Paternalism Vs. Self-Determination

Paternalism Vs. Self-Determination

By Bridget Ferris, LSW, Medical Social Worker

Picture this: you are a new graduate fresh out of social work school. You have completed your degree and are excited for your career as a social justice warrior. You were prompted multiple times to identify and define your values in school. You were coached during your classes to look deep inside yourself and read your soul. You feel confident that you know which populations you can and cannot be effective with. Then reality hits. You take a job you feel you’ll enjoy, but then you find some practices at the agency are paternalistic or don’t align with your professional values. Where do you go from here?

There are multiple settings in which institutional values can conflict with professional values including the prison/jail setting, religious based agencies, substance abuse agencies and medical settings. Social workers struggle with institutional paternalism and the inherent conflict that has with the social work value of self-determination and client agency. Social workers in the intimate partner violence arena have talked about judgmental co-workers who vocalize distaste for client’s choices. Those working in the medical sector relay stories of healthcare professionals advocating for putting patients in restrictive environments like nursing homes due to a perceived lack of safety at home. Folks working in the substance abuse field share about agencies that take a “one size fits all approach” and preach abstinence only or medicated assisted recovery only instead of offering a spectrum of solutions. How do we stay true to advocating for the right to self-determination while working in these contexts?

NASW Code of Ethics. When in doubt, go back to your roots. Remind yourself of why you became a social worker. Review the code of ethics and challenge yourself to apply them in your practice. This is especially important when working in a team setting in which other team members aren’t social workers.

Self-Care. A wise social worker who specializes in professional burn out once told me “doing this kind of work and not expecting to be traumatized is like walking through water and expecting not to get wet”. Self-care is vital to maintaining your motivation for social work. Ignoring self-care is self-neglect in this profession. One runs out of mental bandwidth to resolve psychosocial conflict and advocate for self-determination if they aren’t taking care of themselves.

Seek consultation/supervision. Identify a co-worker, supervisor, former professor or classmate who shares your ideals and talk to them. Seek guidance from someone with an objective point of view. Venting frustrations to this person may also have a cathartic effect.

Ultimately, social workers are the advocates for self-determination in all contexts so feeling confident about this skill is paramount.

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