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Use specific communication techniques to maintain constructive interaction

ContentsOverview 2Put in place strategies to develop a trusting relationship that will enable negotiation of communication barriers 2Use communication skills and processes to identify and address barriers to communication and facilitate identification of individual issues 5Use effective skills in listening and providing feedback to ensure stories are heard and to support exploration and validation of issues raised 10Activity 18: Focusing 2 29Seek agreement on processes to be followed to address issues within scope of own abilities, skills and work role 31Activity 21: Signs of not having the required skills and knowledge to work with a client 35Make referral for conflict resolution and mediation as appropriate 36Summary 36

Certificate IV in Disabilities: CHCCOM403A: Reader LO 10128 1© NSW DET 2009

OverviewDeveloping a positive and constructive (helpful) relationship with a client is critical if we are to be able to help them in a useful and effective way. As mentioned in other topics, effective communication skills are the cornerstone of our work as community service workers. In this topic we will provide you with detailed information on the communication skills you will need to use to help clients ‘tell their story’.

We will start with building trust and then move onto identifying barriers to effective communication before exploring the wide range of skills that we need to draw on when working with clients. The skills that we will focus on include attending behaviour, active listening, paraphrasing, reflecting feelings, summarising, asking questions, focusing and encouraging concreteness and specificity. In this topic we will also discuss what we need to consider when addressing issues with clients and finally how to refer clients.

Put in place strategies to develop a trusting relationship that will enable negotiation of communication barriers

Trust

Trust is fundamental to the counselling relationship. If a client doesn’t trust a counsellor, they are unlikely to share and explore what is happening in their life. It is the counsellor’s job to take responsibility for creating an environment where the client feels safe and able to trust.

While trust is developed throughout the whole counselling process/relationship, how a worker introduces themselves and their role and begins working with a client is crucial if a client is going to open up and share their story. First impressions do matter and trust is often developed in the beginning of the first session.

This would be a good time to attempt Activity 1 before moving on with the remainder of this reading.

Developing trust within the helping relationship is not dissimilar from what is described above. The more time you spend with a client the more likely they are to trust you—as long as you behave in a way that warrants them trusting you of course!

2 Certificate IV in Disabilities: CHCCOM403A: Reader LO 10128 © NSW DET 2009

Introducing yourself and your role, defining the boundaries of the relationship, and showing clients that you are interested in them also helps to develop a trusting relationship. Finally, demonstrating professional values and keeping a client’s stories and experiences confidential proves to the client that they can trust you.

Defining boundaries in a helping relationship

All relationships have boundaries, but usually they are not discussed—that is, they are implicit. When we use the word boundary in the context of a helping relationship we are referring to the rules that surround the relationship. Just like a fence tells us where our property ends (and thus where we can do whatever we like and where we can’t), the rules of a helping relationship tell us what we can and can’t do in that relationship. The great thing about rules is that when we know them we know what to expect and what is going to happen. When we know these things we tend to feel safer and thus more likely to trust.

While we don’t go into minute detail with a client about all the ins and outs of the boundaries surrounding the helping relationship it is good practice to outline them when you first start working with them – not only does this help foster a trusting relationship but it is also more ethical to be transparent!

The main things to discuss with a client regarding boundaries include:

1. The purpose of the helping relationship—to help the client resolve whatever it is that has brought them to see you.

2. The role of the worker in the helping relationship

3. The fact that the relationship is based on the principles of empowerment and client self-determination—though I wouldn’t use those words with a client!!

4. Confidentiality, what it means and what the limits are.

5. Time frames—how long a session might go for and how many times they can use the service (some agencies have limits on how often a client can use the service).

6. Client rights and responsibilities. Many agencies have this in printed format which is given to clients along with other important information about the service provided etc.

7. How and when the client can contact you.

Confidentiality and limits to confidentiality

To keep something confidential means to keep it private and thus not tell anyone else what has been said. While all helping relationships should be


confidential, absolute confidentiality is often not always possible or appropriate. Times confidentiality are breached include:

When talking to your supervisor or a colleague about client’s situation when you are seeking some help, for example, when asking for guidance on the best way to help a client. It is important to mention here, that while this is technically a breach of confidentiality, your supervisor or colleague are also bound by the rules of confidentiality and so the information still doesn’t leave the organisation.

When discussing a client in a case conference or case planning meeting. In this situation you would always get the client’s consent before discussing them and ideally they would also be part of the conference or meeting.

When referring a client to another agency. Again you would always get their consent before disclosing any information to this other agency and would discuss with the client what information would be shared.

When you write case notes and case plans. Though these should always be kept in a locked cabinet or in a password protected folder in the computer and only accessed by relevant workers. Clients should always be told that a file is kept on them and that they can see it whenever they want.

When there are legislative or duty of care issues or concerns.

While you wouldn’t necessarily go through all of these points with a client when you first meet them I would always define confidentiality and mention that there are times that confidentiality has to broken such as if they tell you they have committed a serious crime or if they are at risk of harming themselves of someone else.

Opening an interview with a client

Robyn, it would be great if we could have an audio file here—I have one that I have developed if you want to use it or do you have a facility to record. ‘Trouble at the palace’ has a good opening of an interview but doesn’t include confidentiality as it wasn’t part of the brief for that project.


In the topic Identify communication strategies to build relationships with clients who are involuntary or present communication challenges we will


talk in detail about how to build rapport and establish trust with clients who either don’t want to be seeing you or who have challenging behaviours or communication issues.

Use communication skills and processes to identify and address barriers to communication and facilitate identification of individual issues Communicating effectively is not easy and if we are to communicate well with others we need to be aware of the range of barriers that can make communicating difficult. There are many different barriers to effective communication, but in this topic we are going to focus on:

noise (both internal and external), and

Robert Bolton’s roadblocks to effective communication.

In the topic Identify communication strategies to build relationships with clients who are involuntary or present communication challenges we will address the barriers to effective communication that arise from closed and unreceptive attitudes, mistrust, charged emotional states that are often the result of someone being an involuntary client.

Barriers to effective communication

We all communicate on a daily basis, often with lots of different people and in different situations. The amount of communicating we do and the fact that we do it with lots of different people can make communication complicated and many of us create barriers in interpersonal communications.

We may wrongly believe that communication is easy, so when we come across problems in communication, we give up or blame the other person. This is because we don’t know the nature of the problem and how to deal with it.

Robert Bolton in People skills: how to assert yourself, listen to others, and resolve conflicts lists twelve major roadblocks to communication. Even though this is a very old book, I still find his classification really useful when thinking about what might have gone wrong in my interpersonal communications. Bolton’s roadblocks are as follows.

Judging

1. criticising


2. name calling

3. diagnosing

4. praising in an evaluative way

Sending solutions

5. ordering

6. threatening

7. moralising

8. excessive or inappropriate questioning

9. advising

Avoiding the other’s concerns

10. diverting

11. logical argument

12. reassuring

Reference: Bolton, Robert (1987) in People skills: how to assert yourself, listen to others, and resolve conflicts. Simon & Schuster Australia, Brookvale, NSW, pages 1724

Judging

The psychologist Carl Rogers believed that the major barrier to interpersonal communication lay in our natural tendency to judge. In other words, to approve or disapprove of the statements of the other person.

1. Criticising or blaming. This implies that there is something wrong with the person or with what they are saying. Examples are: ‘It’s all your fault’ and ‘You’re being too selfish’.

2. Name calling and labelling. Labelling prevents us from getting to know ourselves and other individuals. There is not a person, only a type. Examples are: ‘dope’, ‘dole bludger’, ‘Abo’, ‘junkie’.

