1) Assess motivation by examining the client strength and direction
2) Identify barriers to building rapport
- Beliefs about seeking treatment
- Is the treatment voluntary or court ordered
- assess cultural issues and be sensitive to differences
3) Remove barriers to rapport an increase motivation:
- Engage in warm up period.
- Facilitate expression of feelings
- Reframe
- Stress benefits and incentives
- Foster hope
4) Develop a rapport:
- Focus on immediate concerns
- Focus on emotional states
- Relate genuinely
- Respond empathetically
Engaging the client
- Attending = maintaining attentiveness expressed through appropriate verbal following, eye contact, and body language
- Paraphrasing =the social worker expresses the idea of what the client has just said. The relevant points are emphasized.
- Reflection-Affective component= Worker clarifiesand shows the client what he is or her feelings are at the moment. Further expression is also encouraged. Finally, the understanding of those feelings are fostered.
- Clarification
- Leading
- Summarization
- Support
- Approval
- Confrontation
- Interpretation
- Information
- Instruction
Communicating with clients
Facial expressions, posture, voice, physical proximity, moralizing/sermonizing, premature advice giving, persuasion, judging, criticizing, inappropriate interpretation, sympathizing, sarcasm, threats, inappropriate use of questions, excessive interpretation, dominating the interaction, fostering social Interaction, passivity, parroting and using clichés, dwelling on remote past, inappropriate self-disclosure
Barriers to communication with clients
Goal setting and formulating contracts
Types of goals
Discrete (one time activity)
Continuous goals
Goal setting and formulating contracts
Selecting and defining goals
- The client should have a role in goal setting
- The client and therapist need to devise explicit and measurable Goals
- The goals must be feasible
- The therapist should only participate in treating clients if it is within the scope of the social workers license and competence
- Goal should be stated in positive terms to help instill hope and accentuate strength
Goal setting and formulating contracts
Negotiating goals with clients
- Determine the clients readiness to negotiate goals
- Explain the purpose of the goals and language that is meaningful to the client
- Therapist and clients select goals mutually
- Goals must be defined explicitly
- Discuss the risk as well as the benefits of each goal
- Rank goals in accordance with what is most important to the client
Goal setting and formulating contracts
Contracting
The contract should include:
- Ranked goals
- Social workers and clients goals
- Interventions and techniques that will be Used
- Time-frame, frequency and length of sessions
- a description of how progress will be monitored
- Terms for renegotiation of the contract and details of each renegotiation
- Office policies (fees, procedure for cancellations, fee for missed appointment etc.)
- An update on the clients progress at each session
Goal setting and formulating contracts
Facilitating desired change
- The clients right to self – determination is primary. Self – determination is an ethical principle in the field of social work which recognizes the rights and needs of clients to be free to make their own choices and decisions. The social worker helps the client know what the resources and choices are and what the consequences of selecting any one of them may be.
- The clients rights to self – determination may be bypassed when the clients life is threatened or when an individual cannot care for her/himself.
- This social worker’s use of self to facilitate desired change is another important element:
- the social worker should be congruent and authentic
- the social worker should you self – disclosure appropriately
- The social worker should respond to personal questions in a professional way
- The social worker should give positive feedback to the client
- This social worker should model assertive behavior at all times
- The social worker should maintain the continuity of the session
Goal setting and formulating contracts
Termination
- The conclusion of the worker/client intervention relationship is called termination
- Termination should occur:
- When goals are reached
- When the time limit for therapy is up
- When the client is no longer interested in continuing therapy
- Termination must be planned from the first session forward
- The following our techniques for fostering a successful termination:
* Explore emotions and issues related to termination
* Develop a treatment plan that allows positive outcomes to be transferred to real-life settings
* Acknowledge client progress
* Note and support clients efforts toward achieving positive outcomes
* Include discussions about anticipating and resolving future difficulties
* Include discussions about how to find additional resources to call on as future needs indicate - The following are possible client reactions to termination:
* Resistance to termination
* Relief and a feeling of competence
* Anger, denial, frustration, guilt, embarrassment (If the client feels conflicted about termination)
* Regression
* Flight into illness= Client family exhibit new symptoms of the presenting problem(It is considered to stem from over dependence on the social worker) - The following are possible social worker reactions to termination:
* Belief that more could’ve been done to help the client
* Frustration
* Relief and a feeling of competence
Goal setting and formulating contracts
Getting a psychosocial history
- The following are sources of information about the client:-Client(ask questions at interview and have client fill out personal data on intake forms)
- Direct observation of the client( Nonverbal behavior and social interactions)
- Collateral sources(Physicians report etc.)
