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Practice II: Interpersonal Skills SOW 3352 The Interview Attending and Listening Nonverbal Communication All Cultures Have Helpers These helpers include neighbors and community members, organizations, groups to whom many people turn for advice, consolation, and concrete resources: examples Culture? of helpers in your community? Family? Older Terms for helpers Shamans Elders Curanderos Healers Wise women Current day terms? What are some of the characteristics /styles of a helper? Learning that there is NO ONE “Right” Way - Each person has a style Clinical work is rife with theoretical ambiguities and clashes over what constitutes best practice. While this may be frustrating, in time you will discover that patiently struggling with ambiguity may lead to new ideas and new approaches. Your professional education is designed to teach you how to evaluate and distinguish among the many useful ideas and applications in the context of specific cultures, individuals, families, groups, and situations. What is your natural style? According to Neukrug and Schwitzer (2006), natural helpers can be classified as natural “listeners, analyzers, problem solvers, or challengers.” Natural listeners are good at “active listening, empathic understanding, and rapport building.” Analyzers focus on “case conceptualization, diagnosis, and treatment planning.” Natural Style continued Problem solvers “tend to be more directive, attempting to mobilize the person in need to make decisions, take action and decisively change behavior.” Challengers believe that they “can quickly push the client into seeing the world in a different manner, and will often confront clients through the use of questions, particularly ‘why?’ questions (pp. 4-7).” What’s your style? Style may inform theory choice. How? A Note on Social Work Practice and Theory To be effective generalists, social workers must be grounded in a broad range of practice theory A generalist is able to draw upon any theories or components of theories and pull them together to create a reasoned and comprehensive approach to addressing client needs Psychosocial, developmental and personality theories help us identify why people do what they do. Examples of theories learned? Ecosystems, strengths, and empowerment perspectives give us frameworks to guide our assessments and practice Practice theories like cognitive-behavioral therapy guide our interventions. Most practitioners use an eclectic mix of theory; however, most also have a particular theory they favor (even though they may not identify) Hearing v. Listening Review: hearing v. listening – what’s the difference? Hearing is physiological act Listening is a learned activity Listening is the dynamic process of attaching meaning to what we hear. Purposeful, selective listening requires effective attending and shows respect and concern for the interviewee Why important? Give an example of someone who hears you but does not listen What are some of the Hallmarks of a good listener? An effective listener/interviewer: Understands purpose of interview in order to listen for recurrent and/or dominant themes that may be related to the purpose Good listening requires an assumption and acceptance of ignorance Effective interviewers suspend closure, holding everything they listen to subject to revision because of what the client may say next Listens carefully in order to be able to reflect/paraphrase accurately, summarize correctly, offer appropriate feedback and show respect and concern Listening means not just listening to words but “listening” to what the client is not saying verbally IT IS IMPOSSIBLE NOT TO COMMUNICATE No matter what we do we transmit information about ourselves! Look around the room – what are your classmates communicating?? A majority (about 90%) of what we communicate is nonverbal) Posture, facial expressions, gestures, eye contact, touching, clothing, personal boundaries (zones), environment, etc. Even an expressionless face at a funeral says something What messages are you sending at this very moment? Nonverbal cues often reveal feelings a person is trying to hide Since feelings stem from thoughts, nonverbal clues that reveal what people are feeling also transmit information about what people are thinking Body language (kinesics) is concerned with movements, gestures, posture and facial expressions Helps confirm or negate the validity of the spoken messages Nonverbal signals are useful in managing transitions during the interview Nonverbal may communicate what the interviewee cannot bring themselves to say – example: client uncomfortable talking about an issue – what body language would they project? Provides information about feelings and attitudes of which the interviewee may have only a dim awareness or they are totally unaware (or may not want to be aware of, i.e., anger at a partner or child). Nonverbal messages may modify, refine, reinforce, clarify, elaborate, and substitute for verbal messages. In inferring meaning from our observations: Best if we respond not to individual components of nonverbal communication but to the pattern formed by the total configuration Chronomic communication: time as a general nonverbal message How we manage time sends a message Cultural considerations and time – example? Artifactual communication: Language of objects The channel is visual: clothes, hairstyle, make-up, jewelry, office décor (client’s home décor) – example? Smell Olfactory channel is rarely utilized as a form of communication Can trigger memories, etc.