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Boundary Issues and Dual Relationships in Social Work

Boundary Issues and Dual Relationships in Social Work
Frederic G. Reamer, PhD
September 3, 2021

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Editor’s note: This text-based course is an edited transcript of the webinar, Boundary Issues and Dual Relationships in Social Work, presented by Frederic Reamer, PhD.

Learning Outcomes

After this course, participants will be able to:

  • Identify ethics and risk management issues related to professional boundaries and dual relationships.
  • Apply relevant ethics standards to manage boundaries and dual relationships.
  • Use protocols designed to protect clients and help prevent litigation and ethics complaints.

Introduction and Key Concepts

Let me start with several key concepts. First, I think it is important to acknowledge that until the 1990s, the social work profession did not explore boundary issues in great depth. We've always been aware of some obvious issues. For example, involving intimate or sexual relationships with clients and former clients. Beyond that, there was not much in-depth exploration of the nuances, the challenging issues until the 1990s, and this reflects what I think is the remarkable maturation of social workers’ understanding of and exploration of ethical issues in the profession.

It is easy, I think to demonstrate that in the 1990s, there was a sea change when along with many other professions, social workers began to really appreciate the complexity involved in ethical challenges that emerged in our work.

In my opinion, boundary issues occur when practitioners relate to clients in more than one relationship, and dual or multiple relationships can occur simultaneously or consecutively. Dual or multiple relationships can occur in three different contexts:

  1. They can arise in a professional relationship. For example, when a former client of ours becomes a colleague. I have been involved in a number of cases where that in fact has happened, where a social worker is attending a meeting in-person or via Zoom with staff members at the agency, and another participant was once a former client who got training in social work became a colleague and is now interacting in a professional way.
  2. They can arise in social relationships. Many of you, I suspect have encountered clients in the community. Sometimes these are very brief innocuous encounters that do not present any significant complications, but some of you may, for example, live in small and rural communities where it is virtually impossible, not to have social encounters with clients or former clients, and some of these can become quite complicated.
  3. They can arise in business relationships. You might be thinking, what business relationships? Who would go into business with a client? Well, I have in fact, testified in several litigation cases and licensing board cases where social workers entered into a business relationship with a client or former client, and it erupted and led to a lawsuit or a licensing board complaint or both.

This is kind of a global definition of boundary issues and dual or multiple relationships. There is a very important conceptual distinction between what we call simultaneous dual relationships and consecutive relationships that involve boundary issues. 

Simultaneous Dual/Multiple Relationships

In my experience, sometimes we encounter clients simultaneously. For example, we may live in a small and rural community. We have children that are of similar ages, they are in class together, and we are interacting as social worker and client. And on other days of the week, we may be encountering each other as parents of our children who have become playmates in their respective third grade class. That is a simultaneous dual relationship. 

Another example, you may be a social worker who goes to a church or a mosque or a synagogue, and you encounter a client in your congregation; whether it is in-person or a remote service, and you are interacting simultaneously, not in the very moment, of course, but during the period of time, when you are providing professional services, you are also interacting with your client in a place of worship. 

Consecutive Dual/Multiple Relationships

Then there are so-called consecutive dual relationships where for example, social workers may encounter clients quite some time after they have terminated services. So, a year later, two years later, all of a sudden you find out that your former client is working in your place of employment. As I mentioned earlier, as an example, or in the digital age, sometime after termination of services, you get a Facebook friend request from a former client, and that raises an interesting boundary issue with regard to whether it is permissible to engage in an online relationship with a former client.

So, dual relationships can be simultaneous that is they occur during the time you are  providing services to clients or consecutively following the termination of services. 

Examples of Boundary and Dual Relationship Challenges in Social Work

Let me give you some examples of boundary and dual relationship challenges in social work. I have divided them into two groups:

  • Before the digital age
  • Since the onset of the digital age

When I first got involved in my exploration of boundary and dual relationship issues in the early to mid 1990s, there was no digital technology. I was not thinking about, I was not lecturing about, I was not writing about any boundary issues that involve online relationships, for example, or electronic communications, because the technology simply didn't exist. But now these issues have become quite pervasive in contemporary social work.

Before the Digital Age

Before the time we are in now, where many of us are providing services remotely to clients, we may have online or text exchanges with clients or email exchanges, before any of this technology was available, there were lots of boundary issues in social work, examples include:

  • Responding to clients’ personal questions (self-disclosure)
  • Managing gifts from clients
  • Managing invitations from clients (e.g., lifecycle events)
  • Managing boundaries in small and rural communities
  • Hiring former clients (e.g., substance use disorder treatment programs)
  • Intimate relationships with former clients 

Responding to clients’ personal questions (self-disclosure)

 I imagine all of you have been asked personal questions by clients. So how old are you? Lets say you are relatively young and you have a client who is an adolescent or a relatively young parent of a child who thinks you are not much older than them. How old are you? Where do you live? 

Clients might look at your left hand to see if there is a ring on the finger. They are curious to know, whether you are married. They might ask you, are you married? Do you have any children? Are you a person of faith? If so, which one? If not, why not?

 These are perfectly reasonable questions. We are not surprised when clients ask them, and social workers throughout history have had to make decisions about whether to disclose personal information to clients.

As it relates to self-disclosure, I think there are three options:

  • One option is you do not disclose any personal information because of potential boundary issues.
  • Option two is you answer the client's questions honestly and routinely.
  •  Option three, you are selective. You use your judgment about whether to disclose personal information to clients keeping in mind the client's clinical challenges and the possible ramifications of self-disclosure.  

