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Work Process3

S

ocial workers traditionally use a series of steps or processes to help
clients resolve their problems. These steps include collecting information about the client (assessment), making sense out of the information(diagnosis), collaborating with the client to develop a plan to change
the problems being experienced (the treatment plan), and determining
whether the process has been helpful (evaluation). We use two very powerful approaches to help the client change: (a) the helping relationship wedevelop with the client and (b) using one of the five or more helping
approaches described in the prior chapter. This chapter discusses thesocial work process and the importance of developing a positive and cooperative helping relationship with clients.

Collecting Information About the Client: Assessment
Whereas medicine uses labels to describe conditions, social workers try
not to use labels because they may fail to accurately describe the client’s
unique qualities or the historical reasons clients currently are having problems in their lives. Instead, we use a psychosocial assessment that summarizes the relevant information we know about a client into concise
statements that allow other professionals to understand the client andthe client’s problem(s) at the same level that we understand them.
Psychosocial assessments try not to use psychiatric labels or words thatmight create a biased perception of the client. They differ from the terms
often used in the most commonly used diagnostic manual in mental
health (the Diagnostic and Statistical Manual of Mental Disorders [DSMIV]) because they provide brief historical information about the possible
cause for the problem. Although they are problem-focused, they also provide an evaluation of the best evidence from the literature to support the33

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assessment. The client’s strengths are included in the assessment, as well as
the problems that might interfere with the client’s treatment. Van Wormer(1999) describes the need to include the positive behaviors of the client
when doing an assessment:
The first step in promoting the client’s well-being is through assessing
the client’s strengths. A belief in human potential is tied to the notion thatpeople have untapped resources—physically, emotionally, socially, andspiritually—that they can mobilize in times of need. This is where professional helping comes into play—in tapping into the possibilities, into what
can be, not what is. (p. 51)

An Outline of a Psychosocial Assessment
SECTION I: BRIEF DESCRIPTION
OF THE CLIENT AND THE PROBLEM
In this section of a psychosocial assessment, we include concrete information about the client such as age, marital status, family composition,
what he or she is wearing, level of verbal and nonverbal communication,
emotional affect, and anything of interest that may have happened in theinterview. We should also include the defined problem(s) as stated by
the client. We normally don’t make interpretations here but just report therelevant information. Important information might be that the client
cried throughout the interview, or he or she just stared off into space andanswered questions in a flat monotone. We aren’t certain exactly what thisbehavior means, but it tells us that the client isn’t doing very well forreasons we have yet to discover.

SECTION II: HISTORICAL ISSUESThis section includes any past issues of importance in understanding
the client’s current problems. For example, if a client complains of memory loss, we might want to find out if he’s been in an accident that caused
minimal organic brain damage, if he has an illness that might be causing
the symptoms, if he’s using legal or illegal medications that might cause
memory loss, or if he’s had a traumatic emotional experience that has led
to repressed memory loss. Many people who have experienced violence intheir lives do not remember the violent situation and may have repressed(forgotten) it so that they don’t reexperience the event and then feelanxious or depressed.

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SECTION III: DIAGNOSTIC STATEMENT
The diagnostic statement is a brief overview of what we consider themost relevant problems experienced by the client and their potential causation. In the diagnostic statement, we combine material from the prior
two sections and summarize the most relevant information into a brief
statement.
A diagnosis often suggests a label defining what the client’s problem is.
However, words such as schizophrenic (mental illness) and bipolar disorder(manic-depressive behavior) have powerful negative meaning in our society,and it’s important that we not think of a diagnosis as a negative label.
Although labeling for diagnostic purposes may be relevant in medicine,diagnostic labels for mental health purposes are sometimes poorly definedand biased. Labels often harm people, and the most vulnerable among
us—the poor, minority groups, women, immigrants, and the physically,
emotionally, and socially disadvantaged—are those most harmed
by labels. This may be particularly true of minority clients, where harmfrequently occurs when labeling is used. Franklin (1992) says that African
American men want to see themselves as “partners in treatment” andresent labels that suggest pathology because labels send signals to black
clients who have had to deal with labels that subtly or overtly suggest
racism. Franklin also states that African American men want to be recognized for their many strengths, and that clinicians should take into
consideration that they may be doing well in many aspects of their lives.
According to Franklin, African American men are particularly sensitive
to male bashing and other sexist notions that berate men or negatively
stereotype men in general and black men in particular. I think this is trueof everyone. No one wants to be defined by a label that fails to include
unique human qualities that make one person very different from another.

