Professional Boundaries in Social work and Social care A Practical Guide to Understanding, Maintaining and Managing your Professional Boundaries FRANK COOPER Foreword by Jonathan Coe
Professional Boundaries in Social Work and Social Care A Practical Guide to Understanding, Maintaining and Managing your Professional Boundaries FRANK COOPER Foreword by Jonathan Coe ‘Frank Cooper provides helpful checklists and some core questions to assist practitioners in their decision-making. […] [He] does much to improve professional understanding, and to protect the public.’ – From the Foreword by Jonathan Coe, Managing Director, The Clinic for Boundary Studies, UK Professional boundaries between worker and client underpin all areas of practice in social work and social care, and the mismanagement of these boundaries can lead to unprofessional conduct and negative consequences for both worker and client. This book is a no-nonsense guide to boundaries – what they are, why they are there and how to maintain them, from legal boundaries and policies governing behaviour to rules surrounding confidentiality. Presenting a flexible framework of rules and guidelines which can be applied to any client relationship, the book offers practical advice and suggestions on how to judge boundaries and how to manage a situation when they have been crossed. It also explores the benefit to both worker and client of establishing a good rapport whilst maintaining a professional emotional distance. Throughout the book, and in the self-assessment test provided, the reader is invited to examine his or her personal responses to working with clients and their effect on maintaining professional boundaries. This simple and practical reference guide will be of essential use to professionals in social work and social care working with or managing support for clients. Frank Cooper is a freelance trainer specialising in professional boundaries in social care, and has over 16 years’ experience as a social care professional. He previously also taught in the fields of volunteer training and drugs awareness, and has developed accredited courses in his chosen fields of speciality. His website can be found at www.professionalboundariesinsocialwork.com. Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Cover image © Sylverarts | Dreamstime.com Cover design by Jan Marshall Professional Boundaries in Social Work and Social Care FRANK COOPER
Professional Boundaries in Social work and Social care
Professional Boundaries in Social Work and Social Care
500 Tips for Communicating with the Public Maggie Kindred and Michael Kindred ISBN9781849051750 A Practical Guide to Working with Reluctant Clients in Health and Social Care Maggie Kindred ted by Catb K ISBN9781849051026 Social Work Under Pressure How to Overcome Stress, Fatigue and Burnout in the Workplace Kate van Heugten ISBN9781849051163 ng Social Work Supervision Jane Wonnacott ISBN9781849051774 Mastering Social Work Skill series Relationship-Based Social Work Getting to the Heart of Practice Edited by Gillian Ruch, Danielle Turney and Adrian Ward ISBN9781849050036 The Social Workers Guide to Child and Adolescent Mental Health Steven Walker Foreword by Stephen Briggs ISBN9781849051224 Reflective Practice in Mental health Advanced Psychosocial Practice with Children, Adolescents and Adults Edited by Martin Webber and Jack Nathan Foreword by Alan Rushton ISBN9781849050296 Reflective Practice in Social Care series The Survival Guide for Newly Qualified Child and Family Social Workers Helen Donnellan and gordon Jack ISBN9781843109891
of related interest 500 Tips for Communicating with the Public Maggie Kindred and Michael Kindred ISBN 978 1 84905 175 0 A Practical Guide to Working with Reluctant Clients in Health and Social Care Maggie Kindred Illustrated by Cath Kindred ISBN 978 1 84905 102 6 Social Work Under Pressure How to Overcome Stress, Fatigue and Burnout in the Workplace Kate van Heugten ISBN 978 1 84905 116 3 Mastering Social Work Supervision Jane Wonnacott ISBN 978 1 84905 177 4 Mastering Social Work Skill series Relationship-Based Social Work Getting to the Heart of Practice Edited by Gillian Ruch, Danielle Turney and Adrian Ward ISBN 978 1 84905 003 6 The Social Worker’s Guide to Child and Adolescent Mental Health Steven Walker Foreword by Stephen Briggs ISBN 978 1 84905 122 4 Reflective Practice in Mental Health Advanced Psychosocial Practice with Children, Adolescents and Adults Edited by Martin Webber and Jack Nathan Foreword by Alan Rushton ISBN 978 1 84905 029 6 Reflective Practice in Social Care series The Survival Guide for Newly Qualified Child and Family Social Workers Hitting the Ground Running Helen Donnellan and Gordon Jack ISBN 978 1 84310 989 1
Professional Boundaries in Social work and Social care A Practical Guide to Understanding, Maintaining and managing your Professional boundaries FRANK COOPER Foreword by jonathan Coe Jessica Kingsley Publishers London and philadelphia
Professional Boundaries in Social Work and Social Care A Practical Guide to Understanding, Maintaining and Managing Your Professional Boundaries Frank Cooper Foreword by Jonathan Coe Jessica Kingsley Publishers London and Philadelphia
First published in 2012 by jessica Kingsley Publishers 116 Pentonville road London NI 9 B, UK 400 Market Street. Suite 400 Philadelphia, PA 19106, USA Copyright o Francis Cooper 2012 Foreword copyright o Jonathan Coe 2012 All rights reserved. No part of this publication may be reproduced in any material form(including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of licence issued by the Copyright Licensing Agency Ltd, Saffron House, 6-10 Kirby eet, London ECIN 8TS. Applications for the copyright owner's written permission to reproduce any part of this publication should be addressed to the publish Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Library of Congress Cataloging in Publication Data A CIP catalog record for this book is available from the Library of Congress British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN9781849052153 eSBN9780857004468
First published in 2012 by Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright © Francis Cooper 2012 Foreword copyright © Jonathan Coe 2012 All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing of an unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Library of Congress Cataloging in Publication Data A CIP catalog record for this book is available from the Library of Congress British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN 978 1 84905 215 3 eISBN 978 0 85700 446 8
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
