Widener University Narrative of Interviews with Social Workers Discussion

STRENGTHS-BASED GENERALIST
PRACTICE
A Collaborative Approach
THIRD EDITION
John Poulin
Widener University
with Contributors
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Strengths-Based Generalist Practice:
A Collaborative Approach
Third Edition
john Poulin with Contributors
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I 2 3 4 5 6 7 13 12 11 10 09
THE CoLLABORATIVE MoDEL
PRINCIPLEs AND CoNCEPTS
CHAPTER
3
45
46
Part I Generalist Social Work Practice
Julie V. was a first-year MSW student placed in a unit of a drug and alcohol
rehabilitation center. Her unit provided discharge planning for patients who
were leaving the facility. Typically, Julie had one or two contacts with her clients
before they were discharged.
Before she entered the MSW program, Julie worked for two years in a foster
care agency that served children who were in long-term placement. She spent a lot
of time with her clients, and she felt that she got to know them and developed
strong helping relationships with them. In contrast, her work at the rehabilitation
center was fast paced and short-term. She had to complete the assessment and discharge plans after one or two brief client contacts.
By the end of her first week of placement, Julie was concerned about the effectiveness of her work. She felt that her approach was too task focused and that she
was not making any connection with her clients. Instead, she was getting information as quickly as possible, filling out a form, and telling the clients about the plan.
It felt rote and dehumanizing to her. She wondered what she could do to make the
experience more positive for her clients and for herself. Was it possible, desirable,
and important for her to engage her clients in the discharge planning process?
Was it realistic to expect a positive helping relationship to develop in one or two
brief contacts? How would the helping relationship in a short-term setting differ
from one that developed over a longer period of time?
It is through the helping relationship and associated practice principles that social workers provide help and facilitate the change process. The helping relationship is the mechanism through which the client and the worker address the client’s
identified concerns. The helping relationship supports and structures clients’ efforts
to change. This chapter presents a model of generalist practice that focuses on the
helping relationship. It begins with a review of the assumption of the collaborative
model and its practice principles. The chapter concludes with a presentation of
the phases, tasks, inputs, skills, and outputs of the model, followed by a review
of the Helping Relationship Inventory, a rapid assessment instrument that measures
the strength of the helping relationship.
By the end of this chapter, you should be able to help Julie
1.
2.
3.
4.
5.
6.
Conceptualize the helping relationship
Understand the importance of the helping relationship in the helping process
Describe the principles of a strengths-based assessment
Describe what is entailed in a collaborative approach to generalist practice
Identify ways to empower clients
Develop a rationale for using the Helping Relationship in work with clients
THEORETICAL PROPOSITIONS
The collaborative model of social work practice presented here is built upon three
theoretical propositions and three practice principles. The propositions are:
1.
2.
3.
Disadvantaged and oppressed clients often mistrust helping professionals
Client change occurs through a collaborative helping relationship
Relationships are built upon trust
Chapter 3
The Collaborative Model Principles and Concepts
47
Proposition 1: Disadvantaged and oppressed (reluctant) clients often mistrust
helping professionals. Alienation theory (Guillaumin, 1995; LaFromboise, Cole-
man, and Gerton, 1993) provides an explanation for the reluctance of oppressed
and disadvantaged clients to fully engage in a helping relationship with social work
professionals. People that are stigmatized and discriminated against on a continuous
and systematic basis feel devalued by people who have power and occupy positions
of authority in society (Fordham, 1996; LaFramboise and Dixon, 1981). A natural
response to feelings of powerlessness, oppression, and devaluation is to distance oneself physically and emotionally from the oppressors. This sense of separateness or
alienation can be viewed as a normal response or as a coping mechanism that helps
protect the oppressed. Therefore, people who have experienced racism, discrimination, and other forms of oppression are unlikely to be willing to engage in an open
and trusting relationship with a helping professional who, by virtue of her authority,
has power and influence over their lives and well-being.
Most social work clients from disadvantaged communities have a long history
of negative experiences with helping professionals and people in authority. They
have learned to cope with “the system” by adopting a complying but noninvested
style of interacting with it. At best, they become reluctant clients. Their experiences
have conditioned them to be guarded with social work professionals and to approach them with mistrust. Marginalized people have no reason to trust social
workers and other helping professionals. Overcoming mistrust is the primary
obstacle faced by social workers working with marginalized client populations.
