How to maintain proper relations between practitioner and service user

    When was the last time you invited a service user round for dinner or accepted a client’s offer of a drink at their local? The answer to both of those questions is likely to be never. Both actions would be a clear breach of the professional boundary between service user and professional. Not all scenarios, however, are so clear-cut and social workers are presented with situations daily that could lead to blurred professional boundaries.

    Jonathan Coe is the chief executive of Witness, a charity that runs services including a helpline for people who have been abused by care professionals. He explains: “I don’t think anyone has got the boundaries right in all circumstances. Things will always come up and people need to be able to articulate these challenges and discuss them with supervisors and managers.

    “It is not the case that only bad practitioners have boundary issues. They come up every week,” he adds.

    Disclosing personal information is an issue that is likely to crop up and which could prove tricky. Sharing information may enhance the relationship with a client but just how much and what to divulge are issues that need to be carefully thought through. Clive Baulch, a senior practitioner with a foster care provider, says at most he would tell an anecdote but only without identifying himself.

    “I don’t think it can ever be right to disclose such personal information as ‘I am gay too’. Not only would this ‘burden’ the service user inappropriately, but also it is information which is bound to be used against the worker at some stage in the future – either by that individual service user, or another service user since these things inevitably ‘go the rounds’,” he argues.

    Drawing boundaries

    On the other hand, Coe says: “Telling a ­client about your sexuality, what car you drive and the area in which you live are not at all exploitative. But what we do know is that where practitioners have seriously violated boundaries it has almost always been preceded by a number of minor transgressions.”

    Sharing personal details repeatedly with a service user would change the dynamic of the relationship, potentially changing its focus so that it is transformed from a professional one into a friendship, which would, says Coe, be completely inappropriate.

    “Are social workers really there to form friendships with service users? Haven’t they got their own friends?” he asks.

    Most professionals would agree. But advances in technology over the past 10 years have introduced a whole new raft of challenges for workers when it comes to maintaining boundaries. Mobile phones, text messaging and e-mail have all aided communication between social workers and service users but they may also have increased the potential for that communication to be misconstrued.

    Dangers of texts

    And, although actively encouraged to exploit the convenience offered by mobile phones – many social workers are issued with them by their employer – there is a lack of general guidance on using them appropriately.

    Handing out a personal mobile phone number should only be done in very unusual circumstances, such as an emergency, says Coe. But he adds that in that event it could mean that the social worker changes their number.

    As a former agency social worker, Baulch says he has been forced to use his personal mobile phone, while always remembering to use the prefix 141 so that the number cannot be traced.

    Texting is a little more complicated, he adds. “It’s problematic in terms of professional boundaries. It’s such a commonplace, taken-for-granted experience that we often don’t think through the issue. I see it like this: texting is what we do between mates or lovers. So if you then text a service user it flags up the possibility that the social worker and the service user are mates or even more intimate than mates. Certainly equals. This is not the case.”

    Baulch also believes that, by its nature, texting, which is for shorthand messages, is unsuitable for communicating anything other than the briefest message, which means it is inappropriate for social work.

    Ruth Cartwright, professional officer at the British Association of Social Workers, agrees. She says that, although it can be useful for communicating short messages such as a change of appointment, it is a poor substitute for a conversation.

    “A direct conversation on the phone or even a letter is preferable in terms of proving the necessary formality – you are not just dropping in for a chat – so if a service user texts you, you should probably phone back to talk,” she says.

    Code of conduct

    Certainly the potential for unintentionally creating a false familiarity or intimacy by communicating in this way exists. Advice on relationships with service users is contained in the General Social Care Council’s code of conduct 5.4 which states that social care workers should not form inappropriate relationships with clients, while 5.8 states they should not behave in a way, in work or outside work, which would call into question their suitability to work in social care.

    But it is doubtful that the advice, which is inevitably general, will help when weighing up whether to text a service user. Coe says: “You cannot have an absolute list of do’s and don’ts when it comes to professional boundaries. If you were to try to list everything you would end up with a situation where workers become so remote and distant from clients they would be unable to engage with them properly.”

    Nevertheless, training and education on professional boundaries by employers has in many organisations been a neglected area and, given the commonplace use of mobiles, for example, better guidance is needed.

    “It is amazing that it’s not a fundamental requirement in this area and we want to see this happening,” says Coe, especially given that some clients, such as those who may have been abused, may repeatedly test the boundaries with workers because they are seeking assurances that the boundaries are there.

    In the end, social work is not untouched by modern technology. “Mobile phones are an inescapable fact of contemporary life. They are a standard way of communicating and can be useful because employees aren’t tied to the office,” Coe points out.

    And professionals who are exploiting their usefulness and want to make sure they use them appropriately should keep one thing in mind, he says. “It’s not about the medium it’s about the message.”

    Good practice

    What constitutes good practice when working with clients in social work and how does it compare with guidance for counsellors? (see Counsellor Guidance, below).

