Week 12: Effecting Change - Empathy, Confrontation, & Barriers

Location: CBC Campus - SWL 206
Time: Wednesday from 5:30-8:15
Week 12: 11/04/19 — 11/10/19
Reading Assignment: Hepworth et al. (2016) Chapter 17 & 18
Topic and Content Area: Effecting Change
Assignments Due: Reading Quiz
Other Important Information: N/A

• Additive Empathy & Interpretation
• Confrontation
• Barriers to change

Taken from Rudish, E. (2013) Increasing empathy: Empathy training manual. Retrieved from http://cultureofempathy.com/References/Experts/Others/Files/Marieke-Kingma-Empathy-Training-Manual.pdf

Time: 60 min

Materials: Flap-over, marker, pencils, paper and enclosure 11

Learning objective: The participant is aware of the fact that every individual has his own point of view and knows the own perspective is not universal. The participant can enter the perspective of the other by focusing the attention on the differences between himself and others and by temporarily putting aside the own references.

[Small Group Activity]

Follow the steps below to perform this exercise with the participants.

1. Write the word OCEAN on the flap-over and ask the participants to close their eyes for a moment and let their senses take over as they imaging OCEAN. See it, smell it, hear it, feel it. Then ask the participants to share their thoughts and feeling when they think about the word OCEAN. Write down what you hear. How are the images different?

   Discuss with the participants how earlier personal experiences filter what we imagine. All of us have slightly different filters that helps us to make meaning of the world. This is why our perceptions are never exactly like anyone else’s (Lieber, 1994).

2. Divide the participants in three groups of four. Each participant will need a pencil and paper. Make three copies of enclosure 11 “Perception Cards” so that each group receives five or six different cards. Beforehand, cut out the card.

3. Explain that the groups may select cards and participants will write down what the word on the card means to them. Then each participant in the group will read their definitions in a go-round. Remind the participants that they don’t interrupt or ask questions during this phase and remind them that the purpose of this exercise is to see how perceptions vary, not to determine a correct definition.This is also an opportunity to monitor for accurate listening skills and temporarily putting aside the own references. Each group may choose three words to use in this exercise.

For example:

1. The group picks the first word they want to define. For example, Freedom.
2. Each participant in the group takes a few minutes to write down a few words or phrases which give the word meaning.
3. When every participant is finished writing, the group goes a go-around, each participant taking turns sharing what they wrote.
4. If there is time left, participants reflect back to further explore the meaning each person shared.
5. After 15 minutes, tell the participants to choose a next word.

In closing this exercise you can check out whether participants understanding of the words on the cards changed after they were discussed in their groups.

Exercise from Lieber (1994)

“Empathy has been defined as perceiving, understanding, experiencing, and responding to the emotional state of another person (Barker, 2003, p. 141).” (Hepworth, p. 513). Decety and Jackson (2004) describe two basic types of empathy.

• Emotional Empathy - as the ability to be affected by a client’s emotions
• Cognitive Empathy - is the translation of such feelings into words

There are three basic components of empathy laid out by the Hepworth text.

• Affective Sharing: Person sharing something to respond to
• Self-Awareness: so that the social worker recognizes himself or herself as different from the person with whom he or she has empathy
• Mental Flexibility: requiring skills in both turning on receptivity and turning it off. Such skills are essential in regulating compassion fatigue by enabling the social worker to separate from the client’s experience (Adams, Boscarinao, & Figley, 2006; Harr & Moore, 2011).

“Additive empathic responses go somewhat beyond what clients have expressed and, therefore, require some degree of inference by social workers. Thus, these responses are moderately interpretive— that is, they interpret forces operating to produce feelings, cognitions, reactions, and behavioral patterns” (Hepworth, p. 513). Cormier, Nurius, and Osborn (2009) describe that

• Lead to Interpretation: Such additive empathic responses lead us to interpretation
• **The identification of patterns, goals, and wishes that clients imply but do not directly state **. Insight through interpretation is the foremost therapeutic principle basic to psychoanalysis and closely related therapies.”

“Levy (1963) classifies interpretations into two categories: semantic and propositional” (Hepworth, p. 514).

Semantic interpretations: describe clients’ experiences according to the social worker’s conceptual vocabulary

“By ‘frustrated,’ I gather you mean you’re feeling hurt and disillusioned.”

-> Semantic interpretations are closely related to additive empathic responses.

Propositional interpretations involve the social worker’s notions or explanations that assert causal relationships among factors involved in clients’ problem situations

“You have a tendency to worry about problems down the road and lose focus on dealing with your anxiety about taking the exam.”

If you never played Pitfall on the Atari (or have no idea what that is, there might be a problem… )

“moderate interpretations (those that reflect feelings that lie at the margin of the client’s experiences) facilitate self-exploration and self-awareness, whereas deep interpretations engender opposition” (Hepworth, p. 514)

We need to remember that we want to make interpretive statements that are closer to the clients own understanding a self image.