Self-disclosure is an issue that is been around a long, long time. So, nothing particularly new there. 

Managing gifts from clients

I imagine that many of you have been offered gifts by clients. And you have had to make decisions about whether to keep the gift, whether to say to a client “I am not permitted to accept a gift because of the policy in my agency around boundaries.” These are clinical judgments that involve both ethical and boundary related issues. And you know option one is, never accept gifts from clients. Option two always accept a gift from clients. Option three, it depends on the nature of the gift, the client's clinical issues, the possible implications of accepting a gift and so forth.

Managing invitations from clients 

 I imagine that many of you have received invitations from clients. A client who invites you to the wedding, the graduation ceremony, the christening of the baby, because you are so important in the client's life. The client would like you to be there. Well, this is again, not a new issue and we have to make ethical and clinical judgments about whether to ever accept that invitation. Should we always say no? Or is it reasonable to go? If it is reasonable to go based on what considerations?

Managing boundaries in small and rural communities

Some of you may be living in relatively small and rural communities. Notice I say small communities. Over the years, I have had the opportunity to lecture in a number of international settings on military bases that employ social workers. These are social workers who live and work on military bases in Japan, in Italy, in Korea and other remote places in Bahrain, in Djibouti, and Diego Garcia in the middle of the Indian Ocean. These are not rural communities to the strict sense, but these are small communities and it is inevitable that social workers, (the ones I have met in these locations) will encounter their clients, some of whom are active duty military personnel or their dependents, their spouses, their children, their partners. They are going to encounter them on the base, at the swimming pool, at the mess hall, and/or at the exchange when they are shopping. They have to manage boundary issues in these small communities.

Hiring former clients

Again, these are not new issues. Some of you may work in settings that on occasion, or even as a matter of routine hire former clients. I see this most often in substance use disorder treatment programs where employers think that some former clients who are stable have a lot to offer clients because of their lived experience. They can empathize in a unique way because they have lived substance use challenges. I fully understand why some programs hire former clients, and I also recognize that can introduce some very complicated boundary issues. 

A number of years ago, I testified in a case in a Southern State that was prosecuted literally prosecuted by the Attorney General's Office, who alleged that the social worker who was executive director of a prominent behavioral health agency violated state law and violated prevailing ethical standards because that social worker hired several former clients without allegedly complying with a prominent standard related to boundaries in dual relationships. 

When I testified in that case, I did not say when I was on the witness stand, that I oppose hiring former clients in all instances, what I said in my testimony under oath is that I believe when social workers hire former clients, they must comply with widespread, widely embraced ethical standards related to boundaries and dual relationships, and conflicts of interest.

They have to hire them in a very specific way addressing issues related to privacy and confidentiality and potential conflicts of interest. You don't just hire them and leave it at that. But again, that is not a new issue. I know that a number of mental health agencies have also hired former clients who have struggled with mental illness who are stable and doing well. They can be of great help to other clients who are struggling with symptoms of schizophrenia or bipolar disorder, anxiety symptoms, other mood disorders, and so forth. 

Intimate relationships with former clients 

The final example, before the digital age, is intimate relationships with former clients. This is not a new issue. Throughout social work's history, there have been instances where there was evidence that a social worker became involved in an intimate or sexual relationship with a former client. The debate was whether that violated prevailing ethical standards.

Do we believe that once a client always a client, a client in perpetuity, there are no exceptions? Some of our sister behavioral health professions such as psychology, they have different ethical standards than social work does with regard to whether it is ever permissible to engage in an intimate relationship with a former client. The American Counseling Association, the Association for Marriage and Family Therapist, they have somewhat different standards than social work does with regard to this issue, but again, this is not a new issue. 

Since the onset of the digital age

Since the onset of the digital age, I have seen a number of really complicated, rather novel boundary and dual relationship issues that I had never seen in my career until the emergence of online and distance technology. So here are some examples:

  • Clients searching online for information about social worker
  • Searching online for information about clients
  • Responding to current clients’ Facebook “friend” request
  • Managing Facebook relationships with former clients
  • Managing after-hours digital communications
  • Social workers and clients “see” each other’s homes during virtual sessions

These are not exhaustive. These are simply examples, I have been involved in all of these cases.

Clients searching online for information about social worker

 Clients search online for information about you, and because their online searches are likely to find information about you, this can introduce some really complicated boundary issues. In other words, instead of asking you where you live, instead of asking you whether you have any children and so forth, they may be able to find out that information online by doing a Google search or a Facebook search. I know for a fact that there is a good chance clients will learn personal information about you, that they might bring up in a clinical session.

For example, I was involved in a case where a social worker was pulled over by the police for driving under the influence. It turns out that the social worker who did not have a history of driving under the influence, had been taking some medication for a medical condition, was not supposed to have alcohol, but did have some alcohol and was pulled over and charged with driving under the influence. Well, a client did an online search and found the “blurb” online, describing the social workers arrest, and brought it up in a clinical session. Ironically that client had been court ordered for counseling because that client had been charged on three different occasions with driving under the influence. So, you can imagine how that led to a very complicated clinical discussion. 

Searching online for information about clients

The other side of that coin is that of course we have to make decisions about whether it is permissible to search online for information about clients. All of us have the capacity to turn on our computers or our smartphones or our tablets, and to search for information about clients without their knowledge or their consent. And if we were in a room together, which of course we are not, but if we were in a room together, I would ask how many of you know, what the current NASW Code of Ethics says about conducting online searches for information about clients without their knowledge or consent.

