Ebook Fundamentals of case management practice - Skills for the human services (4th edition): Part 2

www.downloadslide.com CHAPTER 10 Bringing Up Difficult Issues Introduction There will be times when you have a concern about something the client has said or done. You may be concerned for your client’s well-being, and you do not want your client to do something harmful or continue to behave or think in ways that are destruc-tive. Occasionally you will have a problem because someone other than the client has in some way interfered with your ability to do your job well.As noted earlier, when your needs are not met, you are responsible for resolving the matter or, at the very least, for bringing your concerns out in the open where they can be discussed and examined by the client. Bringing something out into the open is called confrontation.To most people this means an angry, accusing action. In social services, however, it means matter-of-factly bringing something out to gain a better understanding and perhaps to make meaning-ful changes or take important new steps. When you bring up your point of view, you are holding reality as you see it before the client for the client to consider.The client is in no way obligated to see things your way, but now both points of view are known and considered. Many opportunities to grow and make constructive changes will be discovered when you use confrontation. The decision to use confrontation is another strategic decision. This chapter examines when confrontation might be a useful tool to help you and your client explore differences and resolve possible conflicts. Chapter 10 Bringing Up Difficult Issues 183 www.downloadslide.com When to Use Confrontation Discrepancies There are times when a client will communicate two different messages. Confronta-tion can help the client see the discrepancies and can offer an opportunity to look at the situation and at the person in another way. Some examples of discrepancies follow. The Client Says One Thing but Does Another. Dalia tells you that she really wants to go to the job-training program and that getting a job is a top priority for her, but she does not register for the classes. On the other hand, she has numerous excuses for not registering, some of which do not seem entirely believable. The Client Has One Perception of Events or Circumstances, and You Have Another. Harold thinks you are uncaring and self-involved. He got this idea because you did not come to work the Friday after Thanksgiving even though the office was open. He was off work that day, and he wanted to make an appointment with you so that he would not have to miss work at another time.Your perception is different. To you it was reasonable to be off work the Friday after Thanksgiving because there was only a skeleton staff working that day.You also needed to take a day off before the end of the year or you would have lost some of your accumulated time. Clients rarely come in on this date, and there was a crisis team to cover any crisis that might have come up.To Harold you seem uncaring, while to you your actions seem reasonable. The Client Tells You One Thing, but the Client’s Body Language Sends a Very Different Message. Andrea tells you that she is “fine,” that she feels “okay,” and that “everything is all right.” She looks, however, as if the opposite is true. She speaks in a monotone, looks at the floor as she speaks, and appears depressed and disheveled. These are clues that the spoken message and the unspoken message do not match. The Client Purports to Hold Certain Values, but the Client’s Behavior Violates Those Values. Paul tells you he “likes everyone” and “accepts” everyone. He tells you ethnic differences are unimportant to him and he fi nds them enriching. In one of his meetings with you, he tells a decidedly racist joke that obviously denigrates a minority group. All of the examples discussed here are situations that contain discrepancies that deserve to be addressed. Doing so will help to clarify the issues and help you and your client come to understand one another’s point of view. Ignoring discrepancies interferes with understanding between you and your client because of conflicting perceptions. Other Reasons to Use Confrontation There are other reasons besides discrepancies for using confrontation. It can also be used to bring out in the open behavior or communications that seem to interfere with clients meeting their goals. Following are some examples of such situations. The Client Has Unrealistic Expectations for You. Marcy expects that you will drop everything to see her or to take her phone calls. She does not want to see anyone 184 Section 3 Effective Communication www.downloadslide.com else in the agency and does not think she should have to see anyone else at night.You are her case manager, and she wants you to be there when she needs you. The Client Has Unrealistic Expectations for Him- or Herself. Miguel has been in a partial hospitalization program for a number of months and has been sick for about 4 years. Stress seems to trigger his schizophrenic symptoms, and regulating his medication is difficult. He is very good at cleaning and janitorial tasks around the center, and there is a good supervised janitorial program for clients in which they hold a regular job and clean actual establishments. Miguel is set on going to work at the highway department and getting a job driving a steamroller. He applies for the job repeatedly but gets no response. The Client Asks for Assistance, but Actions Indicate the Client Is Not Interested. Serena asks you to help her find suitable housing so she will not have to stay at the shelter any longer. You have some leads she could pursue, but she breaks appointments, calling in to say she was detained and will reschedule. She does not follow up on the leads you give her, and the two apartments she went to see that were suitable she turned down for minor problems, refusing to live there. The Client’s Behavior Is Contradictory. Art comes in to group and tells the group he will stop drinking. He never misses AA meetings, gets a good job, and begins to help others stop drinking. Later you learn that he is actually drinking in spite of what he says in group and at AA meetings and that he goes to AA on Tuesday and Thursday and to his favorite bar on Friday and Saturday nights. Art’s behavior is contradictory in another way. While he talks to newcomers in the group about how helpful it is to stay in group and how wonderful the agency is, he has been denigrating a certain member of the staff