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by Linda May Grobman, ACSW, LSW

 

THE NEW SOCIAL WORKER’s Book Club started in May 2009.  So far, we have read three books—The Soloist, Still Alice, and Push.

 

“The New Social Worker Book Club” has an official group on Facebook. You can join the group at: http://www.facebook.com/group.php?&gid=98840583520 – the club has grown to 926 members!   

 

I am looking for ideas for our next book club selection.  Have you read a great book with relevance to social workers?  Let me know at linda.grobman@paonline.com and I will consider it for a future book club selection.

 

Visit the book club group page on Facebook (http://www.facebook.com/group.php?&gid=98840583520) for more details and to discuss books with members of the book club. 

 

Happy reading!

In the February 2010 Social Work E-News, the biographical information for Zia Ullah Akhunzada was incorrect.  It should have read as follows:

 

We apologize for the error.

 

 

We asked our Facebook fans how they are celebrating Social Work Month.  Here are some of their answers:

 

 

We also asked what they love about social work.  They said:

 

 

You can find THE NEW SOCIAL WORKER on Facebook at http://www.facebook.com/newsocialworker.

 

 

 

 

by John A. Riolo, Ph.D.

 

In the age of Google, Facebook, and Twitter, it seems that privacy as we knew it is dead.  One can find out almost anything about anyone with little effort and technical skill.  For psychotherapists, that poses some very interesting questions and dilemmas. 

 

How much should clients know about us?  In the old days, when psychoanalytic oriented therapists dominated the field, the therapist was to present a blank face or mask to patients. If a client/patient were to question the therapist about anything personal, the therapist was to analyze the patient’s resistance rather than give any disclosure, lest it interfere with the appropriate transference.  While many therapists still maintain that stance, others have moved away…some so far in the other direction that they maintain that it is an ethical obligation to reveal anything that may potentially affect treatment, including their own private medical information and any medications, both prescribed and over-the-counter.  Each group sincerely believes in the efficacy of its position.  So, is there a reasonable balance?

 

To answer that question, we need to examine several factors. What do patients have a right to know? What are therapists comfortable in sharing?  What can be learned by patients/ clients whether we voluntarily disclosed it or not? And what should we keep confidential to the best of our ability?

 

Licensing boards and ethical standards generally grant patients the right to know such things as your credentials, limitations to your scope of practice, office policies, your participation in insurance panels, and your fees.  They also have a right to know your license status, including whether you are licensed to practice independently, whether there is any action against your license, and if supervised, who supervises you. 

 

Most other things are really a matter of the therapist’s comfort level, the patient’s desire or need to know, and his or her ability to find out with or without your cooperation.  Some therapists choose to share nothing personal, and others are comfortable mentioning their family, hobbies, and other interests. Some will disclose their sexual orientation and religious beliefs, whereas others choose to keep these things private.  Some clients/patients will insist on knowing your sexual orientation or your religion before committing to see you. So it’s partly a matter of preference and partly consumer demand.  As long as it is done in the patient’s interest and does not interfere with what the patient is seeking help to address, this is a therapist’s decision based on comfort and practicality.

 

Like it or not, patients can sometimes discover things on their own that we may not be comfortable sharing or discussing with them. In an excellent article titled The Google Factor, Dr. Ofer Zur describes the various things your clients or anyone can find about you, whether you like it or not.  This can include any public records about you, such as many court documents that are classified as public records, including marriage and divorce records, lawsuits, liens, and so forth.  They can also find anything you wrote or that was written about you on the Internet, including alleged confidential discussion groups and social networks. By using a combination of Google searches and/or by paying a relatively inexpensive fee, clients can employ special services that can retrieve financial information and tax information; credit reports, debts, liens, or bankruptcies; criminal records and small claims civil judgments; past and present lawsuits; marriages and divorces; allegations of domestic violence or molestation; ownership of property and businesses; and phone records with minimal effort.

 

Most of these searches are perfectly legal, but even those that are outside the law are accessible and available to be done without your knowledge. Most clients/patients who stay with the legal methods at least are simply curious or are doing due diligence in checking out who they will do business with. It has become almost a reflex for many of us. Before we buy anything, we Google or go to www.Yelp.com to learn all we can first.  The reality is that, comfortable or not, this is something we need to accept.

 

So, what’s left of our privacy? The sad reality for those who value privacy and confidentiality is that the answer is “not much” these days.

 

But one thing that is as private as it gets is still our medical records. Not absolute, but still protected.  Should we ever be compelled to reveal our medical history? Not without a fight, or a court order!  Notice I said compelled. There could be times when revealing certain aspects of our medical history may actually help a client, if disclosed with discretion and with the purpose of aiding the helping process. It depends on the context of therapy (i.e., client, setting, therapy, relationships, and therapist).  For  more on context, see: http://www.zurinstitute.com/dualrelationships.html#context. Or, if we have such an obvious and noticeable disability, refusing to discuss it would be the proverbial elephant in the room.  But that is and should be our choice.