3. Diagnosing. This can be a very common and tempting one for workers in the CSI field. However, it’s really just another form of labelling. Examples are: ‘Do you know what your real problem is?’ and ‘You only saying that because you’re suffering from…’

4. Praising in an evaluative way. Often people are surprised to find this among the roadblocks to communication. Praise is supposed to build confidence, motivate learning and improve human relations. However, praise is often used as a gimmick to try to get people to change their behaviour. When someone with ulterior purposes offers praise, there is often resentment of the effort to control and manipulate. Examples are: ‘You’re a good boy’ and ‘You’re perfectly right. That’s what I’d do too’.


Expressing positive feelings toward people is an important element of interpersonal communications, but some forms of encouragement are detrimental.

Sending solutions

Sending a solution in the form of advice, an order or through moralising can also be a problem. These can compound the problem and inhibit a person’s personal growth.

5. Ordering. An order is a solution sent coercively and backed by force. There may be authority, as with a parent or employer or the words may simply be phrased in an authoritarian way. Examples are: ‘Don’t say that!’ and ‘Go right now and tell her your sorry!’

6. Threatening. A threat is a solution that is sent with an emphasis on the punishment that will occur if the solution is not implemented. Threats produce the same kind of negative results that are produced by orders. Examples are: ‘You’d better start treating him better or you’ll lose him’ and ‘If you don’t listen to me, you’ll be sorry’.

7. Moralising. Many people love to put a halo around their solution for others. Moralising speaks with ‘shoulds’ and ‘oughts’ but it chooses other wordings too. Examples are: ‘You should’, ‘You really ought to’, ‘It’s your duty as a… to…’ Moralising is demoralising! It fosters anxiety, arouses resentment, tends to inhibit honest self-expression and invites pretence.

8. Excessive or inappropriate questioning. Not all questioning is wrong. You’ll learn about how to ask questions appropriately later in the module. Inappropriate questioning often depends on the tone of your voice in asking and when and how often you question. Questions can interfere with the spontaneous flow of communication, diverting it in directions of interest to the questioner but not for the speaker. Examples are: ‘What makes you feel that way?’, ‘How are you going to do that?’

9. Advising. Advice is often an insult to the intelligence of the other person. It implies a lack of confidence in the capacity of the person with the problem to understand and cope with difficulties. The advice giver draws on her or his own store of knowledge and experience to recommend a course of action. Examples are: ‘What I would do is…,’ ‘Why don’t you…’

Avoiding the other’s concerns

10. Diverting. One of the most frequent ways of switching a conversation from the other person’s concerns to your own topic is called diverting. This happens because some people are not good listeners. You’ll learn more about listening skills later in the module. Others want to grab the focus to themselves. People may resort to diversion if they are uncomfortable with the emotions stimulated by the conversation. Examples are: ‘Let’s talk about


that some other time’, ‘That reminds me of the time…’ ‘You think you’ve got problems! Let me tell you…’

11. Logical argument. When people are under stress or there is conflict between people, logical argument may be the last thing that is helpful to them. You take the risk of alienating them, so look carefully before you put your cool, logical argument forward. An example is: ‘The logical thing to do is…’

12. Reassuring. The intent here is usually to make the person feel better. You may ask, ‘What’s wrong with that?’ Nothing perhaps, but it’s not listening! Examples are: ‘Things aren’t really that bad’, ‘Don’t worry, you’ll look back on this in a year and laugh…’


Noise

Another barrier to effective communication is noise. You might remember in the topic Communicate effectively with clients and staff, when discussing a model of communication, we said that noise is the distortion, interruption or loss of the intended meaning of a message. We also said that noise can be physical, emotional, ideological or attitudinal. In this section we are going to explore the concept of noise in more detail.


There are different types of noise and we can divide them into different types:

physical noise—loud music, people talking, jackhammers outside, garbage truck dropping bins etc

emotional noise—this includes the things we are worried about, things we are excited about, our feelings about ourselves etc

social noise—this relates to the impact culture, social status, power etc have upon the interaction we are having

word (semantic) noise—this relates to words that are used and how comfortable people are with the words that are being used. Jargon is an example of semantic noise.


Barriers to identifying individual issues

It is important to remember that our thoughts, feelings, attitudes, values, beliefs and world view affect how we listen to what people tell us and influence what we hear and react to. Once we are aware of this we are much more likely to listen to people’s stories in a way that is client-focused and thus allows them to identify their own issues rather than what we think is important. When we communicate effectively with someone we use our knowledge and skills regarding communication to help them feel comfortable, heard and understood. If they feel this they are much more likely to share what it is that has brought them to your service and then be willing to work on their own issues.

The role of the community services worker is to help the client to identify their issues and decide how best to address them. Our job doesn’t involve telling the client what to do or giving advice but rather providing information about available options so that the client themselves can decide what they wish to. If we do start to do this it usually means that we have started to lose client focus.


Removing barriers so that we can focus on client issues

The challenge for all of us as community services workers is to be able to let go what is happening in our own lives (and head) so that we can focus on the client and their issues. Here are some things you can do that can make this a bit easier:

Be aware of what your own values are.

While listening to a client, think about how you are reacting at a personal level to what they are telling you and then remind yourself that how you feel or what you think isn’t relevant here as it is all about the client!

Be a reflective practitioner. Regularly stop and think about what you are doing with clients and assess what might be preventing you from being truly client focused.

Have regular supervision in which you explore how your own values, beliefs, prejudices, attitudes etc might be impacting upon your work.

Keep case notes on each client so that you can remain focused on the client who is currently with you. It is always helpful to write up case notes immediately so that you don’t have to worry about remembering everything that you need to do.


Have in place good stress management techniques and strategies so that you keep on top of your stress levels.

To be client-focused we have to remain vigilant about how we are working with the client and in reminding ourselves that it is the client’s life and they have the right (and responsibility) to make decisions that are right for them and who they are.

Use effective skills in listening and providing feedback to ensure stories are heard and to support exploration and validation of issues raised If we are to help clients explore their own issues and feel heard we need to call upon a wide range of specific communication skills and techniques. Effective listening means being an active listener and in this next section we will explore the range of skills that make up active listening.

Active listening

Listening is not only done with the ears but is a process of showing someone that we are listening to them through our behaviour, and by using other skills that we are about to explore. We call this active listening. Active listening is the process by which the worker hears what the client has to say, paying careful attention to the client and showing them with attending behaviour that they are being listened to. Active listening refers to listening to the meaning of the message as well as the words.

Most of us are not good listeners. It has been reported that we listen at about 25 per cent of our potential. This means that we ignore, forget, distort or misunderstand 75 per cent of what we hear.


Being a good listener in your work situation helps to develop rapport with the client and enables you understand their needs, so that you can assist them in the right way.

Key components of active listening

We use a number of skills to show that we are listening actively to someone. These include:


using attending behaviours—showing someone through our body language that we are listening to them

responding to non-verbal cues—smiling when they smile, looking concerned when they cry

accepting others and giving them time to talk

being non-judgmental—not judging them when they share something about themselves

using silence

using minimal encouragers—hmm, yes, go on…

asking open and closed questions

paraphrasing

reflecting feelings and content

clarifying

summarising.

Attending behaviour

Showing people that we are interested in them and what they have to say is crucial to the listening process. It is no good hearing and understanding what someone is saying if we don’t let them know through our behaviour that we are really listening to them.

We call demonstrating that we are listening to someone attending behaviour. We do this through body language (non-verbal behaviour) such as gestures, facial expressions, posture and tone of voice. Demonstrating good attending behaviour is the first step in developing a good rapport with our clients.