- example? Touch Powerful (both negative and positive), nonverbal method of communication – example? Proxemics: language of space and distance (what is your comfort zone – bubble of space) Demonstrate nonverbal: role plays The Interview The interview is purposeful and this distinguishes it from friendly or casual conversation – other distinguishers? This purpose and focus are always informed by assessment – the ongoing gathering of data and impressions that guide all aspects of the work. Although there is a general purpose for the overall work together, there may be a number of specific goals for each session. The guiding purpose of the clinical interview is to help the client. ©2011 Brooks/ Cole Publishing | Cengage Learning, Inc. Beginnings Introductions: Following a friendly greeting, the interviewer usually begins by acknowledging the names and roles of all present and reviewing either the initial request for help or the reason for the interview. The clinician needs to clarify the amount of time available for the initial meeting, as well as the total number of sessions available to the client. Focal opening lines: “So you are interested in speaking with me about some things that are going on with your son” Lend structure without foreclosing client contributions opening remarks that lend structure to initial clinician-client interactions and often provide a conversational framework, agenda, and tone Non-directive opening lines: “So what brings you here today” Leave client greater opportunity to set agenda, pace, focus, and tone These involve introductions, including names and roles, the reason for meeting, and time available Use client’s formal name unless invited to do otherwise; learn pronunciation of name/ask for clarification Three Stage Model of Interviewing Stage 1: Exploration: to build a working relationship with the client and to discover what brings client to you (what problems/issues) Stage II: Clarification: to facilitate the definition of the client’s problems/issues; to help client order those problems/issues requiring further action and redefine them into attainable goals. Attending behavior Effective questioning Reflecting content Reflecting feeling Confronting Communicating feeling and immediacy Self-disclosing Interpreting Stage III: Action: to assist the client in taking action Information giving Structuring the interview for exploration, clarification and action Enlisting cooperation A Unique Relationship: How So? The social work interview is: Purposeful – requires an intentional focus on the client’s needs and goals Theory based– provides a framework (eclectic) Structure – the interview and the process have a beginning, middle and end Contract – working agreement stating the purpose, goals, roles, expectations, time, structure and fees Intimacy between strangers Mutuality but not equal Social worker is accountable for the effectiveness of what is happening Intentional focus on the client’s story, needs, goals Goals for each session as well as for the overall work Roles: client and clinician Use of self: own actions and reactions, deliberate decisions about what to disclose Multiculturalism: knowledge about cultures and customs of clients Time-limited: beginning, middle, end Confidential: limits Expectations: client’s and worker’s Values and ethics: NASW Code Intentional focus on client’s story; goals for each session and for overall work Our worldview: Ecosystems Interrelated, interdependence of biological, psychological, sociocultural, political, economic Belief in the capacity to change and grow Reframe Strengths perspective Advocacy Multiple realities The Environment Even if you don’t have control over your own office settings, you need to take responsibility for the space in which you work: as private as possible accessible to persons with disabilities furniture placement should reflect equality, respect and comfort (how would you accomplish this?) Borrowed space (special challenges) Could be prison, school, hospital, agency, institution, home, etc Home Visits: Give worker an expanded perspective Challenges: Unfamiliar environments Intrusions Clinician as guest Social rituals Video: Chapter 3 Skills Demonstrated: Attending Attending and Listening Focused attending: attend in order to listen; listen in order to understand Psychological attending: put aside distractions and worries Psychological readiness and openness to clients Physical attending: SOLER S: sit squarely O: open posture L: Lean forward E: eye contact R: relax Listening to Client’s Stories Context Immediate context-personal circumstances Larger systems context Meaning How client makes sense of their situation, feelings, behaviors and thoughts (danger of making our own interpretation/reacting) Emphasis Theoretical models emphasize different components of the client’s story Themes Recurring sets of ideas, beliefs or notions Patterns Behavioral or affective sequences either within the interview or across a series. Clinical Listening Listening to verbal and nonverbal communication Appearance, body posture, gestures, facial