The Angry Client

Paula Mackey is a clinical social worker providing mental health services at a public clinic in a largely Hispanic-serving community center in Lansing, Michigan. At the beginning of the counseling session, Abe, a Hispanic client, makes disparaging remarks about Anglo clients, suggesting also that he believes they receive preferential treatment at the clinic and that this fact has influenced the quality of his progress with Paula, an Anglo therapist. As Abe complains to Paula, “we’re in the capital of Michigan and the guys in charge give all kinds of good citizen awards for big-shot Mexicans, but the service doesn’t trickle down to us in the community; the whites have the governor in their pocket and they get everything—even at this community center—including the only good counselors.” Upset about the tenor of the discussion, an agitated Paula elects to review it with her supervisor, who suggests that Paula discuss it openly with her client at the next session, attempt to correct his mistaken impressions, address directly his racially charged opinions, and, if all else fails, consider transferring the client to another therapist, matched by ethnicity. The practice decisions Paula must make in this scenario include the manner in which she discusses this issue with her client and her course of action at the next therapy session.

Consulting her NASW Code of Ethics, Paula ascertains that social workers have a responsibility to promote social justice (Ethical Standard 6.01), a guideline that might inspire Paula to take the stance that racism in all its forms must here, as everywhere, be confronted as it arises. Additionally, Paula uncovers Ethical Standard 1.02, which suggests social workers have a responsibility to honor their clients’ right to self-determination, a rule suggesting Paula should carefully evaluate the client’s expectations concerning therapy and then attempt to honor them. In light of this standard, further discussion of Abe’s beliefs, Paula is inspired to believe, would probably be futile and in any event inappropriate.

Consulting relevant law, Paula believes that constitutional principles, including equal protection and due process, may have application in this dilemma, insofar as they suggest that neither Abe’s ethnicity nor the content of his speech should be used by a public employee—the community center is city-sponsored—as the basis for any official action involving clients. In other words, Paula concludes, transferring Abe’s case might not be in compliance with basic constitutional principles.

Following the decision making framework, Paula elects to apply general legal principles first, which leads her to choose not to modify the general course of her work with the client and to avoid, at least for the present, the transfer of Abe’s case. Instead of confronting Abe directly with his race based beliefs, Paula elects to continue to explore the mental health aspects of the client’s statements, consistent with those legal and ethical standards that may offer additional guidance in this area. As she sees it, perhaps she needs to examine alternative cross-cultural practice techniques with Abe. As Paula’s supervisor also counsels, however, “I’m not for racially matching clients and therapists, but don’t ignore the possibility that Abe’s comments might have more truth in them than we’re ready to admit.”