 

Yet, for a profession that claims to value privacy, I have come across some well-intentioned but, in my opinion, misguided colleagues both young and experienced who have suggested that we disclose to our patients any medical problem or medications that might potentially affect our treatment of patients. The rationale is that it is in the interest of full disclosure and informed consent. But this seems to be going to extremes.

 

First, it solves little. If, in fact, some condition or medication rendered us truly impaired, what good would it do to simply disclose our medications to a client/patient? Most experts in the field, including Zur, would say that if we are impaired, we must step down, regardless of how we present it to our clients. We can tell them as much or as little as the circumstances and the context of treatment dictate, but the key is we need to step down.

 

Second, if we must disclose pain or medication with clients as some suggest, should it be for something as temporary as a toothache, or only long-term chronic problems? There is a real danger that clients can misconstrue and assume we take pain medication regularly and are abusing medications, which is not the same as taking legitimate medications as prescribed.  Such misunderstandings could be used against us in any number of ways. 

 

Third, talking to patients/clients about our own pain must be done very judiciously and in the context of what’s good for the patient.  We must guard against putting the patient in the position of feeling sorry for us and feeling the need to console or care for us.  That could be an ethical conflict.

 

Lastly, what message would we give to patients, if we are so readily willing to disclose our most private information without cause?  What will our patients think about our willingness to protect theirs?

 

In conclusion, we need to be keenly aware of what our clients have a right and a need to know about us. We need to reconcile what we are comfortable sharing with what they will be able to find out anyway. But if we value confidentiality, we need to set an example and protect our own as much as possible. 

 

One way to deal with the curious client is to have a public profile on Facebook or MySpace, where we  post innocuous materials that are light, humorous, and fun.  It may not seem an ideal solution to those of us who value privacy, but it may be the best we can hope for in the age of the internet.   

 

 

 

 

 

Hospice is a valuable resource that can be utilized by professional social workers working in a variety of fields. According to the Harris Survey on End-of-Life Care in 2002, 86% of people prefer to die at home. Yet, almost 70% of Americans die in hospitals or nursing homes. Hospice upholds the social work value of self-determination by allowing clients to die at home if they so choose. According to the Administration on Aging, the population of people ages 65 and older is expected to grow from 40 million in 2010 to 55 million in 2020, which will dramatically increase the number of people with a terminal illness.

 

Hospice embraces the core social work value of respect for the dignity and worth of individuals by helping terminally ill patients to maintain their dignity and quality of life through pain and symptom management. Spiritual, emotional, and bereavement support are also offered to patients and their families. Hospice helps patients to die with comfort and dignity, yet the National Hospice and Palliative Care Organization (NHPCO) reports that 83% of people do not know anything about hospice. As social workers, we have a duty to educate clients about this compassionate healthcare option.

 

As social workers, we must be prepared to discuss all available end of life care options with clients and their families. Healthcare decisions often cause family disagreements, and social workers must be prepared to provide education, and dispel myths, about hospice for families while helping to facilitate family discussions. We must also be prepared to work with physicians who may not be comfortable discussing all of the options available to patients when a terminal diagnosis is made.

 

Hospice is covered by the Medicare Hospice Benefit and is included in many private insurance plans, yet it is underutilized. Patients are eligible for the Medicare Hospice Benefit after they receive a terminal diagnosis with a prognosis of six months or less. However, according to the NHPCO, the average length of stay in hospice programs in 2008 was 21.3 days, and 35.4% of patients died within seven days. These facts suggest that referrals are being made too late. Social workers must recognize when clients may be able to benefit from hospice services, discuss these services with clients and their families, and make appropriate referrals.

 

Knowledge about hospice services can be useful to social workers who encounter clients, in any setting, who have a loved one who is terminally ill. Social workers can inform clients about the availability of hospice services and the bereavement support that is available after patients die. The illness and death of loved ones is a common experience that will be shared by clients in a variety of settings and, as professional social workers, we must be prepared to help clients cope with their grief and to navigate available resources.

 

Before we can educate our clients about hospice, we must educate ourselves. The Web sites of NHPCO and other hospice organizations listed below offer valuable information about hospice. Most hospices have speaker’s bureaus that are available to make educational presentations to professional and community organizations. Presentations can be scheduled easily by contacting your local hospice agencies. Please take the time to educate yourself about hospice so that you can better serve your clients.

 

Hospice Foundation of America. http://www.hospicefoundation.org/

Medicare Hospice Benefits. http://www.medicare.gov/publications/Pubs/pdf/02154.pdf

National Hospice and Palliative Care Organization. http://www.nhpco.org/ templates/1/

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Take Charge of Your Life. http://www.takechargeonline.org/