Welcome to Seminar 4 – Case Management and Effective Communications Heather Valentino, LCSW This seminar PowerPoint adapted by Craig Owens, exclusively for use in HN330, with materials from Kaplan Course HN330-02 and power points from Fundamentals of Case Management Practice: Skills for the Human Services, Third Edition, Nancy Summers, Brooks Cole, Cengage Learning, (2009) and is subject to all copy-write rules and regulations that apply.

Seminar Agenda Review last week & apply the learning! Good and bad responses “Listening” to clients Asking questions of clients Dealing with angry clients Questions This seminar PowerPoint adapted by Craig Owens, exclusively for use in HN330, with materials from Kaplan Course HN330-02 and power points from Fundamentals of Case Management Practice: Skills for the Human Services, Third Edition, Nancy Summers, Brooks Cole, Cengage Learning, (2009) and is subject to all copy-write rules and regulations that apply.

We just completed our discussion on working with people from different cultures. What is one thing you learned that you think you will never forget about working with someone from a different culture?

TWELVE ROADBLOCKS TO COMMUNICATION Warning, admonishing, threatening Moralizing, preaching Advising, giving solutions Lecturing, teaching Judging, criticizing, disagreeing, blaming Praising, agreeing Name-calling, ridiculing, shaming Analyzing, diagnosing Sympathizing, consoling Probing, interrogating Withdrawing, distracting humor, diverting Ordering, directing

USING THE PHRASE “I UNDERSTAND” Why is this often a block to effective communication? How does it make you feel when I say “I understand”?

USING THE PHRASE “I UNDERSTAND” “I understand” - often sounds superficial and trite. “I understand how you feel” - Most of us can never know exactly how a client feels. “I understand how you feel, but…” - the “but” tends to negate the client’s very real feelings and push the worker’s perspective instead.

SHOWING APPRECIATION FOR WHAT HAS BEEN SAID Appreciate it when clients bring up their concerns. This makes it safe for the client to discuss issues they may have with you or the agency. EXAMPLE: I really appreciate your telling me about this. It is helpful to know. Thanks for bringing this up. I appreciate your bringing this issue to my attention.

TWO other Communication Killers Doing one of these can derail a good connection: You assess your client’s feelings incorrectly Here the client may correct you giving you more accurate information. She says she did not feel angry but rather she was disappointed. This is helpful to know. Your mind wanders - your mind on occasion will wanders away from the conversation. Practicing good body language, showing interest in what the client is saying will prevent these momentary shifts in focus from becoming real problems. (This can become a major issue quickly!)

THREE MAJOR PROBLEM AREAS There are three major problems that can occur when communicating with others: You cannot wait to pass judgment - rather than listening the worker is judging what the client is saying and what the client has done. These workers are preoccupied with what they want to say and can’t wait to pass along an authoritative judgment. You ignore the client’s feelings - The client expresses emotion but the worker does not notice and focuses instead on the facts and a solution. You cannot wait to offer a solution - the worker rushes to a solution without establishing rapport or letting the client know that the underlying feelings were heard. In my experience this is the most frequent mistake we make as human service workers.

DEFINING REFLECTIVE LISTENING Reflective listening involves listening to content and listening to feelings. Reflective listening does not include advice or solutions. Reflective listening does not judge the feelings or the message Reflective listening has three purposes. 1. Lets clients know you have heard their concerns and feelings accurately. 2. Creates an opportunity for you to correct any misperceptions. 3. Illustrates your acceptance of where the client is at that moment.

RESPONDING TO FEELINGS Empathy is the ability to hear accurately the underlying feelings and emotions the client is experiencing. First, listen to what the client is telling you. Next, identify the predominant feeling you are hearing. Finally, construct a single statement that includes that feeling. EXAMPLE: Hi, I am so freaked out today, I can’t stop crying and I have a stomach ache and headache, I feel like I’m going to be sick. My wife was hospitalized today for her kidney problems and the doctors tell me she may not be coming home again unless a donor is found.

RESPONDING TO CONTENT Reflective listening to content lets you check that you heard what the client told you accurately. Reflective listening to content lets the client know you are interested in the details of the concern or event. Reflective listening to content, combined with listening to feelings, is a good way to help individuals who have been through a trauma of some sort. EXAMPLE: Hi, I am so freaked out today, I can’t stop crying and I have a stomach ache and headache, I feel like I’m going to be sick. My wife was hospitalized today for her kidney problems and the doctors tell me she may not be coming home again unless a donor is found.

