Professional Boundaries that Promote Dignity and Rights in Social Work Practice

ABSTRACT

In this essay I present some of my thoughts on the issue of boundaries in the professional relationship between service users and social workers. As a graduate student of social work, I had an opportunity to discuss ethical dilemmas in an international perspective in one of my courses. A guest professor, who provided international perspectives, was Prof. Kim Strom from UNC at Chapel Hill in North Carolina, USA. The lectures offered a fresh perspective that raised many questions about thick and thin boundaries in social work – especially when approaching social work by following prevailing guidelines for social work in Slovenia requiring us to co-create solutions through dialogue with service users, keeping in mind that service users are actually the ones who are the experts from experience. In this way, the working relationship seeks to foster a sense of partnership between social workers and service users. In this essay I would like to challenge the idea of rigid boundaries in social work and explore the possibility of fluid boundaries, keeping in mind that boundaries should reflect their main purpose, which I believe is to protect human dignity.

KEYWORDS:

• Boundaries
• human dignity
• human rights
• codes of ethics

Social work in Slovenia follows the so-called postmodern paradigm. Čačinovič Vogrinčič et al. (2011) explain the fourth wave in social work by using O'Hanlon's description of the postmodern paradigm in psychotherapy. They say that the focus has extended from pathology, problems and solutions to the helping process itself, which is established through a constantly developing working relationship between the social worker and the service user. The working relationship is established through the sphere of dialogue, where both parties are treated as equals, where both parties are involved in the process of co-creating new solutions. We should never forget that when working in social work, the service user is considered an expert from experience. Flaker (2003) considers dialogue to be a fundamental tool of social work, as it is not only a tool to create one's world but also a tool to recreate it. Flaker (2003) considers dialog as a way of understanding the world, how we name it and think about it, and ultimately dialog is also a way of overcoming the limitations that arise from our own understanding of the world.

As we can see, the postmodern paradigm requires of us to be personally involved in the process of helping, it requires us to persevere in an ongoing dialogue with the service user who is seen as our partner, our equal in co-creating positive outcomes. The postmodern paradigm may not require us to befriend the service user, but it certainly requires us to be friendly and open to pushing at least some of the boundaries in our relationship with the service user. Flaker (2020), for example, goes even a step further when talking about boundaries. In his blog (Flaker 2020) he puts forward a rather radical thesis describing boundaries as poison for social work. He writes that social workers should be building bridges, not setting boundaries. Of course, he is not talking about all boundaries, but mainly about boundaries that are set in advance, boundaries that arise from the working relationship, where the roles are not the roles of two partners, but the roles that emphasise the power imbalance between social worker and service user. According to his notes, boundaries should be developed organically, individually for each working relationship, similar to how they develop in the personal sphere of our daily lives.

As I have already said, this year, I had a privilege of discussing ethical dilemmas in an educational setting among international professors and international students. At the lectures, we were offered an insight into the field of ethics from the United States. The professor introduced us to the NASW Code of Ethics and was willing to discuss many dilemmas with us. However, I find that her perspective was quite different from the perspective in Slovenia, especially regarding boundaries in the social work profession, especially if we think about boundaries in a similar way as Flaker (2020). From the US perspective, boundaries should be much more clearly established and, if possible, very well defined, which brings me to my dilemma. What boundaries enable the use of self and in what kind of relationship? Can boundaries be pre-determined and pre-established or are they negotiated in the relationship? Should they be set in advance or should they evolve gradually? Should they be set rigidly or in relatively fluid way? To resolve this dilemma, I looked closely at the NASW Code of Ethics (NASW Code of Ethics n.d.) and also: Slovenian Code of Ethics of Social Workers (Kodeks etike socialnih delavk in socialnih delavcev, n.d.) to see if they offer guidance on how to find a way and set the appropriate boundaries.

The NASW Code of Ethics (NASW Code of Ethics n.d.) urges social workers to be mindful of their relationship with a service user in order to avoid potential conflicts of interest. NASW further advises that social workers should not have dual or multiple relationships with their service users. Dual or multiple relationships are when the social worker is associated with the service user in more than one way in the professional, social, and/or business arenas. When multiple relationships cannot be avoided, the social worker has an obligation to set clear, appropriate, and culturally sensitive boundaries (NASW Code of Ethics, n.d.).

The NASW Code of Ethics prohibits any sexual relationships with current and former service users, their families, and others with whom service users have close personal relationships. All four paragraphs of Section 1.09, which describes sexual relationships, state that the social worker has the full responsibility to set clear, appropriate, and culturally sensitive boundaries. The social worker's responsibility to set appropriate boundaries is also emphasised in the next section, 1.10, which sets forth rules for physical contact. Section 1.13 also places a very strong emphasis on boundaries, strongly discourages accepting goods or services from service users to prevent inappropriate boundaries in the social worker-service user relationship (NASW Code of Ethics, n.d.).

In general, I can say that the NASW Code of Ethics is written in a much more precise and concrete way, unlike the Slovenian one. Slovenian Code of Ethics of Social Workers (Kodeks etike socialnih delavk in delavcev Slovenije, n.d.) is on the other hand written in much more general way, emphasising human rights and respect for human dignity.

