Ethical Dilemmas in Social Work: Reflective Essay

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Throughout our careers, we all are presented with ethical dilemmas. Regularly reviewing your own professional ethical standards and values is necessary to maintain a balance in practice. As a student in social work, I am faced with the task of continuously challenging my personal values and principles against interactions with persons whom I work with; this is an exhausting responsibility. Reflecting and resolving ethical dilemmas based on our professional values is essential to maintain accountability as social workers so that we can achieve the best outcomes for people.

My personal ethical standards and values have been developed out of my experiences as a private child carer. Most of the children I looked after were from single mothers dealing with drug and alcohol issues or domestic violence. I spent many hours talking to mothers about their life experiences that have brought them to their current circumstances. Many of the discussions were around safety, rehabilitation, and access to services. Working with children and women of domestic violence, and drug and alcohol abuse led me to situations that challenged me to the very core of my values.

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I was given children to care for because the mother's party had gotten out of hand, babies recovering from the mother’s friend forcing them to inhale marijuana, basic neglect, and other horrors. I have been given children for months on end with no knowledge of when I can return the child to the mother, and no pay to cover the child’s care. Child protection services (for those times) operated under the rule that if the child is being cared for by me, then there is no crime or neglect. My lack of wages is not of concern, and if I returned the child to their mother while the parent was under the influence, I would be arrested and charged with child endangerment. My values and ethical standards in the care of a child, care of a mother, and care of myself were all challenged. I developed regular care and action plans depending on the appointment and initial intake interview.

In student placement, a recent experience in resolving an ethical dilemma has magnified the importance of engaging in relevant processes and practice to achieve equilibrium and prevent complications. This paper aims to explore the ethical issues faced by the use of unconditional positive regard in practice, a vital tool. It also will highlight an ethical dilemma about the AASW Code of Ethics 2010 and how this situation was resolved. I will begin by detailing a case study from practice and discuss the ethical dilemmas that arose from the situation and the process of resolution. The lessons learned from this process about the AASW Code of Ethics 2010 will also be highlighted.

Case Study

For five weeks, I had been counseling Natasha, a 14-year-old female (I was a student in my final year placement). Natasha had stopped attending school because of severe anxiety; the anxiety was clinically diagnosed by her psychologist. During our counseling sessions, Natasha disclosed that her anxiety has been a growing issue since her childhood, and this has had a major impact on her developmental years. This included developing relationships with her peers and being comfortable in the school environment. At the intake stage of our counseling, Natasha formulated her long- and short-term goals, which included positive internal self-talk, returning to school and completing her education, going to TAFE, and working towards a photography career.

The theoretical framework of the solution-focused framework and the strengths perspective were the main foundational applications of the therapeutic approach. By using unconditional positive regard, I was able to encourage Natasha to externalize the problem. This allowed Natasha to be able to explore her strengths and abilities to reach her goals. The use of unconditional positive regard has been vital in building trust with Natasha, so she was willing to be open about discussing her anxiety with me. Unconditional positive regard and reflective listening have also been vital in maintaining my ability to avoid becoming a trigger for Natasha’s anxiety when we have been talking about her issues.

The use of unconditional positive regard has brought with it some ethical dilemmas. While it has been useful in developing trust and openness with Natasha when she was discussing her anxieties with me, Natasha developed an inappropriate emotional attachment to me. I noticed that during our sessions Natasha was open to engaging in her goals, but she constantly required me to positively affirm her actions. I also noticed that Natasha’s motivations towards achieving her goals became more to please me and gain a warm, positive response. When I attempted to withdraw my responses to her achievements, I noticed Natasha became less motivated to move forward, and I even noticed Natasha deliberately failing in areas where she had already overcome, just to draw out my unconditional positive regard response.

Natasha’s care team included her family, school, and a psychologist who were all working on Natasha’s mental health in a collaborative approach. Part of Natasha’s overall care plan was that she would return to school within a set time frame, and pressure was being put on me to move Natasha forward towards this goal. There was some trepidation expressed as to how long Natasha has been absent from school and that she was not engaging adequately in the online classes and tasks that were put in place to assist Natasha’s education while she was absent from school. At the care plan meeting, where Natasha’s progression was the primary focus, it was depicted that anxiety research stipulates Natasha's return to the source of her anxiety which is the school environment, and it was my role and duty to make this happen. I was then given a time limit of four weeks, which left me feeling uncomfortable with the lack of attention to Natasha’s achievements to date. This is where I reflect on the ethical dilemmas about the AASW Code of Ethics 2010.

Ethical Dilemmas, Resolution and the AASW Code of Ethics 2010

As a student, I felt anxious about the outcomes of the meeting and why this raised issues for me. I was concerned about my adequacies as a professional, but since I was still a student, there should be some guidance if there was an error in my application to the best practice models. I met with my supervisor who instructed me to spend my weekend reflecting on why this raised issues for me. This was the best thing she could do as an instructor.

I did not doubt that Natasha’s care plan was built from professional experience and with Natasha’s recovery as the primary focus. The medical care and corresponding care plan must be followed. My personal values and ethics were applying the solution-focused framework, as well as the ethical standards and values applied by the organization’s best practice model and code of conduct. This meant that I believe that Natasha is the expert in her own life, she has inherent strengths and extensive resources that can be drawn on to solve the problem. It is the client who sets the agenda of therapy, and their goals define the direction their care takes. My question is if the person is in charge of their goals and therapeutic approach, who are we to tell Natasha to return to school in four weeks? The goals in Natasha’s care plan did not always correlate with Natasha’s own personal goals. Reflection upon my views and standards within the context of being a student under supervision and the AASW Code of Ethics 2010 highlighted many values and principles.

