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5 c h a p t e r the human services worker

Introduction Different Styles of Helping Relationships

The Relationship in Psychoanalytic Therapy The Relationship in Behavior Therapy The Relationship in Humanistic Therapy

Characteristics of Effective Helpers

Empathy Genuineness Objective/Subjective Balance Self-Awareness Acceptance Desire to Help Patience

Basic Helping Skills

Listening Communicating Giving Feedback Observing Confronting Clarifying Report Writing

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Factors That Influence the Use of Skills

Values Professional Codes of Ethics Physical and Emotional Well-Being Environmental Factors Multicultural Awareness Prior Training Crisis Intervention

Human Rights, the Law, and Human Services

Voluntary and Involuntary Services The Right to Refuse Services Due Process The Least Restrictive Alternative

The Worker in Group Settings

Definition of a Group

The Worker in the Community

Advocacy Community Organizing Community Outreach Case Management Providing Information

Additional Reading References

INTRODUCTION In Chapter 4, we discussed the major theories of the human services/mental health field. This chapter begins with the premise that theoretical knowledge alone is not sufficient for effective helping. Some workers know their theory but are ineffective in applying it. Other helpers seem to work well with clients but have very little theoretical background. In short, there is no definite relation- ship between the effectiveness of helpers and their knowledge of theory. Besides, it often happens that workers using the same theoretical approach vary greatly in effectiveness. What makes one helper more effective than another?

We explore this question in terms of the characteristics that have been shown to contribute to successful helping. These characteristics, attitudes, and skills have been identified mainly by humanistic psychologists, who have done a great deal of research on the nature of the helping relationship. Empathy, gen- uineness, and self-awareness are some of the helper characteristics that con- tribute to a good relationship with a client. In addition, this chapter reviews some of the basic skills, such as the ability to listen and communicate effec- tively, that are vital to the helper’s success. The chapter closes with a discussion of the special skills required in group and community settings. Throughout this

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chapter, worker, helper, counselor, and therapist are used interchangeably, much as in the real world where human services workers who perform similar work are referred to by different terms depending on their location and setting.

DIFFERENT STYLES OF HELPING RELATIONSHIPS As you will recall, the psychoanalytic, behavior, and humanistic therapies each have different goals, and each places emphasis on different aspects of the help- ing relationship. The therapist’s use of the concept of self will vary greatly, based on the choice of theoretical model and therapy utilized. To understand this more fully, we will now examine the relationship between therapist and client in each of these perspectives.

The Relationship in Psychoanalytic Therapy

Psychoanalytic therapy seeks to bring unconscious material into the conscious and to strengthen the ego so that behavior is more reality-based and less driven by primitive instinctual desires. The emphasis is on exploring the client’s early past experiences in the hope of achieving a deeper level of self-understanding and insight (Kohut, 1984). The therapist who practices classical psychoanaly- sis seeks to maintain a sense of neutrality and objectivity with the client. There is very little self-disclosure by the therapist. The anonymous stance assumed by the therapist, sometimes called the blank-screen approach, is considered essen- tial to the psychoanalytic method. The purpose is to develop a transference relationship, in which the client will project onto the therapist unresolved feel- ings that originated in the client’s past significant relationships. It is believed that if the therapist remains neutral, the feelings that the client develops toward the therapist must be derived from the client’s past relationships (Corey, 1991). For example, the client may begin to see the therapist as a stern, cold, control- ling authority figure. In doing so, the client may be transferring to the therapist unresolved feelings derived from previous experience with his or her father.

In psychoanalysis, the client usually does most of the talking. The thera- pist’s primary role is to listen, understand, and eventually interpret the mean- ings of the client’s experience. A major purpose of this process is to uncover unconscious motives and to help clients achieve insight into their problems. The attainment of insight through the analysis of the transference is assumed to be necessary for the client to change in meaningful ways.

The Relationship in Behavior Therapy

Behavior therapy is a direct, active, and specific problem-solving approach to treatment. The focus is on the clients’ current problems and life situation as opposed to their past history. Clients learn new coping skills and are urged to take specific action to reach desired goals, rather than to reflect passively on prior experiences. Behavioral practitioners do not view the development of spe- cial client-therapist relationships as being central or all-important to this treat-

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ment approach. Instead, they contend that factors such as warmth, empathy, authenticity, permissiveness, and acceptance are considered necessary—but not sufficient—for behavior change to occur (Corey, 1991). The relationship is viewed primarily as a setting for the use of various behavioral strategies and techniques. The client becomes actively involved in the selection of his or her own goals, and the therapist applies specific techniques to help the client achieve those goals.

The helping relationship in this form of treatment has been characterized by critics as being somewhat rigid, overly directive, impersonal, and manipu- lative. However, many behavioral practitioners believe that establishing a good interpersonal relationship is highly desirable. Spiegler (1983) emphasizes that a good therapeutic relationship increases the chances that the client will be cooperative and receptive to therapy. Cormier and Cormier (1985) also stress that the behavioral approach should be based on a highly collaborative relationship between client and therapist. In fact, they view the process of selecting and achieving goals as a mutual, social influence process in which relationship variables are involved.

The Relationship in Humanistic Therapy

The humanistic approach places a great deal of emphasis on the client- therapist relationship as a catalyst for personality change. The focus is on the clients’ current life situation rather than on helping clients come to terms with

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One of the many nonprofessional groups that affects social policy through its representatives and by testifying before legislative bodies. Julie Jensen

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their personal past (May & Yalom, 1989). Humanistic therapists practice a client-centered approach, in which the therapist does not actively establish goals or provide specific advice or direction to the client. The basic premise is that clients are capable of self-directed growth and have a great potential for resolving their own problems if provided with a helping relationship that facil- itates such growth. The underlying belief of this approach is best summarized by Rogers (1961) when he states, “If I can provide a certain type of relation- ship, the other person will discover within himself the capacity to use that rela- tionship for growth and change, and personal development will occur” (p. 33). The use of any directive techniques designed to get the client to “do something” are, at best, considered secondary to the development of this unique client-therapist relationship. This approach places great emphasis on the “personhood” of the therapist. Not only does the therapist need effective helping skills, but he or she must also have the ability to create a growth- producing environment and must possess the personal characteristics and attributes amenable to these conditions.

CHARACTERISTICS OF EFFECTIVE HELPERS Although research has not yet indicated a “correct” method of helping, it has identified certain characteristics of helpers that are associated with successful helping. For example, the findings of Avila, Combs, and Purkey (1978), Bram- mer (1981), Truax and Carkhuff (1967), and Rogers (1961) indicate that effective workers possess certain personal characteristics that contribute to success. The discussion that follows examines these characteristics that con- tribute to the development of helping relationships.

Empathy

Empatheia is the Greek word that refers to affection plus passion touched by the quality of suffering. In Latin, the word pathos is analogous to the Greek patheia with the added dimension of “feeling.” Through the years, this some- what vague meaning has evolved into a more comprehensive definition of empathy. For example, Brammer (1981) views empathy as the ability to appreciate and understand the client’s perspective. More simply, empathy is the ability to see things from another’s point of view. Empathy is viewed by many professionals as the most important characteristic in a helping relation- ship. It serves as a basis for relating and communicating. For example, when clients feel deeply understood, they are generally more willing to risk disclo- sure of their inner feelings. Carkhuff and Berenson (1967) conclude that “the therapist’s ability to communicate at high levels of empathic understanding involves the therapist’s ability to allow him or herself to experience or merge in the experience of the client” (p. 109).

Empathy is often viewed as conveying sensitivity to the client and trying to understand what “walking in the other guy’s shoes” may feel like. The helper

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need not necessarily have undergone the experiences of a client to understand the client’s feelings. Feelings are universal. Different experiences often generate similar feelings. For example, death of a loved one and divorce may both gen- erate feelings of loss and anguish.

For empathy to be constructive and worthwhile, it must be demonstrated, as in the following example.

client: I just recently lost my father, who had cancer.

helper: It must be a very painful experience, causing you to feel angry, sad, and abandoned.

Genuineness

Genuineness is the expression of true feelings. To be a genuine helper, one must avoid role playing or feeling one way and acting another. Genuine helpers do not take refuge in any specific role, such as counselor or therapist. Genuineness involves self-disclosure. It implies a willingness to be known to others.

In most types of helping relationships, a certain degree of modeling behav- ior takes place. The client sometimes tries to emulate the characteristics of the helper. If the helper is genuine, free, and expressive, the client is also free and able to express authentic feelings.

Schulman (1991) adds two dimensions to our examination of this charac- teristic by introducing parallel elements: “Two words are closely related in explaining the meaning of genuineness—congruency (when one’s words and actions correspond) and authenticity (when one is him- or herself, not a phony)” (p. 307; emphasis added). Being genuine, however, is not free license for the helper to do or say anything to the client on a whim. Helpers are not “free spirits” who inflict themselves on others. Being genuine does not neces- sarily mean expressing all one’s thoughts to the client.

Helpers can be genuine without being hostile or hurtful to the client. For example, a client may ask the helper, “What do you really think of me?” Assuming that the helper has negative feelings at the moment toward the client’s behavior, these feelings could be openly expressed in a variety of ways without appearing as a direct attack on the client. The helper might express disappointment at the client’s unwillingness to attempt to change his or her behavior. In other words, one can dislike a person’s rigidity but still respect the person as an individual.

Sharing personal experiences with the client can sometimes be helpful. For instance, the counselor may be helping someone come to grips with problems generated by a recent divorce. The helper may have been divorced and can therefore understand the range of the client’s feelings on a personal level. In this instance, it may be appropriate to share experiences with the client and disclose how one worked toward resolving and understanding those feelings. Of course, it is possible for the helper to share emotions and feelings without discussing specific events or circumstances in his or her life.

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Objective/Subjective Balance

Subjectivity refers to private, personal, and unique ways of experiencing situ- ations. Being subjective means one’s experience is unique and not directly observable by another person. It is a private reaction to or feeling about some- one or something. This reaction tends to be biased because it only pertains to the individual’s experience.

Objectivity emphasizes verifiable aspects of an event. Objectivity involves the noting of facts without distortion by personal feelings or prejudices. It stresses description of what can be seen, heard, touched, and so on. An objec- tive statement based on verifiable evidence might be “Bill is 5 feet, 6 inches tall, weighs 145 pounds, and has blue eyes,” whereas a subjective statement of these same conditions could be “Bill is too short, overweight, and has unat- tractive, weird-looking eyes.”

Subjectivity and objectivity represent opposite ends of a continuum. In the helping process, there are disadvantages to each quality when carried to extremes. The helper who is too subjective can become too emotionally involved with the client, as in the case of taking sides in marital counseling. In this sense, the helper can run the risk of losing the ability to make appropriate decisions or judgments.

