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Read: France & Weikel: Chapters 1, 2, 5

Weikel, K.F. K. (2019). Helping Skills for Human Service Workers: Building Relationships and Encouraging Productive Change (4th ed.). Charles C Thomas Publisher Ltd..  https://mbsdirect.vitalsource.com/books/9780398093044

Chapter 1 INTRODUCTION

Clients in helping relationships make progress when they feel understood and actively work toward goals they care about, as documented by extensive research (Norcross & Lambert, 2018). This book applies those findings by presenting ways for promoting rapport and facilitating desired change. We describe ways to create positive relationships and engage clients in joint efforts that focus on develop-ing adaptive targets to work toward and achieving productive out-comes. There are many approaches one can take when working with clients. Research indicates, however, that regardless of the approach taken, clients improve more when they experience a strong helping bond with the human service worker (Flückiger, Del Re, Wampold, & Horvath, 2018). To better understand that bond, the American Psy-chological Association’s Society for the Advancement of Psychother-apy and Society for Counseling Psychology developed a task force to investigate specific relationship factors associated with productive client change. After rigorous review of extensive research, the task force concluded that strong and consistent research findings docu-ment the effectiveness of several factors in person-to-person human service relationships: developing a helping alliance, demonstrating empathy, collecting and providing client feedback, communicating positive regard and affirmation, and agreeing on goals (Norcross & Lambert, 2018). Those factors are important components of the help-ing skills discussed in this book. We address ways of developing a helping alliance in Chapter 3, with emphasis on conveying empathy and positive regard. We suggest enhancing the helping alliance through collaborative problem solving in Chapter 4 and cooperativegoal setting in Chapter 6. Collecting and providing client feedback regarding progress toward those goals is also a central focus of the material in Chapter 6. The remaining chapters discuss ways to en-hance those fundamental skills. Now that we have looked at the worker’s perspective, let’s consider the client’s point of view. Clients requesting assistance from human service workers often are feeling anxious, low, or combinations of both emotions. There are essential commonalities among anxiety and de-pressive disorders according to empirical evidence reviewed by Barlow, Allen, and Choate (2004; reprinted in 2016 by the same journal). They assert that at the core of those disorders is a sense of being un-able to control events, which results in negative emotions. Emotional disorders can arise out of biological predispositions and early learning experiences, and then intensify during challenging situations in which individuals perceive a lack of control. According to Barlow and his colleagues, successful therapeutic in-terventions focus on building a basic sense of being able to influence events. The development of such confidence can be supported in a number of ways. Possibilities include the following three strategies: (1) logically thinking through things prior to taking on challenging situa-tions (such as realistically estimating both the likelihood of negative events happening and the true nature of negative consequences that actually might occur), (2) actively exploring ways of confronting and dealing with challenging situations, and (3) accepting emotions rather than expending effort trying to avoid them. Consistent with the ideas of Barlow and his associates, the problem-solving approach described in Chapter 4 can be used to help clients control what they are able to influence. We support the following: (1) logically thinking through challenging situations in advance, (2) exploring ways of confronting those situations and dealing with them adaptively, and (3) accepting negative emotions and then addressing their causes via realistic problem solving to bring about environmen-tal change and/or by adaptively modifying the way one views the cir-cumstances. ENCOURAGING CLIENT AUTONOMY AND SELF-EFFICACY Throughout the book we emphasize providing a supportive rela-tionship in which clients can explore their thoughts and feelings, consider options, and make their own decisions regarding changes they might like to implement. In