March/April 2008

Black, White … and Lots of Gray
By Frederic G. Reamer, PhD
Social Work Today
Vol. 8 No. 2

Over the years, I have noticed a clear pattern: When many social workers think about ethics, they think about cases with bold, dramatic, headline-grabbing details. These are the distressing cases where some of our colleagues—a distinct minority—have become involved in an inappropriate dual relationship with a client, disclosed confidential information without proper consent or authorization, falsified records, or harmed clients by using abusive interventions.

Of course, these dramatic cases deserve attention. Social workers need to know about colleagues’ unethical behavior and indiscretions as long as they are on public record to learn what went wrong and how to prevent these serious departures from the profession’s ethical standards.

But beyond these magnetic headlines are diverse ethical issues far more common, subtle, and vexing—albeit less sensational—in social workers’ professional lives. Once we move past the compelling black-and-white cases—those that hold little mystery concerning what is morally right and wrong—we quickly bump into ethical challenges wrapped in layers of gray. These cases have fuzzy contours and can lead reasonable, thoughtful, principled, and seasoned social workers to disagree. The following are several examples:

• A long-term client of a clinical social worker in independent practice was struggling with alcoholism. The client heard a rumor from a friend that the social worker is a recovering alcoholic, which was true. In a clinical session, the client asked if the social worker was in recovery. The social worker had to decide whether to answer the client’s question candidly and, if so, how much detail to share.

• A social worker employed at a residential treatment facility for teens accepted a new job in a neighboring city at a family service agency. The social worker had formed a meaningful, productive therapeutic alliance with one client at the residential treatment facility. The social worker was interested in becoming the teen’s therapeutic foster mother after ending her employment at the facility.

The administrator of the therapeutic foster program was eager to facilitate this arrangement to sustain the teen’s impressive clinical progress and, in part, because the agency had considerable difficulty recruiting therapeutic foster parents for teen clients who were ready to transition into that program. The social worker was concerned about boundary issues but felt they were manageable.

• A clinical social worker’s client at a community mental health center read a newspaper article about the social worker, which featured the social worker’s avocation as a poet and upcoming poetry reading. The client, a woman struggling with depression, liked to write poetry and asked the social worker to share some of his poems with her. Some poems explored the social worker’s traumatic childhood experiences. The client, who had been somewhat resistant to treatment, also announced her plan to attend the social worker’s poetry reading and buy a collection of his poems that would be sold at the event. The social worker was uncertain about how to respond.

• The administrator of a prominent crisis center posted an advertisement for an entry-level crisis worker. One of the most impressive applications was submitted by a man who had been a client of the agency approximately three years earlier. When he was a client, the man had suicidal thoughts and was hospitalized briefly following his infant son’s death. The man received counseling at the agency during two periods of time and during both periods, the man’s therapist was a social worker who now ran the agency. The man has been stable since then, was eminently qualified for the job and, during the interview, disclosed his status as a former client. The agency was unsure how to balance the applicant’s right to not be discriminated against and their obligation to avoid an inappropriate dual relationship.

• A social worker at a pediatric hospital learned while watching the news that the hospital’s nurses had decided to go on strike after protracted contract negotiations broke down. The following morning, the nurses formed a picket line at the hospital. The social worker, who was very concerned about vulnerable patients with whom she worked in the hospital’s oncology unit, had difficulty deciding whether to cross the picket line.

My experience with cases such as these is that a cross-section of social workers will have difficulty reaching consensus about their ethical duties. In each instance discussed previously, I predict that social workers would line up behind different, conflicting options; some would feel certain of their position, and some would be keenly ambivalent. After contemplating the first example, some would argue that the social worker in recovery should not disclose her personal history and some would say that, managed carefully, such disclosure can be both appropriate and therapeutically productive.

Some social workers would applaud and support the social worker who wants to become her client’s therapeutic foster parent, and some would claim that the boundary issues are too complex and risky. Some would warn the poetic social worker to separate his personal and professional lives with clear boundaries, and some would entertain ways in which the social worker might use his poetry as a way to help his client.

Some social workers would argue that the crisis agency director should not hire the former client. Others would argue that the former client has a right to be hired, given his competence, valuable insights from his experiences as a client, and potential contributions. Some social workers would argue that colleagues should not cross a picket line, particularly when they believe the labor action is justified and may lead to needed improvements in working conditions and client care, while others would argue that the hospital social workers should report to work because their primary duty is to their clients’ immediate, compelling needs.

What does all this mean for the social work profession? As social workers, we must be earnest in our efforts to focus on and wrestle with ethical challenges that are subtle, complex, ambiguous, and controversial. This may run counter to our instinctive focus on the dramatic, disturbing, and sometimes salacious cases that occasionally appear in the media and dominate water cooler discussions. Rather than be preoccupied with the obvious black-and-white circumstances that occasionally surface in our profession, social workers are wise to push themselves to drill deep into the grayer recesses of professional practice.

In the long run, hard thinking about subtle but equally important ethical conundrums will lead us to provide superior service to clients, organizations, and communities. Our efforts to sort through the muddle will be more productive when we strive to recognize elusive ethical issues and engage in the kind of rigorous conceptual analysis and hard thinking needed to comply with social work’s ethical standards. As in health club workouts and physical therapy, the greatest gains occur when we push hard to challenge ourselves and avoid the paths of least resistance.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work, Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, healthcare, criminal justice, and professional ethics.