Sometimes you get the feeling that no one is listening

A male colleague is standing, speaking to a seated female colleague who is looking through her handbag.



All these behaviours send the message, ‘I’m not interested’. When we receive this message, we tend to feel uncomfortable, boring, uninteresting and, if we are feeling vulnerable, we can feel devalued and worthless. Showing that we are genuinely interested in a person and their story is, therefore, the first step in communicating effectively in our industry.

The way to show we are attending to what someone is telling us is to use our non-verbal behaviour appropriately. We need to show people that we are physically and emotionally prepared to listen to them.

How to show someone you’re listening

Remove physical barriers

You need to ensure physical barriers to effective communication are removed by freeing the environment of distractions and noise. For example, try to provide a quiet, private space away from other noises. This might mean taking the phone off the hook or letting the answering machine do its bit. It might also involve negotiating a good time to talk free of distractions and pressures.

Be on the same eye level as your client

This is important because standing, while the person you are talking with is sitting, can intimidate them—as you can be seen as imposing your authority over him or her. The role of community services workers is not (usually) to impose decisions on a client, but rather to listen to their stories and work with them to find the best solutions to their situations.

Be aware of personal space and face the client

Sit facing your client, leaving room to manoeuvre—as facing the client indicates that you are there, ready to listen to them. Leaving room to manoeuvre gives them a feeling of space. If you’re too far away it can give the impression that you don’t want to connect with them. If you’re too close it is an invasion of personal space.

Tip: Try sitting with your upper body (from the waist up) facing the client front on, with your legs (from the waist down) positioned at a slight angle away from the client. Sitting this way shows you are open and interested in what the person has to say but having your legs at a slight angle tends to look more relaxed and be less physically confronting.


Use eye contact in a culturally appropriate way

In Australian culture, eye contact is perhaps the most powerful way of demonstrating that we are listening and interested in what someone is saying. To facilitate good eye contact, you should make sure you are sitting on similar chairs that help you to be at the same eye level as your client.

However, you should be aware of different cultural protocols and use eye contact appropriately—as different cultures have different values attached to eye contact. For example, in all western cultures it is usually considered appropriate to look someone in the eye when you are speaking to them. People can even be viewed as dishonest if they don’t look you in the eye. This is not the same for all cultures. In some cultures, it is thought a mark of respect to look down or away if you are speaking to someone in authority—for example in Aboriginal cultures. When listening to someone make sure that you use the right amount of eye contact, taking into account their culture and their understanding of your culture.

Use appropriate eye contact

Drawing of a two women making eye contact

Maintain an open, relaxed body posture

Again, how you sit conveys a message about how interested you are in someone. If you have a relaxed and open posture, you are showing someone that you are ready to listen. Leaning forward slightly also shows that you are interested. It’s important to get the balance right; if you are too relaxed and slumped in your chair you could actually send the message that you are so laid back that you’re not really there.

Communicate with warmth and empathy

Being warm and welcoming is another way to show interest in a client. Using their name, smiling when you greet them and offering them a seat are great ways to set the scene of warmth, positive regard and interest. Using correct facial expressions is a way of tuning in to the client’s feelings and showing them you’re tuned in.


Use minimal encouragers

In the early stages of developing rapport with a client, it’s best to keep your talking to a minimum and let the client express what the problem is or why they have come to you for assistance. You should still introduce yourself and give a brief outline of your role or function at the agency, but after you do that the next step is listening. You can show that you are listening by:

using one word encouragers (for example ‘mm’, ‘uh-huh’)

nodding to communicate attention

asking them to tell you more.

Use non-coercive icebreakers

Icebreakers are those things we use to introduce ourselves, establish warmth and help people to feel comfortable. Non-coercive means doing this in a non-threatening way. For example, ‘Hi, I’m Alfred and I’m one of the community service workers here … how can I help you?’ Once you have done this, you might tell the person a bit about you and the agency, or before asking them how you can help them. This way you have introduced yourself so that the other person has a sense of who they are talking to and they can then decide how much to tell you at that stage of the conversation.

Use silence positively

If there is a moment of silence when someone is telling us a problem, we may become uneasy and want to fill it up with words. We often think this is the moment to give advice or solve the problem for the client. One of the important things we need to learn in order to be a good listener is to cope with these uneasy feelings when there is silence. We need to allow the other person silent time to reflect and collect their thoughts, and often they come up with their own solutions!

Don’t rush the client

People are often upset, anxious or distressed in some way when they have come to us for help and are trying to discuss a problem. They may never have spoken about it before and not have a clear way of expressing what they need or what the issue is. The best thing we can do for them is give them time. If we rush them, this will only escalate the distress. This takes tolerance, and awareness that we need to set aside time for this to happen.


A woman sitting at a desk asks how she can help the male sitting on the other side of the desk

Reflective listening

Reflective listening means that we attend to the meaning of the person’s verbal and non-verbal communications and respond in a way that promotes further exploration of both the feelings and content of what is being said.

The reason why we reflect is that the person telling us the story will be keen to know that we have received at least the significant components of the message sent. As workers in this field, it is our responsibility to give feedback on our understanding and encourage the client to correct or affirm (to say ‘No that’s not quite it’ or ‘Yes, that’s right’) until there is an accurate understanding for both worker and client. Workers can reflect content by paraphrasing and summarising, and they can reflect feelings.

Content refers to the words that people say (the story that they give), while feelings refer to the meaning the story has to that person.

Paraphrasing

Paraphrasing involves repeating back what the other person has said, but in your own words. By doing this, we are attempting to communicate an understanding of the essential aspects of what the person has said. Paraphrasing needs to be used appropriately, so the person is encouraged to continue with the story. It is a concise re-wording of what has been communicated so far.

Example 1

Client statement: ‘I’m really worried about Mum. She’s been to the police to try to get Peter, my stepfather, to stop hitting her when he is angry or depressed. She reckons they had a real bust-up last night and he said he’s going to kill her for going to the cops. She’s really scared. I’d be able to help her if I could get some money and another place to live.’


(When you paraphrase, it’s a good idea to listen to key words and phrases: worried about Mum; he’s going to kill her; if I could get another place to live.)

Response: ‘So, you’re really worried about your Mum, who is really scared that Peter will kill or hurt her because she went to the police about his violence. You wish you could help her by finding a safe place to stay.’

Example 2

Client statement: ‘I’m finding it really tough at the moment trying to support my four children alone on a supporting parents benefit. The older ones are always needing something for school and I don’t want them to miss out. I would like to work to bring in more money but with the cost of child care for the little ones, I don’t know if we would be better off. I also haven’t been able to find anyone to take me on. Unemployment is really bad in this town. The stress of trying to make ends meet every week is sending me crazy and I get really angry with the kids. I don’t want to do this.’

Response: ‘You’re finding it incredibly stressful trying to support your family on such a limited income. However, with unemployment as it is, you don’t know a way out of it. As a result, you find that you are losing it with the kids and you don’t like it.’

Paraphrasing helps you when working with clients when it is done with care and discretion and not as a mechanical procedure. The process helps as it feeds back to the client your understanding of what has been said. The client can then confirm that your understanding is correct, or clarify it if it is wrong. It also indicates to the client that you have been listening and are trying to understand the issue—it shows empathy. This builds rapport with the client. Rapport is the positive feeling of connectedness and understanding shared between client and worker. As clients begin to feel understood through the skilful use of reflective listening they will reveal more of themselves to the worker.

