Analysis of NASW code of ethics and ethical dilemmas in social work

Social Worker Ethics

Ethical dilemma:

Privacy and Confidentiality

One of the most difficult situations for a social worker is when he or she must deal with confidentiality issues regarding a minor. For example, if a social worker is counseling an adolescent girl with an eating disorder in the context of a family intervention, the girl's understandably concerned parents may wish that the social worker disclose what the girl says during private therapy sessions. However, the adolescent must feel as if he or she can speak freely, to fully benefit from the sessions.

At the beginning of the session, the nature of the private counseling sessions should be defined, according to the social worker's code of ethics: "(f) When social workers provide counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual's right to confidentiality and obligation to preserve the confidentiality of information shared by others. Social workers should inform participants in family, couples, or group counseling that social workers cannot guarantee that all participants will honor such agreements."

Parents may not have a right to know the content of the sessions, but they do have a right to know the rationale and why privacy must be maintained, and assured that the social worker will intervene if the girl is in medical danger. Presumably, given the girl's condition, she will also be monitored by medical personnel with experience in treating eating-disordered patients, to ensure her vital signs are monitored.

The girl should also understand the parameters of confidentiality regarding therapy. For example, she should understand that if she says: "I hate my mother," the social worker will not report on her to her mother. On the other hand, if the social worker becomes aware of negative behaviors that could impact the girl's health, the social worker has an obligation to tell someone to preserve the girl's safety. The social worker may urge the girl to reveal some of the things that the girl says in therapy -- for example, to say to her mother "It makes it hard for me when I see you call yourself fat in the mirror." But the social worker will not break privacy obligations to do so. Perceived coercion is associated with a poor outcome in eating-disordered patients, and while in some instances it may be essential to breach the patient's confidentiality to preserve her life, this should not be done lightly, and only as a last resort (Guarda 2006).