Eye on Ethics

Social Work Ethics as a Moving Target — The Evolution of Ethical Standards
By Frederic G. Reamer, PhD
March 13, 2013

When you began your social work career, did you ever imagine that a client might send you an electronic request to be her Facebook friend? Could you have imagined earning your social work degree online? Did ethical guidelines exist concerning social workers’ relationships with former clients? Indeed, for most of social work’s history, the profession’s ethical standards did not address these issues.

Clearly, social work’s ethical standards are not carved in stone. Rather, they have evolved over time as societal norms and challenges have changed. In this respect, the NASW Code of Ethics and other prominent ethical standards throughout the world are living documents.

Consider, for instance, the unanticipated predicament that Melissa, MSW, recently encountered. Melissa has a thriving clinical social work practice in a large Midwestern city. One of her clients, Amanda, recently informed Melissa that she was relocating to an East Coast city after accepting an attractive job offer. Melissa had provided therapeutic services to Amanda for nearly two years. Their work together focused primarily on Amanda’s struggles arising from her serious trauma history (childhood sexual abuse), multiple foster care placements, and challenging intimacy issues.

Shortly before Amanda’s move to the East Coast, she asked Melissa whether they could continue their therapeutic relationship using videoconferencing (Skype). Amanda explained that she was distraught about not being able to continue receiving therapy from Melissa. Amanda said she dreaded relocating and starting with a new therapist, especially considering the rich, meaningful, and profoundly helpful relationship she had developed with Melissa.

Melissa and Amanda spoke at length about the tradeoffs involved in continuing their work together using videoconferencing technology. Melissa was well aware of the disadvantages involved in distance counseling in place of in-person meetings. Nonetheless, Melissa also understood the benefits of continuity in her therapeutic relationship with Amanda. The pair eventually decided to give the distance-counseling arrangement a trial run and assess the situation after four clinical sessions.

The Ethics Quagmire
Melissa completed her formal social work education in 2000, several years before Skype was invented. Melissa never imagined she would provide distance-counseling services to clients using video technology.

Unfortunately, Melissa was unaware that in recent years many states have developed ethical and licensing guidelines concerning social workers’ provision of remote or distance counseling. For example, Melissa’s client, Amanda, had moved to a state that recently adopted a strict licensing law that regulates distance counseling. According to the law, “Individuals who provide social work services, including psychotherapy or counseling, either in person, over the Internet or by telephone are required by state law to be licensed and credentialed by this state’s social work licensing board, including practitioners who live in another state.”

Unwittingly, Melissa violated state law each time she conducted a videoconferencing therapy session with Amanda. In effect, Melissa was practicing clinical social work in Amanda’s new state of residence without a license, even though Melissa had never set foot in Amanda’s new state of residence, thus exposing Melissa to considerable ethical and legal risk.

Keeping Current
Many ethical issues in social work have endured since the profession was founded in the late 19th century. Long before the advent of more modern, unprecedented ethical challenges, social workers have had to make judgments about maintaining relationships with former clients, disclosing personal information in response to clients’ probing questions, sharing confidential information about minor clients with their parents to protect these youths from harm, and accepting clients’ gifts and wedding invitations. Although some ethical issues in social work have appeared anew under today’s sun, many are more than a century old.

Contemporary social workers must recognize that the ethical issues they learned about during their college and graduate school years are not static. Social work practice today is saturated with a range of ethical puzzles that the profession’s forebears never knew or imagined.

Social workers can take several steps to keep pace with emerging ethical challenges and guidelines:

• Review the current NASW Code of Ethics. Social workers who concluded their formal education before 1979 entered a profession that was guided by a one-page code of ethics. The first NASW code, which went into effect in 1960, resembled a Hippocratic Oath more than a guide for practice, not unlike the ethics codes that were then common across the various professions. That code said nothing about the limits of clients’ right to confidentiality or the protection of people who participate in social workers’ research and evaluation projects.

Although the 1979 code was far more ambitious, it too was silent on many ethical issues that are now recognized as key—for example, managing relationships with former clients and the challenge of impaired colleagues. Today’s code, in contrast, broaches an intimidating array of issues unacknowledged by predecessor codes, including electronic relationships and communications between social workers and clients. Indeed, ethical standards change.

• Monitor changes in state licensing regulations. A significant percentage of today’s social workers entered the profession before state licensing laws and regulations existed. During the past several decades, states have enacted increasingly comprehensive licensing laws; it was not until the late 20th century that all jurisdictions in North America licensed and regulated social work.

Today’s legal guidelines include detailed ethical standards to which social workers are held accountable. In principle, social workers who violate these ever-changing guidelines can be disciplined and sanctioned in the form of probation, license suspension, license revocation, and various forms of corrective action (eg, mandatory supervision and continuing education). Thus, social workers should regularly review their respective licensing laws to ensure compliance with ethical standards.

• Attend ethics continuing education workshops. Many social workers learn about evolving ethical standards by attending continuing education workshops. Practitioners also can avail themselves of quality ethics education in the form of webcasts (also known as webinars), videoconferences, podcasts, and online courses. Increasing numbers of licensing boards are mandating periodic ethics education as a condition of license renewal.

• Know the ethics literature. Until the late 20th century, the social work literature contained few in-depth, scholarly discussions of social work ethics. This changed dramatically with the onset of the broader field of applied (practical) ethics, itself an outgrowth of the emergence of the bioethics field in the 1970s. Along with all other major professions, social work now has a growing collection of rich analyses of a wide range of ethical issues, including ethical decision making, confidentiality, boundary issues, conflicts of interest, informed consent, documentation, impaired practitioners, and challenges posed by the digital age.

Readers of a certain age will recall a car commercial from the 1980s whose tag line was, “This is not your father’s Oldsmobile.” The ad’s intent was to persuade its audience that the car with which they grew up, and whose appeal may have waned, had been significantly redesigned and now had contemporary value and appeal. In important respects, that’s the story of today’s thinking about social work ethics.

— 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.