Pure objectivity alone is also not a desired quality. Objectivity refers to a detachment from one’s personal feelings. The purely objective helper can run the risk of being viewed by the client as cold, uncaring, aloof, and uninterested in the client’s well-being. This can cause obvious difficulties in communication and build up feelings of resentment on the part of the client.

Either quality, when carried to extremes, can lead to difficulty in under- standing people. The quality to be desired is an objective/subjective balance. A helper must have the ability to stand back and view a situation accurately but without becoming detached from personal feelings. Human services helpers need a blend of both qualities.

Self-Awareness

Self-awareness is the quality of knowing oneself. It includes knowledge of one’s values, feelings, attitudes and beliefs, fears and desires, and strengths and weaknesses. The self is composed of one’s thoughts about oneself. This means that there are literally hundreds of ideas and images that make up the sense of self. One’s values, beliefs, ideas, and images become clear when one asks ques- tions such as, What’s important to me? What aspects of myself do I like or dis- like? The self-concept can be regarded as the inner world in which one lives. In the helping process, the helper often expresses this inner world and makes it visible to the client.

The effective helper must be aware of what messages are being transmitted to the client through both word and action. It is only through self-examination that we can begin to understand what aspects of ourselves would be most beneficial to the helping process. Combs, Avila, and Purkey (1978) stress the following:

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Professional helpers must be thinking, problem-solving individuals. The primary tool with which they work is themselves. This understanding has been referred to as the self as instrument or self as tool concept. In the human services a helping relationship always involves the use of the helper’s self, the unique ways in which helpers are able to combine knowledge and understanding with their own unique ways of putting them into operation. (p. 6)

Many professionals generally accept that if one wants to become more effective as a helper, it is necessary to start with self-awareness. Helpers who aspire to use self in an effective way must be aware of their patterns of per- sonality and their needs. Helpers have a responsibility to be conscious of the ways in which their personalities and behaviors affect others. The helper’s beliefs, values, and attitudes can have a powerful effect on the helping process.

Acceptance

Acceptance is demonstrated by viewing the client’s feelings, attitudes, and opin- ions as worthy of consideration. The accepting helper sees each person as hav- ing a fundamental right to think, act, and feel differently. From the humanistic perspective, communicating acceptance of the other person is vital to develop- ing and maintaining the helping relationship. Communication of acceptance leads to feelings of psychological safety on the part of the client. In this setting, the client believes that no matter what he or she discloses, the counselor will react in an accepting manner. As an accepting person, the helper recognizes the uniqueness in each human being. Brill (1998) suggests that the basis of any rela- tionship is acceptance of the individual’s right to existence, importance, and value. Out of acceptance should come freedom to be oneself—to express one’s fears, angers, joy, rage, to grow, develop, and change—without concern that doing so will jeopardize the relationship.

A major problem with understanding the quality of acceptance is that one can confuse acceptance of a client with approval of the client’s behavior. Accepting a person does not imply that one likes or approves of all the values or behaviors of that person. For example, a counselor may be working with a heroin addict who is attempting to kick the habit. The counselor may accept the client’s feelings, experience, and beliefs but not approve of heroin addic- tion. Thus, when a helper says of a client, “I can accept anyone except a child abuser,” the helper is judging the behavior as a total representation of the client. Individuals are made up of numerous values, attitudes, and behaviors. No single value, attitude, or behavior represents the total individual.

Desire to Help

Many proponents of the humanistic perspective believe that effective helpers have a deep interest in other people and a desire to help, which allows them to receive satisfaction in promoting the growth and development of others. The feelings of self-satisfaction derived from seeing others make positive changes in their lives are a basic reward to the helper. This sincere desire to help is

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displayed and becomes readily observable in the helper’s attitude toward his or her work. Just as people respond more favorably to a salesperson who evi- dences enthusiasm and interest in the product he or she is selling, so clients respond more favorably to a helper who is enthusiastic about and interested in helping. One caution should be noted in this regard: Sometimes the helper’s desire to help can extend too far, creating unnecessary client dependence on the helper for various tasks that clients should take care of themselves.

Helpers accept as a social value the belief that people should help one another. When one devotes a considerable amount of time and energy to help- ing others, it demonstrates a basic belief that those being served do have the fundamental ability to change (Cowen, Leibowitz, & Leibowitz, 1968). Many professionals agree that a desire to help people is a basic value for those who enter the human services field.

Patience

Patience is the ability to wait and be steadfast; it is refraining from acting out of haste or impetuousness. As a helper, one may often feel that it would be beneficial to a client to do a particular thing, confront a situation, and so on. Patience is based on the understanding that different people do things at dif- ferent times, in different ways, and for different reasons according to their individual capacities.

Frequently, a helper must wait for a client to be ready to take a next step toward resolving a particular problem or toward achieving a desired goal. For example, a helper might be helping a retarded individual to use eating utensils, a task that often involves a lot of repetition over a long period of time. People do not always proceed on a prescribed timetable. Human beings can be awe- somely frustrating creatures who often resist change even though the change is recognized as ultimately beneficial. An effective helper must have the patience to allow for the client’s development and growth according to the client’s needs and abilities.

BASIC HELPING SKILLS Human services professionals must master certain basic skills to be successful. A skill is an ability to perform a particular task in a competent fashion. Many individual skills make up the helping process.

Individuals are not born with the skills that are essential for relating effec- tively to other human beings. These skills are learned through training. Some helpers do, however, have more natural abilities than others. Effective helpers continue to acquire additional skills and strive to refine already existing skills. Because each individual is different, each helper must develop his or her own style and way of using these skills, which become the “tools of the trade.” In this section, we discuss seven basic helping skills.

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Listening

To listen means to pay attention to, to tune in to, or to hear with thoughtful consideration. Skillful listening is as important as talking and acting. It is through listening that the helper begins to learn about the client and how the client sees the world and himself or herself. The helper needs to listen atten- tively to all messages from the client about matters such as how the client views his or her problems and what the client expects the helper to do about them. Without listening, all forms of potential help may become misguided.

To be effective as a listener, one must become aware of more than just the words that are spoken. There is a basic difference between hearing words and listening for the full meaning and message of the words. It is often not what the client says but how she or he says it that is important. A client’s body pos- ture, tone and pitch of voice, silences and pauses, and speech patterns are all significant in understanding what a client is trying to communicate. A phrase spoken in a sarcastic tone means something different from the same phrase spoken in a voice filled with cheer and lightness. You probably often ask friends, “How are you?” When a friend responds “Fine,” you can either accept it at face value or suspect that there is something beneath the surface that contradicts the message. In other words, you may sense a negative feeling that contradicts the overt statement. Effective listening requires sensitivity to inconsistencies between a person’s words and actions. The client who says “I’m fine” while tears begin to well up in his or her eyes is obviously commu- nicating a contradictory message.

When listening to clients, the helper must recognize both the cognitive and affective content of what is being communicated. Cognitive content refers to thoughts and ideas. Affective content refers to the feeling tone of the message. When we watch a mime perform on stage, no words are spoken, but the mime’s actions convey a full range of feelings and behaviors. The affective con- tent sometimes differs from the cognitive content and is often less apparent. Responding accurately to a client’s statement depends on the helper’s ability to hear and understand what is being said and to perceive the underlying mes- sage. Helpers must ask themselves, “Does the client’s behavior fit his or her words?” and “What is the client really trying to communicate?”

Another aspect of listening is the concept of selective perception. Selective perception means that individuals sometimes hear only the aspects of another’s message that they wish to hear and disregard the rest. For instance, a helper might ignore the message conveyed by a client’s tone of voice and respond only to the usual meaning of the words spoken. Johnson (1986) adds the following:

There is considerable evidence that you will be more sensitive to perceiving mes- sages that are consistent with your opinions and attitudes. You will tend to mis- perceive or fail to perceive messages that are opposite to your opinions, beliefs, and attitudes. If you expect a person to act unfriendly, you will be sensitive to any- thing that can be perceived as rejection and unfriendliness. (p. 93)

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The helper’s beliefs and attitudes can distort the message being received. When listening to others, it is essential to be aware of the possibility of selec- tivity in what you hear and perceive. Effective helpers are always listening for the full message.

Communicating

Communication is the process of transmitting feelings or thoughts so that they are understood. This process involves conveying information verbally or non- verbally through a variety of means such as body movements, facial expres- sions, and gestures. To communicate, there must be both a sender and a receiver of a message. Generally speaking, all behavior transmits certain infor- mation and may, therefore, be involved in communication.

Many aspects of human services work require the ability to communi- cate. Communication is an integral part of human services and may take the form of transmitting particular knowledge, information, or skills. For exam- ple, when a helper is counseling individuals facing retirement, the content of the communication may focus on financial planning, housing needs, or social or emotional concerns. At the other end of the life cycle, helpers working in children’s human services programs may focus the content of their communi- cation on the development of basic life skills. Communicating effectively and responding appropriately are often the key factors in determining the success of any attempt to help.

You can easily understand the complexity of communication by consider- ing the example of the game of passing a single message through a series of individuals. In this game, one person thinks of a message and in turn whispers it to another. The next person attempts to whisper the same message to another person, who does the same, passing it to as many people as possible. When the last person tells the entire group what his or her version of the mes- sage is, it is usually very different from the original message. How does a rel- atively simple message become distorted when conveyed to another person? To understand this, we must look at the various factors involved in communica- tion and understand the obstacles and barriers that can distort even the sim- plest of messages.

Accurate communication occurs between people when the receiver inter- prets the sender’s message the way the sender intended it. Difficulties in com- munication arise when the receiver imparts to the message a meaning that was not intended. When the sender attempts to convey a message, the receiver interprets the message before he or she can respond to it. All forms of com- munication require some degree of interpretation, meaning that an individual must construe, understand, and attach individual meaning to a message. It is through this act of interpretation that communication can become distorted. The process of interpretation is always filtered through our individual biases, expectations, and prejudices. As mentioned previously, when information is transmitted, the listener tends to accept what seems to fit into his or her belief

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system and sometimes rejects or distorts information that is inconsistent with those beliefs. Also, people are sometimes so positive they know what the other person is going to say that they distort the incoming message to match their expectations. For example, if a man who has very low self-esteem asks his boss for a raise, he may take the boss’s statement “I’ll have to give it some thought” as a sign of refusal.

A common problem in communication occurs when the receiver under- stands the words of the message but fails to recognize the sender’s underlying meaning. For example, a person might say “Sure is a rainy day” in an attempt to change the subject, but the receiver might assume the person is really con- cerned about the weather. Another example is the client who sits in the office looking down, arms crossed, slouched deeply in his or her chair, and responds to the question “How do you feel?” by saying “Fine.” The client’s nonverbal behavior, consisting of posture, eye contact, and facial expression, seems to indicate the opposite. Which message does one respond to? The answer is both. The helper must hear the words but also be aware of additional infor- mation conveyed in the communication.

