Fall 2026 SOWK 486 Week 05 - Communication Skills Day 01

The focus of week five for SOWK 486 is on communication skills. There are many that Hepworth et al. (2023) term as verbal following skills. Rogers (1957), who developed the concept of person-centered counseling, described what he called the facilitative condition. This includes empathy, unconditional positive regard, and congruence. He proposed that when clinicians can maintain these aspects, they can support and help promote positive changes in their clients. The plan for today is to talk about the core skills that help clinicians help their clients. The plan is as follows:

Communicating Informed Consent, Confidentiality, and Agency Policies
The Facilitative Conditions
Empathy
Authenticity
Praise

Learning Objectives

Describe the requirements of substance use disorder confidentiality
Demonstrate an understanding of facilitative conditions (empathy, respect, authenticity) and how to apply them in helping relationships.
Practice recognizing and responding to client emotions using levels of empathic communication and reciprocal empathy strategies.
Apply principles of authenticity to build trust and connection.

Treatment Outcomes

As we have talked about, the relationship and client belief in the process are essential to positive outcomes.

Nearly half of the outcome relies on fundamental skills and abilities that social workers need to learn, apart from the type of treatment offered (As cited by Hepworth – Adams et al., 2008; Miller et al., 2013)

Factor	Percentage
Client or extra-therapeutic factors	40%
Relationship factors	30%
Placebo, hope, and expectancy factors	15%
Model/technique factors	15%

Role Clarification: Helping Clients Have an Idea of What to Expect

Clarifying our expectations is a key intervention for social workers engaging with involuntary clients. This practice is also very beneficial for clients that are more voluntary but sometimes carries less weight or direct impact on the client. We should realize that clients might have unclear or different expectations from what to expect from us. We have a need to help define these things for a clients.

Determine your client expectations: Ask questions to determine what their expectations are. Help them to manage unrealistic or unreasonable expectations.
Emphasize client responsibility: What are the expectations that you or others have of them?
Emphasize difficulties inherent in the process: Making change is hard. Extinction burst and Skinner (1933).
Clarify your own role: What will you be doing, and what expectations can they have of you

[Small Group Activity] Pick a group project that you have. It could be the paper for this class or another assignment. Spend some time clarifying your own roles in that.

(Hepworth et al. 2023)

Reference

Skinner, B. F. (1933). “Resistance to Extinction” in the Process of Conditioning. The Journal of General Psychology, 9(2), 420-429. https://doi.org/10.1080/00221309.1933.9920945

Substance Use Disorder Confidentiality

If you work in a health care setting, you likely have to follow the regulations of HIPAA. If an agency presents itself as providing substance use disorder (SUD) treatment, diagnosis, or referral (an SUD agency, an SUD unit within a hospital or clinic, or staff whose main job is SUD care) and is federally assisted (e.g., receives grant money, accepts Medicaid, or has non-profit status), it must also follow 42 CFR Part 2 (Actionable Intelligence for Social Policy, 2024,).

Purpose of Part 2: “Confidentiality protections help address concerns that discrimination and fear of prosecution deter people from entering treatment for SUD” (U.S. Department of Health and Human Services, 2026, para. 2)
- Records can’t be used to investigate or prosecute the patient without the patient’s consent or a court order, and a subpoena alone isn’t enough (think drug court, probation, and child welfare)
HIPAA and the Additional Requirements for Part 2
- Part 2 was updated on February 8, 2024, to align more closely with HIPAA; compliance was required by February 16, 2026
- Can’t confirm someone is a patient
- Written consent is required. One consent can now cover treatment, payment, and health care operations, but SUD counseling notes need their own separate consent
- The records follow the person who receives them. A notice comes with every disclosure, and most people who receive Part 2 records can’t pass them on (health care providers who get them through a treatment consent can share them under HIPAA’s rules, but never for legal proceedings against the patient). Even if you never work in a Part 2 program, in child welfare, housing, schools, or case management you may receive these records
- Exceptions are narrow: medical emergencies, research, audits, and crimes on program premises or against program staff. For suspected child abuse, the program can make the initial report but can’t release records for the later case without a court order
- There is no clear duty-to-warn exception, so talk with your supervisor and get legal consultation
- In Washington, youth 13 and older can consent to their own outpatient SUD treatment without a parent (RCW 71.34.530). When a minor consents to their own treatment, only the minor can consent to sharing those records (42 CFR § 2.14)

[Content Note] ✅ SUD (r)

(Confidentiality of substance use disorder patient records, 42 C.F.R. pt. 2, 2024) (Outpatient treatment of adolescent, RCW 71.34.530, 2019)

Reference

Actionable Intelligence for Social Policy. (2024). Demystifying 42 CFR Part 2: Legal and ethical use of SUD records. University of Pennsylvania. https://aisp.upenn.edu/wp-content/uploads/2024/12/Final-Demystifying-42-CFR-Part-2.pdf

Confidentiality of substance use disorder patient records, 42 C.F.R. pt. 2 (2024). https://www.ecfr.gov/current/title-42/chapter-I/subchapter-A/part-2

Outpatient treatment of adolescent, RCW 71.34.530 (2019). https://app.leg.wa.gov/rcw/default.aspx?cite=71.34.530

U.S. Department of Health and Human Services. (2026, January 30). Fact sheet: 42 CFR Part 2 final rule. https://www.hhs.gov/hipaa/for-professionals/regulatory-initiatives/fact-sheet-42-cfr-part-2-final-rule/index.html

Facilitative Conditions

Carl Rogers and person-centered counseling emphasize the most basic helping attitudes.

Carl Rogers (1957) initially described the facilitative conditions (or core conditions) in helping relationships as…

Empathy
Unconditional positive regard
Congruence

(I have a paper talking about it from a later date, 1979)

Much of the current research describes these as:

Respect
Authenticity
Empathy

The current iteration of the textbook doesn’t describe the distinction between respect and warmth.

Facilitative conditions are often thought to be the foundation-level skills that undergird many treatment models and help create a positive client–social worker relationship.
Research has mainly supported the correlation of empathy with positive social work outcomes.
The facilitative skills are instrumental in treatment situations with voluntary clients.

[Whole Class Activity] As a whole group, brainstorm antonyms for each facilitative condition. Groups will have a couple of minutes to create a short role-play to do in front of the class to demonstrate the skill. The rest of the class will have to guess what the team is role-playing.

(Hepworth et al., 2023)

Reference

Rogers, C. R. (1979). The foundations of the person-centered approach. Education, 100(2), 98-108.

Developing Perceptiveness to Feelings

With empathy being such an important skill, we need to discuss how we can develop perceptiveness to feelings. Feelings and emotions also exert a powerful influence on behavior and often play a central role in clients’ problems.

To respond to the broad spectrum of emotions and feeling states presented by clients, the social worker must be fully aware of the diversity of human emotions.
- Position of not knowing…
- They also need to take a “not knowing” position of learning what emotional expression means for the particular client in front of them.
It is essential to realize that high-level empathic responding has two parts:
- Self-Awareness and Emotional Regulation
- Empathetic Action

Applicants or voluntary clients often enter into the helping relationship with openness, hoping to explore both their concerns and their related feelings.

(Hepworth et al., 2023)