expressions, affect. Behaviors How feelings/thoughts etc, are expressed (Grandma) Cognitive style Paralinguistic cues: how clients say things (tone, rate of speech, inflection, intonation and articulation) Silence (cultural meanings). Ordered, positive and flexible How can words be barriers to communication? Metacommunications: an act of communication between two agents that also communicates something about the communication itself, or about the relationship between the two agents, or both. the message behind or about the message. Common Errors in Listening Formulating a response while giving peripheral attention to incoming communication Listening to what you hope to hear (example?) IPV Listening to what you expect to hear (example?) Client: these things I’ve told you… Worker: (interrupts client says) …are strictly confidential Client: (continuing)…are the way I think most of the time, and I hope you don’t misinterpret me Failure to listen to what you fear to hear What does this mean? Listening with too much attention to detail, neglecting patterns Inattentive listening resulting from boredom/fatigue (shopping list) Inattentive listening resulting from internal emotional distractions or daydreaming (breakup, vacation) Listening without sufficient knowledge of the purpose of the interview so that you cannot direct your attention to what is most relevant •Linguistic differences If client’s native language is different from yours Translators: complexity of three person relationships, confidentiality, etc. Feelings or Affect Clinicians should note the frequency of each feeling state and which feelings seem to predominate. Does the client have limited feeling words? Intellectualizer – I think Clinicians should listen to discern whether clients can regulate their feelings or whether they feel overwhelmed by them. ©2011 Brooks/Cole Publishing | Cengage Learning, Inc. Clinical Repose Clinical repose is the relaxed, attentive, reassuring steadiness of the clinician, which helps the client to relax and feel confident of the clinician’s reliability. This repose is expressed by a relaxed, open posture and gaze, along with a calm, confident manner. Warmth and Caring Unconditional positive regard is the appreciation and affirmation of clients as people of worth. This is done by the clinician communicating nonjudgmental acceptance and genuine care for the client. People rate warmth and caring extremely high when asked to list attributes they would like in a potential clinician, mentor, or adviser. Clinicians may find it difficult to decide how to show caring. They don’t want to appear too detached and professional. They also don’t want to be too sweet and “touchyfeely” because clients may feel put off by this. Genuineness According to Carl Rogers, the therapist is willing to express and be open about any persistent feelings that exist in the relationship. He goes on to state that this “means avoiding the temptation to hide behind a mask of professionalism.” Process the process Clinicians need to avoid fake smiles, counterfeit approval, and false reassurance. The goal is to accompany the client in the moment of his or her experience, not to be a mind reader Intentional Use of Self continued Attending to self is important for several reasons: (1) We need to be aware of what our reactions may convey to clients, both intentionally and unintentionally. (2) The reactions that the client’s story evokes in us may provide important information about responses the client may engender in others. (3) Introspection increases our own selfknowledge. Thoughts and Cognitive Style Clinicians should listen for: what clients think about; the degree to which clients seem to think about their inner lives, external events, or their connections with others; the degree to which their thoughts are positive and hopeful or negative and pessimistic; and how they think and how they handle new thoughts or conflicting ideas. Validation occurs when we endorse and appreciate the realities of the client’s story. Universalizing is a technique in which the clinician verbally places the client in a community of people sharing similar feelings, experiences, or opinions. Ex: “Many people who lose a loved one experience intense feelings like you are describing” Clinicians who hold a strengths perspective recognize clients’ courage or persistence in working toward goals. Recognition and confirmation can build self-esteem and initiative. As clinicians, we can usually validate client strengths more effectively when we are aware of and secure in our own strengths Empathy Empathy is the process of experiencing the world from another’s subjective perspective while maintaining one’s own perspective as an outside observer. Empathy provides the clinician with important human experience and information on which to base hunches that inform future clinical work. Empathy is NOT sympathy. Empathy is much more than just putting oneself in the other person’s shoes. Empathy requires a constant shifting between my experiencing as you what you feel and my being able to think as me about your experience. ©2011 Brooks/Cole Publishing | Cengage Learning, Inc. Think of a time when someone really understood you Developing Clinical Empathy To be empathic, we need to both broaden our knowledge of the wide range of human experience