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Homework answers / question archive / Skills in the Helping Process In Chapter 7 (page 177, Box

Skills in the Helping Process In Chapter 7 (page 177, Box


Skills in the Helping Process

In Chapter 7 (page 177, Box. 7.3), “A Client Speaks” describes a veteran from the wars in the Middle East diagnosed with PTSD.

Using the key terms and concepts from Chapter 7, as well as examples to support your answers, please respond to the following:

  • What helping skill or skills would you use to strengthen the client-helper relationship in the stages of exploring the problems (assessment process) and interventions strategies?
  • In addition to the above skills, how could you specifically apply Motivational Interviewing techniques as an intervention strategy to respond to the client’s questions about group therapy?
  • Last, identify one Rapid Assessment Instrument (RAI) and one Evidenced-Based Intervention (EBI) that would align with the client’s needs and presenting problems.

 CHAPTER 7 Intervention Strategies LO 7-9 Summarize the goals of motivational interviewing. LO 7-10 Identify the phases of a crisis and the skills necessary for crisis intervention, LO 7-11 Apply the four stages of resolution-focused brief therapy. Helping can take many forms, such as gathering information from the client, other sources, looking for assistance, deciding how to solve a problem, and talking (2) How can the needs of the client be met? In human services, assistance to the client occurs through the helping process. As clients engage in this process, human service professionals must remember that clients are responsible for themselves F process. ei a fe ( and make their own decisions. Giving advice or telling someone what to do does not encourage responsibility or promote self-help, which are goals of the helping The effectiveness of the helping process depends greatly on the skills of the helper and the helper's ability to build the helping relationship, which is the focus of this chapter . The helper's ability to communicate an understanding of the client's feelings, clarify what the problem is, and provide appropriate assistance to resolve the problem contributes to the effectiveness of the process. Of course, this help occurs within a multicultural context, emphasizing the uniqueness of the individual and recognizing individual strengths. The nature of the helping relationship, the skills of helping, group work, and the challenges of difficult clients will be explored in this chapter. A look at special human service methodologies such as motivational interviewing, crisis intervention, and resolution-focused brief therapy will provide descriptions of the helping process. To illustrate some of the important concepts in this chapter, we renew our acquaintance with Carmen Rodriguez, the helping professional you met in Chapter 2. Then, you will read about Joan, a wife abandoned by her husband, resolved. who needs support and assistance during a crisis and help after the crisis has been a h t i THE NATURE OF THE HELPING PROCESS The helping process occurs in both formal and informal settings. In this chapter, we will explore the helping that occurs in formal settings, for example, offices, institu tions, agencies, street corners , and any other setting where human service profes. sionals deliver services to clients . The term client can refer to an individual , a small group such as a family or a street gang, or a larger group such as a neighborhood a geographic area. We will discuss the client in detail in Chapter 8. OP THE HELPING RELATIONSHIP LO7 The cornerstone of helping, the medium through which help is offered, is the help. ing relationship. The helping process takes place within the context of a relation ship that differs from others in that one person sets aside personal needs to focus on the needs of the other (or others), refraining from expressing opinions or giving advice. THE HELPING PROCESS 159 Cultural Background Attitudes Values Feelings Experiences Knowledge Training Skills Human Service Professional The Helping Process Human Service Client Cultural Background Attitudes Values Feelings Experiences Strengths Needs Problems Expectations FIGURE 7.1 THE HELPING PROCESS Each participant brings to the relationship different perspectives and experi- ences (see Figure 7.1). Both the client and the helper bring cultural backgrounds, attitudes, values, feelings, and experiences, which may be similar or may be dif- ferent. In addition, the client brings strengths, needs, problems, and expectations about what will happen as well as personal and environmental strengths. The helper comes with knowledge, training, and skills to assist with the problems of the client. Matching clients with helpers is often random, but there is considerable evidence that compatibility between the two is important for an effective helping relationship. Because the helper has the knowledge and expertise that the client is seeking, much of the initial responsibility for establishing the relationship rests with the helper. The importance of the characteristics and values of the helper was discussed in Chapter 2. A growing body of research shows their importance in establishing and maintaining the helping relationship. The following questions (adapted from Rogers, 1958) may help you increase your self-awareness in relation to your own helping skills: Can I be perceived as trustworthy, dependable, and consistent? Can I express myself well enough that the client understands what I am saying? Can I experience attitudes of warmth, caring, liking, interest, and respect for the client? separate my needs from those of the client? Am I secure enough myself to allow the client to be separate and independent from me? Am I able to see the world as the client does? Can I identify the cultural uniqueness of the client? Can I accept the client as he or she is? Can I Can I help the client see his or her strengths? 1 you begin to grasp the concept of the helping relationship and its impor- As tance to human service delivery, you may be asking yourself how it differs from other relationships. Several characteristics make it unique. First, helping relation- are formed for a recognized and agreed-upon purpose; they are goal oriented. hveral sessions (depending, of course , on the nature of the problem), the relation- ships Second, carries authority. In this sense, the word authority has a very different meaning from ship ends when the purpose has been accomplished. Third, the helping relationship the TIM 160 CHAPTER 7 notes while in the knowledge and skills that enable him or her to work with the client toward resolving the problem. The client maintains authority by working with the helper to establish the direction and nature of the help. Finally, this relationship is for the client. The focus is always on the client's problems and concerns within the context One of the most interesting aspects of the helping relationship is its bi-directionality, the client is p difficult for ti sions. Others technology as of client strengths and the client's cultural context. The same This means that both individuals are involved in the helping relationship and the helping process. One way it is reflected is through the concept of authority pleted before may have litti we dis- cussed; both the helper and the client assume positions of authority in the helping process. In addition, to meet the intention of client empowerment, growth to self-sufficiency, and advocacy, both the professional and the client must be actively involved in this relationship. We will discuss the ways that this collaboration may happen as we discuss the stages of the helping process (Goh, 2015). client comple assist the clier with the clien tance of culti another langu Finally, b client that is tion needed? the client? H client? STAGES OF THE HELPING PROCESS LO 7-2 Usually the agency or organization with which a helper works shapes the focus, the services, and the duration of the helping process. For example, vocational reha- bilitation agencies are concerned with the work histories of clients, any disabili- ties that may prevent them from being employed, and their vocational capabilities and aspirations. Finding low-income housing, arranging adoptions, and processing applications for food stamps are not part of their services. Regardless of the focus of an agency and its services, you will find that the stages of the helping process are similar. They will include components of problem solving such as identifying the problem, setting goals to resolve the problem, and determining and applying strate- gies designed to help the client reach those goals. It also includes building a relation- ship, establishing trust, developing empathy, identifying strengths, building hope, and maintaining a respect for the cultures in which help occurs. The stages that we describe include preparation, the arrival of the client, exploring the problem, inter- vention strategies, and ending client services. The help first encount experiencing an initial visi cal setting, th services recei The first t office was folding ch of people babies, so partition. in front o voice I tho before she Before the client arrives, the helper will want to attend to several PREPARATION matters. Each of these aspects of preparation is grounded in respect for the client's culture. One is the physical setting. Are there any barriers that will prevent or make it difficult to establish a relationship with the client? For example, many clients will perceive a desk as a symbol of authority, which may seem a barrier to them when the helper sits behind it. It may also be unwise to seat the client facing a window. Activities outside may distract clients and prevent them from focusing on what is happening in the office. Sounds from electronic devices may provide addi- tional distractions. Does the physical setting ensure confidentiality? Promising client that all matters discussed will remain between the two of you means nothing if the setting is such that any discussion may be overheard by others. Culture may help dictate how the physical office is arranged. For many cultures, positions of authority are important, while in others, sitting behind the desk may be a symbol of oppression and marginalization. In some cultures, a client will arrive with other family members; these individuals will need a place to sit. Most agencies require extensive recordkeeping on clients. How will As I sat th operated. screen. I speak litt which I cc to let the site, he clo computer the of the exc When nur The local handle you note taking, filling out forms, and recording information? These decisions are best made before the client arrives. They can be handled in several ways; each helper THE CLIENT acceptance is introduction and sometim ing will help THE HELPING PROCESS 161 ard per the the client is present. Others say that taking notes while the client is talking is too notes while interviewing the client because it enables them to get all the facts while sions. Others believe computers greatly assist the note taking, while the rest view difficult for them. They find that they miss important gestures and facial expres- ext technology ity. che IS- ng may as a hindrance to relationship building. The same is true of filling out forms. Some agencies require forms to be com- pleted before the client sees a human service professional. In such cases, the helper have little choice. If there is no such policy, the helper may choose to have the to client complete necessary forms before their meeting, or the helper may wish to Sco ely ay 2 is, assist the client in completing the forms, using this opportunity to establish rapport with the client and begin developing a helping relationship. Returning to the impor- tance of culture, the helper needs to know if the forms need to be translated into another language and if an interpreter is needed for the first meeting. Finally, before the client arrives, the helper reviews the information about the client that is already accessible. What records are available? Is additional informa- tion needed? Based on the information available, what is the best way to approach the client? Has the helper made arrangements to have uninterrupted time with the client? The helper needs to remember that the client has also been preparing for the first encounter. This preparation may include imagining the encounter as well as experiencing anxiety, shame, or curiosity. What follows is one client's description of an initial visit to a Social Security office. As you read it, pay attention to the physi- cal setting, the professional staff, and the climate. What messages do those seeking services receive? a- li- es ng IS re ? ?? re 2- 7- es re al The first thing I noticed when I entered the double glass doors of the Social Security office was the back of everyone's head. There were rows of people sitting in metal folding chairs facing a blank white wall that had a door in the middle of it. All kinds of people were there—young, old, White, Black, Hispanic, a couple of mothers with babies, some with disabilities. On the left side of the room was a counter with a glass partition. Three women were behind the counter. I watched the person who entered in front of me. He approached the counter and one woman told him, in a rather loud voice I thought, to take a number and sit down to wait his turn. I took number 38 before she could yell at me. As I sat there facing the blank white wall, I had a chance to observe how the agency operated. As each professional was ready for a client, a number would flash onto the screen. I was so nervous that I would miss my number. I watched a person who could speak little English approach the counter, and there was an exchange of information, which I could plainly hear. The individual could not read the sign that asked for him to let the agency know if he needed an interpreter. When asked if he had read the web site, he clearly didn't understand the question. The staff member then pointed to her computer; and he indicated that he didn't have one, or at least that is my interpretation 's e ES n a n g ? of of the exchange. When number 38 was called, I found out I needed to write a letter to the regional office. The local office could not help me with my problem. 