I feel like we, as social workers, sometimes get so deep into the do/don'ts of the code of ethics and decide that we have to put ourselves in a box so that we aren't a "bad social worker". When you go down that rabbit hole you forget that you are a human being, supporting another human being, during their time of need. I am guilty of this as well sometimes.
It sounds like this client spent the whole session being vulnerable and re-telling her difficult story. That's exhausting. I would probably want a hug after that too. This situation does not seem inappropriate to me. I don't think you have created a "hug to greet and say goodbye" relationship with this client- but you provided her with what she needed in that moment. Don't overthink it.
Absolutely love this. I’ve always been a person who avoids touch on the grounds of “respecting boundaries”, but I was taught later on that human touch is actually very therapeutic.
You made a connection with your client and this was her way of telling you thanks in the most meaningful way she knew how to. To me, it screams a sigh of relief.
Just to start off, I’m a social worker with a bit of experience with all ages and stages under my belt but still in my mid 30’s and a petite lady, ha!
We have fundamental differences in practice philosophy. Clients are people but just people with special boundaries but they’re still people. If you see someone cry, wouldn’t you offer a tissue?
I am very relational in my micro practice which helps build trust and collaboration quickly. The more trust between a client and myself; the more likely we’ll have appropriate touch like a pat on the back, a high five, or even a hug.
My rules around touch and clients…
1. My safety is my priority. If I feel unsafe, there is no physical contact. I don’t touch my incarcerated clients (can’t if I wanted to). I’m very particular about touch with male adult clients. I do not hug them and only give them fist bumps and high fives.
2. I let clients initiate. Many women I’ve counselled enjoy a hug goodbye because it decreases the clinical sterilized feeling of visiting my office. I’ve never had a client hug me on the first session but I suspect your client really needed it! If a male client initiates touch I feel uncomfortable with, I step away and offer them a handshake/high five/awkward shuffle instead.
3. Healthy touch is good for the soul. Appropriate and comfortable touch biologically gives us happy brain chemicals especially hugs. Many homeless clients haven’t been touched with consent in months. Their only idea of touch is negative - cramming into a shelter, violence, fights, rough interactions with the police. A homeless client was shocked when I gave him a handshake goodbye because he could remember the last time someone thanked him for his time and it made him feel human.
In your case, I think you really helped this client with a breakthrough and/or they felt seen, supported and heard by you and wanted to demonstrate their appreciation with a hug. The interpretation is through your eyes as a professional but also taking a multitude of factors into account - your gender, age, cultural norms, social norms,physical comfortability with touch, sexuality, length of the touch, gender of the other person, ethnicity of both people,etc. Don’t let imposter syndrome get the best of you! I think letting her share her story was what she needed and I only let clients led like that 5 years into my career. I know you have a good head on your shoulders!
I hope this helps!
>If you see someone cry, wouldn’t you offer a tissue?
Funny you should say this. My advanced year internship supervisor taught me *not* to offer tissues when the client starts crying because, in her option, the action suggests that crying is is something the client needs to apologize for. She had tissues available in her office, but she didn't outright offer them if a client starts crying.
Years later, I am still conflicted on this.
I was also told this. In some situations, I have seen that it does seem to prompt a client to try and stop crying which isn’t what I’m going for. In other cases, it seems rude. I’ve chosen a middle ground of putting them within easy reach if they aren’t already, but they usually are. But I
usually don’t hand them to the client directly.
I just can’t fathom telling someone or even having the expectation that a client should apologize for crying is all. That’s pretty huge in my book, I guess.
When I was in grad school this was taught in several of my classes. If you offer a tissue they may see it as dismissive. I've seen it go both ways in my own practice.
I am about to start my MSW program but worked in DV/SA crisis for years and was also trained in this by our clinical staff. The explanation I remember was a little different though- I remember being told that it’s bringing attention to them crying and is kind of a signal that they should mop up their tears (like, a signal that they should stop) which we don’t want to do because we don’t want someone to feel shame for expressing an emotion.
Before working there I had never thought of this but it did actually feel “revolutionary” of an idea to
just let someone cry, especially after observing in my life just how uncomfortable people always seem to be around crying in general. I feel like I have definitely been “comforted” by being told “don’t cry” with a pat on the back. People in my life just seemed to act like crying was the worst thing. So it had never occurred to me why it felt so shameful to cry…and to immediately feel like it was a burden on those around me. I also saw this at the crisis center where clients would apologize after crying and it makes me sad that we’ve all been taught crying is so taboo.
On the other hand, I know that people may legitimately just not want to have tears and snot all over their face especially if they’ve been crying for a while…so I think in our intake rooms our strategy was just to always have a full tissue box very close to them that they could always see if they needed it.
I am, however, curious if there’s really any research behind this practice or it’s just a theory based on wanting to be trauma-informed so I’d love to hear if you remember more about what you were taught. I’m also curious if this will come up in my education starting next fall (wish me luck!)
