The Code of Ethics: A Guide for Difficult Decisions

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.

How Social Workers and Mental Health Providers Can Help Clients Adjust to the Pandemic

Over the last year and a half, there has been no shortage of media coverage about the mental health implications of the pandemic. Generally, these articles fell into one of two broad categories: those which warned of an impending large-scale mental health crisis and those which sought to help the public cope with whatever they were going through during the heart of the pandemic be it the loss of a job, a loved one, or simply cherished routines. Now, we seem to find ourselves in an in-between moment. While the pandemic is certainly not over, and we are seeing surges of the Delta variant in areas throughout the country, those who are vaccinated and not immunocompromised may have already returned to varying degrees of their pre-pandemic lifestyles.

As people have done so, however, they may have noticed a sense that all was still not well with themselves. Since the most urgent task for many of them in the earlier parts of the pandemic was simply to keep their heads above water, it’s normal and to be expected that they would only now be noticing certain mental health symptoms such as lingering anxiety, depression, burnout, or physical symptoms resulting from chronic stress. Meanwhile, from the mental health providers’ perspective, we seem to have arrived at a point in which there is a collective sense of, “What now?

A Period of Psychological Adjustment

One of the challenges that people commonly face in the wake of a disaster or traumatic event is adjustment. This isn’t the kind of practical adjustments made in the early stages of the pandemic—such as working remotely or having to accommodate for children being at home—but rather psychological adjustment. After a disaster, people feel confused, displaced (physically, emotionally, or both), have a hard time making sense of things, finding purpose, or just generally feeling like something is “off.” In fact, “Something just feels a bit off,” is a common way that people tend to characterize what they are feeling after a disaster. In the case of the Covid-19 pandemic, people’s confusion may be amplified by the lack of situational clarity: Are we still in the disaster? Are we out of it? Something in-between?

Helping clients through this period of vagueness, confusion, and adjustment is, and will be, one of the key tasks of social workers, therapists, and mental health providers right now and in the months ahead.

Being Direct to Assess People’s Needs   

While it’s safe to say that most people, if not everyone, maybe feeling a bit “off,” we also don’t want to make the mistake of assuming that everyone has had a similar experience or is currently in the same place. Because of this, social workers and mental health care providers will want to systematically assess the particular needs of new clients seeking services, of which there has been a significant increase in recent months. This may be particularly important for clients from communities of color since their experiences are going to be magnified due to the various disparities in how their communities have experienced the pandemic.

There are different ways that mental health professionals can go about this. It could be incorporated into the standard questionnaires and self-assessments that are typically used to assess the needs of new clients. Or, perhaps, some professionals may prefer a more direct and personal method by asking targeted yet open-ended questions as part of the initial rapport-building with clients. For instance, during a first session, a social worker or therapist can ask, “This has been a very strange, difficult year for many people. What might be contributing to your added stress levels, currently?”

This is one of the most important components of doing trauma work, which is unless you ask specifically, it can take a very long time until you get around to why a client has come into your office, or until they’re able to make the connections of what’s really causing all the problems. While typically this is allowed to gradually unfold over several sessions, now may be a time when it’s useful, or even necessary, to begin with new clients in a more direct way.

Incorporating a Disaster Crisis Counseling Model

Another reason why it may be useful to be direct right now, and to help clients address their most immediate problems, is that social workers and mental health providers may only be able to see new clients for one, two, or just a few sessions. While greater numbers of people are seeking mental health services, many of them may not be ready or able, for various possible reasons, to delve into deeper or preexisting mental health issues. While the hope is always to be able to do that, after disasters it’s common for people to seek just one or two sessions. Fortunately, even these limited sessions can be helpful when clients are given specific and concrete tools—for example, the six Skills for Psychological Recovery (SPR).

Mental health providers may therefore find themselves, in many cases, having to adhere closer to a disaster crisis counseling model, rather than a long-term therapy. In this scenario, the best way to help clients is to provide them with positive coping methods and strategies that can be immediately applied, especially since many of them may have come to rely on unhealthy coping mechanisms throughout the pandemic. For mental health professionals who haven’t been trained in disaster response, it will almost undoubtedly be useful to look up disaster response methods and incorporate them if possible since they may be what many of their clients need most right now.

The aforementioned lack of situational clarity regarding the ongoing nature of the pandemic, and the global scope of it, may preclude the kind of organized mental health outreach efforts we saw after localized disasters such as Hurricane Katrina and the Gulf oil spill which have been found to be effective. In the current absence of such programs, we will likely continue to see more people seek out mental health services on their own. By keeping in mind the principles covered in this article, and by being flexible with the way we might normally prefer to work with new clients in non-pandemic times, social workers, therapists, and mental health providers will be able to help their clients in the ways that they need it most during this period of psychological adjustment.

Self Help Tips and Advice For Social Workers

There is no denying the positive impact social workers have on hundreds of families and individuals throughout their career. They will tell you about the rewarding experiences they have helping others in need. Unfortunately, for every success, there is at least one case in which they could not help. Social workers see the best and the worst of society every day, and even the strongest among us can crack under the pressure. That is why self-care is so important. Being mindfully aware of your needs as well as the needs of those around you can keep you healthy and able to be there when you’re needed.

What is Self Care and How Can You Do It Every day?

Self-care is a practice that becomes a lifestyle. Understand and commit to the idea that it is not something you do once, it is something you do every day. The key is to be mindful and aware.

It is important to be mindful of where you are and what you are doing as you go about your day. Whether you are in a meeting or at the grocery store, notice how you are feeling in the moment. This can range from listening to your body and noticing your state of health to recognizing an emotional situation in your life.

Become aware of your breathing. When we are feeling stressed, emotional, or run down, we forget how to breathe. Our breath can become fast and shallow which deprives our bodies of the oxygen it needs. Pay attention to your breathing and focus on slowing it down. Allow the air to fill your abdomen, not just your lungs. You will find that mindful breathing exercises calms your thoughts, allows for greater clarity, and lessens your anxiety.

Now That You Are Aware, How Do You Improve?

It’s one thing to be mindful and aware of how you are feeling, but doing something about it is another matter. Improving your physical and emotional state requires some life changes as well.

Many social workers have the stress relieving habit of smoking or grabbing an unhealthy snack from the vending machine. It makes us feel like we’re taking a moment for ourselves. Instead of grabbing a cigarette or a bag of chips, try an e-cigarette starter kit or grab a granola bar. This gives you a moment away while making healthier choices through controlling the nicotine and sugar you intake. The idea is not to deprive yourself but to make small changes that will make you feel better over time.

Changing the way you approach daily tasks is another life change that will give you some added peace of mind. For decades we have been taught to multitask but all we’ve learned is how to start tasks but not finish them in a timely manner. By focusing on one task at a time you’ll allow yourself to finish a job before moving onto something else. This creates a sense of accomplishment and boosts your confidence at the job you are doing.

Maintaining Your New Found Awareness

Creating a support system is important when attempting to care for yourself. By relying on your friends and family you are willingly accepting love and nurturing that you simply cannot give to yourself. When meditating on an issue in your life doesn’t result in answers, one of the best things we can do is turn to our support system for help. It’s not necessary to face every challenge alone and often times, they can see from a perspective that you cannot. You may also find that the more willing you are to receive care from others, the easier it becomes for you to provide care for the people you’re working to help.

Self-care is difficult for those who spend their lives taking care of others. By allowing yourself the care you need you will find that it not only feeds your soul but it will improve your ability to care for the people around you.

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