By: John K. Mooradian, Ph.D., ACSW, LMFT
Professional social workers operate in the context of human relationships and often encounter situations in which clients live with patterns that signal abuse, even if decisive action or legal procedures are not immediately mandated. These patterns are conceptualized as “everyday violence” because they diminish human experience and imbue relationships with tension, fear, and limited options. Under the conditions of everyday violence, clients may face the difficult choice between maintaining a valued but flawed connection and pursuing safety by ending the relationship. Social workers who are involved in such cases face the ethical challenge of balancing client self-determination with the requirement to keep clients safe, while simultaneously upholding the primacy of relationships. This article outlines the ethical issues involved in such situations, provides case examples for application of relevant ethical principles, and offers a brief framework for ethical practice.{quote_top} The preamble of the NASW Code of Ethics states that, “The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people….” (NASW, 1999). This is a noble and meaningful description of our work, and it propels many of us into the private plots of human experience. To be a social worker is to enter the warm spaces of human contact and connection, and also the cold corners of harm and humiliation. To be a social worker means that we must labor within the limits of other people’s lives, and sometimes a professional course of action requires that we balance conflicting values, choices, actions, and consequences.
As a professional, you are in the business of change. That’s clear, but how do you decide what changes to pursue? When do your values and those of your client intersect, when are they parallel, and when do they conflict?
Often, our clients experience events that don’t manifest as full-blown domestic violence, but are dangerous nonetheless. These situations are unclear, ambiguous, and fraught with disturbance. They may, in fact, characterize whole relationships or arise at any time in an unpredictable way that puts a person on constant guard. In this way, we might think of these events as “everyday violence.”
Clients may find themselves in the position of choosing between the comfort of connection with a significant other and the physical and emotional safety that comes from leaving the relationship. As a professional, you may have to balance both, or prioritize one of these elements. You may even have to establish intervention plans that support either the improvement or the termination of a relationship that is meaningful to your client. What actions are you prepared to take when people find themselves in unsafe situations? What are your alternatives when people seem to choose an unsafe relationship? How will you handle the dual responsibilities of ensuring safety and respecting client choice, while holding relationships to be of primary importance?
The NASW Code of Ethics provides a welcome framework for professional decision-making in this context. Despite the clear language and obviously careful efforts to specify actions, any such code requires translation to be a usable guide for action. Taken principle by principle, the code is clear and specific. These ideals seem to predict fair weather sailing, but the skies in the real world are a bit cloudier, and under the prevailing winds of human relationships, the sail can begin to flutter.
An ethical challenge is raised when professionals attempt to implement the value of self-determination in situations of everyday violence. The process is often further complicated by the professional value that recognizes the importance of human relationships.
We must adhere to the ethical principle that social workers recognize the central importance of human relationships, and that continues to state:
Social workers understand that relationships between and among people are an important vehicle for change.... Social workers seek to strengthen relationships among people in a purposeful effort to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities.
Ethical Standard 1.01 specifies the social worker’s commitment to clients and states: Social workers’ primary responsibility is to promote the well-being of clients…. This standard directs professionals to focus on what will be best for clients and to act accordingly.
Ethical Standard 1.02 requires social workers to support self-determination:
Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients' right to self-determination when, in the social workers' professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.
This provision also alludes to the legal obligation to take decisive action to protect clients from harm. In many cases, clients may not foresee serious or imminent risk, but a competent professional may be able to identify a progressive process that poses increasing risk over time. A fully abusive relationship may not yet exist, but may be easily predictable in the near future. In some situations, the possession of professional judgment may complicate decision-making, because the social worker holds knowledge of progressive problems that is not immediately available to the client.
To apply these principles and standards, and to prepare yourself to sort out your options when you face such an ethical challenge, it may be helpful to wrestle with the following case examples. Each of these is real and emerged from my experience in private practice. Read them and try to determine your own answers to the following four questions:
1. In which cases should the relationship end?
2. Under what conditions, if any, would you support the relationship?
3. What actions would you take to end or support each relationship?
4. How will you assist the primary client in making a sound decision about the relationship?
“No one will ever harm my child!”
Billy and Bobbi are a married couple with a 3-year-old son named Ben. Billy has been experiencing a lot of stress in his sales job. When he got home from work one evening last week, Ben was crying, and Billy yelled at him to stop. When Ben’s cries got louder, Billy raised his hand to strike the child. Bobbi intervened and took Ben with her to a domestic violence shelter. She told the counselor about her experience as a child who was beaten regularly by her own mother, and vowed that no one will ever harm her child.
{quote_middle} Is the worth of the marriage higher than the safety risk? Is this an isolated incident, or a portent of things to come? Who is at risk, the mother or the child? Can the mother effectively protect the child? Should she have to do so?
