UNDERSTANDING GENERALIST PRACTICE   by   KIRST-ASHMAN & HULL

 

Chapter One

 

What social workers do:

 

“They work with individuals, families, groups, organizations, and social systems…” (pp. 5-6).

 

The generalist approach requires “that the social worker assess the situation with the client and decide which system is the appropriate unit of attention, or focus of the work for the change effort” (p. 6).

 

“The social worker has an eclectic theoretical base for practice which is grounded in a systems framework suitable for assessing multiple points for potential intervention…frequently the most effective and beneficial changes occur through multilevel interventions” (p. 6).

 

“The purpose of social work is to (1) enhance the problem-solving and coping capacities of people, (2) link people with systems that provide them with resources, services, and opportunities, (3) promote the effective and humane operation of these systems, and (4) contribute to the development and improvement of social policy” (p. 7)

 

“Flexibility and creativity are key qualities for generalist social work practitioners.” (p. 7).

 

“Social work assessment seeks to answer the question, ‘What is it in any particular situation that causes a problem to continue despite the client’s expressed wish to change it?’  A person-in-environment perspective allows social workers to assess many aspects of a situation.  Assessment may involve not only individual, personal characteristics and experiences (micro events), but also mezzo and macro events” (p. 11).

 

Common Generalist Skills:  (p. 19)

 

1.        “First, generalist practitioners must prepare for the intervention before they begin.  They need to get information and make plans, not just rush in haphazardly and ‘do something.’”

2.        “Secondly, generalist social workers must know how to communicate. … Effective communication involves understanding the issues and problems.  It also involves understanding how others view these same issues and problems.

3.        “Thirdly…analyze the problem situation regardless of whether individuals, groups, or communities are involved.”

4.        “…formulating a contract with the client system.  Problems must be clearly identified and goals established with clients.  Procedures to attain goals---including who is to do what by when---should be clearly specified.”

5.        “Fifth, the generalist practitioner may need to assume a variety of roles…. advocate, enabler, educator, manager, broker and mediator.”

6.        “The sixth skill needed, regardless of level of practice, is stabilizing. The social worker needs to continually guide and monitor the intervention and its progress.  Goals may need to be modified when relevant conditions change.  New roles may be assumed in order to continue progress.  Additionally, workers must evaluate interventions…recognize when goals are attained and termination achieved.”

 

The problem-solving process involves six major steps:

 

1.        Assessment: “…assessment refers to defining issues and gathering relevant information about a problem so that decisions can be made about what to do to solve it” (p. 25).

2.        Planning:

(a) “…it is important to work WITH the client, not AT the client.  The client must be involved in problem definition and must agree as to which problems merit attention.  Additionally, the planning  process should take advantage of the client’s strengths” (p. 31-32).  (Frost would say that this is not a “should” but a “must” if you are going to be effective.  The strengths of your client are what they use to create effective change.)

(b)     Prioritize Problems: “Again, the client must be a partner in this process” (p. 32).

(c)     Translating Problems into Needs: “Clients come to you because they are suffering from problems. The way you can help them is to establish what they NEED to solve the problem” (p. 32).

(d)     Evaluation of Levels of Intervention: micro, mezzo, and macro. (p. 32).

(e)     Establish Primary Goals: “Goals provide you and your client with direction regarding how to proceed with the intervention” (p. 32).

(f)      Specify Objectives: “Goals…should be so clearly stated that it is as easy as possible to determine when they’ve been attained and when they have not…primary goal statements should be translated into objectives…Objectives are very specific.  They should include WHO should do WHAT by WHEN, and HOW they should do it” (p. 32-3).

(g)     Formalize a Contract with the Client: “A contract formalizes the agreement between client and worker.  It also clarifies their expectations…Contracts are flexible agreements” (p. 33).

 

3.        The Intervention: “Progress dur9ing the intervention must be constantly monitored and assessed.  Sometimes new issues, situations, and conditions require that the plan be changed” (p. 34).

 

4.        Evaluation: “Each goal is evaluated in terms of the extent to which it has been achieved” (p. 36).

 

5.        Termination: “Appropriate timing of the termination is important…The most effective terminations follow a process of disengagement and stabilization…Social workers need to acknowledge that endings are near before they abruptly occur. They must encourage clients to share feelings about the termination, and in turn share their own. Additionally, practitioners must clearly identify whatever progress has been made” (p. 37).

