Week 04 - Overview of the Helping Process

SOWK 486 Fall 2019 Planning: Class 04

Location: CBC Campus - SWL 206
Time: Wednesday from 5:30-8:15
Week 04: 09/09/19 — 09/15/19
Reading Assignment: Hepworth et al. (2017) Chapters 3 & 4
Topic and Content Area: How Do We Help
Assignments Due: Reading Quiz
Other Important Information: N/A

First Impressions: Who Would You Want to Meet

Making a good impression is essential.

[Small Group Activity] Think of a person you would want to meet in history. Ask them to imagine that they have won a competition to meet and interview that person this afternoon for a local TV station. Talk with a partner about the following:

• what would you do?
• what would you wear?
• how would you feel?

[Whole Class Activity - Discussion] Lead the discussion to get them to recognise they would make an effort with their appearance and their behaviour because they wanted to impress the person.

Relate this to making a good impression with clients and collegues

appearance body language greeting answering a query / helping the customer housekeeping and tidiness

Activity Information: This is a useful exercise to demonstrate to the group the importance of creating good impression.

Good for: team meetings, customer service training, refresher and review sessions. This exercise works well where people work face to face with customers

Length: Can vary depending on the time you have available, the size of group, and whether you do this in full group or in pairs. Suggested running time 15 - 30 minutes.

Customer Service Training Helper (n.d.) Training activity good impressions. Retrieved from https://www.customer-service-training-helper.com/training-activity-good-impressions.html

Agenda

• Overview of the three phases of the the helping process
• Setting the environment
• Interviewing clients

Phases of the Helping Process

There are three phases outlined in the text regarding the helping process. This semester we will be going more in-depth through them as the weeks go on. Today is meant to be more of a introduction to the overall process.

Phase I: Exploration, Engagement, Assessment, and Planning Phase II: Implementation and Goal Attainment Phase III: Evaluation and Termination

Phase I: Exploration, Engagement, Assessment, and Planning

Exploring Clients’ Problems

For every one of us, first impressions matter. The first meeting with a client is important and we should attempt to make it as good as possible.

[Small Group Activity] Share a positive first impression that you had of somebody and how it impacted your relationship with them.

• Explaining the process the, the services, and yourself
  • Potential clients may be anxious about the prospect of seeking help and lack knowledge about what to expect
  • First impressions.

Establishing rapport and enhancing motivation - Rapport

Rapport is one of the most important aspect of the client clinician relationship, and is highly related to positive outcomes. This rapport can also be connected to a clients motivation and willingness to change.

[Partner Group Activity] Talk to a partner about somebody that you have a really strong rapport with. Talk about how that relationship is, and how you know that you have a good rapport with them

[Small Group Activity] Turn your partners to groups of four, and discuss how you know that you have good rapport with that somebody, what it looks like

[Whole Class Activity] Brainstorm writing on the white board potential ways of developing rapport with clients.

Strategies and Behaviors that Improve Client Trust (1 of 2)

Leach (2015) describes some strategies and behaviors that improve client trust, communication and rapport.

Maintain:

• Client comfort
• Confidentiality & trust
• Enthusiasm
• A collaborative relationship
• Interest in client concerns
• Objectivity
• Attentiveness
• Eye contact
• An open posture

Avoid:

• Passing judgement
• Jargon and technical language
• An authoritarian demeanor
• Interruptions

Strategies and Behaviors that Improve Client Trust (2 of 2)

Leach goes on to talk about how we should be and what we should use.

Be:

• Dependable
• Open minded
• Flexible
• Reassuring & supportive
• Confident
• Friendly
• Genuine
• Warm
• Sincere
• Honest
• Empowering
• Engaging and interactive
• Respectful of client wishes and needs
• Sensitive
• Empathetic
• Altruistic

Use:

• Open-ended questions
• Rationales for procedures, treatments and decisions

Leach, M. J. (2005). Rapport: A key to treatment success. Complementary Therapies in Clinical Practice, 11(4), 262–265. https://doi.org/10.1016/j.ctcp.2005.05.005

Who's Guiding the Interview

[Activity] Watch video clip from The Office: Who’s Leading the Interview

[Whole Class Activity] Who was leading the interview

This is not what we want to happen in our session.

Starting the Interview - Overview

With this understanding the importance of both starting the client / worker relationship and developing rapport, the start of the interview is where this beginnings. Kirst-Ashman and Hull (2015) describes strategies we should be using as we start an interview. These include:

• Purpose
• Setting
• Preparedness
• Starting

Starting the Interview - Purpose

Making sure that we are clear as to what the purpose is

Discuss the way the concept of an interview

• The major goal of any interview is effective communication with the client.
• Interviews make use of communication with clients to solve problems, encourage positive change and promote clients well being.