other words, we support client autonomy. Research has demonstrated that individuals try harder and perform better when changes are more internally motivated and are developed in a nonauthoritarian context, than when change is motivated by the expectations of others (Jang, Kim, & Reeve, 2012; Levitt, Pomerville, & Surace, 2016; Sheldon & Elliot, 1999; Vansteenkiste, Simons, Lens, Sheldon, & Deci, 2004). Consequently, we discourage advice giving and encourage active client involvement in problem solving and in the establishment of targets for change. Clients who actively participate in setting targets for behavior change may experience greater self-confidence or, more specifically, greater self-efficacy regarding their abilities. Albert Bandura (1997) de-fined self-efficacy as belief in one’s ability to successfully execute a par-ticular behavior. He noted that self-efficacy predicts how much effort and persistence one puts into changing a behavior. Clients with high-er self-efficacy regarding coping and behavior change (in other words, clients who believe they actually will be able to cope with difficulties and accomplish desired change) are more likely to persist when faced with obstacles and are, consequently, more likely to successfully bring about desired change. Research confirms that stronger belief in one’s ability to accomplish change is associated with greater success. This effect has been demonstrated in a variety of areas, including the fol-lowing: overcoming phobias, achieving and maintaining weight loss, improving athletic performance, increasing activity level, coping with anxiety, and abstaining from drug and alcohol use (Bandura, 1997; Bandura & Locke, 2003; Evon & Burns, 2004; Kuusisto, Knuuttila, & Saarnio, 2011; Rejeski et al., 2003). Research has also suggested that self-efficacy is associated with in-ternal motivation and helping alliance. For example, one study (Heins, Knoop, & Bleijenberg, 2013) looked at factors influencing fatigue in persons who had participated in treatment for chronic fatigue syn-drome. Lower levels of post-treatment fatigue were associated with higher self-efficacy for controlling one’s fatigue and with the person’s degree of agreement with the therapist on what the necessary steps were to achieve one’s treatment goals. Researchers are now suggesting that increases in self-efficacy may be one of the reasons that helping bond is associated with productive change. Links between helping alli-ance and improved client self-efficacy have been found to be associated with outcomes such as improving diet and exercise following car-diac events (Burns & Evon, 2007) and abstaining from misuse of alco-hol (Hartzler, Witkiewitz, Villarroel, & Donovan, 2011). Given the links among autonomy, self-efficacy, and successful cop-ing, efforts to foster autonomy and self-efficacy seem important. Bandura (1997) identified a number of ways to enhance self-efficacy, including receiving credible verbal encouragement and successfully accomplish-ing what you set out to do. He suggested that performance success, or what he called mastery experience, is a primary way of increasing self-efficacy. From our perspective, both self-efficacy and autonomy are enhanced when the worker encourages productive change by helping clients engage in adaptive coping efforts that foster success in areas which are important to them. Consequently, in this book we empha-size developing rapport and alliance, while also encouraging autono-my and self-confidence through collaborative problem solving and goal setting. REWARDS AND COSTS OF USING HELPING SKILLS Let’s consider some of what you do as an effective human services worker. Since the ultimate goal is for clients to develop insights and to cope more adaptively, you encourage their input and foster their ini-tiative. Using the least amount of authority necessary, you seek to understand feelings, and you encourage the expression of ideas. By sharing responsibility for determining the subject matter and the pac-ing of interactions, you put clients in position to take credit for pro-gress they make, thereby enhancing their self-efficacy and autonomy. The preceding considerations imply both rewards and costs for you. Costs include: • as a student, trainee, or new employee, you must make the effort to learn the art of helping; • as a skilled worker, you will need to allot sufficient time for prob-lem-solving interactions with clients (with about 20 minutes being the minimum for an initial problem-solving discussion).