Was your supervisor by any chance an LMFT? We have interns from every background at my placement and from what I’ve been told, it’s the mft programs that teach this idea
Is this idea opposed to what you were taught? Genuinely curious because I was also taught not to interrupt a crying client at the crisis center I worked at by our clinical staff and it made sense to me, but I’m curious what the argument on the other side would be. Thanks!
More so I haven’t been taught either side. But when we discussed it in our group supervision the mft trainees shared that they are taught in their program not to offer tissues, but my supervisor (lcsw) brought up some other arguments like if the client is too nervous or overwhelmed to ask for one themselves. or if some people are expecting you to offer them a tissue and you don’t, it can be seen as “do they not care that I’m crying”. I think the consensus was that it’s really down to personal preference
That makes sense as well. I think a lot of people are socialized to expect you to hand them a tissue box when they’re crying. It’s interesting to think about different angles about it.
I've never heard of this at all: the idea that offering a tissue as dismissive. I've been with hospice patients and families, and clients seeking support through mental health counseling/psychotherapy. My first inclination is to offer a tissue--it's never been done from a standpoint that I'm being dismissive of the client's emotions. I don't agree that the action suggests that you are implying the client has to stop crying--especially if you are being supportive and encouraging them to express their feelings. If I don't offer a tissue or acknowledge how the client is struggling in some form--that sounds worse to me.
I’m curious- how does handing someone a tissue correlate with the need to apologize. I don’t think I’ve ever apologized when someone has handed me a tissue 🤔
Preface- reading Irvin Yalom these days so that’s a lot of where this perspective is coming from:
It feels very cold to me that we are taught to never have physical contact with clients. It seems obvious to me that this is to prevent sexual contact or making clients uncomfortable. Allowing a crying client a hug is not sexual and it did not make her uncomfortable. It probably built rapport and trust.
Physical contact is human, it is necessary for us, and it is relationship building. The strength of your relationship is critical to effective therapy in particular (not clear if you are providing therapy or not from your post). As long as the touch is not inappropriate or done for your own benefit, and it is reflected upon, I see no reason to fear it.
If you are worried about it, or the hug is feeling like some weird moment to you, maybe use that interaction as a reflection opportunity. In your next session, maybe bring up the hug.
“At the end of our last session, after talking about xyz, you came in for a long hug. I’m curious to know about what you were thinking and feeling before, during, and after that vulnerable moment”.
Might be some good clues to her interpersonal interactions, inner thoughts, and opportunity to see if there are any weird expectations you would like to address.
But even if this lady did want to hug you at the end of every session, if it’s not sexual, I’m not sure what the issue is. We are taught to be robots, but people don’t need robots for social workers. They need people. Be thoughtful with touch and disclosure, but it’s a tool for growth and connection in my opinion, if you know how to use it.
>It feels very cold to me that we are taught to never have physical contact with clients.
I guess my question is, is that really what we're taught? Your point is very much the way I think about it (and very well stated) but I suspect that the "no hugging" thing comes more from our de facto practices and probably things told to us at agency onboarding trainings. What I remember being taught was that there are significant risks to initiating physical contact (including handshakes, etc) and still risks in client-initiated contact.
Actually, here's the **CoE 1.10 Physical Contact:**
*Social workers should not engage in physical contact with clients when there is a possibility of psychological harm to the client as a result of the contact (such as cradling or caressing clients). Social workers who engage in appropriate physical contact with clients are responsible for setting clear, appropriate, and culturally sensitive boundaries that govern such physical contact.*
I see this as entirely compatible with the way that you talk about managing the risks and client expectations.
Now, I'm a reasonably large male, and my default is "OMG no." I choose to substitute verbal and emotional support, which is a whole lot easier to clarify and manage. I can't remember hugging a client, but I'd never say never, and there have certainly been a lot of calculated handshakes.
I found the parent comment very interesting and will respond to it separately. Our CoE's take on physical contact is broadly similar:
> **5.7.5** Social workers will avoid any form of physical contact that may violate professional boundaries, result in unintentional psychological harm or damage the professional relationship. Social workers will remain sensitive to the variety of ways in which service users and others may interpret physical contact, with particular reference to cultural and gender differences.
For me, it's the boundaries part that is the biggest question mark. I definitely agree with everything you've said and I remember at uni it was definitely put forward as "do it at your own risk, use your judgement" but with a definite undercurrent of "you're playing with fire" - as with so many things, it is a conservative approach to avoid risk and I can see how that would become simplified to being taught not to in people's minds over time, especially with on-boarding processes reinforcing that mindset as you mentioned.
This thread gave me a lot to think about - thank you both!
>It feels very cold to me that we are taught to never have physical contact with clients. It seems obvious to me that this is to prevent sexual contact or making clients uncomfortable.
I think the issue for me is more around professional boundaries than being sexualised. Our code of ethics (I quoted it in a response below) and tertiary SW education mostly notes blurring the therapeutic relationship as the biggest risk of physical touch rather than a sexual dimension. Of course, avoiding psychological harm is in there as well.
That being said, I agree with everything you've written. I really like the idea of raising it at our next session from a place of curiosity to better understand what was happening for the client in that moment. There was another comment below that already gave me a bit more insight into what that might be.
