1.7 Establishing boundaries
Activity 6 Managing the hidden culture
Imagine now that you are Marie's manager and you decide to call in at the unit on your way back from a day out. You often drop in unannounced to make sure everything is OK and because it is the only chance you get to talk to some of the night staff. You walk in on the joke-telling incident and hear from the corridor what has been said. What do you do?
Go in and join in the laughter.
Go in and confront the staff – if so what exactly would you say?
Turn around and pretend you didn't hear.
Decide not to challenge the staff now but to put on some staff training at a later date.
Now write a paragraph saying why you decided to tackle it this way. What went through your mind? If you decided not to intervene, think about how much worse it would have to get before you did go in and say something.
Well, managers clearly have a role to play in containing these aspects of the work: acknowledging difficult issues, setting agreed limits on how tasks should be approached, and helping individual staff to walk the tightrope of not being too cut off or too close to those they are working with. If Marie's manager joined in, or even initiated the joking, there would be no containment and nothing to stop things getting worse. It is up to the manager, or occasionally inspectors, to set out what is expected and then monitor whether staff keep within agreed boundaries.
Intimate care is an area in which boundaries are almost inevitably crossed but it is by no means the only area in which a spontaneous response can have unforeseen implications.
Now we look at a real-life attempt at establishing the boundaries of care relationships. Enfield Social Services (1996) has drawn up guidelines on professional boundaries for a wide range of staff including field social workers and those working in residential care. The guidelines attempt to set markers on a range of issues in professional relationships with children and adults. In particular they cover issues about:
not taking advantage of clients (e.g. in sexual or financial transactions)
disclosure of personal information within professional relationships
expressing affection in worker-client relationships.
Click on the player below to hear Vicky Golding of Enfield Social Services discuss their guidelines on professional boundaries
Transcript: Guidelines on professional boundaries
Activity 7 Guidance on professional boundaries
Listen to this audio clip now. You will hear Vicky Golding, an Area Manager for Enfield Social Services, describing why her department decided to develop these guidelines and talking about some of the controversial areas in the guidelines and what it means to be ‘professional’.
As you listen to the audio clip jot down anything you react strongly to.
Then look through at Enfield Social Services' guidelines on professional boundaries between staff and service users (click on the link below to access the file) and note which items you agree with and which you would not want to be bound by in your own situation. If you are on the receiving end of care, think about whether you would want this kind of ‘professional’ relationship with your carer or if you expect them to be more open and personal with you.
Enfield Social Services' guidelines grew out of two situations in which workers had ‘overstepped boundaries’ by taking individual children home, but they cover the more general issue of where to set limits in professional relationships in terms of how much personal disclosure and expression of affection is ever appropriate in a professional relationship. The model of professionalism represented here is one which errs on the side of maintaining a certain distance. Did you agree with this, or would you have drawn the line at a different point?
One of the controversial areas is just how much we expect workers to reveal of themselves. The Enfield Social Services guidelines suggest that workers should not reveal much about their personal lives to their clients but this can also create difficulties. For example, Marie told Richard about her boyfriend Barry as one way of re-establishing some distance when he was interpreting their relationship on a more personal level. Another exception might be that a gay worker at Marie's unit might be able to provide a very positive role model to gay or lesbian young people if they were allowed to be open about their sexuality. Vicky Golding drew a distinction between the kind of reciprocal sharing which goes on in a self-help group where one's personal experience would be seen as an asset in the work, and the more anonymous role of a care worker or social worker. Do you agree with this distinction?
Another difficult area addressed in the guidelines is the expression of affection and touch, which would be considered quite normal for children if they were being cared for within their families; kissing and hugging, saying ‘I love you’ and so on were also singled out as issues in services for older people and people with learning difficulties. It might be different for service users who get affection from other relationships in their lives than for people who are isolated and otherwise deprived of any such contact. What do you think? The guidelines also address the issue of favouritism; for example, if one resident is given gifts or taken out more than others in a group care setting.
Actions are ‘graded’ in the guidelines so that some are forbidden altogether, such as having sex with a client, others are subject to a manager's discretion and others are up to workers to decide for themselves. Did you find this helpful? Craft and Brown (1994) highlight the importance of guidance which works to ‘define the greatest possible leeway within which individual workers and teams can reach their own decisions’ (p. 18) and which balance these two functions:
… to draw some acceptable boundary around the personal and the professional and to define the boundaries within which individual workers can respond as they think best.
(Craft and Brown, 1994, p. 18)
The open consultation which has taken place in Enfield Social Services goes to the heart of what social and care services are about. Are social workers or care staff there to replicate ordinary relationships, to compensate for a lack of them, or to provide practical help while staying in the background so that people can ‘live their own lives’? Some clients may rely on professional carers to provide them with affection and social contact which they do not get elsewhere. The answer is bound to vary for different people and different settings, but the process of consulting with a wide range of people and attempting to provide some clarity is an important one for clients, staff and managers.
Vicky Golding emphasised that ‘professional boundaries’ are important for service users who:
are often very vulnerable – they can be needy and boundary-less themselves and open to exploitation by a worker in a powerful position …
But she also points out their usefulness as a framework for managers because they:
clarify what is acceptable and so where a boundary has been breached, we can actually point to it and use [the guidelines] as a management tool …
and for workers:
but they are also for protecting the worker, which is really important because workers are vulnerable and don't always realise how they're leaving themselves open.
This reflects the triangular nature of accountability.
Managers need to ‘contain’ difficult areas of care work.
Boundaries are not only crossed in intimate care but in ‘social’ settings as well.
Professional relationships are different from ordinary reciprocal friendships.
Formal guidance provides a reference point which can protect service users, staff and managers.