Clarification with a paraphrase

Often clients find it difficult to find the words to tell their story to you. This could be because they are distressed or lack verbal skills. To you, it may seem as if they are all over the place, rambling, repeating themselves and presenting a jumbled story. A paraphrase may clarify what they are saying at this point. Paraphrasing helps you to check your own and the other person’s understanding of what’s being said.

Example

Client statement: ‘You know, it’s hard to talk about. My wife was really mad when she found out. But what could I do… you know. It is hard on me too. I really wish she would understand it isn’t my fault. What will I do now… being retrenched when there are no more jobs around? You know? You feel sort of… you know?’


Response: ‘Losing your job has really shaken you, and you would like your wife to understand the position you’re in.’


Summarising

A summary is when you offer back the key ideas, themes and feelings another person has been giving you. It is a tying together of your understanding of what has been communicated over a period of time. Counsellors often do this at the end of a session with a client as a way of summing up the key elements that have been covered in the session. They may also do it at the beginning of a session as a reminder of what happened in the last one.

Even though you may not be a counsellor, summarising can be a useful tool when you have spent some time listening to someone’s problem or story. It can be a way of expressing what you see as the whole picture and checking whether you have understood correctly.

A summary may:

pull together the important elements of both information and feelings conveyed in the message, delivered over several minutes

rearrange the content of the message into an order that gives fresh insight

help you to identify and highlight themes or common threads in a story

be useful when you are losing touch with the story.

Examples

Worker summarises to client: ‘Now let me see if I have understood what you have been saying. You recently separated from your wife and have temporarily gone to live with your parents. You would like to reconcile with your wife but from what she is saying, you don’t think this is a possibility. She is saying she doesn’t want a divorce but under the circumstances you feel there is no alternative. How does that sound?’

Worker says to client: ‘I hear you saying that you aren’t getting any sleep at night because you’re worried about your elderly mother who is in a nursing home. You feel anxious during the day because you’re unsure whether you will sell your business with the recent turndown in the economy. Both of your teenage children are having problems at school and you’re unsure what to do about this. It sounds like a lot is going on in your life at the moment. Which of these issues would you like to focus on first?’


Questions like, ‘Am I describing your situation correctly?’ or ‘Which of these issues would you like to focus on first?’ are very useful in the checking process.

When giving your summary, check whether you are on track with the person and where they want to go next with the issue. This gives them the opportunity to reflect on what they have told you, correct any misunderstandings and move on to the next stage.

Worker says to client: ‘Well Peter, I can see that you are really progressing. Over the few weeks you’ve come to see me, you’ve really begun to make some definite decisions about what you want with your life, especially in relation to your job and where you want to live. I can hear the enthusiasm in your voice when you talk about the changes that are occurring.’

Summing up what someone has said obviously requires careful listening. Again, it is a situation where you are not giving advice or changing the content of what is being said. You are feeding back your understanding of the key issues that someone has expressed to you, or you are summing up what has happened over a period of time. You do this to check with the person that you are on track, that you understand what they are telling you, and that you have been listening to them.


Reflecting feelings

From the time we are born, we react or act from our feelings, even if we don’t put labels on these feelings. In western cultures, it is considered to be an intimate experience to share your feelings with another person; this is especially the case if we share feelings that are private or define who we are. Many people find it hard to express some feelings in words but may show them in their body language or non-verbal behaviour. Even if someone has told us their feelings, we always look to their non-verbal behaviour to check out if they really seem to be feeling that way.

When we reflect back someone’s feelings, it can show that we care enough to listen. It can also indicate to the person that feelings are normal. It can facilitate the development of a genuine and meaningful relationship between worker and client. Giving people permission to talk about feelings may lead to further exploration of emotions. The process can enable the client to identify, label and acknowledge their emotions. By acknowledging a client’s feelings, the worker can communicate empathy and understanding.

Feelings play a central role in everyone’s life. Feelings, thoughts and actions all seem to be interrelated but frequently the feeling part is difficult to grasp, let alone express.


The ability to recognise and reflect feelings is a significant skill. Often it is a difficult skill to acquire. When people are expressing deep or painful feelings it may provoke different reactions within us. Firstly, we may feel the desire to jump in and make the person feel better, with statements such as, ‘It will be ok. Don’t get yourself upset about it’ or ‘Everything will be alright’.

We may also want to stop the person from expressing their feelings, because it arouses some pain in us that we don’t want to feel. Again, we may cut the person off by making some comment of our own to prevent them from expressing their feeling. Also, depending on our cultural upbringing, we may have been taught all sorts of things about the rightness of expressing feelings, especially to strangers.

We also make judgments about who has the right to express their feelings. In the alcohol and other drug field, people with problems have sometimes been wrongly stopped by workers from expressing any personal pain because it has been seen as self pity.

Helping clients to express feelings helps them to make sense of what is happening to them. If they can explore what they feel and why, they can usually go on to understand why they have acted and reacted as they have and thus get clues as to how they can make changes for the future.

It’s important for workers in the whole CSI field to develop the skill of reflecting feelings. It takes practice, and often beginning listeners will feel uncomfortable focusing on a client’s feelings, as it tends to go against our cultural norm.

How people express their feelings:

Some of the ways people express their feelings are through:

Physiological reactions: Tears, blushing, restlessness, clammy palms or changes in breathing rate.

Body language: How someone gestures, moves, sits in a chair, places their arms and legs, and their appearance.

Paralanguage: Tone of voice, pitch, pace or volume.

Indirect description as a projected message: For example, ‘You don’t like me, do you?’ Here the person is telling someone else what they suspect they are feeling.

Direct description: When we are aware of our feelings, we can describe them directly.

Intensity of feelings

Our first task in reflecting a feeling is to find the words that accurately describe that feeling. The words we choose should identify the feeling and the intensity with which it is expressed. Correctly identifying both the


feeling and the strength or intensity of the feeling is essential when reflecting, if the client is to feel understood.

Sometimes when people are new at working on this skill, they underplay (minimise) the intensity of feelings. A severely depressed person may have her feelings reflected back to her as, ‘You’re feeling a bit down’. Such reflections can be very annoying (and frustrating!) to the client and may tell her that she is not really understood.

Why does this occur? The new worker may be feeling embarrassed at the intensity of the feelings expressed. There may also be a desire to bring feelings down to a level that is manageable for the listener.

Similarly, it is important not to express feelings back at a more intense level than that at which they are being expressed. For example, a client who expresses mild disappointment will not feel understood if it is reflected back as, ‘You must feel absolutely devastated’. Generally, a client will find it easier to correct an overstatement than an understatement.

In order to be able to reflect feelings, you need to have in your vocabulary a wide range of words that reflect the different intensity of possible feelings you may encounter. There are a number of interpersonal communication books that provide lists of feeling words. See if you can borrow some of the references mentioned in the Study guide and have a look at their lists.


Observation and deduction

It’s not a good idea to decide how someone is feeling from just one sign. We should look for a range of clues: content of message plus a number of different non-verbal behaviours to support our assessment.

Mixed messages are often communicated about feelings. ‘I really love my father’ along with a clenched fist may indicate considerable hostility that the client has difficultly acknowledging. In reflecting, we give the client the opportunity to correct any misinterpretation we may have.

How can feelings be reflected?

As a question. This usually begins with words like, ‘You feel (annoyed or another emotion)?’ These responses are presented in a question form, seeking confirmation of the reflection. They arise from awareness that the feeling cues may have been misread.

As a statement. This may be presented as in these examples: ‘You’re feeling really angry’ or ‘It sounds like you feel really angry’. Even if said


as a statement, this gives your client time to correct you if that is what is required.

