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.

Social Worker Mental Health: An Ethical Dilemma?

Social work can be an incredibly personal profession- exposing social workers not only to others’ traumas but often forcing them to face triggering experiences from their own pasts while on the job. The personal experience that a social worker brings to the table can often be one of their greatest strengths. It can increase their capacity to connect with clients and to express empathy. Yet, from an ethical perspective, at what point do a social workers’ personal history or struggle negatively impact their client? What should they do if they ever find themselves in this situation?

The Dilemma

These are the exact questions that this MSW student finds himself or herself asking on Reddit. Working with parents at a community clinic in the final year of their internship, this student has quickly realized that their own childhood was riddled with significantly more trauma than they had originally thought. Still in the process of coming to terms with a childhood of neglect and emotional abuse, they are exposed to constant reminders of these experiences on the job and it is greatly affecting their mental health. Though currently in therapy to help address this trauma, this student’s situation still brings to light ethical dilemmas surrounding their ability to cope within this profession, properly distance themselves from clients and ethically serve in the social work profession.  

When examining any ethical dilemma within the social work field, it is important to use the NASW Code of Ethics as a guideline to protect both one’s professional career and clients. In this Reddit user’s case, it is important to consult the Impairment standard under Standard 4, which covers “Social Workers’ Ethical Responsibilities as Professionals.” According to the this standard, “Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of the people for whom they have a professional responsibility.” This ethical standard does not imply that it is unethical for social workers to experience these difficulties, as they are bound to happen simply by nature of being human, but rather stresses the importance that these problems do not effect the social worker’s decisions or professional capability.

Deeper Issues

When examining Impairment in this case, there are a few elements of possible concern. For example, this student explains that when observing clients they make “comparisons between what they are going through and what (they) went through” and even find themselves jealous of the families that were not abusive. These feelings raise concerns about whether or not the student is able to exert enough distance to provide unbiased and informed client care. This student also experiences physical symptoms that could be indicative of a further mental health issue such as feeling drained, sad and in a bad mood upon returning home. While these symptoms or a mental health issue alone do not indicate one’s job performance, it is important to examine whether these symptoms themselves could impair decision-making capacity or the ability to consistently show up for clients. 

It is the responsibility of this social worker to look critically at whether or not these personal or mental health components allow them to ethically practice their internship. They should do this by reviewing their supervisors’ feedback, consulting with their therapist and using a significant amount of introspection. If they feel comfortable approaching their supervisor to review these concerns, they should do so, however approaching their supervisor does pose risk for potential unintended career consequences. An academic or field placement advisor could also serve as a good resource to review ethical concerns and explore solutions. If these steps do indicate an unethical situation which is not able to be controlled by the resources at hand, this student must adhere to the social work standard of impairment by “seeking professional help, making adjustments in the workload, terminating practice or taking other necessary steps to protect clients and others.” 

Widespread Problem

Unfortunately, this student is not alone, mental health struggles in the social work field pose a widespread issue both for practitioners and clients that needs to be addressed. According to a UK Community Care survey, “96% of social workers feel either moderately stressed or very stressed,” which has resulted in 76% of social work professionals considering leaving their job within the past year. These mental health difficulties are not unique to social workers in the field full time, but also apply to social work students. The University School of Social Work found that “34% of the students indicated high levels of depressive symptoms and were at high risk of clinical depression, while 6% met criteria for posttraumatic stress disorder (PTSD).” Thus, further preventions must be put in place within the profession as a whole.

Solutions

When looking at possible preventions from a student perspective, it is important that mental health care is regularly discussed in a transparent manner and that high quality mental health resources are available. According to a study published in The Journal of Social Work Education, 23% of social work students had fear or distrust of mental health and 22% were concerned to seek services due to the quality available. Overcoming these mental health barriers are critical in creating a safe an ethical student population. Some programs might even consider the idea of mandating a certain number of therapy hours for students, so that they may explore triggering topics before they come up in field, as well as give students greater appreciation for their clients. 

Increasing internship autonomy for students could also be beneficial in allowing students to avoid triggering populations. At Boston University School of Social Work, students are able to list populations that they would be interested in working with, as well as populations that they do not feel as comfortable working with. While it is important to expose students to many different populations throughout their internship experience, allowing social work students to avoid select populations could minimize triggering social work experiences and help to prevent social work burnout. In the full time professional world, social workers are often able to choose to work with populations that do not trigger them, and students should be allowed this same opportunity. 

If you are a student in the social work field that struggles with mental health during your internship, you can use your voice to advocate for some of these changes to be enacted by getting faculty and student organizations involved. Until these preventative measures are in place, it is important that you maintain strong mental health care practices, seek support and use the NASW Code of Ethics to guide your social work practice. 

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