1 When the client enters the office, a climate of respect and r THE CLIENT ARRIVES a e acceptance is established if the client is greeted with a smile, a handshake, and an introduction. Remember that clients come with problems, often feeling vulnerable, and sometimes in pain or discomfort. A helper who takes charge of the initial meet- ing will help the client feel at ease by giving the client time to adjust to the new t r g IM 162 CHAPTER 7 become BOX situation. The use of "icebreakers” or “door openers" allows the client to accustomed to the setting and the helper: "Did you have any trouble finding the office?” or “Parking is sometimes a problem here. I hope it wasn't for you." Since the helping relationship is time bound and goal oriented, the helper will a some point need to inquire about the client's problem. Many clients will be eager to share their problems. Others will be reticent about discussing problems that are per- sonal and painful; they may test the helper by sharing less important problems first, The helper can initiate problem identification in a number of ways: "Let's talk about why you're here," "Tell me what's going on," or "I'm wondering what's on your mind." In addition, the helper works with the client to identify personal and environmental "What do you consider your best characteristic?" These are relatively nonthreatening of problem successfully," or Carl Rog therapy. for his w counseli history a minister. Theolog College, and a dd trouble approac trusting standing lenges ar ways strengths: "Tell me about a time when solved this you type of focusing on the client and the problem. Another way to do this is to have focused dialogue. After greeting the client, the helper and client can fill out the intake form together. This is a humanizing way to complete the form, and it does not require asking so many questions. Some forms include questions that build on strengths, such as “What do you enjoy?” “What do you do well?” “Who do you go to for help?" or “What have you learned from your family and friends?” At this time, the helper also begins to introduce aspects of culture. Many times as a way to begin this discussion includes statements such as “Another way that we can begin to know each other better is talk about the backgrounds and cultures we come from. I want to make sure that I understand you, where you are from, and what race and ethnicity mean to you.” Many clients will be happy to talk about cul- ture and hear about yours. For others, the conversation may require an introduction to the topic and then pursued later during the relationship. During this initial stage, the helper can provide the client with information about the agency. For example, the client may want to know exactly what services the agency can provide. Other questions might concern the cost of the services, the criteria for eligibility to receive services, and the responsibilities of clients. In turn, the helper will probably have additional questions for the client: Does the client have any insurance? How did the client hear about the agency? Did someone refer the client here? What expectations does the client have for the agency and the helper? At this time, the helper establishes a tone of cooperation and collabora- tion to establish a foundation for rapport and trust between client and helper. This occurs when the client believes that the helper understands his or her world. Even though rapport develops over time, helpers in this initial stage of the helping process INTERV and de time, t buildin status and so ant to find th helper has the arises or bias client. De service been in may in client a to the or her negoti Chapte provide a positive and realistic setting in which the helping occurs. icebreakers and an openness on the part of the helper may help welcome the client, client may system, the client may still be on guard. The client perspective is different from the helper perspective. Certainly, But the client may not be easy with the introduction and may experience anxiety early in this process. Because this may be a novel experience for the client or the have had previous positive or negative encounters with the social service on cli- EXPLORING THE PROBLEM Chapter 8 will introduce different perspectives ent problems. As the helper and the client begin to explore the problem, the helper person and the multidimensionality of problems will also guide this phase of the should keep those perspectives in mind. The human service concepts of the whole ENDIN ing of the he! when objecti service to the next stage. THE HELPING PROCESS 163 BOX 7.1 CARL ROGERS AND CLIENT-CENTERED THERAPY As Rogers extended his understanding of the thera- Carl Rogers is known as the proponent of client-centered therapy. His early background provided the foundation peutic process, he developed his well-known approach to for his well-known work in the field of helping, including therapy, client-centered therapy. At the core of this ther- history and theology, and his early aspiration was to become a minister. While studying theology in New York City at Union Theological Seminary, he decided to transfer to Teachers own life. In Counseling and Psychotherapy (1942), he extended his model as he defined a nondirective approach to helping; the helper reflects the client's feelings and College, Columbia University where he earned a master's refrains from asking questions, advice giving, and problem and a doctorate . He began his work and his research on solving. Many of the skills that are fundamental to helpers troubled children and began to develop his well-known today such as unconditional positive regard, genuineness, approach to clinical work. He suggested that by forming a and empathy are at the heart of Rogers's client-centered trusting relationship with the client, demonstrating under approach. standing an acceptance, clients could both solve their chal- lenges and begin to understand their lives and their world. Source: From Taylor (1985). INTERVENTION STRATEGIES During this stage, the helper and the client set goals and determine how those goals will be reached to resolve the problem. During this time, the helper and the client focus on client empowerment, client self-sufficiency, building client strengths, and hope for the future. This means addressing the current status of the problem, the client's aspirations and desires, and the client's personal and social resources, environmental resources, strengths, and barriers. It is import- ant to include culture as an aspect of the intervention process. Should the helper find that the client's problems or issues call for expertise or experience that the helper does not have, the helper should refer the client to another professional who has the necessary knowledge and skills. Another reason for referral at this point arises if, once the problem has been identified, the helper has such strong feelings or biases about the situation that he or she is unable to work objectively with the client. Referral will be discussed in detail in Chapter 9. Depending on the problem, strategies may be as simple as providing a one-time service such as pregnancy testing or as complex as working with a client who has been injured in a car wreck and is permanently disabled. In the latter case, problems may include the client's loss of ability to work at a previous job, difficulties of the client and the family in adjusting to the client's disability, and barriers in the home to the client's mobility. These issues must be addressed if the client is to adjust to his or her new reality. Each strategy used supports client strengths and helps the client negotiate his or her own environment. The role of cultural broker, introduced in Chapter 2, adds a cultural dimension to interventions. ing of client services or termination of the helping process. The relationship between ENDING CLIENT SERVICES The final stage of the helping process occurs at the end- the helper and the client may end in several ways. The most positive conclusion objectives have been reached. Unfortunately, not all terminations are so positive; when the needed services are provided and both participants are satisfied that the Services may be interrupted by either the helper or the client before the objectives M 164 CHAPTER 7 There are several ways BOX ferred, is promoted, or leaves the agency; or the client refuses to return for services, have been reached. For example, the client moves from the area; the helper is trans- the client to receive help have been resolved or the client and agency objectives have that services may end. Perhaps the issues that brought been met. In other instances, the agency may limit the services they provide. Often helpers leave their jobs for a variety of reasons, and, although the services are not terminated, there is a transition between helpers. Finally, clients may decide they no It is important to discuss the ending of client services during the first visit. The client needs to understand the terms of service delivery whether it is based upon the progress made during the helping process or it is time limited. The help and the helping relationship may become an important part of the client's life, so reminding longer want to participate in the helping process. Carmen In this c clients t ment ar ual, in a 1. Ho hel the client during the helping process is also important. A process of counting down can be used. A helper may say to a client that we have been working together for the past three months. As we talked about earlier, the agency provides help to you and your family for four months. As we begin this last month, let's begin to describe what we have accomplished thus far and decide what orities we will have for this final month. TABLE pri- Phys Whe pro Con pro! Inte: Terr obje my In the case study that follows, we visit Carmen Rodriguez, whom we met in Chapter 2. Here she discusses how she deals with many of the concepts discussed in this section. One aspect of work that makes it challenging is that I perform a variety of roles and I have various responsibilities. For example, I always begin my work with a client with an interview. During this initial contact with the client, I try to establish rapport. I believe that each helping encounter represents a multicultural experience. I tell the cli- ent throughout the process, I am interested in learning how gender, race, ethnicity, and other factors influence client values and experiences. Then, I explain our work together and what the schedule is like at our agency. It also helps clients know what is expected of them. One of the best ways I've found to get this relationship off on the right foot is to talk to the