Helpers must have an awareness of their own styles of communication. Becoming aware of style means that you know when you as a helper might be creating difficulty in communication by sending out conflicting verbal and non- verbal messages to the client. To this degree, you can see how the quality of self- awareness enhances the skill of communicating effectively. Inappropriate use of

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Family communication within a therapy session Bob Daemmrich/Stock Boston

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language can also lead to mishaps in communication. The helper should avoid using words the client may not understand or may find objectionable. The helper’s vocabulary must be understandable to the client. Because words do not mean the same thing to all people, the helper must sometimes provide clear def- initions and examples of meaning. If the client’s message is unclear, the worker has the responsibility of helping the client clarify its meaning.

Giving Feedback

Giving feedback is the process of conveying to clients perceptions, feelings, observations, or other information concerning their behavior. Feedback basi- cally represents an individual opinion or evaluation of the client by the worker. It helps clients become aware of how they are perceived by others. Clients can then decide to correct errors in judgment, change undesirable behaviors, and establish goals.

People do not operate in a social vacuum. We often seek out other indi- viduals to give us their evaluation of how well we accomplish a particular task or perform a certain job. For example, actors and actresses often anxiously await the theatrical reviewer’s evaluation of their latest performance. In the same manner, a child proudly displays his or her latest work of art to the par- ents and awaits the parents’ comments. Feedback is a basic requirement of human beings in many aspects of life.

For the human services worker, learning how to provide feedback effec- tively is an essential task. Danish and Haner (1976) state that “to be helpful, the feedback must be given in such a way that the receiver (a) understands clearly what is being communicated; and (b) is able to accept the information” (p. 14). Timing is an important factor in the appropriate use of feedback. Is the client receptive to another point of view at this time? Sometimes a client is not receptive because he or she is in a highly emotional state. The relationship between worker and client is another critical issue in the use of feedback. If one respects and values the opinion of the other, one is more likely to accept what is offered.

The worker has to exercise judgment in regard to clients’ abilities to accept feedback concerning their behavior or problems. Consider the example of the client who thinks she has a wonderful sense of humor, yet people tend to shy away from her when she jokes around. Several individuals may already have informed her that her jokes are not funny, but she may ignore these peo- ple, claiming they have no sense of humor. If in the worker’s judgment the client would be more receptive to feedback from a helper, the worker can point out to the client that her sense of humor tends to be sarcastic and hurtful, which may be why people shy away from her.

Feedback serves many purposes. It can reaffirm what the client already believes and feels. It can inform clients of aspects of their behavior of which they were not previously aware. It can provide motivation for change and can also be a source of support during difficult times.

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Observing

For the purpose of this discussion, we define observing as the process of not- ing or recognizing an event. An event could be almost anything from the weather to the facial expression of a particular individual. Observing occurs in two stages: receiving sensory input and giving meaning to the information.

The human services worker always looks for any signs or clues to under- stand more of what is going on with the client. Areas in which clues can be found include the following:

• Facial expressions • Vocal quality • Body posture • Gestures • Clothing • General appearance • Eye contact • Distance between worker and client

Workers usually rely on the sense of sight to provide them with basic infor- mation. The sense of hearing is equally important, however. In fact, all the senses receive messages that can supplement, confirm, or negate the initial impression derived from sight.

For example, the worker notes that the client is slouched, apparently at ease. However, as the interview progresses, the worker hears the client’s rapid speech and intermittent stuttering, indicating tension. In effect, the worker’s initial impression of the client as being relaxed has now been negated by other sensory information. This example also illustrates that an important aspect of observation is interpretation, or attaching individual meaning to an occur- rence. Another helper might come up with a different interpretation of the behavioral clues.

Confronting

Confrontation is a word that conjures up fear in some individuals. People often associate the word with some form of attack, anger, or hostile behavior. In the context of the helping profession, the term requires a different under- standing. Confrontation can be defined as calling to the attention of the client discrepancies between or among the client’s thoughts, attitudes, or behaviors (Ivey, Ivey, & Simek-Downing, 1987). A confrontation is actually an invitation to the client to become more aware of and to examine more fully certain aspects of behavior that seem to the counselor to be harmful or self-defeating for the client. It is through the process of confrontation that clients are made aware of specific obstacles that have impeded or could interfere with reaching their desired goals. Through this process, clients optimally learn to accept responsibility for their behavior.

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Confrontation need not focus exclusively on negative aspects of clients’ behavior. It can be used to show clients strengths and resources that they have overlooked. The acknowledgment of strengths can sometimes produce anxiety in clients, however, because then more can be demanded of them. Thus, con- frontation involves challenge even when a positive aspect of behavior is pointed out. Before individuals can change, they must perceive a need for change. Confrontation provides one stimulus for change.

Constructively challenging the client can take various forms. Counselors can call attention to the client’s self-defeating attitudes, point out discrepancies between what the client says and what he or she actually does, focus on vari- ous manipulations or forms of game playing, or, as mentioned previously, address unrecognized areas of strength. Following are some examples of the use of confrontation in counseling.

example a client: I am not really interested in a better-paying job. It will probably demand

more of my time and I will have to learn new skills and even wear a tie and jacket to work.

counselor: You say you are not interested in a better job, yet you have spent several sessions talking exclusively about it. Is it possible you really want to go after the better job and are afraid of failing, so you have convinced your- self that you really do not want the job? Are you possibly afraid of new demands that could be placed on you?

This confrontation addresses the client’s incongruent behavior.

example b client: I am really concerned about the shape of the world today. People do

nothing to change the situation. People are starving. Trash is scattered all over the streets, crime is everywhere, and people do not get out and talk to one another anymore.

counselor: You say you are a concerned person, but the bulk of your time is spent sitting in front of the television and drinking beer.

This confrontation focuses the client on the discrepancy between what he claims concerns him and what he actually does about it.

The misuse of confrontation can have negative effects on clients. If the client is not ready to accept the challenge of the offered information, the con- frontation is not helpful. The counselor must time the confrontation so that it is most helpful.

Clarifying

The basic purpose of clarifying is to make clear what information is being con- veyed by the client and how it is being received by the counselor. Sometimes, difficult situations and painful emotions can create problems with communi- cation. When the counselor clarifies aspects of the client’s message, the client

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knows how the message has been received. The process of clarifying often involves using the skills of paraphrasing, highlighting, and summarizing.

Paraphrasing When the counselor paraphrases a client’s message, he or she rewords it. In doing so, the counselor attempts to focus the client’s attention on the main element of an immediate message. Through the use of paraphras- ing, the counselor conveys to the client that the meaning and the feelings of the message have been received and understood. Consider the following example:

client: Even though I feel I have a lot of friends, I feel as if no one understands me or really wants to. My mother and father don’t listen to me. My teachers ignore me, and my girlfriend says I’m no fun to be with anymore.

counselor: It sounds as if you feel that you have no one you can really talk to.

client: Yeah, I guess that is how I feel.

In this example, the counselor rewords and restates the client’s message and pinpoints the basic feelings. This serves to focus the client on the main areas of concern in addition to conveying to the client that the counselor under- stands what is being expressed.

Highlighting Highlighting is very similar to paraphrasing but has a slightly different purpose. Paraphrasing is often done as a response to the client’s immediate message. Highlighting, however, is not an immediate response and does not necessarily follow the sequence in which the client is expressing the message. Highlighting is an attempt to capture the recurring theme of mes- sages during a counseling session. In this way, the counselor emphasizes the main aspects of what the client is expressing over a short time. This serves to focus the client’s train of thought and draws the client’s attention to the main areas of concern being expressed.

Following the previous example, the counselor has just spent 20 minutes listening to the client’s appraisal of himself and his many friendships. The counselor is now attempting to highlight the major theme and feelings expressed by the client.

counselor: Even though you say you have many friends, you still feel that no one really understands you.

The counselor has now identified the major theme of the client’s message and is again drawing the client’s attention to what he has already expressed as his main concern.

Summarizing Like paraphrasing and highlighting, summarizing is a means of giving back to the client the essence of what he or she has been trying to convey. The distinction concerns the amount of material covered. Paraphras- ing and highlighting concentrate on the immediate aspects of client messages during parts of a single counseling session, whereas summarizing involves restating the chief elements of the client’s message over one or a series of

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counseling sessions (Schulman, 1991). When the worker summarizes the major points of information and recurring themes brought forth by the client over several sessions, the client can develop a broader perspective on and deeper understanding of the depth and significance of specific problem areas. This process brings to the client’s attention changes in feelings and attitudes that may have gone unnoticed. It enables clients to develop a frame of refer- ence in which to see where they were, where they are now, and where they would like to be.

Report Writing

Report writing is a means of recording the interactions between clients and events. Most reports concern client behavior and progress. Report writing is not generally perceived as one of the more exciting skills to acquire within the human services field; nevertheless, it is one of the most practical and valuable. Report writing in one form or another is necessary in many aspects of the human services field. All professionals and institutions require a consistent method of keeping track of what happens to whom, when, and why, although specific methods and styles of report writing vary. Many human services agen- cies use a standardized form for the various types of reports. Obviously, writ- ing clearly and using language accurately are important. More specifically, reports are usually compiled with two basic objectives in mind: to establish a documented record for future reference and to convey current information regarding a specific case or event (Wicks, 1979).

A counselor working with many clients must keep an accurate report of each one’s progress. Clients may be taking medication, which necessitates that a consistent and accurate report be kept on the type of medication, dosage, and consequent reactions. If a client changes counselors, the report of the pre- vious counselor may be requested by the new counselor as a means of gaining background information on the client. In many clinics, it is mandatory to keep reports of patient contacts, diagnoses, and treatments. Very often these reports are monitored by state and federal agencies to ensure a continuous level of compliance with state and federal regulations.

Reports are crucial when professionals evaluate or consult with public or private agencies, institutions, or schools. For instance, a human services specialist might be brought in to evaluate the effectiveness of a specific pro- gram or service. The evaluator would rely heavily on the records and reports submitted.

FACTORS THAT INFLUENCE THE USE OF SKILLS This chapter has so far described a variety of skills and characteristics needed for effective helping. There are a number of factors that can influence the way in which the worker applies these skills and characteristics. These factors are discussed in this section.

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Values

A person’s sense of right and wrong, likes and dislikes, and standards of appropriate behavior are all a part of values. One’s personal, professional, and societal values develop through one’s experiences with family, peers, and culture. Of immediate relevance is the fact that the individual’s values guide behavior in professional or working relationships. How a worker reacts to a particular client, situation, or problem is partly determined by the worker’s values. Most workers of the humanistic orientation accept the principle that the helper should not try to impose values on the client but should help the client clarify his or her own values. To be effective, workers must fully understand their own values and respect the client’s right to have different values.

Consider the example of a human services worker who has strong per- sonal values against abortion. The worker is asked to counsel a pregnant teenage client who is unsure about having the child. Obviously, the worker’s personal values could have a strong influence on the way he or she goes about the helping process. If the worker pressures the client to make a decision in line with the worker’s values, the client may later feel that she betrayed her own sense of what was right in this situation.