 

6.        Follow-up: “Follow-up…involves checking to find out whether clients have maintained progress and are still functioning well on their own” (p. 37).

 

Chapter Two: Micro Practice Skills: Working with Individuals

 

“Sometimes interviewing is broken up into beginning, middle, and ending phases” (p. 44).

 

Verbal and Nonverbal Behavior:

 

“Verbal behavior is what is being said.  Nonverbal behavior is communication in ways other than spoken words.  People communicate by facial expressions, hand movements, eye contact, the manner in which they sit, and how close they stand to you” (p. 45).

 

a.        Eye Contact: “It’s important to look a client directly in the eye…On the other hand, maintaining continuous eye contact can make a person uncomfortable” (p. 45).

b.       Attentive Listening: “…listening is not always easy.  It demands concentration, perceptiveness, and the use of a range of interviewing skills” (p. 47).

c.        Facial Expressions: “Facial movements and expressions provide an excellent means of communicating.  A furrowed brow…a casual smile…raising the eyebrows…Facial expressions can be used to reinforce what is said verbally and corroborate the fact that you mean what you say….It’s not helpful to give a client a mixed message and SAY one thing while LOOKING like you mean another” (p. 47).

d.       Body Positioning: “Body tension…quick, nervous gestures, such as continuously tapping a foot or finger, or jingling loose change in his or her pocket…opposite of a tense stance is a relaxed one…slow, loose movements and a decidedly casual, informal presentation of self” (p. 47)  In most situations, you are trying to find a balance between these two---neither too tense nor too relaxed.  “You need to appear genuine” (p. 48).  “The use of personal space is another part of body positioning.  This is the actual space or distance between you and the client…Another aspect of body positioning and defining personal space involves where workers sit in their offices in relationship to where clients sit” (p. 48).

 

 

 

Warmth, Empathy, and Genuiness:  (Frost: please substitute “unconditional positive regard” for “warmth.”)

 

All three of the above can be communicated to a client both verbally and nonverbally.

 

Empathy: “Empathy involves not only being in tune with how a client feels, but also conveying to that client that you understand how she or he feels” (p. 49).

 

Genuineness: “sharing of self by relating in a natural, sincere, spontaneous, open and genuine manner” (p. 52).

 

Starting the Interview

 

The Interview Setting:  “Social workers need to be sensitive to the overall impression their office environment itself presents…Some interviews will take place in the client’s own home, which provides the advantage of seeing where and how he or she lives” (p. 54). Note: home visits also can be hazardous!

 

How to Dress: “…your appearance will make an impression and it’s to your advantage to make a good one.  The rule of thumb is to start out dressing ‘nicely’ and ‘relatively conservatively’” (p. 54).

 

Thinking Ahead: “…think ahead about at least three variables.  Fist, is there any specific information which will be needed such as addresses and phone numbers of specific resources?  Can you anticipate any questions the client might ask for which you should be prepared?  Second, the interview’s time frame should be clearly specified.   The time frame means when the interview is scheduled to begin and when it needs to end.  The meetings should start punctually…The third variable which needs consideration prior to the interview is the interview’s purpose” (pp. 54-5).  Note: you should also engage in anticipatory empathy.

 

Initial Introductions: “Names are exchanged with typical pleasantries…It’s usually best to use surnames as they imply greater respect.  Handshakes are also often appropriate” (p. 55).

 

Beginning Statement of Purpose and Role: (1) “Clearly explain the interview’s purpose to the client…(2) explain the worker’s role to the client…(3) ask the client how he or she feels about the identified purpose…and (4) make a statement about the usefulness of the intervention process…there is hope to begin to solve his or her problems” (pp. 57-8).

 

Conducting the Interview:

 

Simple Encouragement: “Many times a simple one word response or nonverbal head nod while maintaining eye contact is enough to encourage a client to continue” (pp. 58-9).

 

Rephrasing: (Also called Paraphrasing): “Rephrasing does not involve offering an interpretation of what the client has said.  It simply repeats a statement by using other words” (p. 59).

 

Reflective Responding: “…translating what you think the client is feeling into words.  It is a means of displaying empathy” (p. 59).