client as someone I really want to get to know. I do have some back- ground information on the client (usually an intake form and a financial statement) that I briefly skim before I see the client. When I meet with the client the first time, I always stand up and invite him or her in with a handshake and a smile. My greeting changes if this traditional Western greeting does not seem to be appropriate. I leave the folder in a drawer, because I can concentrate on the client totally if I'm not distracted by reports. IL ba cli ma Wc TC sic AN IN present- After the initial meeting, I read the client's folder carefully. At that point, I usually ask myself the following questions: What do I know about this client? What are the ing needs or problems? What strengths does the client possess? I always focus on the client's strengths as a way of boosting confidence and building on past successes. What do I know about this client's culture? Finally, what additional information would be helpful to best serve this client? Comn messa impor under: develc In clients of the necess in Cha C consc For the protection of the client, the agency, and the human service professional, it is nec- time-consuming. I've noticed that each professional handles this task differently. What works for me is reserving the last 30 minutes of the day for updating files. I realize that these notes are important--the client may be transferred, I may change jobs, or I may be out sick-but some days it's a real chore to pull all the files and condense what's nec essary into two or three sentences. Our computer software continues to change. Switch- essary to maintain written case notes and documentation of services. This can be very ing to new systems always requires additional time and effort. in Fig THE HELPING PROCESS 165 BOX 7.2 CLASS DISCUSSION Carmen and the Helping Process In this chapter, Carmen talks about her involvement with ment and answer the following questions as an individ- clients throughout the helping process. Review her state- ual, in a small group, or as a class: 2. Thinking about the concept of bi-directionality you learned about earlier in this chapter, describe specific ways Carmen might influence her clients throughout the helping process? How might Carmen's clients influence her? helping? 1. How does Carmen perform each of the stages of seo Discuss your responses with your classmates. TABLE 7.1 SUMMARY POINTS: HELPING STAGES Physical setting, paperwork, and review of information occur before the client arrives. • When the client arrives, the helper greets the client, inquires about the problem, and provides information about the agency. Concepts of the whole person (including culture) and the multidimensionality of the problem guide problem exploration. • Intervention may involve referral, service provision, or both. • Termination that is positive occurs when the needed services are provided and the objectives obtained. I hope to continue in my job for several more years, but eventually I would like to go back to school for further training. I want to develop my counseling skills to work with clients as individuals or groups in a more specialized way. My current position as a case manager gives me practical experience and allows me to explore my career options by working with a variety of clients and professionals To better understand my professionals work, read and review Box 7.2, Class Discus- sion, Carmen and the Helping Process. 11 AN INTRODUCTION TO HELPING SKILLS Communication is the foundation for all interpersonal relationships. Exchanging nessages to understand another's perceptions, ideas, and experiences is especially important in helping relationships . Helping others will be difficult if we do not understand their problems or concerns. And good communication is at the heart of developing the relationship and establishing rapport. In this section, we introduce basic helping skills. We begin by focusing on the message, which means perceiving both the verbal and the nonverbal messages build upon what we learned client's necessary for effective listening and responding. Finally, wel of the client. Next, we focus on the helper's communication by identifying the skills in Chapter 5 to understand what the helper needs to know about cultural differences. Communication involves sending a message to another person with the conscious intent of affecting the receiver's behavior. This process is illustrated Figure 7.2. When the receiver interprets the message the way the sender in 166 CHAPTER 7 Message (verbal or nonverbal) Receiver commur sages, b provide nonvert nonvert Sender FIGURE 7.2 COMMUNICATION of how is a goc paying Americ challen Try ing wit intended, effective communication has taken place. When one person interprets the message differently from the way it was intended, the result is communi- you ch · that a person sends can be verbal or nonverbal. Both of these partici you ma cation failure, the most common source of misunderstandings in interpersonal relationships. The message messages occur within a cultural context, and a message within one culture is not necessarily the same message in another culture. The most common example of a verbal message is the spoken word: “Hello, how are you today?” The smile and handshake or hug accompanying that verbal greeting are nonverbal messages. The skillful helper is able to “hear” the client's behavior (the nonverbal message) as well as what is actually said (the verbal message) and is able to respond verbally and nonverbally to these messages (Okun & Kantrowitz, 2015). It sounds complicated, and it takes practice to communicate effectively. A good beginning is through an introduction to each component of the communication process. TABLE Cue Lifting Lower Lifting Eye co Winki Slappi Rubbi Turnir Cocki Little NONVERBAL MESSAGES LO 7-3||LO 7-4 Nonverbal messages (body language) include a person's posture, tone of voice, gestures, eye contact, and touch. Everyone communicates nonverbally within the context of their own cultural environment. Each of us engages in some nonver- bal behavior that we are aware of and perform intentionally. For example, when meeting someone for the first time, most of us want to make a positive first impres- sion, so we deliberately greet that person with a smile or some other pleasant facial expression. However, we also communicate unconsciously in a nonverbal fashion, You recall a time when you visited the doctor's office for shots and afterward wondered at the soreness in your muscles. The tension, fear, or hurt you experienced during the visit caused you to tense your muscles. In a normal two-person conversation, more than 65% of the meaning is car- ried nonverbally. This fact emphasizes the importance of nonverbal communication in a helping situation. Frequently, you may find that a clients nonverbal message will provide you with valuable clues about what the client is thinking or feeling may Raise Retra , Squar Bowe Shrug Sittin Clasf Tapp Fond Lean nonverbal cues and their meanings. important ideas that the client is unable to verbalize. Table 7.2 lists some common Lean Another area in which nonverbal cues are important is the expression of feelings. Feelings are most often communicated nonverbally, particularly by facial expressions and tone of voice. One difficulty with “hearing” the nonverbal expres- sion of feelings is the ambiguity of the nonverbal message. A nonverbal behavior such as crying could be interpreted in various ways; one cannot determine just from disappointed. In fact, be scared or even very happy. Thus, we may think that nonverbal a the Lean Posty THE HELPING PROCESS 167 sages, but it is actually a provide complicated mode of communication. Although they communication is a fairly straightforward process of sending and receiving mes- us with important clues about the person with whom we are conversing, nonverbal messages should be interpreted with caution. It is important to note that nonverbal messages vary from culture to culture. Here are a few specific examples is a good example. In Western cultures, eye contact provides the message, “I am of how nonverbal messages vary from culture to culture. Maintaining eye contact paying attention; you can trust me.” In Asian, Middle Eastern, Hispanic, and Native American cultures, direct eye contact may be considered rude; often it is considered challenging ing Try this exercise: At some point today, select two people who are communicat- with each other. (You may be in the library, a food-service area, or anywhere you choose.) For 10 minutes, observe the nonverbal communication of one of the make about the meanings of the behaviors? participants. What behaviors do you observe? What possible interpretations can you TABLE 7.2 NONVERBAL CUES AND THEIR POSSIBLE MEANINGS Cue Meaning Lifting an eyebrow Lowering eyebrows Lifting both eyebrows Eye contact Winking an eye Slapping forehead Rubbing the nose Turning up corners of mouth Cocking head to one side Little or no head and/or hand movements Disbelief Uneasiness, suspicion Surprise Interest, confidence Intimacy Forgetfulness Puzzlement Happiness Friendly, human Cool, no emotion Fear Raised shoulders Retracted shoulders Square shoulders Bowed shoulders Shrugging shoulders Suppressed anger Responsibility Carrying a burden Indifference Withdrawal, resistance Sitting with arms and legs crossed Protection Clasping arms Tapping fingers Impatience Loneliness Fondling and touching inanimate objects Interest Leaning forward in a chair Leaning back, arms uncrossed Leaning back, arms crossed Open to suggestion Not open to suggestion Finished with interaction Postural change—facing away ETIM ) 168 CHAPTER 7 VERBAL MESSAGES LO 7-3J|LO 7-4 THE sive Verbal messages consist of words spoken by a person, again within a cultural con- text. Such messages can be divided into a cognitive component and an affective component. The cognitive component consists of the facts of a message and reflects the person's thinking processes. This is the realm in which we are most comfortable, A cognitive message addresses such matters as who, what, where, when, and Consider the following statements and try to pick out the cognitive messages. I left work at 5:00 p.m. today. The last client I saw was Raphael Santini, and I just can't seem to get him off my mind. He is making such an effort to find a job, but he's had no they mak that feelii respo to cl guess lines actil by tl for a moment. S luck. I couldn't believe it when he showed up today. I hardly recognized him, and I he could tell I was surprised, because I couldn't think of anything to say He looked great. His hair was clean and neatly combed, and his clothes were new. He was so proud of himself , and I was proud of him, too. I told him I was so pleased with the changes. I also felt good about myself , because some of my hard work with this client has paid off. I'm going to send some emails, text a few of my colleagues, and conduct an Internet search first thing in the morning to see what assistance I can find to help him locate a job. There's just got to be help for a motivated client like Raphael. Some of the cognitive messages you probably identified were the speaker's leav- ing work at 5:00 p.m.; the appointment with Raphael Santini, who is trying to find a job; and the description of his neat, clean appearance. In the cognitive realm, facts are the focus. O L E R Rer acc par The affective component, the feeling part of the message, may be expressed directly or indirectly. Many clients who are unsure about what they are feeling, or who are simply uncomfortable talking about feelings, may choose to express their feelings indirectly. This means that the individual may not name the feeling at all (“Stop driving so fast!”) or may describe it by telling what he or she feels like doing (“I feel like punching him on the nose”). One of the helper's main tasks may be to encourage the client to become aware of feelings and to learn to express feelings appropriately and directly: “I'm scared when you drive so fast" or "I'm angry at you for spoiling the surprise.' Review the statements about Raphael Santini. What feelings are expressed directly? In fact, there are very few, but they do include feeling “proud,” “surprised," and “good.” These feelings are named, and the reader clearly understands how the helper feels. Read the excerpt again, and consider the feelings that are being expressed indirectly. (It might be helpful to read it aloud.) You might identify such feelings as discouragement