Inexperienced Student

It is necessary to first acknowledge my lack of experience as a student in placement. This is an important factor to consider because my skills and abilities in counseling and ethical decision-making practices are still developing. I am being supervised, but if I were on my own, my inexperience put me at greater risk of drifting from ethical standards and the AASW Code of Ethics, which could cause harm to the person.

The comments in Natasha’s care plan meeting had a huge bearing on me as I felt pressured to insist Natasha return to school earlier than she had planned. I doubted my effectiveness in practice, and the achievements that Natasha had obtained during her time with me became veiled in a cloud. I discussed this with my supervisor and she mentored me about taking on responsibility for the issues. This in itself became an ethical dilemma because I had taken on board the responsibility of Natasha achieving her own goals. I had become too involved with the person I was caring for, a mistake regularly made by students, inexperienced workers, and even seasoned social workers. My supervisor reflected to me that as social workers we need to be mindful to not take on the responsibility of resolving a person’s problems. We facilitate self-determination, informed decision-making, and empowerment, but we are not responsible for decisions or when the care plan and clients' own goals clash. In critically analyzing the AASW Code of Ethics, I will consider the ethical dilemmas and issues and their application to the situation with Natasha.

Person-Centered, Self-Determination, and the Highest Possible Regard

Self-determination focuses on a person's rights to make his own goals and interventions, in the absence of the impingement of other rights and responsibilities like self-harm or harm to others. It is the equality between the person and the social worker in their relationship that assists and ultimately drives the successful person; this is a core value described in the AASW Code of Ethics. In the interest of the client, a successful care plan is a collaborative approach with other appropriate service providers, including social work, and, where possible, upholds the person’s right to self-determination. Natasha’s self-determination allows her to formulate her own goals and how she can work towards returning to school. If her goals and aims were not upheld, I would run the risk of breaching her trust, and a shift in the equilibrium of the relationship would occur. This situation is more difficult because of Natasha’s age, there is a question about her competence to drive her own goals because of her maturity levels. However, Natasha's failure to return to school is not necessarily a reflection on her abilities to drive her own therapy, and if I were to take over, this would have a detrimental effect in a person-centered framework, Natasha’s goals take priority, however, this does not stop me from renegotiating a time frame with Natasha with careful use of reflective listening and positive regard.

Informed Choice and Use of Creativity

Informed choice enables a person to self-drive his goals with all of the right information available to them. The client needs a range of alternative choices and a wide range of information made available to them so they can make the correct self-determined choice. For Natasha to make informed choices, she needs to know about other strategies and alternative methods to be able to obtain her goals. The solution-focused framework maintains that the choice must remain with the person, but it is the role of the social worker to educate and inform Natasha about the best option to choose. If I dictated to Natasha that she must be in school in four weeks, this would hinder her informed choice and destroy her self-determination. Based on the 2010 AASW Code of Ethics and the solution-focused framework, the best approach is to go with the person and try to apply an alternative approach to the situation. My supervisor and I formulated an approach that incorporated positive regard, person-centered therapy, and art therapy in the form of creative writing to guide Natasha to a better understanding of her goals.

The use of unconditional positive regard allowed Natasha to feel most comfortable and supported, while at the same time, she felt lifted up in her successful application so far. In the application of art therapy, I sat with Natasha and we wrote our own adventure story where we drove through a labyrinth of scenarios in the journey to obtain Natasha’s goals of going to school, going to TAFE, and becoming a photographer.

Empowerment

Empowerment is the groundwork for the self-determined practice and informed choice, this is summed up by Zastrow: “Social work is done with, not to a client”. The relationship between a person and a social worker is built on support systems for the person to make informed choices about their goals. Overall, the aim is to empower the person to solve their own problems and explore and search for their own information so they can self-advocate. The therapeutic process of Natasha’s case is to focus on her goals and not take control.

Lessons Learned

In considering the ethical dilemmas I have faced as a worker, I learned several lessons from Natasha's case. Solution-focused theory plays a major role in the values and ethical standards of social work because these disciplines focus on self-determination, and both disciplines complement each other, making them easy to apply. The addition of art therapy as a means to educate Natasha and make sure that she has a complete understanding of her informed choices was a creative idea. I wanted to reach Natasha at her level and inform her that she needs to return to school and have Natasha explore why doing this earlier would be the best move forward.

As a student and moving into practice, I found that the constant parallel reflection of my values and ethics against the AASW Code of Ethics was a valuable and vital tool. It is my responsibility to improve practice by critically reflecting and reanalyzing the situation to allow for new actions, engaging in supervision and education, and other supports that provided me with the ability to self-govern and resolve the ethical dilemmas that arose with Natasha that are not purely based on my own reflective skills.

The use of unconditional positive regard and the ethical dilemmas that arose with it have also been managed through reflecting the ethics and values provided by the AASW Code of Ethics. The AASW Code of Ethics provided a framework that allowed me to challenge conflicts between other professionals caring for Natasha. This also allowed me to ground my values in practice to self-determination and respect while helping her reach her goals.

Conclusion

As a student, my learning curve integrating theory into practice is steep, and the consequences of my errors can be harmful, particularly in ethical practice. This paper reflected upon the case and demonstrated reflection should be done in conjunction with the AASW Code of Ethics. This has shown the structures of the social work code of conduct and how reflection provides practitioners with the ability and skills to learn new tools and initiate core values that may have been overlooked. The use of unconditional positive regard as a vital tool in social work practice has provided its own ethical dilemmas. These issues were resolved with further reflection on my own ethical values against the AASW Code of Ethics. By introducing a creative approach through the use of art therapy and with the aid of my supervisor, I was able to realize my errors and make corrections with little impact on the person.

References

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