Contents Foreword by Jonathan Coe Chapter 1 Introduction 11 Chapter 2 How Tight Are Your Boundaries? Chapter 3 Why Do We Have Boundaries? Chapter 4 Generic Boundaries 41 Chapter 5 Confidentiality 73 Chapter 6 Beginnings and Endings Chapter 7 Professional Boundaries and the Law 95 Chapter8 Broken Boundaries 105 tpter 9 Understanding Negative Consequences 131 Chapter 10 Maintaining Boundaries 140 Chapter 11 Self- 159 Appendix I Useful Organisations 168 Appendix II Further Redding 170 171
Contents Foreword by Jonathan Coe 7 Chapter 1 Introduction 11 Chapter 2 How Tight Are Your Boundaries? 17 Chapter 3 Why Do We Have Boundaries? 29 Chapter 4 Generic Boundaries 41 Chapter 5 Confidentiality 73 Chapter 6 Beginnings and Endings 87 Chapter 7 Professional Boundaries and the Law 95 Chapter 8 Broken Boundaries 105 Chapter 9 Understanding Negative Consequences 131 Chapter 10 Maintaining Boundaries 140 Chapter 11 Self-awareness 159 Appendix I Useful Organisations 168 Appendix II Further Reading 170 Index 171
Foreword The creation of boundaries is at once d psychic necessity and an illusion. Tbe need to draw lines allows for the existence of make thinking possible. We also establish rules that demarcate psychic space: don't touch me there, don ' t ask me that. However, there are no real lines, even on a pbysical level, just horizons where one entity meets anotber and the outer skin defines the borders between the two. In the psychic world, the lines are more blurry still. Who is to say where one's self ends and tbe otber begins? Andred Celenza ( 2007) The American psychoanalyst Andrea Celenza captures a central issue in thinking about professional boundaries -that they are both real and chimerical. Whilst there must be clear and unequivocal rules which outlaw some forms of behaviour(don' t have sex with your clients, don,t steal their money, etc.), in day-to-day practice most boundaries require reflection, thought and readjustment where necessary. Of critical importance is the need to be able to articulate any action, with colleagues and with supervisors, and to focus on the clients wellbeing as the trump card in choice-making One of my earliest memories is from 1971: my father bringing home a client of his, a young woman who had been prescribed Thalidomide during her pregnancy, and her daughter, whose crude prosthetics fascinated and alarmed us as we rolled around the floor together. Reflecting on this some 40 years later my father, the social worker, did not feel good about his decision to invite her into our home: What must she have thought?"he said Special treatment, and the urge to provide it, is one of the early warning signs that we teach practitioners to be aware of, part of a potential'slippery slopeof behaviours which can lead to significant
7 Foreword The creation of boundaries is at once a psychic necessity and an illusion. The need to draw lines allows for the existence of categories – this is this and not that – and, in this way, boundaries make thinking possible. We also establish rules that demarcate psychic space: don’t touch me there, don’t ask me that. However, there are no real lines, even on a physical level, just horizons where one entity meets another and the outer skin defines the borders between the two. In the psychic world, the lines are more blurry still. Who is to say where one’s self ends and the other begins? Andrea Celenza (2007) The American psychoanalyst Andrea Celenza captures a central issue in thinking about professional boundaries – that they are both real and chimerical. Whilst there must be clear and unequivocal rules which outlaw some forms of behaviour (don’t have sex with your clients, don’t steal their money, etc.), in day-to-day practice most boundaries require reflection, thought and readjustment where necessary. Of critical importance is the need to be able to articulate any action, with colleagues and with supervisors, and to focus on the client’s wellbeing as the trump card in choice-making. One of my earliest memories is from 1971: my father bringing home a client of his, a young woman who had been prescribed Thalidomide during her pregnancy, and her daughter, whose crude prosthetics fascinated and alarmed us as we rolled around the floor together. Reflecting on this some 40 years later my father, the social worker, did not feel good about his decision to invite her into our home: ‘What must she have thought?’ he said. Special treatment, and the urge to provide it, is one of the early warning signs that we teach practitioners to be aware of, part of a potential ‘slippery slope’ of behaviours which can lead to significant
PROFESSIONAL BOUNDARIES IN SOCIAL WORK AND SOCIAL CARE harm for clients, and professional disgrace for the practitioner. Frank Cooper provides helpful checklists and some core questions to assist practitioners in their decision-making Awareness of boundaries in professional practice has been around a long time, and they were memorably articulated by Hippocrates, in the Oath written in the fifth century BC. It included mention of staying within what one is trained to do: I will not use the knife/./ but will withdraw in favour of such men as are engaged in this work. It was clear on the need for confidentiality: What I may see or bear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself bolding such things shameful to be spoken about. And it outlawed improper relationships th clients: Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons/./ But, as Cooper notes, there has been a dearth of education social workers and there is no mandatory component on boundaries in formal social work qualifications. Statutory regulation for qualified social workers has thrown light on the previously hidden; we now know that significant numbers of cases coming before professional conduct panels have concerned violations of boundaries, in fact they represent one in five of all misconduct findings, a rate far in excess of figures published by for example, the General Medical Council Boundary transgressions occur across all professions and the Clinic for Boundaries Studies is aware of cases involving hospital doctors, surgeons, complementary therapists, priests, psychoanalysts, counsellors and social workers. There appears to be a higher risk in disciplines which involve relationship as a central part of their practice. This may help to explain why there are significant numbers of cases within the talking therapies, why GPs and psychiatrists are reported more often than other doctors to the GMC and, perhaps, why social workers have seen such significant percentages in front of the Social Care Councils There are some dangers around the raising of awareness about professional boundaries. One is the overly rigid application of theory, a response which leads to organisational policies which make any self-disclosure by practitioners whatsoever(as one NHS