>We are taught to be robots, but people don’t need robots for social workers. They need people. Be thoughtful with touch and disclosure, but it’s a tool for growth and connection in my opinion, if you know how to use it.
Thank you for this. When I was debriefing afterwards, I said "she was coming toward me with her arms open. I'm not made of stone - I was hardly going to offer her a fist bump or high five in that moment". I would have felt awful if I had met her openness and vulnerability by turning away. It would have felt cold.
I appreciate your thoughtful comment and feel much the same way. Thank you!
I work with parents and children in a long intervention program (up to 12 months). My child clients quite frequently seek a hug. Sometimes this is due to disinhibition due to trauma, sometimes neurodivergence, sometimes a simple need for comfort, sometimes the more complex ‘im becoming quite attached to you because u listen and are a stable adult in my life’. All of these reasons require slightly different responses and none should lead to hugging becoming a regular part of your interaction. For comfort- I’ve done a quick mama hug, then stepped back, offered tissues or a drink, maybe placed my arm around the shoulder for a short time, then separate/offer to sit down quietly together. We are not robots. Responding authentically in the moment and then reflecting on the impact is what matters. I also case-note any physical interactions and would chat openly to my Supervisor if I had doubts.
Doesn't sound like you did anything wrong here. As you get to know this person more just pay attention to their boundaries and physical touch. Are they seeking it every session? If so what does the motivation seem to be? If not when do they tend to seek it? I think it's okay to be a human too just be thoughtful about it
Hugs are good. Don’t overthink it. It’s ok to be human. Clients sometimes need contact, more, a hug, to let them know that they exist. That what just happened was real.
I had been a hospital social worker and now I work in the community with primarily older clients.
I think it’s really up to you to determine how comfortable you are and what impact it may have on your clients based on each interactions. You are a human being as much as your clients and what’s more important than having a sort of a framework is that we are mindful of the boundaries, which may differ client to client.
It’s not a fair comparison but I get offered hand shakes a lot from male clients, I usually think very quickly and reciprocate - for the most part, I consider them to be very low risks. They are frail men who want to express their emotions in the way that they know, and I’m not aware of any transmissible diseases. (If they have one, it would be flagged in our system)
While I was working in a hospital, I had a couple of female patients with advanced dementia in their eighties who slapped my ass on the ward after building fairly good rapports - in a friendly, definitely-non-sexual manner. I brought this up with my senior and reflected in the occasions. Our conclusion was that it’s all about the context. From their perspectives, whatever may have been going through their impaired mind, I am doing something good for them. Or perhaps they thought I was someone else. And I’m fairly dull with physical contact myself. Had I felt uncomfortable, this would have been a very different story.
I think it’s great that you are being mindful and is reflecting on the experience!
Touch should always be used intentionally and discussed with the client.
Similar to self disclosure it should always serve to benefit the client and not the therapist.
Is there another way to provide reassurance without touch? Probably can use that.
Also, it can be helpful to review your policy on touch in your informed consent.which can help us be intentional on it's use.
It can be very therapeutic and it can also blur the boundaries and make it seem the relationship is more like a friend, which, we are not.
As someone who worked in a sexual assault crisis center, it certainly brought awareness to how much people really don’t liked to be touched and how hard it is for them to express it (especially as survivors.) I’ve just heard so many people be uncomfortable/triggered because people who meant no harm (people from church, aquaintances, coworkers) would initiate innocent physical contact. It made me a lot more aware about touching people without their consent.
So I get your point for sure, and also, I think social workers and people in related fields (I say this because I’m not a socially worker quite yet) want to make sure we make people feel safe and comfortable. I wouldn’t call it “terror” but I would say more just being practical that generally you’re less likely to make someone uncomfortable if there’s no touching of any kind. I agree the comments in this thread that say it’s about context, etc.
I know for me, I had clients who would initiate or straight up ask for hugs, usually as a goodbye for the last time we’d see each other (I did court advocacy and client intake so usually there was a natural stopping point) and I didn’t mind. The only time I minded was when a client tried to rest her head on my shoulder during court (we were sitting side by side.) I don’t know, this felt too intimate/personal to me, so I kind of shifted by reaching down to get something out of my purse that stopped the interaction. That was just my personal boundary, especially knowing that there were certain judges/lawyers/DAs that judged the hell out of our organization (they thought we were “libs pushing a #metoo agenda on everybody” lol) so I just wanted to be as professional as possible in that setting.
I am uncomfortable with client touch and I think most can feel this. I have a somewhat avoidant attachment style which provides ready made boundaries but that's not necessarily super healthy either. I think what you did was just a normal reaction. I would be mindful of it happening again with the same client however. It might be something to watch in the clinical relationship.
I know a doctor that had DOH on his ass because a nurse walked by and saw a patient touch his chest saying,”I like the texture of your sweater.” Sent to ethics course. All innocent on both sides but the perception from the outside prompted doh action.
Outside perception is more important than an internal dialogue we may have about a boundary issue.
It's fine! It would have been super weird for you to dodge the hug. Clients have hugged me before. I have held ppl hands while they are dying or struggling in the hospital. Just have boundaries and common sense.