    ● Social workers must be good at starting, continuing and closing relationships.

    ● Social workers must explain their role and purpose of contact, such as assessment, and their powers (including legal powers).

    ● Social workers must have respect for families, individuals, carers, groups and communities regardless of their age, culture, ethnicity, level of understanding and need.

    ● They must treat each person individually, and respect and maintain the dignity and privacy of service users.

    ● They must not form inappropriate personal relationships with service users.

    ● They must not abuse or neglect service users or carers, nor exploit them in any way.

    ● Social workers must declare issues that might create conflicts of interest and must make sure that they do not influence their judgement or practice, including adhering to policies and procedures about accepting gifts and money from clients and their carers.

    More from: The National Occupational Standards for Social Work from Skills for Care (then Topss UK Partnership)

    Counsellor guidance

    ● Practitioners must not abuse their client’s trust in order to gain sexual, emotional, financial or any other kind of personal advantage.

    ● Respecting client confidentiality is a fundamental requirement for keeping trust.

    ● Practitioners should be clear about any commitment to be available to clients and honour these commitments.

    ● Practitioners should think carefully about – and exercise caution – before entering into personal or business relationships with former clients. They should expect to be professionally accountable if the relationship becomes detrimental to the client or the standing of the profession.

    ● Working with young people requires specific ethical awareness and competence, including understanding their capacity to give consent to receiving any service.

    ● Practitioners should not allow their professional relationships with clients to be prejudiced by any personal views they may have about age, gender, disability, race, sexuality, belief, lifestyle or culture.

    More from: Ethical Framework for Good Practice in Counselling and Psychotherapy from the British Association for Counselling and Psychotherapy

    Some common dilemmas

    What should a social worker do if a client constantly sends them non-work related texts to their mobile phone?

    “Mobile phones have innumerable benefits, not least of which they mean people are always contactable – which is also a disadvantage. For this reason it is not standard practice for social workers to give out mobile details to the people for whom they work. Any misuse should be dealt with in the same way as any other misuse of information or inappropriate contact. The practical solution would be to bar the person’s number to the mobile or change the number then provide an alternative contact method to allow for appropriate communication and finally engage with the person to explore the reasons for the inappropriate contact and address it in your work.”

    Michelle Miller, chief social work officer at Edinburgh Council

    What should a social worker do if after ending a professional relationship a client wishes to maintain a friendship?

    “It is essential to reaffirm the professional boundary. This is important for future contacts the client may have with the organisation as he/she needs to understand and accept relationships with workers are working relationships. This is particularly important in mental health as some individuals can be very adept at manipulating and/or transgressing boundaries. In all cases a firm, open and honest approach is required – explain you worked with the individual because they needed a particular service and the relationship has to end there but you wish them well for the future. Also point out their strengths and positive qualities with reference to what they have achieved – this may enable them to consider how they might develop and sustain appropriate informal relationships.”

    Sarah Skelly, senior social worker at Cardiff Council

    What would you do if a client was continually contacting you by phone, e-mail and text with questions or queries about their case, and you suspect the client just wants to maintain contact with you rather than having genuine questions?

    “There is a balance to be struck between responding to the requests and drawing a realistic boundary. I would consider why the person is continually contacting me, and how vital the information is that they are requesting.

    I would treat them with respect throughout, and explain that I am not able to respond to all their contacts, when they are so frequent. I would initially suggest a more structured contact, with a clear mutual expectation of regularity of communication, such as weekly, and to stick to this arrangement.

    I would also attempt to negotiate with them what elements of their case they can take control of themselves, to attempt to reduce dependence on me as the professional.”

    Steve Chamberlain, approved social worker team manager at the Royal Borough of Kensington and Chelsea

    Should a social worker reveal something about themselves, such as their sexuality, to help a client come to terms with the same issue?

    “The sharing of personal information with service users is generally inappropriate, in particular because this is not helpful or constructive to the work being done. It is very different from the concept of the “use of self” in a therapeutic relationship, which is a core element in a social worker’s toolkit. The skill is not to share intimate or personal details or experiences, but to use the learning and growth that these experiences give us as social workers to enable us to show empathy and to support the individual in ways that are relevant to them.”

    Michelle Miller

    What would you do if a client asked you to attend, in a personal capacity, a significant positive event such as their graduation, a christening of their child or an awards ceremony? Where do you draw the line?

    “I would never say ‘never’, but to be very cautious on the event and the nature of the relationship with the client. This request can be an indication of the value of the relationship, a sign of the progress made by the client, or a way of the client giving something in return for the service they have received.

    Awareness of the client’s cultural norms is crucial, which will help inform the motivation for the invitation. The event should be directly related to the work that has been done, and involvement limited to just that event. Further hospitality, such as a reception or party afterwards should be declined.”

    Steve Chamberlain

    Contact the authors
    Anabel Unity Sale

    Sally Gillen

    This article appeared in the 7 June issue under the headline “Too close and personal”

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