Professional boundaries

Andy Atkins knows how easy it can be to overstep the professional boundaries in social work.

In July 2005, Atkins began a relationship with service user Anita, who had previously been under his care. According to the General Social Care Council's (GSCC) conduct committee, the relationship started "within a relatively short period" after Atkins had stopped being her designated social worker.

During the subsequent GSCC misconduct hearing in November 2007, it emerged that Atkins' career had been otherwise "exemplary" and he had not harmed or exploited Anita while working at Leeds community mental health service. Atkins received a nine-month admonishment for failing to inform his employer immediately when the relationship began. He says he simply fell in love. "I didn't choose to - it just happened," he says.

Since then, Anita has become his wife and together they run training courses for social workers on professional boundaries. Atkins believes his punishment was the "right response" and hopes other social workers can learn from his experience. His case highlights the complex nature of the issues that practitioners face in one of the most emotionally demanding professions.

"My circumstances raise the question of when is a service user not a service user. Should there be a time limit before a professional can have a relationship with a service user, or should professionals never have personal relationships with former service users?" he asks.

Common breaches

But subverting boundaries can cause serious harm to service users. In one recent case, East Sussex social worker Peter George was struck off the social care register for sexually assaulting a vulnerable teenager under his care. George, a senior professional, was found to show no insight or remorse and demonstrated a "blatant disregard" for social care standards, the GSCC found in October last year.

Analysis published by the GSCC has revealed that 40 per cent of social work conduct cases involved allegations of inappropriate relationships. Other common breaches of the code include behaving in a way in or outside of work that would call into question practitioners' suitability to work in social care services, abusing the trust or personal information of service users or care and putting people at unnecessary risk.

At present, social workers are required to abide by the GSCC's Codes of Practice for Social Care Workers. Divided into six sections, the codes require workers not to abuse, neglect or harm service users or form inappropriate relationships with them, among a number of other measures.

But the GSCC is aware that clearer advice is needed. Later this year, it will publish guidance to assist social workers "to practice ethically".

Sherry Malik, director of strategy and social work education at the GSCC, says the toolkit will help social workers reflect on their practice and is likely to encourage practitioners to become more self-policing rather than prescribing what they should do. "It will not set out a list of dos and don'ts, but will instead use examples of actual conduct cases to illustrate instances of real-life professional boundaries violations," she adds.

Complex relationships

Naomi Milton*, a children and families social worker in London, admits it can be tempting for social workers to cross the professional boundaries, especially if they believe they are acting in the interest of service users. But she is aware of the perils that this presents. "I know of social workers who have given out their personal mobiles in an emergency or who have inadvertently used their personal phone to make an urgent work call. There is always deep regret, as the number is then passed around, or the person called has made a note of the number and will use it - often a lot - to call the social worker out of hours. It is a nightmare," she says.

Setting professional boundaries in social work is far from clear-cut. Where you draw the line will depend on the individual situation, argues Professor Jennifer Davidson, from the University of Strathclyde. Davidson, who has written training materials on professional boundaries in social work, believes that practitioners need to be made aware of what is appropriate behaviour in particular contexts. "Relationships are complex and multi-faceted. Professional judgment is the fundamental component here," she says, giving the example of hugs as one potentially difficult area that can be interpreted in a myriad of ways.

"A social worker employed in a residential care facility might reassuringly hug a scared young child who is spending the first night away from home. We would anticipate that this same worker might consider a less physical action to express reassurance when newly working with an adolescent who has a history of sexual abuse. What are the intricate dynamics that guide wise judgment? Would we say that all hugs are off-limits, in all contexts?" she asks.

"Certainly some victims of professional sexual misconduct might advocate for a ban, given their common experience that hugs can function as a step toward boundary violations. Attachment theorists, however, could provide us with an argument against a ban on hugging clients," Davidson adds.

She also points out that professionals have to strike a balance between being too open or closed. "What's rarely discussed is the professional boundary of being too rigid - when social workers default to prioritising bureaucratic systems," she says.

Sharing information

London social worker Milton admits that it is "very easy" to get drawn into service users' lives and practitioners usually learn fast about the importance of boundaries. "If your boundaries are loose and everyone finds out it is very damaging," she says.

To help social workers maintain a healthy professional distance, Andy Atkins' training course explores scenarios in which their actions could be perceived differently by service users. Such dilemmas include the sending of text messages to service users and whether this can lead to the expectation that you're available 24 hours a day, and whether you should use your client's toilet in case it sends out a certain message, such as whether you are checking on the cleanliness of their home.

Other experts advise social workers to recognise the warnings that they are getting too involved with a client. Such signs include constantly thinking about a particular client or sharing personal information with them (see box).

The forthcoming GSCC guidance will encourage social workers to consider whether they would be comfortable talking about their actions in supervision and if they could justify their behaviour according to social work values if they were challenged.

Atkins welcomes such guidance but says that it will be "impossible to legislate for every scenario". He adds: "I believe every case is different - apart from the obvious ones of abuse - and as such should be treated on a one-to-one basis by the disciplinary body."

Davidson agrees that the issue of professional boundaries can never be treated as a "black and white issue," saying: "The territory of professional relationship boundaries is clearly not one of simple answers."

*not her real name

ADVICE ON MAINTAINING A PROFESSIONAL DISTANCE

• Recognise warning signs that you may be getting too close - for example, if you are daydreaming about a service user, exchanging gifts with them or revealing too much information about yourself
• Use supervision to get support and reflect on your professional relationships
• Preserve a personal support system and spend time with family and friends
• Maintain an identity that is distinct from your professional role
• Watch your level of stress, and adjust professional responsibilities during times of personal crisis
• Be properly trained to meet the demands of your work
• Explore your own personal history and recognise how this may affect your relationship with service users
• Engage in reflective discussion and debate with colleagues about ethical issues that arise in practice
• Develop confidence in questioning your own and others' actions
• Have a monitoring and alert system to help when things go wrong on home visits
• Seek out support from senior colleagues and take opportunities to shadow other workers
• If you are a newly qualified social worker, get support on developing confidence around professional boundaries

Sources: The University of Strathclyde, the GSCC and BASW - The College of Social Work

Resources

• British Association of Social Workers' Code of Ethics
• Professional Boundaries Research Report, Sheffield Hallam University
• GSCC Professional Boundaries Report
• International Federation of Social Workers' Ethics in Social Work, Statement of Principles