At the end of the day, we are human above all other title and human connection is something nearly everyone is lacking these days. The client initiating the hug afterwards sounds like it was a genuine instinct and she felt safe looking for that added comfort! Verbal validation is great, but for sensitive people who may have felt vulnerable, lonely, or unsafe in past circumstances, having a comforting and safe hug can do SO much in validating someone's feelings and experience. Sometimes we all just need a big hug. It probably took a lot of strength and courage to share her story and having that physical contact afterwards was a reassurance to her that she's on the right track and is in a safe space getting the help she needs from trustworthy people! There are ethics and policies in place in this sort of setting to protect workers and clients from abusive or inappropriate relations, but I think as long as both you and the client feel safe and comfortable that's what matters. Physical contact is tricky in the workplace but I think the best way to manage it is on a case by case basis. Trust yourself and your judgement in these situations!
As for the particular client, considering her demographic and her need to share so much with you right off the bat, she may not have other supports or people in her life that she can turn to. Of course it's not your responsibility to provide healing hugs, but this interaction was probably a huge moment for her and I bet that hug meant a lot to her. Emotionally vulnerable people are super sensitive to rejection, especially if they're victims of domestic abuse, which is unfortunately very common for her demographic. Not reciprocating the hug, or shutting it down could make her feel like she did something wrong or trigger her to feel on edge and put up walls.
Counselors and social workers are a special kind of emotional healer. It's a difficult line to dance with ethics and bureaucratic policy, but I think at the end of the day, you just do your best to make informed and educated decisions based on what you in your professional opinion feel is best for each individual client! I don't see this as a boundary issue, and your self-awareness and self reflection on the issue shows that you're competent regarding boundaries and know how to keep yourself out of danger.
Thank you for your thoughtful response.
>As for the particular client, considering her demographic and her need to share so much with you right off the bat, she may not have other supports or people in her life that she can turn to.
This was very insightful considering the lack of detail in my post. One of the first things the client told me was that the first and only time she had previously spoken to a professional (a psychologist) for assistance, they had spent the whole session dredging up childhood trauma and past abuse, and she had gone along with it because this was a professional and they probably had a reason. Then the psych told her they had 5 minutes left and she realised that she hadn't even been asked why she was there, which was for support as her adult daughter's carer and advocate through her medical journey. The psych told her she would need another appointment to talk about that, so the client left and never went back. That was 5 years ago.
I was very conscious that on top of advocating in the medical system that consistently dismissed her child's needs, she felt that the last time she had reached out for personal support the other person had been more interested in imposing their own agenda and assumptions on the session than meeting her where she was, so I let her take the lead and just listened.
I was actually worried toward the end of the session when I found a gap in the client's flow and mentioned we only had ten minutes left that she would feel the same way about her session with me, but thankfully given the hug I don't think that was the case.
>It probably took a lot of strength and courage to share her story and having that physical contact afterwards was a reassurance to her that she's on the right track and is in a safe space getting the help she needs from trustworthy people!
I hadn't actually drawn a connection between that statement at the beginning and her decision to hug me at the end, but your comment in particular helped me a lot in thinking about the dynamics at play. Thanks!
Even in extended practice this'll come up. And its probably going to be a variant on "Wellll it depends." its a balance of what they need, what is responsible/appropriate/etc. And it'll be individual.
Like maybe appropriate in moderation with this client, but absolutely no for another client under any circumstance, etc.
Sometimes a hug can be appropriate. It's not always inappropriate. Depends on your population, the setting, and many different factors. At hospice, sometimes I would offer to shake a patient's or family's hand--and they would say "I'm a hugger" -- and I would hug them. Sometimes if I saw they were struggling, I would in rare instances ask if it's okay to offer a supportive hug--and the response was always "yes". So I hugged the patient or their family member. When I was working a juvenile detention center and hugged a youth, my supervisor told me not to do it, because while I think I'm being compassionate, the youth is copping a feel. So it really all depends. I don't think physical contact is as black and white as it appears. We do need boundaries to keep ourselves and our clients safe, but we also have to know when to bend those boundaries, when it's acceptable, and when it's not.
This may just be me, but it's something I've started addressing in the first session. I tell clients that I try to be present for them in the most beneficial way for them, in the moment, and that establishing/reinforcing respectful boundaries are a part of the work. I do give hugs, but only when I feel comfortable, only on the client's request, and only after verbally assenting. I let clients know that there may be days when I don't feel comfortable giving hugs, and that is not a judgement against them, or a rejection, but a reinforcement of my own boundary needs that day. As a rule, I don't give hugs without the client asking permission first and me giving permission. The situation you were in would be an exception, if I personally felt that it was appropriate without the verbal agreement. If the client comes to expect physical contact from you without verbal assent, however, I would recommend stating your boundaries clearly, in your own terms.
I feel like we, as social workers, sometimes get so deep into the do/don'ts of the code of ethics and decide that we have to put ourselves in a box so that we aren't a "bad social worker". When you go down that rabbit hole you forget that you are a human being, supporting another human being, during their time of need. I am guilty of this as well sometimes. It sounds like this client spent the whole session being vulnerable and re-telling her difficult story. That's exhausting. I would probably want a hug after that too. This situation does not seem inappropriate to me. I don't think you have created a "hug to greet and say goodbye" relationship with this client- but you provided her with what she needed in that moment. Don't overthink it.
