This document discusses various ethical dilemmas and issues that may arise in private practice for social workers. It covers topics like maintaining social work core values, defining ethical dilemmas, and the differences between ethics, values, morals, and laws/policies. It provides guidance on making ethical decisions using the E-T-H-I-C method and developing qualities like cultural competence. The document also addresses issues around promoting a practice ethically, maintaining client confidentiality, dual relationships, informed consent, scope of practice, record keeping, and closing a practice.

1. Ethical Dilemmas and Overlooked
Issues in Private Practice
NASW Conference 04.02.15
Kate McNulty LCSW
CreateYourPrivatePractice.com

2. Social Work Core Values
• service
• social justice
• dignity and worth of the person
• importance of human relationships
• integrity
• competence

3. Ethical DILEMMA Defined
• SW must make a decision about best course of
action
• A choice is involved
• Arriving at a decision will involve some
compromise of one or more ethical principles
See socialworker.com, What is an Ethical Dilemma

4. Ethics
Professional
standards based on
logic and reason,
rationality
Cognitive tools
used to arrive at a
best solution
Root of rational is
ratio, reckoning

5. Values
Concepts that are
honored
Aspirational ideas with
a component of
emotion: root of the
word aspiration in
Latin is related to
longing for, seeking
after

6. Morals
Code of conduct for
one’s own behavior
Provides guidance for
our relationship life

7. Laws and policies
Prescribed conduct for
one’s professional role
Mandated or
prohibited behaviors
for all members of a
society
SW ethics include
obligation to
challenge unfair laws
and policies

8. When Bad Things Happen to Good Social Workers
Great article for those interested in more detail on SW ethics: Frederick
Reamer, socialworktoday.com

9. E-T-H-I-C
• Examine relevant personal, societal, agency, client and
professional values
• Think about what ethical standard of the Code applies + laws
and case decisions
• Hypothesize about possible consequences of different
decisions
• Identify who will benefit and who will be harmed
• Consult with supervisor and colleagues about most ethical
choice
• Elaine P. Congress, What SWs Should Know about Ethics

10. Qualities needed to make
thoughtful ethical decisions
• Cultivate reflective time and attitude
• Receptive to and valuing of feedback
• Humility
• Lifelong learner
• Discernment about associates you choose
• Cultural competence
• Technological competence

11. Colleagues should let you know if you’re off track
Develop candid relationships with people you trust so you get regular
feedback on your clinical judgment and decision-making.

12. Support structures for arriving at
reasonable ethical outcomes
• Paid consult in 1:1 or
group format
• Plentiful and frequent
continuing education
events
• Risk management
consults through
malpractice insurer
• Peer consult in 1:1
format or as needed
• Participate in NASW
Board or other
organization

13. Role of Licensing
Board
If you are the subject of a Board
inquiry, consult an attorney before
responding to any letters or phone
calls.
The Board is not your advocate.
The Board acts to protect the
concerns of clients and members of
the public.
They pursue inquiries and investigate
complaints about possible wrongdoing
by licensees.
It is your responsibility to protect your
livelihood and license by seeking
advice from a malpractice attorney.

14. Promoting your practice ethically
and effectively

15. Free first sessions?
This is often used as a marketing
technique but introduces some
possible confusion at the start of the
relationship:
Are they your client in a free first visit?
Does this serve as a screening process
for you?
Do they complete introductory
paperwork?
What liability do you carry if they
choose not to return?
Are you causing harm, if after an initial
visit you decide to refer the client
elsewhere?
Is this the most effective use of your
marketing time and energy?

16. Testimonials
While clients may offer favorable comments, all codes of ethics prohibit
soliciting or employing client testimonials.
You may use testimonials from non-therapy relationships like classes and
workshops.

17. Claims about
results
We cannot imply or
make promises about
outcomes of our work
That might mis-lead
prospective clients or
suggest that they can
expect the same
results other clients
have experienced

18. Wait lists
Busy therapists sometimes
create waiting lists.
Is this in the best interests of
the client?
How can you know the client
is appropriate for a wait list if
you haven’t met them?
What about the concept of
client readiness or urgency?
How do we set priorities?
What about considering the
client’s need for treatment
versus our business and
monetary concerns?