Introduction 7 Rewards include: • knowing you can flexibly deal in-depth with a wide range of top-ics; • possessing the skills to create and maintain a productive alliance in which the client eventually emerges as being responsible for positive change. In addition to rewards within the worker-client relationship, learn-ing helping skills has other advantages, including both relationship-building and career-enhancing benefits. Let’s consider some of those, starting with the career side. When CEOs of human service organizations are asked to name the skills they would most like to see in an entry-level staff member, effec-tive interpersonal communication often tops their lists. Consequently, developing the skills discussed in this book will give you very mar-ketable abilities. With regard to relationship building, one of the most universally helpful forms of assistance is appraisal support. This form of assistance means aiding others in understanding and coping with problems. Since facilitating problem solving is a key skill that we will address, learning the material that follows will enhance your ability to provide one of the most valued forms of social support. Of course, when you are with friends, you aren’t always talking about problems, and lighthearted exchanges often have an unfocused quality. But in this book we are concentrating on something different. Compared to social conversation with acquaintances, discussions with clients can be distinguished in several ways. First, the interactions are planned. Second, the focus is on clients’ thoughts and feelings. And third, human service workers do not avoid unpleasant topics. MAKING PROGRESS Since you are reading this book, it’s likely that communicating effec-tively is important to you. And because of your interest, you probably already possess a good set of abilities. But you may be in for a surprise. When trying helping strategies for the first time, individuals often feel awkward and uneasy. And it is common to find that the quality of your skills actually declines during the initial phase of training. Al-though it is not unusual for helping skills students to doubt their abil-ities, results of empirical studies suggest that self-efficacy increases and stress decreases with training and experience (Goreczny, Hamilton, Lubinski, & Pasquinelli, 2015; Lent et al., 2009; Levitt, 2001). Wrestling with the material that follows will be demanding and fre-quently will require a fair amount of trial and error. On the other hand, perseverance probably will lead to an ability level that is far bet-ter than your present one. In order to reach that higher plane, you must develop ways of combining your current skills with what you are about to learn. If you are in a class that teaches helping principles, you will see that students progress at different rates. For those who hit their stride a bit later than some of their classmates, seeing others excel can be exas-perating. But such frustration actually can be productive, if it helps one become more effective in using feedback to make adjustments. When you are responsive to feedback and subsequently are able to improve your performance a bit, your self-efficacy for learning helping skills should increase, and you should feel more motivated to contin-ue practicing the skills. Another way of gaining motivation for sticking with the material is to see how productive it is when used in professional settings. If there are opportunities for you to observe skilled human service workers, take advantage of those possibilities. Such experiences can energize you and can help you perceive the value of the techniques you are learning. Another benefit of such observations is that you can see the professional manner in which veteran human service workers do their jobs. Observing staff members calmly handle difficult situations may help you realize that the pressure of being a novice eventually dissi-pates. Bandura (1997) refers to such observation as vicarious experi-ence, and he notes that it can increase self-efficacy. Unfortunately, you may also observe veteran staff members who dis-play inappropriate behavior. Some persons fail to use the helping techniques in which they have been trained. When bad performance is what you encounter, pay attention to the effects it has on clients. And remember that you can learn how to do a better job than the one you are seeing.

THE ROLE OF PRACTICE This book presents essential content and provides realistic scenarios in which you can apply helping principles. Studying the material and completing the exercises will be useful, but we believe the most important learning will take place when you practice with another person, record the interaction, receive feedback from knowledgeable observers, and then use what you have learned the next time you do a role play. Learning from your critiqued performances may be easier if you maintain your own library of recorded role plays you do. Having your personal copy of interactions allows you to review them at your con-venience and also provides evidence of your improvement over time. If you are a student in a helping skills class, you probably will do role-play interactions as part of the course. But it is also possible to arrange role plays yourself. Such efforts can be worthwhile if you re-cord the interactions and have them critiqued by a person who appre-ciates what you are trying to learn. Doing recorded role plays and being evaluated by others can be nerve-wracking. As we have noted, however, such nervousness usual-ly decreases with time and experience. During the interaction, try to