Chapters 4-6 MSW 520

Empathic Responses Level 0-3

0: anti-empathic, there can be circumstances where the norm in the setting or the skill and beliefs of SWer that it is not assumed of the helping professional to convey empathy or understanding. This practice is not condoned but it does happen. Frequency in settings where the client is involuntary, stigmatized or considered deviant. Responses by SWer may provoke client anger but usually have few consequences for SWer. Judgemental and inappropriately confrontational responses towards clients. 1: SWer has limited awareness or understanding of the client's feelings. SWer's responses are irrelevant and often abrasive, hindering rather than facilitating communication. Operated from a personal frame of reference, the SWer changes the subject, argues, gives advice prematurely, lectures or uses other ineffective styles that block communication. SWer nonverbal responses are not appropriate. 2: SWer responds to the client's surface message but erroneously omits feelings or factual aspects of the message. SWer may inappropriately qualify feelings or inaccurately interpret feelings. Responses may emanate from SWer own conceptual formulations which may be diagnostically accurate but not empathetically attuned to client's expressions. 3: Swer's verbal and nonverbal responses convey understanding and are essentially interchangeable with client's obvious expressions, accurately reflect factual aspects of the client's messages and surface feelings or state of being. Reciprocal responses do not add effect or reach beyond surface feelings. Reflect immediately apparent emotions in the client's message but deeper feelings and meaning are not added.

Furthering Responses

Indicate social workers are listening attentively and encourage the client to verbalize. Two different types of furthering responses. Nonverbal minimal prompts: head nodding gestures conveying continuity Verbal minimal prompts: conveying brief messages to encourage continuity

Confrontation

Is employed in the change oriented phase to expand client's awareness and motivate them to action. It is most appropriate when clients are contemplating actions that are unlawful or dangerous to themselves or others. Also appropriate when actions conflict with the goals and values the client has chosen for themselves. -In order to make the intervention more palatable, employ empathetic responses immediately following a confrontation.

Describe the difference between a personal and professional values, their conflicts, and strategies to resolve dilemma.

Personal: We all have values: our beliefs about what things are important and/or proper that then guide our actions and decisions. Social Work Professional: Values that indicate what is important for social workers and guide the practice of the profession

Self Determination

Practical recognition of the right and need for client's freedom in making their own choices and decisions. Strength oriented perspective Believe clients can change/grow and develop solutions to their difficulties.

Self Disclosure

conscious and intentional revealing of information about oneself through both verbal expressions and nonverbal behaviors. -types: self-involving statements and personal self disclosure messages. -Ranges from superficial to highly personal statements. -The decision on whether or when to self-disclose must be guided by a perception of benefit to the client not a SWer's need to share.

Client Records

Record no more than essential to the services provided Facts and not opinions. Descriptive terms Unconfirmed reports about a third party by the client Do not include verbatim/process recording in case files. Maintain and update records to ensure accuracy, relevance, timeliness, and completeness.

Transference

Refers to the same dynamic when the client consciously or unconsciously associates the social worker with past experiences in such a way that perceptions and inter-actions with the social worker are affected.

Closed-ended questions/ responses

define a topic and restrict the client's response to a few words or a simple yes or no. These questions restrict the client and elicit limited information; these responses can be appropriate and helpful when used chiefly to elicit essential factual information.

Cardinal Values of Social Work

1. Access to Resources: All human beings deserve access to the resources they need to deal with life's problems and to develop their full potential. 2. Dignity and Worth: social workers' place on the dignity and worth of their clients is demonstrated through respect for the inherent value of the persons with whom they work and in efforts to examine prejudicial attitudes that may diminish their ability to embrace each client's individuality 3. Interpersonal Relationships: The value placed on human relationships affects the way social workers relate to their clients and the efforts that social workers make to improve the quality of the relationships in their client's lives 4. Integrity: The value of integrity means that professional social workers behave in a trustworthy manner. 5. The Value of Competence: social workers practice only within their areas of ability and continually develop and enhance their professional expertise.