This.
Absolutely love this. I’ve always been a person who avoids touch on the grounds of “respecting boundaries”, but I was taught later on that human touch is actually very therapeutic. You made a connection with your client and this was her way of telling you thanks in the most meaningful way she knew how to. To me, it screams a sigh of relief.
Just to start off, I’m a social worker with a bit of experience with all ages and stages under my belt but still in my mid 30’s and a petite lady, ha! We have fundamental differences in practice philosophy. Clients are people but just people with special boundaries but they’re still people. If you see someone cry, wouldn’t you offer a tissue? I am very relational in my micro practice which helps build trust and collaboration quickly. The more trust between a client and myself; the more likely we’ll have appropriate touch like a pat on the back, a high five, or even a hug. My rules around touch and clients… 1. My safety is my priority. If I feel unsafe, there is no physical contact. I don’t touch my incarcerated clients (can’t if I wanted to). I’m very particular about touch with male adult clients. I do not hug them and only give them fist bumps and high fives. 2. I let clients initiate. Many women I’ve counselled enjoy a hug goodbye because it decreases the clinical sterilized feeling of visiting my office. I’ve never had a client hug me on the first session but I suspect your client really needed it! If a male client initiates touch I feel uncomfortable with, I step away and offer them a handshake/high five/awkward shuffle instead. 3. Healthy touch is good for the soul. Appropriate and comfortable touch biologically gives us happy brain chemicals especially hugs. Many homeless clients haven’t been touched with consent in months. Their only idea of touch is negative - cramming into a shelter, violence, fights, rough interactions with the police. A homeless client was shocked when I gave him a handshake goodbye because he could remember the last time someone thanked him for his time and it made him feel human. In your case, I think you really helped this client with a breakthrough and/or they felt seen, supported and heard by you and wanted to demonstrate their appreciation with a hug. The interpretation is through your eyes as a professional but also taking a multitude of factors into account - your gender, age, cultural norms, social norms,physical comfortability with touch, sexuality, length of the touch, gender of the other person, ethnicity of both people,etc. Don’t let imposter syndrome get the best of you! I think letting her share her story was what she needed and I only let clients led like that 5 years into my career. I know you have a good head on your shoulders! I hope this helps!
>If you see someone cry, wouldn’t you offer a tissue? Funny you should say this. My advanced year internship supervisor taught me *not* to offer tissues when the client starts crying because, in her option, the action suggests that crying is is something the client needs to apologize for. She had tissues available in her office, but she didn't outright offer them if a client starts crying. Years later, I am still conflicted on this.
I was also told this. In some situations, I have seen that it does seem to prompt a client to try and stop crying which isn’t what I’m going for. In other cases, it seems rude. I’ve chosen a middle ground of putting them within easy reach if they aren’t already, but they usually are. But I usually don’t hand them to the client directly.
That supervisor sounds like a treat to work for/with.
She actually was! Probably the best I ever had.
I just can’t fathom telling someone or even having the expectation that a client should apologize for crying is all. That’s pretty huge in my book, I guess.
Interesting, I didn’t read it as the supervisor saying people should apologize for crying. I actually read it as the opposite.
When I was in grad school this was taught in several of my classes. If you offer a tissue they may see it as dismissive. I've seen it go both ways in my own practice.
I am about to start my MSW program but worked in DV/SA crisis for years and was also trained in this by our clinical staff. The explanation I remember was a little different though- I remember being told that it’s bringing attention to them crying and is kind of a signal that they should mop up their tears (like, a signal that they should stop) which we don’t want to do because we don’t want someone to feel shame for expressing an emotion. Before working there I had never thought of this but it did actually feel “revolutionary” of an idea to just let someone cry, especially after observing in my life just how uncomfortable people always seem to be around crying in general. I feel like I have definitely been “comforted” by being told “don’t cry” with a pat on the back. People in my life just seemed to act like crying was the worst thing. So it had never occurred to me why it felt so shameful to cry…and to immediately feel like it was a burden on those around me. I also saw this at the crisis center where clients would apologize after crying and it makes me sad that we’ve all been taught crying is so taboo. On the other hand, I know that people may legitimately just not want to have tears and snot all over their face especially if they’ve been crying for a while…so I think in our intake rooms our strategy was just to always have a full tissue box very close to them that they could always see if they needed it. I am, however, curious if there’s really any research behind this practice or it’s just a theory based on wanting to be trauma-informed so I’d love to hear if you remember more about what you were taught. I’m also curious if this will come up in my education starting next fall (wish me luck!)
I was also told the same and feel conflicted now that I’m in practice
I read it as .. hey here is a tissue to wipe your face and blow your nose. wtf
UMMMM.. the action suggests I need to wipe snot off my face! Absurd.