Put into context. An extension of the first two is to link the feeling with the situation or the cause, placing the feeling in context to make it more concrete. For example, ‘You feel depressed because you can’t get a job?’ This method checks not only the feeling but also the event or situation with which it is associated.

The think/feel trap

In English, the word feel is used not only to describe actual feelings but also as a substitute for the word think. This is a trap for the unwary who may feel (really think) that they are reflecting emotional feeling when they are reflecting thoughts.

A simple check is to substitute the word think for feel. If the statement still makes sense then you have a thinking rather than a feeling statement.

Feel followed by that is another clue that feel is being used to indicate a tentative thought. The that may be implied, as in ‘I feel she will come early’.

When to reflect feelings Reflecting feelings can be used at the beginning phase of an

interview to help establish rapport.

Reflection encourages important feedback when the worker wants to make sure that their understanding of the client’s feelings is right..

Reflecting feelings can be used when the message that the client is sending is incongruent; that is, when how they are saying something does not match with what they are saying.

When not to reflect feelings

Reflecting feelings is not helpful:

when the situation requires immediate practical action; for example, finding emergency housing for someone

when the person appears to be mentally ill. They may be disordered and agitated

when the person is aggressive and you fear for your own safety

at the end of a session with a client.



Reflecting feels isn’t easy and it really helps to practice. If you feel a bit uncomfortable practicing on friends of family you can practice with the TV. I know that this may sound a little mad but when you are watching a soap or movie just try and think what emotions the characters are expressing and then (quietly and in your head if watching with others) reflect their feeling.

Using questions

Another way of letting someone know we are listening to them is to ask them questions. By asking questions we can clarify what they are saying and find out more about their story.

Why ask questions?

The most obvious reason for asking questions is to gain information; however, there are other reasons, such as:

to encourage the client to share concerns openly

to help the client identify and clarify the problem

to help the client expose the problem further

to show others that we are interested in, and want to understand, what they have to say.

Tips for asking questions:

Only ask questions that will help move the client forward.

Avoid asking questions because you feel at a loss and asking a question gives you a way out.

Avoid questions that satisfy curiosity but have little or no relevance to the issues at hand.

Too much questioning can make the client feel they are being interrogated.

Too little questioning can imply a lack of interest or concern.

Avoid questions that ask for trivial information which does not relate to the client’s immediate concerns.

Types of questions

There are two broad types of questions: open and closed.

Open questions

Open questions encourage the exploration of thoughts and feelings as they ask the talker to describe something in their own words. Open questions are great to use when you want the other person to expand on the topic or issue they are talking about.


Open questions often start with:

What—this is when you are asking for facts

When—the time something has occurred

How—the way the process or feeling has emerged

Where—the location of the event

Would/could—to open the focus or for decision-making.

Open questions are useful to find out about a problem, for example: ‘What seems to be the problem?’ They are also used to begin an interview or counselling session: ‘What’s been happening since last time we met?’ ‘Why’ questions are technically open questions but we encourage workers in the community services industry to avoid using them as they tend to sound threatening or judgmental.

A seated male worker facing an elderly seated client and asking her a an open question

An open question invites the client to explore ideas and expand on a response

Closed questions

Closed questions usually lead to a specific answer and often narrow down communications. They usually begin with:

Is … ?

Are … ?

Have … ?


Has … ?

Do … ?

Did … ?

Does … ?

Can … ?

They require either a yes or no answer or a short factual comment. Closed questions don’t encourage clients to talk further. They are useful, however, if you want a specific answer (‘Are you on medication?’).

A closed question is useful if you require specific information

A seated male worker facing an elderly seated client and asking her a closed question


Now ask a friend or colleague these questions and note the differences in the amount of information you get when you ask an open question.

You might have noticed that when you asked an open question, you got a better picture of what was going on for your friend in relation to their work.

When we use questions as a tool to let someone know that we are interested in them and their story, it’s good to make sure that we don’t ask leading or loaded questions.

Leading questions are questions that suggest what the best answer would be. An example would be ‘That’s not the right way to behave is it?’ The


person asking the question wants a no answer. It is a leading and closed question. People who ask leading questions are really making a statement about how they want the person to respond.

When someone asks a loaded question, they are often wanting support for an idea or belief they have; for example ‘What do you think about the Coordinator’s support for a needle exchange next door?’ Questions should be asked in their most neutral form so that the person answering doesn’t feel that they have to take sides.

Sometimes you may need to ask people questions about very sensitive issues such as family crises, violent behaviour, behaviour of older family members, drug or alcohol use or questions about sexual practices. We need to ask these questions to ensure that people are safe or not endangering others. We should never ask these questions for the sake of it or because we are curious.


When asking questions it’s a good idea to ask one question at a time rather than asking three questions all at once and expect the other person to know what we want from them.

Strategic questioning

Strategic questions are used when you’re trying to bring about change in a situation where people have become stuck. They allow you to find out more specific and concrete information and also create choice and empower the person you’re interviewing. Most strategic questions are open-ended, so they begin with ‘What’, ‘Tell me’, ‘When’, ‘Who’, ‘Where’ or ‘How’.

You should never ask questions without knowing the reason for asking them. The questions that you ask should aim to help the client make sense of their situation. You should never ask a question because you are curious or want to know something for your own benefit. Strategic questions are always planned and purposeful, and there are different kinds for different purposes. Here are some examples.

Information gathering questions

Questions that help you work out what the key issues are:

1. What are you most concerned about? (or What are you most pleased about?)

2. How has this affected you?

3. What happened when …?


4. Tell me more about …

Questions that look at what your client has noticed about a situation:

1. What did you notice about …?

2. What do you know for certain? (Wait for an answer then ask ‘What aren’t you sure about?’)

3. How did you find out about that?

4. When is this most likely to happen?

Questions that help you find out what the client thinks about a situation:

1. What does this mean to you?

2. What do you see as the relationship between … and … ?

3. What was your purpose in doing …?

4. What thoughts went through your head when this happened?

Questions that help you find out what the client feels about the situation:

1. How do you feel about this?

2. How has this situation affected you physically and/or emotionally?

3. Where in your body do you feel the anger (or whatever feeling)?

4. What feelings do you have right now, when you think about it?

Planning questions

Questions that help the client set some achievable goals:

1. What would be your wish if either of us had a magic wand and could make any wish come true?

2. How would you like it to be, realistically?

3. What would you like to be different?

4. What things are really important to you?

Questions that help the client move on to a more ideal situation:

1. How could the situation change?

2. What would it take to make this change?

3. How could you make a difference?

4. What have you tried? (Wait for an answer then ask ‘What works?’)

Questions that help explore different options:

1. What are all the ways you could accomplish these changes?

2. Tell me about some of your ideas, even if you think they won’t work.


3. What would you like to do, even if it seems outrageous?

4. What are some other possibilities, even if you don’t like them?

Questions that help explore the consequences of each option:

1. What would most likely happen if you chose to do …?

2. What impact might this have on …?

3. What difference would this make to the situation?

4. How would you feel if you did this?

Questions that help the client look at what might get in the way of making these choices:

1. What stops you from doing …?

2. Tell me about your concerns regarding this option.

3. Who is likely to object if you …?

4. What barriers might get in the way of…?

Questions that help the client explore the strengths they have that will help them carry out their plans:

1. What would it take for you to…?

2. What do you like to do that might be useful to…?

3. What can you do that will help you achieve your goal?

4. What support do you need to make this work?

Action questions

Questions that try to ensure that the client is specific about what they will do, when and how:

1. What’s the first step you’ll take?

2. Who will you need to talk to?

3. What will you say?

4. When is the best time to approach them?


By actively listening and asking strategic questions, you are showing the client that you have heard and understood what they have said. This is empathy in action. By using these skills, you are also clarifying what they’ve said. You are checking that you have understood correctly, as well as gathering more relevant information to gain a fuller picture of their story. You are also rephrasing what they’ve said so that they can become clearer


about what it is that’s important to them. This process of clarifying makes both the worker and the client more aware of all the issues involved.

