Ethical Decision-making and Dual Relationships
Online course on Dual Relationships: The Ethical Way Ethics code of all major psychotherapy professional associations (e.g., APA, ApA, NASW, ACA, NBCC). home» psychology» dual relationships» ethical decision making for Changes in the APA Ethics Code regarding Dual Relationships, Multiple Relationships. The NASW Code of Ethics is intended to serve as a guide to the everyday .. (c) Social workers should not engage in dual or multiple relationships with clients.
With growth in the use of communication technology in various aspects of social work practice, social workers need to be aware of the unique challenges that may arise in relation to the maintenance of confidentiality, informed consent, professional boundaries, professional competence, record keeping, and other ethical considerations.
In general, all ethical standards in this Code of Ethics are applicable to interactions, relationships, or communications, whether they occur in person or with the use of technology. Technology-assisted social work services encompass all aspects of social work practice, including psychotherapy; individual, family, or group counseling; community organization; administration; advocacy; mediation; education; supervision; research; evaluation; and other social work services.
Social workers should keep apprised of emerging technological developments that may be used in social work practice and how various ethical standards apply to them. Ethical Principles The following broad ethical principles are based on social work's core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence.
These principles set forth ideals to which all social workers should aspire. Social workers' primary goal is to help people in need and to address social problems.
Social workers elevate service to others above self-interest. Social workers draw on their knowledge, values, and skills to help people in need and to address social problems. Social workers are encouraged to volunteer some portion of their professional skills with no expectation of significant financial return pro bono service.
Social Justice Ethical Principle: Social workers challenge social injustice. Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. Social workers' social change efforts are focused primarily on issues of poverty, unemployment,discrimination, and other forms of social injustice. These activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity.
Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people. Dignity and Worth of the Person Ethical Principle: Social workers respect the inherent dignity and worth of the person. Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity.
Social workers promote clients' socially responsible self-determination. Social workers seek to enhance clients' capacity and opportunity to change and to address their own needs. Social workers are cognizant of their dual responsibility to clients and to the broader society. They seek to resolve conflicts between clients' interests and the broader society's interests in a socially responsible manner consistent with the values, ethical principles, and ethical standards of the profession.
Importance of Human Relationships Ethical Principle: Social workers recognize the central importance of human relationships. Social workers understand that relationships between and among people are an important vehicle for change.
Social workers engage people as partners in the helping process. Social workers seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities.
Social workers behave in a trustworthy manner. Social workers are continually aware of the profession's mission, values, ethical principles, and ethical standards and practice in a manner consistent with them. Social workers act honestly and responsibly and promote ethical practices on the part of the organizations with which they are affiliated. Social workers practice within their areas of competence and develop and enhance their professional expertise. Social workers continually strive to increase their professional knowledge and skills and to apply them in practice.
Social workers should aspire to contribute to the knowledge base of the profession. Ethical Standards The following ethical standards are relevant to the professional activities of all social workers. These standards concern 1 social workers' ethical responsibilities to clients, 2 social workers' ethical responsibilities to colleagues, 3 social workers' ethical responsibilities in practice settings, 4 social workers' ethical responsibilities as professionals, 5 social workers' ethical responsibilities to the social work profession, and 6 social workers' ethical responsibilities to the broader society.
Some of the standards that follow are enforceable guidelines for professional conduct, and some are aspirational.
The extent to which each standard is enforceable is a matter of professional judgment to be exercised by those responsible for reviewing alleged violations of ethical standards. Social Workers' Ethical Responsibilities to Clients 1.
In general, clients' interests are primary. However, social workers' responsibility to the larger society or specific legal obligations may on limited occasions supersede the loyalty owed clients, and clients should be so advised. Examples include when a social worker is required by law to report that a client has abused a child or has threatened to harm self or others. Social workers may limit clients' right to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.
Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients' right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions.
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This may include providing clients with a detailed verbal explanation or arranging for a qualified interpreter or translator whenever possible. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients' wishes and interests.
Social workers should take reasonable steps to enhance such clients' ability to give informed consent. If clients do not wish to use services provided through technology, social workers should help them identify alternate methods of service. Exceptions may arise when the search is for purposes of protecting the client or other people from serious, foreseeable, and imminent harm, or for other compelling professional reasons.
This includes an understanding of the special communication challenges when using technology and the ability to implement strategies to address these challenges. Social workers should assess cultural, environmental, economic, mental or physical ability, linguistic, and other issues that may affect the delivery or use of these services. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients' interests primary and protects clients' interests to the greatest extent possible.
In some cases, protecting clients' interests may require termination of the professional relationship with proper referral of the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. You may have heard in workshops or read in books or journals that hugging a client, giving a gift to a client, or meeting a client outside of the office constitutes a multiple relationship and is prohibited by our ethics code or by the standard of care sustained by professional licensing boards.
You may also have heard or read that telling a client something personal about yourself or unexpectedly encountering a client at a social event are examples of unprofessional multiple relationships. The inaccuracies, or errors, in our thinking about nonsexual multiple relationships, mire us in confusion and controversy. The errors cripple our movement towards a comprehensive and practical model of ethical decision-making regarding multiple relationships with clients.