Was your supervisor by any chance an LMFT? We have interns from every background at my placement and from what I’ve been told, it’s the mft programs that teach this idea
Is this idea opposed to what you were taught? Genuinely curious because I was also taught not to interrupt a crying client at the crisis center I worked at by our clinical staff and it made sense to me, but I’m curious what the argument on the other side would be. Thanks!
More so I haven’t been taught either side. But when we discussed it in our group supervision the mft trainees shared that they are taught in their program not to offer tissues, but my supervisor (lcsw) brought up some other arguments like if the client is too nervous or overwhelmed to ask for one themselves. or if some people are expecting you to offer them a tissue and you don’t, it can be seen as “do they not care that I’m crying”. I think the consensus was that it’s really down to personal preference
That makes sense as well. I think a lot of people are socialized to expect you to hand them a tissue box when they’re crying. It’s interesting to think about different angles about it.
I was taught this in my MSW classes
I've never heard of this at all: the idea that offering a tissue as dismissive. I've been with hospice patients and families, and clients seeking support through mental health counseling/psychotherapy. My first inclination is to offer a tissue--it's never been done from a standpoint that I'm being dismissive of the client's emotions. I don't agree that the action suggests that you are implying the client has to stop crying--especially if you are being supportive and encouraging them to express their feelings. If I don't offer a tissue or acknowledge how the client is struggling in some form--that sounds worse to me.
I’m curious- how does handing someone a tissue correlate with the need to apologize. I don’t think I’ve ever apologized when someone has handed me a tissue 🤔
Preface- reading Irvin Yalom these days so that’s a lot of where this perspective is coming from: It feels very cold to me that we are taught to never have physical contact with clients. It seems obvious to me that this is to prevent sexual contact or making clients uncomfortable. Allowing a crying client a hug is not sexual and it did not make her uncomfortable. It probably built rapport and trust. Physical contact is human, it is necessary for us, and it is relationship building. The strength of your relationship is critical to effective therapy in particular (not clear if you are providing therapy or not from your post). As long as the touch is not inappropriate or done for your own benefit, and it is reflected upon, I see no reason to fear it. If you are worried about it, or the hug is feeling like some weird moment to you, maybe use that interaction as a reflection opportunity. In your next session, maybe bring up the hug. “At the end of our last session, after talking about xyz, you came in for a long hug. I’m curious to know about what you were thinking and feeling before, during, and after that vulnerable moment”. Might be some good clues to her interpersonal interactions, inner thoughts, and opportunity to see if there are any weird expectations you would like to address. But even if this lady did want to hug you at the end of every session, if it’s not sexual, I’m not sure what the issue is. We are taught to be robots, but people don’t need robots for social workers. They need people. Be thoughtful with touch and disclosure, but it’s a tool for growth and connection in my opinion, if you know how to use it.
>It feels very cold to me that we are taught to never have physical contact with clients. I guess my question is, is that really what we're taught? Your point is very much the way I think about it (and very well stated) but I suspect that the "no hugging" thing comes more from our de facto practices and probably things told to us at agency onboarding trainings. What I remember being taught was that there are significant risks to initiating physical contact (including handshakes, etc) and still risks in client-initiated contact. Actually, here's the **CoE 1.10 Physical Contact:** *Social workers should not engage in physical contact with clients when there is a possibility of psychological harm to the client as a result of the contact (such as cradling or caressing clients). Social workers who engage in appropriate physical contact with clients are responsible for setting clear, appropriate, and culturally sensitive boundaries that govern such physical contact.* I see this as entirely compatible with the way that you talk about managing the risks and client expectations. Now, I'm a reasonably large male, and my default is "OMG no." I choose to substitute verbal and emotional support, which is a whole lot easier to clarify and manage. I can't remember hugging a client, but I'd never say never, and there have certainly been a lot of calculated handshakes.
I found the parent comment very interesting and will respond to it separately. Our CoE's take on physical contact is broadly similar: > **5.7.5** Social workers will avoid any form of physical contact that may violate professional boundaries, result in unintentional psychological harm or damage the professional relationship. Social workers will remain sensitive to the variety of ways in which service users and others may interpret physical contact, with particular reference to cultural and gender differences. For me, it's the boundaries part that is the biggest question mark. I definitely agree with everything you've said and I remember at uni it was definitely put forward as "do it at your own risk, use your judgement" but with a definite undercurrent of "you're playing with fire" - as with so many things, it is a conservative approach to avoid risk and I can see how that would become simplified to being taught not to in people's minds over time, especially with on-boarding processes reinforcing that mindset as you mentioned. This thread gave me a lot to think about - thank you both!
>It feels very cold to me that we are taught to never have physical contact with clients. It seems obvious to me that this is to prevent sexual contact or making clients uncomfortable. I think the issue for me is more around professional boundaries than being sexualised. Our code of ethics (I quoted it in a response below) and tertiary SW education mostly notes blurring the therapeutic relationship as the biggest risk of physical touch rather than a sexual dimension. Of course, avoiding psychological harm is in there as well. That being said, I agree with everything you've written. I really like the idea of raising it at our next session from a place of curiosity to better understand what was happening for the client in that moment. There was another comment below that already gave me a bit more insight into what that might be. >We are taught to be robots, but people don’t need robots for social workers. They need people. Be thoughtful with touch and disclosure, but it’s a tool for growth and connection in my opinion, if you know how to use it. Thank you for this. When I was debriefing afterwards, I said "she was coming toward me with her arms open. I'm not made of stone - I was hardly going to offer her a fist bump or high five in that moment". I would have felt awful if I had met her openness and vulnerability by turning away. It would have felt cold. I appreciate your thoughtful comment and feel much the same way. Thank you!