outside the building where he goes to smoke during the break. The I-Message in Confrontation Because the problem is yours and the observations are your own, confrontations should begin with or include a reference to you. The term used for these statements by Dr. Thomas Gordon is “I-messages” because they contain the words “I” and “me.” Confrontation is not helpful, as we have seen, if statements contain the accusatory “you.” Figure 10.1 shows some examples of correct and incorrect I-messages to dem-onstrate the difference between them.The first example consists of messages to a cli-ent who was late on Tuesday; note the use of “I” in the correct version and the use of “you” in the incorrect version.The second example demonstrates a worker’s concern for what her client is about to do. A complete I-message usually contains four parts: 1. Your concerns/feelings/observations about the situation 2. A nonblaming description of what you have seen or heard—of the behavior 3. The tangible outcome for you as a result or the possible consequences for the client 4. An invitation to collaborate on a solution Chapter 10 Bringing Up Difficult Issues 185 www.downloadslide.com FIGURE 10.1 Examples of I-messages To a client who was late on Tuesday: Correct: Incorrect: “I’m concerned about when we got started on Tuesday morning. Starting late got my day behind more than I wanted, and I spent a lot of time trying to catch up. Could we look at your scheduling and mine and see if there is a way we can start on time?” “You were late on Tuesday, and you held me up. My whole day was behind, and I spent a lot of time trying to catch up.” I-messages broken into the four parts: Correct: “(1) I’m concerned about (2) when we got started on Tuesday morning. (3) Starting late got my day behind more than I wanted, and I spent a lot of time trying to catch up. (4) Could we look at your scheduling and mine and see if there is a way we can start on time?” To the client who is distressed over having to go before the District Justice: Correct: Incorrect: “I guess it just seems to me that you could get in more trouble if you follow through on your plan to yell at the District Justice about this. It might cause him to be even tougher on you. Let’s look at this and see if there is some other way to handle this.” “If you go out there and yell at the District Justice, all you are going to do is get yourself in a lot of trouble. My advice is to cool down and just go in there and listen to what they have to say” I-messages broken into the four parts: Correct: “(1) I guess it just seems to me that (3) you could get in more trouble (2) if you follow through on your plan to yell at the District Justice about this. It might cause him to be even tougher on you. (4) Let’s look at this and see if there is some other way to handle this.” The second part of Figure 10.1 provides more examples of messages given to clients, with each message broken into the four parts. Compare the correct and incorrect mes-sages. Note the following about the incorrect ones:They begin immediately with the accusatory “you” rather than “I,” and they contain no invitation to the client to col-laborate on a solution (in the second example, the worker gives advice instead). The Rules for Confrontation There are ways to talk with a client about the issues that concern you. An important goal is to do so in a way that allows the client to hear you and make use of what you have said. We all benefi t from the feedback of others, but the manner in which it is given often interferes with our ability to accept and use that feedback. The following text discusses rules for making I-messages less threatening and more acceptable to the listener. Figure 10.2 contains examples of correct and incor-rect messages for each rule. As you read about each rule, examine the sample mes-sages in Figure 10.2 under the heading for that rule. Note that in the correct messages the speaker emphasizes “I” and “me,” taking responsibility for the observations and concerns, whereas in the incorrect messages, the emphasis is on “you.” 186 Section 3 Effective Communication www.downloadslide.com FIGURE 10.2 Examples of I-messages based on rules for confrontation Be Matter of Fact To a person whose goals are unrealistic for the present: Correct: Incorrect: “I need to talk with you about something that bothers me. It seems to me that some of your goals are a bit further down the road. I’m wondering if we could look at some preliminary steps for you to take first to help you get ready.What do you think?” “You better reconsider! You’re not at all ready to undertake a job like that. Let’s get cracking on some training first, something to prepare you. You don’t just walk in and get the best job right away.” Be Tentative To a person who may not be seeing all of the issues with his mother: Correct: Incorrect: “I guess I’m wondering about this problem you’re having with your mother. I could be wrong, but when you describe the way she talks to you, it sounds to me as if she is angry for some reason.What do you think?” “It seems to me your mother is obviously angry at you.” Focus on Tangible Behavior or Communication To a client who is frequently late for appointments: Correct: Incorrect: “I have a problem with the number of times you have come for your appointment late. Maybe we should take a look at it together and see if you can make some arrangements that will fit your schedule better. For example, you were 20 minutes late on July 10th, 1 hour late on July 17th, and 45 minutes late on July 24th. I need to talk about what is happening here and see if we can come up with something.” “You’re always late. Every time we have an appointment, you come in when you feel like it.” or “I’m really upset with you.You’re never on time.” Take Full Responsibility for Your Observations To a person who needs housing but is doing little to obtain it: Correct: Incorrect: “I think what bothers me is that it seems as if the sessions we have together to get you better housing aren’t as important to you as I first thought. What I mean is that to me it seems you have some other more important priorities. I might be wrong. I’m basing this on the fact that you never went to see the three apartments that were available to you. Can we talk about where you are right now with housing and where we should go from here?” “I can see you don’t care about housing.” or “The way it appears, housing certainly isn’t a high priority for you! You never follow through.” (continued ) Chapter 10 Bringing Up Difficult Issues 187 ... - tailieumienphi.vn