Client Relationships and Ethical Boundaries for Social Workers in Child Welfare - dayline.info
Workers in child welfare are often found in dual client relationships. Social workers must be knowledgeable and mindful of the NASW Code of Ethics . Is it a violation of ethical boundary if I work in HSS and mental health clinician and met. The Clinical Social Work Association (CSWA) code of ethics presented here is of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, ) b) Clinical social workers do not exploit professional relationships sexually. Ad Hoc Work Group on Revising the Ethics Annotations. Members. Rebecca W. The ethical and professional basis of the physician-patient relationship .. by religion, and the complex social and economic contexts of practice. Obtaining .
This way of thinking is intended to be protective of clients and can help prevent various kinds of abuses, up to and including taking advantage of clients sexually. Among students, senior clinicians, and many faculty, this is a near universal opinion. To challenge it can bring some negative reactions from peers.
But is it a valid premise? Is it always helpful to think that way? Before you read further, let me be absolutely clear. In no way am I supporting or encouraging any activity with a client or former client that would be exploitive.
This includes sexual relations with clients, as well as any situation in which we exert undue influence over a client for our own benefit. And if so, what are the logical ramifications or consequences?
In small rural communities, this situation would be more acute, but the principle would be the same in big cities, too. You are interested in politics in your community and decide to run for school board. You find out a former client has also announced his or her candidacy. Do you campaign against your former client, or withdraw because it would be a conflict? Our clients are often free to join many, if not most, of the organizations where we are members.
Do we withdraw if they join our groups? Do we bar their membership if we can? This could include online networks, as well. You provide therapy to a child. Ten, fifteen, or more years later, that patient becomes a prominent, top in their field, attorney, surgeon, or other highly specialized professional.
You discover that you need someone with those highly specialized qualifications. If the client is still a client even after all those years of no contact, is that a conflict of interest and a prohibited dual relationship? If it is an issue of power, who is in the position of power?
Is power in any relationship always static, or is it variable and subject to change based on the circumstances? Dual or Sequential Relationship When a therapist and client enter into a relationship that is outside of or in addition to the therapeutic relationship, it is generally referred to as a dual relationship. Dual relationships are discouraged by most professional organizations.
However, not all experts in the field believe that all dual relationships are necessarily harmful. It would depend on the context.
- Client Relationships and Ethical Boundaries for Social Workers in Child Welfare
- 'Til Death Do Us Part: Does a Client Ever Stop Being a Client?
- Dual relationships in mental health practice: issues for clinicians in rural settings.
However, when a therapist and long past patient enter into a relationship separate from the therapeutic one, is that actually a dual relationship? Would it be more accurate to call it a sequential or serial relationship?
Dual relationships in mental health practice: issues for clinicians in rural settings.
Is there a difference? If one believes that our patients grow mature and sometimes surpass us in knowledge, wisdom, and power, then it is a significant difference. Of course, of all the dual or sequential relationships that are potentially possible with patients and former patients, when the issue of sex comes up, most all therapists of all disciplines react forcefully. Having sex with a current patient or even a recently discharged patient is not only unethical—it is illegal.
It is truly a betrayal of the trust the patient places in us. However, over time as in yearscan that change in some very special circumstances to allow exceptions to the rule? If a therapist and former patient meet some 10 or 15 years after the last therapeutic session and develop a personal relationship, get married, and have children, can we say that an ethical violation or a crime has been committed?
The therapist must decide where advice ends and therapy starts. And where advice itself is therapy. The therapist may have to get involved in a mutual participatory model, wherein there is a lot of give and take of ideas and action plans. Clients, who prefer to take charge of their lives, but with specialised help, are especially suited for this model.
The psychiatrist has more chances to develop social and physical intimacy with his patients. However, the guidelines maintain that this is unprofessional. In a case where you already have social intimacy with a patient, it is preferable to refer this patient to another psychiatrist. Certain reportable conditions Patient expressing suicidal or homicidal intentions: Consents Informed consent is both an ethical and legal issue.
It consists of the following components: The patient and relatives must be given reasonable information about the sickness and possible modes of treatment in the language they understand. Common side effects of any drugs need to be told.
Consent for any procedure or treatment is necessary. Either implied consent, oral consent or written consent, as the case may be. In case of procedures like electroconvulsive therapy in psychiatry, there is the need to have details in the language understood by the patient and his relatives.Ethics in Professional Social Work
This is the capacity to weigh, reason and make reasonable decisions based thereon. If a patient is incompetent, appropriate health care proxy, e.
For practical reasons, when a patient is not competent, relative's consent for the treatment should be considered sufficient.
Doctor-Patient Relationship in Psychiatry
However, when legal hassles are anticipated, e. Malpractice and liabilities Misdiagnosis: It is not expected that a psychiatrist should diagnose by the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases system. But he must use his average skills in coming to conclusions. Legal issues arise when an organic condition in missed, and suicidal or homicidal risks are not properly evaluated. This includes under-treatment, over-treatment, wrong treatment, treatment without informed consent, involuntary treatment, side effects of treatment.
When prolonged hospitalisation is necessary, the patient and relatives should be properly explained.
If necessary, a second opinion should be sought even in case of voluntary admissions. Definite guidelines exist in the case of involuntary admissions and must be followed. Improper relationship with the patient. Sexual relationship with a patient, exploiting a patient, social and economic deals with patient are not acceptable. As written earlier, even social intimacy with patient is not desirable.
Any sexual or physical intimacy is considered malpractice. There remain certain grey areas: Who bears responsibilities for mistakes done by subordinates? What is a psychiatrist's legal standing in a joint consultation? Liability prevention Liability prevention consists of the following: Needless to say, the greater the competence, the lesser the need for liability prevention.
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Updating on knowledge and skills and judicious use of therapy is mandatory. Case histories and case records are a must. Even as case papers may be given to the patient, a record of the same in the office is a wise practice.
Knowledge of legal and ethical issues: Adequate knowledge of legal and ethical issues to anticipate and abort potential liability action is necessary for a clinician, much as he cares for and is dedicated to patient welfare.
Also, remember the Bolam principle which states that management of a patient should be in accordance with a practice accepted at the time as proper by two different responsible groups of medical opinion of the same speciality.
Consultation second opinion in difficult and complex cases: It is always wise to seek a second opinion or senior's opinion in difficult and complex cases.
This does not undermine one's authority, rather it adds a necessary alternative opinion and outlook which may help patient welfare, and also protect the doctor against potential liability threats. This had been discussed earlier. This is the refrain of this whole paper. Better the relationship, lesser the chance of liability hassles.
In spite of doing the best of everything, Medical Indemnity insurance must be taken; for, sometimes, the best of intentions, procedures and therapies may not guarantee immunity from potential legal difficulties.
Commercial aspects Professional fees: In private practice, a doctor has the right to charge his appropriate fees. He should reveal his fees to the patient at the first interview if asked about it. If not, charging appropriate fees depends upon time, area of practice, seniority, etc. If the patient refuses, or is unable to pay, politely guide him regarding other avenues for treatment; or, if felt appropriate, give due consideration to his limitations by lowering the fees. Withholding prescription and advice because patient cannot pay is generally not done at the first interview.
This helps them determine further involvement with therapy.