SW 3203: Chapters: 1-12, 14 Rivas Chapters 3,9,
Educational group
to educate through presentations, discussion and experience
social action group
to empower members to engage in collective action and planned change efforts to alter some aspect of the social or physical environment
Support Group
top help members cope wit stressful life events and revitalize existing coping abilities
What are some skills in this course?
Basic listening, interpersonal skills, influencing client actions skills, crisis situations, ethical dilemma in the therapeutic relationship
Defining empathy and empathic understanding:
Helps clients feel understood, engage in the counseling process, and gain a better understanding of themselves.
How do we evaluate client change?
Level 1: Denial Level 2: Partial examination Level 3: acceptance Level 4: New solution Level 5: transcendence
A client should not be your:
Lover Relative Employee or Employer Instructor Business Partner Friend
Group-centered interaction positive and negatives
Positive aspects •Increases social interaction •Improved group morale •Better member commitment to goals •Innovative decision making Negative aspects •Less efficient •May not work as well for some types of task groups
What is the "RESPECTFUL" model? (As a Bio/psycho/socio/cultural/spiritual approach)
R eligion/spirituality E conomic/class background S exual identity P ersonal style and education E thnic/racial identity C hronological/lifespan challenges T rauma F amily background U nique physical characteristics L ocation of residence/language
What are some science and art factors?
Science: Solid research, scientific base, specific qualities and skills Art: integrating your natural personality into your work, bringing your natural skills to the table, weaving your unique qualities into your practice
What are some other methods for confrontation?
Sit in silence or say "tell me more" when they are presenting with incongruities Center your body and mind and use a stronger and firmer stance with antisocial or clients who are "acting out" •These type of clients do not respect weakness in counselors This is especially helpful with clients who have been known to seek out your opinion
Why is Reflection of meaning interpretation / reframing so important?
Two closely related microskills of reflecting meaning and interpretation/reframing seek to enable clients to think differently about themselves, their feelings, and their stories •Help clients explore deeper values, visions for the future, and life mission •Examines the role of resilience in the life of your clients •Assists clients in finding an alternative way of thinking which in turn helps them grow
example of intentional and non-attending behavior:
When a client continues to talk about the same thing over and over again, you might look away briefly or subtly shift your body posture
What are common areas on which to focus?
oSelf oWhat is going through your head right now? oProblem oWhat problem do you think is most important for us to focus on here? oContextual focus (culture / environment) oWhat is the meaning of XXX among people in your family / church / neighborhood? oSignificant others oHow do you think your mom might react if you told her that? oMutuality (client and SW) = "we" o How do you think we are doing so far? oSocial justice focus oLooking at your genogram, do you think there may be other causes for your feelings of depression?
Reflection of feelings
observing emotions, naming them, and repeating them back to the client.
Discerning the Skill of empathic self-disclosure
-the self disclosure needs to be relevant to the client's worldview. It needs to be brief, genuine, authentic, and timed appropriately to client needs. - use the 123 pattern: First attend to and determine the clients frame of reference; Then, assess her or his likely reaction before using an influential skill; finally, check out the client reaction to your use of the skills. -empathic self disclosure involves indicating your thoughts and feelings to a client as follows: 1. Listen 2. Self disclose and share briefly 3. Use "I" statements 4. Briefly describe your thoughts, feelings, or behaviors. 5. Be empathically genuine and use appropriate immediacy and tense. -self disclosure tends to be more effective if it is genuine, timely, and phrased in a present tense. Keep your self disclosure brief. At times, consider sharing short stories from your own life.
What is Part of the generalist SW model and planned change process of therapeutic practice?
1. Interviewing 2. counseling 3. diagnosis 4. treatment
Education & Information-giving includes:
1.Providing useful, relevant, up-to-date information to the client 2.Specific information for specific problems 1.i.e. shelters for the homeless 3.Generalized information about the client's experience 1.i.e. "Lots of kids experience mood swings during adolescence. It's part of growing up."
What is a crisis?
•A disruption or breakdown in a person's or family's normal or usual pattern of functioning. A crisis cannot be resolved by a person's customary problem-solving resources/skills.
How does multiculturalism and intersectionality apply to practice?
•All counseling / interviewing is multicultural •contextual background •changes the meaning of the interview and the way clients and counselors behave
Monitoring and evaluating
•Focus is on group process and outcomes •Task groups can monitor or evaluate other entities as well •Develop feedback mechanisms
Three parts of group cohesion
•Member to member attraction and liking for the group •Sense of unity and community (group identity) •Sense of teamwork and success working as a coordinated unit
Education & Information-giving is appropriate when:
•Presenting facts •Presenting information in an objective manner •Correcting incorrect information •Correcting myths or faulty beliefs
Capacity-building Strategies
•Spiritual images •Role-play enactment •Positive reframing •Relaxation •Journaling •Physical exercise •Thought-stopping •homework
The first word of questions sets a tone
•What questions lead to facts •How questions lead to process and/or feeling/emotion •Why questions lead to reasons and can sound blaming •Could, can, or would are open and put some of the control in the client's hands
Defining the skills of reflection of meaning
- a reflection of meaning looks very much like a paraphrase but focuses beyond what a client says. Often the words meaning, values, and goals will appear in the discussion. Clients are encouraged to explore their own meanings in more depth from their own perspective. Questioning and eliciting meaning are often vital as first steps. -interpretations/reframes provide the client with a new perspective, frame of reference, or way of thinking about issues. They may come from observations of the counselor; they may be based on varying theoretical orientations to the helping field; or they may link critical ideas together.
Defining Directives, providing information, and psychoeducation
- all these influencing skills are concerned with imparting information from the client. -all directives in the book follow these microskill specifics: 1. Listen and observe 2.use specific and concrete language 3. check out 4. use the client change scale - provide specific data, judiciously, that will help clients in the decision making; you may follow up with logical consequences. Counselor advice may be taken too seriously, so use it sparingly. Use the 123 pattern of listening when providing information or advice and check out with the client how you were received. -making referrals to community resources. We all need to be aware of and use community resources that support mental and physical health. -to use these skills effectively, listen first and ensure that your client is interested and ready for your information
Awareness, knowledge, skills, and action for multicultural competence:
- developing multicultural awareness, knowledge, skills, and actions in a lifelong process of continuing learning -awareness of yourself as a cultural being is a vital beginning -there are many ways in which you and your client interpret humanity and the world -use a culturally and diversity sensitive approach to interviewing and counseling adapt your strategies in a cultural manner.
Observing Crisis Counseling in action
- each type of crisis is different; adapt your approach accordingly - establish trust; the working relationship with client is essential
refining: executive functioning, microaggresions and diversity issues
- executive functions are the cognitive mental processes that regulate human behavior. The brain's frontal lobes provide the biological substrate for these functions. - cognitive skills help clients become aware of their emotions and regulate their emotional reactions - cognitive-based counseling and therapy focus on changing clients' cognitions in order to achieve change -microagressions are small hurts that accumulate over time. They may cause stress and trauma. -discrimination and prejudice are other examples of cumulative stress, and trauma. -The listening skills are widely used cross-culturally and throughout the counseling and psychotherapy world, but more or less participation and self-disclosure on your part may be necessary depending on the characteristics of the interviewing context. -trust building occurs when you visit the client's community and learn about cultures different from your own. Best of all is having a varied multicultural group of friends.
Discerning: Individual and Multicultural issues in attending behavior
- listen before you leap - by attending and giving clients time to talk, you demonstrate that you truly want to hear their story and allow them time to unfold their issues. -vocal qualities express emotions, and each client may interpret your voice differently -verbal tracking is the skill of focusing on clients topics and identifying topics of concern -respect multicultural and individual characteristics in the client's body language . Remain authentic to your own style. -nonattention may help clients shift from negative, nonproductive topics to more appropriate conversation. There are times when silence is the best approach.
Defining Active Listening
- the purpose of the listening skills it to hear the client and feed back what has been said -listening is active. How you selectively attend to clients affects how they tell their stories or discuss concerns -listening helps in exploring and clarifying issues during the session. -encouraging, paraphrasing, and summarizing represent different points on a continuum from single words and short phrases to summaries of a section of an interview, or even a series of sessions.
Defining empathic feedback
- use the 123 pattern to ensure appropriateness of feedback. Involve the client as much as possible. -feed back accurate data on how you or others view the client. Remember the following: 1. The client should be in charge 2. focus on strengths 3. be concrete and specific 4.be nonjudgmental 5.keep feedback lean and precise 6. check out how your feedback was received
How do you create and maintain boundaries?
-As early as possible in the relationship, establish clear agreements regarding your role as a service provider, your availability, best ways to communicate with you, what to do if you see each other in a public setting -When boundary issues appear, address them quickly and clearly being sensitive to your client's feelings -If you disclose personal information, make sure it is relevant to the client's goals. Too much self-disclosure shifts the focus from the client to the provider and can confuse the client's understanding of the relationship. -You may need to frequently clarify your role and boundaries to ensure understanding. -Use your supervisor or professional colleagues as a sounding board if you have questions or concerns. -Dual relationships - if you had a social relationship with a client prior becoming a service provider you must consider how future interactions impact a client's confidentiality, and physical and emotional security. -Working with a team of providers: Promote positive, open communication and respectful sharing of information. Build trust and recognize that you can't and shouldn't be the only help your client receives. -Take care of yourself! Make sure you are getting enough sleep, eat well, have healthy relationships, exercise and "leave work at work".
What are boundaries? Why do we talk about them?
-Clearly established limits that allow for safe connections between service providers and their clients -Understanding of the limits and responsibilities of your role as a service provider Reduces risk of client exploitation Reduces client anxiety as rules and roles are clear Increases well-being of the worker Provides role model for clients
What does the NASW code of ethics say our responsibilities to our clients are?
-Commitment: Promote the well being of clients, clients' interests come first except where client may bring harm to someone else - child abuse, murder, etc. -Self determination: Except where clients' actions pose a "serious, foreseeable, and imminent risk to themselves or others -Informed consent: Factors to consider - literacy, language, lack of capacity, receiving services involuntarily. -Competence: Practice only within boundaries of education, license, certification, etc. -Cultural competence and social diversity: Knowledge base of clients' culture, sensitivity -Privacy and confidentiality: Not solicit information that is unnecessary to providing services, get releases of information for only necessary agencies, be aware of where you discuss client info, make sure clients understand the limitations of confidentiality (who has access). Technology has had a significant impact on privacy and confidentiality (email, fax, cell phones, texting, social media - facebook). -Access to records: Clients should generally have access to their records unless there is compelling evidence it would cause harm to the client. Requests and any denials should be documented in case notes. -Sexual Relationships: NO. With clients, clients' family members or other people the client has a close personal relationship with. -Physical contact: Generally not a good idea. If you engage in physical contact you are responsible for setting clear, appropriate, and culturally sensitive boundaries. -Sexual harassment: Includes sexual advances, solicitation, requests for sexual favors and other verbal or physical conduct of a sexual nature. -Derogatory language: Written or verbal. -Payment for services: Fees are to be fair and reasonable. Ability of client to pay needs to be taken into consideration. -Lack of capacity: Safeguard interests and rights of clients. -Interruption of services: Make reasonable efforts to continue services in the event social worker is not available. -Termination of services: When services are no longer required. Don't abandon clients. Non-payment - can terminate if client does not pose risk to self or others.
What are some consequences of poor boundaries?