stay calm. You will feel more relaxed as the novelty wears off. Once you are a veteran with several practice role plays under your belt, the learning cycle will be more familiar. You will become accus-tomed to the process that involves (1) identifying areas needing im-provement, and (2) making appropriate adjustments. It is natural to regret having behaved in ways that led to corrective feedback. But the goal is to learn from your miscues, rather than to become anxious about the fact that you are not perfect. Instead of worrying about your own imperfections, during a role play you should focus on the client. As a worker who is supposed to be assisting that person, the number one priority in your practice in-teractions is to concentrate on the client’s words and nonverbal behav-ior. Keep your focus on the other person. Pay attention to what the individual is saying. While the person is talking, do not think about what you are going to say next. Simply listen. When there is an oppor-tunity for you to speak, gather your thoughts and make an appropriate response. Immediately prior to your comment, a few moments of relaxed silence are perfectly acceptable. You may need to read the preceding paragraph again. As informa-tion from a client begins to accumulate, most novices feel a great temptation to begin planning a response, in order to be ready with a comment when the opportunity arrives. But if you start thinking about yourself, you stop listening to the client. Consequently, the response you make is likely to be out of touch with the totality of what the client has communicated. On the other hand, accomplished human service workers rarely make such gaffs, because they focus on their clients rather than on themselves. In order to assist your efforts at becoming a skilled human services worker, this book presents a number of useful techniques. In general, a set of techniques has value if it provides effective ways of thinking and behaving. Much of the power of these adaptive strategies comes from the self-efficacy you experience once you become proficient with them. When armed with a set of methods that you feel comfortable using, you expend less effort on thinking about your abilities, and you focus more energy on actually getting the job done. Although techniques can be beneficial, it is also possible for them to be counterproductive if they are applied in a rigid or artificial man-ner. Consequently, when employing the strategies described in the chapters that follow, you should always use them with flexibility and common sense. INTRODUCTIONS If you are learning helping skills in a group setting, how you get along with others in the group is more important than interpersonal relationships in traditional lecture-discussion environments. Since most skill-development formats involve giving feedback to one another, par-ticipants and leaders need to feel comfortable with each other and need to share a certain amount of trust. One approach to laying a foundation for group cohesiveness is to begin with an introductions exercise. The activity we recommend is found in Appendix A. If you are in a class that will be using it, you should not read Appendix A be-fore participating in the exercise.

YOUR CURRENT SKILLS In preparation for the next chapter, it is worthwhile to take a base-line measure of your current helping style. A good way to sample your skills is for you to do a role play. If you are in a course, one option is for the instructor to conduct a baseline exercise, which can be struc-tured in the following manner. The class divides into three-person groups. In each group there is an observer, a client, and a worker. The task of the observer is to write what the worker says. (It probably will be impossible to write everything, so just be sure to jot down the first few words of each comment and as much of the rest of it as you can.) The task of the client is to portray a person in need of problem-solv-ing assistance. (Your instructor may provide you with a scenario to role play.) And the task of the worker is to do what you think is appro-priate in such an interaction. The role play need not be long. Gen-erally, three to five minutes is sufficient. The reason for the baseline exercise is to get an indication of your group’s current skills. Consequently, these role plays probably will dif-fer from later ones in two ways. First, there is no feedback after the role play. The intent is to get a sample of everyone’s skills, rather than to change those skills. Second, the observer keeps the observation notes rather than giving them to the worker. Observers retaining their own observer notes allow the workers to remain anonymous as the baseline measures are discussed in class. When processing baseline role plays, remember not to identify indi-viduals who made worker comments that come up for discussion. The purpose of the exercise is not to identify who said what. Instead, the objective is to discover the kinds of responses made by members of the group. Another way of measuring your current skills is to do the dialog exercise in Appendix B. Your instructor may give you directions with regard to the exercise. If that is not the case, you should do it on your own prior to reading Chapter 2. feedback. The purpose of such critiques is for participants to consider their efforts and to modify behaviors that show room for improve-ment. But, as results of empirical research have demonstrated (Daniels & Larson, 2001), being told that one has made mistakes can evoke strong reactions. Since feedback is helpful only if the recipient uses it, here are some guidelines for