at Raphael's lack of success, exasperation at the job situ ing may be more difficult when feelings are expressed indirectly. ΤΑΙ Ver Mi ation, disbelief at his appearance, and determination to find some type of assistance Cla Shc LISTENING AND RESPONDING LO 7-5 ship. The first thing a helper must do before making any response to the client is to The way we listen and respond to the client is crucial in building a helping relation- listen carefully to what the client is expressing, both verbally and nonverbally. Even though listening takes up more of a person's waking hours than any other activity I many people consider themselves good listeners, few of us actually Pro Pro Exi Sha Bei Asl ??. use are. This promote that and section will introduce listening behaviors and some helper responses effective helping (see Table 7.3). THE HELPING PROCESS 169 sive listening or active listening. These terms describe the behaviors of helpers as THE HELPER LISTENS The kind of listening that helpers engage in is called respon- they attend to both the verbal and the nonverbal communication of the client. What makes this type of listening special or different from other listening behaviors is feelings of the client, which are not expressed in words. Two that helpers also attend to what is not said, that is, to the underlying thoughts and responsive or active listening as helping behaviors are presented here. ways of considering Egan (2013, pp. 77–78) suggested several things helpers can do to communicate ro clients that they are listening. These five behaviors are presented as a set of guide lines that helpers can follow to let their clients know they are physically present and actively involved in the helping relationship . You can easily remember the behaviors by thinking of the acronym SOLER. S O L Face the client Squarely. This is a posture of involvement. To face away from the client or even at an angle lessens the degree of involvement. Adopt an Open posture. This is usually perceived as nondefensive. Crossing arms or legs may not communicate openness or availability. Remember that it is possible at times to Lean toward the other. A natural sign of involvement, this posture is a slight forward inclination. Moving forward or backward can frighten a client or communicate lessened involvement. Maintain good Eye contact. This is normal behavior for two individuals who are involved in conversation. It is different from staring. Try to be relatively Relaxed. This means avoiding nervous habits such as fidgeting or tapping a pencil. Behaviors such as these can distract the client. E R Remember that these are only guidelines. A helper's physical behavior may vary in accordance with the cultural identity of the client or what is comfortable for that particular helper. TABLE 7.3 HELPFUL BEHAVIORS IN COMMUNICATING Nonverbal Verbal Making eye contact Listening Mirroring feelings Clarifying Showing a sense of humor Providing support Providing information that client needs Smiling Nodding one's head Leaning forward Maintaining a relaxed posture Facing the client Displaying facial expression Being punctual Maintaining a moderate rate of speech Explaining helper's role Sharing information about oneself Being nonjudgmental Asking few questions Occasionally making appropriate use of gestures and touching SIM 170 CHAPTER 7 The goal of attending behavior is to encourage the client to talk about and examine Attending behavior is another way to let the client know the helper is listening. V 7 your client. verbal components and one verbal component (Ivey & Ivey, 2014). 1. Visualleye contact. If you are going to talk to people, look at them. The man. ner in which eye contact is maintained depends upon the cultural norms of 2. Vocal qualities. Your vocal tone and speech rate indicate clearly how you feel about another person. Think of how many ways you can say, “I am really interested in what you say” just by altering your vocal tone and speech ráte. 3. Verbal tracking. The client has come to you with a topic of concern. Do not change the subject; stick with the client's subject matter. 4. Body language: attentive. Clients know you are interested if you face them squarely and lean slightly forward, have an expressive face, and use facilitative, encouraging gestures. In short, allow yourself to be yourself—authenticity in attending is essential. Again, the degree to which you maintain this behavior reflects the cultural norms of the client. Engaging in these behaviors encourages the client to talk, reducing the amount of talk from the helper. Benefits include communicating interest and concern to the client and increasing the helper's awareness of the client's ability to pay attention. Attending behaviors also allow the helper to modify helping behaviors to work effectively with clients who may be racially, culturally, or sexually different. THE HELPER'S RESPONSE Once the helper has heard the verbal and nonverbal messages of the client, it is time for the helper to speak. Remember that helpers' responses must be purposeful. Think about the characteristics of the helping rela- tionship. This is not a casual conversation between two people but a goal-directed exchange. Therefore, the helper must know his or her intent before speaking. The helper has several options at this point. For example, did the helper under- stand what the client said? Was the message clear? Does the helper need further information to grasp the message correctly? Questions such as these will assist the helper in determining the intent of his or her response. Let us examine some of these options. First, suppose the helper does understand the client's message and decides that the most helpful response would be one that lets the client know this. To commu- nicate that intent, the helper may choose to paraphrase, to make a statement that is interchangeable with the client's own words. Client: Helper: I've been able to complete five tasks today that were on my list. You've had a productive day today. The helper may determine that more than a simple paraphrase is needed to help the client become aware of or clarify feelings. In this case, a helper statement that reflects both the feeling (or affec- tive component) and the facts (or cognitive component) is helpful. For example: Helper: set out to do today. You're really pleased that you were able to accomplish what you THE HELPING PROCESS 171 If the helper is confused about what the client said, perhaps because the client s relating a complicated incident, the helper should ask the client for clarification. To attempt a response that will make little sense to the client and will let the client such as “I'm not sure I understand ..." or "I'm confused about know that the helper did not understand what was said is not helpful. Responses at this point. They also let the client know that the helper is interested enough to want to get the story right in order to be able to help. Beginning helpers sometimes encounter situations in which clients are asking believe they should know everything and may feel embarrassed about being asked tops of their heads” or give an answer they believe may be correct. A better response in situations like this would be, "I do not have that information, but I do know questions or seeking information that the helper does not know. Many helpers CG where we can find it; let me check on that for you” or “I'm not sure about the eligibility requirements for that type of assistance, but I can refer you to someone who knows.” Helpers are not supposed to have all the answers. The effective helper who wants to maintain a relationship with the client will enrich that relationship by being honest with the client. ASKING QUESTIONS Another technique that beginning helpers should be wary of is questioning. Most of us consider ourselves skilled at asking questions and find it a natural form of communication in everyday life-particularly questions that begin with the words who, what, where, why, and when. For the beginning helper, the question is the most common method of eliciting information from the client, and many helpers find themselves resorting to questions frequently. Unfortunately, one question seems to lead to another, and too many questions can interfere with the helping relationship, causing the client to feel like a witness. An overreliance on questioning, and neglecting other kinds of responses, hinders the helping process. It also creates a dependent client who has no role other than answering questions. Most questions can be rephrased as statements that elicit the same information. For example, the question, “What was the last grade completed in school?” can be rephrased as, “Tell me about your school experiences.” In addition to discovering the final grade completed, the helper may learn how the client felt about school, whether the client enjoyed learning, and what circumstances surrounded the end of the client's educational experience. Now that you have been alerted to the pitfalls of questioning, let us explore the time when asking questions is appropriate and how one asks good questions. There are several situations in which a question is helpful. In the first situation, you can begin the interview with a question: "How would you like to begin?” or “Could you tell me a little about yourself?” A second situation occurs when specific information is needed. Asking for information to clarify (“How long have you been ill?”) or to elicit examples of specific behavior (“How does that make you feel?”) can provide the additional information necessary for complete understanding. Finally, questions can be useful to focus the client's attention. For example, a client who is digressing on about several problems may need the helper's assistance to focus. Such assistance can be provided by statements such as the following: or rambling You've mentioned several concerns that you have about your daughter. You're afraid she is using drugs, and you suspect she is not doing well in school. I guess I hear you expressing the most concern, though, about your inability to talk with her. Let's focus on that. What happens when you do try to talk with her? TIM 172 CHAPTER 7 TABLE 7.4 SUMMARY Points: WHEN TO ASK QUESTIONS of the to fair, (Davis, One fun To begin the interview To obtain specific information • To seek clarification • To elicit examples of specific behavior To focus the client's attention keep cc the inte Th educat increas becom skills i recogn work 21st c league the question role o WOR Thus, there are times in a helping relationship when asking questions is appro- priate and beneficial. How does one ask good questions? The helper might first want to consider how the question will relate to and promote the helping relation- ship (Egan, 2013). Having specific objectives in mind before asking will help in formulating a good question. Both closed and open questions can facilitate the development of the helping rela- tionship when the helper has specific intentions. Closed questions are those that elicit facts necessary to facilitate the helping process. “How old were you when your father died?” and “How many brothers and sisters do you have?” may provide important information regarding the client's family situation if the client is having difficulties at home. Closed questions that require a “yes” or “no” answer should usually be avoided, because they lead the beginning helper to ask more and more questions. Open questions, on the other hand, are broader, allowing the client to express thoughts, feelings, or ideas. They contribute to building rapport with the client and also assist him or her in exploring a situation, a problem, or an interaction. For example, “How did you feel after talking it over with your parents?” asks for the client's view. On the other hand, “Did you feel better after talking with your par- ents?” can be answered with a simple “yes” or “no,” which does not enhance the helping process. In summary, questions can be useful tools in the helping process. As with other types of responses, the key to effective questioning is knowing the intent of the question before posing it to the client. Are you seeking factual information or ask- ing the client to offer thoughts or opinions about the topic of discussion? Consider- ing how the question will promote the helping relationship will assist the helper in determining the appropriate strategy. Group for su mode living place tasks lems alcoh wher abus Thes of so sibili that tion- Nati tone trast from mun both