HIPPA

1. Psychotherapy notes: are protected under HIPAA, release of records requires special and separate authorizations, records must be kept separate in client files and must meet criteria to be considered protected. 2. If a person has the right to make health care decisions, they should be given information with that decision. 3. The client's access to psychotherapy notes is restricted. 4. Clients must be given information on organization privacy policies and must sign the form. 5. Client records or data should be protected from nonmedical uses like marketing unless the person gives permission

Confidentiality basic

1. safeguard client's information 2. respect client's privacy 3. gather info only for the purpose to provide effective services 4. disclose info only with client's consent 5. need to not disclose info in inappropriate situations 6. no gossiping about work 7. no posting photos of clients on social media 8. electronic records collection, transfer, and storage of info (voicemail, texts)

Verbal Following Skills

6 Verbal Following Skills: 1) Furthering Responses Indications that you are listening attentively and encourage the client to verbalize. Ex: Nonverbal ways- head nodding, facial expressions, showing gestures to continue Ex: Verbal ways- "I see", "tell me more", "Please go on" Ex: Accent responses- Client: I've really had it with how my supervisor is treating me.Social worker: "had it?" (this short response is intended to prompt further elaboration) 2) Reflection Responses Are used to respond to both content messages and affect. Ex: "Wow I can hear how hard that would be" Reflections of content- Emphasize the cognitive aspects of client messages, such as situations, ideas, objects, or persons. Ex: Senior Client: "I don't want to get into a living situation when I will not be able to make choices on my own." Social Worker: "So independence is a very important issue for you." You do not have to agree or condone the thoughts. Reflections of affect- Focus attention on the affective part of the communication. Help reflect and sort through their feelings. Forms of Reflections: Simple Reflections Identify emotions expressed by the client Simply identify- do not take a stand or attempt the client to deal with the emotion. Complex Reflections Go beyond what the client has directly stated or implied adding substantial meaning or emphasis to convey a more complex picture Add content to focus on meanings or feelings that the client did not directly express. Reframe Another form of adding content. Puts the client's response in a different light beyond what the client had considered Double-sided Reflection Captures both sides of the dilemma that is fostering ambivalence about acting. Reflections with a Twist Reflections in which the social worker agrees in essence with the dilemma expressed by the client but changes the emphasis, perhaps to indicate that the dilemma is not unsolvable but rather that the client has not at this time solved it. 3) Close-ended and open-ended Responses Close-Ended: Define a topic and restrict the client's response to a few words or a simple yes or no answer Ex: "When did you obtain your divorce?" Open-Ended: Statement invites expanded expression and leaves the client free to express what seems m

Identifying Feelings

A SWer must be able to distinguish between readily apparent feelings and probable deeper feelings. -Formulating reciprocal responses and empathetic responses will assist you in increasing your perceptiveness to feelings.

Compassion Fatigue

A SWer needs to be able to both experience what the client is conveying and separate themselves from those feelings. Failure to separate can contribute to compassion fatigue, making the SWer less effective. -This can happen when the SWer has prolonged contact with client's with trauma.

Reframing

Another form of content adding. Putting the client's response in a different light than what the client had considered. " I have gone through treatment 3-4 times; maybe one of these times I'll get it right." reframe: "It sounds like you have persisted in trying treatment again after earlier disappointments; you haven't given up on yourself"

Dual Relationships

Colleagues and supervisors take care that the helping relationship is preserved and not impacted by questionable boundary situations. Consultation helps social workers determine whether these relationships are avoidable and/or problematic. Occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.

Social Work Competence

As with the value of integrity, this principle places the burden of self-awareness and self-regulation on the social worker. This principle means that social workers will decline cases where they lack sufficient expertise and that they will seek out opportunities for continuous self-examination and professional development. Be aware of health vs. mental health impacting SW performance and personal problems.

Countertransference

Circumstances in which a psychoanalyst develops personal feelings about a client because of the perceived similarity of the client to significant people in the therapist's life. Refers broadly to how a social worker's experiences and emotional reactions influence his or her perceptions of and interactions with a client.

Elicit Factual Information

Close-ended questions. Use these questions sparingly because clients will actually give a lot of factual information spontaneously as they unfold their stories when aided by open-ended and furthering questions.

Reflection of Content

Emphasizes the cognitive aspect of the client's messages, situations, ideas, objects, or persons. Ex. Client: I don't want to get into a living situation in which I will not be able to make choices on my own. SW: So independence is a very critical issue to you

Expanded Expression

Expanded Expression: Open ended questions and statements that invite client to express what seems most relevant and important Asking a questions Giving a polite command Don't' be to direct Use different vocabulary to soften the request Turn the command into a question. Ask "would you mind?" Express it as a negative question Avoid overstatement

Exploration

Exploratory questions such as the following may help elicit the client's meaning attributions:●: "What do you make of his behavior?"●"What were the reasons for your parents disciplining you?"●"What conclusions have you drawn about why your landlord evicted you?"●"What are your views on why you did not get a promotion?"Discovering meaning attributions is also vital because these beliefs about cause and effect may represent powerful barriers to change.

