Chapter 7

Exploring

A Look… …Into the Client Box

Perspective

 Each of us lives within our own unique situation from which we interpret and discover meaning.

 Although we can never fully understand the situation of another we can approach a better understanding.

 More importantly, the client can increase their own understanding - that is really the whole point.

The Client…

What you see and what you don’t… What you must go beneath to gain understanding of…

The outside vs. the inside

     We are all composed of outer and inner shells It is easier for people to see and judge the outer It is harder for people to see and judge the inner We can also mask the inside through altering our outside appearance Let’s see how good we are at recognizing a discrepancy between human real and fake smiles  http://www.bbc.co.uk/science/humanbody/mind/s urveys/smiles/index.shtml

Guess What?

 Most people are surprisingly bad at spotting fake smiles.  One possible explanation for this is that it may be easier for people to get along if they don't always know what others are really feeling.  Fake smiles can be performed at will  Genuine smiles, on the other hand, are generated by the unconscious brain  Social workers often have to decipher with respect to the client system and situation that which is genuine and real

Assumptions

 Be careful of possible assumptions you may make about clients and their environments and situations.

 Intuition, hunches, and assumptions can be correct but can just as easily be wrong.

 Let the client tell their tale.

Caution!

Explorer

Social Workers can be powerful mediums Interaction of Social worker and client Increased Client and Worker Understanding and Insight Can Lead to and Decreased Resistance and Misunderstanding

The Video Example

 Dan sits before you upset. He is a resident in Orthopedics. A six foot six former university football tackle, he passed up a CFL career to come into Medicine and has never regretted his decision. Up to now he has shown lots of promise but his girlfriend has recently split up with him and moved out of the apartment. He has contacted her repeatedly to try to reconcile but has not been successful. He is distraught and wants to drop out of his program to get his relationship back on track.

Video

 As you watch play close attention to the client therapist interaction  Identify the different interview phases  Write down all of the skills the therapist uses  Write down all of the techniques the therapist uses  Write down the main problem/issue

Exploring

   This section contains the seven essential skills which social workers use throughout their careers in almost any setting.

Exploring involves examining the status of the problems/issues of the client within context Through this:    You can engage the client in a deeper and more meaningful way.

The client gains greater self-awareness. You gain a better understanding of the genuine and true nature of client and their inner core.

Keep in Mind…

There are so many things about a client that can be explored There are so many things about a client that need to be explored with caution There are so many things about a client that are fragile

Culturally Valued Competencies

Personal, Interpersonal, Behavioral, Academic, Artistic, Physical

Individual Factors

Personal Resources

Self-Efficacy Coping Skills Relationship Skills Problem Solving Skills

Personal Vulnerability

Personal History Family History Disability

Exploring with the The Conceptual Model of Psychological Well Being

Cultural Factors

Social-Cultural Resources

Peer Group School Staff Family/Relatives Neighbors Religious Community Mental Health Facilities

Cultural Norms

Gender Roles Peer Relationships Adult-Child Relationships

Socialization Agents

Parents, Teachers, Peers, Media

Socialization Practices

Discipline, Education, Modeling,

Social-Cultural Stressors

Community Violence Family Conflict Bullying/Harassment Poverty Adapted from Nastasi, Varjas, Sarkaar, & Jayasena, 1998

Exploring & Empowerment

 Through this process you are facilitating the process of self-discovery for the client.

 Thinking you know what the client should do, and telling them what to do, is almost always totally ineffective.

 You empower the client to discover their own path through exploration of their situation.

Person-In-Environment

 Conceptualization of the total person is a value and skill within social work practice.  One tool for understanding the person-in environment (PIE) is the exploration matrix.

 Remember, you and the client are both involved in a process of discovery. Use of the matrix increases understanding for both you and the client.

The Exploration Matrix



The exploration matrix is a holistic method of exploring the many dimensions of a client situation.

  Within the matrix you explore  the issue   the person the situation Within context of the    past present future

Exploration Matrix

Exploration Matrix

 Moving systematically through the matrix provides a logical method of obtaining information in a useful format.

 Full exploration of the problem/issue requires finding out about:

Onset Evolution Frequency Intensity/severity Situational Context Duration

Strengths

List some popular and common words used to describe PERSONAL STRENGTHS

Additional Strength Words

Seek first to understand who you are so you can be clear to others--

Remember…Clients Have Strengths Too

 According to Saleeby, almost anything can be considered a strength under certain circumstances. This includes:  What people have learned about themselves and others        Personal qualities, traits, and virtues What people know about the world around them Talents people have Cultural and personal stories and lore Pride The community Spirituality

The Search For Strengths

  Occurs by:  Asking Questions  Seeking responses  Listening Actively Should occur only after client problems and/or have been explored and discussed

Competencies Social Support Successes Life Lessons Person Situation Issue

Strengths Based Assessment Questions

     Survival questions:  How have you managed to overcome/ survive the challenges that you have faced? “What have you learned about yourself and your world during those struggles?” Support questions:  Who are the people that you can rely on? Who has made you feel understood, supported, or encouraged? Exception questions:  “When things were going well in life, what was different?” Possibility questions:  What are your hopes for your future, or the future of your family?