19. Thanking referral
sources
It is good business to thank
referral sources for the clients
they send. They also
appreciate notification of the
results of their referrals.
Our obligation is to protect
client privacy, so even simple
notes of appreciation should
only be sent after we have
obtained a release of
information, so we have
permission to communicate.

20. Media inquiries
At times you may receive calls from media personnel looking for
comments on news stories. They are often urgent in their manner.
You should not offer diagnostic opinions about people you have not met,
even if you are asked about well-known celebrities.

21. Complex situations
involving confidentiality
Maintaining confidentiality with
children, teens and families can
be especially complicated. Using
plain language, carefully explain
informed consent and limits of
confidentiality in advance.
Cases involving divorce and step-
parenting are also difficult; obtain
written consent of both parents
unless one has sole custody and
there is a good clinical reason to
exclude the other parent from
therapy.
Group work with teens is another
place to exercise special care with
boundaries and information-
sharing.

22. Explaining limits of confidentiality
Ensure clients understand what information you will and will not
disclose, before the question is raised. Take all the time you need to
review this in detail, so you use these concerns to build on rapport.

23. Inquiries to be aware of
• You should refer out cases
like this unless you are
qualified to treat them as a
specialist:
• Forensic cases
• Disability evaluation
• Fitness for duty (police, transport
professionals)
• Court mandated evaluations
• Child custody evaluations
Many problems can be
prevented through proper
screening at the time of the
initial inquiry
Be prepared to turn away
these cases and have referrals
at the ready if you often
receive inquiries about
problems like this

24. Child custody & Divorce cases
• Don’t bite off more than you can
chew- nor take on a professional role
if you are not trained for it.
• Leave comments and legal opinions
on parenting arrangements to
qualified child custody evaluators.
• Divorcing clients may seek your
advocacy; provide them with
professional referrals and continue
offering therapeutic support to them.
Do not cross professional lines. Seek
consultation from a colleague or
advisor if you are not sure how to
proceed.

25. Dual relationships
Dual relationships: are they necessary,
or avoidable? Can you see the forest
for the trees?
May be impossible to avoid in rural
setting or in sub-communities in urban
areas
May see current or former clients in
community contexts
Can still maintain professionalism and
limit the types of conversations and
interactions that occur outside the
therapy space

26. Other potential compromises in
confidentiality
• Shared office spaces
• Shared waiting rooms
• Shared file cabinets and storage
• Advice and referrals on listservs
• Curbside consultations

27. Boundary crossings
and violations
“Out of office experiences” may be
unavoidable; not necessarily harmful
Responding to emergencies may
include phone contact outside office
hours
Assess effectiveness of soundproofing
in your office
Artwork and furnishings in your space:
are they comfortable and welcoming
for all? Do your furnishings include
religious or spiritual imagery that
could alienate some people?

28. Scope of practice and limitations
• Stay within realm of
your training and
expertise
• Demonstrate that you
are truly specialized in
certain topics
• Refrain from claiming
mastery of too many
subjects
• Maintain ongoing
training, reading and
research
• SW Code states you
must be culturally
competent and
equipped to treat
diverse populations

29. Details of informed
consent
Allow time for thoughtful and
thorough conversations about consent
A signature on a form is only the
beginning
Obtaining consent involves ongoing
discussions and evaluation of your
technique and the results you’re
achieving
Make sure fee and terms of treatment
are agreeable
Obtain signature if you are on panel
and client elects not to use insurance
Secure written permission to work
with collaterals as needed

30. Provisions for reasonable care
• If you end therapy with someone
due to a poor fit or your lack of
expertise, you must find them
some alternate sources of
treatment
• For this reason and many others,
your practice should include a
multitude of connections with
other clinicians and professionals
• Most states oblige you to have a
peer who agrees to act as
conservator of your practice in
case of disability or death

31. Moving, closing or retiring from a
practice
• Review contracts with insurers and provide adequate notice
in the event of closing your practice
• Take clients’ ongoing care needs into account and prepare to
make appropriate referrals
• Allow enough advance notice to ensure clients are connected
with new providers
• Review state requirements for storage of records
• If leaving records stored, assign a qualified person to retrieve
in the event of a subpoena or other necessary circumstance

32. Keep good records and maintain good clinical habits.
You will end your career on a high note, ready for the next chapter of your
life.