I had the opportunity and privilege to chair the national task force that wrote the Code of Ethics adopted by NASW in the 1990s, and recently served with several colleagues on a task force to update that code, to include new, very different standards pertaining to social workers’, use of technology. We added a very explicit standard having to do with social workers’ online searches for information about clients, without their knowledge or consent. That is a complicated boundary issue that did not exist when many of us became social workers.

 If we were in a room together, I would ask how many of you are familiar with the relatively new practice standards? These are national practice standards jointly adopted by the National Association of Social Workers, the Association of Social Work Boards, the Council on Social Work Education, and the Clinical Social Work Association, that includes a number of boundary related standards having to do with our use of technology, including the issue that I just mentioned, conducting online searches for information about clients without their knowledge or consent.

I would argue every social worker must know what is in the current version of the Code of Ethics. Every social worker must know what is in these national practice standards related to our use of technology, specifically related to management of boundaries. We are held to these standards. 

Responding to current/former clients’ Facebook “friend” request

Another example, responding to current clients’ Facebook friend requests, obviously that introduces a boundary issue. It introduces a dual relationship issue. And as I mentioned a little while ago, we also may get these so-called Facebook friend requests from former clients. Well, should the standards be the same as they are when we get a request from a current client, or is it different? If we get a request from a former client, does it depend on the nature of that relationship? 

Managing after-hours digital communications

Because of technology, we now have the option to engage with clients after hours, after so-called normal working hours. So, what are the potential boundary issues? If you have an online exchange by text, by email, by Facebook private messaging, by LinkedIn, or something like that during the weekend, when you are not ordinarily working, what kind of boundary issue might that introduce? 

Should you have guidelines regarding your after-hours online interactions with clients and should you be sharing those guidelines with clients? We never used to have to think about these issues, but we do now.

Social workers and clients “see” each other’s homes during virtual sessions

Many of you may be providing distance or remote services to clients that may have started when we first heard of COVID-19 and the pandemic, and may continue beyond that. As a result of the virtual services or the distance services we are providing to clients, you may now see the inside of client's homes. 

You may meet their children who come on camera and they look at the camera, even though mommy or daddy said, "Leave me alone. Please don't come in. The door's closed. I am having an important meeting," but the four-year-old opens the door anyway and comes over to the laptop and looks and sees you and says, "Who's that mommy?" Starts waving, and then you have to respond. 

What do you say? “For reasons I am not at liberty to disclose. I am not going to tell you who I am.” You know, you are not going to handle it that way, presumably, but you have to figure out what to say, how to manage that boundary when you are interacting with clients’ family members, during your virtual online counseling session.

You might see how tidy or untidy their homes are. You are getting information. It is like doing a virtual home visit in some limited respects, even though you are not providing home-based services in the literal sense that introduces a boundary issue. 

The other side of that coin, is that your client may see the inside of your home. If you are providing services from home you may set up a virtual screen or you may have a private space, although we know that not every social worker has that luxury, and there are some social workers who have a difficult time finding private space in their own homes and clients may see the inside of some of their personal space.

Your child may march into the room, even though you said, "Please leave me alone. Please don't come into the room," but your three-year-old child may not read the sign on the door, may disobey, so to speak and all of a sudden your client is meeting your child. Who is now on-screen. Well, that is an interesting and challenging boundary issue.

 Those are some examples of boundary and dual relationship issues that have been around a long time before the so-called digital age and then in more contemporary times now that we're using technology so pervasively. 

Boundary Issues: Key Concepts

Let me share with you some key concepts. The first bullet point on slide six is a quote from colleagues of mine, Gutheil and Brodsky. I love this definition and this pertains to clinical relationships where they say, "A boundary is the edge of appropriate behavior at a given moment in the relationship between a client and therapist, as governed by the therapeutic context and contract." 

I realize that may seem a little abstract, but let me break it down a bit. I love this concept of a “boundary is the edge of appropriate behavior”. The challenge in social work of course, is to try to figure out where that edge is and to not cross that edge. I do not think that is always easy.

 Notice the use of the terms therapeutic context and therapeutic contract. So, what does that mean? One of the things I am going to argue is that some boundary issues are black and white. Do not have sex with a client. Okay, we all understand that. Do not exchange graphic-text messages, which we call sexting, a term that did not exist, when many of us became social workers. Do not engage in text or sext messages with a client. That is easy, that is a black and white issue.

Although I think that a lot of boundary issues are not black and white, but they're gray. And in fact, there are multiple shades of gray where reasonable, thoughtful, prudent social workers may disagree about how that boundary issue ought to be handled. The context, what Gutheil and Brodsky referred to as the “therapeutic context”, that makes a difference. 

For example, are you providing home-based services? That is a therapeutic context, where by definition, the boundaries I think are likely to be somewhat looser or more elastic because you are in the client's home. If you live and work in a small community like a military base or a rural community, that is a different therapeutic context than if you are providing traditional office-based services in a large city, such as Los Angeles or Chicago or Boston or New York or Miami where the therapeutic context is different. You are not as likely to encounter those clients in the community. It is not as likely that your respective children are going to be playmates. We would not be shocked if that happened in a small rural community, right? That is not to say it ca not happen in Los Angeles or Chicago or Boston or New York or Miami. It is just less likely to happen. So, the context, I think, is important.