Proposition 2: Client change occurs through a collaborative helping
relationship. The helping relationship is the heart of the helping process. Several
studies have examined the correlation between the client’s ratings of the relationship and the outcome of therapy. In a meta-analysis of 24 of these studies,
Horvath and Symonds (1991) found that client ratings were positively associated
with positive therapeutic outcomes. Others have verified that this correlation
occurs with at least three types of therapy: behavioral, cognitive-behavioral, and
interpersonal (Dore and Alexander, 1996; Marziali and Alexander, 1991). A large
study funded by the National Institute of Mental Health found strong correlations
between relationship and outcome, regardless of the type of treatment provided
(Krupnick et a!., 1996). Thus, social work and psychology research consistently
and convincingly support the association between development of a positive helping relationship and successful treatment outcomes.
Historically, the profession of social work has recognized that the success of
the helping process is dependent on the quality of the worker-client relationship
(Biestek, 1957; Hollis, 1970; Perlman, 1979; Richmond, 1917). Biestek (1954)
characterized the helping relationship as the “soul” of the helping process, a
dynamic interaction of feelings and attitudes between the worker and the client.
Perlman (1979) defined the professional helping relationship as a supportive, compassionate working alliance between the worker and client. Drawing on Rogers’
(1957) work, Perlman named five worker attributes necessary for the development
of a therapeutic relationship: warmth, acceptance, empathy, caring-concern, and
genuineness. Clients who experience their interactions with social workers as caring, empathic, nonjudgmental, and genuine are more likely to engage in the helping
48
Part I Generalist Social Work Practice
process and to develop a sense of trust than those who do not. Perlman’s worker
attributes have been widely accepted by the social work profession, and the importance of the worker-client relationship is a common assumption of social work
practice. As with all assumptions, the importance of the helping relationship has
been seen as a given rather than critically examined (Perlman, 1979). As early as
1979, Perlman noted that less and less attention was being paid to the helping relationship in social work research and practice literature. More recently, Coady
observed “the continued neglect of relationship factors” in social work research
(1993, p. 292). Although social work theory has consistently accorded the relationship between worker and client a central role in treatment, “the precise nature of
this relationship and the manner in which it contributes to treatment has not been
spelled out” (Proctor, 1982, p. 430).
Instead, social work research has for the most part focused on developing and
testing models of intervention and on measuring outcomes (Reid, 1994 ). Much of
the research conducted between 1970 and 1988 attempted to establish a scientific
basis for clinical social work interventions (Russell, 1990). Social work practice research has consisted of outcome-oriented investigations that test the efficacy of structured interventions. There have been few direct studies of the helping relationship.
Most conceptual work and research on the helping relationship during the past
20 years has been done in the field of psychology (Dore and Alexander, 1996). It
has been stimulated by the seminal ideas of Bardin (1979), who defined the construct
of a therapeutic or working alliance. In social work, the focus has tended to be on
the feeling dimension and on worker characteristics that promote positive feelings.
In clinical psychology, on the other hand, the concept of the helping relationship
has been expanded to include treatment goals and tasks (Hartley and Strupp, 1983;
Horvath and Greenberg, 1986; Lubarsky et al., 1983). These investigators view “the
working alliance as a collaboration between the client and the therapist on the work
of therapy” (Tichenor and Hill, 1989, p. 196). The relationship between therapist
and client includes the specification of goals and agreed-on tasks for both the therapist and client, as well as the emotional bond between them.
In the collaborative model of generalist practice, the helping process has two components, which influence each other: a structural component and an interpersonal
component (Poulin and Young, 1997). The structural component encompasses the
purposeful activities or tasks undertaken to address the target concern or problem.
The interpersonal component is the bond or mutual attraction that develops between
the worker and the client. Both the structural and interpersonal need to develop for
the helping relationship to be effective. The two components tend to develop concurrently. The process of collaborating on the structural activities builds and strengthens
the interpersonal connection or psychological bond between the worker and the client.