SECTION IV: THE TREATMENT PLAN
The treatment plan describes the goals of treatment during a specificperiod of time and comes from the agreement made between the worker
and client in the contractual phase of treatment (see below). As an example of a treatment plan, let’s assume that a client comes to see a social
worker because he or she is experiencing marital problems and is feelingdepressed. The treatment plan answers the following questions: How long
might it take to resolve the problems in the marriage? How will we know
if the problems are resolved? and Which approach will we use to help theclient (see chapter 4)? It also implies a cooperative relationship between
the social worker and the client and assumes that they will work together
to achieve the same goals in ways that involve the client fully and focus on
the client’s strengths.

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SOCIAL PROBLEMS, SOCIAL WELFARE, AND THE SOCIAL WORK PROFESSIONSECTION V: CONTRACTThis is the agreement between the worker and the client. It determines
the problems to be worked on in treatment, the number of sessions agreed
to, and other relevant rules related to being on time, payment, and the cancellation policies. Many workers have these rules in written form, with theclient and the worker signing the contract.

You Be the Social Worker
This case was first presented in a book I wrote on evidence-based practice (Glicken,
2005, pp. 77–79) and is modified for this book. After reading the following material, try to conclude what exactly is wrong with the client. Some questions are posed
after the case to help you decide what problem(s) the client is experiencing.

The Case
Jorge Rivera is 19-year-old Mexican National who came to the United States under
the sponsorship of his maternal uncle to attend a California university. Jorge had
been in the country a year and was doing well until signs of emotional change
became apparent to his family. He was becoming increasingly aloof and secretive,
had stopped attending school, and seemed to be a very different person from thehappy, motivated young man he had been just a year earlier. Suspecting an emotional or physical problem, Jorge’s uncle took him to see his family doctor, an
American of Hispanic descent. The doctor was immediately struck by Jorge’s aloofness, fearfulness, and social isolation. He did multiple tests and, unable to find anything physically wrong, urged the uncle to take Jorge to a Hispanic male social
worker with whom the doctor had had prior positive experiences.
Because Spanish is Jorge’s more proficient language and the one with which hecan express his inner feelings with more accuracy, the first interview was conducted in this language. Jorge told the therapist that he was hearing voices at night
when he tried to sleep and that the voices were telling him to do things that Jorge
found repulsive and dangerous. These voices were new to Jorge, and he feared that
he was going insane. Jorge began to talk about his fears that he was becoming psychotic and how this would place him in great jeopardy with his family. He said thatbeing “muy loco” was what happened to people who were sinful, and that hewould be punished by his family and friends with ostracism.
It was clear to the therapist that Jorge was in great distress, but pending additional
information, the therapist deferred making a diagnosis. By using the major diagnostic tool of the helping professions, the DSM-IV, the therapist saw signs of schizophrenia. He decided to interview the uncle’s family to determine the point of onset
of Jorge’s symptoms. Everyone confirmed that Jorge had been very outgoing, showing
none of the signs of the mental illness he was now exhibiting. The onset was sudden, within the prior 3 months, and the symptoms had been rapid and worsening.