 Here is another example. Some of you may work in agencies that provide addictions services, chemical dependency services. I know from my experience that, that is a unique therapeutic context to use Gutheil and Brodsky's language, by which I mean, and most of the programs that I have collaborated with or consulted with on occasion have people on staff who are in recovery, that is the model. Because of that therapeutic context, it is not unusual for staff, some of whom are social workers to share some of their personal story with clients. That is part of the reason why they are on staff, because they are in recovery. They are there as role models, and that is quite different from other settings where self-disclosure would not be permitted. 

By way of another example, in addition to my duties as a professor, I have spent many years working in prisons. In a prison setting, a social worker typically does not share personal information with inmates. It is just not the norm. 

Are there some exceptions? I am sure there are, but that (as in prison setting)  therapeutic context is quite different from a community-based program that serves people who struggle with addictions, where some of the staff were hired because they are in recovery, different therapeutic context, and I would argue different norms pertaining to self-disclosure.

I would argue that dual or multiple relationships are not necessarily unethical. I do not believe that all relationships are unethical. I think some are, and I think some are not.

For example, I think there are times when it is appropriate for social workers to share some limited personal information with clients in some circumstances. Does that constitute a boundary issue? Yes.

Do I think it is inherently unethical? No. I think for example, that there are some limited circumstances where it may be appropriate for a social worker to accept a modest gift from a client. There may be relevant cultural issues to refusing that gift, and refusal of the gift could have dire clinical consequences.  I think it may be permissible in some limited circumstances for a social group to accept a gift, I have done that. I also think there are other circumstances where I would not accept a gift. I think it is too loaded. The boundary issues are too complicated, and so it depends on the circumstances.

 So, to reiterate, I think some dual or multiple relationships are unethical and some are not. It is important to distinguish between boundary crossings and boundary violations. I think this is a wonderfully useful and a very important distinction. 

Boundary Crossings

We typically define boundary crossings as acceptable, perhaps inevitable or unavoidable dual relationships. So, let me break that down a bit. I would argue, that there are times when some limited carefully selected personal information might be disclosed by a social worker to a client without violating ethical standards. I think it is acceptable. You may live in one of those small or rural communities where it is inevitable that you are going to encounter clients in the community outside of the professional context. And that is a boundary crossing. That is not inherently unethical. It is just a fact of life, and it requires skillful management of those boundary issues. 

You may have yourself, a spouse or a partner who works with your client. And so, this is a boundary crossing, right? You may be at a holiday event that your spouse or partner's firm has sponsored, you show up because you are invited, and then you discover that your client is there because your client works at that agency or has done some business with that agency. There you are in this social setting, does that mean it is an inherent boundary violation? I do not think so, but I do think it requires skillful management because it is a boundary crossing. 

Boundary Violations

Boundary violations in contrast are unacceptable exploitation of clients. These involve serious conflicts of interest. As you might imagine, examples would be having a sexual relationship with a client or entering into a business relationship with a client. That kind of thing. It is unacceptable and often involves exploitation and an inherent conflict of interest.

Boundary Issues and Dual Relationships: A Typology

I have consulted on and testified in many litigation cases and many licensing board cases involving social workers where boundary violations were part of the evidence. A number of years ago, when I began to recognize how common or how pervasive boundary and dual relationships are in social work, I began to gather a lot of data. I teach research and I teach statistics, so I actually practice what I preach.  I gathered a lot of data on social workers' encounters with a broad range of boundary issues. When I analyzed the data, I identified five patterns:

  • Intimate relationships
  • Emotional and dependency needs
  • Personal benefit
  • Altruism
  • Unavoidable and unanticipated circumstances

I will summarize them briefly and then go into a bit more depth. Number one, intimate relationships. Notice it does not say sex. It includes sexual relationships with clients and former clients, but I was aiming for a somewhat broader concept of intimacy. It can be very intimate self-disclosure without sexual contact. There can be a very intimate friendship with a client or former client, that is not sexual in nature, but there is an element of intimacy. Then there is what I call emotional dependency needs. I know that is kind of a clunky label, and I wish I could have come up with something a bit more succinct and elegant. I did not succeed. What I mean by that, is that in my experience, based on the data that I have collected over many years is that some of the boundary and dual relationship issues that emerged in social work involve the intersection between our emotional needs, our dependency needs, and our interactions with clients. Sometimes our efforts to address our own emotional needs and to manage our own dependency issues will lead to some complex boundary issues, but not necessarily intimate in nature. 

The third pattern that I found is what I call personal benefit. These are cases where the evidence suggests that the boundary issue, the dual relationship issue included some benefit to the social worker. For example, a social worker who did accept a rather expensive gift from a client, or a social worker whose client had some very unique, specialized skill as a physician, as a nurse, as an accountant, as a house painter, where the client performs favors for the social worker, where there is a personal benefit for the social worker. These are not abstract examples. I have testified in court cases and in licensing board cases where social workers allegedly derived a personal benefit from a client that constituted a boundary violation. 

And fourth, cases involving altruism. One of the things that I really love about being a social worker and I mean this, is that it provides me with a regular opportunity, day-to-day, sometimes night to night, depending upon the context to encounter social workers who are very caring, giving people. I love the fact that our profession is filled with practitioners who care so much about others. I find that very satisfying. I would not be a very good business person. I am just not cut out to do that kind of thing.

I like being in a profession, surrounded by colleagues who care about others.  I applaud that feature of our profession and our professional community. I have discovered there is a slippery slope. There is a downside, a potential downside. I have been involved in quite a few court cases and quite a few licensing board cases where the evidence suggested that the social worker was so nice, was so giving, performed favors for clients that crossed the line, that constituted either a boundary crossing that was problematic or a boundary violation. It was not out of some sort of self-serving intent. A social worker who gets involved sexually with a client that is self-serving, I am talking about cases where the evidence suggests the social worker was very giving, very generous, very altruistic, and it led to a major boundary problem.