WORKING WITH INTERPRETERS One aspect of communication that may influence the helping relationship and the helping process occurs when the helper and the client must use an interpreter Mer a gr seve translate for the client. In some situations, you might have to rely on an informal interpreter. Examples of informal interpreting may be when parents interpret i their children, children interpret for their parents, or other members of staff may be asked because they speak the same or similar language as the client. Preferred is the use of a professional interpreter who has had education and training, is cer- tified, and understands the professional obligations of participating in the helping process. The helper can expect the professional interpreter to communicate clearly, use the words of the speaker, and convey the tone of the words and the emotion cha pate inflt The THE HELPING PROCESS 173 of the speaker. And both helper and client should be able to trust the interpreter (Davis, 2005). In the best of all possible worlds, the interpreter becomes invisible. to fairly and honestly convey the meaning that passes between helper and client One final expectation both participants have for the interpreter is the ability to keep confidences. This professional commitment to confidentiality on the part of the interpreter enhances communication and promotes quality service delivery. This section has been a brief introduction to helping skills. As you pursue your education and training in preparation for work in the human services, you will increase your knowledge about these skills and refine your use of them so that Oro- first recognized on- you become an effective helper. One area that requires a mastery of communications Skills is working with groups of individuals. By the end of the 1980s, groups were as viable means of helping individuals in a variety of settings. Group work flourished during the 1990s and will continue to be a major strategy in the 21st century to provide direct service to clients as well as to collaborate with col- leagues and community groups. An introduction to basic group concepts and the role of communication in group work follows. ion ela- icit her LO 7-6 ant cies be ess nd or he ar- he WORKING WITH GROUPS Groups are natural. Since the beginning of time, individuals have banded together for survival, security, tasks, and problem solving, thus making groups a critical mode for accomplishing what needs to be done. Think about your own life—your living situation, your work, and even your leisure time. Most of these activities take place in groups. In human services, individuals also band together to accomplish tasks. Membership may be voluntary. For example, individuals with similar prob- lems or experiences, such as victims of incest or suicide survivors or children of alcoholics, may work together on their problems. Involuntary membership occurs when participating in a group is mandated by some authority. Joining a group for abusive parents or one for substance abusers may be a condition for probation. These human service-focused groups exist face to face and online. With the growth of social media, Skype, chat rooms, discussion boards, and weblogs (blogs), the pos- sibilities of belonging to a group expand. Online communities represent one way that individuals form groups to address social problems. For example, organiza- tion-sponsored online communities, such as the support group established by the National Alliance on Mental Illness, have an articulated goal and a professional tone consistent with for-profit, nonprofit, and governmental organizations. In con- trast, peer-initiated online communities, such as Breast Cancer Support, emerge from the ground up as the members themselves determine the goals for the com- munity and provide the space for social interaction. Additional information about both examples may be found by searching the Internet for the National Alliance on er he k- er- in ze o al Mental Illness and Breast Cancer Support. In this section, we will define groups, explore the skills necessary to work with is a number of individuals who interact with each other. Groups have DI a group, and consider the trends that will affect ?? d A group r- several characteristics (Brandler & Roman, 2015) (see Figure 7.3). An important characteristic is the interaction that occurs among group members. They partici- pate in group meetings and discussions, share resources, give and receive help, and influence each other. Sharing common goals and values is a second characteristic. group may be formed for an agreed-upon purpose, or the group may establish ig y, n The M 174 CHAPTER 7 KOLNIE VOLUNTER Ariel Skelley/Blend Images/Getty Images Working with Groups FIGURE rather t togethe domina each cu of men Ald its own goals once members meet. The group also develops its own values, identi- fying what is important to the group and translating it into behavior for individ- uals as members of the group and for the group as a whole. Groups also have a social structure. Roles define the formal structure of the group and influence how individuals act in the group. Different group members play different roles. Exam- ples of roles include the leadership role, which may be a designated person or a shared role among members; the maintenance role, which sees to the well-being of the group by encouraging and compromising; the facilitative and building role , which helps everyone feel part of the group by initiating, seeking information and opinions, coordinating, and evaluating; and the blocking role, one that is aggressive, dominating, and antigroup. A final characteristic of a group is cohesiveness among members. Members perceive that they belong to a group, they are interdependent in some way, and they work together to keep the group going as well as focus on common goals. Groups have their own dynamics that influence the group's development and its productivity. One important influence is the context or purpose for which the group was formed. For example , if a group is formed to help members deal with many group. Group process also influences how the group functions. Conflicts, anxieties, validations, agreements, and hopefulness are all by-products of meeting together trates t 1960s, ers who of the activities of the such a Anony for exa mong To tha regular other S organi GE Groups do develop unwritten rules and often resemble a family unit. Group dynamics, or how members of the group behave with each other, can be directed by helpers who understand the conditions that help a group run smoothly. Multicultural dimensions both enhance and complicate the ways in which groups work. In a most positive light, as individuals from different cultures work develop ways of communicating effectively, and create strategies that include areas l establi ists in groups coming together, in groups together, they can develop a unique culture as a way of forces THE HELPING PROCESS 175 Share Interaction Develoc Cohesiveness Develop Common Goals Characteristics of Group Work Act According to Roles Share Common Values FIGURE 7.3 CHARACTERISTICS OF GROUP WORK rather than exclude. On the other hand, when members of different cultures work together, there is a chance of forming cliques and subgroups, and members of the dominant subgroup marginalize the other members. Creating a healthy respect for each culture and developing an inclusive approach help the groups with a diversity of membership (Means, Davey, & Dewe, 2015). Alcoholics Anonymous (AA) is an example of a well-known group that illus- trates these characteristics. Although many self-help groups formed during the late 1960s, AA is one of the more enduring ones, established in the late 1930s by found- ers who realized the effectiveness of individuals meeting together and interacting in such a way to support change (Brandler & Roman, 2015; The History of Alcoholics Anonymous, 2016). Interaction among members is the foundation of AA meetings; for example, members share experiences and information. They also have a com- mon goal, which is to gain and maintain control of their lives by remaining sober. To that end, members encourage, coordinate, evaluate, support, and lead, both in regular meetings and outside meetings. These techniques are similar to those used in Groups are formed for reasons other than self-help. Today, there are specialty organizations also use online groups to provide support to their members. other self-help groups such as Parents without Partners and Weight Watchers. These areas in group work and a set of core competencies and standards that have been established for preparation for group work in these areas (Association for Special- ists in Group Work (ASGW], 2016). Identified specialty areas include task or work groups that are focused on accomplishing identified work goals, for example, task forces, planning groups, or community organizations. The organization always 176 CHAPTER 7 examples of this type of group. Guidance and psychoeducational groups are another type of B group whose focus promotes “the principles of multiculturalism, social justice, and global perspectives" related to working in groups (ASGW, 2016). The teams described in Chapter 1 are is education, prevention, or both. In these groups, information may be shared about logical disturbances. Another type of group is counseling and interpersonal problem AIDS, bereavement, or divorce. The goal is to prevent the development of psycho- solving, whose focus is the resolution of problems group members face. Examples may be test anxiety, relationship difficulties, or career decision making. Psychotherapy and personality reconstruction groups are most often found in mental health facilities such as clinics or hospitals and include individuals who have serious psy- chological problems of long-term duration. Both abusers and victims of abuse may Eve bot the the but ing wa GE en! to groups, wa be fo (IE H Η we I si the re group S benefit from involvement in such a group. What is the role of the human service professional in a group? In natural such as a family or a street gang, human service professionals enter as outsiders and must make a place for themselves (Levine, 2012). They are present because a mem- ber is in trouble or there are significant problems in the group or both. In formed groups, that is, those that are organized for a specific purpose or goal, the human service professional may have responsibility for getting people involved and getting the group underway. Organizational issues such as meeting times and places, pur- pose, and group structure must be addressed by members before the real work of group begins. At this point, the human service professional facilitates the work of the toward its goal. The foundation of all group functioning is communication skills. As stated ear- lier, interaction is key to the group's existence and involves the exchange of infor- mation and transmission of meaning. It is by means of effective communication that group members reach some understanding of one another, their goals, the divi- sion of labor, and other group tasks. Both verbal and nonverbal behaviors com- prise effective communication and are every bit as complex in groups as they are in individuals. For example, silence may have many meanings: processing information, mulling over what was said, avoidance, or discomfort with the topic. Therefore, many of the points made earlier in the chapter about sending messages, listening, asking questions, and responding are critical for group work. In fact, the core skills identified by the ASGW (2016) include the communication skills to open and close group meetings, impart information, self-disclose, give feedback, and ask open- ended questions. Groups are experiencing increased popularity at this time and focus on special populations . Examples are groups for individuals who are divorcing or are divorced, adult offenders, overeaters, those with HIV/AIDS, adolescents, elderly living in insti- tutions, unwed teenage fathers, veterans, and those who need support for Ic li ? V T V n i any num- ber of situations. Many groups focus on very specific members, since characteristics of the members may help focus the help and support. For example, related to HIV/ 1 1 AIDS, there are support groups for gay African-American men, female teens, and mothers with HIV/AIDS. Most face-to-face groups provide support for a community or online regional area; of services upon his return. group membership can include individuals