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Come back soon for a question related to confrontation!

Over the last few weeks, the posts have talked about various SW techniques such as interpretation, summarization, active listening, etc. Most of those can be summed up in a paragraph, however I believe this one needs its own post due to specific guidelines of when to use confrontation, as well as the confusion that I see at times with what confrontation means.

Sometimes in my work with helping people prepare for their licensure exam, I will see how some are confused with this term. They are confusing this term with what we think of "confrontation" in society. Please note, confrontation in SW has a different meaning...

What is confrontation? When using the technique of confrontation (also called challenge), you engage in respectful and gentle efforts to help a client recognize that he is  using distortions, deceptions, denials, avoidance, or manipulations that are getting in the way   of desired change (Sheafor & Horejsi, 2003). You challenge and invite the client to examine a thought or behavior that is self-defeating or harmful to others and to take action to change it. Here’s an example:

Client: “He goes out every weekend and gets drunk. When he’s home, he’s hung-over. I really don’t mind, he deserves some fun, but I feel that our relationship should mean more to him than it does.”

Social worker: “First you said you don’t mind his behavior, then you said you feel your relationship is not as important to him as it is to you.”

Confrontation may be used in a similar manner to help a client see his role in a problem or to point out patterns in a client’s behavior. Behavioral patterns often emerge gradually during the course of your work with a client (e.g., patterns of impulsive or fearful behavior). If you notice a pattern, you should call it to a client’s attention if it is interfering with his problem-solving ability.

Guidelines for Using Confrontation Effectively: 

• Use confrontation in an atmosphere of warmth, caring, and concern: (a) Do not use confrontation until you and the client have a good working relationship. Confrontation will be effective only if a client feels respected by you and has similar feelings toward you. (b) Do not confront or challenge a client when you are feeling angry. Confrontation must come from a place of genuine concern for a client; it should never be an expression of anger or frustration.

• For confrontation to be effective, it must be used at a time when a client seems ready to hear and consider your message. Avoid using confrontation when a client is emotionally upset. For example, if you challenge a client who is feeling depressed, he may feel criticized and withdraw from the relationship.

• Pair a challenging message with a positive observation about the client (e.g., one that recognizes his strengths) and follow it with empathic responsiveness.

• A challenging message should be descriptive and nonjudgmental. When confronting a client, include a detailed description of his self-defeating or negative behavior and concrete examples of how it creates problems for him.

Has there been a time in your work that you have used confrontation with a client? Share below in the comments!

Share your answer in the comments. The answer and rationale will be posted in the comments soon...

A client says to a social worker: "I keep getting passed over for promotions at work. My boss says I’m doing fine, but I just feel like no one really sees me or values what I do." Which of the following responses by the social worker BEST demonstrates the use of interpretation as an active listening skill?

a. “It sounds like you’re feeling unappreciated and overlooked at work.”

b. “Can you tell me more about what happens when you’re passed over for promotions?”

c. “I wonder if being passed over at work might connect to feeling unseen in other areas of your life as well."

d. “That must be really frustrating for you to experience.”

Last week we focused on different types of active listening that include paraphrasing, reflecting, summarization, etc. I wanted to include interpretation in that same post, but realized it is slightly different and needs a post of its own to highlight the important guidelines that come with interpretation. Come back soon for a question related to this topic…

An interpretive response is one that encompasses not only what a client has actually verbalized but also an inference you’ve derived from the implicit parts of his message. It offers a client an explanatory statement that responds to something about his thinking or behavior that he is not aware of, with the goal of increasing his self-understanding and understanding of the problem, fostering his insight, and/or helping him make connections that he hasn’t seen on his own. This assists a client to view a problem from a different perspective, thereby opening the door to new solutions.

Note that while helping skills such as paraphrasing, reflecting, and clarifying all remain within the client’s frame of reference, interpretation goes a step further by providing a new frame of reference for the client to consider. For instance, interpretation may involve presenting an hypothesis about a cause-effect relationship or other significant meanings in a client’s actions, thoughts, or feelings:

Client: “My life is so boring right now. Some good drugs and a few bucks would sure set me right.”

Social worker: “It seems as if you believe you need money and drugs to feel good about yourself.”

A client may be defensive at first when you offer an interpretive response; however, a relevant and responsive attempt to point out the source of a client’s difficulties often turns out to be therapeutic. In particular, offering relevant and timely interpretations is an important way of facilitating a client’s insight.

Guidelines for using the technique of interpretation include the following:

Until you have a good working relationship with the client, use interpretive responses sparingly.

