Sept/Oct 2007

Facing Up to Social Worker Sexual Misconduct
By Frederic G. Reamer, PhD
Social Work Today
Vol. 7 No. 5

Melvin was a clinical social worker in independent practice. For many years, Melvin provided clinical services to children and families, specializing in child behavior management problems, couples counseling, and family therapy.

Melvin had been providing service to 10-year-old Ezra and his single mother, Iris, since a school counselor referred them to Melvin. School personnel had been concerned about Ezra’s “acting out” and aggressive behavior in school. Melvin met with Ezra and his mother—sometimes individually and sometimes together—for approximately seven months.

For several months, Melvin, who recently divorced, felt attracted to Iris. He found himself thinking about her on and off throughout the day. Melvin went out of his way to spend extra clinical time with Iris during their counseling sessions; when possible, Melvin scheduled their sessions for the end of the day so that no other client’s appointment would force them to end the session after precisely 50 minutes.

Toward the end of one session, Melvin asked Iris if she would like to spend a little time with him outside the office “so we can get to know each other a little better.” Melvin went on to explain to Iris that he was feeling attracted to her and sensed that she may feel something toward him. Melvin was careful to explain to Iris that he wouldn’t do anything to harm her or Ezra’s progress in treatment. Within three weeks, Melvin and Iris were involved sexually.

Sadly, the pattern associated with Melvin’s unethical client involvement is not unusual among the small percentage of social workers who enter into inappropriate dual relationships. The good news is that relatively few social workers become involved in such relationships. The bad news is that it happens at all.

Do No Harm
Sexual misconduct between clinical social workers and clients takes various forms. It may include overt and explicit sexual behavior—such as sexual intercourse, oral sex, or fondling—or sexually suggestive behavior, such as using sexual humor and making suggestive remarks or glances.

Beginning with the Hippocratic Oath, all the helping professions have prohibited sexual relationships with current clients and patients. The Hippocratic Oath obliges physicians to keep “far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women and men.” In this same spirit, the National Association of Social Workers’ Code of Ethics states: “Social workers should under no circumstances engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced.” (standard 1.09[a])

In recent years, various helping professions have added prohibitions concerning practitioners’ sexual relationships with former clients. Unlike earlier versions, the current Code of Ethics generally prohibits sexual relationships with former clients: “Social workers should not engage in sexual activities or sexual contact with former clients because of the potential for harm to the client. If social workers engage in conduct contrary to this prohibition or claim that an exception to this prohibition is warranted because of extraordinary circumstances, it is social workers—not their clients—who assume the full burden of demonstrating that the former client has not been exploited, coerced, or manipulated, intentionally or unintentionally.” (standard 1.09[c])

Patterns of Misconduct
All available data suggest the vast majority of cases involving sexual contact between clinicians and clients involve a male practitioner and female client, although there are many exceptions. The professional literature offers diverse theories about the causes of and factors associated with clinician sexual misconduct. Some clinicians appear to struggle with their own major mental illness, which can take the form of borderline, narcissistic, impulse control, and antisocial personality disorders. Other clinicians lack basic competence and insight around professional boundaries, while others appear to be “situational offenders.”

Situational offenders typically understand prevailing ethical standards concerning sexual misconduct and that they are violating professional boundaries; in spite of this knowledge and insight, these clinicians experience what is, for them, an unusual breakdown in judgment because of some life crisis (e.g., a divorce or career-related calamity). Many clinicians in this group express remorse for their misconduct, stop their unethical behavior on their own, and seek consultation from peers.

Still other offending clinicians are simply naïve. They may be relatively inexperienced professionally and lack understanding of basic ethical standards concerning boundaries and related clinical dynamics.

Sexual misconduct between a social worker and a client is often the end result of a series of boundary-related indiscretions in that relationship. Many of these situations start with a gradual erosion of the social worker’s neutrality in relation to the client; the social worker may take a special interest in the client that gradually leads to discussion of personal issues not part of the therapeutic relationship. The social worker may begin sharing confidential information about other clients, partly because the “special” client has gained favored status. The social worker may then begin disclosing personal information, touch the client casually, and spend unusually long periods of time with the client. This may lead to dating and social worker-client sex. The pattern is not always this linear, of course, but these elements are not uncommon.

Experts working with offending clinicians often suggest guidelines to protect clients and prevent inappropriate dual relationships. Most importantly, social workers should strive to maintain neutrality in their client relationships and avoid favoritism; be scrupulous about client confidentiality and avoid “gossiping” about other clients; avoid physical contact with clients, except for typical handshakes and similar accepted forms of touching; avoid clinician self-disclosure; avoid allowing clients to accumulate large unpaid bills (this can be a correlate of “favored” relationships); provide clinical services in private and professional settings; and maintain clear boundaries around the time and length of clinical encounters.

The overwhelming majority of social workers maintain clear and professional boundaries with clients. Like all professionals, however, social workers need to be vigilant in their efforts to avoid inappropriate dual relationships. It is natural for professional helpers and clients to occasionally find themselves attracted to each other, especially considering the intimate nature of the clinical work they do together. One hallmark of ethical practice is the social worker’s ability to identify and properly manage these feelings. This is essential to protecting clients, as well as social workers.

— 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.