How can you as a beginning worker avoid placing values on others? It may help to think about the influences that shaped your values and beliefs. This will help you to appreciate the fact that people who come from different backgrounds may have values different from your own. Other people feel that their values are “right” just as your values feel “right” to you.

To begin the process of clarifying your values, you might answer these questions:

• What values underlie your desire to help others? • What social issues do you feel strongly about? • Which client behaviors would you have trouble accepting? • Which of your values would you like to change? • What would you like to accomplish in human services? • How do you go about solving personal problems? • Do you readily seek help from others when you need it?

Professional Codes of Ethics

The development of professional codes of ethics involves the concept of “moral correctness.” Deciding what is morally correct for everyone all of the time is a difficult, if not an impossible, task. One needs only to read a news- paper or listen to a TV news report to hear of the major battles fought daily in our elected legislative bodies over issues such as abortion, homosexuality, obscenity, premarital sex, or euthanasia. Certainly, the religions of the world vary in their views toward these and other issues. Even the law of the land varies considerably in different sections of the country regarding each of these

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issues. In 1973, the U.S. Supreme Court in the case of Miller v. California stated that local municipalities have the right to set their own standards con- cerning what is obscene. Those charged with the responsibility of developing professional codes of ethics face the same difficult challenges. How can a par- ticular set of guidelines or set of principles encompass everyone’s varying beliefs? How one personally interprets the individual codes of ethics is yet another issue.

At present there is no single code of ethics that applies to all careers or disciplines in the broad field of human services. Rather, the professional organizations that represent individual careers have established separate codes of ethics to provide guidance and direction for their own members. Some professional organizations that have established such codes are the American Psychological Association (APA), the National Association of Social Workers (NASW), the American Medical Association (AMA), the Council for Standards in Human Service Education (CSHSE), the National Organization for Human Service Education (NOHSE), the American Coun- seling Association (ACA), the American Association for Marriage and Fam- ily Therapy (AAMFT), and the National Academy of Certified Clinical Mental Health Counselors (NACCMHC).

The general guidelines offered by professional codes of ethics could not possibly instruct the practitioner on what to do or how to behave in all pro- fessional situations. Ethical codes do, however, serve various important func- tions. For example, codes define minimal standards of professional conduct and attempt to ensure that workers meet various standards, requirements, or levels of competency (Corey, Corey, & Callanan, 1993). Ethical codes also define the scope or range of responsibilities for individuals and help clarify various common issues of major concern within a particular field. Van Hoose and Kottler (1986) cite additional reasons why such codes exist: (a) they are self-imposed as an alternative to having regulations imposed by legislative bodies, (b) they are designed to prevent internal bickering and disagreement within the profession, and (c) they are designed to help protect the practitioner in areas of malpractice.

There are many areas of overlap among the various codes of ethics. The issue of client confidentiality and the right to privacy is one such area. The concept of confidentiality serves to protect the client from any unauthorized use of information by the human services worker without the informed con- sent of the client. In general, confidentiality can be viewed as a safeguard for clients’ rights. Various professional codes offer guidelines articulating what is considered to be appropriate or responsible action for the practitioner in mat- ters pertaining to this issue. For example, should a human services worker always share information concerning his or her client with the court if asked to do so? Is the worker ethically obligated to get the client’s consent? The issue of client termination is another example. When is it considered to be ethically appropriate to disengage or terminate your work with a particular client? What responsibilities does the worker have to the community at large when working with dangerous or high-risk clients?

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The Code of Ethics of the National Association of Social Workers (1993) addresses the issue of confidentiality in this manner:

H. Confidentiality and Privacy—The social worker should respect the privacy of clients and hold in confidence all information obtained in the course of profes- sional service.

1. The social worker should share with others confidences revealed by clients, without their consent, only for compelling professional reasons.

2. The social worker should inform clients fully about the limits of confidential- ity in a given situation, the purposes for which information is obtained, and how it may be used.

3. The social worker should afford clients reasonable access to any official social work records concerning them.

4. When providing clients with access to records, the social worker should take due care to protect the confidences of others contained in those records.

5. The social worker should obtain informed consent of clients before taping, recording, or permitting third party observation of their activities.

The Ethical Standards of Human Service Professionals (2000) also address client confidentiality:

the human service profess ional’s responsib il ity to cl ients

Statement 1 Human service professionals negotiate with clients the purpose, goals, and nature of the helping relationship prior to its onset, as well as inform clients of the limitations of the proposed relationship. Statement 2 Human service professionals respect the integrity and welfare of the client at all times. Each client is treated with respect, acceptance, and dignity. Statement 3 Human service professionals protect the client’s right to privacy and confidentiality except when such confidentiality would cause harm to the client or others, when agency guidelines state otherwise, or under other stated conditions (e.g., local, state, or federal laws). Professionals inform clients of the limits of con- fidentiality prior to the onset of the helping relationship. Statement 4 If it is suspected that danger or harm may occur to the client or to oth- ers as a result of a client’s behavior, the human service professional acts in an appropriate and professional manner to protect the safety of those individuals. This may involve seeking consultation, supervision, and/or breaking the confiden- tiality of the relationship. Statement 5 Human service professionals protect the integrity, safety, and security of client records. All written client information that is shared with other profes- sionals, except in the course of professional supervision, must have the client’s prior written consent. Statement 6 Human service professionals are aware that in their relationships with clients power and status are unequal. Therefore they recognize that dual or multi- ple relationships may increase the risk of harm to, or exploitation of, clients, and may impair their professional judgment. However, in some communities and situ- ations it may not be feasible to avoid social or other nonprofessional contact with clients. Human service professionals support the trust implicit in the helping rela- tionship by avoiding dual relationships that may impair professional judgment, increase the risk of harm to clients, or lead to exploitation.

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Statement 7 Sexual relationships with current clients are not considered to be in the best interest of the client and are prohibited. Sexual relationships with previ- ous clients are considered dual relationships and are addressed in Statement 6 (above). Statement 8 The client’s right to self-determination is protected by human service professionals. They recognize the client’s right to receive or refuse services. Statement 9 Human service professionals recognize and build on client strengths.

As we have discussed, in many instances professional codes of ethics can be very helpful to practitioners in their own fields. As with any set of guiding principles, the limitations are also apparent. Mabe and Rollin (1986) point out some of these limitations as follows:

1. Some issues cannot be suitably covered within the context of a code. 2. There are difficulties with the enforcement of codes. 3. There are possible conflicts between two codes, between the practitioners’

values and the code requirements, and between the code and institutional practice.

4. There are instances in which issues in the various codes may be in conflict with the results of a court decision.

For additional information concerning the various professional codes of ethics, refer to the listing of professional organizations at the conclusion of Chapter 6. You can write directly to a professional organization and request a copy of its code of ethics.

Physical and Emotional Well-Being

Even relatively mild physical maladies such as a cold, a toothache, or an upset stomach can alter or diminish one’s ability and efficiency in attending to oth- ers. While experiencing physical discomfort, we tend to be more focused on ourselves than on other people. In addition to distracting us, physical discom- fort can distort the accuracy of sensory information we receive. A worker who feels depressed, run-down, or in a state of mental fatigue is also less likely to be as efficient as he or she ordinarily could be. When the worker is aware of these difficulties, he or she might do well to keep in mind how the difficulties can affect interaction with a client.

Environmental Factors

Physical space influences both the worker and the client. For example, arrangement of furniture influences behavior. Barriers placed between individ- uals, such as a desk separating a worker from a client, create a more formal, businesslike, less personal style of interaction. This physical separation of sev- eral feet is analogous to keeping someone “at arm’s length.” Many large organizations serving the public often use barriers such as desks or counters with large plastic windows to create this type of environment. Acting in an intimate, personal, or less formal manner in this type of setting is often con-

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sidered inappropriate. Removing the barriers and consequently becoming more physically accessible and closer to others create a different set of behav- ioral expectations. The worker should consider these factors.

Multicultural Awareness

In the United States, immigration patterns continue to add to the mosaic of a culturally diverse population in which many different ethnic groups exist side by side. U.S. Census figures predict that sometime between the years 2030 and 2050 racial and ethnic minorities will become the majority population (Sue, 1996). Within the human services field, it is increasingly likely that human ser- vices workers and their clients will have cultural backgrounds that differ. Understanding and working with cultural diversity have always been a part of the training of human services workers; however, their importance has become increasingly obvious, as the current population data confirm.

One’s culture has a major influence on how one sees and experiences the world. Culture creates and shapes just about every aspect of a person’s life, including language, beliefs, values, leisure activities, food consumption habits, clothing preferences, attitudes toward time, eye contact, gestures and body movements, facial expressions, and even attitudes toward life and death. Does a human services worker need a thorough knowledge of every client’s cultural background in order to be effective? Current research findings differ some- what on this question. For example, must all Native American counselors be trained to fully understand Chinese culture in order to work effectively with all Chinese clients? Lewis, Lynch, and Munger (1977) point out that counselor and client ethnic identity may have little relationship to the counselor’s over- all effectiveness. On the other hand, Dillard (1987) concludes that to work effectively with clients of different cultures, counselors need to understand the social and psychological forces that affect their clients’ verbal and nonverbal behavior. Cultural diversity is a fact of life in today’s world. Pedersen (1990) makes the point that counselors have two choices: to ignore the influence of culture or to attend to it. Either way, culture will still influence both the clients’ and the counselors’ behavior. Pedersen believes that the focus on cultural diversity is the most important development in the counseling profession in the past decade. Although various research studies ascribe different degrees of importance to the need for multicultural awareness, we believe that a sensitiv- ity toward and a knowledge of a client’s cultural background can only serve to make the human services worker more effective.

Most people identify with a religion or have a religious conviction (She- bib, 2002). Often a client’s spiritual and religious beliefs are an important part of their cultural identity. Their religious identity may inform their values and the important decisions they make in life, such as who they will marry, how they relate to their family, and so on. Sometimes there is a belief that a per- son’s problems need to be solved by a greater participation in their religious practices such as going to church more often, following religious laws more scrupulously, or praying. It is not uncommon for people who are connected to

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their religious institution to believe that their problems should be addressed by their clergy rather than a human service worker. Clients with strong religious convictions who seek counseling can best be helped by a professional who is aware of their spiritual orientation and beliefs; therefore, it is important for the human service professional to become informed about a client’s spiritual background just as they would a client’s cultural background.

