SOCW-6111-Discussion Wk7
SOCW-6111-Discussion Wk7
Discussion 1: Self-Reflection and Awareness
Exploring the reasons for wanting to be in social work and examining your motives for choosing a career of helping others is very important. Your background, including childhood experiences, may be instrumental in bringing you into the field of social work. Understanding the possible connection and working to resolve any underlying unresolved issues is essential to becoming an effective social worker. While working with a client, you must strive to be objective, but in the end we are all human with past hurtful experiences that can impact our ability to effectively work with clients. While complete objectivity is impossible and not expected, it is necessary to self-reflect and become aware of when a situation or a certain personality type causes you to react in an unprofessional manner. Understanding potential internal and external barriers you and your client bring to the room will assist you in balancing an appropriate empathetic response with proper objectivity. SOCW-6111-Discussion Wk7
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For this Discussion, review the Geller & Greenberg (2012) article and the program case study for the Petrakis family, and view the corresponding video.
· Post your explanation of the importance of identifying internal and external barriers of the client and social worker.
· Then describe the barriers experienced by Helen and the social work intern.
· Finally, suggest ways the intern could overcome these barriers.
References (use 2 or more)
Gutiérrez, L. M. (1990). Working with women of color: An empowerment perspective. Social Work, 35(2), 149–153.
Geller, S. M., & Greenberg, L. S. (2012). Challenges to therapeutic presence. In Therapeutic presence: A mindful approach to effective therapy (pp. 143–159). Washington, DC: American Psychological Association.
McTighe, J. P. (2011). Teaching the use of self through the process of clinical supervision. Clinical Social Work Journal, 39(3), 301–307.
Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
· The Petrakis Family (pp. 20–22)
Hill, C. E., & Knox, S. (2001). Self-disclosure. Psychotherapy: Theory, Research, Practice, Training, 38(4), 413–417.
Discussion 2: Self-Disclosure
Knowing that clients might react negatively to your work with them may cause anxiety, frustration, and even anger. It is inevitable that you will work with a client who expresses anger or disappointment over working with you. This does happen in the social work field and is to be expected over time. Understanding how you might react to allegations of incompetence or anger over incomplete goals is essential to managing this type of exchange. While a negative interaction may be justified if either person did not fulfill responsibilities, often it is a result of the client’s personal reaction to the situation. The best response is to use these interactions to build the therapeutic bond and to assist clients in learning more about themselves. Stepping back to analyze why the client is reacting and addressing the concern will help you and the client learn from the experience. SOCW-6111-Discussion Wk7
For this Discussion, review the program case study for the Petrakis family.
· Post a description of ways, as Helen’s social worker, you might address Helen’s anger and accusations against you.
· How might you feel at that moment, and how would you maintain a professional demeanor?
· Finally, how might you use self-disclosure as a strategy in working with Helen?
References (use 2 or more)
Gutiérrez, L. M. (1990). Working with women of color: An empowerment perspective. Social Work, 35(2), 149–153.
Geller, S. M., & Greenberg, L. S. (2012). Challenges to therapeutic presence. In Therapeutic presence: A mindful approach to effective therapy (pp. 143–159). Washington, DC: American Psychological Association.
McTighe, J. P. (2011). Teaching the use of self through the process of clinical supervision. Clinical Social Work Journal, 39(3), 301–307.
Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
· The Petrakis Family (pp. 20–22)
Hill, C. E., & Knox, S. (2001). Self-disclosure. Psychotherapy: Theory, Research, Practice, Training, 38(4), 413–417.
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WAL_SOCW6111_07_Petrakis.pdfPetrakis Family Episode 3
Petrakis Family Episode 3 Program Transcript
FEMALE SPEAKER: And you’re sure Alec is stealing from her? Pills. From his own grandmother.
FEMALE SPEAKER: I can’t call the police. He’s still on probation! Possession.
FEMALE SPEAKER: Have you spoken to him about it?
FEMALE SPEAKER: He denied it. But I found them. He got her oxy prescription refilled so he could take them himself. How old are you?
FEMALE SPEAKER: Excuse me?
FEMALE SPEAKER: I said, how old are you?
FEMALE SPEAKER: I don’t see what that has to do with anything.
FEMALE SPEAKER: You’re too damn young to be doing this job. That’s it. You don’t know what you’re doing! None of this would have happened! It was your bright idea! You’re the one who told me to have him move in with her and take care of her!