The final category that I identified when I examined the data after this large-study that I conducted, I describe as unavoidable unanticipated circumstances. We did not see it coming. We did not intend for there to be a boundary problem, but it landed in our lap, so to speak. 

Intimate Relationships

We do not have the time to explore these in great depth, although intimate relationships, examples include: 

  • sexual relationships (current and former clients): varied code of ethics standards
  • physical contact: absolute v. relative prohibition 
  • providing services to former lover
  • sexual relationships with clients’ relatives or acquaintances
  • sexual relationships with supervisees, trainees, students, colleagues
  • intimate gestures (e.g., notes, meals, gifts)
  • sexualized messages online/social networking

 I have examples of all of these, real life examples from my consultation with social workers around the United States and abroad and my consultation as an expert witness in court cases and my involvement as an expert witness in licensing board cases. So these are not hypothetical, these are drawn from real life cases, sexual relationships with current and former clients.

The ethical standards in social work are different from the ethical standards in psychology, which are different from the ethical standards in the counseling profession, mental health counseling profession, and so on. 

Social work has the unique language in its Code of Ethics that my colleagues and I put in there for the first time in 1996, when we completely rewrote the Code of Ethics. We did not just revise. We came, we started over, and we had to make a decision about social workers' relationships with former clients. And as you may know, I hope you know, our code does not say, well, it cannot happen within two years of termination.

Psychology's code says that, ours does not. It does not say within five years, it says basically once a client, always a client, a client in perpetuity. Our code recognizes there may be some very limited exceptions depending on unique circumstances. It says that in our Code of Ethics, we are the only profession whose code says what I just said. 

The reason we have that exception in there is that when my colleagues and I sat in Washington DC, and we drafted the Code of Ethics, we had this very honest conversation about whether we thought there was ever any exception to the prohibition along the lines of once a client, always a client, and all of us recognized, and maybe some very narrow exceptions, outside, for example, of clinical relationships, not all social workers or clinicians, should the same rules govern non-clinical relationships, right?

 I remember that discussion very clearly from the 1990s when we came up with some very unique circumstances, which we thought constituted reasonable exceptions, but our code is very clear. The presumption is once a client, always a client, a client in perpetuity, and the burden is on the social worker to demonstrate that there are any grounds for any exception to that physical contact. Our Code of Ethics does not say, you are never permitted to have any physical contact with a client. What it says is physical encounters with clients are discouraged. They can constitute boundary violations, and that there may be some limited exceptions to that. So, I imagine many of you have shaken client's hands. You may have a client who during a clinical session was in deep emotional distress, and spontaneously reached out to hug you for comfort.

There was not anything sexual about it. It was for comfort. Well, are you suppose to back off and say, no, I can't hug you? How do you handle that?  So, we acknowledge in the Code of Ethics that there may be some limited exceptions to this prohibition. The presumption is no physical contact, but there may be some limited exceptions. Providing services to a former lover. This is not hypothetical. I have been involved in cases where a social worker began clinical services, the delivery of clinical services to a client who years earlier had been a lover of that social worker. Well, that raises some interesting boundary issues where there is an element of intimacy. Sexual relationships with clients, relatives, or acquaintances obviously that can introduce some conflicts of interest that are quite complex. Sexual relationships with supervisees, with trainees, with students, or with colleagues, can clearly introduce very complicated boundary issues. 

Intimate gestures 

Many of you, I suspect over the years have received a very, very sincere, thank you note from a client and it might have been signed “love”, not in the, I love you intimate kind of way, but love with a different connotation as an expression of affection. 

 I have also been involved in cases where a client sent an affectionate note, saying “I am sorry” or a social worker sent an affectionate note to a client after the death of a client's spouse or a child, and the social worker signed it “love”, as an affectionate gesture. And that became an issue when that relationship ruptured for other reasons down the line, or when a client gives a very, very intimate gift to a social worker. 

We know that some clients develop a crush on a social worker and may decide to give a gift, like chocolate chip cookies or a drawing. Nothing particularly intimate about that, but lets say it is an item of clothing, maybe even intimate apparel, right? This has actually happened, and a social worker has to manage that kind of intimate gift. Now with the advent of digital technology and sexualized messages, I have testified in several cases, three, and I am involved in a fourth right now where the evidence indicates that a practitioner and a client exchanged sexually explicit graphic online messages. This is known as sexting. Sadly, the evidence in the cases in which I have been involved in and the one case I am involved in right now, the evidence includes digital images exchanged between practitioners and clients. Very troubling.

Natural History of Boundary Violations

 Some years ago, I came across this research conducted by Simon, a psychiatrist on boundary violations. When I read this years ago, I thought this is a very helpful overview of what I have seen occur when there are boundary violations involving intimacy. Simon, the psychiatrist also examined a large collection of boundary cases, boundary related cases, involving intimacy and outlined what he describes is the natural history of boundary violations.

Now I am not suggesting, and I do not think Simon suggests that this progression always occurs in this order. That it is always this linear. I do not think that is the case, but when I first read this years ago, I thought to myself, this is exactly what I have observed in many cases, there is a gradual erosion of the therapist neutrality where the social worker or the other mental health professional takes a special interest in that particular client. There is something about that relationship that is unique, and the boundary violation begins between the chair and the door. I think that is a lovely phrase that captures what I have observed in some of these cases where at the end of a clinical session, there's some chit-chat, you know, the client is getting up ready to leave the room.