Educational systems and traditional human services training programs must embrace an expanded multicultural perspective and structure new poli- cies and practices that are responsive to all groups in society. Depending on the cultural perspective from which a problem is considered, there can be various solutions (Corey, Corey, & Callanan, 1998). Pedersen (1990), Sue (1996), and Corey et al. (1998) indicate that the majority of the techniques and practices associated with most models of professional helping are derived from the point of view of Western culture. This can, of course, present some very real prob- lems when you consider that Eastern cultural values present a differing world view. Ho (1985) and Saeki and Borrow (1985) illustrate this contrast by point- ing out that Western culture stresses individuality, encouraging expression of one’s feelings, self-assertion, and the fulfillment of individual needs. Eastern culture emphasizes interdependence, compliance, conformity, cooperation, collective goals, and acceptance of one’s environment. Helpers will increas- ingly come into contact with client populations who do not share their world- view; therefore, culturally diverse approaches to helping become mandatory. Guidelines for practice and culturally diverse perspectives have already been added to various professional codes of ethics, including those of the American Psychological Association, the American Counseling Association, and the National Organization for Human Service Education.

Axelson (1985, p. 17) strongly suggests that all human service workers:

• Become knowledgeable in several cultures • Study differences and similarities among people of different groups and

their special needs and problems • Gain an understanding of how the individual relates to important events

in life, what his or her personal values and morals are, and how they are constructed to form his or her worldview

Skilled human services workers must become consciously aware of how their own background influences the application of their skills. Brill (1995, p. 251) stresses that workers must be aware of what they hold in terms of per- sonal attitudes, biases, beliefs, and knowledge about their ethnically different clients that can affect their ability to consider problems objectively, define them accurately, make valid assessments, and present acceptable solutions. They must be particularly aware of the ever-present danger of stereotypes and gen- eralizations as explanations of behavior. They must also consider the impact that conflicting demands have on people of one culture who are trying to adapt to life in another culture. Conflict can arise between family loyalties that may require a person to select a mate from within his or her original cultural group as opposed to the new environment, which offers many other possibilities. It is therefore essential that helpers resist making value judgments for their clients.

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Prior Training

As we indicated in Chapter 4, various theoretical approaches to helping are prevalent in the field. The approach a worker follows can influence how he or she perceives the client and therefore can affect which aspects of behavior he or she notes with particular emphasis. For example, the worker who employs a behavioral approach to helping might be more apt to notice and emphasize the client’s overt physical manifestation of symptoms such as insomnia, weight loss, or nervous habits. The behaviorally oriented worker might not pay atten- tion to certain aspects of the client’s life history that could indicate an early childhood trauma. The psychoanalytically oriented worker, on the other hand, would be much quicker to notice and emphasize the client’s earlier life experi- ences. Strict adherence to a specific theoretical approach can limit the scope of one’s skills.

Crisis Intervention

As discussed in Chapter 1, crisis intervention is a special form of help designed to meet the needs of a person faced with an unusually difficult life situation. It is a timely and skillful intrusion into a personal crisis to diffuse a potentially disastrous situation before physical or emotional destruction occurs (Green- stone and Leviton, 2002). Crisis is a perception of an event or situation as an intolerable difficulty that exceeds the resources and coping mechanisms of the person (Galliland and James, 1988).

Crisis intervention is a helping process that occurs at a much faster pace than other treatment modalities, such as case management or counseling, where weekly, monthly, or quarterly contact is sufficient. (Poindexter, Valentine, and Conway, 1999). The goal is problem management not problem resolution. The primary focus here is to make all supportive services available immediately.

Recognizing Crisis Crisis results from tension and stress in one’s life. It can be caused by an accumulation of things or an immediate and sudden experi- ence. Stress is thought of as the key element in crisis development. As stress mounts, the individual’s normal coping mechanisms may become ineffective and the potential for crisis increases. A crisis is an individual’s personal, emo- tional, and physical reaction to a situation or hazardous event; it is not the event itself.

Types of Crises Much of the research in the field of crisis intervention has indicated that crises can be classified into two major types:

Developmental Crises: Erik Erikson (1963) was one of the first to describe developmental crises resulting from the psychosocial maturational process. As we chronologically age, we undergo periods of major transition from childhood to puberty, into adolescence and then adulthood and old age. Each of these periods of transition in life requires a role change and the introduction of new tasks and brings its own unique conflict situations. For example, teenagers seek to further develop their identities, adults choose

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career paths, and older adults seek to redefine their lives upon retirement. It is the short periods of psychological upset that occur during a critical transition point in the normal development of a person that will be a major focus for the crisis worker (Kanel, 1999). It is generally accepted that indi- viduals are more vulnerable to crisis at these pivotal points in life.

Situational Crises: Unlike crises that may arise during major transition stages of life, situational crises do not occur with any regularity. Often this type of crisis is sudden and is caused by specific traumatic events. Examples of situational crises are numerous and may include losing a job, physical abuse, rape, alcohol or chemical dependency, death of a rel- ative or close friend, divorce, or experiencing a natural disaster or act of terrorism. These types of events create heightened stress and anxiety and increased psychological, emotional, or behavioral imbalance, which can cause a crisis. The chief characteristic that differentiates these from developmental crises are (1) sudden onset, (2) unexpectedness, (3) emer- gency quality, and (4) potential impact on the community (Slaikeu, 1990, pp. 64–65).

Crisis Symptoms As discussed, individuals react to crisis situations in a vari- ety of ways. Clearly, one’s past experiences play an important role in how one may react to any given event. There are, however, certain behavioral charac- teristics that may make an individual more prone to crisis; these include a lack of meaningful personal relationships, feeling of low self esteem, unresolved prior crises, and lack of social support or family systems.

Hoff (1995) describes four identifiable stages of crisis development:

1. The individual reacts to a situation with heightened anxiety and attempts to utilize prior problem-solving skills.

2. The individual’s usual problem-solving skills are ineffective in resolving the situation and the anxiety increases.

3. All attempts at the resolution of the problem have failed. 4. Tension and anxiety overcome the individual as the situation remains

unresolved.

As an individual moves through the stages of crises development, common signs and symptons will become more apparent. Greenstone and Leviton (2002) describe the emotional, cognitive, and behavioral symptoms to include the following:

emotional cognit ive behavioral

Generalized Anxiety Confusion Sleep Disturbance

Shock Poor Attention Span Withdrawal

Denial Loss of Trust Change in Appetite

Insecurity Difficulty Making Crying Decisions

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emotional cognit ive behavioral

Fear Increased Irritability

Panic Change in Level Despair of Activity

Depression Regression

Anger Unresponsiveness

Grief

Outrage

Crisis Intervention Strategies There has been considerable research in the field of crisis theory and intervention strategies since the pioneering works of Lindemann (1944), Erikson (1963), and Caplan (1964). Currently there is no single interevention strategy that is proven effective in all types of crisis situa- tions. Rather than present a single model of crisis intervention or multiple models, the following represents an eclectic intervention model drawn from the works of Hoff (1995), Kanel (1999), Poindexter, Valentine, and Conway (1999), and Greenstone and Leviton (2002).

Attending to the Person: Actively listen to what the person is trying to com- municate both verbally and nonverbally. Remain calm, supportive, and try to quickly establish and maintain a rapport. Try to identify the precipitat- ing events. Act to relieve anxiety and try to prevent further disorientation.

Assessment: Accurately assess and clarify the source and meaning of the stress and anxiety of the person. Ascertain the level of intensity and decide if the situation warrants other supportive services or appropriate referral immediately. Decide on a priority of which problems should be handled first, second, and so on.

Provide Structure: Establish what you can do for the person and define goals and objectives with the person. Explore options. Think creatively. Allow the person to rely on you until they can gain control.

Identify Strengths and Resources: Communicate to the person that you believe he or she to be a capable person who is momentarily in a difficult and stressful situation. Convey that anxiety and stress are normal and expected reactions to an unusual situation. Help the person to identify other people or personal resources in their lives that may be of assistance.

Evaluation: Decide what is the appropriate next step for the person. Con- sider additional help and referral sources. Develop a plan of action. Con- sult a supervisor or agency guidelines, if needed.

Follow-Up: Contact the person within a few days to check if referral to the specialist or agency was appropriate. Check if the person contacted the referral sources in a timely manner. If necessary, contact the referral source directly to check if the person has engaged the service.

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Crisis Outcomes The outcome of a crisis can take various forms. Some view crisis as both a danger and an opportunity for further growth. Whether the individual comes out of the crisis state productively or unproductively depends on how he or she deals with the crisis (Kanel, 1999). If the individual is able to develop and integrate the problem-solving skills learned as a result of the crisis, it is expected that he or she will return to the level at which they were functioning prior to the crisis. Another outcome suggests that the acquisition of new problem-solving skills and coping mechanisms will facilitate further growth of the individual. It is very possible the individual may then function much more effectively and will have gained greater self-confidence. While many individuals do learn to cope with and resolve crises, some do not. For these individuals, unresolved problems may cause increased deterioration— such as anti-social behavior, depression, or withdrawal—leading to further problems associated with alcohol or chemical dependency.

HUMAN RIGHTS, THE LAW, AND HUMAN SERVICES The laws of society affect all areas of human behavior. The law requires the members of a society to learn what is acceptable (that is, legal behavior) and what is unacceptable (that is, illegal behavior). It defines the rights of individ- uals and outlines society’s obligations to its members. In many instances, the legal system has a direct influence on the provision of human services. As soci- ety becomes more complex, the interaction between the law and the human services system tends to increase. Slovenko (1973) has highlighted several of the more significant areas of concern as follows:

• In some instances, human services have assumed the role of religion in explaining the causality of behavior. Behaviors previously viewed as sinful or unlawful may now be attributed to physiological or genetic causes. In this manner, individuals are not held responsible for their actions. Our dis- cussion of the medical model in Chapter 4 highlights this point.

• Emphasis may be placed on rehabilitation rather than retribution. The offender should be helped through our human services system rather than punished through our legal system.

• The state can intervene in the lives of those considered unable to handle their own affairs and who might present a problem to society. Some per- sons judged by the courts to be suffering from mental illness might be deprived of their rights.

The law can override the values of a professional code of ethics of a par- ticular profession. This might occur when deemed legally necessary to protect the health, safety, and welfare of the public. For example, one such situation involves client confidentiality. The need for confidentiality is outlined in vari- ous professional codes of ethics and considered necessary to ensure the effec- tive treatment of clients. However, the law may require the disclosure of client

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information in an effort to prevent harm to others. An illustration of this issue is the California Supreme Court decision in the case of Tarasoff v. Regents of the University of California (1976). The court supported a “duty to warn” possible victims of clients whose counselors or therapists have such informa- tion. In general, the court stated that when therapists determine that a patient presents a serious danger to another, they are obligated to warn the intended victim. They are to apprise the victim of the danger, notify police, and take whatever other steps are reasonably necessary to protect the potential victim. Mehr (1995) expands these issues further when he points out the increased concern with the constitutional rights in regard to issues such as involuntary treatment, incarceration, and protecting the public.

As we have discussed, working within the complexities of our human ser- vices system requires a basic knowledge of the law. Specifically important is the relationship of law to various human rights issues. We now examine some of these more common and controversial issues further.