-Compassion fatigue - service provider's role may not feel sustainable -Client may not receive appropriate or helpful services, which could affect his/her willingness or ability to accept future services -Client may feel betrayed, abandoned, or poorly served -Teamwork with other agencies may fall apart -Service provider may act unethically -Reputation of agency/profession may be compromised -Client and/or service provider may be emotionally traumatized and/or put in physical danger -Exploitative - Client may feel they "owe" you -Impair judgment - Giving a client preferential treatment -Negative consequences - loss of trust
What are some features of group role play?
-Define the skill, central features, and purpose -observe the skill in action -learn the skill and its implications -practice, practice, practice
Discerning the specifics of psychoeducation
-Different from directives and information, psychoeducation involves relatively short comments in the interview and integrates listening and other influencing skills. -psychoeducation sets specific objectives in connection with client needs and desires; it teaches them skills of daily living, ranging from how to be more assertive to life skills training, to helping them meet their needs. -life skills training usually involves role-playing and enactment of scenes from the client's life or anticipated for the future. Specific psychoeducation steps include: 1.check out your clients interest in learning listening skills 2. role-play ineffective listening 3. debrief the specific behaviors that the two of you have observed. 4. provide information on the content of the attending behavior (eye contact, verbal following, vocal tone, and body language) 5. role-play positive communication using good listening skills 6. work with the client to take actions in the real world. -therapeutic lifestyle changes (TLCs) is an important positive force leading toward mental and physical health. -psychoeducation plays an important tole enabling clients develop a healthy lifestyle, including good nutrition, exercise, relaxation, and meditation.
Why is it difficult to establish/maintain boundaries?
-Dual relationships - service provider & client know each other from another setting -Values conflicts - client and service provider do not share similar viewpoints on choices, relationships, lifestyle, etc. -Vicarious trauma - service provider may experience trauma symptoms due to hearing about client's experiences -Playing the "hero" - service provider feels the need to "save" the client -Service provider does not trust other team members, believes they can provide services better, believes they are the only ones who can help client
What are some examples of therapeutic skills?
-Interviewing: the process for gathering data, helping clients resolve issues, and providing information and advice to clients. -Counseling: : more intensive and personal process than interviewing. Listening to and understanding a client's life challenges and developing strategies for change and growth Psychotherapy: focuses on deep-seated personality or behavioral difficulties, incorporates a mental health diagnosis and the approach is intentional
What are some examples of boundary crossing and violations?
-Intimate Relationships -Personal Benefit -Emotional and Dependency Needs -Altruism -Unavoidable Circumstances -Planning social activities with clients -Having sex with clients -Having family members or friends as clients -Being "friends" on facebook
What are some examples of questions to ask regarding potential boundary issues?
-Is this in my client's best interest? -Whose needs are being served? -How would I feel telling a colleague about this? -How would this be viewed by the client's family or significant other? -Does the client mean something 'special' to me? -Am I taking advantage of the client? -Does this action benefit me rather than the client?
Discerning: Basic Techniques and Strategies of Attending Behaviors
-It is helpful to observe clients' verbal and nonverbal behavior in a culturally sensitive way. -the 3 v's and B reduce interviewer talk time and provide clients with an opportunity to tell their stories in as much detail as needed
Summarize Attending behavior:
-Listening is the core of developing a relationship and making real contact with clients. -attending behavior is fundamental to interpersonal communication in all culture -all theories and methods of interviewing, counseling, and psychotherapy rest on a base of attending behavior, which is necessary to build a working relationship or therapeutic alliance with the client -neuroscience demonstrates that your brain "lights up" when you are listening. -Demonstrating poor listening skills through role-play is an affective way to identify the importance of listening and the specific skills of attending behavior -attending behavior involves the 2v's and B: visuals, vocal qualities, verbal tracking, and body language.
Discerning Specifics of Crisis Counseling
-Normalizing: survivors of a crisis need to know that however they responded to severe challenges is OK and to be expected, thus normalizing the situation as a natural reaction -Cruses can turn into posttraumatic stress, which requires more long-term counseling and therapy. - Calming and caring: provide some sense of calm and possibly in the situation. Establish an empathic relationship by indicating you care and will listen. Use calming language. -Safety: Offer verbal reassurance that the crisis is over and they are now safe, if they are indeed safe. Help persons find basic shelter, medical attention if injured, food, and connection to other resources. -Action: focus on clients' needs and take action to fulfill those needs. Stay with clients and ensure that their needs are met. Debrief the story: the basic listening sequence is helpful here clients need to know that someone is hearing them -follow up: concrete action in the immediacy of the crisis is essential. Where possible and appropriate, arrange to meet the client again for debriefing and planning in more detail for the future. Watch for strengths and resilience.
How do you deal with Dual relationships?
-Open and honest discussion with client on the nature of your relationships -Separate functions by locations- work, home, etc. -Be aware of threats to confidentiality -Understand your role as professional
refining the skill of empathic feedback
-Positive feedback is "the breakfast of champions". Une this skill relatively frequently; it will balance more challenging necessary corrective feedback -corrective feedback will be necessary at times. It needs to focus on things that the client can actually change. Seek to avoid critics. Be specific and clear and where possible supplement with client strengths to support that change. - In some cases(such as abusive or criminal behavior) negative feedback-- including the negative consequences the client's actions can bring-- is necessary and can be beneficial. It is our responsibility to act in these situations, But listening to the client's point of view even if the client is the perpetrator, remains important. Use this skill sparingly. -feedback from the client can help guide your interventions, increase relationship satisfaction, and reduce breakdowns. When asking clients how things are going, the use of formal methods of seeking feedback provides the best benefits.
What is the importance of boundaries?
-Role modeling healthy communication and professional relationships -Avoiding "rescuer" role -Staying focused on your responsibilities to the client & provision of appropriate services to the client -Avoiding compassion fatigue (burn-out) -Maintaining healthy, functioning team (if working with other providers) -Maintaining physical and emotional health and safety
What are the NASW Core Values?
-Service - helping people in need; Empowering people, not rescuing them. -Social Justice - challenge injustice; Advocate for clients, be aware of issues, be involved. -Dignity & Worth of the Person - respect for each individual; Culturally competent, appreciation of diversity, non-judgemental. Pay attention to tone of voice, expressions, etc. -Importance of Human Relationships - recognition and support -Integrity - act honestly and responsibly; Don't make promises you can't keep, follow through. Keep client information confidential. -Competence - increase knowledge; : Do not practice outside your area of knowledge, continuing education
What are some signs of boundary issues?
-Service provider & client begin referring to each other as friends -Service provider receives gifts from or gives gifts to clients -Sharing of home phone numbers or other significant personal information -Asking/expecting socialization outside of professional setting -Service provider reveals excessive personal information to client -Discussion regarding work/clients dominates service provider's social interactions with friends & family -Service provider offers to provide assistance to client outside of his/her role (babysitting, transportation, etc.) -Service provider finds him/herself "venting" with client about other service providers
Observing: introducing therapeutic lifestyle changes through decisional counselling
-TLC's are a "different" way to approach interviewing and counseling. -TLCs involve psychoeducation, providing information, and at times even giving advice. -encouraging clients to engage in new behaviors and ways of thinking is never easy.
"Magic," samurai, neuroscience, and the importance of practice to mastery and competence
-The samurai effect helps us understand the importance of practicing and assimilating each skill -many highly demanding activities, including sports, driving, golf, dance and music are improved with single skills practice -continued and intentional practice are needed to achieve mastery -the microskills approach breaks interviewer skills into single units. When learning single skills one by one, you many experience a temporary decrease in competence. However, continued intentional practice and experience develops competence and a natural integration of skills.
How do we maintain interpersonal awareness of ourselves?
-Understanding your own needs -Understanding your role as a professional -Staying focused on the job at hand -Taking care of your emotional and physical health -Establishing clear limits
Refining the Skills of crisis counseling and suicide risk
-a calming and caring approach is helpful to the client -prevent burnout by taking breaks, getting enough sleep, and keeping some exercise routine and consulting with colleagues and supervisors. -offer follow-up counseling and other appropriate mental health treatments to those who are unable to overcome trauma without assistance.
Observing attending behavior and empathy in action: Do I want to become a counselor?
-be sensitive to clients multicultural and individual characteristics. Never stereotype. -when the interviewer demonstrates culturally appropriate attending skills, it shows interest in the client and promotes greater client talk time. -expect individual and cultural differences on the four key dimensions of attending.
observing reflection of feelings in action
-because human change and development are rooted in emotional experience, reflection of feelings is critical in all theories of counseling and therapy. -reflection of feelings clarifies the clients emotional state, leads clients in new directions and results in new discoveries. -identify positive qualities and emotions to help clients deal more effectively with negative emotions
Defining reflection of feelings
-both paraphrasing and reflection of feelings feed back to clients what they have been experiencing -a paraphrase focuses on the verbal content of what the client says; reflection of feelings centers on both verbal and nonverbal emotional underpinnings. -unspoken feelings may be seen in the client's nonverbal expression, may be heard in the clients vocal tone, or may be inferred from the client's language -feelings are layered like an onion. words like frustration, mixed up, and confused represent conflicting emotions underneath surface words. -checkouts can help confirm the accuracy of paraphrases and reflections of feelings.
observing listening skills and children
-children, adolescents, and some adults will be more comfortable if you provide something for them to do with their hands. Avoid abstractions, use short sentences and simple words, and focus on concrete, observable issues and behaviors. -note that the case of Damaris demonstrates effective verbal attending through encouraging, paraphrasing, and summarizing, which help the client explore the issues more effectively. Effective questions are used to bring in new data, organize the discussion, and point out positive strengths.
observing the skill of focusing
-client issues are seldom one-person matters. Focusing on family background, community, and spirituality enriches the session and helps the client focus on positive strengths. -the community genogram provides a clear visual picture of the clients background and helps the counselor understand the social context more quickly and fully.
observing questions in action: interview transcript, conflict at work
-closed questions can bring our specific data, but if they are overused, the interviewer will run out of things to say and so will the client. - open questions give more control to the client and encourage more client talk time.
What are some influencing skills?
-confrontation -reflection of meaning -interpretation and reframing -feedback -directives
Discerning the basic skills of empathic confrontation
-confrontation does not stand alone as a skill but is a combination of skills. -when confrontation is used clearly and concisely, it encourages clients to look at their situation from a new perspective. -There are THREE steps of confrontation, each using different skills: step 1: identify conflict step 2: point out issues of incongruity and work to resolve them step 3: evaluate the change - the Client Change Scale can be applied to any client statement in the interview, or you can use these concepts to evaluate client changes over several sessions. The five dimensions are: 1. Denial 2. Partial examination 3. acceptance and recognition 4. generation and new solution 5. development of new, larger and more inclusive constructs, patterns or behaviors-- transcendence
Defining Empathetic confrontation
-confrontation is a supportive challenge to client conflict and incongruity that helps bringing a clearer understanding of core issues. -confrontation is based on effective listening and observation of discrepancies, incongruity and mixed feelings and thoughts.
what is my role as my helper, goals, and competencies?
-counseling is an art and a science -interviewing and counseling have a solid research and scientific base -Love is listening. the identified listening skills are central to competent helping. -ask yourself: What brought you here? what natural talents do you bring? what do you need to learn to grow further?
ethics and morals: Professional and personal:
-counselors must practice within boundaries of their competence, based on education, training, supervised experience, state and national credentials, and appropriate professional experience. -confidentiality of information is addressed in the ethics codes of all helping professions and provides the basis for trust and relationship building. Informed consent requires us to tell clients their rights. When recording sessions, we need permission from the client. -interviewers and counselors have more perceived power than clients. Efforts need to be made to equalize power in the relationship. -Helping professionals are asked to work outside the interview to improve society and are called upon to act on social justice issues.
