by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way
For most of us, our social work education begins with an introduction to the NASW Code of Ethics. The fact is that we all need to come up with our own set of guiding principles, as well. The Code of Ethics is an excellent set of guidelines, but increased clinical experience forces us to more clearly articulate a set of ethical standards that inform our clinical interactions and decision-making processes.
Over time, I have found tremendous comfort in the NASW Code of Ethics. I have also come to some additional conclusions about how to practice ethically. These ethical guidelines have been born of work with a highly diverse caseload across multiple practice settings.
What differentiates our field from parallel disciplines is our commitment to understanding the system within which our clients function. What this means in practice can vary. It can mean that we understand socioeconomic oppression prior to subscribing to diagnosis. It can also mean that we rarely see an individual’s functionality as distinct from the family system that they are embedded in. For me, thinking from a systems perspective has come to mean that I pay attention to the everyday context of our world. For example, issues of racial injustice have dominated our social discourse in the last several weeks. The vitriol of the presidential campaign is inarguably pervasive. When thinking about client functioning, I have come to think of the system they live within, in addition to the moment by moment impact of pulse and environment of our lives. Clients often disavow or are unaware of how the background noise of our world is affecting their psyches. It is our work to help our clients to understand that we are living in times that truly brutalize the psyche and that it is worth understanding how we can become triggered and how we can work to protect ourselves.
The NASW Code of Ethics calls on us to have utmost respect for diversity. We often think about sexuality, gender, and race when discussing diversity. And although religious diversity is named, we don’t study the significance of this as closely in our training. I have come to find that, ethically, I will believe in whatever God my client believes in while we are meeting with each other. This may seem odd, but the fact is that to truly join clients in their journey, I surrender fully to their belief system while we are together. I find that this allows me to stop judging, questioning, wondering about if there is a God or not. It also allows me to stop wondering if a client is using religion defensively or dysfunctionally. Instead, through a surrender, I am able to enter my client’s world, which has invariably led to richer clinical work.
To work in better accordance with social justice values, the notion that social inequity has reached absurdist levels is worthy of serious consideration. The old adage, “If you aren’t outraged, you aren’t paying attention,” is of particular import at this moment in time. The income gap between men and women, White people and Black people, gentrified vs. non gentrified neighborhoods is absurd. While there are systemic issues that we ought to pay attention to in order to understand why things are the way they are, this should not alleviate the level of outrage that we feel about it. I have found that if I am able to hold the outrage for my clients, it provides them with some relief from having to hold it all themselves. I have also found that my clients feel supported by my understanding of how systemic oppression is affecting their lives. Part of our underlying clinical work must be to keep a steady eye on the increasing ways in which oppression traumatizes the psyche. Our psyches become traumatized when meaning cannot be made of pain. The level of inequity, at this point, completely lacks justifiable meaning, thereby rendering it all the more psychically dangerous. Recognizing and holding this truth is a clinical imperative and ethic.
While there is great attention paid to the importance of valuing diversity in the NASW Code of Ethics, less attention is paid to the fluidity of identity. Awareness has grown around the fluidity of gender identity. However, fluidity around all aspects of identity is a valuable clinical ethic. It is very difficult to not become attached to seeming facts about our clients. In fact, we even introduce our clients with their demographic information. For example, I might present a client by saying: My client is a White, 31-year-old, heterosexual woman who is Christian. The problem with this is that all of these stated “facts” become ideas that I am now attached to in order to orient myself to my client. However, subscribing to the possibility that many of these identities are fluid allows our clients more space to grow, change, and evolve. I have a client who has converted, religiously, two times. I have another who has moved between multiple gender identities. This becomes difficult for me when I feel as if I know something about my client for sure. Instead, I am coming to try and orient myself to my clients’ need to change and grow, knowing that there are very few places in their life where alternating identity presentations are possible.
I am absolutely confident in the essential need for supervision in social work. We ought to use supervision to help us with our blind spots. We also need to use it to keep ourselves boundaried and clear. We ought to use it to support our case conceptualizations. However, part of our social work mandate is to also recognize when not to use supervision.
Not everything our supervisors say is true or right. We need to find ways to use social work supervision honestly and openly, but not with complete deference. Our social work mandate, instead, is to hold onto ourselves and to develop our own clinical voices, taking supervision into consideration, while gut-checking our own values and making our choices in accordance with what feels most true to us. We inevitably know our clients best, and nothing can substitute for this truth.
One of the most difficult social work challenges is to occupy multiple psychological spaces while working with our client. We need to be close to our clients, listening to their stories, hearing their questions, noting their attachment styles. We also need to be hovering above the treatment, making sense of what is happening in a larger way, identifying patterns, tracking symptoms, and studying defenses. We need to be in the real relationship, while also making sense of powerful transference and countertransference trends. A social work ethic is to become someone who straddles multiple ways of being at the same time. We can easily fall into one role or the other, only studying our client or only being with our client. However, our work is only truly made clinical and potentially curative if we are able to hover between worlds and spaces. It may seem strange to consider this an ethic, but at the same time, if our role becomes oversimplified or two-dimensional, we are not fully serving the complexity of our responsibilities.
Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. Read more of her clinical perspective and tips on the most burning questions of developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.