Voluntary and Involuntary Services

These concepts and their implications have broad meaning within our human services system. As Mehr (1995) suggests, the concept of voluntary services generally embraces some of the following guidelines:

1. The client decides that some form of help is needed, and he or she con- tracts with the service provider for help.

2. The client takes part in creating the objectives and goals of his or her own treatment.

3. The client can discontinue or terminate the treatment if desired.

The concept of involuntary services is quite the opposite. Services are assumed to be involuntary based on these guidelines:

1. An individual or agency other than the client decides that a service is nec- essary. For example, the police or courts might require a homeless person to leave a public area and go to a shelter.

2. Various authorities (for example, courts, legal guardian, therapist) require the client to obtain a particular service.

3. Various individuals other than the client set treatment goals. 4. The decision to terminate the service is determined by someone other than

the actual client.

These concepts are examined more closely in Chapter 2 in our discussion con- cerning drug treatment programs.

The Right to Refuse Services

As helping professionals, we assume that our actions toward our clients are intended to be in their best interests. It has sometimes been assumed that we could successfully administer services even if the clients resisted our efforts.

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The clients’ resistance was regarded as a function of their particular disor- der, and it was thought that we knew what was best for them. Such actions of the past are no longer valid or legal in certain situations under current law. Recent law now stipulates that clients do have the right to refuse ser- vices. A common and often cited example would be the case of a patient within a mental hospital setting who refuses to take a particular medication prescribed by a physician. The courts have stated that it is illegal to force a patient to take the medication. However, if a judge declares the specific patient to be legally incompetent to make such decisions on his or her own behalf, then the patient can be forced to submit to involuntary treatment. Each situation must, of course, be reviewed based on its own individual cir- cumstances. People may still be committed to hospitals against their will and be required to receive treatment for specified periods of time. This issue is a multifaceted, controversial problem. The limits of the law relating to the extent to which patients can refuse certain types of treatment are currently being reexamined.

Due Process

The Constitution of the United States contains a provision under the 5th and 14th Amendments that states if government activities affect an individual in a manner that would deprive the individual of liberty or property, this must be done with due process of law. Put quite simply, if you feel that you have been treated unfairly and would like the opportunity to state your position in court and rectify the wrong, you are seeking due process. For example, before a client can be committed for involuntary service for an unspecified period of time, the law provides for a hearing before a judge. Within a school setting, the right to due process may take the form of requiring school administrators to specify in writing various offenses for which a student can be disciplined. They must notify the children and their parents when rules are violated and then conduct a hearing. There can be either full or partial due process proce- dures. Full due process procedures usually involve representation by a lawyer, a hearing before an impartial judge and jury, the right to present evidence and have witnesses, and the right to a written statement of findings. This type of procedure is most common when a person might be seriously damaged by a particular decision.

In certain situations, when there is less potential for harm, the law pro- vides for partial due process procedures. Partial due process procedures are usually less formal and may involve an administrative hearing rather than trial by jury. In these circumstances, there might be a notice of the charges and some type of assistance given in the preparation of a case. Human services organizations most commonly are involved with partial due process proceed- ings in disputes with clients. In this instance, the client has a right to appeal an organization’s decision. An administrative hearing may be requested in which the client is allowed a legal advocate and an opportunity to state his or her case.

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The Least Restrictive Alternative

Clients have the right to treatment in settings that are the least restrictive to their personal freedoms and liberties. For example, as Mehr (1995) points out, if clients can receive proper outpatient treatment while residing in a commu- nity setting, then they should not be hospitalized because that would deprive them of more personal freedom than necessary. Many individuals, however, remain in institutional settings, such as mental hospitals, mental retardation facilities, or nursing homes, because there may not be a less restrictive alter- native available to them in a particular community.

THE WORKER IN GROUP SETTINGS The responsibilities of a human services worker very often involve working with groups. They work in settings such as settlement houses, community cen- ters, educational institutions, hospitals and Ys, among others. This requires using skills previously discussed in a somewhat different manner, as well as the use of additional skills. This section will focus on the basic skills necessary to facilitate work with groups. It is an introduction for the beginning human ser- vices student to many additional concepts, skills and techniques that can be acquired through advanced training in group work.

Definition of a Group

Some human service workers define a group as a collection of individuals who share a common purpose and work together to achieve their goals. Another definition according to Brown (1991), is that “A group is considered a small face-to-face collection of persons who interact to accomplish some purpose.” Either definition is helpful and useful. There are two basic categories of groups. The first consists of natural groups. They include groups such as fam- ilies, friendship groups, various interest groups, gangs and many self-help groups, among others. These types of groups most often do not have a human services worker to help or guide them and they generally do not meet in a human service agency or setting. The second category includes groups such as therapy groups, personal growth groups, counseling groups, many self-help groups, and club groups, among others. These groups most frequently meet in some human services agency or setting and are generally formed and led by a worker assigned by the agency or setting.

It should be noted that the various types of groups can—in terms of pur- pose, leadership, and agency sanction—fit into either category. Human service workers are concerned mostly with formed groups meeting within a human service setting.

Group Leadership Skills Group leaders share many traits with orchestra con- ductors (Benjamin, 1978.) Both help their group to develop their pace and tone in order to achieve their respective goals. According to Garvin (1981,

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pp. 113–114) group workers “. . . use the group approach to accomplish the goals common to all social work activities: (1) to prevent members from developing dysfuntional ways of coping with their situation; (2) to enhance members engagement in a creative use of artistic, social, intellectual, and other endeavors; and (3) to rehabilitate members who have developed handicaps in their social and personal functioning” In this context Goroff (1983, pp. 29–31) introduces certain principles that deal with how to help groups reach their goals. He states that “. . . being responsible to and not for . . .” a group is a basic principle of group work. Other principles are “. . . not tak- ing the power many people seem ready to give up.” And “. . . not to do for others which they must do for themselves.” To ignore these principles is in effect telling the group and individual members that they are not capable, equipped, or ready to take responsibility for their decisions or actions. In other words, the worker must continually recognize and affirm the individuals’ strengths, dignity, worth, and integrity. The worker helps the group achieve its goal through the use of group leadership skills.

Selecting Group Members In many groups, especially in therapy or counsel- ing groups, the selection of group members is an important consideration. Establishing a balanced group is often desirable. The worker might want to provide a varied mix of young and old, male and female, or talkative and quiet members. Previous knowledge and information about an individual can help the worker make appropriate decisions concerning a person’s suitability to participate in the group.

Establishing Goals Once the group is established, the group tries, with the help of the worker, to determine the group’s goals and objectives. Goals are based on the members level of functioning. In a group with a very low level of functioning, the goals are usually set by the worker. Whether they are specific or general, they must be clearly defined and agreed upon by group members. The leader should provide every opportunity for the group members to express their views concerning goals.

Establishing Norms Establishing a clear set of rules at the beginning of the group helps the group to proceed more effectively toward its goals. The worker helps the group determine and establish such guidelines. Group rules or guidelines can address the issue of confidentiality by having participants agree to discuss group matters only within the confines of the group. Deter- mining how the group should make decisions would be an important rule. Another rule might involve allowing each member to finish talking before another member can interrupt.

Intervening The human service worker intervenes when necessary by step- ping in and, attempting to help the group change, modify, or point out some- thing that is happening in the group. Essentially it is focused on behaviors,

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decisions, and discussions, both positive and negative, in order to help the group reach its goals. For example, a worker may intervene between two clients who are arguing over a particular issue, to point out to one of the clients that she finally is standing up for what she believes. The helper may also intervene when a member violates the established rules of the group.

Sometimes groups get stuck. The leader may intervene when a discussion has reached an impasse. He or she may then suggest additional or alternative ways of viewing the situation or problem. Workers may also intervene by introducing a specific therapeutic technique, such as role-playing, to help clar- ify and bring additional insights to a particular problem that a client or group may be experiencing. Knowing how and when to move in is as important in group work as it is in interviewing and helping clients.

Promoting Interaction The group leader helps promote and bring about interaction among the group members. Promoting interaction can lead to establishing clear channels of communication among clients. When group members are linked to one another, they begin to work together and relate per- sonally. To be effective as a facilitator, the worker needs to be insightful and sensitive. The leader has to find ways of relating the concerns of one individ- ual to the concerns or struggles or others. This process provides further oppor- tunities for mutual support and helps develop a feeling of interconnectedness and cohesiveness.

The result of this process can be the creation of a climate of safety and acceptance in which members trust one another and therefore are likely to engage in productive interchanges (Corey and Corey, 1987). As a facilitator, the group leader helps the participants express their problems and provides support as members explore aspects of themselves. He or she essentially helps group members reach their individual goals as well as group goals through this mutually influencing process.

Appraising/Evaluating The group leader and members of the group must appraise the ongoing process and goals of the group. It is particularly helpful to do this during and after each group meeting. The leader must reflect on what is happening in the group, the direction it seems to be taking, how it helps certain participants and not others, and the kinds of issues that may be helpful in the next group session. Very often the leader will encourage the members to become part of this process. Workers sharing their evaluations of what is happening in the group with the group, helps the members become more aware of how they influence each other. As a result of this process, con- structive changes or new goals can be implemented to enable the group to ful- fill more of each member’s stated needs.

Terminating the Group The issue of termination emerges in every group in many ways. Workers must know when and how to help the group end each session. The leader can help the members discover how to transfer what they

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have learned in the group to other life situations or environments. The leader can help the group summarize what happened during a session or to think about some point that had emerged. The leader can help the group end a ses- sion by suggesting mini goals for clients to work on.

In some instances, workers must know when it is most appropriate for a member to leave the group. In this decision, the worker must consider and evaluate all available information that pertains to the client, such as the client’s stated goals, his or her past and present ability to achieve stated goals, and whether the group is still useful for the client’s present situation.

A worker must help the group determine whether the group has com- pleted its work and if it is time to disband. If the group has previously high- lighted a clear set of goals, developed constructive group guidelines, and consistently monitored its progress, the group is now in a good position to decide about termination.

THE WORKER IN THE COMMUNITY As human services systems have developed to identify and meet human needs, new and diverse activities and functional roles have been created for workers. Workers are spending increasing time in community settings because of the need to locate services for clients, to enlist the aid of various organizations in developing new services, and to provide information that might help prevent problems. As any system gets larger, workers need additional skills and knowl- edge to understand and effectively use the resources available within the sys- tem. The individual and group skills previously examined in this chapter are, of course, components of all human services activities. As the contemporary worker has become more involved in various aspects and activities of the com- munity, the need for additional knowledge and skills has emerged. Additional skills useful for the community worker are the following:

• Advocating • Negotiating • Organizing • Coordinating • Educating • Planning • Consulting • Gathering information • Acting as liaison • Lobbying • Reaching out

By examining some of the functional roles and activities most often per- formed by workers in the community, you can begin to understand why these skills are needed and how they might be used.