8 Professional Boundaries in Social Work and Social Care harm for clients, and professional disgrace for the practitioner. Frank Cooper provides helpful checklists and some core questions to assist practitioners in their decision-making. Awareness of boundaries in professional practice has been around a long time, and they were memorably articulated by Hippocrates, in the Oath written in the fifth century bc. It included mention of staying within what one is trained to do: I will not use the knife […] but will withdraw in favour of such men as are engaged in this work. It was clear on the need for confidentiality: What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about. And it outlawed improper relationships with clients: Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons […]. But, as Cooper notes, there has been a dearth of education for social workers and there is no mandatory component on boundaries in formal social work qualifications. Statutory regulation for qualified social workers has thrown a light on the previously hidden; we now know that significant numbers of cases coming before professional conduct panels have concerned violations of boundaries, in fact they represent one in five of all misconduct findings, a rate far in excess of figures published by, for example, the General Medical Council. Boundary transgressions occur across all professions and the Clinic for Boundaries Studies is aware of cases involving hospital doctors, surgeons, complementary therapists, priests, psychoanalysts, counsellors and social workers. There appears to be a higher risk in disciplines which involve relationship as a central part of their practice. This may help to explain why there are significant numbers of cases within the talking therapies, why GPs and psychiatrists are reported more often than other doctors to the GMC and, perhaps, why social workers have seen such significant percentages in front of the Social Care Councils. There are some dangers around the raising of awareness about professional boundaries. One is the overly rigid application of theory, a response which leads to organisational policies which make any self-disclosure by practitioners whatsoever (as one NHS
Fo Trust has done) a disciplinary offence. Another is the idea that the boundary breachers are uniquely bad, nothing to do with the rest of the profession, and must be eliminated. In fact, boundary transgressions by intentional predators are much less common than those by ordinary professionals and with this book Frank Cooper does much to improve professional understanding, and to protect the public Jonathan Coe Managing Director, The Clinic for Boundary Studie. www.professionalboundaries.orguk
Foreword 9 Trust has done) a disciplinary offence. Another is the idea that the boundary breachers are uniquely bad, nothing to do with the rest of the profession, and must be eliminated. In fact, boundary transgressions by intentional predators are much less common than those by ‘ordinary’ professionals and with this book Frank Cooper does much to improve professional understanding, and to protect the public. Jonathan Coe Managing Director, The Clinic for Boundary Studies www.professionalboundaries.org.uk
Chapter 1 Introduction What are professional boundaries? Professional boundaries are a set of guidelines, expectations and rules which set the ethical and technical standards in the soci care environment. They set limits for safe acceptable and effective behaviour by workers. The earliest known set of professional boundaries within Western society is the Hippocratic Oath. This was a code written in ancient Greece in roughly the fifth century Bc and was intended as an ethical code for doctors and physicians. A translated and modernised version of the code is still used by some medical colleges around the world The oath included, amongst other things, the following boundaries You must understand the limits of your knowledge and not work beyond them You must work with the good of the patient to the best of your ability and not do any harm to patients. You should not enter into sexual relations with anyone who as connection to your work. You should keep the details of your work with clients Although the oath was directed at medical professionals, it featured many concepts that we use within the boundaries for social care professionals to this very day. Modern professional boundaries are derived from a variety of sources. Some are from law or government papers, laid down and codified in quality standards, some are
11 Chapter 1 Introduction What are professional boundaries? Professional boundaries are a set of guidelines, expectations and rules which set the ethical and technical standards in the social care environment. They set limits for safe, acceptable and effective behaviour by workers. The earliest known set of professional boundaries within Western society is the Hippocratic Oath. This was a code written in ancient Greece in roughly the fifth century bc and was intended as an ethical code for doctors and physicians. A translated and modernised version of the code is still used by some medical colleges around the world. The oath included, amongst other things, the following boundaries: • You must understand the limits of your knowledge and not work beyond them. • You must work with the good of the patient to the best of your ability and not do any harm to patients. • You should not enter into sexual relations with anyone who has connection to your work. • You should keep the details of your work with clients confidential. Although the oath was directed at medical professionals, it featured many concepts that we use within the boundaries for social care professionals to this very day. Modern professional boundaries are derived from a variety of sources. Some are from law or government papers, some are laid down and codified in quality standards, some are generally