“I can keep him calm.”
Ellen and Donald have been married for 18 years. They have two sons ages 16 and 14, and a daughter who is 11. On their first date 19 years ago, Donald told Ellen to have sex with him in his car and said that he would not let her go unless she did. She had been a virgin until that time, felt responsible for what had happened, and married him. She is currently depressed and mentions suicidal thoughts. She works in her own retail business, and Donald comes in occasionally to check on her. When he’s there, he intimidates her employees. At home, Donald yells and swears at the kids quite often and threatens to hit them, although he has never acted on these threats. Ellen tries to stay in constant touch with each of the kids when they are at home with their father. She tries to protect her children, because she fears that her husband will become violent with them and is terrified of what he would do if she ever decided to leave him. She believes that she can keep Donald calm as long as she has sex with him regularly.
If you believe that the husband raped the wife prior to marriage, can this be considered a valid relationship? Is it fair for the wife to live with the pressure of predicting the husband’s violence and having to protect her children? Should she continue to have sex as a means of reducing risk? Does the fact that they’ve been married for 18 years affect your assessment of risk? What would you expect to happen if she decided to leave him after all these years of marriage?
“He’s usually a good guy.”
Jamie is 21 and has a 5-year-old daughter born out of a teen pregnancy with a prior boyfriend. She has been afraid that she will never find a guy who will “want” her since she already has a kid. That’s why she was so excited to meet Brian at a bar and enter into a relationship with him about a year ago. Brian is a “rich kid” with a “big inheritance” who’s a few years older than Jamie and “doesn’t need to work.” He tells Jamie that he loves her and that he can’t live without her. He thinks she’s beautiful and says that he will stay with her forever.
Brian drinks alcohol every night, and when he’s with his friends, he gets falling-down drunk. One night, he managed to get to Jamie’s house after leaving his favorite bar. He pinned Jamie on her bed with his body weight and attempted to have sex with her while her daughter was asleep in the next room. Jamie didn’t want to have sex under these conditions and put him off by talking her way out of it until he passed out. Then, she pushed him off. She wants to give him “another chance” because he is “usually a good guy.” Sometimes, though, he harshly criticizes her child rearing and tells her that she is too dependent on her mother. Jamie and Brian also argue often about his drinking and his lack of responsibility.
Does the lack of commitment make this relationship expendable? Does alcohol abuse increase the safety risk? Does the sexualized aggression require an end to the relationship? What do you make of Jamie’s fears that no man will want her?
10 Decision-Making Steps
In addition to considering these scenarios and addressing the questions provided, it may also be useful for you to practice applying the following steps in your attempts to resolve ethical challenges like the ones outlined above.
1. Clearly identify your personal reaction to the situation. What thoughts and emotions does this situation raise for you as a person? What kinds of actions do you want to take?
2. Clearly identify your client’s perception of the level of risk. How dangerous is this situation according to your client? Do you see the same level of risk, or is it higher or lower based on your knowledge?
3. Ascertain your client’s preference under the current conditions. What does your client say she or he wants to do with this relationship? What motivations, fears, or needs underlie the stated preference?
4. Determine what part of the current conditions your client would like to change. What would your client like to keep in this relationship? What would your client like to remove from this relationship?
5. Identify the systemic cycle of interaction that perpetuates the problem, without blaming either party. What does each participant do that keeps the problem recycling? Which of these actions can be changed?
6. Anticipate the effect each choice might have on members of the client’s natural system (children, family of origin, non blood-related kin, and others) If conditions do not change, what will happen to the client, to the partner, to the children? If a change is made, what will happen to the client, to the partner, to the children?
7. Review the case, including your possible actions, with your supervisor or an experienced and trusted colleague.
{quote_bottom} 8. Select what appears to be the best course of action under the circumstances and share the decision-making process with your client.
9. Implement your action plan with your client.
10. Review the consequences of the actions taken and provide continuing support for your client.
Being prepared through study, supervision, reflection, and anticipation can ease your journey through the sometimes stormy waters of ethical practice. Your efforts at this point in your career will help you stay the course and make the trip very rewarding.
Reference
National Association of Social Workers. (1999). Code of ethics. Washington, D.C.: NASW Press.
John K. Mooradian, Ph.D., ACSW, LMFT, is an Assistant Professor in the School of Social Work at Michigan State University. He is coordinator of the Certificate Program in Clinical Social Work with Families. Inquiries should be directed to Dr. Mooradian at 254 Baker Hall, School of Social Work, Michigan State University, East Lansing, MI, 48824-1118. He may also be reached at mooradi1@msu.edu.
This article appeared in THE NEW SOCIAL WORKER magazine, Spring 2006, Vol. 13, No. 2. All rights reserved.