Defining Crisis Counseling
-crisis counseling is an action-oriented form of helping. -everybody experiences crises or traumas in their lifetime. "Normalizing" reactions to crises is key. -crises make include natural events (hurricanes, earthquakes) or human made (war, rape) -Working with crises includes two phases: 1: working though the initial trauma 2: appropriate follow-up and further counseling. Resilient clients may not need or may bot appear for further help.
defining natural and logical consequences and decisional counseling
-decisions are the most basic issue in interviewing, counseling, and therapy, as all clients will be making decisions. -decisions have consequences. Even good decisions may have negative natural consequences that we need to prepare our clients to face. -explore concrete positive and negative consequences that may logically follow from each decision. Use the "if you do this, then this will possibly be the result" approach. -making decisions is observed in all of the more than 500 theoretical approaches to helping. -The steps of decision strategy of logical consequences are: 1. listen to clients and clarify issues 2. generate alternatives with them to resolve their issues. 3. carefully sort out the positive and negative consequences of each alternative 4. summarize the alternative using nonjudgmental and positive stance 5. encourage client decision making -decisional counseling underlies the five stages of the interview and involves the skills in which you have already become competent throughout the book. -the cognitive and emotional balance sheet, created by Australian Leon Mann clarifies natural and logical consequences
refining empathic self-disclosure
-demonstrate genuineness. Share truly and honestly felt feelings, thoughts, or experiences as appropriate in relation to the client. -put clients first. When clients ask you what you would do in their place, your task is to help them make their own decisions. Involving yourself too early can foster dependency and potentially mislead clients. -it is important to discuss multicultural differences openly and with respect. Be culturally intentional and diversely respectful.
refining directives and psychoeducational strategies for building mental and physical health
-directive strategies are used to tell the client what to do in a timely, individually and culturally appropriate manner. Directives may range from telling the client to seek career information to using complex theoretical strategies. -used sparingly, directives can be critical in leading to client change and growth, as measured on the client change scale (CCS) - TLC's are a key component to psychoeducation to promote mental and physical health and wellness. -TLC's offer clients a way to improve health, prevent physical and mental decay, manage stress, and promote wellness and well-being. -other strategies include spiritual imagery, role-play enactment, positive reframing, relaxation, meditation, physical exercise, imagery focusing on a relaxing scene, thought stopping, journaling.
Refining the skills of eliciting and reflecting meaning and interpretation/reframing
-discernment is a form of listening that goes beyond our usual descriptions and could be termed "listening with the heart". Both you and the client seriously search for deeper life goals and direction. Specific discernment questions are in box 10.1 -multicultural and family issues and stories may be key in helping clients discover personal meaning. Eliciting meaning and focusing reflection on contextual issues beyond the individual will enhance and broaden the client's understanding of life's deeper concerns. -focusing and multicultural counseling and therapy are the most certain ways to bring multicultural issues to the interview. A woman, gay or lesbians', or a person of color may be depressed over what is considered a personal failure. Helping the client see the cultural/environmental context of the issue may offer a new perspective, providing a totally new and more workable meaning. -neuroscience reminds us that finding life's meaning and vision involves both the prefrontal executive and the faster moving emotional limbic system and amygdala.
Discerning the basic techniques and strategies of encouraging, paraphrasing, and summarizing
-encouraging, paraphrasing, and summarizing are key active listening skills that keep the client talking. -encouragers help clients elaborate their stories and include key words, uh-huh's, smiles, a warm style, and short comments -the restatement is a form of encourager that repeats short phrases back to the client -the paraphrase includes: 1. a sentence stem, often with the client's name 2. key words used by the client 3. the essence of what a client has said in briefer and clarified form 4. a checkout for accuracy. The accurate paraphrase will catch the essence of and clarify what the client says - the summary covers a longer period of the interview. It is also often used to begin or end a session to repeat back to the client what was said in the previous session(s) -checking what you hear helps you better understand clients' comments and increasing accuracy - all these skills communicate that you are listening and help the client feel heard, further explore his or her story, and gain greater understanding of issues and concerns
Practicing: Becoming competent in encouraging, paraphrasing, and summarizing
-exercise the skills presented in this chapter to increase awareness, knowledge, and competence - to increase effective use of encouragers, paraphrases, and summaries, learn about your style and possible variations and practice with others to receive feedback.
How to communicate that we are listening:
-eye contact -body language - vocal qualities -verbal tracking
What are ethics?
-focus is on social justice; doing what is right. Ethics may be in conflict with unjust laws. -¨the "rightness" or "wrongness" of an action. Moral standards by which people judge and behave.
What is the importance of multicultural competence?
-interviewing and counseling are global phenomena used with individuals from many different cultures and customs -it is an ethical imperative that interviewers and counselors be multiculturally competent and continually increase their awareness, knowledge, skills, and action in multicultural areas.
What are some key points to remember with interviewing, counseling, psychotherapy, and related fields?
-interviewing is a basic process for gathering data, solving problems, and providing information and advice. -counseling is more comprehensive and is generally concerned with helping people cope with life challenges and develop new opportunities for further growth, whereas psychotherapy is focused on more deep-seated personality or behavioral difficulties. -currently there is a high degree of overlap among interviewing, counseling, and psychotherapy -multiple fields that use the skills of this text range from business interviewing through in -depth work in clinical social work, counseling, or clinical psychology and psychiatry. -you will use microskills presented in the text in any working or social context, but with varying emphasis and objectives.
Refining stress management as pschoeducation
-more than 40% of adults suffer adverse health effects from stress. -stress accounts for 75% to 90% of all doctor's office visits and plays a part in problems such as headaches, HBP, heart problems, diabetes, skin conditions, asthma, arthritis, depression, and anxiety. -stress can be positive (eustress) but with high intensity, long duration, or both, it produces damaging mental and physical consequences. -stress management is an organized series of instructional, psychoeducational and counseling strategies to enable clients to deal more effectively with stress. -stress management is based in solid neuroscience research and is used by therapists and counselors for many theoretical orientations.
Therapeutic lifestyle changes: specifics on which build wellness for lifetime resilience:
-most of us can benefit from the therapeutic lifestyle changes (TLCs) for managing stress and building mental and physical health, brain reserve, and resilience. An effective plan to implement the TLCs can improve the quality of your life and work. - Review the TLCs and select one to three as a beginning step toward improving your own mental and physical health. -you can use the TLCs in every interview to help clients increase well-being and effective coping -as with your own health program, it does little good to change all the TLCs at once. The client can select those that are most immediately meaningful.
Discerning: specifics of observation
-movement synchrony, movement complementary, and mirroring my represent particularly effective movements and close relationships in the interview. Also, these movements provide information regarding the clients experience -movement desynchrony and noncommutative body movements may indicate that the client is uncomfortable with you our the session -multicultural variations in verbal and nonverbal behavior will require a lifetime of learning on your part.
Refining nonempathic confrontation, dealing with resistance, multicultural issues, and working with groups
-nonempathic confrontation is an ineffective attempt to force clients to change. It often increases clients' argumentation and resistance. -respect client resistance, listen, and maintain awareness that the resistance often has important protective functions for the client. -be aware of individual and cultural differences, particularly if you are culturally different from the client. -Conflicts are part of our lives and create opportunities for resolution and progress. developmental skills to mediate and manage individual and group tensions. -treat people as they would like to be treated.
Defining Questions
-open and closed questions are an essential part of helping theories and practices. -closed questions focus the interview, provide specific information, and are answered in few words; open questions allow more client talk time and exploration fo client concerns
Discerning: The basic techniques and strategies of observing and reflecting feelings
-people constantly feel and express emotion in verbal and nonverbal ways. -the proficient interviewer will hear explicit emotions, observe implicit emotions, and feed these emotions back to the client. -sad, mad, glad, and scared are primary emotions used to root words for building a vocabulary of emotions. They appear to be universal across cultures. -social emotions (embarrassment, guilt, pride) are modified and built on primary emotions. they are learned in a family and cultural context. -everyone has complex emotions associated with people and events in their lives. Helping clients sort out these feelings is an important part of interviewing, counseling, and psychotherapy. -proficient interviewers are able to observe and reflect emotional dimensions accurately. -the components of reflection of feelings are: 1.a sentence stem 2. the feeling word 3. some context 4. present tense 5. a checkout 6. positive strengths Beginning with the client's name is helpful, and present tense, here-and-now reflections are often more powerful than a review of past emotions. -research and clinical experience reveal that special attention to positive emotions can provide clients with strengths to better address their emotional challenges.
practicing questioning skills
-practice intentional prediction with classmates and volunteers to find out most likely outcomes of questions. -practice open and closed questions. Focus on a particular issue, and create questions to search for positive strengths and resources. -record your role-play or practice and seek feedback afterward. Use group practice to get immediate comments from your classmates and observers.
Practicing: integrating the skills and strategies of chapter 12
-practice providing directives, information, and natural consequences. -explore the stress in your own life and in the lives of others: current, past, and future. -practice pondering alternatives using cognitive and emotional balance sheet. -Take advantage of website activities: 1. Writing Logical Consequences Statements 2. Logical Consequences using attending skills 3. group practice with logical consequences 4. natural and logical consequences -Complete interactive exercises -conduct a group practice exercise -review online video activities
Practicing: becoming competent in observing and reflecting feelings
-practicing what you have read is essential for skill mastery -start with self-reflection. How comfortable are you with emotions? are there areas where clients may cause you to feel uncomfortable? -go back and review your first interview. Focus on feeling word observed in the interview. Notice what you did and what you learned. -practice acknowledgment of feelings, as a brief recognition may be more helpful sometimes. use acknowledgment and naming feelings. -work with another person and record an individual practice session reflecting feelings. seek feedback. review the session, noting the clients emotions and your response to them. -practice with a group of three of four classmates. Use the group guidelines to facilitate practice in reflecting feelings.
positive psychology:
-promotes the development of optimism and resilience. -optimism can be measured with sales such as the Six-point optimism scale. -Search for positive assets, which are the resources and strengths that the clients bring with them -clients aware of their strengths and resources are more resilient and can face challenges in a more effective manner.
Discerning the how of using questions
-questions help begin the interview and open conversation -initial questions may lead clients and determine their responses. -key sentence stems of certain open questions may predict client response. What tends to lead to facts, HOW to process and feelings, and WHY to reasons; COULD/CAN/WOULD were described as maximally open - potential difficulties with questions include client grilling and bombardment, the use of questions to make to make statements, and defensiveness in response to WHY questions. -many people have negative experiences with questions. We may have been "put on the spot" or grilled. It becomes key to determine when and how to use questions effectively. -open questions help clients elaborate and enrich their stories. -questions used to identify strengths can help clients face their issues with more confidence and ability. -questions' effectiveness can be enhanced when used respectfully and with consideration of multicultural dimensions of clients.
refining: extensions of the questioning skill
-questions help clients tell their story and bring out the concrete details of the clients world. - The "What else?" question brings out missing data. It is maximally open and allows the client considerable control. -questions may be seen as rude and intrusive and may be inappropriate. Sufficient trust needs to be present for questions to work effectively, particularly when multicultural differences are present. -with less verbal clients, be particularly careful not to lead the client into your own frame of reference.
privilege as a multicultural interviewing issue:
-race and ethnicity are especially important multicultural issues. We need to be aware that white, male, and economically advantaged often puts a person in a privileged group. -the interviewer needs to be client centered rather than directed by "politically correct" terminology. This is an issue of respect, and clients need to say what is comfortable and appropriate for them.