Esteem questions:  What makes you proud about yourself? What positive things do people say about you?

Additional Resources for Assessing Client Strengths

 Child Strengths Checklist  http://health.utah.gov/able/PDF_forms/handouts /StrengthChecklist.pdf

Interviewing Skills

List as many interviewing skills as you can…

(Some) Interviewing Skills

1. Introduction/Purpose 2. Non-verbal cues 3. Asking about feelings 4. Following up on feelings 5. Body language/eye contact 6. Open-ended questions 7. Closed-ended questions 8. Effective confrontation 9. Reflecting 10.Paraphrasing

11.Advice giving with caution 12.Facts vs. feelings 13.Termination

Attentive listening

More Interviewing Skills

Facial Expression Encourage -ment Portraying Compe tence Clarifi cation Empower ment Client self determin ation Dress Reflecting Self disclosure Body positioning Initial Intro The setting Clarifying Summar ization Warmth Alleviate anxiety Opening statement Interpre tation Eliciting info Empathy & Genuine ness Portraying confidence Rephras ing Providing Info The use of WHY?

Interview Skills for Exploring

The Seven Basic Exploring Skills These are skills for facilitating the exploration of the client situation.

REMEMBER…

WHAT

and

HOW

You Do and Say

MATTERS

Exploration Skills

This section covers seven particular skills for exploring the client situation.



Asking questions



Seeking Clarification



Reflecting Content



Reflecting Feelings



Reflecting Feelings & Meaning



Partializing



Going Beyond

Asking Questions

Who?

What?

When Where?

Appropriate Questions?

 In the classroom you are usually free to ask whatever question you like as long as it has even the most vague connection to the subject matter.

“There are no stupid questions.”

 This luxury does not exist when working with clients.

 The classroom and to some extent your field placdements exists for your edification the consulting room for that of the client.

Asking Questions

 In general, asking questions is a skill which helps the worker to elicit ideas, facts, feelings and to identify strengths.

 Questions help to facilitate the process of understanding the person-in-environment (PIE) and in building a working relationship.

Types of Questions

Open Questions

 Elicit information

Questions

Closed Questions

 Gather specific information   What did you think of the movie?

How would you describe your relationship with your parents?

 Did you like the movie?

 Do you have a good relationship with your parents?

Combining Open and Closed Questions

How would you describe your marriage?

What do you enjoy about the relationship?

What are these arguments like?

Have you and your husband ever separated?

How long have you been married?

CHANGING CLOSED TO OPEN

 Are you having troubles with your partner?

 What is your relationship with your partner like?

CHANGING CLOSED TO OPEN

 Are you feeling stressed now?

 How are you feeling right now?

WHEN CLOSED QUESTIONS ARE GOOD

 You need to intervene in a crisis situation e.g. Do you have a plan to kill yourself?

 When you require specific information – e.g. Are you going to hurt your girlfriend because she broke up with you?

WHY?

    Why haven’t you resolved this issue?

Why do you feel that way?

Why do you put up with your abusive husband?

Why do you tolerate your daughter’s behavior?



The Problem with Why type questions is that:

 They put people on the spot  Pressure the client to provide an explanation when they don’t know

WHY

VS.

OPEN

QUESTIONS

Why are you failing that course?

 Could you tell me about the difficulties you are having with your course?

 What are some of the things that trouble you about your coursework?

TRIED AND TRUE QUESTIONS

          What brings you here to see me?

What prompts you to come now to talk?

How did you think I might help?

Where would you like to begin?

Can you tell me more about your situation?

Can you elaborate some on what you just said?

Can you say more about it?

Could you put that in other words so I can understand better?

Does what I am saying make any sense?

Seeking Clarification

   Asking questions to have the client explain or expand on what they have said.

Helps worker understand an ambiguous message Confirms the accuracy of worker’s perception  Examples of simple but effective clarification questions:  

What does that mean?

What do you mean by ___________?

   

Could you be more specific?

Are you saying that….

Could you describe for me… Say what you mean by…

Activity: Answer the following questions?

What thoughts are you having about being in class today?

What are the feelings that go along with these thoughts?

Reflecting Content

   With this skill you rephrase, or paraphrase, what the client has said.

This skill helps you to communicate your attentiveness while the client speaks.

It also helps you to check your own understanding of often complicated situations.