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Below is a list of warning signs suggesting the onset of schizophrenia that wasdeveloped by families who have a relative with this disorder (World Fellowship for
Schizophrenia and Allied Disorders, 2002, p. 1). Although some of the behavior
would be considered normal, family members felt that there was a subtle yet obvious
awareness that the behavior they were witnessing was unusual. Everyone noted social
withdrawal as an important early sign that something was wrong. Most respondents
believed that their relative had been a “good person, never causing any trouble”; however, seldom had the person been socially “outgoing” during his or her formative
years. The warning signs of schizophrenia identified by family members were:• excessive fatigue and sleepiness or an inability to sleep• social withdrawal, isolation, and reclusiveness• deterioration of social relationships• inability to concentrate or cope with minor problems• apparent indifference, even in highly important situations• dropping out of activities (e.g., skipping classes)• decline in academic and athletic performance• deterioration of personal hygiene; eccentric dress• frequent moves or trips, or long walks leading nowhere• drug or alcohol abuse• undue preoccupation with spiritual or religious matters• bizarre behavior• inappropriate laughter• strange posturing• low tolerance to irritation• excessive writing without apparent meaning• inability to express emotion• irrational statements• peculiar use of words or language structure• conversation that seems deep but is not logical or coherent• staring; vagueness• unusual sensitivity to stimuli (e.g., noise, light)• forgetfulness
As a way of comparing the subjective reports of family members of clients witha diagnosis of schizophrenia, the National Institute for Mental Health (NIMH)
identifies the following diagnostic signs for early-onset schizophrenia:
The first signs of schizophrenia often appear as confusing, or even shocking, changes
in behavior. The sudden onset of severe psychotic symptoms is referred to as an“acute” phase of schizophrenia. “Psychosis,” a common condition in schizophrenia, isa state of mental impairment marked by hallucinations, which are disturbances of(Continued)

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sensory perception, and/or delusions, which are false yet strongly held personal
beliefs that result from an inability to separate real from unreal experiences. Less
obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may precede, be seen along with, or follow the psychotic symptoms.
(1999, p. 1)
In the next interview, the social worker asked Jorge to tell him about his life in
Mexico and to provide the therapist with the client’s theory about what was happening. Jorge had been romantically involved with a young woman who camefrom a highly affluent and influential family in Mexico. The couple were in love,
but the young woman’s parents were opposed to the marriage and had hired a
bruja (literally, a witch) to cast a spell on Jorge so that he would become unattractive to the young woman and she would lose her feelings for him. The bruja wassending Jorge little totems that represented evil, which were frightening him anddriving him into social isolation and withdrawal. He was convinced that the voices
he heard were her doing and, as a result of the spells she had cast, that he would
become insane, lose his beloved, and die a horrible death. He had known others
who’d had similar fates in Mexico. Brujas were evil and caused immense harm, hetold the therapist.
The therapist had grown up with stories of witches and spells, but wasn’t abeliever. Nonetheless, he contacted the uncle, told him what had happened, andwondered if he knew of some way to deal with the effects of the bruja. The uncle
contacted a well-known curandero (remover of spells) he knew of in Mexico, paid
his way to come to the United States, and had the curandero remove the spell in aritual that lasted 24 hours. When the ritual was over, the curandero gave Jorge anamulet to wear around his neck to ward off future evil spells and urged him tobreak off the relationship with the young woman to cease the bruja’s attacks on
Jorge’s mental health. The uncle again intervened, spoke to the young woman’sfamily in Mexico, promised that Jorge would no longer be in contact with theyoung woman, and urged them to cease any more witchcraft on Jorge. Her family
agreed, and a broken-hearted but functioning Jorge was able to return to schoolwith his family’s support and an occasional visit to the therapist.

Questions
1. Witches and counterwitches are pretty hard to believe. Couldn’t Jorge have
had a brief bout of mental illness brought on by the stress of school, loneliness, andhis new life in the United States?
2. On the other hand, isn’t it possible that Jorge was actually responding to his
fear of witchcraft and that the fear (and nothing actually done by the bruja) was
responsible for his psychotic-like condition?
3. The sudden onset on schizophrenia is a frightening thing for most clientsand their families. Is it possible that, much like a disease or illness that comes and03-Glicken_21st-45024.qxd

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goes, that schizophrenia is an opportunistic disease that often runs its course and,much like a severe virus, goes away in time?
4. You can see that a diagnosis of schizophrenia suggests a serious problem.
What do you imagine most people believe are the chances of getting well again if
someone is diagnosed with a mental illness?
5. Wouldn’t most Anglo therapists assume that the story about witchcraft
was just another indication of Jorge’s mental illness? How can we protect against a
misdiagnosis happening to people from other cultures?

