7.3 Common Ethical Challenges for Interns
Ethical challenges in Human Services work are part of the territory as we are working with vulnerable and at-risk populations. To prevent mistakes as much as we can, we need to acquaint ourselves with the most common situations that have the potential for ethical risks and develop risk management protocols to address these issues should they come up. In the following sections, we address some of the most common ethical dilemmas you might encounter in your field placement. This is not meant to be a comprehensive list, but merely some areas to be particularly aware of.
Dual Relationships
Dual or multiple relationships occur when a service provider is acting in a professional capacity with a client but is also acting in a different professional, social, or sexual capacity with the same person. Some professions’ ethical standards do recognize that not all dual relationships are avoidable. The American Psychological Association’s (APA) Code of Ethics believes that multiple relationships that do not impair the psychologist’s objectivity, competence, or effectiveness while performing their work and do not endanger the patient are not unethical (APA, 2016). However, the National Organization of Human Services does not support dual or multiple relationships due to the potential for harm or exploitation of the client.
Many dual relationships start with the best of intentions. You live in the same area as the client, so you begin to offer them rides home from their appointments, saving them an hour bus ride with three children in tow. Another client, recently released from prison, is starting their own lawn care company and asks to take care of your yard. Knowing how challenging many people may find their history, you agree to help them get the business on its feet. There is another client who shares your sense of humor, and you begin spending time with him after sessions, talking and joking around.
Any time you stray from your role as a human service provider, you begin to muddy the ethical waters. Again, your intentions may not be to take advantage or exploit your client, but once you are outside the bounds of the professional relationship, it is easy for actions to be misinterpreted, both by the client and by others. The fastest way to find yourself in a very difficult situation is to not tell anyone about either your plan to engage in the behavior or reveal that you did engage in the behavior. We talk further about dealing with ethical dilemmas later in the chapter, but getting professional input is critical when it comes to dual relationships. It will not be surprising if you come across this in your internship. In fact, one of the most common reasons that mental health professionals get reprimanded or get their licenses revoked is a dual relationship (specifically a sexual relationship).
Sometimes, it is difficult to avoid a dual relationship. If you reside in a small town in which you also intern, you will likely work with people you have seen at the grocery store or with whom you went to school. You may live in a larger city but are interning at the only agency that provides a particular service. Should a potential client be denied services based on the fact that you live next door to them? When it is unfeasible to avoid dual or multiple relationships, human service professionals should carefully evaluate potential exploitation or harm and discuss this situation with a supervisor.
Confidentiality and Professional Gossip
Due to the nature of human services, confidentiality of information is critical to the relationship between worker and client. The client shares personal information with the understanding that this information will be kept confidential and not be shared with others. Confidentiality, or sharing information outside of the professional relationship, can only be breached when the care provider believes it is in the best interest of the client, for his/her safety, or for the public’s safety. The law may warrant the need for confidential information to be disclosed in cases of suspected harm to a person with a disability or child or elder abuse. Billing for services provided also creates a possibility for confidentiality to be breached. Client confidentiality may also be breached if a court of law subpoenas the client’s file. When a confidentiality agreement is ignored or breached, you are exposing yourself to lawsuits, loss of client-caseworker relationship, and placement termination.
Confidentiality, as most interns know, is a key ethical responsibility. There are many dimensions to this issue, such as keeping client and staff information confidential, as well as conversations and observations made at the site and in classroom discussions. Another dimension of confidentiality to consider is outside of your work and academic environments. Most people have a natural desire to talk about their experiences, particularly meaningful ones, with others. Always check with the supervisor to find out the limitations as to what can and cannot be discussed within and outside of the workplace.
Keep in mind that when talking outside of the workplace, a person’s real name and identifying information (information that can be used to identify someone, such as gender, age, physical characteristics, behavioral history, place of residence, occupation, and so on) should never be used. The same rules apply to journals, notes, and, of course, social media. In fact, it is probably best not to even think about “discussing” anything from your practicum using social media, as that record never goes away.
Example: You are in your practicum class and say, “I was taken by surprise at my internship site when Suzie, my best friend from high school, came out of the therapist’s office who treats only opioid addicts.” It may seem like you have “permission” to share this information at your classroom meeting because there are many Suzies in the world, and you did not mention a last name. However, that would be a mistake because you have revealed what is called personally identifying information. For example, you identified the person as having a common name. Furthermore, you also specified a location and a relationship. Together, these three bits of information are more than enough to identify someone. In this case, someone in the class may have known Suzie in your high school and that she had a best friend who had your first name! Or perhaps the school’s social media pages showed a picture of you and Suzie together at an event.
Sometimes, it is not clear that your behavior is breaching confidentiality. As stated previously, we all have a desire to share our work—both when things go well and when things do not go so well. Many agencies have a norm of caseworkers informally sharing stories about clients with each other on a daily basis.
In general, it is fine to share information on a client with a supervisor or colleagues for coordination of services. Likewise, it is also allowable to share information when seeking assistance with questions about the situation or available services. The need to share information can tempt us to share beyond what is necessary. Professional gossip is a hazard in all workplaces but can be especially difficult when working in human services. It may be that you had a very difficult client interaction, and you feel the need to vent. Or perhaps you overhear other workers sharing stories of challenging cases, and you want to feel a part of the team, so you share a story about a client. Remember to be careful about sharing specific details that can identify a client. Another caseworker may end up working with your client later and have their views influenced by your story.