and open our hearts. It is good to push yourself beyond the familiar and expand the network of those with whom you interact. You can broaden your human experiences by volunteering in the community. Reading professional literature and attending conferences are other ways to expand your level of empathy. Attending to these failures can be extremely important in modeling for clients that mistakes can occur without destroying relationships. Also, mutuality is increased because the client gets to educate and correct the clinician about what was actually said or what is happening between them The Importance of Worldview Values are mediated by personal prejudice, xenophobia, misinformation, and stereotyping. The characteristics of individuals and groups obtain meaning within larger social contexts, which include geography, historical period, and prevailing cultural norms. How does this inform practice? Empathic Echo Empathic echo is a verbal reflection of both the content and the affect within a client’s story, to signal that the clinician is attending closely to what the client says and does in the moment. Ex: “Right now I get the feeling that you are uncomfortable talking about your Dad. Lets talk about what is so painful for you in relation to your Dad” Clinicians often distinguish between content and affect, although the two are always interacting at some level. Reflection of feeling: making statements about the feelings that may wrap around the client’s words Empathic Echo continued Clinicians usually paraphrase what the client has said using similar words and phrases that hopefully convey the same meaning. This can be risky because the clinician may choose words that don’t convey the same meaning as the client intended. Linguistic differences can also complicate accurate reflection. Empathic Failures Empathic failures are clinical interactions in which clinicians reflect the wrong content, feeling, or meaning; miss important themes; pile on too much sympathy; confuse one client’s story with another; or seem disingenuous. Attending to these failures can be extremely important in modeling for clients that mistakes can occur without destroying relationships. Also, mutuality is increased because the client gets to educate and correct the clinician about what was actually said or what is happening between them ©2011 Brooks/Cole Publishing | Cengage Learning, Inc. Transference/Countertransference in the helping relationship Transference: the unconscious process by which early unresolved relational dynamics or conflicts are unwittingly displaced or transferred onto the current relationship with the worker. Can be both positive and negative Example/positive: teen client seems to view worker as a “kindly grandfather” even though the worker is a 26-year-old woman. The young man had fished and hunted with his grandfather, the only positive figure in his life. (Such idealizations are thought to fuel the early stages of most human attachments and can be helpful in sustaining the working alliance) Unscrupulous workers Example/negative: the client may unconsciously express or act out in the moment, old, unhappy, scenarios with the clinician as though the worker were actually the abandoner, the punisher, etc, who harmed the client in the past. May lash out at worker: “you don’t really care about me,; “you will hurt me/leave me just like _________ did” Can be valuable in helping client see relationship patterns, attractions; process it and talk about. Countertransference: worker’s unconscious reactions to the client Can occur in situations that replicate unresolved scenarios in the worker’s past Example: a normally accepting worker might begin to loathe or dread a particularly critical client. On reflection, she comes to see that, because of her own early experience of criticism from her perfectionist father, she is taking the client’s criticism personally and is resenting the client for it. Johnny’s example Reflecting on Self in the Relationship Why am I reacting with this particular client in a way that is unusual for me? What buttons might this client be pushing in me? What buttons might I be pushing in this client? What do critical (bossy, self-centered, demanding, etc) type people stir up in me? Are my reactions to the client being displaced from another life experience? Can I identify a pattern of reacting to certain types of people in characteristic ways that are not purposeful or helpful to the client? Do I think of some clients all the time and some almost never? Am I favoring some clients over others? Is personal reflection enough to change my reactions, or do I need supervision or personal therapy to assist with professionalizing my responses with clients? Safety Challenges Safety challenges (avoid working alone, let someone know where you are going, carry your cell, position yourself near the door, look for signs of intoxication/drug use, avoid home visits at night if possible, learn selfdefense techniques). OSHA (1996) announced that “more assaults occur in health care and social service industries than in any other” (Weinger, 2001, p.3). According to Weinger (2001), half of all human service workers will experience client violence at some point in their careers. Know your agency policies regarding home visits, office procedures during emergencies, etc.