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Advocacy

Advocacy in the human services has become, if not a major function of human services workers, an essential one. In fact, both the NOHSES’s Ethical Stan- dards of Human Services Professionals and the NASW’s code of ethics makes it clear that workers, whenever and wherever needed, should advocate for their clients. (We strongly support this point of view.) While there are many defini- tions and many types of advocacy, we believe Ezell’s (2001, p. 8) definition is clear and helpful. He states “Advocacy consists of those purposive efforts to change existing or proposed policies or practices on behalf of or with a client or groups of clients.” Furthermore, according to Schneider and Lester (2001, p. 19) advocacy is “action oriented.” They assert that “Action is a fundamen- tal basis for advocacy. While actions may constitute very different activities, the essential elements of initiative, taking steps, participation, engagement, expend- ing energy and involvement must be present” Some of the different types of advocacy are identified by Schneider and Lester (2001). They include client, class, legislative, and administrative advocacy as major strategies practiced by social workers. Ezell (2001) lists and defines 13 types of advocacy that human services workers can and do practice. They include case, class, internal (admin- istrative), legal, legislative, and community advocacy among others.

A brief look at case or client advocacy will provide some insight to what the roles of the worker are. Essentially, the worker prepresents the client and attempts to help the client acquire whatever resources are needed to be helpful.

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The worker and client identify and assess the needs of the client so that the appropriate resources can hopefully be obtained. For example, a client may be denied Social Security or welfare benefits to which he or she may be entitled. The denial may be based on a lack of knowledge, an error on the part of the provider, or some other inappropriate reason. The worker could then educate the client about the desired services and how to access and obtain them. The worker also might literally act for the client, confronting and negotiating the bureaucratic mazes to ensure that the client receives whatever services and ben- efits he or she is entitled to receive. Often this work involves gathering and coordinating substantial amounts of information concerning the services sought. The information might include criteria and procedures necessary to qualify for the various programs. As the representative of the client, the worker often, in appropriate instances, actually pleads the clients’ case to individuals, agencies, or governmental services within the larger system. This process can often be extremely frustrating.

Knowledge of many advocacy activities and skills are essential here. Ezell (2001) points out that “In each case, the practitioner is seeking change by arguing, provoking, negotiating, giving, lobbying, litigating, representing, or influencing” In order to be successful, these activities require certain charac- teristics of the worker as well as the use of the various skills. Schneider and Lester (2001) see the worker as opposed to injustice, action-oriented, patient, and hopeful, among other traits. Ezell (2001, p. 22) sees the effective advocate as being persistent, tenacious, and patient as well as assertive and flexible. The effective advocate also needs to be skilled as a negotiator, resourceful and assertive, persuasive, and able to deal with conflict. The sensitive use of these characteristics, activities, and skills can make the difference between success or failure in obtaining the needed services or achieving change.

Community Organizing

Community organization is a method of practice taught in schools of social work as well as other educational institutions and disciplines. Practioners are referred to as community organizers, change agents, and community workers, among other titles. The community organizer tries to help bring various sec- tions of the community together to create, improve, or maintain programs, agencies, or organizations. Examples might include the development of job training programs within an agency or as an independent organization. Help- ing create a needed after-school program or family clinic could be other goals of the community and worker. In order to be effective, the change agent must recognize that communities consist not only of individuals but of organizations, both formal and informal. Human service workers are generally educated to understand and work most often with individuals and small groups; however, knowledge and understanding of how organizations—private, public, formal, or informal—develop and function is essential for the community organizer. Michael, Daley, and Netting (1994, pp. 40–41) emphasize this clearly when they state: “Professionals need to understand the inner workings of organiza-

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tions while at the same time see beyond formal organizations, recognizing and valuing the importance of natural support networks that are not organization- ally based but that play essential roles in the everyday lives of people.”

In order to accomplish tasks like those mentioned, the community organ- izer must know the community politics and financial resources as well as all other possible resources. Knowing who has influential power in the commu- nity is very important. It is also very helpful if the worker is a skilled and artic- ulate speaker, for it is often necessary to try to persuade individuals, groups, or committees to see a particular point of view. The change agent must be able to work independently and under pressure even though assistance and approval is needed. Horman (1999, p. 99) points out that: “A critical issue you will face as a change agent is that of obtaining sanction for your efforts.” That sanction (or permission) must come from those whom the change agent is trying to affect, or represent or from the worker’s employer. In addition, patience, sensitivity, and diplomacy are essential characteristics for the effec- tive community organizer.

Community Outreach

Human services workers who perform outreach activities can generally be found working directly in the clients’ environment. In many instances, a client may be unable or unwilling, owing to physical or emotional illness, to come to a specific human services center. In this case, the outreach worker actually visits the client’s residence and helps with a variety of concerns related to all aspects of daily living. A typical service involving these types of activities is a homebound elderly program. Elderly individuals can become, through illness or other factors, unable to accomplish certain tasks for themselves. The worker’s activities here might involve helping the client shop for groceries, teaching the client how to budget money more effectively, informing and edu- cating the client about health and nutrition concerns, and actually helping the client learn or relearn many daily activities that other people take for granted.

Other outreach activities and services focus on the recently discharged psychiatric patient, who may require some form of help to make the transition back into community living. Here, the worker might be involved in teaching a client how to use forms of public transportation, linking clients to other ser- vices available in the community, and helping clients develop a range of per- sonal interests that could enhance their quality of life. It is often the outreach worker who is the primary liaison between clients in the community and avail- able community services.

Case Management

Consumers of human services frequently need more than one form of support to meet their needs. With so many types of services available within our human services delivery system, how does one know which services are appro- priate for his or her specific needs? How does one know how to directly access

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or coordinate several available services? Who monitors the ongoing effective- ness of these services to ensure that the consumer is reaching his or her desired goals? Case management is the current response to this issue. Case manage- ment is the generally accepted term for helping those in need negotiate the complicated systems designed to deliver legal, medical, and social services and to help them obtain services in an appropriate and timely manner (Rubin, 1992). If executed properly, case management would assure a quality of care to those in need. The tasks and roles usually labeled “case management” can also be referred to as “care coordinator,” “service coordinator,” or “service management” (Kane, 1990). Different human services organizations often use different terms to designate the same activity. Regardless of the term used, case management has become one of the cornerstones of service delivery in our contemporary human services system.

Although the terms case management and case manager are relatively new (over the past 15 years) in the human srvices field, the activities associated with these terms have their roots in the earlier human services movement of 30 to 40 years ago. With the widespread mandate of deinstitutionalization beginning in the 1960s, case management activities became prominent as many thousands of mentally ill people, who were formerly institutionalized, were discharged into community settings. Most of these discharged patients continued to need a variety of services that were no longer located or provided within their former institutions. In a fragmented system of services, case man- agement became a viable means to access and provide services for this popu- lation. Today, case managers are found in such areas as community mental health centers, childrens’ services, public welfare agencies, programs for the elderly, alcohol and substance abuse treatment programs, vocational rehabili- tation services, programs for people with special needs, health care systems, legal systems, and many more (Mehr, 2001).

It is important to realize that case management is not a single event, per- formed by the case manager only at the time he or she first meets a client. Rather, it is an ongoing process providing services over a period of time. The amount of contact with the client will vary depending on the specific needs of the client. Case managers will arrange for, coordinate, develop, provide, and/or oversee services for the person or persons who might benefit from accessing resources. (Poindexter, Valentine, & Conway, 1999). Woodside & McClam (2002) point out that the goal of case managers is to teach those who need assistance to manage their own lives but to support them when expertise is needed or a crisis occurs.

Human services workers who function as case managers have job respon- sibilities that focus on the “whole person.” The case manager becomes the pri- mary worker who understands the client’s total life situation. A case manager has the responsibility for the comprehensive care of the client, often making sure there is a quality control so the client does not risk becoming lost in the system. Case management duties are not limited to one area of human services training. Social workers, psychologists, counselors, nurses, and generalists can each have case management responsibilities.

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Some of the diverse work activities and core functions include the following:

Assessment: Gathering all necessary information regarding the client. This can include family history, insurance data, housing information, and so on. Establishing and prioritizing client needs and goals. If needed, an interdisciplinary team may be established to represent the various needs of the client.

Treatment Planning: Developing a comprehensive plan of action that will enable the client to reach his or her optimal level of functioning.

Service Implementation: Linking and providing the client with access to the needed services. The case manager may contact the various agencies or personnel who will be serving the client to coordinate treatment goals.

Counseling: Often the case manager works directly with the client either in person or through consistent telephone communication. This ongoing contact allows the case manager to help the client with a variety of ques- tions or concerns.

Advocating: Contacting appropriate agencies/programs or governmental services and representing the client in an effort to arrange for whatever services may become necessary such as vocational training, housing, health services, or counseling.

Coordinating: Overseeing and monitoring the client’s coordinated system of treatment to ensure that all services work together toward the desired goals.

Record Keeping: All essential information regarding the client must be maintained, updated, and periodically reviewed.

Evaluating and Monitoring: Periodically assessing the continued value of all services provided to the client. The treatment plan itself must be reviewed for its continued effectiveness. Contact must be maintained with all service providers to assure continued suitability of services.

The following example illustrates some of the various daily work activi- ties of a case manager.

Kim is employed as a case manager with a large community mental health center. This center has a variety of programs and services, which include an out- patient clinic, day treatment program, prevocational training center, sheltered workshop, and social support system. Kim has a caseload of 20 clients. During the morning hours she conducts an intake interview with a new client and gath- ers all pertinent information regarding the client’s personal history. She later attends a staff meeting where various program directors discuss the progress of several of Kim’s clients. After the meeting, Kim spends a great deal of time on the telephone trying to arrange for the eligibility of several of her clients to receive public assistance funds and arrange for a group home placement for another client. After lunch, Kim goes across town to visit two different voca- tional training programs to assess the suitability of each program for three of her clients. The remainder of the day is spent back at the center, where Kim

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meets individually with two clients to discuss problems they are having with public assistance, health insurance, and a group home living arrangement.

Providing Information

One of the major tasks confronting human services is to educate and inform the public. Often, people can prevent small problems from becoming larger ones if they only know who to turn to for help, what legal rights they possess, and what alternatives are available to them. Access to information can actu- ally prevent some prevalent social problems.

To provide information to the community, human services workers are involved with many aspects of our daily lives. For example, workers can be found visiting local high schools to provide current information on topics such as drug abuse, birth control, and alcoholism. In other segments of the com- munity, workers are likely to be involved with civic or church-related groups, providing information concerning social security benefits, welfare procedures, or family planning. Many community mental health centers have a specific consultation and education department whose designated task is to provide these types of information to a particular community. A more in-depth exam- ination of the role of prevention in the human services field is provided in Chapter 8.

Additional Reading

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Aguilera, D. C. (1998). Crisis interven- tion:Theory and methodology. St. Louis: Mosby.

Andrews, L. M. (1989). To thine own self be true. New York: Doubleday.

Barsky, A. E. (2000). Conflict resolution for the helping professions. Pacific Grove, CA: Brooks/Cole.