It takes time and the sharing of experiences to develop a strong interpersonal connection. The structural activities provide the interactions on which the interpersonal relationship is built. Through verbal and nonverbal interactions and collaborative efforts,
the client experiences the worker as motivating and supportive.
As workers carry out structural activities, they should engage clients in an empowering collaborative process that is client centered. For example, during the initial sessions, the primary structural task is identifying concerns and strengths. The
way the worker interacts with the client during this process profoundly influences
Chapter 3
The Collaborative Model Principles and Concepts
49
Structural
(purpose)
Shared
experiences
Interpersonal
(bond)
FIGURE
3.1
THE HELPING RELATIONSHIP PROCESS
the development of their interpersonal relationship. The worker should strive to
motivate and support clients as they tell their stories. If the worker communicates
understanding of the client’s concerns and difficulties, provides comfort and calming strength, and pays attention to the client as a whole person, the client will
probably experience the worker as supportive. This will in turn strengthen the client’s interpersonal connection with the worker. Similarly, if the worker helps the
client expand his or her self-understanding, strengthen his or her self-belief, and
find hope and inspiration, the client will probably experience the worker as motivating. These experiences will also strengthen the psychological bond between the
worker and the client.
As noted above, developing a
strong positive helping relationship is a process. Relationships are built over time. A
key factor in developing a strong helping relationship is having shared experiences. In
a professional relationship this occurs by undertaking the activities or tasks of the
helping process, such as identifying client strengths and concerns and developing goals
and a plan of action. Engaging in these purposeful activities helps build trust. Trust, in
turn, helps strengthen the interpersonal connection or worker-client bond, which
strengthens the client’s motivation to engage in the structural activities. Figure 3.1
illustrates the interrelationships between the structural and interpersonal components
and the effects that positive interactions have on client trust and motivation.
A key to developing a strong positive collaborative relationship is establishing
some level of trust. The client must be able to trust the social worker. Relationships
cannot be built in the absence of trust. A certain degree of trust must be established
between the client and the social worker for the client to engage in a collaborative
helping process.
Trust is essential for relationships to develop and grow between social workers and their clients. To build strong collaborative relationships, the social worker
must reduce the client’s fear, suspicion, and mistrust at the same time as the
worker promotes feelings of acceptance, support, and affirmation.
Building trust with reluctant clients is an interactional process. Trust cannot be
built in the absence of interpersonal interactions between the client and the social
worker. It is built upon a sequence of trusting and trustworthy interactions. The client
must act in a trusting manner and the social worker must respond with trustworthy
actions.
Proposition 3: Relationships are built on trust.
50
Part I Generalist Social Work Practice
Client exhibits
trusting behavior by
being open and
taking a risk
Worker exhibits trustworthy
behavior by communicating
acceptance and support
I
FIGURE
3.2
I
Trust
L
I
Worker reciprocates and
exhibits trusting behavior
by sharing ideas, feelings,
and reactions
TRUST-BUILDING INTERACTIONS
Within each interaction three conditions are required for trust to develop in a
helping relationship. First, the client must take a risk (make a choice) where the potential harmful consequences outweigh the potential benefits associated with the risk. Second, the client must realize that the beneficial or harmful consequences associated with
the risk depend upon the worker’s actions (response) as the helping professional.
Third, the client must experience the worker’s actions as beneficial (Fong and Cox,
1983). All three conditions must be present for the interaction to contribute to the
trust-building process. Figure 3.2 illustrates a trust-building interaction.
The bond of trust is built over time, through a series of trusting actions (risks)
and trustworthy responses (confirmations). Although it takes time for trust to be
established with reluctant clients, it can be destroyed through a single client risk
and worker disconfirmation (nontrustworthy) response (Fong and Cox, 1983).
The critical element in developing trust is risk. Collaborative social work requires the client to actively participate in the helping process. The client is an active
partner in the search for understanding and solutions. This cannot happen if the
client is unable to take a risk by being open and honest with the social worker. Clients have to be willing to share their wants, desires, dreams, goals, skills, abilities,
talents, and competencies as well as fears and concerns with a social worker. Reluctant clients usually have no reason whatsoever to be open with helping professionals. Why take a risk with someone in authority? Why risk exposing the real
me to someone who can cause me harm or make my life difficult? The primary
task for the social worker in working with reluctant clients is to facilitate risk taking. Trust cannot be built in the absence of risk.