Defining Focusing
-selective attention will broaden the depth and breadth of a client's story. Through your attending skills (visuals, vocal tone, verbal following, and body language), you consciously or unconsciously indicate to your client the topics that you consider most important. -if we help clients understand their web of relationships, they will be better prepared to understand themselves, have less blame, and see their issues in a more complete context
Defining Empathic self-disclosure
-self disclosures are basically "I" statements made by the interviewer to share her or his own personal experience, thoughts, or feelings. Here-and-now self disclosures tend to be the most powerful -self disclosure is ever present and takes one of three forms: deliberate, unavoidable, and accidental. -when used appropriately and empathically, self disclosure encourages more in-depth client disclosure, may result in a more egalitarian relationship in the session, and may help the client find a new solution related to the counselors self disclosure.
Discerning: Levels of empathy
-subtractive empathy takes away from client conversation -interchangeable empathy catches the essence of what the client has said and usually encourages them to move on. -additive, positive empathy finds strengths and resources in the client. Questions are often labeled "potentially additive" because we must wait to see how the client responds to be sure how helpful the comment was.
What is the importance of RESPECTFUL interviewing and counseling?
-the RESPECTFUL model lists 10 key multicultural dimensions, thus showing that cultural issues inevitably will be part of the interviewing and client relationship
Practicing mapping the web of relationships, community, and family genograms
-the community genogram is a visual map of the client in relation to his or her environment, showing both stressors and assets. This type of genogram is useful for understanding a clients history and identifying strengths and resources. -the gamily genogram can be a useful supplement to the community genogram, bringing out additional details of family history. -you as an interviewer or counselor also come from social context, and all the focus dimensions apply to you as well. You may consciously or unconsciously focus on certain issues and dimensions while ignoring others.
observing the skills of reflection of meaning and interpretation/reframing
-the counselor uses listening skills and key word encouragers to focus on meaning issues. -open ended questions oriented to values and to meaning are are often effective in eliciting client talk about meaning issues -a reflection of meaning looks very much like a paraphrase except that the focus is on implicit deeper issues, often not expressed fully in the surface language or behavior of the client.
practicing the skills of empathic self-disclosure and empathic feedback
-the exercises offered in this section will help you critically think about self-disclosure and practice to increase relevant and effective use of self disclosure. - bank on your personal experiences with feedback to guide your understanding of this skill. Practice in a group and get immediate and constructive feedback and master the skill of feedback.
Discerning the skill of focusing:
-the interviewer and counselor may facilitate understanding of the client's web of relationships through focusing on the client, the client's issues and concerns, significant others, other key individuals and groups, the cultural/environmental context, and/or the immediate interpersonal relationship of the session.
discerning the skills of reflection of meaning and interpretation/reframing
-the two skills are similar in helping clients generate a new and potentially more helpful way of looking at things. Reflection of meaning focuses on the clients worldview and seeks to understand what motivates the client; it provides more clarity on values and deeper life meanings. -an interpretation results from interviewer observation and seeks new and more useful ways of thinking. Eliciting meaning is accomplished by carefully listening to the client for meaning words. Questions related to values, meaning, life goals, and ultimate casual issues bring out client meanings. "What meaning does that have to you" or "What sense do you make of that?"
Refining: The Power of Positive
-the words we say produce expectations that have a major impact on clients bodies and minds -positive and negative expectations can improve or deteriorate client performance
Observing empathic confrontation in action
-three main points are covered in the example interview: 1. listening skills are used to obtain client data 2. confrontations of client discrepancies are noted. 3. the effectiveness of the confrontations can be assessed using the client change scale -major client change is an extended process; it may require several interviews, group sessions, and some time for the client to internalize and act on new ideas
Refining: attending behavior, empathy, and observation in a multicultural context
-use attending skills to open and close client talk. -value silence -remember clients cannot speak while you are talking; give clients talk time.
Refining: Focusing on challenge issues
-you are going to face situations in which your best counseling efforts are insufficient to help your clients resolve their issues and move on with their lives. The social context of poverty, racism, sexism, and many other forms of unfairness may leave your clients in nearly impossible situations. -those who adopt a social justice orientation with ethical witnessing move beyond understanding and take both remedial and preventative action for their clients.
refining: Observation and reflection of feelings
-you can assist your clients to get more accurately in touch with their emotions. By focusing on breathing patterns and other nonverbal behaviors, you can help clients increase or decrease emotional expressiveness. -mirror body language to encourage clients to express more emotion if needed. Use here and now strategies such as "what are you feeling right now?" to increase emotional awareness or "What did you feel then" to move the client away from here and now experiencing. -check your own comfort level with your own emotional expression, as this will affect how clients face their feelings. If you are uncomfortable with a particular emotion or topic, your clients will likely avoid it. -show culturally appropriate and supportive behavior, as clients from diverse groups will present varying degrees of comfort working with emotions. -positive emotions broaden clients' behavioral responses. To facilitate growth, focus on what clients "can do" rather than what they "cant do." -help clients reflect on positive emotions and feelings. Use the positive wellness assessment and the therapeutic lifestyle changes. Reflect the feelings associated with these -remember to use positive focus in a way that is helpful to the client. Avoid minimizing or being overly optimistic. -building the relationship is central, as some clients may be reticent to reveal their deepest feelings to others. - reflection of feelings can be overdone, particularly if the client comes from a family or culture that believes emotional expression is inappropriate. -not all clients are comfortable discussing emotion. exploring emotions can be uncomfortable for some, especially if they have avoided this in the past. Also, less verbal clients are those who are not used to dealing with emotions and may respond negatively to your reflections. Initially, brief acknowledgment of feelings may be a better option with these clients.
Suicide watch: Awareness basics
-youth suicide is of real concern. Suicide was the second major cause of death among youth 15-24 years old, and still appears to be increasing. -Risk assessment: assess for suicide potential, provide immediate crisis support, and ensure a careful referral with client follow up when needed. -focus on strengths and resources to build on and increase long term safety. Connect clients with positive social support. Observe the presence of three key warning signs: 1: making actual threats to hurt or kill oneself 2: seeking access to pills, guns, or other routes 3: talking or writing about death, dying, or suicide -do not hesitate to ask key questions and listen for the answers in a nonjudgmental and respectful way
Overview of Course
-•Reflect on your goals for helping and your natural style of being with others. •Focus on client story to identify strengths and positive resources, and use these for building resiliency. •Gain knowledge of ethical principles of practice in one-on-one interactions. •Engage and assessment from a multi-cultural lens •Develop empathy, warmth in working on-one-one •Learn differences between counseling, psychotherapy and interviewing •Gain knowledge of the microskills approach to the interview •Consider significant factors related to the place you conduct your interviews and how you engage with clients
WHAT IS "ATTENDING"?
-•What we do to encourage a client to talk •When we listen (more than talk) Observation skills •Understanding verbal and nonverbal cues •Becoming aware of our own verbal and nonverbal cues •Being aware of individual and cultural styles of listening and talking
Client change scale:
1. Denial 2. Partial Examination 3. Acceptance and recognition, but no change 4. Creation of a new solution 5. Transcendence
What are five stages of the counseling session?
1. empathetic relationship 2. story and strengths 3. goals 4. Restory 5. Action
What are some positive orientations to practice?
1.Empathic Relationship: Clients want to tell their story to someone who is interested or who is warm and welcoming. 2.Story and Strengths: As told by the client. Focus on client's strengths and wellness. 3.Goals: Work on mutually agreed upon goals. 4.Restory: Generate new ways for the client to see and talk about themselves. 5.Action: Help the client bring new ways of thinking and being into action.
Problem solving in task groups
1.Identifying a problem 2.Developing goals 3.Collecting data 4.Developing plans 5.Selecting the best plans 6.Implementing the plan 1.Identifying a problem - what is the problem at hand? •Make sure it is solvable, specific and measurable 2.Developing goals - what are some tentative goals you can set? •Should be realistic, attainable, and time-limited 3.Collecting data - what data would you need to collect as a group to get a sense of the problem or how you are progressing towards a solution 4.Developing plans - what is your group working on during this phase? 5.Selecting the best plans - how does your group select the best plan? 6.Implementing the plan - what does your group have to keep in mind to ensure a successful implementation?
What are the components of reflection?
1.Name the emotion 2.Tense (here and now OR then and there) 3.Context 4.Checkout
Overly discriminatory / oppressive behavior
A client of yours is expressing overtly racist attitudes and thoughts to you during a session. •What are your thoughts? •What does the code of ethics suggest? •What are you going to do when faced with these challenges?
examples of treatment groups
A group for prospective foster parents sponsored by a child welfare agency(educational) A gay pride group sponsored by a community health clinic serving the gay community in a large urban area(socialization) A monthly Vietnam Veterans evening social at a rural VFW hall(socialization) A hospital-sponsored group for people addicted to drugs(therapy) Gamblers Anonymous, a group for people who are trying to remain free of a gambling addiction(support) A group of children meeting at a school to discuss the effect of divorce on their lives(support and therapeutic)
Ways to get started with empathy in session
Acknowledge their pain •"I'm sorry you are going through this." •"I hate that this happened." •"That must be hard." •"That sounds really challenging." •"I can see how that would be difficult. Share how you feel and encourage I am in awe of your courage and bravery, what can I do to help?" I don't know what to say, but I am here and ready if you need to talk." "I can't imagine what you must be going through, but I can offer to listen if you need someone." "It makes me really sad to hear this happened to you. what do you need right now?" I have no experiences that relatable, but I am here for you?" Show gratitude that the person opened up •"Thank you for sharing with me." •"I'm glad you told me." •"Thank you for trusting me with this. That really means a lot." •"This must be hard to talk about. Thank you for opening up to me." Show interest "How are you feeling about everything?" "What has this been like for you?" "I want to make sure I understand..." "What I'm hearing is that you are feeling ____. Is that right?" "Is there anything else you want to share?"
What is cultural intentionality?
Begin by asking "Would you like to start by sharing with me what happened during this incident?" •This is our goal! •It's adaptive, creative, and flexible interviewing •If a helping lead or skill doesn't work, we try another approach!!! •The same comment may have different effects on different individuals •Importance of language •"problem" vs. "concern" •Rape example •Listen to the client for clues and cues •Reflecting feelings
Community Coalitions
Bring together broad representation of citizens within a locality to address a community problem.
What are some examples of paraphrasing?
C: "I just broke up with Jason. The way he was treating me was just too much to bear. Every time I tried to touch on the subject with him he would just clam up. I feel so much better now." SW: "You feel much better after breaking up with Jason." ---------------------------------------------------------------- C: "I was shaking and didn't feel like I could move. It was just so scary. I have never seen anything like that. I didn't know what to do." SW: "It was so scary. You felt frozen." C: "Yes! I couldn't move. That has never happened to me before. It took me a few minutes to even recover my sense of where I was and what I was doing there." C: "I mean, I love her. I want to be with her. I just don't know how to save our relationship. I feel like I have tried everything." SW: "You want to be with her, you just don't know how to make that happen or if it is even possible. Is that correct?" ------------------------------------------------------------------C: "I feel as if everyone is against me. Every time I try to improve my situation, I run up against a wall. It makes me want to give up fighting. It's so frustrating." SW: "It sounds like you feel powerless. You keep trying, but something always gets in your way. Is that right?"
What are microskills?
Discrete communication skills that enable us to interact more intentionally with clients •Attending behavior / observation •Questioning •Paraphrasing •Summarizing •Reflection of feeling •Structuring interviews •focusing
What are some examples of conflicts?