FEMALE SPEAKER: I did tell you to do anything! I only suggested it. And we talked about it together.
FEMALE SPEAKER: No, no. That’s not true. I followed your advice. You’re going to have to fix this. You have to do something. I don’t know what else to do. I can’t call the police. He can’t go back to jail. Awful things will happen to him. I can’t let that happen. I won’t!
Petrakis Family Episode 3 Additional Content Attribution
MUSIC: Music by Clean Cuts
Original Art and Photography Provided By: Brian Kline and Nico Danks
©2013 Laureate Education, Inc. 1
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GellerGreenberg.pdf
143
8 CHALLENGES TO
THERAPEUTIC PRESENCE
To optimize the moments of kairos (opportunity) in the therapy rela- tionship, in ourselves, and with our clients, therapists must be aware of and work through the potential barriers to relational therapeutic presence. A level of intimacy with the moment is needed for therapists to go deeper through the levels of therapeutic presence, which can be scary and make one feel vul- nerable. In particular, it can be more challenging to rely on one’s self and the deepest strata of one’s being to facilitate a response or choose a technique in resonance with what is most poignant for the client in the moment than to rely on a therapy plan or a particular technique. The challenges to engaging intimately in the moment in a psychotherapeutic encounter can arise from within the therapist (internal barriers) or from the client, the relationship, or other demands (external barriers). Although it is helpful to conceptually cat- egorize challenges as internal or external, even those that emerge externally (e.g., the client’s anger) are ultimately internal challenges to the therapist to be aware of and work through. SOCW-6111-Discussion Wk7
The challenges we examine in this chapter include internal ones such as countertransference, trust in the process, and personal barriers (stress, lack of self-care, appropriate use of energy) as well as external factors such as work- ing with challenging clients (e.g., clients with dual diagnoses or receiving
If you think you’re enlightened go spend a week with your family. —Ram Dass
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http://dx.doi.org/10.1037/13485-008 Therapeutic Presence: A Mindful Approach to Effective Therapy, by S. M. Geller and L. S. Greenberg Copyright © 2012 American Psychological Association. All rights reserved.
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end-of-life care, trauma survivors). However, first we invite you to pause briefly to uncover your own personal obstacles to being present with a client.
PAUSE MOMENT. Stop and notice any obstacles to presence:
� Take a moment to pause from reading and turn your attention inward. Close your eyes, soften your gaze in front of you, or jot down some notes.
� Focus briefly on your breath and allow yourself to bring your awareness to your bodily experience of breathing.
� What are you first aware of as you pause? Notice the busyness of your mind, judgments, or discomfort in your body that may pre- vent you from feeling centered or still. Notice any rushed feeling, as in wanting to get to the next page, the next moment, or the next task. Notice it without judgment, keeping awareness on your breath without following the thoughts about what you are expe- riencing, allowing each breath to take you back to the moment.
� Now reflect about the difficulties in being present with a client. What kinds of obstacles emerge in session with a client that hijack your focus or attention? Notice what they are. Then let them go.
� How do you know when you are not present with a client; what are the clues? How do you bring yourself back to the moment in session? What is one way you can work on noticing your barrier to being present and bringing your attention back in session?
INTERNAL CHALLENGES TO THERAPEUTIC PRESENCE
In this section, we explore some of the internal challenges that therapists can face as they open up to the contact that therapeutic presence entails. Being fully in the moment with a client requires having a level of self-awareness and inner health and integration. Presence is not just a passive state but an active engagement with one’s whole being, which demands a level of engagement with the other that requires that we take care of ourselves on a personal and professional level. Even so, we are human beings, and the challenges that can arise for us include countertransference, tolerance of uncertainty, the role of stress, and appropriate use of energy. SOCW-6111-Discussion Wk7
Countertransference
Countertransference is defined as “the therapist’s internal or external reactions that are shaped by the therapist’s past or present emotional conflicts and vulnerabilities” (Gelso & Hayes, 2007, p. 25). Although the notion of
144 THERAPEUTIC PRESENCE
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countertransference may have originated in the psychoanalytic tradition, the possibility of countertransferential reactions, or feelings in the thera- pist in relation to clients, can occur in any therapeutic modality. Note the perspective of Gelso and Hayes (2007):
Countertransference is universal in psychotherapy . . . by virtue of their humanity, all psychotherapists, no matter how experienced or emotion- ally healthy, do have unresolved conflicts and vulnerabilities, and that the relational intimacy and emotional demands of psychotherapy tend to exploit these conflicts and vulnerabilities, bringing them into play in the therapeutic work. (p. 133), SOCW-6111-Discussion Wk7
We believe that countertransference reactions, such as therapists’ emo- tional reactivity, are highly possible in present-centered work because thera- pists are open and in direct emotional, physical, cognitive, spiritual, and relational contact with their clients as well as present in these domains within their selves. In the presence process, the therapist is using the self as a sensor or an indicator. Therapists are taking in the depth of the client’s experience and accessing and attending to their own internal experience as a key indi- cator in understanding and responding or offering an intervention from moment to moment. We also believe that being aware of one’s self and the other, in the way that therapeutic presence evokes, allows therapists to rec- ognize countertransference reactions when they do emerge and either work with them internally to let them go and not act them out or use them in a positive therapeutic manner to reflect what the client is experiencing or may be evoking in the other.