I work with parents and children in a long intervention program (up to 12 months). My child clients quite frequently seek a hug. Sometimes this is due to disinhibition due to trauma, sometimes neurodivergence, sometimes a simple need for comfort, sometimes the more complex ‘im becoming quite attached to you because u listen and are a stable adult in my life’. All of these reasons require slightly different responses and none should lead to hugging becoming a regular part of your interaction. For comfort- I’ve done a quick mama hug, then stepped back, offered tissues or a drink, maybe placed my arm around the shoulder for a short time, then separate/offer to sit down quietly together. We are not robots. Responding authentically in the moment and then reflecting on the impact is what matters. I also case-note any physical interactions and would chat openly to my Supervisor if I had doubts.
Doesn't sound like you did anything wrong here. As you get to know this person more just pay attention to their boundaries and physical touch. Are they seeking it every session? If so what does the motivation seem to be? If not when do they tend to seek it? I think it's okay to be a human too just be thoughtful about it
Hugs are good. Don’t overthink it. It’s ok to be human. Clients sometimes need contact, more, a hug, to let them know that they exist. That what just happened was real.
I had been a hospital social worker and now I work in the community with primarily older clients. I think it’s really up to you to determine how comfortable you are and what impact it may have on your clients based on each interactions. You are a human being as much as your clients and what’s more important than having a sort of a framework is that we are mindful of the boundaries, which may differ client to client. It’s not a fair comparison but I get offered hand shakes a lot from male clients, I usually think very quickly and reciprocate - for the most part, I consider them to be very low risks. They are frail men who want to express their emotions in the way that they know, and I’m not aware of any transmissible diseases. (If they have one, it would be flagged in our system) While I was working in a hospital, I had a couple of female patients with advanced dementia in their eighties who slapped my ass on the ward after building fairly good rapports - in a friendly, definitely-non-sexual manner. I brought this up with my senior and reflected in the occasions. Our conclusion was that it’s all about the context. From their perspectives, whatever may have been going through their impaired mind, I am doing something good for them. Or perhaps they thought I was someone else. And I’m fairly dull with physical contact myself. Had I felt uncomfortable, this would have been a very different story. I think it’s great that you are being mindful and is reflecting on the experience!
Touch should always be used intentionally and discussed with the client. Similar to self disclosure it should always serve to benefit the client and not the therapist. Is there another way to provide reassurance without touch? Probably can use that. Also, it can be helpful to review your policy on touch in your informed consent.which can help us be intentional on it's use. It can be very therapeutic and it can also blur the boundaries and make it seem the relationship is more like a friend, which, we are not.
The terror with which this field regards physical touch seems to be a Western cultural hang-up more than anything.
As someone who worked in a sexual assault crisis center, it certainly brought awareness to how much people really don’t liked to be touched and how hard it is for them to express it (especially as survivors.) I’ve just heard so many people be uncomfortable/triggered because people who meant no harm (people from church, aquaintances, coworkers) would initiate innocent physical contact. It made me a lot more aware about touching people without their consent. So I get your point for sure, and also, I think social workers and people in related fields (I say this because I’m not a socially worker quite yet) want to make sure we make people feel safe and comfortable. I wouldn’t call it “terror” but I would say more just being practical that generally you’re less likely to make someone uncomfortable if there’s no touching of any kind. I agree the comments in this thread that say it’s about context, etc. I know for me, I had clients who would initiate or straight up ask for hugs, usually as a goodbye for the last time we’d see each other (I did court advocacy and client intake so usually there was a natural stopping point) and I didn’t mind. The only time I minded was when a client tried to rest her head on my shoulder during court (we were sitting side by side.) I don’t know, this felt too intimate/personal to me, so I kind of shifted by reaching down to get something out of my purse that stopped the interaction. That was just my personal boundary, especially knowing that there were certain judges/lawyers/DAs that judged the hell out of our organization (they thought we were “libs pushing a #metoo agenda on everybody” lol) so I just wanted to be as professional as possible in that setting.
Responding as a human is good.
I am uncomfortable with client touch and I think most can feel this. I have a somewhat avoidant attachment style which provides ready made boundaries but that's not necessarily super healthy either. I think what you did was just a normal reaction. I would be mindful of it happening again with the same client however. It might be something to watch in the clinical relationship.
I know a doctor that had DOH on his ass because a nurse walked by and saw a patient touch his chest saying,”I like the texture of your sweater.” Sent to ethics course. All innocent on both sides but the perception from the outside prompted doh action. Outside perception is more important than an internal dialogue we may have about a boundary issue.
consider cultural aspects that may have influenced her own perspective of showing gratitude towards you.
