Overview
Read Box 6.3 on page 166 of your textbook.
- Identify the four dimensions of effective empathy. Describe the reason(s) each element is important to the practice of social work.
- Additionally, think of a challenge you experienced at some point in the past. Share about that time and describe an occasion when someone made a good demonstration of empathy toward you (related to the challenge you experienced), as well as a time when someone made an ineffective attempt at empathizing with you.
- Compare these two experiences, and explain what made the former example a good demonstration of empathy compared to the latter.
In your response posts, practice empathizing with your peers.
Discussion Board Guidelines
- Remember to relate to the readings.
- Initial posts should be at least 200 words.
- Use correct grammar and spelling.
- Use APA style citations and references to support the ideas you present.
- Case ManagementOne of the direct practice roles that a generalist social worker frequently fills when working with individuals is that of case manager. Case management “is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s needs through communication and available resources to promote quality cost-effective outcomes” (CMSA, 2010, p. 6).
Rather than just providing a specific service, such as alcohol counseling, a case manager coordinates a program of services and refers clients to appropriate places where they can receive these services. The case manager also follows up with the client, ensuring both continuity and coordination of the services that are provided. Over time, a case manager can develop a good rapport with, and a deeper knowledge of, the client and his or her concerns. With this understanding, the case manager can serve as an advocate for the client while providing linkages with other service providers.
One of the key provisions of case management is to view the client from the person-in-environment and strengths perspective. The case manager is uniquely positioned to follow the individual’s needs in the context of his or her home, work, and community environments and help to facilitate linkages across those systems. Case management strategies include outreach and engagement, assessment of strengths and needs, planning for service or treatment, linkages to resources and referrals, service delivery monitoring, and evaluation of outcomes (NASW, 2013). The components of case management fit social work well, making it a significant part of our practice.
Here, we use a case example with an individual to help demonstrate the dynamic and interactive processes used in case management: engagement, assessment, intervention, and evaluation.
Case ExampleMichael is a 38-year-old, gay, white male. Although HIV positive for years, he had been fairly healthy. However, over the past year, he has developed more health problems and is now HIV symptomatic. Michael had been employed as a retail store manager, but frequent absences this past year made him take a position in the store as an hourly clerk, and his employer no longer paid for his health insurance coverage. At first Michael used his savings to pay the portion of the premiums previously paid by his employer, but his savings were exhausted. His health is deteriorating. When he was hospitalized with pneumonia, one of the nurses recommended support services. In the past, Michael preferred to rely on himself, his friends, and his family, but he realizes that he needs additional help. Thus, Michael has come to the HIV/AIDS Social Service Center.
Engagement and Assessment
EP 8
Michael’s social worker, Gwen, uses empathy (see Box 6.3) and other interpersonal skills in the initial engagement process to establish a relationship with Michael. Gwen begins by listening to Michael’s story and asking questions to elicit information about Michael’s concerns and challenges. Once Gwen has put Michael at ease and determines that he is currently not in a state of crisis, she reassures him and tells him that she will be able to assist him.
Box 6.3. More About…Empathy
EP 2.1.10(a)
Empathy is one of the most powerful and effective skills a social worker can develop, use, and model for clients. Empathy is a multidimensional construct that includes both “bottom-up” and “top-down” components (Decety & Jackson, 2004). The bottom-up part of empathy is the automatic or unconscious affective process that allows us to recognize another’s emotional state. The top-down part of empathy is the conscious cognitive processes that enable us not only to explain and predict our own behaviors but the behaviors of others as well.
There are four definable components of empathy, one bottom up and three top down, that correlate with brain activity observed in four isolable neural networks (Decety & Moriguchi, 2007, p. 4). They are as follows:
Affective SharingThis refers to the subjective “reflection” of another person’s observable experience (e.g., feeling amused when someone else laughs, or sad upon seeing another’s grief). This is based on automatic neural mirroring, and the “shared representations” such as facial expressions or activities associated with feeling. This is the bottom-up component of empathy.
Self-AwarenessMirroring alone can be so powerful that it effectively erases the perceived boundary between self and other. Self-awareness implies that the empathic person clearly differentiates between his or her experience and that of the person being observed.
Perspective-TakingThis refers to the cognitive ability to learn about the situations affecting others and to effectively imagine what it would be like to experience the world from the other’s position. It requires abstract thought, calculation, and applied knowledge.
Emotion RegulationThis refers to the empathic person’s ability to “turn down the volume” of his or her own feelings as they arise from mirroring another’s experience. Inability to regulate emotion can result in overwhelm and burnout for individuals in helping or caretaking social roles.
All four neural networks must be activated for a social worker to have a complete experience of empathy for a client. If any of the components is missing or inhibited, social workers may have a partial reaction (e.g., wincing when someone else feels pain) but not a truly empathic response (e.g., reacting to the “empathic wince” as a personally uncomfortable experience, but failing to extend enough attention to imagine what the other person is subjectively experiencing). We now know that our minds are hardwired to provide an inner simulation of our clients’ feelings, thoughts, and experiences.
Source: Excerpt from Gerdes, Segal, Jackson, & Mullins (2011).
EP 6b
Gwen will draw from the theoretical framework we discussed earlier to inform her assessment and intervention plan. She begins the assessment process by identifying Michael’s medical, psychosocial, behavioral, and spiritual needs. The most important assessment task that Gwen must complete to be successful is recognizing Michael’s needs and concerns and communicating her cognitive understanding of them to him (Tsang, Bogo, & Lee, 2010). Gwen happens to be African American. The most critical factor in effectively addressing and overcoming cross-cultural differences between a worker and a client in the engagement process is the worker’s ability to achieve emotional attunement with the client or demonstrate empathy (Tsang et al., 2010).