Deontological Perspective

Fixed guidelines that should be applied universally.

Complex Reflections

Going beyond what the client has stated, adding meaning or emphasizes to convey a more complex picture. These reflections may add content that focuses on the feeling the client did not directly express. Verbalizing an unspoken emotion is a form of reflection that names an emotion the client has implied but not stated.

Open-ended questions/responses

I statements, invite, expand expression, and leave the client free to express what seems most relevant and important to them. These questions often start off with "how", "why", "what". Leave the topic to the client's choosing, ex. "tell me what you would like to discuss today?"

Usage of Supervision

Important in professional development and ongoing competence Supervisor is usually a mentor, teacher, coaches, counselor. Successful use of supervision involves being honest self aware in seeking guidance, raising issues, for discussion, sharing challenges and successes, and being open to feedback, praise, critiques, and change. Effective supervision will help you develop your skills to look clearly at you to understand strengths/weaknesses, preferences and prejudice and become able to manager for your benefit of clients.

Directives

In order to assist clients when they are working to relate more easily and work constructively to solve their problems SWers will frequently make requests of them and these requests can actually be directives. They are declarative statements that place the burden on the clients to object if they are uncomfortable. You state what you would like them to do in a polite fashion. Ex. "Welcome to my office you can either sit here or here."

Continuance/ Discontinuance

In the context of verbal following, incongruent responses to clients are associated with discontinuance. In verbal following, skills in following have been related to client continuance.

Eliciting Clarification of Information

Open-ended responses will elicit clarifying information. They enhance communication with peers too. ex. "How have you concluded that you are depressed?" or "Tell me more about your problems at work."

Role Clarification- client's expectations

Role clarification embodies the following elements: (1)acknowledging and empathizing with the client's unrealistic expectation and sense of urgency, (2) expressing the SWer's helpful intent, (3) explain why the client's unrealistic expectations cannot be fulfilled and (4) as part of the SWer's expertise, clarifying the helping process and defining a working partnership that places responsibility on the client for actively participating and ultimately making choices as to the courses of action to be taken. -This becomes a key intervention in work with clients who are involuntary. -The client's initial expectations consist of lectures, advice giving, magical solutions, changing other family members, etc. You have to manage their unrealistic goals when their expectations are stated. If they're not stated you need to elicit them.

Setting Limits

SWers must occasionally decline requests or set limits. Commitment to helping others is a desirable quality but must be tempered with judgment as to when acceding to clients' requests is in the best interest of SW and client. -For example: clients will sometimes expect SWer to do all the work but the client will be more empowered by the scope of their actions if they take on the responsibility. - Special implications with involuntary clients. Swer and client will have negotiated relationships, SWer will be a compromiser, mediator and counselor. If a client decides to break the performance of a court order, Swer must be clear about the client's choices and the consequences of making those choices. (tactfully assertive) -Ex. Where you may need to decline client's requests and set limits -> Declining client's request for FB friends, requests for physical intimacy, and when a client asks you to intercede in a situation that they should handle themselves.

NASW Code of Ethics with ethical issues. 4 key areas of immediate relev

Self Determination: the practical recognition of the right and need of clients to freedom in making their own choices and decisions. Social workers may limit clients right to self-determination when, in their professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others. ( paternalism: i.e., preventing self-determination based on a judgment of the client's own good infringes on autonomy.) (paternalistic beneficence, wherein the social worker implements protective interventions to enhance the client's quality of life, sometimes despite the client's objections) Informed Consent Maintenance of Client -Social Work Boundaries: They are intended to help prevent conflicts of inter-est, making the client's interests the primary focus and avoiding situations in which the social worker's professionalism is compromised. Confidentiality

Empathetic Responses

Serves as a critical function by enabling social workers to focus in depth on troubling feelings. ex. Client: I cannot imagine not going to work every day. I feel at loose ends already, and I haven't even quit work. I'm afraid I just won't know what to do with myself. Social worker: You seem to say, "Even now, I'm apprehensive about retiring. I'm giving up something that has been very important to me, and I don't seem to have anything to replace it."I gather that feeling at loose ends, as you do, you worry that when you retire, you'll feel useless.

Authenticity

Sharing of self by relating in a natural, sincere, spontaneous, open, and genuine manner. Share feelings personal message (that was really sad: a true feeling).

