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Ethics Alive! Social Work With Client Friends and Family: Avoiding Collateral Damage

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by Allan Barsky, J.D., MSW, Ph.D.

     The first standard in the NASW Code of Ethics (2008) advises social workers that their primary ethical obligation is to their clients. Unfortunately, the Code is silent on what obligations, if any, social workers owe to clients’ family members, friends, and other collaterals who may be brought into the helping process. The Code devotes entire sections on obligations to co-workers, employers, the profession, and society. Does the Code’s silence on collaterals mean that there are no obligations to them? The Code is not intended to limit ethical obligations, but to provide guidance on standards to consider (Reamer, 2013).     

    The Code’s drafters knew that not all ethical questions would be covered by the specific standards enunciated in the Code. The preamble suggests social workers should also use the profession’s values and principles to guide ethical decision-making. The preamble states, “Social workers’ decisions...should be consistent with the spirit as well as the letter of this Code.” Accordingly, social workers may use the spirit, values, and principles enunciated in the Code to inform their ethical choices when social workers are interacting with collaterals (Beauchamp & Childress, 2012; Dolgoff, Loewenberg, & Harrington, 2012). Further, as virtue ethics suggest, the ethical obligation of social workers to act as competent, caring professionals exists regardless of whether a particular situation is covered by the Code of Ethics (Cohen & Cohen, 1999; Tjeltveit, 2004).

Elmer and His Wife

    Consider a social worker, Sly, who is helping an older client, Elmer, cope with traumatic brain injury (TBI). During the second session, Sly suggests that Elmer bring his wife, Wendy, to the next session so he can help educate her about the nature and effects of TBI. Elmer agrees. When Sly meets Wendy, he welcomes her with a kiss. He thanks her for coming to support Elmer. Sly asks about the stress she is experiencing in having to cope with Elmer’s TBI-related personality changes.

    On first glance, you might think that Sly has breached ethical standards related to sexual boundaries (S. 1.09) or physical boundaries (S. 1.10) by kissing Wendy. Further, you might think Sly has breached her right to informed consent (S. 1.03) by inviting her to learn about TBI but then interrogating her with questions to evaluate how she is handling stress. You might also consider whether he violated Standard 1.07 on confidentiality, because he did not explain the nature of confidentiality and its exceptions. Remember, however, that each of these standards refers to obligations to clients. Wendy is a collateral, not a client. Accordingly, Wendy would not have standing to complain to the NASW that Sly has violated these provisions of the NASW Code.

    Still, the principles behind these standards should apply. In terms of the standards on maintaining appropriate physical and sexual boundaries, for instance, social workers believe in the principle of respect for the dignity and worth of all people. For Sly to kiss Wendy during a session, he may be demonstrating disrespect to Wendy (as well as Elmer). He may also be exploiting a vulnerable person. Wendy may feel that she has to tolerate Sly’s advances to ensure that her husband receives services from Sly.

    With regard to informed consent, although Wendy cannot claim that Sly violated Standard 1.03, he did violate the spirit of this section. Even though she is not a client, does she not deserve to know why she has been asked to participate in the session? She thought she was coming to learn about her husband’s TBI, but now she is being asked very personal questions.

    Likewise, although Wendy does not have a right to confidentiality under Standard 1.07, wouldn’t it be respectful for Sly to explain the nature of confidentiality to her? Wouldn’t it be unethical for Sly to share information with the public about Wendy, even though the Code is silent on the ethical obligations to collaterals?

Ross and Friends

    Now, consider a situation in which five friends hire a social worker to assist with an addictions intervention. The friends are concerned that Ross has a problem with alcohol. The social worker designs and facilitates a meeting in which they confront Ross about his condition. The worker counsels the friends to inform Ross that unless he agrees to treatment right away, they will withdraw their friendship and support.

    In this situation, the friends may be viewed as the clients, because they sought the services. Ross has not asked for or agreed to help, so he is not a client. During the meeting, what ethical obligations, if any, does the worker have toward Ross?

    As with the prior case, one could argue that Ross (as a collateral) still has a right to be informed about why he has been invited to the meeting. One could also argue that although the worker’s primary obligations are to the friends, the worker should not ignore Ross’s wishes and well-being.

