Case in Point: How Social Work Regulation Advocates for Client Protection

by Timothy Martel Brown, MSW, LCSW, ACSW

     In its Code of Ethics, the National Association of Social Workers (NASW) defines the primary mission of the social work profession: “To enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.” Professional regulation plays a pivotal role in the profession by having a direct impact on public health and safety, providing accountability to the public and the profession. Furthermore, regulation offers an outlet through which clients harmed by unethical practice or others advocating on their behalf can seek protection, which upholds the social work value of social justice.

     Some who dismiss the need for professional regulation protest that social work practitioners are capable of self-regulation, a singular internal state, trait, or stage that is genetically endowed or personally discovered. Although I agree this is true for some practitioners, my tenure as a member of the Texas State Board of Social Worker Examiners (TSBSWE) has proven that not every social worker can self-regulate ethical practice. I would like to share one case that stood out for me during my years on the TSBSWE Ethics Committee as an example of failed self-regulation.

     An older woman who had a significant history of mental illness and was mostly isolated from her family engaged a social work therapist to provide her with mental health care. The therapist reportedly employed Dialectical Behavior Therapy (DBT) with the client. The client was later found deceased in a wooded area outside an urban community during the winter. Soon thereafter, the client’s sister filed an ethics violation against the social worker.

     Formal investigations found that the social worker had obtained the client’s credit card number and billed the card directly for all intervention activities. According to the social worker, these activities included:

• nightly phone therapy so the client could go to sleep;
• accompanying the client during an MRI;
• flying the social worker’s mother from Canada at the client’s expense to help the client (who the social worker reported was a hoarder) clean her home; and
• accompanying the client to Disney World, which included charging the client for travel expenses for the social worker and the social worker’s daughter, because the social worker reported that the client thought Mickey Mouse was a deity.

     When the TSBSWE Ethics Committee confronted the social worker about the voluminous ethical and boundary breaches, the social worker responded: “You don’t understand the intricacies of DBT processes.” The Ethics Committee knew the use of DBT as a model of therapeutic intervention was not the issue. Two issues were identified: using the model outside the methodology established, and the multiple ethical violations performed by the social worker while providing services.

     This case demonstrates the powerful position social workers hold with the vulnerable populations we treat. Had this social worker not been licensed, what accountability would this practitioner have had to the profession or to the client? If not for a regulatory board, who would advocate that unethical practitioners must be held accountable—and that social justice be served?

Timothy Martel Brown, MSW, LCSW, ACSW, is president of the ASWB Board of Directors.