Gwen’s goal is to collect, organize, and interpret pertinent information. What are Michael’s past experiences with seeking assistance? What has and has not worked in the past? Who are the people in his support network? Does he belong to a religious institution or another group that he is engaged with on a regular basis? From Michael’s perspective, what are his challenges and strengths? What resources does he have access to? Gwen is trying to ascertain Michael’s strengths and limitations. She needs to gather data from Michael but also get his express permission to talk with other people and systems that he is connected to or needs help from (Hepworth, Rooney, Rooney, Strom-Gottfried, & Larson, 2013). For example, Gwen may need to talk with medical professionals, such as doctors and medical social workers who have worked on Michael’s case. If appropriate, Gwen may ask for permission to talk to Michael’s family members.
The assessment process makes use of the skills needed to conduct effective interviews, engage the client in the helping process, and analyze the information collected. Often, the assessment process involves bringing the initial information to a clinical team or supervisor for further assessment. In their next session, Gwen shares her assessment with Michael, and they discuss it. Together they decide on a set of goals:
(1)Apply for Medicaid in order to cover his medical expenses;
(2)find a clinical social worker to help treat Michael’s depression;
(3)investigate low-income housing options;
(4)apply for Social Security disability insurance and Supplemental Security Income (SSI) for financial assistance; and
(5)build Michael’s support network (he currently relies mainly on his sister, who lives nearby).
Intervention
EP 7c
During the intervention phase, Gwen will help Michael achieve his goals by negotiating, mediating, and advocating for Michael with the referral agencies and resources. In addition, the HIV/AIDS social service center offers some direct services for Michael, including a support group for HIV-positive clients. Delivery of services or intervention can take place through information and referral (I&R), the creation of network linkages, and the provision of direct services. Social workers play active roles in all three areas of service delivery.
Information and Referral In Gwen’s position as a case manager, she often provides services through I&R. The overall goal of information and referral is to enhance a client’s access to service by improving awareness and knowledge of services and reducing barriers to them. Often, social services are specialized or are offered as parts of larger systems, and are thus difficult to locate. Without specialized knowledge, and particularly when they are in crisis, clients are sometimes at a loss to identify needed services.
For example, suppose one of your parents is suddenly hospitalized for emergency heart surgery. Although the hospital and medical staff handle the immediate medical emergency and in-hospital care following surgery, what will you do about after-hospital care? Do you know how to find home health care if your parent is not ready to care for him- or herself? What if the recovery period is long, and physical therapy is needed? Can you find an intermediary care facility if your parent needs more care than can be provided at home? A medical social worker can help you cope with the emergency and can provide information on services and refer you to agencies and specialists.
Social workers also help people overcome barriers or obstacles to receiving services. Some social workers are bilingual and can work with people whose first language is not English. Social workers can arrange for transportation to medical appointments or for a child with a disability to attend a special school. Some barriers to service can be physical or legal. For example, agency services may be available only during the day, and people who work may have trouble accessing them. Social workers can lobby for extended evening hours or make special arrangements for after-hour interventions. A school may refuse requested accessibility services for a child with a disability, an infraction of a legal right to access. A social worker can advocate for services and ensure that the student’s legal right is upheld.
These efforts are part of reducing barriers to service and fulfilling the role of information and referral. In order for I&R to be helpful, the social worker must know about the breadth of services available in the community, have advocacy skills, and be able to assess problems and needs.
In Michael’s case, Gwen made several referrals in addition to providing information. She referred Michael to his local public assistance office so that he could apply for financial aid, and she made a preliminary determination of whether he was eligible for health insurance through the Affordable Care Act and for disability services. On the basis of his employment history, she referred him to the local Social Security office to apply for disability insurance coverage. She directed him to a group home where he could pay much lower rent and receive support with daily living. All these efforts are examples of I&R.
Network Linkages Knowledge about the breadth of services is a critical component of providing network linkages. People may receive services from multiple social service systems. The social worker can act as the link between the systems.
For example, children’s problems often require the involvement of many social service systems. Consider a child who is caught vandalizing school property by security personnel. A police officer may be called, possibly leading to involvement of the juvenile justice system. The child may be assessed as having severe emotional disturbances, and then the community mental health agency becomes involved. A school social worker may also be involved, as the child is a student at the school. In this case, three systems—juvenile justice, school, and mental health—are all involved with one child. Social workers are trained to work in and with multiple systems. This training helps them ensure that there is neither a duplication of services nor a gap in service.
Gwen began the process of network linkage for Michael. She called a staff person at one of the agencies to which she referred him; she recommended that he see a social worker with specialized skills in treating depression. The network linkages will continue as Michael progresses in the social service system at the HIV/AIDS Social Service Center. The final stage of the intervention process is for Gwen to help Michael transition to the services he needs and eventually end the services he is receiving from Gwen. This will occur only after Gwen has helped Michael resolve his problems or concerns, and he can return for services in the future if his circumstances change.
Monitoring and Evaluation
EP 7a
It is critical for Gwen to monitor and analyze her interventions with Michael. According to the NASW Code of Ethics (2008) Ethical Standard 5.02, Gwen has an ethical responsibility to evaluate her own practice, determine the effectiveness of her interventions, and use her findings to improve her practice. In Michael’s case, Gwen completed an interview before the end of service. They discussed each goal and whether Michael thought the goal had been accomplished.