productive evaluations. Focus on what the worker actually did. To the best of your ability, describe what the worker said or did, then state what you liked or did-n’t like about it. Since there are many correct ways of handling any situation, it generally is not productive to concentrate on “should haves,” “would haves,” or “could haves.” Wide-ranging discussion of alternative responses can take place after feedback to the worker is over, but not as part of commentary on his or her performance. Be succinct. We all have limits on how much criticism we can absorb. Oversaturation is not productive. Consequently, think about the points you want to make, communicate them to the person, and then stop. If there is an instructor or trainer who gives feedback, pay attention to how that person delivers both positive and corrective feedback. Over time, feedback you give will become increasingly more like that of the leader. As we have said, for all but the baseline role plays, there should be written feedback on every training interaction you do. There are a variety of formats for arranging written comments; Appendix C con-tains the approach we use. Just as there are different ways of providing written feedback, there are also various approaches to structuring a helping skills course. In Appendix D, you will find one set of possibilities regarding class orga-nization. SUMMARY When used effectively, helping skills engage clients in an alliance intended to promote effective coping. Once you become a skilled worker who schedules sufficient time for interactions, you will be able to facilitate flexible contacts that leave clients feeling responsible for Introduction 13 productive changes that take place. In addition, learning the art of helping can increase your professional marketability, as well as enhance your effectiveness in offering social support. Learning helping skills typically involves practicing, making mis-takes, and using feedback to do better the next time. The trauma of role playing usually lessens with repetition, and performance general-ly improves when workers focus on their clients rather than on them-selves. Initial tasks in a helping skills course include taking measures of your current skills and becoming comfortable with the persons who will be giving you feedback. When you are the one providing feed-back, you should succinctly focus on actual behavior displayed by the worker.

Chapter 2 FIVE WAYS OF RESPONDING

Take a look at the dialog exercise (Appendix B) and see where your slash mark is for option A. Since the dread being felt by the client is discounted by that response, it is an insensitive comment. Hopefully, you were dissatisfied with the statement and placed your mark toward the left end of the line. But if your mark is on the right portion of the line, and you still believe the comment is a good one, you should dis-cuss the item with a knowledgeable person, such as your instructor or your supervisor. Option A functions as a litmus test. Its purpose is to verify that we share a common starting point for viewing responses as being helpful or detrimental. Now let’s begin to make some finer distinctions. David Johnson (2014) has asserted that when one person is trying to be supportive of another, most comments from the would-be helper can be categorized according to five modes of response. Each of these modes has a different objective, and each has its own effects on the interaction. ADVICE The purpose of advice is to tell others what to do. Results of empir-ical research suggest that such direct guidance is often associated with interactions that workers subsequently view as being shallow and of little value, and that clients subsequently see as being rough and unpleasant (Friedlander, Thibodeau, & Ward, 1985). Advice provides ready-made courses of action, rather than encour-aging individuals to generate their own solutions. When you bypass others’ own decision-making capabilities, you communicate the belief that you are in a better position than them to decide what should be done, and you may damage their self-esteem by implying that your ideas are superior to theirs. Your clients’ agreement or disagreement with your high opinion of yourself will be reflected in one or more of the following basic consequences that can follow advice giving. • Rejected. If you tell a client what to do, the person may reject the advice. When that happens, the individual may also have come to believe that you do not really understand the problem, since you made such an inappropriate suggestion. Consequently, reject-ed advice often is a sign of poor rapport, which can hinder sub-sequent efforts at relationship building. • Accepted. The client may accept the advice. That probably is what you wanted when you made the suggestion. But there still may be trouble ahead, since there are additional possibilities. • Failed. Having accepted your advice, the client actually tries it. The result, however, is a miserable failure. Circumstances now may be worse than they were before, and the client may blame you for the mess. Such finger pointing can occur even if the advice was good and the problem actually was with the client’s implementation of your recommendations. • Worked. This is the best possible outcome. You give advice, it is accepted, and it works. When faced with a new and equally dif-ficult decision, what is the client going to do? Having successful-ly implemented your advice in the past, the person may again turn to you for guidance. If that happens, you may be fostering dependency, rather than encouraging independent problem-solv-ing abilities. Recognizing