No matter how great the intention to clear and manage the therapist’s own issues outside of session, therapists are human beings, and even resolved issues could rise to the surface in session. However, the level of self-insight, self-awareness, and commitment to one’s own growth that cultivating thera- peutic presence demands, such as attending to one’s own inner experience, serves both as protection from countertransference and as an antidote to countertransference reactions. Furthermore, the cultivation and experience of presence can help therapists to quickly distinguish intense countertrans- ference reactions from intense emotional reactions that may be therapeuti- cally useful. SOCW-6111-Discussion Wk7
Self-awareness and a continuous attending to one’s internal world are keys to recognizing and managing countertransference reactions. Gelso and Hayes (2007) described self-insight as a necessary precondition to connect- ing the therapist’s experience with the experience of the client. To use the self as a sensing instrument, “therapists must be able to see themselves, to understand their fluctuating needs and preferences and shortcomings and longings” (Gelso & Hayes, 2007, p. 108).
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VanWagoner, Gelso, Hayes, and Diemer (1991) compared therapists who were perceived as excellent by their peers with general therapists. They found that master therapists were viewed as having greater self-insight, empathic ability, anxiety management, and self-integration. Interestingly, these qualities, which are a part of mastery, are also aspects of therapeutic pres- ence, such as self-insight, self-integration (grounded and centered), attune- ment to the other, and ability to manage anxiety. These skills are central to mastery, as therapists who are perceived as excellent are better able to notice and manage countertransference reactions before they become problematic or manifest in therapy and potentially impede the client’s process. Hence, the practice of presence can also protect against countertransference reactions. SOCW-6111-Discussion Wk7
In addition, therapists’ insight, self-awareness, self-care, and psycholog- ical health as well as their training and professional experience, which are all a part of cultivating presence, will support the therapist in effectively using his or her own receptive openness to understand and facilitate the client’s thera- peutic process toward healing. In fact, openness to one’s own feelings has been associated with less countertransference behavior (Robbins & Jolkovski, 1987). It is often the therapists who have lost touch with what they are feel- ing or are unaware of their own experience in the moment who do not notice what is interfering with their ability to help or be there with their client.
To get out of the way of our client’s therapy, we need to get our own unresolved issues out of the way. Yet even when it is not possible or we are taken by surprise by a feeling (e.g., a sense of incompetence or frustration or anger), we need to develop agility in recognizing the source of that feeling and moving our awareness back into the moment and back to an open yet grounded place. SOCW-6111-Discussion Wk7
The following clinical vignette demonstrates how the therapist’s self- awareness helped her to recognize her own sense of detachment and counter- transference response and recoup her attention when she was struggling in session with a client:
Jane was discussing the loss of her son through an illness encountered when he was 8 years old. She was discussing the “deep hole” in her chest from the hurt and pain she felt at her son’s death. She expressed feeling over- whelmed by having to cope with everyday tasks, as she could barely “face each day.” As she spoke, I found myself cognitively responding to her pain by reassuring her, while my attention felt like it was moving further and further out of the room. I noticed my clipboard, which I rarely use, in my hand with my pen writing furtively. At that moment I recognized that the clipboard was almost acting like a shield to the overwhelming pain she was experiencing. I brought my attention to my present moment disconnec- tion and became aware that underneath the emotional distance I felt to Jane was a feeling of deep sadness and fear of loss. I realized that I had