The Slovenian Code of Ethics of Social Workers (Kodeks etike socialnih delavk in delavcev Slovenije, n.d.) does not say much about setting boundaries; more so, the word ‘boundary’ is explicitly mentioned only once. The only explicit ‘limit’ in the Slovenian Code of ethics is parallel to Berlin's notions of positive and negative freedom (Berlin 1992). Berlin explains that we can be free in making autonomous choices, but only as long as our choices do not interfere with the freedom of others. Similarly, The Slovenian Code of Ethics of Social Workers supports the idea of a free and open society, but only to the point where cultural rights interfere with another person's human rights. Human rights are mentioned here as a limit of cultural rights (Kodeks etike socialnih delavk in delavcev Slovenije, n.d.).

Even though The Slovenian Code of Ethics of Social Workers (Kodeks etike socialnih delavk in delavcev Slovenije, n.d.) does not actually mention the limits, it does give us some guidance on how to act. In the first section, which deals with the basic values of social work, subsection A: Respect for Human Dignity and Integrity states that social workers are bound to work for the well-being of people and that this bond must not be broken by any other interests or goals (Kodeks etike socialnih delavk in delavcev Slovenije, n.d.). Although there is no direct instruction on setting boundaries, we can surmise that this section is talking about conflicts of interest in multiple relationships, against possible sexual relationships, and against accepting goods or services from service users.

The next indication of where to set boundaries is in subsection D: Professional Integrity. Subsection D states that social workers should be trustworthy, fair and righteous. That they should not use their position to oppress or exploit those who are in a weaker position. One should not use one's position to gain personal, financial, or other advantage (Kodeks etike socialnih delavk in delavcev Slovenije, n.d.).

The second part of The Slovenian Code of Ethics of Social Workers (Kodeks etike socialnih delavk in delavcev Slovenije, n.d.) discusses Ethical Principles. This part of the code clearly states that a social worker should never be physically or psychologically violent towards the service user. This is also the part that very directly states that the social worker should not accept goods or services from the service user. However, the statement that I find most important when thinking about boundaries is in subsection A, paragraph 1, which states that social work is based on the service user's consent to enter into a working relationship and the service user's right to influence his or her own life. Even when the helping process involves service users who are compelled to use services, the dignity of the person must be preserved. Even in such cases, the social worker should not work in an unprofessional and condescending manner (Kodeks etike socialnih delavk in delavcev Slovenije, n.d.).

The general idea behind setting appropriate boundaries, as far as I can tell, is the idea of promoting and preserving the human dignity of all those involved in the helping process. But what is a human dignity? And, perhaps even more important, how is human dignity understood by service users? In the paper entitled The Circle of Dignity: How can dignity be promoted in social work practice and policy? (Schmidt et al. 2020), the authors draw on the work of Edlunds, Killmisters, and Pols to examine the notion of human dignity as a two-sided concept. On the one hand, human dignity is an intrinsic virtue that is due to all human beings simply because they are human beings. On the other hand, we can speak of what is called social dignity. Social dignity arises in interaction with others and is therefore a quality that can be lost or gained in interaction with others (Schmidt et al. 2020). Schmidt et al. (2020) conducted a study that tried to answer this very question: What does human dignity mean to the service users? The results of the research showed that service users usually feel that their dignity is denied when they are treated by social workers in four different ways: as a number, as an empty space, as a monster or as a child (Schmidt et al. 2020).

Service users feel that their human dignity is denied when social workers treat them as numbers in an overly bureaucratic manner. Social workers proposed an individualised approach in response to this problem, one that takes into account the whole life-world of each individual and creates space and time for co-creating solutions. This response is also a warning to employers of social workers. Employers should be required to create conditions in which this type of working relationship is possible. Secondly, service users feel that their human dignity is denied when social workers do not acknowledge their plight. The social work system is structured to provide tangible ways to determine, how much distress a person is in, but that does not mean that people below that tangible line are not in distress (Schmidt et al. 2020).

The system is not designed to see people as complex beings, but rather only as a sum of particular parts. That means the system is not able to recognise many maybe smaller issues as one big intertwined problem on one hand, and on the other that all the problems of one person can be reduced to one diagnosis that the system in its narrow view recognises. In both cases, it fails to see people as they are and as consequence to recognise their needs. People may present with multiple struggles, but these may not be recognised or identified by the system as those in need. This may be because these issues are separated. Kimberlé Crenshaw (2016) demonstrates this problem with an example of a woman of colour who is educated and wants to get a job in a factory that produces vehicle parts. She claims that she was not hired for the job due to racial reasons. The judge hearing her case dismisses her claim and asserts that there are many people of colour employed by the same company. However, he overlooks the fact that all Afro-Americans who work in this company are men and they all work in the lowest positions. Kimberlé (2016) names the phenomenon of dealing with multiple problems that masks the distress of individual intersectionality. Social workers tried to offer a solution to this problem by supporting people to become more engaged in society. Social workers suggested their service users to become part of civil society initiatives where people with similar problems can get and offer support, get a source of strength and at the same time make the emerging problems more and more visible (Schmidt et al. 2020). A similar idea is also offered by David Peters (2015) at the Trauma of Racism Panel conference organised by the NYU McSilver Institute. He offered some practical examples of citizenship initiatives that empower people whose problems are not acknowledged by the system.

