"Fix her for me, will you?"

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It seems like the general public’s perception of the social work profession is that we are around to solve everyone’s problems. I can’t tell you how many times a nurse has wandered into my office, handed me a patient’s file, rattled off a list of problems, and wandered back out. I don’t mean to be critical of nurses or of anyone else in these helping professions; Heaven knows we are all overworked and exhausted. But I am getting tired of the idea that I am the resident problem solver. This guy needs Medicaid, get it for him; this lady needs to stop spending her money on cat food and start spending it on medicine, make her do that (and get her the drugs she needs in the meantime); this family needs to pay their mortgage, get them the money. And be sure you do it by today because they might be dead by tomorrow.

I love the concept of Social Work. I love the idea of helping people acquire the resources they need to improve themselves. What I can’t figure out is how to navigate between coworkers expectations of “help” and a client’s idea of “help.” They are two different things.

Many people seem to think that a social worker is not doing a good job if a client still has a messy house, still lives alone, still has denial issues, still has an unpaid mortgage, etc, even whilst working with a social worker. What is not taken into account is the will of the person. I’ll happily help a client make arrangements for a housekeeper or a sitter, or I’ll help a client apply for financial assistance or Medicaid if they would like. But I can’t just go into their home and wave my magic wand and solve their problems for them. And even if I could, there is no section of the Social Work Code of Ethics that give us permission to use magical powers. If no one is in immediate danger, there is not reason to solve problems that clients don’t care about. On the contrary, social workers “enhance clients’ capacity and opportunity to change and to address their own needs.” (NASW Code of Ethics)

“Address their own needs.” Not address the needs that the nurses, the chaplain, or even the social worker think are important. But the client/family’s own needs. What has the client identified as important? What does she need help with? And what effort is she willing to make to get there? If I give her the resources and the support, can she give the effort? Those are some of the questions I ask myself when I am assessing a client.

Empowerment. Sometimes we forget this concept. Or maybe sometimes we think that to empower someone is to make them like us. To introduce them into our culture and our reality. To make them give high priority to the same things that we give high priority.

That doesn’t seem terribly effective.

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Posted in: hospice,social work ethics

Boundaries- Cross at your own risk

I've been wondering about boundaries that as social workers are generally hammered into our heads. Do other disciplines and other helping professions receive the same boundary awareness training that we social workers receive? I can't quite figure it out.

• A therapist brings his wife and children to a patient's house to clean it for her.
• A chaplain adds a patient's adult daughter as a friend on Facebook
• A professor sleeps with a student.
• A doctor sleep with a resident.
• A (fill in the blank) sleeps with a (fill in the blank)
• A nurse buys groceries for a patient because his fridge is empty.
• An aide invites a patient who got kicked out of his home to come and stay at her place.
• A volunteer spends the night at a patient's house because "I just felt like she needed me to be there."
• A nurse notices a patient's mattress springs are poking out of a patient's bed, so she purchases a new mattress for her and delivers it personally.
• A volunteer gives a patient a suppository. ("I just decided that I was his friend for a few minutes and not his volunteer").
• A social worker sleeps with a client. ("I just decided that I was his lover for an hour and not his social worker").

In some agencies, this type of work is lauded and considered very praiseworthy. It is even expected. To me (and hopefully any professionally trained social worker), it screams "INAPPROPRIATE!" Seriously. We are taught from day one not to get too involved, and to maintain professional boundaries. On a personal level, I struggle with this. I become very invested in the lives of my friends and family members. It is a weakness most of the time. But on a professional level, I have no problem (thus far in my career) with maintaining boundaries.
In my opinion, the majority of people who choose to do the actions listed above (all of them made up. Any similarities to actual persons, living or dead, is purely coincidental) do it not to meet the need of the patient or client, but to meet their own needs. In an agency where things like that are expected and even encouraged, the need might be to seek after praise or recognition, or to combat the fear of losing one's job in the uncertain economy. Those who choose to respect professional boundaries may be seen as callous or jaded or out of touch with what the client "really" needs. I think what most clients need are professional, kind people who know how to get them in touch with their needed resources.
When I worked in foster care, I met kids and families that I just wanted to take home with me. Heck, when I taught swimming lessons, I met kids and families that I just wanted to take home with me. Why didn't I? Well, aside from the fact that I would not survive as a foster parent at the moment... duh.. boundaries. I'm sure we've all met people who we love and want to do anything for. But in these cases, it is best to keep our professional distance.
Boundaries protect us. Just like boundaries in our personal lives protect us (choosing not to drink alcohol protects me from drunkenness; choosing to wait until marriage for sex protects me from STDs; choosing to fasten my seat belt protects me from many injuries). We draw our own boundaries in our personal lives. In our professional lives they are drawn for us. At least I thought so.

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Posted in: hospice