Another issue that comes up in human services is how to respond when a client tells you something about another worker. Remember that the client’s recollection of the event will be colored by their own view of the experiences. Definitely refrain from joining in talking about your colleague. If a client shares information you find concerning, it is best to discuss it with your supervisor or instructor before acting on it.
Regulations concerning client confidentiality often apply to human services settings, too. HIPAA is an acronym for the Health Insurance Portability and Accountability Act that Congress passed in 1996 and is a compliance requirement for any health professional or setting. Most human services professionals talk about these requirements when discussing ethics, but it is also the law that makes honoring these rules more than just an ethical obligation. These rules apply to all forms of information, including printed, oral, and electronic forms. Furthermore, only the minimum health information necessary to conduct business is to be used or shared. Criminal justice settings may have different rules concerning confidentiality because some records are open to the public for the asking, such as crime reports, so it is always advisable to discuss the rules with your supervisor early in your internship.
Boundary Crossing
Interactions between workers and clients are quite frequent and often close. We are often talking about difficult or highly personal issues. These circumstances can create a false sense of intimacy with our clients and begin to influence our professional relationship with the client. This can lead to sharing more information about ourselves than we intended or engaging in behaviors that are outside of the scope of our professional role. This can be as simple as sharing details about your own family or giving a client a ride somewhere when that is not a normal service provided to clients.
Once we begin to compromise the professional relationship, it becomes easier and easier to slide into a more personal relationship with a client. This is what we refer to as boundary crossing. These boundaries are guidelines, rules, or limits we create to identify what are the safe, reasonable, and permissible ways we can allow other people to interact with us and what to expect when those boundaries are crossed. Strong and healthy boundaries also help us navigate a professional relationship, even when the relationship includes some intimacy. Healthy boundaries also inform people of the degree of help you are able to provide, either in the amount of time, resources, or energy you can afford to give. Boundaries can also be crossed by clients. One of the most common problems arises when a client gives a gift to a worker. Most agencies have rules around what is admissible to accept and what is not. It is a good idea to become familiar with this policy ahead of time so that you will be able to respond if this happens.
Overidentification is a common cause of boundary crossing. When we identify too much with a client and a situation, it often blurs the lines between our lives and that of the client. This often happens with the best of intentions but can have a negative effect on the relationship and the work. For example, you are working with an immigrant man who is struggling with sobriety. As an immigrant male yourself, you decide to recommend the AA meeting you attend since there are other immigrants who attend. You credit this group with helping you stay sober, and you identify so strongly with the client you become invested in their sobriety as well. You end up giving the client rides to and from the meeting, sometimes stopping for coffee. What started as a professional relationship now looks more like a friendship now that boundaries have been crossed. Now that the client relies on you for extra support, it will be difficult to step back into a more professional role without upsetting the client.
Boundaries are not universally understood or honored. What works well in one country is a disaster in another. In sum, boundaries are not a “one size fits all” concept. It is important to be aware of what some of the cultural norms are around interacting with others that might become important.
Cultural Customs
If your duties include home visits, it is also good to be aware of the cultural customs around hospitality that may come into play when meeting clients in their own homes. For example, many cultures do not wear shoes in the house, and you will be expected to remove your footwear. Also, in many cultures, it is important to serve guests food, and guests who refuse to eat or drink can appear rude or condescending. I had a student once accompany a male supervisor to visit with a very traditional male Muslim client. The client was shocked when the student (a female) tried to shake his hand when they met. In the client’s culture, men and women who are not related do not touch each other in public. It is important to have cultural humility and become comfortable navigating different customs and practices.
In the next section, we discuss how to handle dilemmas when they arise.
Common Ethical Challenges for Interns Licenses and Attributions
“Common Ethical Challenges for Interns” by Ivan Mancinelli-Franconi PhD and Yvonne M. Smith LCSW is licensed under CC BY 4.0.
situations in which you are faced with unclear choices about how to handle a situation with a client. This may be a difference between your ethical guidelines and another’s, a conflict between your personal and professional ethics, or a clash between two competing ethical standards.
a relationship between a human services worker and another person or group that involves a conflict of interest. Common examples include dating a client, or using a client for the clinician’s own personal or financial gain
Ethics are a code of morals or a philosophy that guides an individual’s behaviors and actions. Ethics also include a set of standards or code of conduct set forth by a company or profession.
the ability to perform successfully the duties and activities of your profession.
A credit class in which students apply theory to practice by using what you have learned in coursework in a real-world setting with a supervisor/mentor who is invested in your growth and development (often also referred to as fieldwork or practicum).
spoken, written, and behavioral communication practices designed to provide and maintain an individual’s or group’s privacy. Includes licensing and HIPAA requirements.
the act of ending a relationship. Termination in human services generally refers to the methods used by workers to end relationships with clients.
the rules a governing body sets, maintains, and enforces. Violations may result in fines and loss of licensure or certifications.
the ability to determine our own safe zones to our emotions. Keeping separate needs, desires, thoughts, and feelings from those of others. In the human services context, boundaries most often refer to keeping our needs and wants separate from those of our clients.
the inability to differentiate between one’s own life, work and challenges and those of a client (or clients).
the shared beliefs, customs and rituals of a group of people
approaching clients with respect and curiosity regarding differences in cultural background and/or practices