the therapeutic relationship within clinical social work practice sow6425 professor nan van den...
Post on 19-Jan-2016
215 Views
Preview:
TRANSCRIPT
THE THERAPEUTIC RELATIONSHIP WITHIN CLINICAL SOCIAL WORK
PRACTICE
SOW6425
Professor Nan Van Den Bergh, PhD, LCSW
FEATURES OF THE SOCIAL WORKER’S MANAGEMENT OF THE CLINICAL RELATIONSHIP
Attention to:
Transference
Countertransference
Boundaries
Sustainment
Modeling
Balancing support and demand behaviors
SUSTAINMENT
• What the Worker Does
• Listens actively and sympathetically
• Conveys a continuing attitude of good will
• Demonstrates consistency in the relationship
• Directly expresses confidence or esteem
• Non-verbally communicates interest, attentiveness
• Realistically reassures the client about potential for goal
achievement
• Realistically encourages the client to persist
• Possibly offers environmental support
What This Technique Does for the Client
•Promotes a confiding relationship
•Instills a sense of the worker’s competence and caring
•Provides an antidote to alienation
•Enhances morale and the determination to persist
•Inspires and maintains the expectation of help
•Creates a setting where confrontation can effectively take place
SELF-DISCLOSURE
•Defined as sharing with the client opinions, thoughts, feelings, reactions to the client, and personal experiences
•Self-involving disclosure - Commenting on the process of the worker/client interactions
•Personal disclosure - Sharing a personal experience that may be relevant to the work being done (this can be risky)
TRANSFERENCE
• Defined as all client reactions, conscious and unconscious, to the social worker
• These include reactions based on experiences with similar types of people in the client’s past, and on here-and-now characteristics of the social worker
Positive vs. Negative Transference
• Positive - the client is attracted to the practitioner, which can facilitate the engagement process
• Negative - characterized by such feelings as anger, distrust, or fear that impede the client’s participation in the intervention
• Positive transference does not necessarily facilitate the client’s achievement of goals
• Negative transference does not necessarily prevent goal achievement
COUNTERTRANSFERENCE
Specific and generally conscious attitudes and
tendencies that a social worker has about a range of clients
Ex.: being drawn to working with children or having an aversion to older adults)
Common Signs of Countertransference Reactions
• Dreading or eagerly anticipating a client
• Differing promptness in responding to client’s needs
• Thinking excessively about a client during non-work hours
• Having trouble understanding a client’s problems
• Being bored with a client
• Feeling angry with a client for nonspecific reasons
• Being unduly impressed with a client
• Feeling defensive or hurt by a client’s criticisms
• Performing tasks for clients that they are capable of doing for
themselves
• Feeling uncomfortable about discussing certain topics with a
client
Managing Countertransference Reactions
• Be aware of your emotional and physical needs as much as possible– Be wary of obtaining too much personal gratification at the
expense of a client
• Understand the client’s cultural and community standards of behavior, so as to appropriately assess behavior in those contexts– Ex.: Nonverbal communication cues or silence. Is it culturally
syntonic?
• When appropriate, selectively use self-disclosure with the client to process countertransference feelings. – It is important for some clients to learn that negative feelings
can be contained and processed
Boundaries
• Boundaries are the generally unspoken rules that we internalize about the physical and emotional limits of our relationships with other people.
• They protect our privacy and reflect our individuality.
• We differentially construct boundaries to facilitate our desire to be close to, or separate from, others.
• Each person’s boundaries are unique; we covertly communicate them to suit our assumptions and intentions about particular relationships.
Aspects of Boundaries
• Contact time: How much time is appropriate to spend in the company of the client?
• Difference if face to face or via phone?
• Types of information: What is the appropriate range of topics to discuss with the client?
• social topics, politics, religion, sex?
• Physical closeness/proximity: • Seating distance and arrangement of chairs?
• Physical contact allowed?
• Range of non-verbal communications is appropriate?
Aspects of Boundaries (cont.)
• Territory. To which of my environmental spaces does the client have access? – Is he or she restricted from others? – Can we only meet at the agency? – What about her home, community settings, recreational
settings?
• Emotional space. To what extent am I willing to share my feelings about sensitive topics with the client? – About what topics will we be expected to share feelings?
Benefits to Clients of Clear Boundaries
• A relationship in which the client feels affirmed and respected
• A predictable environment in which the client is likely to feel more comfortable sharing personal information
• A basis from which to determine whether and when the social worker can cross certain boundaries.
• Boundary crossing implies a conscious and appropriate effort to “adjust” the therapeutic relationship toward greater intimacy– Ex: Attend a graduation,marriage or award celebration
Benefits to Clients of Clear Boundaries (cont.)
• Boundary violation is an inappropriate entry into a person’s privacy and space.– If it is not pertinent, it is impertinent
• For some clients the external structure produced by clear boundaries helps to maintain a clearer internal ego structure.
Benefits to The Social Worker of Clear Boundaries
• Role clarity regarding the range and limits of clinical activities
• A basis from which to make decisions about how and when to cross physical or psychological boundaries
• A means of preventing burnout by avoiding role overload
• Physical safety, when territorial boundaries are maintained
Warning Signs of Possible Boundary Violations
• Intrusion into the client’s territory (physical or geographic)
• Some types of self-disclosure– Ex.: How will what you share benefit the client?
– What is your motivation for self-disclosure?
• Being overly “social” with clients
• Investigating certain details of clients’ personal lives
• Sharing information about a client with an outside party
• Loaning, trading, or selling items to a client
• Accepting or giving gifts
• Fluid boundaries between home and work environments may
indicate that the social worker is at-risk for job burnout
Factors To Consider When Assessing One’s Own Boundary Conduct
• The functioning level of the client – His or her ability to use good judgment
• The client’s history in relationships– Patterns of behavior and judgment
• The history of this particular client/worker relationship– What patterns of interaction have been established– Will a boundary crossing activity by the social worker be growth-
enhancing or a setback for the client?
• Cultural norms of both the worker and client.
• Legal liabilities
• The NASW Code of Ethics
Managing Boundary Dilemmas
• Set clear boundaries with clients at the beginning of a working alliance
• Clarify boundaries with the client over time, as they will change
• Consider the preservation of the client’s privacy to be a major guiding value.
• Secure the client’s informed consent for all service activities
• Use peer consulation and formal supervision routinely
Curative Factors in All Practice Interventions
• Perception of practitioner, by client, as competent and caring– Therapeutic alliance
• “Special setting” of seeking therapy promotes client’s sense of safety and expectation of help
• Interventions and procedures are based on an rationale which is understandable to the client – They include an optimistic view of human nature.
• Practitioner is “congruent” with client’s perception of problem and world view– Practitioner’s ongoing attention too client’s frame of reference
• Client is given new opportunities for enhancing mastery
Curative Factors in Practice (cont.)
• Miller, Duncan and Hubble (2005):– Client characteristics associated with clinical
outcome (account for 40% of outcome):• Nature of the problem• Motivation• Participation
– Quality of therapeutic alliance (30%)– Guiding theory or model (15%)– Placebo effect (15%)
Curative Factors in Practice (cont.)
• Carkoff and Truax: Predictors to client retention in treatment:
– Empathy– Congruence– Genuineness
top related