• Use additive empathy sparingly until a sound working relationship has evolved
• Employ these responses only when clients are engaged in self-exploration or have shown that they are ready to do so
• Pitch these responses to the edge of clients’ self-awareness and avoid attempting to foster awareness that is remote from clients’ current awareness or experiences
• Avoid making several additive empathic responses in succession
• Phrase interpretive responses in tentative terms
• To determine the accuracy of an interpretive response, carefully note clients’ reactions after offering the interpretation
• If the client responds negatively to an interpretative response, acknowledge your probable error, respond empathically to the client’s reaction, and continue your discussion of the topic under consideration
• When providing an interpretation to a client who is culturally different from the social worker, recognize that the client may not readily understand the message the way it was intended

The following are some ways that we should consider using additive empathy.

• Deeper feelings
  • To identify feelings that are only implied or hinted at in clients’ verbal messages
  • To identify feelings that underlie surface emotions
  • To add intensity to feelings clients have minimized
  • To clarify the nature of feelings clients express only vaguely
  • To identify feelings manifested only nonverbally
  • Challenging beliefs stated as facts

• Underlying meanings of feelings, thoughts, and behavior
• Wants and goals
• Hidden purposes of behavior
• Unrealized strengths and potentialities

[Whole Class Activity] With a partner, have a discussion about a time when they felt frustrated, upset, uneasy, etc. Practice asking good open ended questions and implementing additive empathetic statements.

“Social workers would more appropriately consider confrontation to exist along a continuum that ranges from fostering self-confrontation at one extreme to assertive confrontation at the other extreme” (Hepworth, p. 524) describing information based on Rooney (2009).

Effective assertive confrontations embody four elements

• Expression of concern
• A description of the client’s purported goal, belief, or commitment
• The behavior (or absence of behavior) that is inconsistent or discrepant with the goal, belief, or commitment
• The probable negative outcomes of the discrepant behavior

On page 525 there is possible formula. Work with a partner to practice using the these parts to effective assertive confrontation using an example of how you could address somebody in your life who might need to be confronted.

• Relational dynamics that occur in the interactions between clients and practitioners Behaviors on the part of practitioners
• Dynamics that are challenging in cross-racial and cross-cultural relationships
• Sexual attraction toward clients and the ethical and legal implication of this behavior

Oz, F. (1991). What About Bob?. What About Bob? (1991). Retrieved from http://www.imdb.com/title/tt0103241/

[Discussion] How many of you have seen the movie “What About Bob?”

[Watch] Death Therapy off of What About Bob.

[Discussion] How could this be an example of transference or counter transference? [Not exactly an correct example… but for discussion]

• Transference
  • Psychoanalysis - the redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood.
  • Client has transference to the clinician
• Counter-transference
  • You have transference to the client

[Discussion] What are some examples of transference and counter transference

The recovery model has been updated by SAMMHSA since the publication of the text book and some of the vocabulary has changed from that utilized in the text. There are 10 different themes that SAMMHSA discusses relating to:

The first theme SAMSA describes is hope.

• The belief that recovery is real…
• Essential and motivating message of a better future
• People can and do overcome (internal and external challenges, barriers, and obstacles that confront them).
• Hope is internalized and can be fostered by peers, families, providers, allies, and others.
• Hope is the catalyst of the recovery process.

The second theme regarding recovery is very in line with social work values of self determination.

• Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals.
• Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience.
• In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.

The third understanding that must be had is that recovery occurs via many pathways.

• Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds - including trauma experience that affect and determine their pathway(s) to recovery.
• Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual.
• Recovery pathways are highly personalized.
• They may include…
  • Professional clinical treatment
  • Use of medications
  • Support from families and in schools
  • Faith-based approaches
  • Peer support
  • Other approaches
• Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks.
• Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families.
• Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions.
• Use of tobacco and non-prescribed or illicit drugs is not safe for anyone.
• In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.

A holistic view is the fourth acknowledgment that must be made.

• Recovery encompasses an individual’s whole life, including mind, body, spirit, and community.
• This includes addressing: self-care practices, family, housing, employment, transportation, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, and community participation.
• The array of services and supports available should be integrated and coordinated.

Having recovery supported by peers and allies is an important aspect for clinicians to understand and is the fifth area discussed.

• Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery.
• Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community.
• Through helping others and giving back to the community, one helps one’s self.
• Peer operated supports and services provide important resources to assist people along their journeys of recovery and wellness.
• Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths.
• While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.

The sixth factor in the recovery process is understanding that recovery is supported through relationship and social networks.

• An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.
• Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.

The seventh area addressed is that of culturally based services and influences.

• Culture and cultural background in all of its diverse representations including values, traditions,and beliefs are keys in determining a person’s journey and unique pathway to recovery.__ Services should be culturally grounded__, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.

Addressing trauma is the eighth area of focus for recovery.

• The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues.
• Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.

The ninth area to evaluate is that of responsibility.

• Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.
• Empowerment: In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery.
• Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery.
• Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.

The tenth and final understanding is that of respect.

• Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems including protecting their rights and eliminating discrimination are crucial in achieving recovery.
• There is a need to acknowledge that taking steps towards recovery may require great courage.
• Self acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.