Internal conflicts •Incongruities between two verbal statements •Discrepancies between what the person is saying and what they do External conflicts •Conflict between the client and a challenging situation or choice •New job •Major purchase •Decision to have a child or not •Dating someone from another culture •Dealing with discrimination / oppression* •Discrepancies between YOU and the client •You don't fully understand where the client is coming from, or don't agree with their choices •Listening more intently can often address this •Question yourself silently, draw out client's perceptions, then work to understand them Discrimination can result in depression and "learned helplessness" or even blaming oneself. When clients are blaming themselves for a problem, it can be helpful to educate them on the issue, this helps reduce self-blame and connects them to the concept of systematic oppression. NORMALIZE feelings that result from discrimination / oppression. For example, after a woman who is raped, or is being sexually harassed at work
Size of group
Larger group: •POSSIBILITIES FOR POTENTIAL RELATIONSHIPS •LESS OPPORTUNITY TO MAINTAIN RELATIONSHIPS WITHIN GROUP •LESS OPPORTUNITY TO PARTICIPATE CAN LEAD TO INCREASED DISSATISFACTION smaller groups: LESS PEOPLE TO MEET AND INTERACT WITH MORE OPPORTUNITIES TO PARTICIPATE IN GROUP MORE DEPENDENCE ON LEADER?
WHY WOULD SOMEONE NEED TO BROADEN THEIR IDEA OF SELF?
Many of the issues we have are conflict, incongruity, and discrepancies between the individual and their family and friends. Many problems are also caused by issues and events in the broader context. If you can help clients see themselves and their issues as person-in-community, they can learn new ways of thinking about themselves and use existing support systems more effectively.
Group interaction patterns
Maypole: leader is the central figure and communication occurs from the leader to the member and from the member to the leader Round robin: when members take turns talking Hot seat: when there is an extended back and forth between the leader and one of the members and the other members watch Free floating: when all members take responsibility for communicating , taking into consideration their ability to contribute meaningfully to the particular topics Share and Tag
stages OF GROUP DEVELOPMENT:
Most groups have both cyclical and progressive stages Open groups rarely move beyond a beginning stage of development Most "work" occurs in the middle stage of group development Beginning middle ending different models open versus closed membership and group development
Closed vs. Open Questions
Open Questions Can't be answered in a few words Encourage others to talk Provide the interviewer with maximum information Often begin with what, how, why, or could* Closed Questions Can be answered in very few words Burden of talking remains with interviewer Provide the interview with focused, specific information Often begin with is, are, and do
What are some examples of blurred boundaries?
Self disclosure - telling client excessive personal info Giving or receiving significant gifts Dual or overlapping relationships Becoming friends Physical contact Provider/client providing services outside of work relationship - transportation, repair work, babysitting
Unconditional Positive Regard
So what IS it? •It's believing the person is doing their best •It's respecting their right to self-determination •It's an attitude, not a behavior •It's encouraging to the client because they don't feel judged NOT •It's not about whether or not you LIKE someone •It's not even about whether you approve of their actions •It's not about being nice to someone or smiling a lot
Elaborate on Dual Relationships:
Some dual relationships may be unavoidable ¤You and a client belong to the same church ¤A client lives in your neighborhood ¤Your agency hires clients as staff or utilizes clients as volunteers
Structured vs. Unstructured Groups
Structured: Reduces members' fears and anxieties May decrease members' commitment to the group More likely to be short-term, time-limited groups Unstructured: May prevent members from exercising their own initiative Allows for more spontaneous learning and growth opportunities More likely to be long term, ongoing groups
What is empathy?
The reality is that there is no script for empathy. It's less about what you say and more about showing up and listening well.
What is an important diagnostic tool?
Using the Diagnostic Statistical Manual of Mental Disorders (DSM) as the only tool when diagnosing different clients from different ethnicities and races with a mental illness is potential harmful. We need to get this right as social workers
What is group culture?
Values, beliefs, customs, traditions •Three levels •Symbols and rituals - ex. AA •The way members interact with each other - ex. the way conflict is handled •Core beliefs, ideologies, and values held in common
Countertransference
When your client is projecting, you are taking it on and personalizing it. Usually crosses our already set boundaries.
A crisis may be different from a problem or an emergency
While a problem may create stress and be difficult to solve, the family or individual is capable of finding a solution. Consequently, a problem that can be resolved by an individual or a family without outside intervention is not a crisis. Oftentimes, a problem may seem like a crisis to a family or individual under stress and not thinking clearly. Interventions that establish trust and provide reassurance, advice or a referral by the case worker may resolve such a problem. An emergency is a sudden, pressing necessity, such as when a life is in danger because of an accident, a suicide attempt, or family violence. It requires immediate attention by law enforcement, CPS, or other professionals trained to respond to life-threatening events. If a situation can wait 24 to 72 hours for a response, without placing an individual or a family in jeopardy, it is a crisis and not an emergency
Dimensions of group dynamics
communication & interaction patterns, cohesion, social integration & influence, group culture
practicing the skills of eliciting and reflecting meaning and interpretation/reframing
completing the exercises including in this section and on the website will help you achieve mastery of these skills and achieve interviewing competence.
Vague or concrete: I'm not following you closely. Could you give me a specific example?
concrete
Vague or concrete: You've been very clever in your statements, but what specifically do you mean? Stop for a moment, sit back... good.... Now I want you to develop an image as if in a dream. Just close your eyes and let it flow.
concrete
discerning the skill of empathic feedback
effective feedback is empathic, timely, genuine, and culturally sensitive
Defining observation skills
observing verbal and nonverbal behavior is critical to understanding the client. Also watch videos of your own patterns to asses your strengths and areas of improvement
practicing becoming competent in empathic confrontation
practicing what you have read is essential for skill mastery. Each of the exercises including this section will help you increase your mastery of empathic confrontation.
observing empathic self-disclosure and empathic feedback
the case of Madison and her difficult situation at work illustrates how feedback can be used to focus the interview, reduce digressions or avoidance, and confront challenging issues
staff development group
to educate members for better practice with clients
socialization group
to increase communication and social skills; to improve relationships
Practicing crisis counseling
use the exercises in the book and the web resources to prepare for both individual and community disasters
Practicing, attending, empathy, and observation skills
use the exercising in this section to improve your 3v's + B and master observation and empathetic skills
Vague or concrete: As I hear you, you sound very excited. Now I want you to just calm down.
vague
What is a code?
¨a "set" of personal ethical principles which guide an individual's decision making.
What is a professional code?
¨a set of guidelines for performance and evaluation based on core values and principles of a profession.
What are laws?
¨legal justice; following the norms established by society through the political process.
examples of reflecting feelings
•"I hear you are feeling discouraged today about the changes to your job description, is that right?" •"Christopher, you are expressing anger about the recent changes at work. Is that fair?" •"It sounds like you feel incredibly frustrated because they made these changes without your knowledge, am I on track with this?"
What is group think?
•A mode of thinking that people engage in when they are deeply involved in a cohesive ingroup, when the members striving for unanimity override their motivation to realistically appraise alternative courses of action •Results in groups becoming close minded •The pressure to conform limits the group's efficacy and/or creativity •The group values harmony more than critical evaluation
Helping members achieve their goals
•A tentative agreement about goals is usually discussed when interviewing potential members during the planning stage of the group •A portion of the time is spent addressing the group's optimal functioning, but the majority of time is spent helping members achieve their goals, using the following steps: •Maintain awareness of goals •Develop specific treatment plans •Overcome obstacles •Carry out treatment plans •Maintain awareness of goals •Brief go-arounds and check-ins can serve as a chance for members to talk about their goals •Workers should be periodically confirming goals with members of the group •Workers should develop a system for monitoring the goals of members •Develop specific treatment plans •Treatment plans are developed with each individual with the group as both a witness and a helper •Tasks can be assigned for "homework" outside of the group •Overcome obstacles •"demand for work" •The leader and the other group members can help the member analyze what factors led to the struggle, while avoiding "why" questions •Help members decide what actions to take to overcome these obstacles and renew progress •Carry out treatment plans •Group leader roles: enabler, broker, mediator, advocate, educator Homework: observational or monitoring tasks to gather information or increase awareness about certain behaviors; experiential tasks to arouse emotion or challenge beliefs; incremental change tasks to stimulate change step by step. Tasks can be individual, shared (buddy system), or reciprocal The demand for work is a gentle reminder to the member that the worker and the other members are interested in seeing that member achieve their personal goals. Enabler: helps members utilize their own strengths and resources; encourages members to share their thoughts with the group Broker: identifies community resources that would help the member carry out her goals Mediator: resoloves disputes, conflicts, or opposing views within the group, takes a neutral stand, helps members arrive at an agreement Advocate: Represents members' interests and needs; helps members obtain needed resourses Educator: presents new information; demonstrates and models new behavior, leads role plays to help members practice new skills
What can we do physically to make clients more comfortable in our space?
•Accommodate space for children if needed--> •Consider waiting room experience --> •Applies with tele-help (internet connection, microphone, lighting, appropriate background) •Give them choices on where to sit!!! •Stay at same level •Have manipulatives on the desk or table for them to play with if needed •Avoid a barrier between you and them •Avoid personal objects and photos, or keep to a minimum •Avoid controversial messages / photographs •Acknowledge any shortcomings in your office space •Keep at a comfortable temperature •Blankets / pillows •Lamps vs. flourescents •White noise machine •Be mindful or perfumes/colognes •Tissues (but don't hand them the box like the book says)
Where are we as a group by the middle stage?
•Accomplishing objectives, goals, and tasks •Group has developed a process or rhythm •A beginning level of group cohesion and culture •Testing, conflict, and adjustment often occur during this phase •Primary goal of the social worker during this stage is to help members accomplish their goals As a facilitator, don't take this as a negative sign! This is a sign that members are getting more comfortable to assert their own needs and their own vision for the group Members are starting to take ownership of the group
Communication and interaction patterns of group dynamics
•As members of a group interact with each other, a reciprocal pattern of interaction emerges •Selective perception: the screening of messages so they are congruent with one's belief system •Language barriers and cultural interpretation can also impact how a message is received •The use of checkouts is still relevant with groups! •The "third ear" comes with experience when social workers develop an awareness of the meanings behind messages and their effect on a particular group member and on the group as a while •This includes the importance of observing non-verbal communication •"I noticed some tension in the group when we started talking about XXX. I am wondering if anyone would like to share their feelings on this?"
Principles for practice when working with groups
•Assess if norms, roles and status help members feel integrated & accomplishing goals •Facilitate norms, roles and status that structure the group •We do not want it to become disorganized, chaotic, unsafe or anxiety producing •Avoid norms, roles and status hierarchies that restrict members' own judgment and free will •Ability to accomplish agreed upon goals, freedom, and independence of acceptable behavior •Make norms, roles and status attractive - the group should be a satisfying experience •Emphasize the importance of the group's work and individual member's contributions •Consider incentives for members to participate •Rewards and sanctions applied fairly- healthy social integration benefits each member/group •Workers should help members examine, compare & respect each others' value systems •Workers should help members understand the values of the agency, community and society •Balance socio-emotional and task needs Mediate value conflicts among members and between the agency and society Model values: openness, self-determination, fairness, acceptance of difference •Observe and talk about discernible and predictable patterns of group development •Workers should help open membership groups develop a simple structure and a clear culture •Develop a safe and positive group environment Expressions of difference and even conflict about norms, roles and status are a normal part of group development Develop sufficient structure in early group meetings to increase feelings of satisfaction and safety early in the group's development Emphasize respect and tolerance and mediate differences about norms, roles, and status to Encourage movement toward the middle stage Stay focused, develop an appropriate culture for work, and overcome obstacles In the ending stage members should: Review and evaluate their work, highlight accomplishments & point out areas that need work Express feelings about endings, & prepare for termination with ceremonies or program activities
Caveats with the use of questions
•Avoid excessive questioning, as it puts the power and influence almost entirely on the counselor •Clients may have negative experiences with questions •May associate them with anger and guilt •Many humanistic practitioners try to use as few questions as possible in their interviews •Avoid questions as statements •"Don't you think you should start planning for that goal?" •Questions can breed distrust, especially in cross-cultural situations •Questions place power with the interviewer •Some cultures consider questions rude if asked before a relationship is built
How can we handle strong displays of emotion by clients?