 You’re saying………………   C: I’m a full-time student and worker. Every day I attend classes in the morning and work in the afternoon. W: You’re saying that…

COMPLETE THE REFLECTION

Reflecting Feelings

 A brief response indicating your understanding of the

emotional

content of the client experience.

 Reflecting feelings has 3 steps    Recall and restate message covertly Identify the emotional part of the message by looking for one or more feelings words used by client Translate the client’s feeling word into your own words at about the same intensity and verbally reflect

 Reflecting feelings is the affective equivalent of paraphrasing content    Client: Everything is humdrum. There is nothing going on, nothing exciting. All my friends are away. I wish I had some money to do something different COME UP WITH both a content and feeling response W (content paraphrase): with your friends gone and no money, there is nothing for you to do right now.

 W (feeling reflection): sounds like you’re feeling bored with the way things are for you right now.

Feeling Word Vocabulary

 It is useful to increase your vocabulary when it comes to FEELING WORDS  How many words do you know for:  Open  Happy  Alive  Good

See: http://www.psychpage.com/learnin g/library/assess/feelings.html

for vocabulary list for feeling words

Role Play on Reflection

I need two volunteers One to play client (S) One to play therapist (D) All you have to do is read a couple of statements on the next slide

Therapist Reflection…Caution

 S: "I'm very depressed today, Doctor." D: "You're very depressed, Mr. Smith." S: "Yes. I haven't been this depressed in a long time." D: "You haven't been this depressed in a long time." S: "I'm so depressed that I'm thinking about killing myself." D: "You're thinking about killing yourself." S: "I'd like to kill myself right now." D: "You'd like to kill yourself right now." S: "Yes, I'm so desperate that I think I'll open this window and jump out." D: "You're thinking of jumping out that window." S: "I'm gonna do it. See? I'm opening the window.... and I'm gonna jump." D: "You're going to jump out the window." S: "Bye, doc. Here I go........ aaaaaaaaaaaaaaaaaaaaah" (splat) D: "Aaaaaaaaaaaaaaaaaaaaaah, splat."

The Role Play

 The role play illustrates the opinion that the basic technique of reflection, by itself, is not sufficient for effective therapy.  Reflection is deceptively simple .  While it may be used in a clumsy, superficial manner, it can also be applied as a versatile and powerful lens for helping a client uncover and clarify extremely important intra-psychic issues

Reflecting Feeling & Meaning

    This is a step beyond reflecting feeling/emotion.

This is a dual reflection of both emotional and informational content. This skill requires that you are able to track the content of what is being said as well as the emotional undercurrent. Remember, what is being said and the feeling behind it might not be congruent.

It is common for individuals to have a preference of one style of communication (emotional vs factual) over another.

Examples of Reflecting Feeling & Meaning

Examples:



You feel_______because________.



You feel_______and____________.



You feel_______but____________.

Partializing

 Clients are often overwhelmed more by sheer number of issues than by the magnitude of any one single issue.

 This skill has two advantages:  Helps the client to prioritize and focus.

 Allows an otherwise overwhelming situation to be broken up into smaller achievable tasks.

 Often progress in one area will have a positive impact on other areas. A chain-reaction.

Partializing

 Client situations can be complex and overwhelming. To you and to them.

 Partializing allows you to break down the totality of the client situation into incremental pieces and then triage what needs to be addressed first.

Partializing Another Perspective

The client is at point A and needs to move to point G.

A B C D E F G

Going from A…C might be all that is required!

Where to start?

   The client system is like a circle with an infinite number of points along the surface. Collaboration with the client on what point to intervene is imperative.

Intervention at ANY point will influence each and every other point.

Client System

Partializing

 Partializing will help you and the client work together to decide what area on the circle should be the starting point.

 Remember: In Partializing you reduce the overwhelming nature of a situation and foster hope by focusing on smaller units.

Partializing Practice

   You’ve addressed a number of topics here. ……… once.

Could we explore them on at a time? You’ve talked about …………, ………….., ……., and There are so many aspects of what you’ve said that we could lose track if we try to consider them all at

Yes

Which would you like to consider first? Would it make sense to start with ………….?

important to you right now.

That seems to be very

Going Beyond

 Going beyond is a slight extension of what has been said using your empathic understanding, reasoning and experience.

 Avoid large jumps which may be inaccurate or which can rob the client of the process of discovering something for themselves.

Going Beyond

   Going beyond is your ability to extend slightly what has been said.

It is the process called

additive empathy

.

Going beyond often combines what is being said verbally with it’s emotive content.

Acquiring Competency

 These are not the types of skills which can be absorbed solely on an intellectual level.

 Acquiring these skills requires both intellectual understanding and practice.

 It also takes TIME and PATIENCE

Review

These are the specific areas we covered:  Asking questions  Seeking Clarification  Reflecting Content  Reflecting Feelings  Reflecting Feelings & Meaning  Partializing  Going Beyond