Clients vary in their willingness to take risks with a helping professional.
Figure 3.3 shows five levels of the worker-client risk continuum. At risk level I,
the client is completely closed and unwilling to share even factual information.
This type of client is often described as hostile or resistant. For people who have
experienced a lifetime of oppression, prejudice, and discrimination, being unwilling
to expose oneself to a stranger and authority figure is a normal and healthy coping
mechanism. As one moves up the risk continuum, the client’s willingness to share
feeling and thoughts increases. At risk level V, the client is willing to be open about
Chapter 3
LeveiV
LevellY
Level Ill
Level
Levell
FIGURE
3.3
II
The Collaborative Model Principles and Concepts
51
Client is willing to share feelings and thoughts
about sensitive personal matters that might be
viewed negatively.
Client is willing to share feelings, and thoughts
about sensitive personal matters.
Client is wHI”Ing to share feelings and thoughts
about nonsensitive personal matters.
Client is willing to provide a factual amount of
information about self but unwilling to share feelings and thoughts about personal experiences.
f–
r–
–
Client is completely closed and unwilling to share
any factual information, feelings, thoughts, or
,..–experiences.
J
CuENT RisK-TAKING CoNTINUUM
sensitive personal matters that place him or her in a potentially negative light. This
level of risk requires a high level of trust and is usually reached over time through a
series of lower-level risk-taking and confirming interactions with the social worker.
The three theoretical propositions discussed above are the underlying assumptions
of the collaborative model of social work practice. These assumptions guide practice expectations. The following three practice principles provide additional guidance in using the collaborative model of practice.
PRACTICE PRINCIPLES
The basic assumptions of the collaborative model of practice are (1) disadvantaged
and oppressed clients often mistrust helping professionals, (2) client change occurs
through a collaborative helping relationship, and (3) helping relationships are built
upon trust. In light of these assumptions, the collaborative model is designed to
build trust with clients whose life experiences have given them very little reason to
trust social workers and people in authority. This is accomplished by adopting a
strengths perspective, by maximizing client collaboration and empowerment, and
by adopting a system of ongoing feedback and evaluation.
The basic principles of the
strengths perspective are discussed in Chapter 2. The focus here will be on reviewing the application of the strengths perspective in social work practice with disadvantaged clients. The strengths perspective focuses on inherent client strengths,
resources, and coping abilities (Saleebey, 2002). Clients are viewed as capable of
Practice Principle 1: Focus on client strengths.
52
Part I
Generalist Social Work Practice
change and as active participants in the change process. Rather than the social
worker being the problem solver, the client becomes the problem solver. The social
worker’s primary function is to help the client recognize, strengthen, and marshal
his or her inherent strengths and abilities (Weick et al., 1989).
This “requires helpers to be open to negotiation, to appreciate the authenticity of
the views and aspirations of those with whom they collaborate, and to be willing to
subdue their own voices in the interest of bespeaking those of their clients” (Saleebey,
1992, p. 12). The worker and the client form a partnership to help the client resolve
his or her own problems or concerns. Social workers cannot promote collaboration
or foster client self-determination if they see their role as reforming or changing clients.
Similarly, collaboration and client self-determination are not achieved if the social
worker tries to fix the problem for the client. Social work is based on the premise that
clients must ultimately help themselves. Self-determination requires workers and clients to collaborate in all decisions and aspects of their work together.
Strengths-based generalist practice places the client in the role of expert regarding his or her life situation. The worker’s role is to help clients identify what is best
for them. In this paradigm, the emphasis is on the collaborative process between
the worker and the client. Engaging clients in a collaborative helping relationship,
a relationship that recognizes the client as “expert,” actually increases clients’ ownership of their decisions and ultimately their level of self-determination. In a collaborative partnership, the worker helps the client expand his or her repertoire of
choices and behaviors. Ideally, this involves helping the client identify the range of
alternatives and the pros and cons associated with each possible choice. With this
approach, the worker finds it easier to balance the offering of expert help with respect for the client’s autonomy.
