Eye on Ethics

Context Matters — Shifting Norms in Social Work Ethics
By Frederic G. Reamer, PhD
August 2014

Several months ago I received a telephone call from the father of a struggling teen. Mr. H., who was a complete stranger to me, told me that he and his wife were desperate to find help for their 15-year-old son who, according to Mr. H., was “spinning out of control.”

“We just don’t know what to do,” Mr. H. told me with a pained voice. “For years Ben was a compliant, cheery, and well-behaved kid. But during the past year or so it’s been a nightmare. Our once-gentle child has morphed into a terror. He won’t listen to us, he’s defiant, he’s been arrested twice during the last three months for drug possession, and he’s probably going to fail the tenth grade because he’s skipped school so many days. My wife and I have tried everything; we’ve tried to take Ben to a therapist, but most of the time he refuses to go. We’ve tried family counseling and we’ve put Ben on medication. We feel like we’re running out of options. I got your name from one of my friends at work who knows you help families like ours.”

Mr. H. then asked me whether I had heard of a particular program for struggling teens that a workplace colleague told him about. “I know this program may sound a bit wacky,” Mr. H. said, “but my buddy at work said this program made a huge difference for his son, who had similar challenges.” Mr. H. then went on to describe some of the program’s features. The social worker does not work out of an office or schedule regular appointment times, recognizing that many struggling teens are not comfortable talking to mental health professionals and resist regularly scheduled office-based counseling. This social worker prefers to talk with adolescent clients in natural, outdoor settings, especially while walking in the woods or sitting under a tree. Sometimes the social worker will meet with adolescent clients during early morning or late night hours, if that’s when the client is willing to talk. On occasion the social worker and client may eat meals together and spend the night in the woods. The social worker claims that meeting with struggling adolescents under these nontraditional conditions is often much more productive than traditional office-based counseling.

The Importance of Context
Based on first impressions, this intervention model seems wildly inconsistent with prevailing social work standards. The professional-client boundaries appear to be remarkably ambiguous and risky. But viewed through a broader lens and considered in context, this intervention model, even with its elastic boundaries, is widely accepted among many competent mental health professionals. It turned out that the social worker to whom Mr. H. referred is licensed, well trained, ethical, and employed in a highly regarded, accredited wilderness therapy program designed for struggling adolescents.  Reputable wilderness therapy programs offer highly structured intensive short-term therapy (often six or seven weeks) in remote locations that remove adolescents from the distractions (smartphones, television, music, computers, cars, drugs and alcohol, movies, delinquent peer groups) available in their home communities. According to the model, the challenges of living full-time outdoors and developing wilderness survival skills help teens develop self-confidence and pro-social behaviors. Some families are advised to send their struggling teen first to a wilderness therapy program and then to a therapeutic boarding school or residential treatment program, rather than return the teen to their home community environment. Highly regarded wilderness therapy programs use evidence-based interventions and employ licensed clinical social workers and other mental health professionals.

The principal moral of this story is that social workers must make ethical judgments based on relevant context. Behaviors that are clearly inappropriate in traditional office-based settings—such as dining with clients and meeting with clients in the woods early in the morning or late at night—are quite normative in other settings. 

Here is another compelling example. Melanie was a social worker counseling a man placed on probation following his arrest for impaired driving while under the influence of alcohol. The client, Adam, struggled with alcohol abuse but had never received professional counseling. During the course of their work together, Melanie shared with Adam that she is a recovering alcoholic. Melanie disclosed this personal information mindful of the importance of professional boundaries. She told Adam about her status as a recovering alcoholic very thoughtfully and for two key reasons. First, Melanie worked in a substance abuse treatment center where nearly half of the clinical staff is in recovery. This particular program’s administrative staffers and clinical supervisors believe strongly that clients can benefit from working with counselors who themselves are in recovery; counselors in recovery can be important role models and have a special ability to empathize with clients’ challenges. The program’s counselors, including Melanie, receive ongoing training about the management of professional-client boundaries. Counselors roleplay how to handle self-disclosure and how to avoid inappropriate boundary crossings and problematic dual relationships. 

The second reason Melanie shared esoteric information about her status as a professional in recovery is that, as a matter of agency policy, counselors are expected to discuss with clients how they handle any unplanned encounters if both happen to attend the same 12-step meeting in the local community. Agency counselors are taught protocols to protect clients’ privacy and confidentiality and avoid engaging in behaviors that might cause boundary confusion. For example, typically counselors who encounter a client at a 12-step meeting will leave the meeting and avoid sharing personal information about their own recovery and challenges in a client’s presence. The philosophy at Melanie’s agency is that discussion of these issues in advance of any inadvertent encounter helps minimize boundary confusion.

Once again, context is important. For example, if Melanie were to resign her position and accept a job at a local prison working with inmates who are in recovery, there is a very good chance that the culture in the prison system would be much stricter with regard to counselor self-disclosure. Having worked in adult prisons for many years, my experience is that forms of social worker self-disclosure that would be considered reasonable and appropriate in one setting, such as an addictions program, would not be acceptable in a correctional setting.

In some instances, context is irrelevant when social workers make ethical judgments. Sexual contact with clients is unethical regardless of setting and client population. The same is true of falsifying documents or billing for services that a social worker never provided. But in many other instances, context matters.

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