the risks of advice, there are times when it is appro-priate. The most crucial occasion for advice-giving is during life-threatening situations. For example, with a suicidal person it is always appropriate to say (if you mean it), “I don’t want you to kill yourself.” Although this is telling the individual what not to do, preserving life is worth the risk of dependency. In the dialog exercise, option B is an example of advice. Take a look at where your slash mark is. Next, if you did the baseline role plays, check your observer notes for examples of advice. Compare what you and your peers thought of advice before, to what you think of it now. ANALYSIS When you analyze, you describe your opinion of how things got to be the way they are. As with advice, the emphasis is on what you believe, instead of on what the client thinks. Sometimes analysis comes in the form of general observations about life. These are truisms that you think are applicable. For instance, you might say, “Most people feel uneasy at first. It takes time to get to know someone.” Clients may or may not see such pro-nouncements as being relevant to their situations. And, as with all analysis, general observations about life put the focus on your beliefs rather than on your clients’ thoughts. Consequently, it is best to avoid such comments. There are occasions when analysis is appropriate. For example, dur-ing initial interviews with new clients, psychotherapists often negoti-ate goals for the intervention, and then provide a rationale for how counseling can facilitate progress toward those objectives. By identify-ing potential helping strategies, therapists also imply the existence of certain causative factors, as in the following scenario. “You have select-ed ‘understand my children better’ as one of your goals. In order to improve that understanding, we will do some role-playing exercises, and eventually you will have homework assignments in which you try out communication skills that we develop in our sessions.” The analy-sis implied in this rationale is that the client’s lack of sufficient com-munication skills has contributed to the problem. Although there are some situations that call for your analysis, such as when providing a rationale for a recommendation you make, we encourage you to use this response sparingly. As much as possible, the focus should be on the client’s interpretation and understanding of events. In the dialog exercise, option C is an example of analysis. Look at the location of your slash mark. Also check your observer notes for the baseline role plays and see if you find any examples of analysis. Now consider whether you have changed your opinion of this response mode.

SYMPATHY/REASSURANCE When laypersons try to be supportive, two of the most commonly used responses are sympathy and reassurance. Sympathy seeks to communicate concern by saying how you feel about the other person’s difficulties, and reassurance is intended to calm the individual by offering some type of guarantee. If you are in a relationship that typically involves self-disclosure of personal information about yourself, it may be entirely appropriate to say how you feel about the other person’s difficulties. But if the rela-tionship does not involve you regularly revealing your personal thoughts and emotions, then sympathy probably is inappropriate. When communicated in a professional relationship, sympathy can be perceived as pity or can be seen as being insincere. In either case, it is likely to hinder rather than to enhance rapport. The appropriateness of reassurance depends on the worth of its guarantee. In order for a statement of reassurance to be believable, there must be evidence to support it. For example, an auto accident victim goes to the emergency room with an injured arm and has X-rays taken. The E.R. physician receives the report of the radiology consult and then says to the patient, “The X-rays show no signs of any broken bones.” Such a statement is an example of appropriate reas-surance because the speaker has evidence to back up the assertion. In order to consider another kind of reassurance, let’s continue the hospital scenario. Imagine the accident victim is a friend, and you are with her in the E.R. examining room. While waiting for the radiolo-gy report, you say, “I’m sure everything will be fine.” Although you are seeking to calm her, this statement may have the opposite effect. She may believe that you don’t appreciate the severity of the situation, and she may belittle your future efforts to be helpful. There is no value in false reassurance. Its guarantee is worthless. (Rather than signifying a response mode, the term “reassurance” can also mean an emotion experienced by the client. Used in this manner, reassurance might describe unpleasant feelings being relieved or pos-itive expectations being strengthened.) In the dialog exercise, look at where your slash mark is for option D. In addition, check your observer notes for examples of sympathy and reassurance. Think about the appropriateness of these two fre-quently encountered responses.

INTERROGATION If you ask questions or specify the topic to be discussed, you are interrogating—a mode of response that has been the focus of several classic empirical studies. When evaluating interactions that contain high levels of such information seeking, workers subsequently have viewed them as being shallow and of little value, and clients subse-quently have seen them as being rough and unpleasant (Friedlander et al., 1985). Ongoing clients have been shown to feel less understood and less supported when the inte