Helping Relationships
Most social workers believe that the quality of the client-worker relationship is the key to whether clients will resolve their problems. In recognizing the importance of the helping relationship, Warren (2001) writes, “Therelationship between the quality of the patient-therapist relationship andthe outcome of treatment has been one of the most consistently cited findings in the empirical search for the basis of psychotherapeutic efficacy”(p. 357). Writing about the power of the therapeutic relationship, Saleebey(2000) says that “if healers are seen as non-judgmental, trustworthy, caring and expert, they have some influential tools at hand, whether they are
addressing depression or the disappointments and pains of unemployment” (p. 131).

DEFINING THE CLIENT-WORKER RELATIONSHIP
Keith-Lucas (1972) defines the client-worker relationship as “themedium which is offered to people in trouble and through which they are
given an opportunity to make choices, both about taking help and the use
they will make of it” (p. 47). Keith-Lucas says that the key elements of thehelping relationship are “mutuality, reality, feeling, knowledge, concern forthe other person, purpose, the fact that it takes place in the here and now,
its ability to offer something new, and its nonjudgmental nature” (p. 48).
In describing the significant elements of the relationship, Bisman(1994) says that therapeutic relationships are a form of “belief bonding”
between the worker and the client, and that both parties need to believethat “the worker has something applicable for the client, the worker iscompetent, and that the client is worthwhile and has the capacities tochange” (p. 77). Hamilton (1940) suggests that bonding takes place when
the clinician and client work together and that “treatment starts only whenmutual confidence is established, only when the client accepts your interest

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in him and conversely feels an interest in you” (pp. 189–190). I use thefollowing definition for the relationship:
It is a bond between two strangers and is formed by an essential trust in thehelping process and a belief that it will lead to positive change. The worker
facilitates communications, enters into a dialogue with the client about its
meaning, and works with the client to decide the best way to change a life
problem. (Glicken, 2004, p. 50)

RESPONDING TO CLIENTS WITH
WARMTH, GENUINENESS, AND EMPATHY
Many social workers believe that client-worker relationships arestrongest when workers respond to the client with warmth, genuineness,and empathy. This means that the social worker is a real human being and
not acting out a role. It also means that the worker is genuinely concerned
about the client and can often sense, at a very significant level, how theclient feels emotionally. As workers respond empathically to what clientssay, clients are often able to continue discussing their problems at anincreasingly introspective and accurate level without any prompting orquestions from the worker.
You can determine your own level of empathy by using this simple
5-point scale and statements a client might say. First, I’ll provide an
example of how the scale works.

Empathy Scale
1.0: A response that actually makes the client feel much worse. Think ofa response that blames the client for the problem or begins, “You always
make the same mistakes and then complain that it’s someone else’s
fault.”
2.0: A response that is generally negative or critical. An example mightbe, “I know you were trying your best, but sometimes that’s just notenough.”3.0: A neutral response. The client neither feels better nor worse (thinkof a response where the worker just restates what the client said but
doesn’t add to it).
4.0: A response that tells the client you understand and are sensitive towhat the client is feeling (this response will bring about the client’s
desire to tell you more).

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5.0: A response that so accurately captures what the client feels that it
puts it into perfect words (this response will bring about a sort of
epiphany in the client).

Example 1:
The client says, “Sometimes I really feel depressed.”
The worker responds, “If you worked harder at your problems, you
wouldn’t feel that way.”
Empathy Score: 1.5. The worker has said something hurtful and isblaming the client. This reduces trust and will stop the client from tellingthe worker anything significant.

Example 2:
The client says, “Sometimes I really feel depressed.”
The worker responds,“It sounds like you feel really depressed sometimes.”
Empathy Score: 3.0. The statement was neutral; it neither helped nor
hurt the client’s ability to progress with what he or she is feeling.