•Be present •Let the client express themselves (to an extent) •Redirect / Reorient when appropriate •Help the client slow their breathing •Reframe the emotional experience in a positive way •Comment that it helps to tell the story •Ask a question
Purpose of reflecting feelings
•Bring clients' attention to emotions •Helps clients sort through complex feelings and thoughts
With less verbal clients...
•Build trust at the client's pace •Use concrete language and search for specifics: •Using more concrete, closed / semi-closed questions can draw out information bit by bit
Importance of vocal qualities:
•Changes in pitch, volume, and speech rate communicate meaning •Verbal underlining is when someone emphasizes key words via volume and emphasis •Speech hesitations and breaks can signal distress, anxiety, or discomfort •Clearing one's throat may also indicate discomfort •It's critical to speak in a natural way with deaf/hoh folks, not too fast or slow
How do we go about using confrontation in practice?
•Clearly identify the incongruity or conflict in the story or comment, using reflexive listening; •"On the one hand.... On the other hand..." •"How do you put these two together?" •Draw out the specifics of the conflict or mixed messages, using questions and other listening skills •Periodically summarize each dimension of the incongruity •Always end with a "checkout" Many clients are unaware of their mixed messages and discrepancies - point these out gently but firmly
who is Reflection of meaning interpretation / reframing relevant for?
•Clients who have recently experienced a life-changing event •Older clients who face major changes in their lives •Anyone struggling to work through issues of daily life What are some examples of life-changing events? AIDS, cancer, heart attack, loss of sight, divorce, death of a loved one, loss of a job
Groups to meet organizational needs
•Committees: to accomplish a goal that is delegated to the group by a higher authority •A group of employees assigned the task of studying and recommending changes in the agency's personnel policy •Cabinets: to provide expertise and advice about policy issues to CEOs or other high-level administrators •A weekly meeting of social work supervisors and the director of social services in a large municipal hospital •Boards of Directors: governing boards vs. advisory boards •Members of the governing board of a family service agency Governing boards are fiscally and legally responsible for the conduct of the organization (Board of trustees at OU) Advisory boards provide counsel and guidance but have no official power to make policy or fiscal decisions
Factors that can change communication patterns in groups
•Cues and reinforcement that members receive for specific interactional exchanges • Encouragement to keep talking by workers or group members • Discouragement to keep talking by other members or the group leader •Emotional bonds that develop between members •Subgroups •Members are sometimes encouraged to join or assigned to a subgroup •Size and physical arrangement of the group •Power and status relationship in the group
Theories of Counseling and interpretation/reframing
•Decisional theory •person centered •brief counseling •cognitive behavioral therapy •psychodynamic slash interpersonal theory •multicultural counseling in therapy
How to develop a community genogram?
•Develop a visual representation of the community. •Select the community in which you were primarily raised (where you learned most about culture) •Represent yourself in the community with a significant symbol •Place family (nuclear and extended) on the paper, represented by the symbol that is most relevant for you •Place important, or influential groups on the genogram, represented by unique visual symbols (i.e. school, family, neighborhood, work, and spiritual groups) •2. Identify relationships between the individual and each particular aspect of the community. •Draw arrows from self to community - they can be one-way, two-way, smooth, broken, or jagged. These are visual representations of the relationship. •Ask for stories about each element of the genogram. •Emphasize positive stories.
Importance of eye contact:
•Direct eye contact can be interpreted as a sign of interest •Most make more contact when listening and less when talking •Many groups avoid eye contact, especially when talking about difficult topics •We tend to look away when thinking about a complex issue or discussing topics that are distressing •Those who are blind or have limited vision may not make eye contact when they speak •Eye contact is critical when communicating with a deaf person through an interpreter
Strengths-based interviewing
•Draw out client's strengths and supports •Give adequate attention to the client's problems •In other words, be positive, but don't minimize* the client's problem •Microaggressions
Steps to interpretations/ Reframing
•Drawing from personal experience or a professional perspective, the interviewer provides an alternative meaning or interpretation of the client's narrative. >>>>•Linking two ideas or concepts that the client has brought up is part of interpretation>>>>•The value of the interpretation / reframing depends on the client's reaction to it and how s/he changes thoughts, feelings, or behaviors
Steps to reflection of meaning:
•Elicit client meaning •Understanding the client is the first step! •Draw out resilience, purpose, and meaning •This can be accomplished often through story-telling •Using discernment •Reflect client meaning •Say back to the client their exact key meaning and value words (not yours) •Structure it similarly to how you would a paraphrase or reflection of feeling, like "You value....." or "You care about ..." •Becomes more difficult when the client's meanings or values conflict - this is when it is helpful to use confrontation
Empathy in Microsoft skills
•Empathy is brining together our skills •Proper attending •Asking good questions •Active listening •Being attentive, kind, sincere •Reflecting feelings
Group Leader Roles
•Enabler: helps members utilize their own strengths and resources; encourages members to share their thoughts with the group •Broker: identifies community resources that would help the member carry out her goals •Mediator: resolves disputes, conflicts, or opposing views within the group, takes a neutral stand, helps members arrive at an agreement •Advocate: Represents members' interests and needs; helps members obtain needed resources •Educator: presents new information; demonstrates and models new behavior, leads role plays to help members practice new skills
Positive outcomes of self-disclosure:
•Encourages client talk •Creates trust between counselor and client - see grey box, p. 231/232 •Establishes a more equal relationship
Intentional Listening
•Encouraging > •Paraphrasing >•Summarizing
Monitoring and evaluating group progress
•Evaluation forms can be used at the end of every group, or after every second or third session •Self-monitoring
Strategies for Addressing Intense Subgroup
•Examine whether the group as a whole is sufficiently attractive to members •Promote the development of norms that emphasize the importance of members' listening to and respecting each other •Promote the development of norms restricting communication to one member at a time •Change seating arrangements •Ask for certain members to interact more frequently with other members •Use program materials and exercises that separate subgroup members •Assign tasks for members to do outside of the group in subgroups composed of different members
Situations Which Can Lead to a Crisis
•Family Situations - a child abuse investigation, spouse abuse, an unplanned pregnancy, a parent's desertion, a chronically ill family member, and lack of social supports are examples of family situations that can create stress and crises. •Economic Situations - sudden or chronic financial strain is responsible for many family crises, such as loss of employment, eviction, no food, a theft of household cash or belongings, high medical expenses, missed child support payments, repossession of a car, utilities cut off from service, money "lost" to gambling or drug addiction, and poverty. •Community Situations - neighborhood violence, inadequate housing, a lack of community resources, and inadequate educational programs illustrate some ways the community may contribute to family crises. •Significant Life Events - events that most view as happy, such as a marriage, the birth of a child, a job promotion, or retirement, can trigger a crisis in a family; a child enrolling in school, the behaviors of an adolescent, a grown child leaving the home, the onset of menopause, or the death of a loved one can also be very stressful life events. •Natural Elements -crises are created by disasters such as floods, hurricanes, fires, and earth quakes, or even extended periods of high heat and humidity, or gloomy or excessively cold weather.
These benefits are true, only if the social worker shares thoughts, feelings, and experiences with clients...
•Genuinely •In relation to self - counselor must truly and honestly have had the experience or idea •In relation to client - experience must be the same or similar, in synchrony with client feelings and experience •In a timely manner •Be careful not to self-disclose out of nowhere or for no particular reason •Imagine that someone is sitting in the room with and observing, would you still feel comfortable making the disclosure? Would you be able to explain why you disclosed? You should know why you are self-disclosing •With appropriate tense •Past tense is most appropriate •"I felt...." •"I have felt..." •Present tense would suggest you are still going through something, that it is not behind you (especially when talking about experiences) •Being careful not to monopolize client's time •Your share should be brief and to the point •Your disclosure should end with a redirect back to the client •With a clear treatment goal or outcome in mind What reasons might you self-disclose? •Normalize the situation •I overcame it, so it is possible for someone else to overcome it •Building trust - open up the doors of trust •Diminish isolation •Comfort •Ideas for overcoming the issue •Take away self-blame on the part of the client •Motivating to the client if shared at the right time •Can challenge the client's preconceived ideas •Reduce embarrassment
Tips for active listening with children:
•Get on their level •Encourage them to use manipulatives, or play a game •Use simple words, short sentences, and a mix of closed and open-ended questions •Use names, not pronouns •More emphasis on encouraging, paraphrasing, and summarization
Making effective decisions
•Groups may sometimes be less effective than individuals •Help the group avoid group think •Members fail to express thoughts and feelings •Go along with predominant sentiment of the group •Risky shift: groups tend to make riskier decisions than individuals •Norms and group climate must develop in a way that encourages a free and open discussion •Consensus building: not everyone may be in agreement, but they are willing to go along with the group's predominant view and carry it out in good faith •Developing amendments or proposing changes could be one way to come to a decision •Majority rule is another way to make decisions - most effective if confidential vote •Good for deciding routine or minor questions
Purposes of task groups
•Groups to meet client needs •Groups to meet organization needs •Groups to meet community needs
What is confrontation NOT?
•Harsh •"going against" the client •The first skill you use with a client •Does not stand alone as a skill, must be used in concert with other skills like listening, summarization, and paraphrasing
Person-centered Counseling: Carl Rogers
•Has its basis in humanistic therapies •Evolved in the 1950s •Rogers believed that clients would be better helped if they were encouraged to focus on their current subjective understanding rather than some unconscious motive •Therapists / counselors should be warm, genuine, and understanding "It is that individual has within himself or herself vast resources for self-understanding, for altering his or her self-concept, attitudes and self-directed behavior - and that these resources can be tapped only if a definable climate of facilitative psychological attitudes can be provided."
What is the goal of encouraging, paraphrasing, and summarizing?
•Help clients speak in more detail about their situation •Communicate you have heard and understand the client •Check on the accuracy of your understanding •Helps us remain in active listening mode
Involving and empowering group members
•Help members become fully involved in the work of the group - let them know through actions and words that they have a stake in the group •Express and/or show that you recognize the strengths of members •Acknowledge and/or recognize the struggles and challenges that have faced group members •Praise / recognize members who have reached out to each other and provided support Caveat: Workers who are insecure about their position and/or experience can make the mistake of becoming too directive or even manipulative. "This is your group, what do you want to see happen in it?"
Sharing information
•Helping members share information, thoughts, and feelings with one another •How information is communicated and used in a group has an important effect on the quality and the quantity of a group's productivity •Ensure all members have a clear understanding of the topic •Develop and share clear procedural steps •Use summarizing and focusing skills •Ensure equitable participation in the group (i.e. rules for participation)
What impact foes focusing have?
•Helps clients consider their situation from multiple frames of reference •Increases cognitive and emotional capacity •Helps clients stay on track •Assists clients in seeing themselves in relation to their community (Genograms) •Helps the practitioner include advocacy, community awareness, and social change as part of interviewing practice
Elements of a crisis
•Hits suddenly, without warning •Difficulty coping •A stressful situation: Threatens safety and security Each crisis situation is unique and will require a flexible approach to the client and situation.
