Lecture 2: Personal Competence of Social WorkerSept 24, 2012 Advanced Social Work Practice I (SOWK 3002, 2011/2012) Amy Chow, Ph.D, RSW, FT, CHt
Exercise 1: Reflective Questions • Recall the moment when you need help, what characteristics of a social worker/ helper/ friend are you looking for? • Are good therapist born or learned?
A Relational Frame for Technical Proficiency in Grief Therapy (Neimeyer, 2012) Holding environment and container for a responsive therapy Unique juncture where a client’s need meets his readiness for a particular intervention in a particular moment of interaction. Techniques and skills in systematic order
Therapeutic Presence • Bring ourselves (therapists) to the encounter as fully as needed • Attending from self to other • Relating respectfully which resonates with Roger’s core condition of empathy, genuineness, and unconditional positive regard
Therapeutic Process • Process is the medium in which the drama of therapy unfolds, with the director (therapist) as one of the actors. • Following the affect trail: attending to the language, gesture, verbal as well as non-verbal expression; articulating the implicit emotion and inviting elaboration. • Privileging experience over explanation: ushering a client into new awareness, clarity and possibility by engagement in an emotionally significant experience of something, not merely a cognitive discussion of it.
Therapeutic Process • Catching the wave: the therapeutic use of timing: seek the right intervention at the right moment. • Harnessing the power of the poetic: use quality terms resident in the client’s speech, use of analogy or
The power of language If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart. Nelson Mandela(http://www.brainyquote.com/quotes/)
Therapeutic Procedure • Address specific goals and draw upon identifiable change strategies
Therapeutic Relationship (Sharf, 2012,p.573-574) • is considered as one of the common factor that leads to changes in psychotherapy • usually related to conditions proposed by person-centred approach: empathy, positive regard, and congruence.
Exercise 2: What are the problems you found in working as a counselor? • Recalling your experiences in summer placement, what are the major problems you are facing?
The King’s Speech • Section 4 (19:20 – 28:30)
Common Problems for Beginning Counselors (Nystul, 2011, pp 75-80). • Focusing on the first issue in a session • Overlooking physical and medical issues • Wanting to rescue clients from their unhappiness: reassuring clients, offering instant advice, and rescuing clients from intense emotions • Having perfectionist tendencies • Having unrealistic expectations • Getting carried away with the latest technique • Getting lost in the counseling process
Common Problems for Beginning Counselors (Nystul, 2011, pp 75-80). • Using inappropriate phrases • Having an excessive desire to help • Having an excessive need to be liked • Getting too emotionally involved • Taking things too personally • Having difficulty differentiating between normal and abnormal • Being uncertain about self-disclosure • Being uncertain about confidentiality
Self-awareness of Therapist (Corey et al., 1988) • Personal Benefits • need to nurture others or need to be powerful? • need for approval, acceptance, admiration, or respect? • need to feel a sense of achievement and accomplishment? • Personal needs are fine but should not be in priority over the benefit of clients
Self-awareness of Therapist (Corey et al., 1988) • 3 reflective questions: a. How can I know when I’m working for the client’s benefit and when I’m working for my own benefit? b. How much might I depend on clients to tell me how good I am as a person or as a therapist? Am I able to appreciate myself, or do I depend primarily on others to validate my worth and the value of my work? c. How can I deal with feelings of inadequacy, particularly if I seem to be getting nowhere with a client?
Self-awareness of Therapist (Corey et al., 1988) • Unresolved Personal Conflicts • aware of the biases, areas of denial, and the issues that I find particularly hard to deal with in my own life. • It is not about whether I have these struggles, but how I am struggling.
Self-awareness of Therapist (Corey et al., 1988) • 3 reflective questions: a. What is the client situation that you’re reluctant or fearful to deal with? b. What are your present unfinished business in your own life? c. What unresolved conflicts are you aware of?
Issues faced by beginning therapists (Corey, 2005b) • dealing with our anxieties • being and disclosing ourselves • avoiding perfectionism • being honest about limitations • understanding silence • dealing with demands from clients • dealing with clients who lack commitment • tolerating ambiguity
Issues faced by beginning therapists (Corey, 2005b) • avoiding losing ourselves in our clients • developing a sense of humour • sharing responsibility with the client • declining to give advice • defining your role as a counselor • learning to use techniques appropriately • developing your own counseling style
Cultural Consideration • Ethnical groups • Geographical differences • Age group or Cohort • Socioeconomic classes • Religion • Sexual orientation • Settings
Culturally sensitive counseling (Day, 2004) • the counselor is aware of, show recognition of, demonstrates some knowledge of, and expresses an interest in the client’s ethnic identity and cultural background. • Aspects of attention: • Use of language • Family roles • Sex roles and gender difference
East meets West (Chow and Chan, 2004) • Issues in relationships • Gearing towards harmony (以和為貴) • Hierarchy (長幼有序) • Insiders and Outsiders (自己人和外人) • Issues in faces • face in family • face as client
East meets West (Chow and Chan, 2004) • View in self responsibility • Guilt and self-blame • Neglected self • Rituals • Yuan • Locus of control • Expression of emotions • lack of vocabulary • somatization
Common Factors in Psychotherapy (Asay & Lambert, 1999) • Reviews of psychotherapy outcome research document the empirical evidence supporting the effectiveness of psychotherapy, with an effect size of around 0.75 (i.e. those who received counseling are better off than 75% of those who did not.)