What are you doing this weekend? "Oh, I am going to a concert, an Aerosmith concert." The client says, and the social casino." I love Aerosmith. Where is it? I didn't even know there was going to be a concert." And they chat about Aerosmith, and they are not talking about clinical issues, but they connect around a musical concert. But the violation begins between the chair and the door, and now with, virtual or distance counseling, it could occur online at the end of a clinical session, socialization of therapy, where there is increased time, spent discussing non-therapy issues. 

The therapist discloses confidential information about other clients, because the relationship with this client is so special. But this is not hypothetical. I have interviewed clients who felt like they were violated by a social worker who said the social worker shared with me information about other clients, because the social worker thought I was so special.

Therapist self-disclosure begins where the social worker begins to share information with the client about her or his own life. What is going on in her/his own life. Why? Because the social worker trusts that special client. And when there is face-to-face or in-person counseling, not distance counseling, there may be some physical contact. The hand on the shoulder, the hand on the knee. Kind of subtle at first, where it is sexualized, the therapist gains control over the client where there is increased dependency. I testified in one case where the social worker ended up balancing the client's checkbook, because the client felt unable to do it, increased dependency, extra-therapeutic context occur, right?

When we do not have to physically distance, there is lunch, there is a drink after hours, therapy sessions extended in time, often scheduled for the end of the day, because there is no one waiting for the next session. In some of the cases I have been involved in and Simon as well, the therapist stops billing the client because we now have this unique relationship of dating and then sex. So, what Simon aptly describes as the natural history of boundary violations, again, not always this linear. 

Emotional and Dependency Needs

The next category, what I describe as emotional independency needs that might include friendships with current and former clients, community contact with clients, where you encounter them at your church, at your mosque, at your synagogue, and you share this special interest; that is unrelated to your professional work together and there's some social contact. And it is very satisfying perhaps. Self-disclosure, as I mentioned a little while ago, I do not think all self-disclosure is inherently unethical. I think sometimes it is, as I say here, judicious, that is the term I like. It is very thoughtful. It is very purposeful. It is very limited. It is saying to the nine-year-old child, who is grieving the loss of a pet "I remember when I was about your age, my cat, oh, I loved that cat. My cat's name was Kitts, I love that cat. My cat died." It is empathy. That is self-disclosure judicious, right? 

As opposed to what I call gratuitous self-disclosure, gratuitous means unnecessary above and beyond what's appropriate or necessary, where the social worker shares personal information with the client that it is not appropriate across the line. The client should not know about the social worker struggles in his own personal intimate relationships. 

Unconventional interventions

 I have testified in cases and I am not exaggerating here. This is not a hyperbole, whereas an alleged therapeutic intervention. The social worker traveled with a client, shared a room at a bed and breakfast. I am not making this up. They had dinner together. Candlelight, went on a camping trip together, and the social worker alleged in court, and I was there to hear the testimony that this unconventional intervention was legitimate. She called it “reparenting therapy” for this client who had a trauma history that the social worker believed that she was functioning as a surrogate parent to kind of normalize parenting, this vulnerable client. 

That relationship ruptured, no great surprise. The client filed a complaint against the social worker. I testified in that case and heard that social worker try to defend traveling with a client, dining with a client, sharing a room at a bed and breakfast with a client all under the name of an allegedly therapeutic intervention. 

Affectionate communications

Those notes signed “love” where there is an emotional quality to it. That suggests there may be something about this relationship, which goes beyond the professional. 

Online Relationships: Social Media and Social Networking

And now with digital technology, text messages and email messages and Facebook posts that have an emotional element to them, right? And we have to think very differently. I would argue, but the way we interact with clients using technology because of the boundary issues that can emerge, I find that many people are so much more casual with their online communications. They do not edit it as carefully or they do not word them so carefully, and the wording might suggest to a client that this relationship goes beyond the professional, particularly if it is exchanged late at night or on weekends, outside of normal working hours. 

Personal Benefit

The third category is personal benefit. Examples from real cases where a social worker ends up in a client's will, the client appreciated the social worker. That is an interesting boundary issue with clearly potential personal benefit to the social worker or where the social worker enters into a business relationship with the client or the former client.

I testified in a case where a social worker literally became an investor in a client's business and the relationship ruptured.  I had to testify about the boundary issues involved when a social worker seeks to benefit personally by investing in a client's business. 

I know of social workers who live in rural communities, for example, who may get paid in the form of fruit or vegetables or livestock, or where a client who doesn't have much money is the house painter and offers to paint the social worker's house, which clearly needs paint. The social worker has a home office. The outside of the house is peeling, and this is how the client wants to pay for social work services. 

Our Code of Ethics has in it a very lengthy standard regarding bartering. If you do a word count, it is the longest standard in the Code of Ethics, and when we put that in there in the 1990s, we had a difficult time saying clearly and succinctly what the ethical standard ought to be. We do not prohibit bartering. What we say is we discouraged bartering because it can introduce all kinds of boundary issues. Suppose the client paints the social worker's home and six months later it begins to peel badly. Then the social worker has to address that issue with the client, “can you repair the defective paint?”, but they have a clinical relationship.

Therefore, our Code of Ethics discourages bartering, but it also acknowledges it, this is why it is a lengthy standard, because there may be reasonable exceptions because of the cultural context, living and working in a small rural community where bartering is part of the culture. 

