This week's focus is on dual relationships, the tension between how close and how far from each other we can be and see through our professional obligations to our clients. Dual relationships come up more often than one would think and affect our ability to solely focus on our client's interests. After reading the articles, share what strikes you, or something you learned, or whether you can relate to any of the situations even prior to starting at UNH in other roles you have had.
Reading this chapter I was reminded of some of the duel relationships I have dealt with in my past professional career. For my undergrad SW internship I worked at a private day/boarding school in the counseling office. My role was to help students with certain school issues including bullying, relationship issues, discipline issues, self-image issues, and conflict management. I saw some students for up to six months and forged deep trust with some of the students. I finished my internship and started my summer job as a Lifeguard at the local town beach, which is in the same town as the school I worked in . The first week of summer I found out that one of my students that I saw for almost 6 months for self-image issues was a new lifeguard on my staff. I panicked when I first saw her, she didn’t even register who I was until we did formal introductions and she almost shrunk into herself. I felt terrible. She came up to me after a meeting and said she thought she would never see me again. I asked her how she felt about working with me outside of school and being my peer instead of my student/client. She told me she felt weird and worried that I would share with other peers what we had discussed in session. I made sure to explain to her that my role as her counselor and the confidentiality that comes with it does not end even though our sessions had. Since I was a supervisor I decided it would be best to make sure she was at a different beach than I would be stationed at.
ReplyDeleteAs the summer continued we got to know each other in a different way but she was always a bit distant with me from then on. Going from counselor to peer with a client was very difficult. I wanted to make sure she never felt uncomfortable with the situation. I believe it was difficult for her as well because I was her supervisor at the beach but a trusted professional at school who she never thought she would see again.
These were really great articles! I think it's important to stay in tune to the complex nature of the sometimes unavoidable dual relationships. I feel like the internship that I am doing this year, has a dual relationship sort of built into it. In many ways we act as case managers for kids. However, we also do a lot of individual counseling with our kids. The two often clash and complicate matters. We often have to share things with parents and other agencies that we would not necessarily share if we were just doing individual counseling with the kids. We occasionally do family counseling as well, and then things become complicated because we had a session with just the parents, and now we're back to just seeing the kid. It's hard not to let what you're learning in one role impact how you respond to things in the other role. I am not sure that I am explaining this well. It's probably not very clear but the role itself really isn't very clear. It changes daily depending on the needs of the family. On any given day I could be connecting kids to resources in the community, attending a kid's basketball game, doing individual counseling, doing family counseling, taking a kid out in the community to do something fun like going to dinner, discussing the case with the CPSW from DCYF, making recommendations to the court, attending court hearings, staying with a kid in crisis at the hospital until they are admitted, fielding crisis calls, and the list goes on. It means a great deal of experience for me which is really wonderful but it also means that sometimes I feel like some boundaries get crossed that shouldn't be.
ReplyDeleteAfter reading the articles I find myself agreeing with the authors about the complexity of dual relationships and how perhaps there should be more focus and "attention to the underlying concerns of boundary management" (Freud & Krug, 2002, p. 491). As the articles pointed out, in rural communities dual relationships are almost unavoidable. Even in this small state of New Hampshire quite often connections are made between clients and the workers circle of friends/family. Living in a small community myself, I can understand what Freud and Krug (2002) mean when they say that these relationships can help the client-worker relationship by knowing the worker as a regular person.
ReplyDeleteAll of this said, I think it is wise of the social worker to continuously recheck client and worker boundaries. And as suggested by Freud and Krug, I agree that all social workers should utilize their peers and coworkers when dealing with ethical issues.
This topic of boundaries is extremely interesting to me and travels through my mind a great deal. In many occasions, I have contemplated what is ethical, appropriate, or the “right” thing to do, such as accepting gifts or giving a hug to a client. One thing from the readings that caught my attention is having the ability to evaluate situations on a case-by-case basis (Nickel, 2004). What I also found interesting from the article was this idea that sometimes these dual or multiple relationships may help the therapeutic process.
ReplyDeleteFor example, I believe it is completely appropriate to give a patient or family member a hug if they initiate it at my current internship at the Hospice House. I believe this would be an example of an appropriate dual relationship and would be beneficial in the therapeutic process during these painful circumstances. Conversely, when I was a psychology technician at the Manchester VA Medical Center, I do not believe that it would be appropriate then or now to give one of my PTSD/Substance Abuse group members, I worked closely with, a hug. It is not that I don’t think that these individuals don’t deserve a hug, but I do not feel that it would not have necessarily benefited the therapeutic process. Hmm…?