The third occasion when service users felt like their human dignity was denied was when they were treated in a condescending manner, as if they were children (Schmidt et al. 2020). The postmodern paradigm clearly states that a service user should be treated as an experiential expert. Both codes of ethics mentioned in this essay are clear that the autonomy of each person and the right to self-determination is to be respected. We as social workers should keep in mind that respecting human dignity should be the top priority in every case.

Nevertheless, I have found myself in doubt quite a few times when working with service users for the first time. These were somehow naïve dilemmas that were demanding from me to set a boundary between respecting one’s autonomy on one hand and providing enough care for a service user on another. I was looking for an Aristotelian middle way in order not to become condescending on one side and neglectful on the other.

For example, if I am going to the court with a person that does not know anything about the justice system in Slovenia, doesn’t even speak Slovene, but is determined to represent him or herself at the court, even though he or she is entitled to free legal help – is it on me to strongly advise this person to accept the free legal help? Or should I respect this person’s decision and most likely see this person fail? Banks, Sobočan, and Wulfekühler (2011) warn about the danger of falling into the position of ethical relativism – we have to offer the service users a possibility of taking an autonomous decision on one hand but on the other, we also have to be in a role of a ‘guardian’, which basically means that we have to know how to explain why some of the decisions are perhaps more appropriate than others.

The fourth and final instance where service users felt that their dignity was being denied was when they were treated as ‘monsters’ (Schmidt et al. 2020). They are treated as monsters when their whole life is reduced to one dominant issue. We as social workers should never forget to consider the service user as a whole human being, to respect their dignity and to advocate for their rights. We are, after all, obligated to be our service user’s allies.

I would like to end this essay by saying that social work is in many ways an art of setting the right boundaries. As social workers, we should try to incorporate all of the above insights when thinking about setting a boundary. It is true that boundaries separate us from others, but we should not forget that those same boundaries also connect us to others. In this respect, I follow the thought of Heidegger (1995) who, at least in my opinion, would defend the concept of boundaries as the only place where real relationships are possible. Heidegger (1995) explains this concept by using Georg Trakl's metaphor of a threshold, which represents a place where being in and out of someone’s home at the same time is possible. The threshold is a symbol of a boundary, which is understood as a safe space where one can maintain one's own individuality, although is at the same time becoming part of someone else's life.

Enduring in the boundary would mean, at least in my opinion, enduring in the intersubjective sphere of the working relationship. Establishing a personal connection, if I am to use Stern's terminology (Čačinovič Vogrinčič et al. 2011), is a process that usually involves three phases – ‘the present moment’, ‘the now moment’ and ‘the moment of encounter’. When we work with service users, we are usually in the present moment. The present moment opens up the sphere of intersubjectivity in which we sometimes consciously, but almost always unconsciously, try to synchronise with the other person's way of being. If we are fortunate, we can take our relationship further into the so-called ‘now moment’ and perhaps even further into the ‘moments of encounter’. The so-called ‘moments of encounter’ are the culmination of every personal relationship. They shift the structure of any relationship to another level. We should allow these moments in professional relationships as well, because these moments are usually followed by important breakthroughs in the helping process.

To reach this level of the working relationship, it is of course necessary to set boundaries. However, it is also necessary to keep in mind that there are some boundaries that need to be written in stone, and on the other hand, there are also some boundaries that need to be adapted to ever-changing relationships. Regardless of whether the boundary may be shifted or not, it is necessary for it to serve its purpose, which is to protect one's dignity and ultimately one’s human rights.

In the end I would like to summarise all the thoughts above into few principles that will hopefully serve me in my practical work in the future. I believe that the key to establish good working relationship with a service user is to learn about his or her wishes, to respect their choices and to provide one with all the necessary data so that one can make informed decisions. In order to be able to do all that I think it is of absolute importance to see a user of social services as a complex individual human being and not only as ‘diagnosis’. I believe that setting boundaries while taking into account all of the above can create a working relationship that is based on mutual respect and also a relationship that promotes human dignity.

Acknowledgements

The author would like to thank Ana Marija Sobočan, PhD, Assistant Profesor of University of Ljubljana, Faculty of Social Work for all her support and valuable comments that helped in creating this Essay.

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No potential conflict of interest was reported by the author(s).

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Ana Kapelj

Ana Kapelj has completed her undergraduate studies in Philosophy and is an MA candidate at the Faculty of Social Work, University of Ljubljana, Slovenia. Currently working on her final thesis, whilst volunteering at a local NGO, Slovenian Philanthropy, she is helping refugees in the process of integration. She has just started to work at the Employment Service of Slovenia as a career counsellor, specialising in individual in-depth counselling for long-term unemployed service users.