Example 3:
The client says, “Sometimes I really feel depressed.”
The worker responds, “It must be painful for you on those days when
you feel depressed.”
Empathy Score: 4.0. The worker has said something that captures what
the client feels inside.
The client might then say, “I feel so down on those days, I don’t think I
can make it.”
The worker’s brief statement has provided us with important information without a question being asked. We now know more about the depthof the depression.
The worker might then add, “And on those days when you don’t feel you
can make it, it must be a real struggle for you.”
To which the client might say, “I think about how maybe it would bebetter if I just stopped living.”
The worker could then say, “It must be painful to feel so depressed thatyou don’t know you can go on, and yet something very positive and hopeful inside of you prevents that from happening.”
And the client might respond by saying, “Yes, I just don’t want to do thatto my family. I think it would destroy them.”

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Discussion. In the above example, the worker has been able to find out agreat deal about the client just by focusing on the client’s feelings andresponding empathically. The worker hasn’t asked a single question, but
has been empathic in responses by focusing entirely on the client’s feelings.
By doing so, the worker is able to determine that the client is not only
depressed but that he or she is also experiencing serious thoughts of suicide, and that the only thing that stops him or her is an unwillingness toembarrass the family. Suicidal thoughts are serious and suggest an at-riskclient. We might never have found this information out if we had justasked a number of direct questions.
Time to try it! Provided are five statements a client might give; write aworker response, then score yourself on the 1–5 scale. You must get a 3.0
or higher to allow the client to give you more information about his or her
feelings and thoughts.
The client says:
1. “I hate my husband so much I just feel like packing up my bags,
taking the kids, and leaving.”
2. “School is so boring. I think I’ll quit and get a job somewhere andmake some money.”
3. “Nobody likes me here. I’d be better off staying at home and reading a book.”
4. “I can’t concentrate on anything. My head just feels all over theplace.”
5. “I’m sick all the time and depressed. Why is God doing this to me?”

Evaluation of a Social Worker’s Effectiveness
Determining if a social work client has improved isn’t as easy as it mightsound. In medicine, we think that if the patient feels better or if his or her
blood work has improved that whatever is ailing him or her might havegone away. Of course, this often isn’t true, and the same problem mightjust be hiding only to return and be even worse than it was originally. And
though we think treatment may be the reason the patient recovers, we
can’t always be certain. Many times people heal on their own without
medication or even seeing a doctor. In social work, it’s even more complicated. How can we possibly prove that it was our treatment that led to aclient getting better? There are many reasons people improve emotionally,
and most are out of our control. A client might have met someone andfallen in love or inherited a great deal of money while seeing us for his or03-Glicken_21st-45024.qxd

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her depression. Was it the money/love or was it us that helped the client?
Who can possibly tell? So to help us decide, researchers have devised thefollowing guidelines to show whether it’s our work that causes this change.
History. How long did the problems last before the client came for help?
The longer a social or emotional condition lasted before the client came tosee us for social work help, the less likely it is that the client recovered bychance. It’s possible, of course, but less likely.
Baseline. When we saw them for the first time, we did a baseline reading of
their problems. We found out how much they sleep, how much they weigh,their level of exercise, how much work or school they miss, and how often
and how much they drink or take drugs. This is called a baseline measure,and it’s similar to what doctors do when they see patients in their office.
They check vital signs such as blood pressure and weight. If those vital
signs improve during the course of our treatment, we usually feel confident that it was because of treatment and not some outside occurrence,
although we can’t be absolutely certain.
Outside verification. We can ask for outside verification to see if the clientis doing well outside of our office. This helps give our evaluation a way offactoring out the tendency of clients to tell us that things are betteror worse than they really are and makes our evaluation more valid andreliable. It doesn’t necessarily tell us that change is because of our work,
however.
Psychological tests. We can give the client a psychological test for any
number of problems, including depression and anxiety. Although tests
aren’t completely accurate, they do give us a good idea about how well theclient is doing and, if the test scores improve as we work together, we canoften feel fairly certain that it’s because of our work. Sometimes clients
work with many professionals, and it might be better to assume that we’re
all helping.
Statistical tests. We can do some very simple statistical tests to tell
us whether it was our work that led to change or some other chanceoccurrence.
Ask the client. We can ask the client directly whether it was our work or
something else that caused his or her improvement. We can also give a satisfaction instrument that helps us know how happy the client is with ourwork. We hope being happy with our work translates into the client doing
better. This isn’t always the case, of course, but we think it’s an importantvariable.