across the United States and out- side the United States. Technology has made the formation of and communication groups easier. And members without easy access can participate. In Box 7.3, a client speaks about his experience in the military and his experiences receiving THE HELPING PROCESS 177 BOX 7.3 A CLIENT SPEAKS Every day I think that this will be the day that I hit rock bottom. I am a veteral trom both the current wars in the Middle East. In 2002, after 9/11, I decided to join job, and needed additional medical care. I was also diag- but I was not interested until I watched the people flee- the service. My entire family had served in the military, nosed with posttraumatic stress disorder (PTSD). While I ing from the buildings and the towers falling. Before the war, I was a high school dropout; I had just received my enlistment; she was pregnant at the time. She was going o live with my parents while I was gone. My little boy After I was released from the rehabilitation center, my life was in shambles. I was on pain meds, unable to get a am at home, I admit that I am not always good with my wife and kid. With my meds, my moods are erratic; with- out my meds, I am aggressive and sometimes violent. I have GED and I was looking for a job. My wife supported my nightmares, night sweats, and even during the day things Things are really hard with me and my family. I came was born while I was overseas. I served for seven years home a different person. My wife even wrote the Veter- before I was wounded in an attack on our unit. I lost my an's Administration and asked that I receive psychologi- foot and my arm when an improvised explosive device cal help and support with my pain medications. She even (IED) hit our Humvee. I was lucky to survive. In our went with me for two days while we waited to be seen Humvee, there were eight of us and six of my buddies or talk with someone in charge. They say they will not were killed. The two of us that survived were disabled. pay any benefits for extensive treatment of I was flown out to Germany and was in the hospital for but they will for group therapy with other veterans. six months. Later, I was flown to the United States for I am not sure what that would be like. What do you think rehabilitation. about my chances of being helped with group therapy? my PTSD, pay SKILLS FOR CHALLENGING CLIENTS LO 7-7|LO 7-8 Ideally, all clients of human services are motivated, cooperative, responsible, and like each of us; however, it is one of the challenges of this profession that not all clients fit that description. In your experience as a helper , you will likely meet clients who are culturally different, resistant, silent, overly demanding, or unmotivated. They may also be different from you in other ways, including background, religion, values, and life experiences. You need to know something about these client groups because they often elicit in the helper feelings of uncertainty, hostility, and resent- ment . They are particularly difficult for many beginning helpers to work with, and it is important to realize that the client's behavior is not necessarily the helper's fault. CULTURALLY DIFFERENT CLIENTS Embedded in the helping process is the commitment to the client to assist in what- involved with understanding these clients and the situations in which they find ever is needed. When human service professionals are helping clients, they are themselves. One first step is to begin to understand the client and develop an empa- thetic response to the client's situation. Also, understanding the client from the con- textual standpoint provides the helper an opportunity to know the multidimensions of that client. Then, together they set goals, make plans, and identify services. This process is not as straightforward as it seems since the work presupposes helping encounter is a multicultural encounter. Each client represents that perspective different from any other. This means cross-cultural communication will occur between the helper and the client. Also complex is the influence of the every a THE HELPING PROCESS 179 wrong things at the wrong moments. My language problem still persists. Conversa- me. I am afraid this makes me boring to talk to and hard to discuss complex subjects tional English is something I find difficult, and people must speak slowly and clearly for it academically and socially at an American university. with. My greatest fear of all is having to go back to Viet Nam because I could not make The young woman in this case study is one among many culturally different clients. The four steps mentioned before this case are useful in understanding Jo Ann as a unique, worth while individual who has the capacity for thought, feeling, and behavior as she attempts to function successfully in a culture foreign to her. A helper would need to learn about the Vietnamese culture and the ways in which it differs from and resembles American culture. Jo Ann has established personal ????? ese goals that focus on academic and social success and is frustrated by the barriers she is experiencing. To engage effectively in the helping process with Jo Ann, the helper would need to explore the relevant differences between the American and Vietnam- cultures. For example, many Asian cultures are collectivist—the individual is less important than the group. Jo Ann may be fearful of not succeeding academically and socially because of the disgrace it would bring to her family that has sacrificed to send her to the United States. The helper would also want to adjust his or her helping behaviors to the indi- vidual of a different culture and to assess appropriate strategies of intervention. In American culture, the individual is perceived as autonomous and separate from groups. Even though a person can be a member of many groups, no one group deter- mines identity completely. In collectivist societies, however, the individual belongs to fewer groups, but the attachment is stronger; often the individual is defined by membership in a group. Taking this information into account, the helper would choose an intervention that would focus on Jo Ann in relation to her group rather than an intervention designed to promote independence. re THE RELUCTANT OR RESISTANT CLIENT There are some distinctions between reluctant and resistant clients, but the prin- ciples for working with them are similar. The reluctant client is one who does not want to come for help in the first place and is more or less forced to come. Such clients may be found in schools, correctional settings, court-related settings, and employment agencies (Egan, 2013). The resistant client may come more or less will- ingly but fail to carry through or participate actively in the helping process. Some of the causes of clients' reluctance and resistance are having negative attitudes about help , seeing no benefits in changing, feeling that getting help means admitting weak- hess or failure, and seeing no reason for going for help in the first place. Reluctant clients may be embarrassed or angry that they are there for help. In many cases, they are there only because the court or some other authority has said they must be. These feelings are compounded by their unfamiliarity with the or the process. To attempt to lessen the reluctance, the helper can explain the pro- agency expec- cess to the client. Discussing matters such as confidentiality, time limits, and tations (for the client as well as the helper) can help demystify the process. Also, the manner in which the helper relates this can allow the client to see him or her in a role other than that of interrogator or advice giver. These clients may helper will not understand them or their culture does not support asking for help or asking for help outside the family or community. IM 180 CHAPTER 7 The following case provides an example. JOSEPH E Joseph came into my office with his mother and father. He sat in the chair with his arms folded. His feet did not touch the floor. He was swinging one toot and then another. He looked at his knees. I talked with his mother and father first for a few minutes and then asked them to be excused so that I could talk with Joseph alone. I am used to working with young children who do not want to see a counselor. When I meet sit and stare at me. Some stare at the floor. Others pretend to be asleep or sing quietly with them the first time, many say nothing during a 35- to 45-minute period. Some just to themselves. On rare occasions, they try to damage the room, me, or themselves in Over the 20 years that I have worked with children, five of them have never talked with me, after weekly meetings for over six months to a year. Many of them will begin Wc Re ent the 1. some way. 2. to relate to me after two or three weeks, mainly through games and drawing or watch. ing short films or videos together. Some will finally talk with me and once they get started, they cannot stop. My foremost approach is to let them know that I care about them in whatever way I can. Even for those who never spoke, I was a consistent, caring presence in their lives for an extended period of time. in hi ir ? ir Resistance is slightly different from reluctance, because resistance can occur at any time in the helping process. Clients who come to the attention of human service agencies may initially feel threatened by the referral and application procedures. Resistance may also arise later in the helping process if the client feels threatened by the subject being discussed, by the helper, or even by the helping relationship. What is resistant behavior? Missing appointments, rejecting the helper, and inattentiveness are examples of such behavior. Clients may try to protect themselves by denying the existence of a problem, claiming it is caused by other people or situ- ations, or distancing themselves from it. 1 P fc S D t f i I feel that the counselor in my school has betrayed me. We have had a good rela- tionship ever since I came to the high school. I have worked with her one-on-one to determine my school schedule. She has conducted groups in our high school. I have participated in ones on family life, balancing a checkbook, how to apply for a job, and how to maintain healthy friendships. Today I went to see her after basketball practice. I have not been feeling well. My coach is concerned and she asked me to go to see Ms. Sharpelli. You know what she asked me? “Do you think you might be pregnant?" I walked out without saying a word to her. Even though she might be right, I promise, I will never speak to her again. The helper can use several strategies when working with a resistant client. r i 9 dif And, as we discussed in Chapter 4, client resistance may be seen as client insis- tence, especially when clients speak their mind or try to rework the process to meet their own needs (Matarese & van Nijnatten, 2015). First, recognizing and accepting the antagonism may defuse the situation. This type of action is very ferent from what the client might expect; a statement such as “You probably don't want to see anyone like me" may minimize the threat to the client. Second, asking for the client's perceptions of the problem will communicate support for the cli- ent's feelings. This does not mean that the helper must accept or believe everything be curious about why the client communicates as he or she does. Asking what the the client says, but it does communicate support and respect. And the helper may client wants to happen in this situation is a third strategy. It engages the client in the helping process and also emphasizes the helper's support and respect for the í THE HELPING PROCESS 181 BOX 7.4 CLASS DISCUSSION Working with Challenging Clients Read through the sections that describe challenging cli- ents. As an individual, a small group, or a class, answer the following questions, 3. With said classmate, role-play the scenario. You are still the client and your classmate is the helper. 4. After the role play, discuss what happened, why you, as the client, presented the challenge, and how the classmate, in the role of the helper, helped you. 1. In order to prepare for working with challenging 5. Then, discuss what happened from the helper's per- clients, list each type of challenge and write a sce- nario that describes you as a client, demonstrating the challenging behavior. 