(Written for upcoming ethics training)

Questions to ask yourself when you believe you are unable to work with a patient because their behaviors, beliefs, choices, or lifestyle conflict with your personal values

When does it not?  Not only do most (if not all) of our patients have at least one behavior that conflicts with our personal values, but we, too, have behaviors that conflict with our values as well.  Comparing another person’s behaviors to our values is not clinically necessary and may not even be relevant.  If we think about it carefully, the patient, also, has behaviors which conflict with his or her own values.  This is what is called “the human condition”.

Why is this one different?  As social workers, we work all day, every day with people who do things we don’t agree with.  We successfully work with people who are actively using illegal substances, who have been abusive to someone they love, who have committed a crime, who are engaging in risky behaviors, who have been dishonest, and an infinite number of things that are outside the value system of not only the us, as clinicians, but of the patient themselves.  That is kind of the point.  That’s why they come for help.  Something is not working well in their lives, they know it, and they want help moving past it or in changing somehow, some way.

Is it “too close to home”?  Many times what is confused as a values conflict is, in reality, an emotional trigger.  We (social workers) are people too.  We have had bad things happen in our lives and, too, have personal challenges we are struggling with.  When a patient has a problem that is too close to one we are facing in our own life it may present a barrier to good service if we do not manage our end of this.  There is also counter-transference possibly taking place (where the patient subconsciously reminds us of someone in our life).

What other modalities are there?  There are a wide variety of treatment modalities, interventions, and techniques available to use in the provision of services or therapy. With all the available options, there are plenty that could be used that would enable us to work with a specific patient in a manner that does not result in us feeling forced to violate our own personal values.  There are few, if any, validated approaches that have unmanageable bearing on our personal values as social workers.  If best practice standards are being adhered to, it would be highly unlikely such a situation would occur.  The therapeutic relationship is not about us, the clinician at all and the professional methods, if followed, would protect both, the clinician and the patient from violating anyone’s personal values on any level.  We, the clinician, would be cautioned to focus on using the best practice standards in the treatment or service provision and to be reminded that we, the social worker (as a person) do not replace the process. 

Are you giving advice?  When people want advice they can write an advice columnist (which does not require a professional license).  The provision of social work service requires a license and therefore techniques used are those that only licensed professionals have the legal authority to utilize.  When we don’t use unprofessional methods, we will be less likely to encounter a conflict with our personal values.

Can you focus on a higher value?  Let’s be honest.  We’ve all violated our own personal values when there has been a conflict among two or more of them.   We have all navigated situations in our lives where one value conflicted with another and we had to choose.  Most often, we select the value with a higher priority and resolve the conflict with ease.  We may tell someone they look nice when, in reality, they look like they’ve been sick for three weeks (because they have).  We opt for a higher value than honesty (in our own value system) which would be about compassion, kindness, and protecting a person we care about from unnecessary hurt over something they have no control over. (We may give our friend an entirely honest and hurtful answer in another situation if an even higher value was present–such as helping them avoid a life threatening mistake).

Is there a conflict with the profession?  This question is very important to the integrity of the clinician as well as the profession.  Does this clinician have a personal value that conflicts with the published values, standards, and principles of the profession?  In this case, there may some deeper ethical issues involved.  Just as it would be unprofessional (and malpractice) if a dentist refused to provide a dental treatment solely based on his personal values against a standard procedure of dentistry, so too, would it be unprofessional (and malpractice) if a social worker declined to support the standards of the social work profession in providing social work care.  When we accept a license, a title, a job, and a client under the heading of “social worker” we are contracting to provide a professional service based on the standards of the social work profession.  We do not have the legal discretion to substitute any standard of the profession with our personal preferences.

Have you consulted with a colleague?  One of the first steps in resolving a concern about the provision of services to a specific client or a specific group of clients is to consult with another professional.  Whether it’s a co-worker or a supervisor, it’s important to seek guidance in any situation that could result in a problem with the treatment of a patient or with the ability of a social worker to provide compassionate, competent care.

Have you consulted with the NASW?  The social work profession, like all professions, have a professional association.  The association has publications with guidance for most all situations a social worker may find themselves.  Professional and ethical consultation is offered and it is a valuable service.  The licensing board in the individual jurisdictions also have numbers available for consultation especially for ethical dilemmas.  Finally, whether you are working independently or for an organization, somewhere there is liability insurance involved.  Insurance carriers also offer consultation for situations that could end up creating a liability for the social worker or the agency.






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