ESSENTIAL BOUNDARIES IN CLINICAL SOCIAL WORK PRACTICE
By Jacalyn Anne Claes, LCSW, PhD
This "Perspective" is a reprinted article which was originally published in the North Carolina Social Work and Licensure Board Update Newsletter [Winter 1999].
Many social workers have difficulty owning the power that the hold in relationships with their clients. Under the veil of egalitarianism and equality, some social workers believe that if they act as though there is no power hierarchy in the therapeutic relationship, then the hierarchy will disappear. However, by not claiming the power they hold, they place their clients at personal risk.
According to Marilyn Peterson, author of At Personal Risk, therapists as members of the professional community must (1) take charge of the relationship with their client, (2) accept responsibility for having greater power than the client, and (3) consistently place the needs of the client before their own. Peterson believes that therapists are “secular shamans” who have been entrusted by society with the care of the psychic well-being of its members.
The social work professional’s code of ethics is the secular expression of the therapist’s sacred covenant to place the needs of the client before their own. This is crucial in making it safe for clients to become vulnerable in therapy and let down their defenses so that change and growth can occur. The client in this process temporarily relinquishes some autonomy in order to be open to influence and change in the therapeutic relationship. The therapist, in turn, agrees not to misuse this vulnerability for their own gain. Our professional code of ethics assists us in boundary maintenance by providing rules that restrict therapist self interest.
Boundary violations are often hard to discern. Some guidelines to assist therapists are delineated by Peterson. One element to be aware of is role reversal. Rather than the therapist nurturing the client, the roles are reversed and the client feels a responsibility for taking care of the therapist. Examples of role reversal range from client appointments being routinely changed to accommodated the therapist’s routine to a client feeling responsible for bolstering the therapist’s ego and therefore not disclosing when they are stuck and therapy is not meeting their needs.
Another guideline for discernment is the withholding of information from a client. This is particularly important when the disclosing of such information would make the therapist appear in a less than favorable light. Often if clients had full disclosure of hidden agendas, boundary violations would not occur.
When boundary violations do occur, clients are placed in a double bind, believing that they will lose, no matter which choice they make. Either s/he risks their integrity or they risk alienating the therapist. When this occurs, the therapist is exploiting his/her privileged relationship with the client and the client is left unprotected.
While the therapist must be conscious of the power that they hold, they also must be aware that it is the client and not the therapist who ultimately controls the outcome of therapy. The client alone decides how much effort s/he will expend toward changing and working toward goals. This dynamic provides a level of tension in the relationship which may cause some discomfort for therapists. As professionals, we need to avoid the temptation of reducing the discomfort by pretending to relinquish our power to the client. Rather, we need to sit with the discomfort of taking responsibility of providing a container that encourages change, and powerful interventions that are catalysts for growth, while acknowledging the client’s power to control the outcome. In doing this, we keep our commitment to an ethic of care.
It is within the sacred covenant of our profession as clinical social workers that we put our clients’ needs first. If we, as clinical social workers, simply remember this, then few boundary violations will be committed. If we always put our clients’ needs before our own desires, our clients will not be exploited in the therapeutic relationship.
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