Starting the Interview - Setting

Thinking about what the setting is of the interview is aso important.

• Variety of Settings: The interview setting can occur in a variety of settings depending on the field of practice and type of agency.
• How do we present ourselves?
  • When deciding how to dress for an interview is important to remember that your general appearance will make an impression.
  • You want to be aware of how the clients react to how you dress.
• Timeliness Be prompt so that the client sees that you feel the time spent with them is important.

Office Setup -- Feng Shui

“In it’s highest and purest form, good feng shui signifies perfect alignment between inner and outer worlds.” ~ Lada Ray

(in Chinese thought) a system of laws considered to govern spatial arrangement and orientation in relation to the flow of energy (qi), and whose favorable or unfavorable effects are taken into account when siting and designing buildings.

I’m not going to tell you how to set up your office… I’m not going to tell you, “sit behind a desk!” or “don’t sit behind a desk.”

[Discussion] What do you believe is important to think about when you evaluate your meeting space?

[Discussion] What is important to think about when you are evaluating your meeting space in some other location?

We should be thinking about what we do, why we do it, and how we do it. Reevaluating our practice.

Starting the Interview - Preparedness

To make a positive impression, we should be prepared prior to the interview.

• What information do you need to gather?
• How long is the interview time frame (i.e. when it is to start and when it is to end).
• Identify the purpose: you should have an idea of what you want to accomplish by the end of the interview.

Starting the Interview - Starting

Once we have determined the purpose, setting and are prepared… we have to actually start the interview.

• Greeting
  • Initial introductions names are exchanged with typical pleasantries such as “Its nice to meet you.”
  • Using surnames is a good idea since it implies greater respect
  • Handshakes are often appropriate, when culturally appropriate.
  • [Discussion] Regarding surnames / formal language (ES)
• Alleviate clients anxiety (think unknown)
  • Alleviating the clients anxiety, you do this by starting where the client is, or putting yourself in the clients shoes.
  • The client may have many questions as to what to expect from the interview and this causes anxiety or you may get someone that is forced to see you and it will be important for you to use your empathy skills at this point to help the client feel less agitated.
  • Portray confidence and competence

Discuss how I generally start my initial contact

• Beginning statement of purpose and role.
• Clearly explain the interview’s purpose to the client
• Workers role to the client
• Encouraging the client to share thoughts and feelings about the interview an what’s being said
• Make a statement about the usefulness of the intervention process

The Initial Interview

This initial interview introduction could be used to present for your role play video (along with some further questions related to an assessment).

[Whole Class Activity] Demonstrate the initial interview process

• Beginning statement of purpose and role.
• Clearly explain the interview’s purpose to the client
• Workers role to the client
• Encouraging the client to share thoughts and feelings about the interview an what’s being said
• Make a statement about the usefulness of the intervention process

[Small Group Activity] Working with partners, practice doing this initial part of the interview.

[Whole Class Activity] Have one or two volunteers come and do the initial part as well.

Interview Structure

Effective interviews conform to a general structure, share certain properties, and reflect the interviewer’s use of certain basic skills.

• Rapport with clients fosters open and free communication, which is the hallmark of effective interviews.
• Starting with client motivation aids social workers in establishing and sustaining rapport and in maintaining psychological contact with clients.
• When ethnic minority and immigrant clients have virtually no command of the English language, effective communication requires the use of an interpreter of the same ethnicity as the client, so that the social worker and client bridge both cultural value differences and language differences.

Discussing Problematic Situations

When clients indicate that they are ready to discuss their problematic situations, it is appropriate to begin the process of exploring their concerns.

• Before exploring problems, it is important to determine clients’ expectations…
• Cultural Differences: can vary considerably and are influenced by socioeconomic level, cultural background, level of sophistication, and previous experience with helping professionals.
• During the exploration process, the social worker assesses the significance of information revealed as the client discusses problems and interacts with the social worker, group members, or significant others.

Focus in Depth

In addition to possessing discrete skills needed to elicit detailed information, social workers must be able to maintain the focus on problems until they have elicited comprehensive information.

• Outlines that list essential questions to be answered for a given situation or problem can prove extremely helpful to beginning social workers.
• During the process of exploration, social workers must be keenly sensitive to clients’ moment-to-moment emotional reactions and to the part that emotional patterns play in their difficulties.
• Because thought patterns, beliefs, and attitudes are powerful determinants of behavior, it is important to explore clients’ opinions and interpretations of those circumstances and events deemed salient to their difficulties.
• Because of the prevalence and magnitude of problems associated with substance abuse, violence, and sexual abuse in the society, the possibility that these problems contribute to or represent the primary source of clients’ difficulties should be routinely explored.