This study also showed that male therapists are more likely to engage in nonsexual dual relationships with clients of the opposite sex than their female counterparts. A Practical Guide, 4th EditionWiley, Clarity in thinking through boundary issues for each client is essential.
Reflexively applying a rigid set of rules A central theme of this book is that we cannot shift responsibility to a set of rules Every client is unique in some ways, as is every therapist.
Each situation is unique in some ways, and situations continue to change. Nothing can spare us the personal responsibility of making the best effort we can to assess the potential effects of boundary crossings Decisions about boundaries must be made with the greatest possible clarity about the potential benefits and harm, the client's needs and well-being, informed consent and informed refusal, and the therapist's knowledge and competence.
What about multiple social roles?
Is it helpful, hurtful, or completely irrelevant for a therapist to provide therapy to a close friend, spouse, or step-child? Are there any potential benefits or risks to social outings with a client meeting for dinner, going to a movie, playing golf, or heading off for a weekend of sightseeingso long as there is no sexual or romantic involvement?
What about lending a client money to help pay the rent or buy food and medications? Under what circumstances should a therapist accept bartered services or products as payment for therapy sessions? The 15 years or so from the early s to the mids saw these and other questions about multiple relationships and boundaries discussed—and often argued—from virtually every point of view, every discipline, and every theoretical orientation.
On Seeing Acquaintances as Patients. Similarly, in the edition of their widely used textbook Ethics in Psychology: Professional Standards and Cases, Patricia Keith-Spiegel and Gerald Koocher discussed ways in which boundary crossings may be unavoidable in good clinical practice and presented ways to think through the ethical implications of specific dual relationships or other boundary issues.
Dual Relationships, Multiple Relationships, & Boundaries
Patrusksa Clarkson, who wrote 'In Recognition of Dual Relationships,' discussed the 'mythical, single relationship' and wrote that 'it is impossible for most psychotherapists to avoid all situations in which conflicting interests or multiple roles might exist'p.
Vincent Rinella and Alvin Gerstein argued that 'the underlying moral and ethical rationale for prohibiting dual relationships DRs is no longer tenable'p. Jeanne Adleman and Susan Barrett took a fresh and creative look, from a feminist perspective, at how to make careful decisions about dual relationships and boundary issues.
Laura Brown ; see also b examined the implications of boundary decisions from another perspective in 'Beyond Thou Shalt Not: Thinking about Ethics in the Lesbian Therapy Community.
Elisabeth Horst and Amy Stockman were among those who explored issues of dual relationships and boundaries in rural settings. Melanie Geyer examined some of the decision-making principles that had evolved for evaluating multiple relationships and boundary issues in rural settings and adapted them for some of the unique challenges faced by Christian counselors and counselors for whom other religious faiths are a focus of practice.
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This model will not only focus on the welfare of the client but, in this world of professional risk, this model should be viewed as a risk management tool designed to also protect the welfare of the professional in this period of enhanced professional accountability When addressing dual relationships one must be aware that the evaluation of boundary violations in professional practice are often outcome driven determinations.
Usually the determination of whether or not a professional committed a violation of professional practice is arrived at retrospectively when experts or ethics committees evaluate a case.
Thus, and consistent with the risk management model of the APA Insurance Trust, when one chooses to enter into a dual relationship one is forced prospectively assess how these professionals might retrospectively view a specific case, potentially years after it occurred.
So, when assessing whether or not to enter into a dual relationship, one is almost forced to predict future reactions to their conduct, something that is not at all easy to do. Hopefully, by answering the following questions in a step by step fashion a professional who is considering entering into a dual relationship will increase the likelihood that he or she will make the correct choice in the matter: Is the dual relationship necessary?
This is a very important question for the mental health professional to answer.
Therapy by itself is complex and difficult to perform without the introduction of other factors. Thus, at the outset a professional must address whether he or she even needs to enter into a dual relationship. Simply put, unnecessary dual relationships can be fraught with unnecessary risk. As a rule, it is likely to be in the best interests of the professional, regardless of location, to avoid dual relationships if at all possible. However, if the dual relationship is necessary, then the professional is forced to answer the next question.
Is the dual relationship exploitive? This is an easy one. Exploitation of patients is unethical and if the proposed dual relationship is exploitive of the patient, then it is unacceptable. If exploitation is not evident or if it can be avoided, then the professional is forced to move on and answer the next question. Who does the dual relationship benefit?
Since it is unethical to exploit patients, just whom does the relationship benefit? This is a dilemma often faced by those who work in small communities. However, not all dual relationships are as easy to assess as this small town dilemma.
For example, what about purchasing a car from the local dealership in a small town when the owner of the dealership is your patient and when failure to do so would make people in the community wonder just why you did not buy the car locally? Benefit in this case is not as easy to assess. To purchase the car elsewhere would not only raise wonder in the community but also could impact your therapeutic alliance. The answer to this example only becomes more complex when trying to decide whether or not to negotiate the price of the vehicle with your patient?
So, assessing just who benefits by the decision to enter into a dual relationship is not so easy to assess. Is there a risk that the dual relationship could damage the patient?Dual Relationship (Role Play)