Encouraging concreteness and specificity

By using reflective listening techniques such as paraphrasing, reflecting feelings and clarifying, in conjunction with strategic questioning, we are able to encourage clients to be concrete and specific. By asking a client to be concrete and specific we are asking them to be clearer, more accurate, and more detailed about what they’re experiencing and how they’re expressing those experiences.

Often when we interview people, they begin with vague and generalised statements such as ‘I’ve messed things up’ or ‘Nothing seems to be going right’ or ‘I’m fed up with everything’ or ‘Things are on top of me’. As workers, we want to know more about what ‘messed up’ means, or ‘nothing’ or ‘everything’ or ‘on top of me’. We need to help the client translate these vague statements into more concrete terms so that they can begin to explore the situation more thoroughly and look at what they want to do about changing it. For example, ‘I’ve messed things up’ might mean:

‘I wanted to tell my partner that she was important to me and that I did respect her family, although I disagreed with her idea of having her mother stay with us, but I got angry and yelled at her. I told her she was uncaring and selfish. I didn’t mean to say that, and now she’s upset and I feel awful.’

Helping the client be more specific enables them (and us as workers) to develop a greater understanding of what’s happening in his or her life. Bringing feelings out into the open and examining the situation thoroughly is a start to managing that situation constructively.

The vague statements that clients make are usually to do with what they experience (eg ‘Nothing’s going right’), how they behave (‘I messed things up’) or how they feel about those experiences or behaviours (I’m fed up with everything’). In order to help them (and us) clarify exactly what is happening, one of the most useful skills we can use is strategic questioning, in order for them to arrive at more concrete statements. For example, in order to move the statement ‘I’ve messed things up’ to a more concrete statement, we might ask:

‘What is it that you think you messed up?’ or

‘When you say messed up, what exactly do you mean?’



Focusing

When we are listening to a client’s story it is also important to focus on the client and their story. Focusing can be harder than it looks because in our social lives we tend to divert (remember Bolton’s roadblocks) rather than focus. When focusing on a client, we need to keep the ‘spotlight’ on them and their issues. The best way to do this is to paraphrase or reflect feels rather than ask a lot of questions. If you are asking too many questions the chances are that you changing the focusing rather than helping the client to explore their issues.

The trap that many community service workers fall into when hearing a client’s story, is to move the focus onto the person the client might be talking about. For example, if a mother of a ten-year-old boy comes in to talk about the problems she is having disciplining her son, the temptation can be to focus on the son and why he is behaving the way he is. As the son is not with you it isn’t helpful to focus on him, instead we should be focusing on the mother, how she feels, what she has been doing, what works etc. She is the person in the room with us so she is the person we should be focusing on!

This would be a good time to attempt Activities 16, 17, 18 and 19 before moving on with the remainder of this reading.

It’s important to realise that until the interviewer acknowledges the client’s feelings and what they relate to, the client is unlikely to be able to work through her concerns and look at what she might do to alleviate them. Focusing on her and her feelings rather than on other people, or on a ‘solution’, will enable her to feel validated and empower her.

Immediacy (or staying in the here and now)

Another important skill of interviewing is the ability to keep the interview in the present rather than getting stuck talking about the past or imagining what things will be like in the future. While it is sometimes important to look at what has happened previously in order to understand what has lead to the current situation, it’s important that you, as interviewer, don’t let your client stay in the past. A process of change won’t take place if this happens.

Of course, in order to create change, we also need to be aware of what we’d like to have happen in the future, what our goals might be. However, when setting goals with a client, we need to decide what has to happen right now, in order to achieve those goals.

It’s also important to focus on things that can be changed rather than on those over which we have no control. A common tendency is for people to talk about injustice or their problems by externalising them. This means


they have trouble using ‘I’ statements like ‘I’m feeling hurt by….’ Instead, they place the issue outside themselves, often blaming others, or ‘it’ or ‘they’ in very general terms. For example, they may tell you that ‘It’s just not fair’ or ‘She shouldn’t do that’ or ‘They always say that.’ While this may well be true, they really have no control over what ‘she’ does or doesn’t do or over even broader social issues.

What they do have control over is how they react or respond to those feelings, those issues and those behaviours. In the community services industry, you will often meet people in this situation and, when you are interviewing them, it’s your role to assist them to deal with what they can actually change, not what they’d magically like to change.

Ending the interview

Finishing an interview or a relationship in an effective way is just as important as the rest of the interview. Often the worker may realise that her or his time is short, and hurry at the end. This can undo all the useful work that was carried out throughout the interview. Therefore, it is important to learn some basic ground rules about closing or ending a session. Here are some things you can do to ensure that the interview ends appropriately:

Establish a structure early in the interview and/or relationship—give the client an idea of how much time you have (for example, ‘Today we only have fifteen minutes together but this should give us time to begin to get to know each other and start talking about what is happening for you right now’).

Stick to this timeframe as closely as possible.

Let the client know when time is starting to run out (for example, ‘I am aware that we only have ten minutes left together today …’).

Don’t finish on a highly emotional issue.

Be assertive if a new issue is introduced at the end of an interview Tell them that you haven’t time to explore this new issue right now but can make another appointment to do so.

Summarise what has happened during the interview before concluding.

If appropriate include a summary of plans for change/action.

Be supportive by showing a belief in the client’s ability to follow their action plan.

Ensure the client knows they can return.

Be honest about any unfinished issues, or issues such as dependency.

Finish as soon as goals are achieved—don’t go on and on.

At the end, don’t start a new topic by asking questions or reflecting content and feeling.


The most important thing to remember is that ending a session is a planned process and has to be controlled by the worker—many clients would be happy to stay and talk for hours!


Seek agreement on processes to be followed to address issues within scope of own abilities, skills and work roleOnce a client has told their story and you have a clearer picture of what their issues are it is time to work out with the client how you will work together to address these issues. How you work with them to address their issues will depend upon a range of factors such as:

client needs and goals

organisational policies and procedures

funding guidelines

government legislation and policies

your abilities, skills and work role.

Client needs and goals

The starting point for any intervention with a client should always be their needs and goals. We use the word intervention to refer to the things we do to help a client meet their goals. Any intervention plan we develop must be done with the client (and not to them) and should be based on what works for them, their values, their lifestyle, expectations, etc. If we establish a plan without involving the client in it we are setting both ourselves and the client up to fail. Plans are always much more likely to succeed if the person they are for has had a say in what is decided.

Usually once you and the client have identified their issues you would together discuss the various options available to address those issues. As the worker, you would always first ask the client what they think they could do to resolve the issues. If they were not sure or were not aware of any options, you, as a worker, would then provide them with information on all available options. When providing information about possible options it is essential to make sure that you do so in a neutral way that does not give away what you think they should do. Remember what we think they should do is not relevant here—it is all about the client and what is right for them!


Once you and the client have discussed all available options and explored the risks and benefits of each option, the client would then decide which option (or possibly options) would be best for them. This then becomes the starting point for working out together what processes you will put in place to implement the option. Processes can include counselling, skill development, referral, support etc.