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Ask other professionals. We can ask other professionals to evaluate the client
before, during, and after treatment ends, and let them decide whether theclient has improved and if it was due to our help.
Ask people in our client’s life. We can ask important people in the client’s life
to provide feedback about the reasons he or she has improved, and if there
were some reasons we don’t know about. Sometimes people get better
because they mature out of their problems. This is particularly true ofadolescents, children, and adults going through a mid-life crisis. It is also
true of people who have an undiagnosed illness that improves on its own.
Life changes. There are life changes that may have a profound effect on
people’s emotional health. Joining a church, becoming more spiritual,
being a volunteer, and finding the right career are all quite separate fromour work and may be more important variables in client change than thehelp we provide.
In the end, the client makes the judgment about whether he or she has
improved. Our job throughout the helping process is to get feedback fromthe client that tells us honestly if what we’re doing is helping and why or
why not. Let’s see if we can tell whether the following client has done better
because of our work.

Evaluating a Client’s Level of Improvement
Gerald Blake is a 21-year-old junior in college. He has sought social work
help from the student counseling center because he’s been depressed for
longer than a year and has begun having suicidal thoughts. When Geraldcame to see the social worker, he was sleeping 14 hours a day, missing halfof his classes, and was close to failing school. After 12 one-hour sessions ofcognitive therapy, he is sleeping 8 hours a day, is doing B-level work inschool, and has stopped having suicidal thoughts. Gerald told the social
worker throughout treatment that he didn’t think he was being helped,
and he was often sullen and angry with the social worker for not doing abetter job; yet he improved. Gerald thinks he got better on his own because
he started taking responsibility for his problems and doing something
about them. The social worker believes that Gerald got better because of
the help he was given.
Although we know that Gerald has improved, we don’t know why. A
check with his roommates and parents provides no other reasons for his
improvement. A discussion with Gerald confirmed that although he hadquestions about the social worker, he admitted that she helped motivate
him to seek solutions for his depression. He also thought the structure of

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having to come for help every week gave him an outlet to discuss his
feelings and to solidify ideas concerning what to do about them. Was hesatisfied with the help he received? No. Did he think he’d changed? Yes.
Was it because of the work he did with the social worker? Probably. So,
didn’t the social worker help? Maybe she did, and maybe she didn’t. The
social worker didn’t seem very concerned, but she did give Gerald somegood advice. So didn’t she help? Yes, maybe she did, but she could havebeen a lot better. And so it went. What do you think? Have you ever goneto a doctor who didn’t seem very warm or concerned about you but was
still a good doctor? Do you think it’s important to be warm, sensitive, andempathic as a social worker? A lot of people think so.
Brent (1998), for example, finds a strong relationship between social
workers who are warm and empathic (the ability to accurately sense how
the client is feeling) and good treatment outcomes: “From the patients’points of view, provision of support, understanding, and advice have beenreported as most critical to good outcomes” (p. 2). In further comments
about empathy, Brent (1998) reports that empathy is a strong factor insuccessful treatment, even stronger than the therapy approach a worker
might use. In successful therapy,
The therapist is described as “helping and protecting, affirming and understanding,” whereas the patient is seen as “disclosing and expressing.” Not
surprisingly, therapists tend to attribute success to technique, whereas
patients attribute a good outcome to the therapist’s support and understanding. (Brent, 1998, p. 2)

