a client from one provider to another is often distressing for the client, so it is important for the case manager to facilitate a smooth transfer, where services are not interrupted in the interim.