Some of you may have clients who have special skills and expertise as physicians, as nurses, as auto-mechanics, and stockbrokers who may offer to share their skill, their knowledge, or their expertise with you. With this potential personal benefit, they may want to perform favors for you. Clients may want to give you gifts, meals, and/or invite you to events where there is a personal benefit to you and an element of a conflict of interest. 

Some of you may now have websites where you have considered having clients provide online testimonials. Well, you are likely to benefit from that. Is it appropriate to ask a client to give you a testimonial that you will post on your website? It is for your benefit, not theirs, right? Technology has introduced that issue. 

Altruism

Giving clients gifts, offering clients favors, meeting clients in social or community settings, having a clinical session at the coffee shop, because it is more relaxed and is less formal, and you think this is going to be helpful to this client who is just not comfortable coming to the formal office. Or providing clinical services on your smartphone while you are walking because you want to be helpful to this client, who wants a more relaxed, informal way to interact. 

Because of the technology you might decide to be available late at night to a client who is vulnerable in crisis, or on weekends, and you want to be accommodating. You are altruistic or caring, but those latenight communications, those weekend communications outside of normal working hours may introduce complex boundary issues. 

As an aside, I now recommend that all social workers have what we call social media policies that explain to clients in very user-friendly language, how we handle boundaries online on the internet. We should say to them, we cannot be their Facebook friends and the reasons why in a very kind way and that we are not available at all hours of the day and night for online text and communications. We should explain when we are available and how to reach us if there is an emergency. I think we have to have these policies in place and share them with clients. When many of us started our careers, there was no need for that because of the technology did not exist. 

Unavoidable and Unanticipated Circumstances

The final category, unavoidable and unanticipated circumstances. As I mentioned, several times, unique boundary issues that arise because some social workers live in close geographical proximity to their clients, and the norms in small and rural communities, I think, inevitably must be different. Boundaries there are more elastic almost by definition. We have personal lives. Some of us may be actively involved in church, synagogue, mosque communities, where we may interact with clients who are members of that same community.

You may be a member of a LGBTQ community, you may be involved in a Black Lives Matter effort that a client joins, where your lives intersect in the community whether in person or online. Professional encounters, the former client, who is so inspired by the help you provided that the former client decides to become a social worker and ends up becoming a colleague of yours. Those social encounters, where it turns out that your sister is dating somebody new who is going to join you for Thanksgiving dinner, and it turns out it is your client.

 Unavoidable and unanticipated. How do you handle that one? And then the possibility of overlapping social networking or social media relationships. You may not be a Facebook friend with your client, but one of your Facebook friends, may be Facebook friends with a client. I call that the transitive property of Facebook. 

You remember to call from like eighth or ninth grade, the transit of property in math, if A is greater than B and B is greater than C, then a is greater than C. I call this the transitive property of Facebook. You may not be friends on Facebook with the client, but your client may be Facebook friends with one of your Facebook friends. And because of the privacy settings, your client may see lots of stuff on your Facebook friend’s site that is about you. Your life may intersect that way. 

The bottom line is, I think all of us in social work, encounter boundary and dual relationship issues. Some of them are easy. We know what to do, do not have sex with the client. We get that one, do not enter into a business relationship with a client. We get that one. But then, beyond these black and white issues are the issues that are saturated with gray and multiple shades of gray, where we have to make decisions sometimes very difficult decisions about how to handle these boundary issues. When we live in small and rural communities, when our agency has hired a former client, when we are considering sharing some personal information with a client for all the right reasons; and what I have found in my career is that this concept of standard of care is so helpful.

Standard of Care in Social Work: Managing Boundaries

The concept of standard of care has been part of the American landscape since the late 1800s. There is a very famous court case known as Coombs v. Beede, which introduced this concept into U.S. law. This is a case that started in Lewiston, Maine and ended up reaching the State Supreme Court. Without getting into all the details, what the Supreme Court said is whenever the court is trying to determine how a professional should have behaved in any circumstance, whether it is a doctor, or a nurse, or an engineer (in the late 1800s, social work was in its infancy, so the court was not thinking about social work), the standard should be what a reasonable and prudent professional, with the same or similar training would have done under the same or similar circumstances. 

So, it goes like this, in my opinion, and this is my lived experience in court cases, in court rooms, in licensing board cases, in licensing board hearings (I have been involved in many of them) Courts of law and licensing boards are going to try to assess and determine how would a reasonable social worker have handled self-disclosure in that circumstance? How would a reasonable social worker have handled hiring a former client? How would a reasonable social worker have handled having a friendship or an intimate relationship with a former client? How would a reasonable social worker have handled the gift, the client offered? Et cetera, et cetera. We call it the reasonable person's standard. It is been in the law for a very long time.

Then there is prudent. The dictionary definition of prudent is careful and cautious. The expectation is that when a social worker, for example, thinks about the possibility of sharing personal information with a client, the social worker will be thoughtful about it. The social worker will be careful and cautious and will not be impulsive. Social workers who are impulsive about self-disclosure in my experience, find themselves in hot water. As I said earlier, I think there is such a thing as judicious self-disclosure, it is prudent, it is careful, it is cautious.

 A social worker who makes a decision about how to handle a gift that a client has offered, does not simply say, "Hey, thank you very much. That was very sweet of you." I think it is important to be careful and cautious. What is the nature of the gift? What are the client's clinical issues? What would it mean to accept this gift from this client? Are there cultural issues to be considered here? That is careful, that is cautious.

