By: Thomas Horn, MSW, RSW
The Code of Ethics of the National Association of Social Workers (NASW) is a clear set of standards that social workers in the U.S. are expected and obligated to follow at a minimum. In my province of Ontario, the Ontario College of Social Workers and Social Service Workers (OCSWSSW) regulates the profession of social work and has published its own Code of Ethics and Professional Conduct, which covers many of the same practice standards. As a Registered Social Worker (RSW) with both the OCSWSSW in Ontario and with the General Social Care Council (GSCC) in England, with yet another code of ethics, I am held accountable by two regulatory bodies to maintain a professional and ethical practice. I could face a disciplinary hearing and possible revocation of my registration to practice social work should I put the public at risk by acting in an incompetent or unethical manner.
I work at a psychiatric hospital in Ontario as a forensic social worker. My colleagues there are aware of my work and would not hesitate to report to management any concerns they have about my skill or judgment. The management is obligated to inform the OCSWSSW should there be evidence of misconduct, but my employer also has its own procedures for investigating a complaint and initiating disciplinary action, which could result in my termination. The police would be invited in to investigate, as well, if there was evidence of any criminal behavior, which could lead to charges against me. There is a great deal of front-line scrutiny when one is an employee.
There is a large contrast between my full-time work as an employee and my part-time work as a self-employed private practitioner—not in terms of my obligation to maintain an ethical and professional practice, but in the level of scrutiny I receive. Even with a clinical supervisor to provide feedback and guidance, this person does not review my clinical files, does not know or ever speak with my clients, and knows only what I share. The responsibility assumed by a clinical social worker in private practice is huge, as are the requirements for a high degree of integrity, knowledge, skill, maturity, and commitment to the Code of Ethics and Professional Conduct.
Ethical decision making can be clear cut, black and white. However, even when the issue is that clear, social workers often need a minute (or more) to process a dilemma and choose an appropriate response. I believe that the risk of making a poor ethical decision may increase significantly within a private practice when there is no direct oversight.
Recently, a situation came up in my private practice during a session with a probation client who had a lengthy history of incarceration (totaling 25 years) with several convictions for violent acts. At his request, a limited number of counseling sessions were arranged for him by his probation officer, with the probation and parole department picking up the tab via third party billing. He had attended a number of sessions, and a positive therapeutic relationship had developed. At the end of one of our sessions, I let “Bob” know that we could not meet on one of our regularly scheduled evenings coming up, because I had another commitment. He was aware of my policy to charge clients the full fee for a session, unless 24 hours notice is given when a session will be missed. Out of the blue, Bob suggested that I keep the appointment and that he cancel it himself with less than 24 hours notice, so that I could still bill and get paid for the appointment.
In my shock, I could not think of what to say to Bob. I immediately knew that I could never agree to such an arrangement, but I also had a flood of other feelings and thoughts. I knew that I had to say something clear and direct, but I was also fearful with the awareness that I had no witnesses, for good or evil. I managed to mumble something like, “That’s not a good idea,” but at the time, I did not state my position clearly and did not give an intellectual reason. The time was up for the session, so I did not have the time to process this with him, even if I had not been at a loss for words.
On reflection, I was able to see the different ways that I was being tested, even if this was not Bob's intent. I remembered that in one of our first sessions, he spoke of how in prison he had earned and built up credits for future favors from other inmates (he was not referring to sexual favors, he said). If you owed him and one day he came to ask for a favor in turn, he made it clear that he expected that request to be honored, no matter how inconvenient or costly for you at the time. Had I agreed to go along with Bob’s proposal, it would have been as if he had done me a favor, and from that point on, he would have power over me through which he could attempt to manipulate and control.
In this case, it would have been an unethical and illegal (fraudulent) scheme for which I would have been totally responsible, and Bob would have been in a position to blackmail me, likely knowing what I had to lose (my license, my career, my savings in legal fees, my freedom in jail time, and by extension, my family). A career criminal, even one who has declared his retirement, tends to count on always coming out ahead, even if it means others get hurt in the process. I had no reason to believe that Bob’s intent was to take advantage of any weaknesses he encountered in me, but it would have been very risky to give him any opportunities to exploit them. Waffling for too long, and not giving him a clear and direct answer that I would never even consider behaving in such an unethical manner, could lead him to believe that I may consider “crossing the line” under different circumstances, which may then have led him on a predatory hunt. I knew that I needed to put this issue back on the table at the start of the next session to clarify my position and the reasons for it.
The other part of the test I encountered that day was perhaps a more therapeutic one. Bob had participated in some group programs while in the penitentiary, but he had never engaged in individual therapy before. He spoke of having respect for the work of the police, correctional officers, and others in authority, because they have a job to do just like he had one as a criminal. However, at no time in his life had he ever developed a trusting relationship with any authority figure, including his absent father or his allegedly neglectful and abusive mother. Perhaps, in his mind, I represent authority, even though he requested these sessions, and I am seen as a willing member of what he considers to be the “shallow” and “dishonorable” system found in the outside world. By comparison, Bob views life in prison as simple, logical, honest, and honorable. He had said before that he distrusted and disliked “society” and “society folk,” but knew he needed to fit in if he was to uphold his promise to his preteen daughter that he would turn his life around and not return to prison.
So, I have to ask myself: Was Bob testing my integrity to see if I can be trusted as an authority figure and an honorable member of society? Was this an act of transference? Was he expecting me to think that his proposal was a great idea, thus confirming his assumption that I am corrupt just like his perception of all other shallow and selfish “society folk”?
He had often complained about getting the “run around” when doing errands at his bank, supposedly being lied to by shop keepers, and being unfairly treated because of his numerous tattoos, physical size, and intimidating looks, while others seemed to get preferential treatment. By passing this test, I would like to believe that Bob will be more trusting in my ability to help guide him toward his goals. His goal is to fit into society as a wolf might fit into a flock wearing sheep’s clothing. This is because he strongly believes that, although retired, he will always be a criminal, just as retired cops will always be cops until they die, because policing is not what they do—it is who they are as an identity.
With these thoughts in mind, I was anxious waiting for the next session, because I did not want Bob to think that my morals were an area of weakness for me, or that I could not be trusted to be honorable. On the other hand, I wanted to be casual and not uptight, as if this was a crisis that really bothered me. After all, I knew from the beginning which direction my ethical compass was pointing and made my choice, but what was bothering me the most was my lack of clarity and firmness in my response to him at the time, and the fact that I did not tell him why it was not a good idea. Thankfully, I was able to deliver these messages to Bob at the start of that session, to which he replied that it was no big deal, because he was just trying to be nice, and that he respected my position. He did not give me much to process with him.
I have to wonder if I would have handled the situation more effectively the first time if, say, this had happened at the hospital and I knew my colleagues were observing the session through a one-way mirror. I would like to think that my inability to clearly and firmly turn down the proposal at the time was because I am human and the setting did not matter. It worries me, though, and as a rule of thumb, I will try to approach every future private practice session as if my colleagues are observing through that mirror and I am being directly scrutinized.
Thomas Horn, MSW, RSW, is a dual Canadian/British citizen and a Registered Social Worker in Ontario and England. He is employed as a forensic social worker at a large psychiatric facility in Hamilton, Ontario, and has a busy private practice. He has worked in inpatient, outpatient, and correctional settings for the past 20 years.
This article is from the Spring 2010 issue of THE NEW SOCIAL WORKER. Copyright 2010 White Hat Communications. All rights reserved.