    Interventions designed to confront people about their addictions can be risky. Although the intent is to motivate the person to accept treatment, the person might reject treatment and suffer further. For instance, Ross might become depressed and suicidal. In addition to being treated with respect, isn’t Ross also entitled to professionally competent practice from the worker (S. 1.04)? Once again, even though the NASW Code is silent about obligations toward collaterals, the general principle of professional competence should apply.

Veronique, the Case Aide, and the Social Worker

    Finally, consider a situation involving two practitioners and one client. Cassidy, a case aide, refers Veronique to Sharon, a licensed clinical social worker who specializes in the treatment of eating disorders. Cassidy, Veronique, and Sharon have a joint session so Cassidy can help Veronique explain her situation to Sharon. Later, Veronique refuses to pay Cassidy for her services, claiming that she “did nothing” to help her. Cassidy’s agency initiates a lawsuit to recover unpaid fees. As part of this lawsuit, Cassidy’s attorney subpoenas Sharon’s client records to help prove her case.

    Assume that because Sharon is a licensed mental health professional, state laws grant privilege to her confidential work with clients. However, Cassidy is not a licensed professional and she may be able to share client information in the court case. The question arises: should Cassidy be allowed to use Sharon’s client records in a court proceeding? Unfortunately, the NASW’s section on confidentiality (S. 1.07) does not directly address this situation. Under S. 1.07, Sharon should try to protect her client’s confidentiality as much as possible; however, does she have any obligation to support a co-professional who has not been paid for services rendered? How should Sharon balance her obligations to Cassidy and Veronique?

Collateral Agreements

    In the absence of laws or ethical standards that speak to particular issues, it is helpful for social workers to have agency policies and contracts that fill these gaps. For instance, before Sharon agrees to meet with Cassidy and Veronique, Sharon should ensure they have an agreement regarding what the meeting is about, what information will be shared, and how that information may be used. Similarly, the social workers in the first two cases could have used contracts to engage the collaterals in informed consent processes. Although informed consent and contracts have traditionally been used with clients, they can also be used with collaterals to clarify expectations, to pre-empt conflicts, and to provide clients, collaterals, and social workers with legal safeguards. Service contracts with collaterals could be used to explain and address the following concerns:

    In practice, there are many times when social workers deal with collaterals without having explicit agreements dealing with these issues. Some workers and agencies may believe that it is not practical or necessary to have agreements with collaterals. Consider, for instance, the time it would take to go through the terms of a service agreement with each and every family member, friend, or associate that a social worker contacted. In some situations, the involvement of a collateral is relatively minor, and the risks of not having an explicit collateral contract are not very high. In other situations, however, collateral contracts could be vital.

    Given that social work values the importance of social relationships and supports collaboration among clients, family, friends, and other supports, workers should at least consider their ethical obligations toward collaterals. Even though the worker’s primary obligations are toward clients, the core values and principles of social work may be applied to guide interactions with all people involved in the helping process.

References

Beauchamp, T. L., & Childress, J. F. (2012). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.

Cohen, E. D., & Cohen, G. S. (1999). The virtuous therapist: Ethical practice of counseling and psychotherapy. Belmont, CA: Brooks/Cole.

Dolgoff, R., Loewenberg, F. M., & Harrington, D. (2012). Ethical issues for social work practice (9th ed.). Belmont, CA: Brooks/Cole—Cengage.

National Association of Social Workers (NASW). (2008). Code of ethics. Washington, DC: Author. Retrieved from http://www.socialworkers.org/pubs/code/code.asp

Reamer, F. G. (2013). Social work values and ethics (4th ed.). New York: Columbia University Press.

Tjeltveit, A. C. (2004). The good, the bad, the obligatory, and the virtuous: The ethical contexts of psychotherapy. Journal of Psychotherapy Integration, 14 (2), 149-167.

Dr. Allan Barsky is Professor of Social Work at Florida Atlantic University and former Chair of the National Ethics Committee of the National Association of Social Workers. He is the author of Ethics and Values in Social Work (Oxford University Press), Conflict Resolution for the Helping Professions (Oxford University Press), and Clinicians in Court (Guilford Press). The views expressed in this article do not necessarily reflect the views of any of the organizations with which Dr. Barsky is affiliated.

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