But Dr. Glicken, I suspect you might argue, the client told us that thesocial worker wasn’t very empathic and he didn’t respect the social worker’s
skills, yet he still admits that he got better. Why is empathy so important if
the client improved and the social worker wasn’t very empathic? Because,
although the client may not experience the social worker as empathic, there
may be issues that arise in treatment that confuse the picture. Such as? Well,what if the social worker reminds Gerald of his mother, with whom hehad a love-hate relationship? What if the social worker is very empathic but
Gerald is looking for a more personal relationship, perhaps a friendship oreven a love relationship? It happens, and when it does and the social worker
doesn’t become the client’s friend or lover (Freud called it transference),clients often become angry because certain basic needs aren’t being met. Of
course, the social worker is not ethically allowed to become a patient’s lover
because it would be a misuse of authority due to information the worker
knows about the client. Being his friend would make it difficult to be his
helping professional. And another thought: What if the client needs to feelthat he resolved the depression on his own to save face? These are all goodreasons, of course, but maybe the client is right and, in this instance, theclient did get better in spite of the worker.

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Why Clients Get Better
There are many reasons why clients improve. The following answers mostof the reasons:
1. Clients improve because they are motivated to and, even when theworker isn’t competent, they do most of the work on their own.
2. Most problems resolve themselves. If you give them enough time,
people can improve.
3. Sometimes the combination of the right worker, the right client, theright approach, and the right timing produce incredibly positive
results.
4. Sometimes people don’t improve while seeing a social worker, but
if you give them time, many of the issues worked on in treatment
begin to have an effect and clients improve as a result of treatment.
5. Sometimes people get better because of a combination of factors,
including the help they receive, their support systems, their own
self-work, and the biological changes that take place as they get well.
This suggests that as the client is better able to cope with his or her
emotional problems, subtle changes take place in the brain thatlessen the biochemical reasons for emotional problems.
6. Sometimes medication taken for an emotional problem has a very
positive effect, or the combination of help and medication together
create change.
7. Sometimes people recover for reasons we can’t explain, or situationsin their lives that might be causing them emotional pain resolve
themselves.
8. People get better because they have self-righting capabilities(resilience) and are able to cope with traumas and stressors in waysthat are often quite unique and amazing.

SummaryThis chapter discusses the social work processes used in helping people
experiencing social and emotional problems. It includes the importance ofthe helping relationship and the ability to be empathic with clients. The
chapter includes a discussion of evaluating change in clients and notes thedifficulty in assuming that change is caused by social work intervention.
A case example of a problem in diagnosis is provided.

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Questions to Determine Your Frame of Reference
1. Doesn’t using labels in medicine help doctors find appropriate
treatments? How could we treat cancer if we never used the word todescribe the patient’s condition? Isn’t there a danger in social workers notusing labels because, although it may be politically incorrect, it’s scientifically necessary?
2. People do awful things in their lives, such as physically and sexually
abuse children. Why should we be sensitive to how they feel? Shouldn’t wejust tell it like it is and let them know how we feel about the awful things
they’ve done?
3. If you’re working with depressed clients, shouldn’t you just comeright out and ask them if they’re suicidal? Why all this beating around thebush with being empathic?
4. I’m unclear about transference. Why would clients expect theirsocial worker to love them? I don’t feel that way about my doctor; why
would clients feel that way about their social worker?
5. Isn’t there a danger that if you’re too nice and empathic to clientsthat they will misunderstand the relationship? If that’s the case, what cansocial workers do to keep this from happening?

Internet Sources
First, Singer explains his model for practice, which was written while he
was an MSW student. Next, Brodley’s paper on relationships does an
exceptionally good job of explaining why the helping relationship is so
important in producing effective professional work. Finally, Tucker-Laddstates how clients effectively use help for social and emotional problems.
1. Singer, J. (1996). Constructing a model for personal practice. Retrieved
November 27, 2004, from http://home.flash.net/~cooljazz/mssw/
my_model.htm
2. Brodley, B. T. (1987). Relationships: A client-centered psychotherapy
practice. Retrieved November 17, 2004, from http://lists.portents.com/~matt/cct.practice.html
3. Tucker-Ladd, C. E. (2000). Methods of developing skill from psychological self-help. Retrieved February 14, 2005, from http://www.mentalhelp.net/psyhelp/chap13/

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