POWER AND STATUS in a group
•INITIALLY, MEMBERS ARE ASSIGNED POWER AND STATUS BASED ON DEMOGRAPHIC CHARACTERISTICS •THESE START TO SHIFT AS CERTAIN MEMBERS GROW IN THEIR PERCEIVED VALUES AND OTHERS DECREASE IN VALUE, BASED ON COMMUNICATION PATTERNS
What is thought-stopping?
•Ideal strategy for dealing with: •perfectionism •culture-based guilt or shame •shyness •mild depression •procrastination •Almost everyone engages in internalized negative self-talk, which can erode self-esteem and increase self-doubt over time •"Why do I do that?" •"I'm such an idiot!" •"nobody will listen to me." Imagine a situation in which you would make the negative self statement. Relax and close your eyes. Take time and let the situation evolve. When the thought comes, observe what happens and how you feel after the negative self-talk. Then tell yourself silently or loudly, "STOP." Start using it in your daily live. Please a rubber band around your wrist and snap it every time you have a negative thought, and say to yourself, "STOP". This is a physical and cognitive way to interrupt the negative thought patterns. Add positive imaging. Immediately after you stop the negative thought, substitute a more positive statement about yourself immediately. "I did the best I could." "I am lovable and capable." "I can do lots of things right."
Things to remember when folks are in a crisis/suicidal:
•If they are disclosing their suicidal thoughts to you, it is because some part of them WANTS THE HELP. •Do not feel badly for asking the questions. It is much better to ask and be wrong, than to NOT ask and wish you had. •"Based on what you've shared with me, I'm really worried about you. I want to be able to help you if I can. Would you be willing to sign a no-suicide contract with me while we get you help?" •If yes -- no mandated report •If no --mandated report •Explain mandated reporting requirements (again) •Offer immediate connection to hospital / mental health authority •Emergency room - Psychiatric ward •Mobile crisis team - Hospital or Treatment facility or Mental Health facility
What is "stuckness"?
•Immobility •Blocks •Repetition compulsion •Inability to achieve goals •Lack of understanding •Limited behavioral repertoire •Limited life script •Lack of motivation •Impasse When clients feel like they have no alternatives for solving a problem. Also defined as inability to resolve conflict, reconcile discrepancies, and deal with incongruity in their lives
Focusing is:
•Important skill that enables clients to gain a better understanding and perspective of issue affecting their lives •This helps often when clients face multiple issues
What are some aspects of Active Listening?
•Intentional participation •Remaining non-judgemental and accepting •This may be an active process for some people, with some clients •Decision making •Responding •Checkouts- perception check, see how accurate your understanding was Have I heard you correctly? Is that right?
Facilitating fact-finding / information gathering
•Interactive group discussions inhibit rather than increase the disclosure of information •Group members may be intimidate by others in group with more power •People tend to aim for conformity •Group members may censor controversial opinions •Interacting groups tend to reach premature solutions with considering all available evidence •Be clear about the boundaries of discussion and what you are expecting
Why do clients become stuck?
•Internal conflict / incongruity •difficulty making important decisions •mixed feelings and thoughts about themselves •External conflict •conflicts with others •coping with failure •living effectively with success •having difficulty achieving an important goal financially or socially •struggling to navigate their cultural or ethnic identities Key words: Conflict Incongruity Discrepancy Mixed message Example: the inability to make a decision can also result in conflict with a significant other who wants to know what is going on
Preparation: during the meeting
•Introductions •Distributing handouts •Opening statement about the purpose of the meeting •Seek approval of written meeting minutes from previous meeting •Task is to guide group through agenda items •Group leader should be acting more of a servant of the group rather than a master who imposes her will on the entire group •End of the meeting: summarize, praise, review next meeting dates and topics
Education & Information-giving is inappropriate when:
•It could potentially overwhelm the client with too much information •Information is inaccurate or untrue •It's an attempt to force information on the client •It's an attempt to give advice or influence the client's plan of action
How to ask someone if they are suicidal or in a crisis
•It sounds like you are feeling pretty hopeless about the present or future. Is that accurate? •Have you had any thoughts about taking your own life / killing yourself? •Do you have an idea of how you would kill yourself? •Do you have access to [that method]? •Have you started putting that plan into action? •Have you ever tried to kill yourself before?
What should you NOT do in a crisis situation
•Label them as a "survivor" or "victim" •Disordering them •Recognize that any person who has gone through a traumatic even would experience extreme stress and challenges •Help clients see that their problem is not "inside" but a very normal reaction to a horrific event •Some call it a Severe Stress Reaction (SSR) •Say •"Calm down, everything will be OK." •"You're lucky that you survived." •Think or say that the client is overreacting They are just a person that went through a disaster or traumatic event
How do we supportively challenge the clients?
•Listening, observing, noting client conflict, mixed messages, and discrepancies in verbal and nonverbal behavior •Point out and clarify internal and external discrepancies by feeding them back to the client, usually through the listening skills •Evaluate how the client responds and whether the confrontation leads to client movement or change What do we do if no change occurs? Try another skill. What does confrontation lead to? New ways of thinking and increased intentionality!
Preparation: between meetings
•Making sure decisions and task are being carried out (encourages and facilitates) •Preparing for the next meeting •Creating agenda
Reluctant and resistant group members
•Members always have the right to refuse to participate, but the group leader must ensure that they know the consequences of refusal •High emotions like anger and shame are usually behind members' reluctance to participate •Very important for group leader to establish a safe, non-judgmental, and accepting environment •Leader should adopt an attitude that maximizes members' sense of control and expertise •Acknowledge their feelings about being in the group •Be authentic and direct •Solicit the members' views about their own problems, instead of making conclusions on your own •Encourage members to make "I" statements •Avoid moralizing or blaming •Use healthy confrontation when necessary
Active listening with LEP / ESL clients
•Memories containing powerful emotions are often stored in the part of the brain that also remembers language •Their memory / problem may not be readily accessible in English •If clients are having issues, you can have them first explain the issue in their first language (even if you don't understand), then translate the story into English •If you have a lot of clients that speak a particular language, consider taking classes or at least learning key words in that language
What does confrontation lead to?
•New ways of thinking •Creativity in solving problems •Increased intentionality •Breakthroughs •The road to change and transcendence is filled with missteps, regression, and even denial!
Social integration and influence
•Norms, roles, and status hierarchies promote social integration by creating a sense of order and familiarity (people like a degree of predictability) •Too many norms and rules can stagnate the contributions of group members
Limitations of reflecting emotions
•Not all clients are comfortable discussing emotions. •Reflection of feeling can be overdone. •Brief acknowledgement may be more helpful than a full reflection of feeling. •Observe cultural implications of the appropriate way to explore emotions.
Attending and authentic body language:
•Noticing our own behavior and/or movement is just as important and noticing the client's movements •People tend to move forward when interested and move away when bored or frightened •Someone who suddenly crosses their arms, looks away, or starts fidgeting may be subconsciously signaling discomfort, disagreement, etc. Personal space: Women tend to feel more comfortable with closer distances than men Introverts need more distance than extroverts Children tend to adopt closer distances Difficult topics cause many people to put more distance between them and you Harmonious friends or couples tend to arrange themselves in closer proximity
elaborate on reflection of meaning
•Often times clients make direct statements of meaning •Other times we need to elicit the meaning from the client: What does XXX mean to you? •Used in conjunction with listening, focusing, and confrontation skills •Helps the client explore issues and questions that are of deep importance to them •These questions bring out strong emotions •We can witness clients struggle with questions that are almost indefinable and sometimes unanswerable •Helps clients explore deeper and from a new perspective •Reflection of Meaning •(client-led)>>>•Interpretation / Reframing •(Interviewer-led)>>>•Clients are enabled to discern life goals and vision for the future. Clients find new ways of looking at their issues / problems. Client is more in control with reflection of meaning. Interpretative statements are more directive than reflection. If the client does not respond to reflective strategies, you can move to more active interpretation and reframing.
Structuring the group's work
•One advantage of structured groups is that they provide an opportunity for members to learn new skills •Structure is essential in psychoeducational groups (treatment groups) •Group session may include a short lecture and then a group discussion or activity, like role-plays •Group structure includes things like: •Agendas - written or verbal •Informing members about beginning and ending the group on time •Leaving structured time at the end of the meeting to summarize and conclude •Maintaining orderly communication / sharing patterns (i.e. round robin)
HELPING CLIENTS MOVE AWAY FROM REPETITIVE TOPICS
•People who have experienced trauma may need to repeat or retell their story many times; these techniques would not be advised for working with trauma •Break in (if necessary) and paraphrase / summarize what you have heard them say •This communicates you have heard them •Ask a question to guide the client back to an earlier topic of importance, or to pick up on an important thread
Political ramifications
•Politics are an important part of the governance of task groups •Where you hold the meeting is of particular importance •Neutral location or one that is "owned" by a member? •Who is invited •Consumers? •Decision-makers or task-masters? •Agenda can be used to keep the topics in neutral or safe zones
Giving feedback (another form of disclosure):
•Positive feedback •Positive, concrete feedback helps clients restore their problems and concerns. Whenever possible, find things right about your client. Help clients discover their wellness, strengths, positive assets, and useful resources •Corrective feedback •Delicate balance between negative feedback and positive suggestions for the future. Used when clients need to seriously examine themselves and need to focus on things they are doing wrong but can fix in the future. Needs to focus on things the client can actually change-When you must give negative corrective feedback, keep your vocal tone and body language nonjudgemental and stick to the facts, even though the issue may be painful.-Praise and supportive statements convey your positive thoughts about the client, even when you have to give them troubling feedback •Negative feedback Necessary when the client has not been willing to hear corrective feedback-E.g.: in cases of abuse, planned behavior that hurts self or others, and criminal behavior, negative feedback- including the negative consequences the client's actions can bring- is necessary and can be beneficial. It is our responsibility to act in these situations, but listening to the client's point of view, even if the client is a perpetrator, remains important. Present clients with clear, nonjudgmental information on how the counselor believes they are thinking, feeling, or behaving and how significant others may view them or their performance -Anticipates result: Clients may improve or change their thoughts, feelings, and behaviors based on the therapists feedback Feedback accurate data on how you or others view the client. Remember the following: 1.The client should be in charge 2.Focus on strengths 3.Be concrete and specific 4.Be nonjudgmental 5.As appropriate, provide here-and-now feedback 6.Keep feedback lean and precise 7.Check out how your feedback was received
Objectives for leading task groups
•Preparing for group meetings •Sharing information, thoughts, and feelings about concerns and issues facing the group •Involving members and helping them feel committed to the group and the agency in which they work •Facilitating fact finding about issues and concerns facing the group •Dealing with conflict •Making effective decisions •Understanding the political ramifications of the group •Monitoring and evaluating the work of the group •Problem solving
Middle stage skills and tasks for the group leader:
•Preparing for group meetings •Structuring the group's work •Involving and empowering group members •Helping members achieve goals •Using empirically based treatment methods •Working with reluctant and resistant group members •Monitoring and evaluating the group's progress
in Education & Information-giving, it helps to:
•Prioritize data •Provide information in small doses •Consider timing - is the client really ready to hear what you have to say? •Write it down for the client, or provide pamphlets/brochures •Discuss their reactions to the information
Benefits of questions
•Questions can be essential •Clients do not always provide us with all the information we need to help them! •"What else..." or "what else?" enables us to find out more, even things we weren't looking for •"What have we missed today?" or "What else can I help you with?" •Phrase it with the assumption that there IS something else •These kinds of questions help us evaluate our practice •They help clients identify strengths •Search for strengths and positives in the client's words, then share these observations with clients •When clients are off-balance (i.e. focused on deficits and what they can't do), the interviewer can help them recalibrate by asking about their strengths •Questions help begin the interview •Questions allow you to use the client's language and specifics from their world so they know you were listening
Culturally competent active listening
•Recognize that you may be culturally biased towards getting to the root of the problem very quickly, while the client may want more time trust- and rapport-building •Seek out opportunities to engage in community events that involve cultures different than your own •Self-disclosure and explaining your methods may be necessary to gain trust •Discuss differences between you and your client (the elephant in the room)
Steps to reflecting on feelings
•Recognize the key emotional words expressed by the client •Observe the unspoken feelings or nonverbal cues used by client •Reflect feelings: develop emotional literacy
THE IMPORTANCE OF SILENCE
•Recognize your discomfort and relish it •Count, if you have to •Sometimes the best support is simply being with the person and not saying anything •Look at your client - do they seem ok with the silence? Uncomfortable? •Be aware of your patterns - do you tend to fill silences with chatter? Are you an extrovert? Are you giving people enough time to think?