Here is an example of how this might work. A client, let’s call him Sam, comes to see you as he is concerned about his alcohol intake. He reports that he tends to get drunk most Friday and Saturday nights and sometimes drinks so much that he has no real memory of his behaviour the next day. Together you explore his drinking habits such as when he drinks, who with, what, how, how much etc. You then talk about the alternatives available to him:

alcohol and other drug counselling at the local community health centre

implementing a controlled drinking program

going to Alcoholics Anonymous (AA) meetings

going into a detox and rehabilitation program.

After discussing the ‘ins and outs’ of each options Sam decides that he wants to see if he can control his drinking himself with some support from you. While alarmed by his drinking, he doesn’t at this stage see himself as having a real problem. You agree to support him though this process and talk about how often you can see him and how you can support him. You both agree to review how the plan is working in three months time and that if there hasn’t been a continued decrease in his drinking behaviour you will look again at the other options available.

Organisational policies and procedures

Often the organisation you work for will have policies and procedures related to working with clients. Examples of policies and procedures relating to work with clients include:

confidentiality and privacy

occupational health and safety (in relation to home visits, violent clients etc)

client rights and responsibilities

eligibility criteria (who can use the service)

fees and charges

time limits

intoxicated clients (can’t be seen if under the influence of alcohol or other drugs)

supervision


duty of care

running group activities (risk assessments etc)

job descriptions

referrals

complaint policies.

These policies and procedures will influence what you can do with your clients. With Sam, for example, you might have to see him at the office and not at his home, you might not be able to see him if he turns up drunk, you might only be able to work with him over six sessions and have to charge him a fee. All of these details would have to be worked out before you agree to support him deal with his alcohol abuse.

Funding guidelines

Most community based non-government organisations (where many community service workers are employed) are funded through a variety of government funding programs. To receive funding the community-based organisation signs a funding, or service, agreement which stipulates what types of programs they are going to run and how. Examples of funding programs provided through the Department of Community Services (DoCS) include Families NSW; Better Futures: Supported Accommodation Assistance Program (SAAP); and, Community Services Grants. All of these funding programs have conditions attached which will relate to how services are provided to clients. Under SAAP, for example, services must case-manage their clients. Case management is an approach to service delivery that goes through a number of stages from assessment to evaluation that is aimed at improving client outcomes.

Workers need to make sure that they work within the funding guidelines and only provide the services they are contracted to do or else the organisation could risk losing their funding.

Government legislation and policies

Funding programs usually reflect government legislation and policies. It is also usual for an organisation’s policies and procedures to be in line with government legislation and policies. Examples of legislation and programs that could influence our work with clients would be:

anti-discrimination legislation

disability, racial and sexual discrimination legislation

Disabilities Services Act 1986 (this then flows onto Disability Service Standards which regulate how services are provided to people with a disability.


the Aged Care Act 1997

guardianship legislation

child protection legislation

MERIT (Magistrates Early Referral into Treatment).

There are of course many other examples of legislation and programs that affect how services are provided and when you start working in our industry it will be important to find out which ones affect you.

If Sam, for example, after working with you for a couple of months relapsed and went ‘on a blinder’ and ended up committing a crime he might be able to apply to MERIT and then might have to be referred to a MERIT provider. This might mean that you would have to stop working with him.

Your abilities and skills

Finally how you will work with a client to address their issues will depend upon your abilities, skills and your work role. Clearly it would be unethical to work with a client if your job role did not allow it or if you did not have the required skills and knowledge. As a community service professional it is essential to work in a way that does not damage the client. If you don’t have the necessary skills or knowledge to work with a client you would have to refer them to another worker or organisation.

Sometimes you might not know about a client’s particular issue but still have the skills to work with a client. In that situation you would normally research the issue and seek support from a supervisor to ensure that you are working appropriately with the client. If you are finding that you are seeing more and more clients with a particular issue you might seek out training so that you can increase your skills and knowledge in that area—training in our industry is on-going and the need to learn new things never stops!


Work roles

Our work roles are outlined in a job description or duty statement and community services workers are expected to work within these job descriptions. Usually you are provided with a job description when you apply for a job or when you are appointed to a position. This document then becomes to basis for your work. While we might be tempted to do something outside our job description (because it looks exciting, interesting etc) we need to negotiate this with our supervisor. Often if we did perform roles that were outside of our job we would find that we would be


impinging on someone else’s job—and they most probably won’t be happy about that!

When planning with a client how we are going to meet their needs or help them resolve their issues we will need to keep in mind what our work role is and thus what services we are able to provide.

Make referral for conflict resolution and mediation as appropriateAs community service workers you will often find yourself in situations where you can’t provide an appropriate or on-going service to your clients. This might be because your agency policies state that you can only assess clients, or work with clients for a specified timeframe. It also might be because you don’t have the skills necessary to deal with certain issues such as child abuse, sexual assault, marital issues, loss and grief and so on. It is important to realise that acknowledging you haven’t the necessary skills isn’t a sign of failure but rather a professional assessment of your strengths and weaknesses. By referring a client on to someone who can help them with their particular issue you are effectively meeting your client’s need and thus helping them move a step closer to resolve whatever is troubling them.

As a general principle regarding when to make referrals, make them if:

you are in doubt of your own capabilities,

you’re over-identifying with your client

you know or suspect that another agency or professional is more appropriate for a particular client.

Referral means putting people in touch with services that have the resources to help them achieve their goals. It is not just about handing out a number. You are responsible for bringing the person and the service together.

When we make a referral, we are basically sending a person to another professional who specialises in working with particular needs or problems. Referring a client to another professional doesn’t mean that we stop working with that client but rather that we work as part of a team to best meet all that person’s needs.

Professionals to whom we might refer a clientExamples of professionals to whom we might refer a client are:


Doctors are trained to assess symptoms and make a diagnosis based on their knowledge and ability to understand the signs and symptoms that a patient is experiencing. Many doctors focus on particular areas of medicine and are called specialists. Specialists who often work with people with a disability are neurologists (brain and nervous system), ear nose and throat (ENT) specialists, ophthalmologists (eyes), orthopaedic specialists (bones), psychiatrists (mental health) and paediatricians (children).

Occupational therapists work with people on activities of daily living, and develop treatment plans to help people gain skills. They also assess what equipment and modifications to the environment might help people to go about their daily activities more easily.

Physiotherapists help people to gain more physical control of their bodies so that they can move more easily or improve their muscle control or strength. Helping people to use aids such as walking frames and crutches is another focus of physiotherapists as is teaching people how to prevent further damage to muscles.

Social workers work with individuals, couples, families, groups and communities. They work to empower people who are disadvantaged or marginalised in and by society. They provide specialist counselling, help people to learn new skills and strategies, and they attempt to make changes to policies and systems that traditionally disempower people.

Psychologists are trained in psychometric testing—this means that they can assess (using certain tests) a person’s intelligence or where they may be experiencing some damage to the brain. Some psychologists work in special schools and can provide educational assistance to children with a disability. Other psychologists specialise in counselling.

Podiatrists look after people’s feet. They treat feet problems as well as assess why people have certain problems affecting their feet. They may suggest (and make) orthotics (inserts that go inside shoes) unique to their patient’s foot or feet.

Orientation and mobility instructors teach people with a visual impairment the skills necessary to move safely about their physical environment. They may teach people how to use a white cane or a guide dog as well as how to use other mobility aids.

Audiologists assess whether or not someone has a hearing loss, what type of hearing loss they have and the degree of loss.

Employment consultants assist people to locate and maintain employment.


TAFE teacher/consultants support students to access and complete their studies at TAFE.

As a worker in this industry it is vital to get to know the range of agencies out there so that you can give the best possible service to the person you are working with.

