Eye on Ethics

Novel Boundary Challenges — Military Social Workers
By Frederic G. Reamer, PhD
September 2014

In recent years I have had the opportunity to provide ethics training and education in various parts of Asia and Europe to U.S. military social workers who serve active-duty personnel and their dependents. Typically we spend a number of days together exploring complicated ethical issues related to client confidentiality, privileged communication, conflicts of interest, boundaries and dual relationships, informed consent, documentation, digital technology and social media, and termination of services. During my presentations I distinguish between ethical challenges military social workers face that are comparable to those encountered by colleagues in civilian settings and those that are truly unique to military settings. Here are several examples of the latter that have emerged during my work with military social workers:

• An active-duty social worker in the Marines was embedded with a battalion as part of the Operational Stress Control and Readiness (OSCAR) program that provides mental health and stress control guidance. Embedded social workers are combat stress control professionals whose mission is to assist Marines wherever they are deployed. The model is designed to enable Marines to have immediate access to a behavioral health professional no matter where they serve. During our discussion the social worker shared anecdotes about challenging boundary, privacy, and confidentiality issues that arise when practitioners share living and working conditions with clients in remote locations.

• An active-duty Army social worker, a captain, told me about a daunting challenge she faced when she provided counseling to a lieutenant colonel who sought assistance to address difficult marital issues. During the seventh week of their work together, the base was placed on high alert. The lieutenant colonel, who outranked the social worker, was required to provide supervision and issue orders to his social worker. The social worker shared how awkward it was to manage her relationship with her client outside of the office in a setting that required the client to oversee some of the social worker’s duties.

• An Air Force social worker provided counseling to a fighter pilot who was struggling with sudden onset of debilitating anxiety. The social worker described to me the difficult decision he had to make when he was ordered by the pilot’s commanding officer to prepare a “fitness for duty” report. The social worker said that in his earlier career as a civilian social worker in mental health settings he never had to wear two potentially-conflicting “hats,” that is, serve as both counselor and formal evaluator.

• A Marine Corps social worker lived on base in Okinawa with her husband, also an active-duty Marine, and two school-age children. The social worker’s older child, age 9, was enrolled in the school on base operated by the U.S. Department of Defense. One afternoon the child told his mother he made a new friend at school and wanted the friend to spend a night at their home during the coming weekend. The social worker, who was delighted that her son made a new friend following their recent move to Okinawa, told her son that would be fine and that she would contact the friend’s parents to make arrangements. The social worker spoke to the friend’s father on the telephone and quickly realized that the mother of her son’s new friend, an enlisted Marine, is the social worker’s client; the son’s surname is different from his mother’s. The social worker discussed how challenging it was to manage the unanticipated dual relationship.

• A Navy social worker embedded on an aircraft carrier provided counseling to a sailor who was ordered to received mental health services following a serious disciplinary incident. One week after counseling began, the social worker was subpoenaed to testify in the sailor’s court martial proceedings. The social worker explained that he was unfamiliar with provisions in the Military Rules of Evidence regarding client confidentiality and privilege in cases that arise under the Uniform Code of Military Justice.

• A school-based Army social worker provided counseling to a 16-year-old student who was struggling in school and manifested symptoms of clinical depression. During one counseling session the youth disclosed that he has been abusing various substances and felt the need for help: “I’m really worried this is getting out of hand. The truth is, I’m scared.” The social worker said she told her client about a well-established program her office sponsors for adolescent dependents of military personnel who are dealing with substance abuse issues. The youth told the social worker he was eager to participate but refused to allow the social worker to inform his parents about his substance abuse issues and obtain their consent. The social worker was unsure how to proceed; the youth’s state of residence, the state where the social worker is licensed, and the state where the Army base is located have very different laws concerning minors’ right to consent for treatment for substance abuse and parents’ right to be notified and consent. 

Ethical Challenges for Military Social Workers       
In a number of important respects, clinical social workers in military settings face ethical issues that are comparable to those found in the civilian sector. In both domains social workers must be knowledgeable about and comply with mandatory reporting laws concerning child abuse and neglect; avoid falsification of records and client abandonment; adhere to the NASW Code of Ethics; and practice only within the limits of their education, training, areas of expertise, and license. But in other ways social work practice in military settings is truly unique. Social workers in military settings must be particularly skilled in the management of boundary and dual relationship issues that arise when practitioners and clients live and work in small communities (not unlike the challenges that many social workers face in rural settings). Active duty military social workers must anticipate the possibility that their clients will outrank them; their relationship outside the office must follow radically different norms and duties. Social workers who are embedded with soldiers, Marines, sailors, and airmen must be skilled at managing complicated boundary, confidentiality, and privacy issues.

Military social workers who serve minors of active-duty personnel must be familiar with informed consent protocols and confidentiality guidelines that are complicated by the fact that services may be provided in a setting, whether in the continental United States or abroad, where the laws differ significantly from those of both the client’s and the social worker’s legal state of residence. Further, military social workers must know how to handle conflicting roles where they serve as both clinician and fitness-for-duty evaluator. And, military social workers must be skilled at making complicated decisions about disclosure of confidential information without their clients’ consent when commanding officers request information or there are national security or other safety risks involved.

Every social work setting poses unique challenges. Although social workers in hospice programs, prisons, child welfare agencies, mental health and addictions programs, older adult programs, foster care and adoption agencies, and schools confront a number of similar ethical issues, each setting also poses ethical challenges one is not likely to encounter elsewhere. The ethical challenges faced by military social workers provide a compelling illustration.

— 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.