2. Ask a classmate to read your scenario and make plans to work with you. spective, including how the helper prepared for and addressed the challenging behavior. Share your responses with your classmates. individual. In addition, it can provide the client with some sense of control over his or her life. Finally, for resistance that occurs later in the relationship, chang- ing the pace or the topic may temporarily lessen feelings of threat. In Box 7.4, Class Discussion, you can learn more about how you would work with challeng- ing clients. THE SILENT CLIENT Particularly challenging for the beginning helper is the silent client. The uncom- fortable silence may cause the helper to believe that nothing is taking place; in fact, silence can have many different meanings. It is the helper's responsibility to evaluate what a silence means so he or she can decide how to respond. Silence can mean that the client is waiting for direction from the helper. In this case, the client may feel that it is the helper's place to determine the topic of discussion or the direction in which the relationship should move. A second meaning of silence can be that the client is pondering what has been said. Resistance (discussed previously) may also manifest itself as silence; a change of pace or topic may be necessary until the client is ready to deal with what is happening. Silence may also relate to culture, specifi- cally cultural norms. For example, in some cultures, women defer to men in conver- sation. In other cultures, the family speaks for the individuals in the family. Within cultures where individuals may bring shame to the entire family, a client's silence may be a way of protecting the family. and his wife were referred for counseling by their family physician. Mrs. Lopez is experiencing signs of dementia, and her deteriorating condition requires that Mr. Lopez Mr. Lopez be the caregiver. During the first session, Mrs. Lopez talked about her son, Enrique, and how he is learning to tie his shoes. Mr. Lopez volunteered the information that Enrique is 24 years old, lives in a neighboring state, and is a computer analyst. Other than this comment, he sat silently. In this case, Mr. Lopez may be silent for several reasons: despair over his wife's condition, confusion about her behavior, discouragement, or simply nothing to say. The helper will want to be sensitive to his behavior and to consider what he is feeling. 182 CHAPTER 7 TABLE 7.5 SUMMARY POINTS: STRATEGIES FOR RESISTANCE Recognize and accept the antagonism Ask for the client's perception of the problem Ask the client for solutions Change the pace or topic 1 THE OVERLY DEMANDING CLIENT Calling the helper at home, monopolizing time in the office, and scheduling frequent and unnecessary appointments are behaviors of an overly demanding client. Some times such clients become so dependent that they may want to be told what to do. When the client makes demands, the helper may become resentful of the time the 4 1 client takes and frustrated with the unsuccessful nature of the helping process . For these reasons, the helper must deal appropriately with the client's behavior. I just called my case worker , Ms. Renfro, and she promised to come right over. I know that she usually goes to church on Sunday evenings, but I really need to see her. She is so good to me and tells me to call her whenever I need her . And she helps me all of the time. I have a regular scheduled appointment with her for 30 minutes every Tuesday morning, but I would not be able to get through a day without talking with her. Last Friday she called to tell me that she was going out of town next Tuesday and canceled our regular Tuesday appointment. I have called her each day to urge her not to go. Ms. Renfro will probably develop some resentment toward this client when her patience is exhausted. At some point, it will be in both their best interests for her to establish some boundaries for the relationship. One strategy that may help with the overly demanding client is setting reason- able limits to decrease the client's dependence. Limiting client-helper contact to working hours only is one step toward decreasing dependence. A second step is to examine the helper's own need to be needed. Is the helper actually encouraging the demanding behavior of the client? may THE UNMOTIVATED CLIENT Clients who are present because someone referred them or encouraged them to seek help may be unmotivated. They may not see the need for the service and may be showing up only because some authority such as their parents, the school, or the court is forcing them to attend. Unfortunately, the unmotivated client is ofren as reluctant clients, and many of the same strategies previously suggested may unwilling to change and only goes through the motions of the helping process. The may come to feel resentful, frustrated, and even angry. Such clients may be classed helpful in establishing rapport with them. A parolee is an example of a client who is be must have regular meetings with a parole officer. Many of my parolees come in to see me just because they have to. In fact, most of them come because it is one of the terms of their probation. They figure seeing me is not as bad as being returned to prison. Each day I try to see at least seven of them; and I also try to make two or three visits to see them at their work site. Most of the conversations are predictable: "How are you doing?” “Fine, I guess." "Looks like your job is going THE HELPING PROCESS 183 tion about a new skills course • well.” “Yep." "Tell me a little about your family.” “They are fine.” “I got some informa- person that they must see or suffer the consequences. client offers no response and shrugs his or her shoulders.) For these folks I am just a ” “Oh.” “Is there anything that I can do for you?” (The INTERVENTION STRATEGIES Now that you have learned about the helping process, it is important to look at three intervention strategies human service professionals are using. Motivational interviewing focuses on the client by exploring internal or intrinsic motivation to change (Miller & Rollnick, 2010). Crisis intervention is a helping process that is used to respond to stressful events and emergencies. Resolution-focused brief therapy is used when limited time or resources require a short-term intervention. LO 7-9 MOTIVATIONAL INTERVIEWING Motivational interviewing provides a methodology to encourage behavior change. According to Miller and Rollnick (2013), this approach encourages the develop- ment of internal (rather than external) motivation or desire for change. Within the context of a client-centered, safe environment, clients and helpers explore client ambivalence about change. Based upon the nature of the ambivalence, the helper matches treatment strategies to individual needs. The ultimate goal of the approach is to increase the desire for change. Professionals report positive out- comes using motivational interviewing with specific populations such as youth and adult probationers, individuals with substance abuse issues, and family interventions. Three aspects of motivational interviewing establish a positive helping environ- ment and address a client's motivation for change (Miller & Rollnick, 2013). First, using motivational interviewing, the helper engages the client in a special conversa- tion about change and the change process. The role of the helper is collaborative; the helper sets aside his or her role as an expert and assumes the role of an equal partner in the change process. Second, the helper's goal is to draw from the client the ideas and feelings the client experiences about working to change his or her behavior. During this time of drawing out, the helper and the client assess the client's strengths. Third, during the motivational interviewing process, the client retains the autonomy for choice and responsibility for actions. Helpers encourage clients to explore ways that might work for them to engage in a change process. The techniques supporting the motivational interviewing approach include aspects of helping we described in this chapter and earlier chapters of the text. They include expressing empathy, providing support for self-efficacy , de-escalating Inter- resistance, and finding the discrepancies between where the client is and where the client wants to be (Miller & Rollnick, 2010). In addition, open-ended questions, affirmation (recognizing client strengths), reflections, and summaries all encourage a client-centered, positive atmosphere. Each of these strategies assists the helper in assessing the client's readiness (ready), importance (willingness), and confidence niques, and motivational interviewing questions. You will find in-depth information net using terms such as motivational interviewing, motivational interviewing tech- about goals and objectives of motivational interviewing, strategies and techniques, and skills and values needed to work with clients. $ 184 CHAPTER 7 While the primary focus of motivational interviewing remains the interaction between the client and the helper, aspects of the social context are understood importance of significant others (Stanton, 2010). Several authors suggest that t as influences on the clients' lives. The strongest influence is acknowledged as the address the cultural dimensions of clients' lives, motivational interviewing needs to include aspects of the social context as primary. For example, with immigrant cli- immigration, contexts of immigration, receptivity of the host community, the lan- guage barrier and discrimination” (Lee et al., 2011, para. 6). The goal of adding TO 6 history around aspects of social context is to enhance the helping relationship. LO 7-10 CRISIS INTERVENTION Crisis intervention is a helping process that occurs at a much faster pace than other helping and incorporates many of the helping roles and skills that have been dis- cussed in this chapter. You may find yourself engaged in crisis intervention when there is an emergency. For example, a crisis can be precipitated by suicide threats or attempts, the discovery of an unwanted pregnancy, abandonment, or natural disas- ters such as hurricanes or tornadoes. In this section, you will read a description of crisis intervention as a human service, including types of crises, the development of a crisis, the principles and skills of intervention, and the role of the human service professional in providing this service. response to the DEFINING CRISIS Stressful events and emergencies are going to occur; individuals can probably handle some but may find themselves unable to cope with others. The inability to cope creates the potential for crisis. An individual's equilibrium is dis- rupted by pressures or upsets, and this imbalance results in stress so severe that the person is unable to find relief by using coping skills that have worked previously. When identifying crises, we need to distinguish between the event or situation and the person's response. The crisis is the individual's emotional threatening or hazardous situation rather than the situation itself. Thus, the crisis lies in the individual's interpretation or perception of an event; the same event does not lead to crisis for all people. What one individual can handle may be a crisis for another person. Crises can be divided into two types: developmental and situational. A devel- opmental crisis is an individual's response to a situation that is reasonably pre dictable in the life cycle. Chapter 8, focusing on the client, will explain how that individual mental problems with which they are able to cope. For those who cannot coppa those circumstances. grows and develops and undergoes periods of major transition such as childhood to puberty, puberty to adolescence, and adolescence to adulthood. the stresses of these stages can have destructive effects, such as suicide attempts, rejec- I crisis in and unpredictable nature of this type of crisis makes or individual any preparation Situational or accidental crises do not occur with any regularity. The sudden control impossible. Examples are fire or other natural disasters, a fatal illness, relo- cation, an unplanned pregnancy, and rape. Hazardous situations such as these may cause periods of psychological and behavioral upset. A crisis may result, depending on the individual's personal and social resources at the time of the event. THE HELPING PROCESS 185 The skills and strategies that helpers use to provide immediate help for a person in crisis constitute crisis intervention. This is short-term therapy that focuses on solving the immediate problem and helping the individual to reestablish equilib- rium. Common practice areas of crisis intervention are