Berry, C. R. (1989). When helping you is hurting me: Escaping the Messiah trap. San Francisco: Harper & Row.

Dalton, J. H., Elias, M. J., & Wanders- man, A. (2002). Community psychology: Linking individuals and communities. Belmont, CA: Wadsworth.

DeJong, P., & Berg, I. K. (2002). Inter- viewing for solutions (2nd ed.). Pacific Grove, CA: Brooks/Cole.

Devore, W., & Schlesinger, E. G. (1981). Ethnic-sensitive social work practice. St. Louis: Mosby.

Ellis, A., & Yeager, R. J. (1989). Why some therapies don’t work. Buffalo, NY: Prometheus.

Fischer, L., & Sorrenson, G. P. (1985). School law for counselors, psychologists, and social workers. New York: Longman.

Green, J. W. (1995). Cultural awareness in the human services (2nd ed.). Boston: Allyn & Bacon.

Halley, A. A., Kopp, J., & Austin, M. J. (1998). Delivering human services: A learn- ing approach to practice (4th ed.). New York: Longman.

James, R. K., & Galliland, B. E. (2001). Crisis intervention strategies (4th ed.). Pacific Grove, CA: Brooks/Cole.

Johnson, D. W., & Johnson, F. P. (1982). Joining together: Group theory and group skills (2nd ed.). Upper Saddle River, NJ: Prentice Hall.

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Julia, M. C. (1996). Multicultural aware- ness in the health care professions. Boston: Allyn & Bacon.

Knapp, M. L. (1972). Nonverbal commu- nication in human interaction. New York: Holt, Rinehart & Winston.

Kottler, J. A. (1983). Pragmatic group lead- ership. Pacific Grove, CA: Brooks/Cole.

Maeder, T. (1990). Children of psychia- trists and other mental health profession- als. New York: Harper & Row.

Miller, W. R. (Ed.). (1999). Integrating spirituality into treatment. Washington, DC: American Psychiatric Association.

Murphy, B. C., & Dillon, C. (1998). Interviewing in action. Pacific Grove, CA: Brooks/Cole.

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Okun, B. F. (1997). Effective helping: Interviewing and counseling techniques (5th ed.). Pacific Grove, CA: Brooks/ Cole.

Schulman, E. D. (1991). Intervention in human services: A guide to skills and knowl- edge (4th ed.). New York: Macmillan.

Welfel, E. R. (1998). Ethics in counseling and psychotherapy. Pacific Grove, CA: Brooks/Cole.

Woodside, M., & McClam, T. (1998). An introduction to human services (3rd ed.). Pacific Grove, CA: Brooks/Cole.

Young, M. E. (1998). Learning the art of helping. Pacific Grove, CA: Brooks/ Cole.

References Avila, D. L., Combs, A. W., & Purkey, W. W. (1978). The helping relationship sourcebook. Boston: Allyn & Bacon.

Axelson, J. A. (1985). Counseling and development in a multicultural society. Pacific Grove, CA: Brooks/Cole.

Benjamin, A. (1978). Behavior in small groups. Boston: Houghton Mifflin.

Brammer, L. M. (1981). The helping relationship—process and skills (4th ed.). Upper Saddle River, NJ: Prentice Hall.

Brill, N. (1995). Working with people: The helping process (5th ed.). New York: Longman.

Brill, N. I. (1998). Working with people (6th ed.). New York: Longman.

Brown, L. N. (1991). Groups for growth and change. White Plains, NY: Longman.

Caplan, G. (1964). Principles of preven- tive psychology. New York: Basic Books.

Carkhuff, R. R., & Berenson, B. G. (1967). Beyond counseling and therapy. New York: Holt, Rinehart & Winston.

Combs, A. W., Avila, D. L., & Purkey, W. W. (1978). Helping relationships. Boston: Allyn & Bacon.

Corey, G. (1991). Theory and practice of counseling and psychotherapy (4th ed.). Pacific Grove, CA: Brooks/Cole.

Corey, G., & Corey, M. S. (1987). Groups: Process and practice (3rd ed.). Pacific Grove, CA: Brooks/Cole.

Corey, G., Corey, M., & Callanan, P. (1993). Issues and ethics in the helping professions (2nd ed.). Pacific Grove, CA: Brooks/Cole.

Corey, G., Corey, M. C., & Callanan, P. (1998). Issues and ethics in the helping professions (5th ed.). Pacific Grove, CA: Brooks/Cole.

Cormier, W. H., & Cormier, L. S. (1985). Interviewing strategies for helpers: Fun- damental skills and cognitive behavioral interventions (2nd ed.). Pacific Grove, CA: Brooks/Cole.

Cowen, E. L., Leibowitz, E., & Lei- bowitz, G. (1968). Utilization of retired people as mental health aides with chil- dren. American Journal of Orthopsychia- try, 38, 900–909.

Danish, S. J., & Haner, A. L. (1976). Helping skills: A basic training program. New York: Human Services Press.

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Dillard, J. M. (1987). Multicultural coun- seling. Chicago: Nelson-Hall.

Erikson, E. H. (1963). The A-B-C method of crisis management. Mental Hygiene, 52, 87–89.

Ethical Standards of Human Service Pro- fessionals (2000). Human Service Educa- tion, 20 (1), 61–68.

Ezell, M. (2001). Advocacy in the human services. Pacific Grove, CA: Brooks/Cole.

Galliland, B. E., & James, R. K. (1988). Crisis intervention strategies. Pacific Grove, CA: Brooks/Cole.

Garvin, C. D. (1981). Contemporary group work. Englewood, NJ: Prentice Hall.

Goroff, N. N. (1983). Social group work as a reflection of the affirmation of the human beings’ dignity, worth, and integrity. In N. Goroff (Ed.), Reaping from the field— from practice to principle. Proceedings of Social Group Work thru 1981. Vol. 1. Hebron, CT: Practioners Press.

Greenstone, J. L., & Leviton, S. C. (2002). Elements of crisis intervention (2nd ed.). Pacific Grove, CA: Brooks/Cole.

Ho, D. Y. F. (1985). Cultural values and professional issues in clinical psychology: Implications from the Hong Kong experi- ence. American Psychologist, 40(11), 1212–1218.

Hoff, L. A. (1995). People in crisis: Understanding and Helping. San Fran- cisco, CA: Josey-Bass.

Horman, M. S. (1999). Promoting com- munity change: Making it happen in the real world. (2nd ed.). Pacific Grove, CA: Brooks/Cole.

Ivey, A. E., Ivey, M. B., & Simek- Downing, L. (1987). Counseling and psy- chotherapy: Integrating skills, theory, and practice (2nd ed.). Upper Saddle River, NJ: Prentice Hall.

Johnson, D. W. (1986). Reaching out— interpersonal effectiveness and self- actualization (3rd ed.). Upper Saddle River, NJ: Prentice Hall.

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Kane, R. A. (1990). The relevance of case management. In B. S. Fogel, A. Furino, & E. F. Gottlieb (Eds.), Mental health policy for older Americans (pp. 201–220). Wash- ington, DC: American Psychiatric Press.

Kanel, K. (1999). A guide to crisis inter- vention. Pacific Grove, CA: Brooks/Cole.

Kohut, H. (1984). How does psycho- analysis cure? Chicago: University of Chicago Press.

Lewis, M. H., Lynch, M. L., & Munger, P. F. (1977). The influence of ethnicity on the necessary and sufficient conditions of client-centered counseling. Journal of Non-white Concerns, 5, 134–142.

Lindemann, E. (1944). Symptomology and management of acute grief. American Journal of Psychiatry, 101, 141–148.

Mabe, A. R., & Rollin, S. A. (1986). The rate of a code of ethical standards in counseling. Journal of Counseling and Development, 64(5), 294–297.

May, R., & Yalom, I. (1989). Existential psychotherapy. In R. J. Corsini & D. Wed- ding (Eds.), Current psychotherapies (4th ed., pp. 363–402). Itasca, IL: Peacock.

Mehr, J. (1995). Human services: Con- cepts and intervention strategies (6th ed.). Boston: Allyn & Bacon.

Mehr, J. (2001). Human Services: Con- cepts and intervention strategies (8th ed.). Boston: Allyn & Bacon.

Michael, J. D. & Netting, E. F., (1994). in M. J. Austin, & J. I. Lowe (Eds.), Contro- versial issues in communities and organi- zations (p. 106). Boston: Allyn & Bacon.

National Association of Social Workers. “Suit Settlement Favors Confidentiality of Records.” NASW News 27, No. 7, Sep- tember 1982.

Pedersen, P. (1990). The constructs of complexity and balance in multicultural counseling theory and practice. Journal of Counseling and Development, 68(5), 550–554.

2753-ch05 5/7/03 10:50 AM Page 234

Poindexter, C. C., Valentine, D., & Con- way, P. (1999). Essential skills for human services. Belmont, CA: Wadsworth.

Rogers, C. R. (1961). On becoming a per- son. Boston: Houghton Mifflin.

Rubin, A. (1992). Case Management. In S. M. Rose (Ed.), Case management and social work practice (pp. 5–20). New York: Longman.

Saeki, C., & Borrow, H. (1985). Coun- seling and psychotherapy: East and West. In P. Pedersen (Ed.), Handbook of cross-cultural counseling and therapy (pp. 223–229). Westport, CT: Greenwood.

Schneider, R. L., & Lester, L. (2001). Social work advocacy. Pacific Grove, CA: Brooks/Cole.

Schulman, E. D. (1991). Intervention in the human services (4th ed.). St. Louis: Mosby.

Shebib, B. (2002). Choices. New York: Allyn & Bacon.

Slaikeu, K. A. (1990). Crisis intervention: A handbook for practice and research (2nd ed.). Boston: Allyn & Bacon.

the human services worker 235

Slovenko, R. (1973). Psychiatry and the law. Boston: Little, Brown.

Spiegler, M. D. (1983). Contemporary behavioral theory. Palo Alto, CA: Mayfield.

Sue, D. W. (1996). Ethical issues in multicultural counseling. In B. Herlihy & G. Corey (Eds.), ACA ethical stan- dards casebook (5th ed., pp. 193–200). Alexandria, VA: American Counseling Association.

Tarasoff V. Regents of the University of California (1976). Pacific Reporter, 2nd Series, 551, 340.

Truax, C. B., & Carkhuff, R. R. (1967). Toward effective counseling and psy- chotherapy. Chicago: Aldine.

Van Hoose, W., & Kottler, J. (1986). Eth- ical and legal issues in counseling and psy- chotherapy (2nd ed.). San Francisco: Jossey-Bass.

Wicks, R. J. (1979). Helping others: Ways of listening, sharing, and counseling. New York: Chilton.

Woodside, M., & McClam, T. (2002). An introduction to human services (4th ed.). Pacific Grove, CA: Brooks/Cole.

2753-ch05 5/7/03 10:50 AM Page 235