You should use interpretive responses only when a client is engaged in self-exploration or is ready to do so (although you may also use them before that, to identify a client’s strengths and goals). A client must be ready to receive an interpretation and accept the insight it provides. Do not share an interpretation if the related material is still far removed from a client’s awareness. When an interpretive statement is offered too early, clients usually reject it as meaningless and inaccurate.

Avoid making several interpretive statements in a row because a client needs time to assimilate what you have said.

Phrase interpretive responses in hypothetical terms.

Observe a client’s reaction after offering an interpretive response in order to determine the accuracy of your response; respond empathically to the client’s response if it is negative.

Select your answer and share in the comments. The answer and rationale will be posted in the comments soon...

A client says to the social worker, “I feel like no matter what I do, I keep disappointing my family. It’s like I can’t get anything right.” Which of the following responses by the social worker BEST demonstrates paraphrasing?

a. “Can you tell me more about what you mean by disappointing your family?”
b. “It sounds like you feel you’re not meeting your family’s expectations, no matter how hard you try.”
c. “You seem overwhelmed, and this may connect to patterns from your past relationships.”

Below are some examples of active listening that include: Clarification, paraphrasing, reflections, and summarization. I deliberately left out interpretation and confrontation because there are so many factors and guidelines to those that they need their own post, so be on the lookout for more discussion on those topics in the coming weeks. Also, come next week for a question related to these topics below. 

Active listening requires you to, first, attend to a client’s verbal and nonverbal messages and, then, reflect back what you’ve heard and observed so that the client will know that his message has been understood accurately. Active listening skills are described below.

Clarification: Clarification is used in response to vague or unclear client messages. Using this skill is appropriate whenever you don’t understand a client’s message, would like a client to become more explicit, or wish to check your understanding of a client’s message. Clarification can also help a client to better understand what he has said.

Client: “Sometimes, I just want to get away from everything.”

Social worker: “Describe for me what you mean by ‘getting away from everything’.”

Paraphrasing: A paraphrase is a selective restatement of the main idea of a client’s message that resembles his message but is not identical to it. A paraphrase emphasizes the literal meaning of a client’s message (the content, rather than affect) and is expressed in fewer words than the client has used. For example:

Client: “I don’t want to get so wrapped up in my relationship with my girlfriend that I lose my ability to make my own choices and decisions.”

Social Worker: “Your independence is important to you.”

Particularly when used in conjunction with responses that highlight a client’s feelings, such as empathic responses, paraphrases are effective for encouraging a client to continue expressing himself. They can also be useful for bringing focus to an idea or situation that you would like the client to consider.

Reflection: The skill of reflection involves repeating or restating something a client has just said with an emphasis on the part of the message that is most helpful. Here are two examples of reflection:

Client: “Everything is so static in my life these days. I need things to change. The new things I try don’t work out the way I want them to. If I had a better job, I’d have some money to try more new things.”

Social Worker: “You’re ready for things to change in your life.” or

Social worker: “You feel frustrated in your efforts to change things.”

A key purpose of reflection is to build understanding. Reflection is effective for clarifying and showing clients what their here-and-now feelings are, which encourages them to continue expressing themselves. In this way, reflection helps clients understand their own feelings. Moreover, because reflection demonstrates your understanding of the client’s feelings, reflection is also a useful skill for establishing rapport.

Summarization: Summarization (summarizing) has several purposes and is used at different times in the intervention process. In all cases, however, its primary purpose is to tie together functionally related elements that occur at different times in the helping process.

Summarization can be used to highlight and pull together elements of what you and a client have discussed during the previous few minutes of an interview, with a focus on what is most relevant or significant. Summarization may be used in a similar way to recap a lengthy client message. Among other benefits, these uses of summarization are effective for bringing focus to an interview. For example, when a client rambles or brings up many different topics, you can identify one theme and narrow the discussion to focus on that theme. Summarization can also be used to tie together the factual and emotional components of several client messages, which is useful for helping a client see connections among several ideas or feelings he has expressed. Usually, this entails emphasizing themes or topics a client has repeatedly referred to in the current interview and/or in prior interviews. For example:

Client: “I can’t get along with my boss. He’s always telling me what to do. I know how to do the job better than he does. It’s not fair. This happens to me all the time, with every job I’ve ever had.”

Social worker: “It sounds like the main problem you have in jobs is that you don’t like bosses who exercise authority over you.”

In this example, the social worker has summarized more than one element of a message and appears to be referring to past messages as well. Finally, summarization may also be used to provide a smooth transition between topics, review progress made during an interview as it draws to a close, recap the highlights of a previous session, and review progress on tasks during the week between sessions. The latter applications are effective for providing focus and continuity between sessions.