When to make a referralUsually you would refer the person who you are working with to another professional when:

the client asks you to

you need specialised information

you do a needs assessment and realise that they need specialised assistance to make sure that their needs are met

your agency does not provide all the services that they need

you are concerned about their physical, social or emotional state or well-being and want a specialised opinion or intervention

there is a change in a person’s physical, emotional or social situation and you need a specialised assessment to get new, different or more services

the person is moving to a new area and needs to be linked to new workers and agencies

you have ethical concerns about working with an individual and believe that someone else would be able to provide a more suitable service.

It is really important to remember that we do not refer clients because we have had enough of them and are finding them difficult to work with. While this is always a tempting option, especially when times are tough, it is not fair to the person and will not help them or their situation. It is much better to try and sort out why problems are happening and what can be done to help rather than ‘passing the buck’.

Steps in making a referral


Graphic: identify the problem, assess the data, identify and assess potential solutions, make the referral

How to make a referral

The following list of things to remember should help you when you are making referrals for a client:

1. Make sure you know what policies and procedures your agency has for making referrals.

2. Always know the agency or person to whom you make the referral. Don’t send a client off to someone or some organisation you know nothing about. Remember, your clients will probably already be feeling anxious about seeking help, so to send them on to an ‘unknown’ will no doubt increase their unease.

3. Contact the agency or worker you are thinking about referring your client to and see who their target group is, what services they provide and what their criteria for access is (that is, who they will accept and what information they need). Don’t give out any identifying details about your client at this stage.

4. Explore the readiness of your client to be referred. Open and honest discussion about referral and the reason for it will enable your client to feel more in control of the situation. If there is a choice of services available, make sure your client has information about each service and can make an informed choice for themself.

5. Discuss the possibility of referral with the other organisation or person before suggesting it to your client. Of course, you need to do this without breaching confidentiality. If you don’t check out the possibility of referral, you may have encouraged your client to move on, only to discover this is not possible.

6. Explore with your client where she or he may have already sought help. It’s no use referring on a client who has already been on the ‘merry-go-round’ of agencies. This would be extremely disempowering.

7. Talk with your client about the fact that you want to refer them to another worker or agency and why. Give them some information about the new agency or worker and give them time to ask questions and talk through the referral process.

8. Be very aware of confidentiality issues. Get your client’s consent for you to contact the agency or worker and give their details to the new worker. Remember that they must give informed consent (know


what it is that they are consenting to and the consequences of giving such consent).

9. Let your client make the appointment, rather than making it for them. Again, this is more empowering.

10. Help prepare your client for their first appointment—talk through with them what information they will have to provide, how to get to the appointment and what they will have to take (if appropriate). Some clients may want you to go with them as an advocate or as support.

11. Maintain your relationship with your client until the referral process is complete. It’s no use, for example, referring a client to an organisation for an appointment in six weeks time and then leaving them without support in the interim. Sometimes, it’s useful to continue support work with a client even though they may be receiving other services. This type of collaborative work is often useful in community services work as each worker has different areas of expertise that they can offer a client.

If the relationship between you and the client is particularly difficult or tense you might not be able to do all of this and you might just give them information about what other services are available. Regardless of how difficult things might be between you and the client it is important to remain professional, respectful and polite at all times, even though you might not want to!

Remember that every referral you make should be aimed at improving the person’s quality of life and opportunities for increased independence. The referral process should be aimed at empowering the person so remember to give them as much information as is appropriate to their level of functioning and allow them to do as much as possible for themselves.

To ensure that you meet your duty of care and professional requirements make sure that you document everything that you have done. In the case notes you should provide an objective summary of what happened and why and what you did. So if a complaint is made you will have all the information necessary to show what you have done and why.

The referral letter

When you refer a client to another service you will need to write a letter of referral. The referral uses the parts of a letter combined with the introduction, body and conclusion of a report. The headings ‘introduction’ and ‘conclusion’ are not usually used; however, section headings are frequently included. Using a letterhead means that the report is written by you, representing your service.

Example of a referral (.doc 45 KB)


Writing a good referral takes practice and the task becomes easier the more you write. Some good advice to new report writers is to spend time planning because this will save you time in the long run.

Referring clients when there is a conflict Often as community service workers we have people come to see us who are in conflict. This conflict can be within families, within neighbourhoods, at work, with friends etc. There are times when conflict can get out of control and the people involved are unable to resolve it themselves or we are unable to work with them successfully. When this happens it is time to seek help from qualified professionals or community service agencies which provide conflict resolution services. There is a whole range of agencies that can help when a conflict gets out of control, including unions, non-government agencies, advocacy support services, private consultants, mediators and counsellors.

At the moment governments are focusing a lot of resources on mediation services. This is because they recognise that when people are in conflict they find it hard to resolve their differences properly and either resort to violence or the courts. Neither option is great or that helpful! As a result there are more services available to refer clients to and a greater acceptance that mediation is a useful process for people to go through.

Identifying specialist conflict resolution and mediation services

How might you go about finding specialist conflict resolution and mediation services available in your local area? You could:

ask another worker or someone you know who works in the industry

contact your professional association

look up a community directory or data base.

If you want to use a professional or agency to help you resolve a conflict or to refer conflicting parties to, always check them out first. For example, do they use qualified people, are they a recognised service, do they have well developed policies and procedures, and are they approachable? You will also have to consider cost and accessibility. Never call in a professional without doing your homework first.


Referrals and confidentialityAs well as maintaining confidentiality within the agency, it is essential to ensure that client privacy is protected when referring clients to other organisations.

Services should ensure with all referrals, that appropriate and accurate information is provided. The only information that needs to be shared is basic contact details for the client, the reason for the referral, the extent and nature of your involvement with the client and your role in the future.

This means sticking to facts and keeping your opinion and any judgemental comments to a minimum. Let the worker meet the client and form his or her own relationship without influencing the worker’s perception by your own experience or opinion.

Under the Freedom of Information Act, clients are within their rights to request to see their client file. Any written correspondence in relation to the client is kept in this file. So, if you have written a referral letter for a client that you would not want them to see, think about why.

Have you stated something that is making a judgement on the client (such as ‘the client is unmotivated’)?

Have you referred to some aspect of your involvement with the client that you have not discussed with the client (such as ‘the client didn’t get on with other clients while in our service’)?

It is much more appropriate to share the client’s perception of their difficulties with other workers, than your own opinion (which could be deemed biased).

The golden rule is, wherever possible, work in close partnership with your client, initiate the referral together and agree on what information needs to be shared.

However, another important consideration in sharing information is not withholding information that the service should know, if they are to fulfil their duty of care to the client and other clients within the service. For instance, if your client has a violent background (they may have been charged by Police), and you are referring them to an accommodation service, then the service has a right to know that information. This is for the safety of other clients in the service. Similarly, if your client has a mental illness, the service may need to know so they can ensure the client receives adequate care and access to a specialist service if required.

Client permission must be gained (preferably in writing) before sharing information. It is a good idea to discuss with the client what you are going to talk about with the other agency. Also, be sure that the client understands the policy and criteria of the service to which they are being referred.


This would be a good time to attempt Activities 22, 23 and 24.

SummaryCongratulations you have made it to the end of this topic. This has been such a long unit because it has contained the essential skills we need to use as community service workers if we are to effectively work with clients. In this topic we have explored issues such as trust, how to develop a helping relationship from the first contact. We looked skills such as attending behaviour, active listening, paraphrasing, reflecting feelings, summarising, asking questions, focusing and encouraging concreteness and specificity. We ended up exploring what we need to consider before agreeing to work with a client and finally how to refer a client if we couldn’t work with them.


clips word template - sielearning · web viewour job doesn’t involve telling the client what to...

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