- Psychological test like:- Mental status exam= A systematic evaluation of individuals level of psychosocial intellectual and emotional functioning
- Clinical test(Beck Depression inventory etc.)
- Vocational test(Myers Briggs, strong vocational interest blank)
- Intelligence test(WAI S – R, WISC – R, WRAT – R, Stanford – Binet)
- Neuropsychological test(luria Nebraska, halstead – reitan)
- Personality test(MCMI, Milan, MMPI)
- Marriage and family self–report scale
- A psychosocial assessment is the social workers summary judgment of the problem to be solved. It should be considered a work in progress throughout therapy. Psychosocial assessments include:
- a description of the family (Current and family of origin)
- a description of the clients health and physical functioning (To rule out organicity)
- a description of the clients interpersonal relationships
- a description of the clients work/school level or experience and current functioning
- A cursory examination for addictive/compulsive disorder
- An indication of the clients current mental functioning
- An examination of the client culture and background
- The problem system must also be addressed during this phase. The following areas must be examined:
- Intrapersonal functioning= Cognitive/perceptual, behavioral, emotional, physical
- Interpersonal functioning= Boundaries, family power structure, family decision-making process, family goals, family affective functioning, communication styles, family roles, family myths, family strengths
Goal setting and formulating contracts
Stages of assessment and intervention
- Initial session
- Create a therapeutic framework
- Assess for crisis
- Respond to crisis
- Address fees, limits to confidentiality, office rules etc.
- Make a provisional assessment and diagnosis
Goal setting and formulating contracts
Stages of assessment and intervention
- Early stages
- Complete an in–depth assessment
- Set goals,formulate contracts
- Choose treatment modality
- Choose intervention strategies
- Make necessary referrals
- Educate client about problem, therapy etc.
- Assign homework
Goal setting and formulating contracts
Stages of assessment and intervention
- Middle stages
- Implement treatment plan
- Evaluate progress
- Examine resistance
- Examine barriers to change
Goal setting and formulating contracts
Stages of assessment and intervention
- Late stages
- Focus on in–depth exploration
- Support client as he/she adjust to change
Goal setting and formulating contracts
Stages of assessment and intervention
- Termination
- Review progress
- Deal with client disappointment
- Make plans for action that will be taken if future problems arise
- Address feelings about termination
- Refer to additional resources
- Schedule follow–up appointment (2-3 months)
Goal setting and formulating contracts
Types of interventions used by social workers
Not an exhaustive list
Goal setting and formulating contracts
Types of interventions used by social workers
Directly representing or defending others. Championing the rights of individuals or communities through direct intervention and empowerment.
Advocacy
Goal setting and formulating contracts
Types of interventions used by social workers
A program designed to teach individuals to express their feelings, needs, and demands directly and effectively
Assertiveness training
Goal setting and formulating contracts
Types of interventions used by social workers
Verbalization and other expression of ideas, fears, past significant events, and associations. The result is a release of tension or anxiety.
Catharsis
Goal setting and formulating contracts
Types of interventions used by social workers
The act of bringing together opposing ideas, impulses, or groups for the purpose of systematic examination or comparison.
Confrontation
Goal setting and formulating contracts
Types of interventions used by social workers
A technique in which an agreement is made specifying the behaviors to be performed for certain consequences to follow.
Contingency contracting
Goal setting and formulating contracts
Types of interventions used by social workers
This social worker offers advice, suggestions, information about resources, and prescriptions for more effective behavior.
Directive therapy
Goal setting and formulating contracts
Types of interventions used by social workers
This therapist analyzes the latent content of a clients dreams.
Dream work
Goal setting and formulating contracts
Types of interventions used by social workers
The act of perceiving, understanding, experiencing, and responding to the emotional state of another.
Empathy