 

Clarification: “…making certain that what the client says is understood…First, the worker can help the client articulate more clearly what he or she really means by providing the words for it. This is clarification for the client’s benefit.  Second, the worker can use a clarifying statement to make what the client is saying clearer to the worker herself” (p. 59).

 

Interpretation: “To interpret means to help bring to a conclusion, to enlighten, to seek a meaning of greater depth than that which has been stated…To interpret means to take a statement a step beyond its basic meaning” (p. 60).

 

Providing Information:

 

Emphasizing Clients’ Strengths: “First, it reinforces a client’s sense of self-respect and self-value.  Second, it provides rays of hope even in ‘tunnels of darkness.’  Third, it helps identify ways to solve problems by relying on the specified strengths.  Client strengths may be found in three major areas.  The first involves behaviors and accomplishments.  The second concerns personal qualities and characteristics.   Finally, the third revolves around the client’s material and social resources” (p.61).

 

Self-Disclosure: “…some amount of self-disclosure enhances relationships…people are more apt to like others who reveal things about themselves.  Similarly, the more you reveal to someone, the more likely he or she will be to self-disclose to you…To some extent self-disclosure is necessary to give feedback to the client” (p. 61).  A basic type of self-disclosure “involves relating aspects about your own life or problems in some way to the client’s feelings or situation.  This approach can convey empathy to the client and indicate that you really understand.  It can also provide a ‘positive role model’ under some circumstances by showing the client that others have learned to live through similar problems…when you as a worker choose to self-disclose, there are some basic guidelines.  The first guideline is to make certain that the self-disclosure is really for the client’s benefit and not for your own…make the self-disclosure relevant to the client…it should be short and very simple” (p. 62).  Note: it is very important in self-disclosure that you don’t communicate to the client that: “Since I did it, so can you!  Since I have had a certain experience, I know how you feel!”

 

Summarization: “summarization involves restating the main points of an interview or a portion of an interview in a brief and concise manner.  Periodic summarization helps the client focus on the main points covered during a portion of the interaction and also helps keep the interview on track…summarization is difficult in that the worker must carefully select and emphasize only the most important facts, issues, and themes” (p. 63).  “Summarizing what has been accomplished during the interview is very helpful when bringing it to a close because it allows the client to leave on a positive note.  Also, summarizing recommendations about who is to do what before the next meeting crystallizes the plans that have been made in both the client’s and the worker’s minds” (p. 64).

 

Eliciting Information: “As a part of the communication process, a worker must encourage a client to reach for and share information.  One way of doing this is simply to ask questions.  There are two basic types of questions, open-ended and closed-ended” (p. 64).

 

Giving Advice:  “…if you tell a client what to do, in a way you are taking responsibility for the result.  In others words, if it turns out that the result of the action is bad for whatever reason, the client has you to blame.  Another problem involves the difficulty of putting yourself in another person’s shoes…Is it ethical for you to tell someone else what route is best for them to take when you don’t have to suffer any possible consequences yourself?  It’s one thing to help a client identify the alternatives available to him or her. It’s another to direct the client as to which one is the best…Sometimes it’s difficult and scary for a client to get going and move onward. In those circumstances a worker needs to use professional judgment regarding how forcefully to encourage the client to proceed…In a crisis situation, clients may need to be pushed out of their frozen, emotional, and perhaps illogical state…There’s one other thing to consider when thinking about telling a client what to do.  Namely, how do YOU feel when someone tells you what you SHOULD do.  Do you run right out and do it readily?  Or, do you resent the intrusion and ignore the advice, or even take off in the opposite direction?” (p. 65).

 

The Use of WHY: “This word can be very threatening to clients because it often implies that the person to whom it’s directed is at fault” (p. 66).

 

Confidentiality: “…a generalist practitioner should make every effort to keep information about the client confidential.  However, the worker should also be aware that, depending on the particular situation, there are many constraints about what really can and can’t be kept secret…The worker should clarify to the client what these constraints are” (p. 68).

 

Silence in the Interview: “…a worker may feel threatened, inadequate, or out of control if long periods of silence occur during the interview…in reality…something is happening all the time…silence is meaningful” (p. 69).  Client-Initiated Silence: This is when the client: “…needs time to organize her thoughts…may be trying to pressure the worker to give some answer…or…is to offer resistance” (p. 69).  Don’t be afraid of silence….USE the silence, the client’s or your own.

