Self-Determination

You are working with an inpatient cancer patient who tells you he is interested in ceasing aggressive medical treatment and starting palliative care.  You’ve had experience with patients dying and also with those who choose to end treatment.  However, in your opinion, he is considering hospice earlier than most other patients usually do, when his chance of survivorship is quite high, and it “feels wrong” to you.

Think of similar situations where you feel conflicted, or outright may not agree, with a client’s desires or actions—a pregnant woman who is considering different plans of parenting, adoption, or abortion.  A domestic violence survivor going back to the abusive partner to give him/her another shot.  A graduate student who tells you about some dishonest paper writing or exam cheating.

Social workers encounter plenty of circumstances with clients that raise personal issues for themselves.  In those, it can be hard (but even more important) to stay professional and recall the ethical guidelines.

The NASW Code of Ethics says explicitly (emphasis my own): “Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals.” This is section 1.02, Self-Determination.

Sometimes it seems like a client’s own decision will result in a chance of harm coming to themselves or others, and we know that promoting a client’s wellbeing is another important part of the code of ethics (section 1.01).  

But when can you limit clients’ own decisions?  The following sentence in the self-determination section of the code states: “Social workers may limit clients' right to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.”  Those qualifiers need to be present in order for a social worker to step in.  Thus:

In real life counseling as well as on the ASWB exam (and California Law & Ethics exam), right/best answers in the self-determination category might look like 1) you helping clients explore the pros and cons of various paths, 2) assisting them in making a decision for themselves, and 3) generally respecting their own decisions – excepting issues involving mandated reporting, duty to warn, suicidal ideation with a plan & means to a plan, etc.  

Good luck studying!

Domestic Violence and Safety

One thing to remember about the ASWB test questions (and real-life social work practice, too) is that there is a priority placed on client’s safety and well-being.  That’s why there undoubtedly will be questions related to a social worker’s legal duty to report suspicions of abuse/neglect of children, elders, and dependent adults. 

But consider a question about domestic violence.  Domestic violence—also known as intimate partner violence—can include physical, sexual, mental, emotional, and/or economic abuse of one partner to the other.  It is usually rooted in the abusing partner’s desire to exert power and control over the victim.

A key thing to remember about DV questions on the exam is that domestic violence is NOT reportable to the local law enforcement or any other entity.  If a child is physically assaulted during a physical attack (accidentally or on purpose), that would be a mandated report to child protective services, but a social worker is not required to report physical violence between two adult partners.  Remember the distinction when you’re taking the exam.

Image credit Pixabay

A few other things to know about domestic violence:

A major goal when working with a victim of domestic violence is to help ensure her/his safety, along with that of any children in the home.  Helping the client come up with a safety plan is of utmost importance.

If the client is out of physical danger and has a safety plan in place, then a social worker might focus on psycho-educational topics.  One initial topic that is important for both the clinician and the survivor to understand is the cycle of abuse.  In short, the cycle looks like 1) tension building, 2) explosion/abuse, 3) apologies and honeymoon phase, and repeat.

Clinically speaking, family therapy and couples counseling are NOT recommended interventions for a domestic violence situation.  There is no way to ensure a victim’s safety in counseling, and often as a result of speaking freely in counseling, the victim is punished more by the abuser later.  Individual therapy for the survivor, and a separate counseling program for the abuser, are preferable treatment plans.

Thanks for reading and study well!