Again, I believe each experiences needs to be evaluated case-by-case. In addition, I think it is necessary to be open and discuss with your clients the comfort level about these dual relationships from the client and clinician standpoint. Finally, I think discussing these ethical dilemmas with your supervisors or team is a great way to weigh out the pros and cons of each dual relationship case.
These articles were really interesting, in discussing dual relationships. In the Freud& Krug article, they made the point that there is a need for more clarity in defining what is considered a boundary issue, then on the other hand, to not make it so narrow that it doesn't allow for the social worker to use their judgement, especially when it comes to working in a rural community. In more remote areas, the boundaries are understandably more blurred as there is more of an interdependence on the individuals to work together. I especially liked the example of the social worker in a rural alaskan town who waited in her office for 6 months, with no clients, then realized she had to join them in their community to foster a trusting therapeutic relationship.
ReplyDeleteIt's difficult to draw clear lines because situations are always bound to change, it's the very nature of human beings working with human beings.
On the other hand, there are obvious boundaries, i.e. don't have sex with a client! There are so many potential issues and this issue is so interesting.
Working in Lowell at Justice Resource Institute, I work with clients in their homes. My first client, a 9 year old boy in foster care would give me a hug every time I greeted him and when I left. In my own family, we always greet one another with a hug so it just seemed normal to give him a hug back.
I think for some things it really boils down to trusting your gut. For example, I work part time with males with co-occuring disorders and on more than one occasion they would go to give me a hug and it was not appropriate and so I would let them know that. I would also extend my hand to shake hands to reinforce this. With that said, I think the most important thing I've learned is to address the issue and talk about it.
This week’s reading discusses in depth about inappropriate relationships in the workplace and whether or not a relationship can continue after termination. If the relationship does continue, what may that look like? Freud and Krug state that they, “Emphatically condemn dual relationships regardless of whether the second relationship “begins before, during, or after the social work relationship.” I have never run into the issue of relationships continuing after termination of services, probably because I have not been in the field long enough. My problems have arisen from meeting with residential clients at the workplace who I have previously known in the past and have encountered the awkwardness of needing to discuss the dynamics of the situation. My end result was to tell my supervisor and not allow the professional relationship to continue any further. In this case, can the personal relationship still continue afterwards?
ReplyDeleteAnother point that jumped out at me from the reading was the section on ethics behind accepting gifts. I was confronted with a similar dilemma at work when a resident attempted to hand me a new bag to carry my belongings. I explained to this resident that I could not accept gifts but was told that, “this is not a gift because I didn’t pay anything for it, and it’s free.” Freud explains that, “Social workers should avoid accepting goods or services from clients as payment for professional services.” Although this particular client didn’t pay anything for this item, and may be saddened by the refusal of acceptance, I still did not feel right accepting this gift because I did not want a change in our work place performance, good or bad.
Well considering I just typed a response and it completely erased it when I hit publish I'm a little irritated so forgive me for being short.
ReplyDeleteI agree with both of the authors in that the NASW Code of Ethics is overly general. Especially, for someone trying to strictly adhere to them. I feel that, as social workers, it is our job to know our clients on a deeper level than most of behavioral science professions. I mean, aren't these the very grounds on which we pride ourselves? We go above and beyond to understand every aspect of our clients lives so how can we ask them to trust us if we can't fully trust ourselves to properly handle dual roles? Maybe it's time to create more specialized ethical codes. One of the reasons I chose this field is because of the seemingly limitless roles we, as social workers, can perform.
I really enjoy Jason’s and Lee’s responses to the articles, for the very reasons that I don’t entirely agree with them on a few levels. In my own experience in the field, I have worked primarily with youths as young as 5 and as old as I am in my mid 20’s. I think it may vary depending upon the social work position and the clientele population, but I think the concept of a gift can vary as well between different clients.
ReplyDeleteI worked with a 6 year old girl who was transitioning into a new adoptive family from a foster home. I was able to establish what I felt was a healthy, appropriate relationship with clear boundaries, however at the end of the service period, she created a card using her own art work and gave it to me. In my opinion, this gesture was not inappropriate because the concept of giving me the card was for her, not my own benefit. While I did experience pleasure in receiving it, I believe it was not similar to payment for services it was a gesture she had learned was appropriate to do for a friend.