 

Confronting Clients: “To confront means to disagree with another person and make a point of stating that disagreement…four major types of discrepancies (are): (1) between two statements; (2) between what one says and what one does; (3) between verbal and nonverbal behavior; and (4) between two or more people…Confrontations involve four components.  First, the worker should communicate that she or he cares about the client and is interested in the client’s well-being.  Second, the worker should clearly express the client’s stated goal within the problem-solving process. Third, the worker should illustrate exactly what the discrepancy is. Finally, the worker should indicate the realistic results of the discrepancy” (p. 71).

 

Exercise: the authors of your text give you an example on page 71 of how a social worker might confront a client at a sheltered workshop.  Analyze this example and tell me how you think the client might react to the confrontation.  What should proceed such a confrontation?

 

Confrontation:

 

“First, as a worker, consider whether your relationship with the client is strong enough to withstand the potential stress caused by confrontation.

 

“Second, be aware of the client’s emotional state.  If he or she is extremely upset, agitated, or anxious, a confrontation probably would have little value.

 

“Third, use confrontations infrequently and only when you have to.

 

“Fourth, continue to demonstrate respect for the client throughout the confrontation…respect concerns keeping in mind that you as the worker are there to help the client, not to get the client to do what you want him or her to do.

 

“Fifth, remain empathic with the client throughout the confrontation.

 

“Sixth, use ‘I’ statements during the confrontation.

 

“Seventh, have patience and allow the client some time to change” (p. 72).

 

Involuntary Clients:

 

“First, acknowledge to yourself that the client is indeed involuntary.

 

“Second, try to put yourself in your client’s shoes.

 

“Third, if the client is resistant, bring that out into the open.

 

“Fourth, know the limits of your authority and power over the client.

 

“Fifth, figure out what you can do for the client that he or she wants.

 

“Sixth, suggest potentially positive outcomes of the intervention which the client may never have thought of.

 

“Seventh, allow the client time to gain trust in you and in the intervention process.

 

“Finally, accept the fact that it is ultimately the client who has the right to choose whether or not to cooperate with you” (pp. 73-4).

 

Handling Hostility:

 

“Although conflicts are generally viewed as being unpleasant incidents to be avoided, there are some positive aspects to conflict. For example, conflicts bring to the surface issues which are of serious concern to clients.  Instead of hiding their negative feelings, clients may voice some hostility. A worker then knows what he’s up against and can begin to address the issues involved.  Additionally, conflict can provide motivating arenas for change.

 

“The following are ten suggestions for dealing with client hostility:

 

1.        Don’t get angry or defensive.

 

2.        Focus on the client’s hostile behavior instead of labeling he client a hostile person.

 

3.        Allow the client briefly to voice his or her anger.  Be empathic.  See the situation from the client’s perspective.

 

4.        Emphasize the client’s personal strengths.

 

5.        Know the facts regarding the client’s situation and the parameters of your role.

 

6.        Focus on the present and future.

 

7.        Look at the various alternatives open to the client and their consequences.

 

8.        Don’t moralize.

 

9.        Summarize what has occurred during the interview.

 

10.     Establish very short-term, initial goals” (p. 73). 

 

11.     Frost would add another suggestion: Say thank you, that you appreciate their honest emotions.  This tends to disarm the client as they usually expect a negative response, not a positive, heart felt, “thank you” for their hostility.  Remember, one of the most important things that you do in the interview is demonstrate genuineness, therefore, you must genuinely express gratitude for their hostility. If you are able to do so, then the other 10 suggestions are more likely to work.

 

When your client may be lying:

 

1. Evaluate the situation logically.  2. Examine the client’s pattern of prior behavior.  3. Usually don’t confront the client if this is the first time.  4. Evaluate the costs of believing or not believing your client.

Frost would suggest the following technique: Don’t say to your client that you think they are lying.  Instead, ask them what they think others might assume if told such a thing.

 

Terminating the Interview:

“First, before the actual interview termination (for example, five, ten, or even fifteen minutes before) mention exactly how much time is left.

 

“Second, tell the client about how YOU feel  as the interview is coming to a close.

 

“Third, ask the client for a review of the learning.

 

“Fourth, draw out your client’s reactions” (pp. 75 & 78).