Common Factors in Psychotherapy (Asay & Lambert, 1999) • In research comparing different psychotherapy approaches indicating that the clients receiving diverse therapies have no significant differentiation in outcome, though they both have significant changes when compared with their own pre-counseling state. Possible explanations: • Achievement of goals through diverse pathways • Measurement limitations in tapping for differences • Different therapies embody common factors that are curative
Common Factors in Psychotherapy (Asay & Lambert, 1999) • Percentage of improvement in psychotherapy patients as a function of Therapeutic factors
Extratherapeutic Change: • factors that are a part of the client (e.g. ego strength, motivation, level of disturbance) and part of the environment (e.g. social support) that aid in recovery regardless of participation in therapy.
Therapeutic relationship: • Includes a host of variables that are found in a variety of therapies regardless of the therapist’s orientation (e.g. empathy, warmth, acceptance, encouragement of risk-taking, affirmation, and a minimum of attack and blame). They are considered fundamental in the formation of a working alliance.
Expectancy: • Also refer as placebo effects, that is based on the client’s knowledge that he or she is being treated and from the differential creditability of specific treatment technique and rationale.People are offered hope that something can be done to help them
Techniques • Those factors unique to specific therapies or model based technical interventions.
Exercise 3: Video Show • What are the unique features in this approach of counseling as you observed in the videos? (The Peron-centered approach) http://www.youtube.com/watch?v=Ew8CAr1v48M
Basic Assumption This hypothesis is that the client has within himself the capacity to understand those aspects of his life and of himself which are causing him pain, and the capacity and the tendency to reorganize himself and his relationship to life in the direction of self-actualization and maturity in such a way as to bring a greater degree of internal comfort.
Basic Assumption The function of the therapist is to create such a psychological atmosphere as will permit this capacity and this strength to become effective rather than latent or potential. (Rogers, 1951)
Person-centered Theory (Sharf, 2012) • Developmental View: • importance of positive regards from those around them • being loved by others • being emotionally and or physically touched • being valued and cared for • sense of self-worth is depending on the perceptions of the positive regards
Person-centered Theory (Sharf, 2012) • Developmental View: • conditions of worth: process of evaluating one’s own experience based on the beliefs or values of others that may limit the development
Person-centered Theory (Sharf, 2012) • Developmental View: • incongruence between one’s experience of self and experiences that interacts with others. • changes to congruence through discounting one’s own experience and accept the values and beliefs of others to please others repeatedly then leads to lose touch of oneself and feel alienated from oneself. • converts to rigid perceptions that “I must be kind to all others, regardless of what they do to me. • experiences anxieties when values of others are incongruent • Unconditional positive regards can facilitate self-worth
Person-centered Theory (Sharf, 2012) • Relationships • relationship can be improved through increased congruence in the relationship, the process of the listener in accurately experiencing (or in tune or empathetic) and being aware of the communication of another person.
Person-centered Theory (Sharf, 2012) • Fully functioning person • should meet the need of positive regards from other and for themselves • be congruent and mature (open, creative, and responsible).
Person-centered Therapy (Corey, 2005) • is a reaction against the directive and psychoanalytic approaches • against the dominating views at that time period : • the assumption that the counselor knows best • the validity of advice, suggestion, persuasion, teaching, diagnosis, and interpretation • the beliefs that clients cannot understand and resolve their problems without direct help • the focus on problems over persons.
Person-centered Therapy (Corey, 2005) • Emphasizes: • Therapy as a journey shared by two falliable people • The person’s innate striving for self-actualization • The personal characteristics of the therapist and the quality of the therapeutic relationship • The counselor’s creation of a permissive, “growth promoting” climate • People are capable of self-directed growth if involved in a therapeutic relationship
Development of the Approach: (Corey, 2005) • 1940s Non-directive Counseling • permissive and non-directive climate • avoid self-disclosure and only reflecting clients’ communications • 1950s Client-centered Therapy • more active emphasis on the client in exploring the inner world of clients
Development of the Approach: (Corey, 2005) • Late 1950s to 1970 Conditions of Client-centred Therapy • necessary and sufficient conditions of therapy • awareness of one’s experiences • 1980s – 1990s Person-centered Approach • Expansion of approach to education, industry and world peace
Core Conditions of Person-Centered Therapy(Kirschebaum & Jourdan, 2005, Corey, 2005) • research on psychotherapy process and outcomes has validated the importance of empathy, unconditional positive regard, and congruence for an effective therapeutic relationship • although relatively few therapists describe themselves as primarily client-centred in their orientation, client-centered principles permeate the practice of many, if not most, therapists.
Congruence • Congruency (Or genuineness) is the state of the therapist during the therapy session where “within the relationship (the therapist) is freely and deeply himself, with his actual experience accurately represented by his awareness of himself …the therapist is what he actually is, in this moment of
Congruence • implies that therapists are real, genuine, integrated and authentic during the therapy hour • without a false front, their inner experience and outer expression of that experience match • openly express feelings, thoughts, reactions, and attitudes that are present in the relationship with the client, when it is appropriate and in well timing.
Congruence • Is sometimes referred as transparency – no pretensions about what the counselor is or does • Are clearly cognizant of what they are experiencing between their gut (feeling) and their head ( thinking), how the two blend together in awareness, and how that awareness is expressed to the client as a presentation of their total personhood and investment in the therapeutic moment.
Unconditional Positive Regards • is the extent that the therapist finds himself experiencing a warm acceptance of each aspect of the client’s experience as being a part of that client.
Unconditional Positive Regards • Entails “ a warm acceptance of each aspect of the client’s experience as being a part of that client…no conditions of acceptance, no feeling of “I like you only if you are thus and so’” (Day, 2004) • communicate deep and genuine caring for the client as a person that is unconditional, and is not contaminated by evaluation or judgement of the client’s feelings, thoughts, and behavior as good or bad