It is for reasons similar to this that I think the NASW Code of Ethics are overly general, as Lee described. One of the bigger draws for me into the field of social work was for the reason it provides a wide array of career opportunities which can span into vastly different occupations, I believe a broad field should have a somewhat broad code within it that can apply to varying situations. It interests me that he used the same reasoning for why he feels the codes should be more specific.
I have a friend who left the agency I work for. She volunteered to occasionally meet independently with this former client as a “mentor.” She sought supervision around this dual relationship and created clear boundaries around what this meant between herself and the former client. After several months, both my friend AND the former client came BACK to work for/with the same agency as before (can’t make this stuff up!). I have no idea what to make of this, as there are multiple levels of relationships being established but it fascinates me nonetheless.
I found both articles very interesting. It is important to have a code of ethics because as human beings we can easily cross boundaries without even realizing it. Many of the examples in the Freud article were clearly inappropriate. The code of ethics is in place to protect clients from being exploited. Social workers need to provide clear boundaries for their clients yet it is often unavoidable. The social worker in Alaska had to engage in social relationships in order to get the people in the community to trust her. Otherwise she would have sat in her office never engaging with her clients. As stated in the Van Wormer article, dual relationships should be avoided but in certain instances they can increase connection and involvement. This is most definitely the case in rural communities. If social workers handle each case on an individual basis, I believe dual relationships can enhance the outcome of treatment.
ReplyDeleteI found both articles to be very interesting. I really enjoy looking at the 'gray zones' within many different issues and it seems like the topic of dual relationships fall into the 'gray zone'. I really enjoyed the points made at the start of the Freud & Krug article because it stated that the Code of Ethics contradicts itself. Ultimately, the goal is to protect and serve the most vulnerable of people in need. In order to avoid exploitation of individuals/clients, it is essential to be aware of the complexity of the situations and to set clear boundaries. The idea that in order to best serve the client, a clinician must maintain distance from the individual, in some cases, is unrealistic. I have never lived in a rural community, but I have heard from friends of their experiences. If you are from a small town, it is inevitable that there will be an element of a dual relationship. I think it is important to maintain confidentiality to protect the client. The idea of gift giving makes me a bit uncomfortable. From personal experience, I have worked a lot with children and the thought of not taking a picture that they drew for me seems absurd. But if the parent gave me an expensive gift, figuratively speaking, I assume that I would feel uncomfortable with the gesture.
ReplyDeleteWorking at my internship, I have not yet run into any former clients, but I expect it will occur at some point as New Hampshire is a small state. I am actually nervous about it, if I am at a bar/restaurant and I see a former client drinking. Within the treatment center, clients are advised to stay sober from all substances, including alcohol. I wonder what that would be like if I did run into someone or see them drinking in a restaurant, or how that could play out in a rural community.
These are both very interesting articles. I really like how Nickel (2004) clearly lays out both the negative and positive consequences that may come from dual and multiple relationships. I have had many experiences with dual relationships in my past employment position working with at-risk youth and families as well as within my current internship. I have had experiences with clients attempting to give gifts, give hugs, and maintain contact after termination of the therapeutic relationship.
ReplyDeleteI believe, like Nickel (2004) that it is important for the social worker to use their best judgment on a case by case basis. I ask myself who it is benefiting, me or the client, as well as if it appears to be a healthy or unhealthy behavior. I think that Brownlee’s (1996) decision making model is valuable. “As the expectations associated with each role become increasingly incompatible, the risk for harm correspondingly rises”. This is such an important point that demonstrates why setting clear roles and boundaries is so essential during the beginning stages of working with a client. For instance, while working at Becket Family of Services I often ran into clients in the community. These clients were already aware of our confidentiality and that if I were to see them outside of the therapeutic setting, I would not say hello, but would allow them to choose whether to acknowledge me or not. This way my clients were clear of my role and gained comfort in knowing that their privacy would be respected.
I am also now noticing how different agencies navigate this issue in different ways. For instance when I worked for Becket Family of Services, the team was unable to have contact with clients after termination. However my supervisor at Crotched Mountain has a dual relationship with a former client who visits for lunch on a monthly basis. One of the clients that I work with at Crotched Mountain recently brought up my leaving in May and asked if she would be able to contact me after termination. I was candid about being unsure if that would be a possibility and suggested that we speak with Christy (my supervisor) together about a plan. Dual relationships can be difficult to navigate which is why it is so great that we have support from our supervisors, cohort, professors, and others int he field.