Collaboration-a partnership between the client and the worker-has been
a pivotal practice ideal since the beginning of the social work profession (Richmond,
1917). Collaboration is closely tied to self-determination (Weick et al., 1989). The
NASW Code of Ethics states that “the social worker should make every effort to foster maximum self-determination on the part of clients” (NASW, 1997, p. 3 ). Selfdetermination is achieved when “the client is fully involved and participating in all
of the decisions and the social worker is working with the client rather than doing
things to the client” (Compton and Galaway, 1994, p. 11). Self-determination is fostered by client participation in the decision-making process.
Self-determination is, for the most part, a “grand illusion” in actual practice
(Perlman, 1965, p. 410). Achieving it is difficult at best. “The challenge for every
practicing social worker is that of balancing the act of offering expert help while
respecting the client’s autonomy” (Bisman, 1994, p. 49). Problems arise when a client makes choices that are self-destructive or inconsistent with prevailing societal
norms. In these situations, the dilemma for the social worker is how to resolve the
conflict between his or her values and the value choices of the client while continuing to honor client self-determination. Levy (1972) suggests that the worker and
the client openly discuss the value conflicts. Differences in value positions should
be aired and the right to have different views respected.
Strengths-based generalist practice is based on the belief that clients are the experts and that they ultimately know what is best for themselves. The emphasis is on
the collaborative process between the worker and the client. Engaging clients in a
Chapter 3
The Collaborative Model Principles and Concepts
53
collaborative helping relationship increases clients’ ownership of their decisions and
ultimately their level of self-determination.
Practice Principle 2: Put clients in charge of the helping process. Collaboration requires the social worker to relinquish power, expertise, and control to the
client. This does not mean that the worker has no expertise or role in the helping
process. It does mean, however, that the balance of power and authority is distributed more equitably between the social worker and the client.
The use of empowerment in social work has grown out of the work of Solomon (1976), Rappaport (1981), and Pinderhughes (1983) and from feminist theory
(Donovan, 1990; Ferree and Hess, 1985). “Feminism, like the civil rights, black
power, and self-help movements, rapidly expanded the conceptual, methodological,
and relational universe of empowerment-based social work of the 1970s and
1980s” (Simon, 1994). It has evolved as a method for working with women, people of color, and other oppressed groups (Gutierrez and Nurius, 1994). Empowerment is defined as the “process of increasing personal, interpersonal or political
power so that individuals can take action to improve their life situations” (Gutierrez, 1990, p. 149). The process of empowerment emphasizes the acquisition of
power, which is “the capacity to influence the forces which affect one’s life space
for one’s own benefit” (Pinderhughes, 1983, p. 332).
The focus of social work practice with individuals should be on the “reduction
of the power imbalance between workers and clients-specifically on increasing the
client’s power resources” (Hasenfeld, 1987, p. 478). The balance of power between
the social worker and the client is inherently unequal. Theories of social work practice do not adequately address this power differential and tend to understate the effect of power on the helping relationship (Hasenfeld, 1987).
Social workers have three types of power: expertise power derived from their
access to and command of specialized knowledge; referent power or persuasion, derived from their interpersonal skills; and legitimate power derived from their sanctioned position. In other words, social workers derive power from their expertise,
their interpersonal skills, and the fact that they control resources needed by the client
(Hasenfeld, 1987). Strengths-based generalist practice requires social workers to recognize the power they bring to the helping relationship and to engage clients in an
open discussion of the various sources of power in their relationship. Acknowledging the inherent power differential is the first step in shifting the balance of power
to the client. Although they rarely mention it, clients are acutely aware of the power
differential between themselves and their social workers. Opening up the topic for
discussion is in itself empowering (Gutierrez, 1990). It gives the social worker and
the client an opportunity to evaluate the resources available to address the client’s
areas of concern. The client is given a voice in defining the resources and determining how they will be used. As Hasenfeld states: “If we view social work practice as
an exchange of resources, social work effectiveness, then, is predicated on the reduction of the power imbalance between workers and clients-specifically on increasing
the client’s power resources” (1987, p. 478).
Although strengths-based generalist practice acknowledges the client’s expertise
regarding his or her life situation, the social worker does not ignore his or her access to and command of specialized knowledge. This knowled