What are some additional ways to reflect feelings?
•Reflect the explicit emotion and the implicit emotion •"I hear your anger, but also now, I sense you are also hurt by his actions. Could that be part of it?" •Comment on body language •"While you were telling me about the fight with your husband, I noticed you may have teared up a bit. So, it seems you might be both angry and hurt. Am I right?" •Less direct approach •"That must be incredibly hurtful." •Just ask •"How do you feel about that?" •"What feelings come to mind when you talk about this?" In general, it is recommended to start by reflecting explicit feelings using the client's actual words. After developing trust/rapport, you can move on to reflect the more implicit, unspoken feelings.
Paraphrasing
•Repeating key words and phrases, but also capturing the essence of what the client has said •Clarifies the client's story and helps client explore issues in more depth •Some clients will want to tell their story over and over until they feel that someone has truly listened •Three parts of paraphrasing:•Sentence stem like "what I hear you saying" or "sounds like", •Use of key words (used by client) to restate their issue in a briefer and clearer form, •Checkout ("Does that sound right?" "Is that close?")
Uses empirically based treatment methods in therapy groups
•Research-based •Can be a challenge when the group members are experiencing different issues (i.e. different mental health diagnoses within one group)
What are our immediate goals in crisis counseling?
•Safety (emotional and physical) •Normalization •"You're reaction and what you did are common and make sense." •Practical, actionable results •Don't overlook basic needs like showering, eating, and making phone calls •"What would help you right now?" •Follow up •Being present in the here-and-now with the client •Listen •Paraphrase, reflect emotions, summarize
Risk factors for suicide
•Severe anxiety •Panic attacks •Depression •Inability to experience pleasure •Insomnia •History of abuse •Addiction •Prior suicide attempts •Self-harm behavior
What are group norms?
•Shared beliefs and expectations about appropriate ways to act in a group •Refer to individual behaviors and to overall group patterns •Norms develop as the group develops •Structure in early meetings is associated with increased cohesion, reduced conflict, and higher member satisfaction •As norms develop and strengthen, the leader's role becomes less significant
Discernment of reflection of meaning and reframing:
•Sifting through our interior and exterior experiences to determine their origin •To separate, to determine, to sort out •A process whereby clients can focus on envisioning their future (or past) as a journey into meaning •Systemic approach on pages 210 - 211 in your text •Meditation / Vision Quests are used by some cultures to explore meaning and direction •Life story work •Ethical Wills / Legacy letters with dying clients https://www.youtube.com/watch?v=MAp0BTg2Trw
summarizing
•Similar to paraphrasing, but captures a longer period of time, like an entire interview •Checkout at the end is critical
Groups to meet community needs
•Social Action: empower members to engage in collective action and planned change efforts to alter some aspect of the social or physical environment •A group of social workers lobbying for increased funding for social services •Coalitions/Alliances: groups of organizations, social action groups, or individuals that come together to exert influence by sharing resources and expertise •A group of family planning and community health-care clinics who have formed a pro-choice coalition to influence state and federal legislators on abortion •Delegate Councils: created for the purpose of facilitating interagency communication and cooperation, studying communitywide social issues or social problems, engaging in collective social action, and governing large organizations •A county task force that coordinates responses to domestic violence, composed of members from various agencies and organizations Coalitions agree to pursue common goals that can't be met by any of the orgs acting alone.
Verbal Tracking:
•Staying with your client's story, following along •Instead of figuring out what to say next as soon as the client starts talking, focus instead on what they are saying •Clients tend to want to please their counselor / therapist / interviewer, and may match your language or try to give you the information you are looking for
Dealing with conflict in task groups
•Task conflict: based on members' differing opinions about ideas, information, and facts presenting during the task group's work •Relationship conflict: based on emotional and interpersonal relationships among members within and outside of the group •Is conflict inherently bad? •Which type of conflict is more harmful to the group? •Win-win orientation vs. zero-sum orientation •Rigidity vs. flexibility •It is counterproductive to avoid, ignore, or try to minimize conflict •Most productive to help members see disagreements as opportunities to gather information and to share views and opinions
Enhancing involvement and commitment
•Task groups can provide support to their members and a sense of belonging that is crucial •Assign members specific roles within the group •Invite input into agenda and decision-making •Group decision-making can also present issues as well •Actively encourage members to participate Group decision-making: takes more time, potential for groups to produce decisions that are unacceptable, could cause conflict
Groups to meet client needs
•Teams: to engage in collaborative work on behalf of a client system •Professional and paraprofessional helpers trained in crisis intervention sponsored by county mental health agency •Treatment Conferences: to develop, coordinate, and monitor treatment plans •An interdisciplinary group of professionals planning the discharge of a patient in a mental health facility •Staff Development: to educate members for better practice with clients •An in-service development seminar on codependency for the staff of an alcoholism treatment agency
Basic-Listening Sequence (BLS)
•The set of Microskills that enable you to draw out the major facts and feelings central to client concerns •Includes questioning, encouraging, paraphrasing, reflecting feelings, and summarizing •In totality, these skills are what encompass empathic communication •Rogers believed that effective interviewing and counseling can be carried out using listening only, he preferred to have clients carry as much of the responsibility for the interview as possible
Preparing for group meetings
•The worker spends a considerable amount of time between meetings preparing the agenda for the next meeting •The social worker tries to select material that would lead to a stimulating and interesting discussion •The use of program materials (activities, games, and exercises) is common here •Choosing appropriate materials / activities requires a careful assessment of the needs of group members •See chart on page 270 for more information on this •Preparation could also include visualizing how the group will go, and even rehearsing certain parts (especially if the worker is new)
vocabulary of emotions
•There are four basic emotions that are considered primary emotions across cultures and languages •Sad •Mad •Glad •Scared •Social emotions are learned from family / culture and are often emotions felt in relation to others •Sad: sympathy, embarrassment, guilt •Mad: jealous, indignant, contempt •Glad: pride, gratitude, admiration •Scared: puzzled, embarrassed, guilt, jealousy
Why genograms are helpful:
•They help us gather more information about the client's history / current situation •Help us identify strengths and resources •Give us a framework for understanding and action •For social workers, having completed our own genograms help us to understand our own social context and possible biases •Can be posted or brought out for subsequent sessions Give us a framework for understanding and action = contextual interviewing
How to introduce positivity:
•Tie in strengths •Assign "positive" homework: yoga, meditation, self-care •Wellness assessment •Make a list of what is "right" in their life, relationship, situation •Service to others: volunteer, help someone else.
When we can use focusing?
•To help a client focus on their thoughts and feelings regarding a situation, not just a retelling of the issue •Could you take a deep breath and tell me what you are feeling and thinking right now? •To help a client identify what issue is of the most importance / urgency •What issue would you like to focus on first? •It sounds like your mother is the most important issue. Have I heard that correctly? •To help a client broaden their idea of self •Your grandmother has been very helpful to you in the past. What would she say to you? •To help them understand the impact of community •Community Genograms A community genogram is a visual map of the client in relation to their environment, showing both stressors and assets with the client's life. Useful to understand client's history and identify strengths and resources.
What are task groups:
•U.S. citizens are involved in task groups and committees more than citizens of any other country •Meetings, meetings, meetings •Social workers are often called up on to chair meetings •We spend so much time focusing on treatment groups, we often ignore the dynamics of task groups •We are often frustrated by meetings •Well-run meetings can be positive and empowering
Encouraging while listening
•Verbal and nonverbal expressions used to prompt clients to continue talking •"ummm" and "uh-huh" •Head nods, positive facial expressions, open-handed gestures, silence •Restatement: repeating two or more words exactly as used by the client •Well-timed encouragers maintain the flow of the conversation and continually communicate that you are listening •And are not that noticeable! •Smiling is a key encourager
Why is it so important to be competent in these Microskills?
•We BELIEVE people can change •We BELIEVE people can overcome trauma •We BELIEVE people can overcome adversities •We BELIEVE the brain has the power to rewrite adverse experiences •We BELIEVE people can develop resiliency
Positive aspects of working with clients who fact extremely difficult situations or death:
•We can help clients appreciate each moment. Working with people who have no choice but to live in the present can change our own perspective. •It is possible to learn something from each client or patient if we are willing to listen and be with them through the experience. •Working with these clients will enable us to witness unconditional love, help our hearts to become bigger, and help us become more loving and caring people. •Helping these clients connect to their sense of purpose or meaning helps them experience better mental health and enhanced physical health.
How do you recognize your own feelings?
•What is your own personal history dealing with emotions? •Are you comfortable discussing feelings? •How do you react when others express their feelings? •Are there any particular emotions that are difficult for you to witness in others?
Requested self-disclosure:
•What might this sound like coming from a client? •What would you do if you were in my place? •Has this ever happened to you? •What do you think? •Self-disclosure should not be the first tool used in this situation •Help the client make her or his own decision first •The right solution for you may not be the right solution for the client •Involving yourself too early may foster dependency
Practice reflection of meaning and reframing: A client has come to you for therapy and, in past interviews, has been reviewing his life as it relates to present problems in his second marriage. Last week you reviewed sexual problems in his marriage, and you noted that he tended to focus on himself with little attention to his wife. Also this week, he speaks of a dream in which he is trying to break into a room, which contains a golden icon, but is frustrated in the process. CLIENT: My wife and I had another fight over sex last night. We went to a movie with a lot of steamy sex scenes and I was really turned on. I tried to make love to her and she rejected me again. •How might you paraphrase what the client just said? •How might you reflect this client's feelings? •How might you interpret the client's statement?
•You are upset and angry (reflection of feeling ) •You had a fight after the "turn on" movie and were rejected again? (paraphrase and restatement) •As I've listened to you over the past two sessions, I hear your deep caring for your wife, and when she rejects you, it means you feel like you are losing her (reflection of meaning) •Sounds like you didn't take it as slowly and easily as we talked about last week and she felt forced once again? Am I close? (interpretation with check out) •Your anger with her seems parallel to the anger you used to feel toward your first wife. I wonder what sense do you make of that? (interpretation with check out) •The feelings of rejection really bothers you. Those sad and angry feelings sounds like the dream you had last week. does that make sense? (linking interpretation with check out)
Here are a few examples of empathic responding:
•You feel anxious because you are giving a presentation at work. •You feel depressed because your relationship ended. •You feel angry because you did not receive the raise you expected. •Describe how you and your boss interacted. NOT an empathic responses: •I hear you are giving a presentation at work. •You feel that your relationship could have continued. •You feel that your boss was not fair in her decision. A TRUE empathic response Tell me more about what is making you anxious. You said the relationship was traumatic. What made it traumatic for you? Describe how you and your boss interacted.