 Should I respond to the after hours text messages or email messages or Facebook posts that I am concerned about, or does that introduce a boundary issue? I need to be careful. I need to be cautious. I testified recently in a very complex licensing board case where a very caring social worker, someone who was truly altruistic in my opinion, and that was my testimony, was so concerned about a vulnerable teenage client that the social worker had late at night, online exchanges, lengthy exchanges, using Facebook private messaging, that in my opinion, crossed the line.

The social worker shared personal information during some of those exchanges, the teenager's postings were of a very intimate nature late at night. This case blew up because the child's mother discovered all of these exchanges online and filed a licensing board complaint. This very caring social worker in my opinion, was neither reasonable nor prudent. The social worker was not careful, was not cautious, and was sanctioned by the licensing board. 

Two Views of the Standard of Care

  • Substantive standard of care
  • Procedural standard of care
    • Consult colleagues and supervisors
    • Review relevant ethical standards
    • Review relevant laws, policies, and regulations
    • Review national practice standards
    • Review relevant literature
    • Obtain legal consultation, when necessary
    • Consult ethics committee, if available 
    • Document decision-making steps

I list two views of the standard of care, what I call the substantive standard of care, where we generally agree. We generally agree on what the standard of care is. Do not have sex with a client; do not enter into a business relationship with a client. Substantive standards of care related to boundaries and dual relationships.

But as I have said several times, I think often reasonable social workers can disagree. Especially with regard to self-disclosure, hiring a former client, and how to manage boundaries in a small rural community.

Reasonable minds can differ on some of these issues. And in those cases, I say a reasonable and prudent social worker, the elements of standard of care would think procedurally. That is why I call this the procedural standard of care. And very briefly, I would argue there are eight key elements, when in doubt about how to manage these boundary issues, get consultation, talk to your supervisor if you have one. Think it through with colleagues.

 I think it is so important. Next review, relevant ethical standards. And the NASW Code of Ethics has a number of boundary related standards that did not exist until January 1st, 2018. They did not exist, but they are in there now. We have to know them. Review relevant laws, policies, and regulations regarding relationships with former clients. They may be embedded in your licensing statute and regulation in your state. 

Next, national practice standards. As I mentioned, we now have national practice standards created by the task force. The task force that I was privileged to chair. National practice standards related to the use of technology. And we put in there, these standards adopted by NASW, ASWB, CSWE, and CSWA. We put standards in there specifically related to boundaries and dual relationships, and we are held to those. 

Review relevant literature. There is literature, prominent literature in social work, on the issues that I have been discussing today. Judges, lawyers, and licensing boards consider that part of the standard of care, so it behooves us to know what is in that literature. When a necessary, consult a lawyer, if it is really complicated, for example, if you are considering hiring a former client. If a client offers a gift, I am not running to a lawyer. I got to think that through on my own or with colleagues. If a client asks me how old I am, where do I live, do I have any children? I am not going to run to a lawyer, but if I work in an agency and I am considering hiring former clients, I want a legal consult because that potentially could lead to some very complex risk management issues.

If I work in an agency that has an ethics committee I would consult that committee. And finally, I would document very carefully every step I took, the consultation, reviewing the Code of Ethics, reviewing relevant standards; I would document all of that, just in case questions surface. 

Risk Management Strategy

  • Set unambiguous boundaries at the beginning of the professional-client relationship.
  • Evaluate possible dual relationship and boundary considering:
    • amount of social worker’s power over client
    • duration of relationship
    • conditions surrounding termination
    • client’s clinical profile
    • prevailing ethical standards
  • Consider whether a dual relationship in any form is warranted or justifiable.
  • Is the relationship exploitative? 
  • Is the relationship likely to harm the client?
  • Ask yourself “For whose benefit?” (Latin: Cui bono?) 
  • Pay special attention to incompatible roles (e.g., clinician-client, administrator-secretary, supervisor-supervisee, instructor-student)
  • In ambiguous circumstances, consult with colleagues, ethical standards, agency policies, regulations, statutes.
  • Discuss relevant issues with all relevant parties, especially clients.
  • Work under supervision whenever boundary issues are complex and risk is significant.
  • If necessary, refer the client to another professional to minimize risk and prevent harm.
  • Document  key aspects of the decision-making process and consultation.

This is a summary of a risk management strategy that I find very helpful. This is my effort to summarize key elements, to try to establish ambiguous boundaries at the beginning, and what we ought to keep in mind when we are evaluating possible dual relationships, including the nature of our relationship with clients and whether we have any power.

For example, if I am a probation/parole officer or a social worker, I have a lot of power over my client. I think it depends on how long the relationship has endured, the conditions surrounding termination, my client's clinical issues, and prevailing ethical standards. Therefore, I need to explore whether there is any alter

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frederic g reamer

Frederic G. Reamer, PhD

Frederic Reamer is a professor in the graduate program, School of Social Work, Rhode Island College. His teaching and research focus on professional ethics, criminal justice, mental health, health care, and public policy. Dr. Reamer received his PhD from the University of Chicago and he has served as a social worker in correctional and mental health settings.  He chaired the national task force that wrote the Code of Ethics adopted by the National Association of Social Workers in 1996 and recently served on the code revision task force. Dr. Reamer has lectured nationally and internationally on social work and professional ethics, including in India, China, Singapore, South Korea, Japan, Taiwan, and in various European nations. His books include Social Work Values and Ethics; Risk Management in Social Work; The Social Work Ethics Casebook; Ethical Standards in Social Work; Boundary Issues and Dual Relationships in the Human Services; Ethics and Risk Management in Online and Distance Social Work; and The Social Work Ethics Audit, among others.  In addition, Dr. Reamer has served as an expert witness in many court and licensing board cases throughout the United States.



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