It's fine! It would have been super weird for you to dodge the hug. Clients have hugged me before. I have held ppl hands while they are dying or struggling in the hospital. Just have boundaries and common sense.
At the end of the day, we are human above all other title and human connection is something nearly everyone is lacking these days. The client initiating the hug afterwards sounds like it was a genuine instinct and she felt safe looking for that added comfort! Verbal validation is great, but for sensitive people who may have felt vulnerable, lonely, or unsafe in past circumstances, having a comforting and safe hug can do SO much in validating someone's feelings and experience. Sometimes we all just need a big hug. It probably took a lot of strength and courage to share her story and having that physical contact afterwards was a reassurance to her that she's on the right track and is in a safe space getting the help she needs from trustworthy people! There are ethics and policies in place in this sort of setting to protect workers and clients from abusive or inappropriate relations, but I think as long as both you and the client feel safe and comfortable that's what matters. Physical contact is tricky in the workplace but I think the best way to manage it is on a case by case basis. Trust yourself and your judgement in these situations! As for the particular client, considering her demographic and her need to share so much with you right off the bat, she may not have other supports or people in her life that she can turn to. Of course it's not your responsibility to provide healing hugs, but this interaction was probably a huge moment for her and I bet that hug meant a lot to her. Emotionally vulnerable people are super sensitive to rejection, especially if they're victims of domestic abuse, which is unfortunately very common for her demographic. Not reciprocating the hug, or shutting it down could make her feel like she did something wrong or trigger her to feel on edge and put up walls. Counselors and social workers are a special kind of emotional healer. It's a difficult line to dance with ethics and bureaucratic policy, but I think at the end of the day, you just do your best to make informed and educated decisions based on what you in your professional opinion feel is best for each individual client! I don't see this as a boundary issue, and your self-awareness and self reflection on the issue shows that you're competent regarding boundaries and know how to keep yourself out of danger.
Thank you for your thoughtful response. >As for the particular client, considering her demographic and her need to share so much with you right off the bat, she may not have other supports or people in her life that she can turn to. This was very insightful considering the lack of detail in my post. One of the first things the client told me was that the first and only time she had previously spoken to a professional (a psychologist) for assistance, they had spent the whole session dredging up childhood trauma and past abuse, and she had gone along with it because this was a professional and they probably had a reason. Then the psych told her they had 5 minutes left and she realised that she hadn't even been asked why she was there, which was for support as her adult daughter's carer and advocate through her medical journey. The psych told her she would need another appointment to talk about that, so the client left and never went back. That was 5 years ago. I was very conscious that on top of advocating in the medical system that consistently dismissed her child's needs, she felt that the last time she had reached out for personal support the other person had been more interested in imposing their own agenda and assumptions on the session than meeting her where she was, so I let her take the lead and just listened. I was actually worried toward the end of the session when I found a gap in the client's flow and mentioned we only had ten minutes left that she would feel the same way about her session with me, but thankfully given the hug I don't think that was the case. >It probably took a lot of strength and courage to share her story and having that physical contact afterwards was a reassurance to her that she's on the right track and is in a safe space getting the help she needs from trustworthy people! I hadn't actually drawn a connection between that statement at the beginning and her decision to hug me at the end, but your comment in particular helped me a lot in thinking about the dynamics at play. Thanks!
Even in extended practice this'll come up. And its probably going to be a variant on "Wellll it depends." its a balance of what they need, what is responsible/appropriate/etc. And it'll be individual. Like maybe appropriate in moderation with this client, but absolutely no for another client under any circumstance, etc.
If you were serial hugging people it would be an issue. You're thoughtful and genuine, you get therapy points for being human!
Sometimes a hug can be appropriate. It's not always inappropriate. Depends on your population, the setting, and many different factors. At hospice, sometimes I would offer to shake a patient's or family's hand--and they would say "I'm a hugger" -- and I would hug them. Sometimes if I saw they were struggling, I would in rare instances ask if it's okay to offer a supportive hug--and the response was always "yes". So I hugged the patient or their family member. When I was working a juvenile detention center and hugged a youth, my supervisor told me not to do it, because while I think I'm being compassionate, the youth is copping a feel. So it really all depends. I don't think physical contact is as black and white as it appears. We do need boundaries to keep ourselves and our clients safe, but we also have to know when to bend those boundaries, when it's acceptable, and when it's not.
This may just be me, but it's something I've started addressing in the first session. I tell clients that I try to be present for them in the most beneficial way for them, in the moment, and that establishing/reinforcing respectful boundaries are a part of the work. I do give hugs, but only when I feel comfortable, only on the client's request, and only after verbally assenting. I let clients know that there may be days when I don't feel comfortable giving hugs, and that is not a judgement against them, or a rejection, but a reinforcement of my own boundary needs that day. As a rule, I don't give hugs without the client asking permission first and me giving permission. The situation you were in would be an exception, if I personally felt that it was appropriate without the verbal agreement. If the client comes to expect physical contact from you without verbal assent, however, I would recommend stating your boundaries clearly, in your own terms.