childhood and adolescence, suicide prevention, and substance abuse. mental health problems, marital and family conflicts, emergency hospitalization, HOW A CRISIS DEVELOPS Even a sudden or short-lived crisis has identifiable com- the helper plays. crisis in terms of its development. You may want to make note of the different roles ponents that create a pattern of development. The case study that follows examines BEN AND JOAN MATTHEWS Background. Ben and Joan Matthews and their three children (ages nine months, two years, and five years) left their trailer in rural Illinois to drive to Florida. Ben had lost his job because the factory where he worked for minimum wage closed down. He hoped to find a job in Florida working on some of the fruit farms. The hope for a job did not materialize in Florida, so they headed back to their trailer in Illinois and an uncertain future. Two of the children became ill, the car broke down twice, and Joan and Ben argued constantly about what they should do next. A couple of times, the argu- ments escalated into shouting matches that ended when Ben hit Joan. About halfway to Illinois, they had no money for food, lodging, or gas. They stopped at a fast-food restaurant so that everyone could use the bathroom and have a drink of water. Joan gathered the children together and headed into the restaurant. When they returned, Ben and the car were gone. Joan's cell phone was in the car so she could not call Ben. Crisis development has four identifiable phases. In the first phase, the person reacts to a traumatic event with increased anxiety. The individual then responds with prob- lem-solving mechanisms to reduce or eliminate stress. Here is Joan's initial response: Phase One. Joan thinks that Ben has gone to get gas, so she returns to the restaurant. Selecting an out-of-the-way booth, she and the children sit watching and waiting for his return. In the second phase, the individual's problem-solving ability fails. The stimulus that caused the initial rise in anxiety continues. In this case, the source of Joan's anxiety does not change: Ben is still missing. Her initial attempts to deal with the situation fail, and her anxiety continues to increase. Phase Two. At this point, the manager approaches and asks if he can be of any assis- tance. By now, the children are crying. They are still hungry, are tired of sitting, and sense their mother's tension. Feeling frightened and alone, but not wanting to upset the children, Joan explains to the manager that her husband went to get some gas and that he will be back soon to pick them up. Joan's anxiety level is increasing, and all attempts at resolution have failed. In the third phase, she uses every resource available to solve the problem and to lessen Phase Three. During the next hour, Joan becomes more and more frightened that Ben is not coming back to the restaurant. The children are very hungry and tired. She is aware people are staring at them, and she is afraid the manager will ask them to leave the restaurant. She asks if she can use the restaurant phone to call her mother collect in her anxiety. Joan tries several alternatives. that Illinois. When she calls, she gets a message that the number is no longer in service. UM 186 CHAPTER 7 TABLE 7.6 SUMMARY POINTS: Crisis DEVELOPMENT pas or Reaction to a traumatic event with increased anxiety Problem-solving ability fails • Additional attempts at resolution fail and anxiety increases Problem remains unresolved and tension and anxiety increase to an unbearable degree At this point in phase three, the crisis may be prevented by redefining goals. Joan's original goal was to locate Ben or at least to wait for him to return to the restaurant . When she realizes that he is not returning, she attempts to resolve the situation by securing help from other known sources such as her mother. Phase Four. She asks the manager if he knows of a shelter or a church that might take them in for the night. He suggests that she call the “welfare people.” She is reluctant to call them. The children are getting hungrier and more irritable. Joan knows no one else ?? Im the ab cat the to call. an This is phase four. A state of crisis results when the problem remains unresolved and the tension and anxiety rise to an unbearable degree. Both social support and internal resources to deal with the situation are lacking. All attempts on the part of the individual have failed to lessen anxiety or change the situation (see Table 7.6). su RE fu ma W THE HELPER'S ROLE IN CRISIS INTERVENTION At this point in the case study, the human service professional becomes involved. To illustrate the steps, principles, skills, and possible outcomes of crisis intervention, the focus of the case study will shift to the perspective of the helper. Before that happens, however, let us review some of the principles and skills of crisis intervention so that you will understand what is happening in the case. 1. Crisis intervention is a time-limited service. The helper must quickly estab- lish trust and rapport with the client and support the client's self-esteem and self-reliance. 2. Two strategies important to crisis intervention are referral for needed services and activation of a social network for support and assistance. 3. The crisis intervention includes (a) assessment of problem(s); (b) planning the intervention; (c) implementing the intervention; and (d) resolution of the crisis. Assessment. Returning to Joan's situation, it is now 8:00 p.m. and the office of the Department of Human Services is closed. Her call is automatically referred to the emergency child abuse line. The human service professional , Shirley, who is on duty if she is in a safe place. Joan and the children can take a cab to the shelter at the W th po th lo R. talks to Joan to try to assess, “What level of danger does the person pose to himself In bi SC a nurse shelter's expense. When Joan arrives at the shelter, assessment continues as the case physical assessment of Joan and each of the children. Joan and the children are taken to their room. re be m CU ca Planning the Intervention. Once the initial assessment is completed, the second step, planning the intervention, begins. The purpose of this step is to restore the of disruption the crisis has caused in the person's life, the amount of time that has person to a precrisis state. Factors considered during this phase are the amount th THE HELPING PROCESS 187 or absence of supports in the person's life. passed since the event, the individual's strengths and coping skills, and the presence In the morning, the family eats breakfast, and the children are allowed to go to the playroom with the other children at the shelter. Joan meets with the nurse and the case worker. They see a bruise on Joan's face, which has developed where Ben hit her the day before. Joan assures them that Ben's action was an isolated incident, caused by frustra- tion, and that he has never hit her before. As they begin to talk about Joan's situation, to her mother. the case worker is able to ascertain exactly what happened, when it happened, and how Joan has coped to this point. The case worker and Joan finally decide that the primary problem is transportation home to Illinois . Together she and Joan begin to explore some options. Joan wants to try to reach her mother's neighbor in hopes of getting a message ????? Implementing the Intervention. The third step in crisis intervention is implementing the intervention. In this case, it may involve only call to the neighbor, who may be able to reach Joan's mother . In other cases, the intervention may be more compli- cated, relying on the skills, creativity, and flexibility of the worker. During this phase, the helper must focus on reality and identify the clients' positive coping mechanisms and support systems. This may help clients deal with feelings that may have been suppressed (such as anger) or feelings that have been denied (such as grief). Resolution of the Crisis. In this final step, the helper and the client plan for the future, reinforcing the new ways of preparing for any new crises that coping and may arise. (Core Joan is finally able to reach her mother, who wires money for bus fare for Joan and the children. While they are waiting for the money to arrive, Joan talks with the helper, expressing her feelings about what happened and verbalizing her need for continued support. In response to Joan's need for support, the case worker gets the necessary information to refer her to a free counseling service at a mental health center near her home in Illinois. As you reflect on the case study, what principles of intervention are illustrated? What roles did the helper play? What skills did the helper use in this situation? How would you describe the outcome? Finally, how is the helping process followed in this example? At the conclusion of the crisis intervention, the client may need to continue with professional services. If the client shows little progress after the crisis intervention, the crisis helpers may recommend more traditional types of problem solving and longer-term services. LO 7-11 RESOLUTION-FOCUSED BRIEF THERAPY response to the demands, guidelines, and funding constraints of managed care, brief therapy has emerged as a strategy to provide help that is limited in time and scope. This brief counseling intervention focuses on reaching specific outcomes in a In relatively short time by making an immediate difference in the client's life, targeting behaviors that need to be changed and facilitating that change, and helping clients make new choices about thinking and behaving. Action is central to resolution-fo- cused helping but takes place rather quickly. It now appears in treatment for chemi- cal dependency, in children and youth services, and in mental health services. Resolution-focused brief therapy is based upon client strengths with a focus on present and the future. This orientation also advocates that small changes make the 188 CHAPTER 7 that helpers and clients can measure the success of client progress. a difference in the lives of clients. For success with each small change, clients begin to believe that they can effect change and continue to grow and develop on their & Zalaquett, 2011). These stages are applied in the two resolution-focused brief There are several stages included in resolution-focused brief therapy (Ivey, Ivey, 1. Relationship building is at the heart of this brief counseling process. The helper Beca assu plan. new thei with ask stre therapy sessions Joan attends once she reaches Illinois. say the she past suc- two as Th ing the establishes rapport and uses listening skills to focus on a precise description of the problem. The helper also assesses client strengths and examples of cessful problem solving. At the beginning of the first session, Mark introduces himself to Joan and asks her to sit down. From a short intake interview, he is able to ascertain information about the crisis Joan and her children experienced. He explains to Joan that his role is to provide a two-session helping experience that will focus on a specific problem she wants to address. Because they only have two sessions, he lets her know that he will ask tions and keep her focused on the present, the future, her strengths, and her positive attributes. Joan explains that she is devastated by all of the responsibility that she is assuming without Ben. She is able to identify her strengths as an ability to problem solve, a commitment to caring for her children, and knowledge of other resources in the area such as her family. clients apy gu ques- KEYT attend bi-dir count 2. The helper continues to identify client strengths by asking the client to talk about a time when she experienced positive outcomes. During this phase, the client does not have to describe the problem in detail; in fact, the focus is really on what successes the client has had so far in dealing with the problem. The helper wants clients to be able to relate their own problems to normal “prob- lems in living.” During this time, the helper and the client continue to look for resources such as client characteristics and skills, support of family and friends, and support of community organizations and institutions. crisis effect CO THIN Mark discovers that Joan has previous experience working as a secretary, has computer skills, is close to her family, makes friends easily, and believes that she is a good mother. Joan explains that sh..

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