Process of Goal Negotiation

Social workers introduce the process of goal negotiation by explaining the rationale for formulating the goals.

• Ending the interview process During the final portion of the interview process, social workers should suggest the length and frequency of sessions, who will participate in them, the means of accomplishing goals, the duration of the helping period, fees, and other relevant matters.
• Continued use of interviewing skills: During Phase II of the helping process, interviewing skills are used to help clients accomplish their goals.

Establishing rapport and enhancing motivation - Other

Along with rapport, there are other important factors that we need to consider as we think about the clinician goal of Establishing rapport and enhancing motivation.

• Strengths-based approach
  • [Whole Class Activity] Discuss what is strengths-based approach
  • Discuss functional strengths vs. strengths
  • Assists in both establishing rapport and enhancing motivation.
• Stages of change
  • especially pre-contemplation and contemplation

Formulating a multidimensional assessment of the problem, identifying systems that play a significant role in the difficulties, and identifying relevant resources that can be tapped or must be developed

“Exploration begins by attending to the emotional states and immediate concerns manifested by the client. Gradually, the social worker broadens the exploration to encompass relevant systems (individual, interpersonal, and environmental) and explores the most critical aspects of the problem in depth.” (Hepworth 40)

Formulating a multidimensional assessment

Formulating a multidimensional assessment of the problem, identifying systems that play a significant role in the difficulties, and identifying relevant resources that can be tapped or must be developed

Social workers end up taking moment by moment assessments of a clients…

• Behavior
• Thoughts
• Beliefs
• Emotions
• Information revealed (during an interview)

Goals

Mutually negotiating goals to be accomplished in remedying or alleviating problems and formulating a contract

• Formulating a contact
• Solution-focused approach
  • My view of solution-focused brief therapy
  • Guiding principles of solution focused approach being that clients have the solution within them… —> Next Slide

Why not having solution to all of their concerns.

The text states…

“we do not assume that all clients have within them the solutions to all of their concerns”

[Small Group Activity] Discuss in small groups why you think that the authors chose to specifically not endorse this concept?

Making referrals

Another important aspect of the first phase of the helping process is that of making referrals.

“Linking clients to other resource systems requires careful handling if clients are to follow through in seeking and obtaining essential resources.”

Phase II: Implementation and Goal Attainment

implementation and goal attainment are the second phase of the helping process.

Phase II: Implementation and Goal Attainment

There are a number of goals and tasks that a a clinician must accomplish during the implementation and goal attainment phase. These include…

1. Prioritize goals into general and specific tasks
2. Select and implement interventions
3. Plan task implementation, enhancing self-efficacy
4. Maintain focus within sessions

Phase II: Implementation and Goal Attainment

5. Maintain continuity between sessions
6. Monitor progress
7. Identify and address barriers to change
8. Employ appropriate self-disclosure and assertiveness to facilitate change

Phase II: Implementation and Goal Attainment

There are a number of factors that need to be evaluated as a part of the implementation and goal attainment phase. These include

• Enhancing self-efficacy: “an expectation or belief that one can successfully accomplish tasks or perform behaviors associated with specified goals”
• Monitoring progress
  • We monitor for progress because…
  • To evaluate the effectiveness of change in strategies and interventions
  • To guide efforts toward goal attainment
  • To keep abreast of clients progress or lack of progress
  • To concentrate on goal attainment and evaluate progress
• Barriers to goal attainment
  • Can be micro, mezzo and macro
• Relational reactions
  • Trigger (both client and clinician)
  • Transference
  • Counter-transference
• Enhancing clients’ self awareness
  • Use of therapeutic techniques (empathetic responses)
  • Difference between additive empathetic response (interpretation, confronting) and reciprocal empathetic response (i.e. restating, rephrasing, summarizing)
• Use of of self
  • Genuineness (basic skills along with empathy and warmth)
  • Assertive about boundaries
  • Self disclosure
    • simple, not detailed, purposeful

Phase III: Evaluation and Termination - Tasks

1. Assessing when client goals have been satisfactorily attained
2. Helping the client develop strategies that maintain change and continue growth following the termination
3. Successfully terminating the helping relationship”

Phase III: Evaluation and Termination - Considerations

• Successfully terminating the helping relationship (difficulty of returning to an environment)
• Planning change maintenance strategies
  • Following up
  • Importance of