Informed Consent

Social Workers must use clear and understandable language to inform clients of the purpose of the services, risks related to services, limits to services b/c of requirements of 3Rd party payers, relevant cost, reasonable alternatives, client's rights to refuse/withdraw consent, timeframe covered by consent Allow clients opportunities to ask questions

Professional Boundaries

Social Workers should not take unfair advantage of any professional relationship or exploit others for their personal, religious, political, or business interests. Social Workers should not have dual/multiple relationships with clients or former clients where there is a risk of exploitation or potential harm to the client. Take steps to protect your clients. Social Workers should not have physical contact with clients when there is a possibility of psychological harm. Social Workers should not engage in sexual activities/sexual contact with clients, whether the contact is consensual or forced. Social Workers should not engage in sexual activities/sexual contact with the client's family members, whether the contact is consensual or forced. Social Workers should not engage in sexual activity or sexual contact with former clients because of the potential for harm to the client.

Moderate Universalism

Social work is obligated to work for cultural change when equal rights are in jeaopardy.

Focusing

Social workers are responsible for maintaining the client's focus within the session. Keep the client focused on the presenting conditions or what brings them to get treatment. Social workers perform vital roles. by assisting clients to focus on their problems in greater depth and to maintain focus until they accomplish desired changes

Limitations of Confidentiality

Supervision/Consultation Client waives confidentiality The client presents danger to self /others Reporting suspicions of a child or elder maltreatment Subpoena /Court Order

Empathic Communication

Swer ability to accurately and sensitively perceive the feelings of a client. Effectively communicate their understanding of the client's feelings. - It is a complex skill that requires systematic practice and an extensive effort to achieve competency. It has no limit or ceiling but is always in the process of becoming. -Many SW do not fully utilize empathetic responding. Examples include: "Could it be that...", "You're feeling...", "What I guess I'm hearing is....", "I'm picking up that you..." -Use language your client will readily understand.

Ethical Dilemmas

The rights of clients and social workers' ethical obligations are superseded by higher-order values (Right to life - safety- well-being). Thus, clients' right to confidentiality takes second place when they confide that they have physically or sexually abused a child or reveal imminent and serious plans for harmful acts that would jeopardize the health or safety of other people. Dilemmas can also arise if you find that specific policies or practices of your employing agency seem detrimental to clients.

Embedded Questions

These do not take the form of a question but embody a request for information. Ex. "I'm curious about", "I'm wondering if", "I'm interested in knowing."

Reflective Responses

To respond to a broad spectrum of emotions and feeling states presented by the clients the SWer must be fully aware of the diversity of human emotions . They need to take a not knowing position of learning what emotional expression means for the particular client in front of them. Further, the SWer needs a rich vocabulary of words and expressions that not only reflect the client's feelings accurately but also capture the intensity of those feelings. -descriptive feeling words ex: furious, provoked, irritated, put out

Social Work Values

Values that indicate what is important for social workers and guide the practice of the profession. SWers must be attuned to their personal values and be aware of when those values clash or mesh with those espoused by the profession as a whole.

Verbal Following Skills

Verbal Following Skill: using and blending of discrete skills that enable SWer to maintain psychosocial contact with clients on a moment-by-moment basis, and convey accurate understandings of their messages. -Further Responses -Reflection Responses -Closed ended questions + Open- ended questions -Seeking Concreteness -Providing and maintaining focus -Summarizing

Additive Empathic Responses

accurately identifying the client's implicit underlying feelings and or aspects of the problem. Level 4 and 5 of empathic responses.

Affective Words and Phrases

an (extensive) list intended to expand your vocabulary so that you can meet the challenge of responding to a wide range of emotions experienced by clients and capture the intensity of those feelings. -They give an exact focus of client's feelings

Bias

are manifested in assumptions about human behavior, development and expression. Concepts taken for granted in clinical training can carry a great deal of cultural bias. -will inevitably surface in clinical work. Mental health work in helping professionals reflects dominant, eurocentric cultural values. The foundation for counseling theory and practice methods were developed out of experience of White clinicians and research mostly in the white client systems. No theoretical recipes to work with individuals of all races.

Reciprocal Empathy

focus on client's immediately evident feelings and assist SWer in increasing perceptiveness to feelings. It is a level 3 on empathetic responses. It is a basic skill used throughout the helping process to acknowledge client messages and encourage exploration of problems. - "You feel_____ about_____ because (accurately identifies or describes feelings)" -Promotes communication and self-disclosure. -Client will feel "empathically received" which gradually creates a low-threat environment and obviates the need for self protection. -Reciprocal responses do not add affect or reach beyond surface feelings nor do they subtract from the feeling and tone expressed.