POSITIVE REASONS FOR REFLECTIVE LISTENING There are two important positive reasons for using reflective listening: The client feels heard-by accepting, without judging, where the client is now, the client can then move on toward something better. You help the client to drain off the feelings - After a trauma a person needs to talk about that event. Reflective listening helps the person drain off the feelings and then move forward with more clarity

FIVE POINTS TO REMEMBER ABOUT REFLECTIVE LISTENING Listen reflectively long enough. Do not cut short this important part of healing. This takes tremendous focus and discipline. Solutions come later. Don’t rush to give advice before you have listened or if you must give advice at first to help the client relax, go back and use reflective listening. Reflective listening does not mean you agree. It simply means that you are where the client is at the moment. You could be wrong. Let the client correct your perceptions if need be. Mind your body language. Lean toward the client. Make eye contact (if culturally appropriate). Be genuinely interested!

Reflective Listening-Practice Time - 1 “I’m telling you, I can’t go back there, my wife is getting more and more violent everyday and refuses to get help. I can’t sleep at night because I never know when she might lose control again or what she might do to me!” Name a feeling: One sentence empathic response:

Reflective Listening-Practice Time - 2 “I’m proud of reaching my one year sobriety anniversary; but sometimes it makes me so sad to think of all the bad decisions I made when I was drinking and all the people I hurt.” Name a feeling: One sentence empathic response:

Reflective Listening-Practice Time - 3 “Everyone here at the half-way house is so much nicer to me than my family and friends ever were; now I know what unconditional love feels like.” Name a feeling: One sentence empathic response:

Reflective Listening-Practice Time - 4 “I’m so excited; I was able to leave my apartment today and do my own grocery shopping for the first today since my panic attacks started two years ago. It is hard to describe how it felt to be able to do this all by myself – and I drove my car too!” Name a feeling: One sentence empathic response:

QUESTIONS THAT CAN MAKE THE CLIENT FEEL UNCOMFORTABLE Questions that imply there is only one answer - implies there is only one acceptable answer. Questions that inflict your values - sound as if only your values are correct. Questions that make assumptions – or worded in such a way that imply you already know the answer. ‘Why” questions - tend to feel judging and imply clients should have done things differently . This mistake gets made a lot! Questions that change the subject too quickly - asking about something completely different than what the client is discussing can feel like you don’t care.

OPEN QUESTIONS Open questions: Give clients more opportunity to talk about their situations. Give you more information. Put the client at ease. EXAMPLES Tell me a little bit about your divorce? How are you feeling about your divorce now compared to when you first went through it a year ago?

Open Questions – Practice Time A child is talking to a youth worker while he waits for his mother to get a place for them to stay. “We’ve lived in 16 places,” he says; as he starts crying “and I’m only 7; I don’t think I’ll ever have any friends.” The worker says, “What was the last school you went to?” Is this an open or closed question? What open question would you have asked this child instead?

COMMON REASONS FOR ANGER Internal Reason’s: The client feels overwhelmed. The client is confused. The client has a need for attention. The client is fearful. The client is exhausted. External Reasons: The client is angry about something the agency has done. The client is angry about something you have said or done.

WHY DISARMING ANGER IS IMPORTANT Establishes safety – Yours, the clients, and others! Allows you to gain empathy/understanding. Focuses on solving the issues instead of emotions.

DO NOT TAKE CLIENTS’ ANGER PERSONALLY This is the number one mistake workers make when dealing with angry clients. There are numerous reasons clients become angry that have nothing to do with us. Taking anger personally may cause you to say or do things that will permanently damage your relationship with the client.

WHAT YOU DO NOT WANT TO DO Do not become defensive - defending yourself makes others angry and you lose the opportunity to solve the problem. Do not become sarcastic - when you thank clients for their comments be sure to be genuine or it will backfire on you! Do not grill the client - when you ask questions for a better understanding don’t ask one after the other in a doubtful tone.

DISARMING ANGER IS A FOUR-STEP PROCESS The 4 “A’s” Appreciate (Validate) that the person is angry Ask for more information without grilling Acknowledge something with which you can agree Assess solutions

Disarming Anger -Practice Time Your client comes in for the weekly skills development group you facilitate and slams his fist on the table and starts screaming, “I’m sick and tired of people in this place telling me I’m a mental case and giving me medicines that make me feel worse!!!” How would you “appreciate/validate” what he is feeling?

Disarming Anger -Practice Time Your client comes in for the weekly skills development group you facilitate and starts slamming his fist on the table and yelling, “I’m sick and tired of people in this place telling me I’m a mental case and giving me medicines that make me feel worse!!!” What are some questions you can “Ask” for more information?

Disarming Anger -Practice Time Your client comes in for the weekly skills development group you facilitate and starts slamming his fist on the table and yelling, “I’m sick and tired of people in this place telling me I’m a mental case and giving me medicines that make me feel worse!!!” How would you “acknowledge” some common ground you both agree on?

Disarming Anger -Practice Time Your client comes in for the weekly skills development group you facilitate and starts slamming his fist on the table and yelling, “I’m sick and tired of people in this place telling me I’m a mental case and giving me medicines that make me feel worse!!!” Now, only after doing the first three steps; how would you help this client begin to assess solutions?

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If not, thank you and Goodnight Questions? If not, thank you and Goodnight