HSM210 Psychology Discussion Paper

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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. HSM210 Psychology Discussion Paper

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. HSM210 Psychology Discussion Paper

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. HSM210 Psychology Discussion Paper

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