Relational Immediacy

here-and-now experiencing that involves emotions toward the social worker (anger, hurt, disappointment, affectional desires, fears). Focusing on the here and now with groups, couples, and families is a potent technique to clear the air for pent-up feelings. Interventions that bring up buried issues pave the way for social workers to clearly identify

Facilitative Conditions: (Aka core conditions)

in helping relationships. -Conditions/skills denoted by Carl Rogers as empathy, unconditional positive regard, and congruence. Now other terms have evolved as empathy, respect (non possessive warmth), authenticity/genuineness. -These conditions are thought to be foundation-level skills that undergird many treatment models and help create a positive client-SWer relationship.

Summarization

involves fitting pieces of the problem together to form a coherent whole. Also valuable technique in sessions with groups, couples and families. Summarizing responses served as a prelude to the process of formulating goals as goals flow naturally from problem formulations. Connecting key elements of his clients and gaining a more accurate and complete perspective of their circumstance. highlights aspects of a discussion, Problems/strengths/resources, makes connections to relevance in what clients say, reviews major focal points, and visits previous sessions to highlight progress.

Empathic Communication

involves the ability of a SWer to perceive accurately and sensitively the inner feelings of a client and to communicate his/her/their understanding of those feelings in a language attuned to the client's experiencing of the moment. -reduces level of threat perceived by client, mitigates their defensiveness -It provides a vehicle for the SWer to become emotionally significant and influential in the client's life.

Critical Race Theory

is an intellectual movement and a framework of legal analysis according to which (1) race is a culturally invented category used to oppress people of color and (2) the law and legal institutions in the U.S. are inherently racist insofar as they function to create and maintain social, political and economic inequalities between white and nonwhite people. -Shifting the view of communities of color with: cultural knowledge, skills, abilities and contacts. - Draw on knowledge students of color bring with them from their homes and communities into the classroom. -Research, practitioners and students are still searching for the necessary tools to effectively analyze and challenge the impact of race and racism in U.S. society. -Framework: -Theorize, examine, challenge the ways race and racism implicitly and explicitly impose social structures, practices and discourse. -Community cultural wealth -role of racism in American law and work if elimination of racism as part of larger goal of eliminating all forms of subordination -emerged from critical legal studies -failed to offer strategies for social transformation because it failed to incorporate race and racism into analysis -unable to listen to lived experiences to history of oppressed institutionalized racism

Empathetic Communication Scale

is employed to help students distinguish between high and low level empathic responses and has been used by peers and instructors in group training to assess levels of students' responses. -This scale operationalizes essential SW skills and also establishes a relationship between these skills and successful outcomes in practice. -The 9 level scale has been collapsed into a 5 level scale.

Sympathetic Responding

it depends on achieving emotional and intellectual accord, involves supporting and condoning the other person's feelings. -A person who experiences feelings in common with another person who is similarly affected by whatever the other person is experiencing usually responds sympathetically rather than empathetically. -Involves supporting and condoning the other person's feelings.

Positive Feedback

plays a vital role in the change process. SWer's should employ this skill in supplying information to client's about positive attributes or specific areas where they demonstrate strengths, effective coping mechanisms and incremental growth. -Increases client's confidence in their own coping ability. -Be able to take client's positive feedback too, be receptive as we ask them to.

Authentic Responses

sharing of self by relating in a natural, sincere, spontaneous, open and general manner. Relating personally so that expressions are spontaneous rather than contrived. -Relate as real people, expressing their feelings and taking responsibility for them rather than denying the feelings or blaming the client for causing them. Be non defensive and admit your own errors (SWer). -Only relate authentically when doing so furthers therapeutic objectives/ facilitate growth of clients. -(paradigm for authentic responses) (1) "I", (2) specific feelings or wants, (3) neutral description of events, (4) impact of the situation on sender or others. Ex. I get frustrated.....when you keep reading the paper when I'm speaking.....because I feel very unimportant to you.

High Degree of Specificity

social workers assist in their client treatment when social workers show efforts to understand by using clarifying terms to describe what the client expressed. Certain feeling words denote general feeling states rather than the specific feeling. Using more feelings words in sessions, the client can think about their feelings differently, promoting self-awareness and growth.