HHS310: H & HS Culture: The Helping Relationship (CGD1716A) Wk5

Getting It All Together

No man can reveal to you aught but that which already lies half asleep in the dawning of your knowledge. The teacher . . . gives not of his Wisdom but rather of his faith and lovingness. If he is indeed wise he does not bid you enter the house of his wisdom, but rather leads you to the threshold of your own mind. —Kahlil Gibran, The Prophet (1935) And from here on in, you take it yourself! he above quotation from Kahlil Gibran’s he Prophet speaks to the learner as well as the teacher. here comes a point at which learners must take responsibility for integration within themselves of all that they have acquired—the values, the knowledge, and the skill—and for use of the total self in the practice of human service. We are a people still strongly under the influence of the work ethic. he person who works is virtuous; the person who does not is without virtue. For many, work provides not only the means of survival but also becomes the basic reason for living, and mandatory retirement becomes a veritable death sentence. People choose the human services as their work for many and complex reasons. hey may enjoy transactions with other people; they may have a strong ethical commitment to ensuring a good life for all; they may use relationships with clients as a way of dealing with their own personal problems; they may enjoy having power over others; they may find the challenges and difficulties intriguing; they may want the reward and prestige; they may just want any job.

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that they cannot avoid involvement of self in their practice. An abiding sense of moral responsibility and a willingness to face and come to terms personally with basic issues involving people are essential (see Figure 12.1). his moral responsibility is all the greater because it is well established that, even in the most controlled experiment, the situation changes when there is outside intervention. Workers do not stand outside of the system—individual or group—but become, in a sense, a part of it, affecting the balance and facilitating the changes; at the same time, they must retain objectivity about the system. Workers who are clear about themselves and what they bring with them are able to deal with this dual demand of human service. Workers must know where they stand in regard to crucial issues that are a part of the times, such as the breakthroughs in genetic engineering that are taking place; the question of who in an expanding population shall share diminishing resources; who shall be permitted to live—or die—when that choice is made; what is the responsibility of society for its deviant members, for those who cannot make it alone, and for those who are “different.” Societies and individuals have always faced such concerns, but modern society not only has increased the reach of people immeasurably but at the same time faces the dilemma of a shrinking world in which interdependence is essential to survival. We realize as never before that all living creatures on this planet are one, that all of us are affected directly or indirectly by what happens elsewhere in the world. A good example of this is the chaos in other parts of the world leading to illegal and legal immigration to this country. We live in an international information society that enables us to share knowledge about, to understand, to make use of, and to influence events that affect all of us. his

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society demands expertise on the part of human service workers in accumulating, storing, retrieving, and making use of such information. It is estimated that half of all workers will be involved with such activities in the future, requiring additions to the knowledge base of practice, increased skills, and changes in point of view. A philosophical stance enabling workers to understand themselves in relation to this changing world and its demands is as much a part of the preparation for practice as theories, techniques, and resources—for in human service, the knowledgeable self is the worker’s most important resource. Such stances are neither cast in stone nor attained overnight. hey will change with changing times and increasing maturity of the workers, but there must always be a solid underpinning of commitment to people and their welfare. In one of the classics dealing with the spectrum of possible philosophical approaches to a changing world, he Yogi and the Commissar, Arthur Koestler (1965) positioned the yogi and the commissar at opposite ends. he commissar, at one extreme, believes that change can occur only through external forces such as a revolution or a radical reorganization of the economy. He further believes that any means necessary, even those that are illegal or immoral, are justified to achieve change. In this world view, the objective, mechanistic, and logical forces of nature are the primary forces driving the universe, and those who do not accept this perspective are escapists. At the other extreme is the yogi who believes that all change happens as a result of individual efforts and introspection, that all violence is rejected regardless of the circumstances, and that the means for achieving change are all that matters. he yogi believes that those who do not ascribe to this viewpoint are escapists. Human service workers tend to swing as on a pendulum between the yogi and the commissar. Extreme proponents of both theories exist, who apparently never realize that one leads into the other and both are essential. Somewhere along that continuum, workers need to find a place for themselves, a place that is compatible with their own basic philosophical stance. Such compatibility can go far in enabling workers to survive in what can only be described as a high-risk profession. Human services cluster along the cutting edge of change, and such interfaces are always characterized by conflict. The work itself is often frustrating not only because of the infinite number of variables involved, the pressure of human need and the emotions that exist around it, but also because of the frequent difficulty in seeing both immediate and long-term results. he incidence of what we are calling burnout is very great.

Burnout

Burnout is a word that is currently used to describe a condition that has always existed. Britannica World Language Dictionary describes it thus: “To become extinguished through a lack of fuel”—with people, this is literally what happens. For a variety of reasons, workers no longer possess energy for their work and no longer find enough satisfaction from it to balance the disadvantages. The stress that results from being in such a condition, particularly when the worker can neither fight nor flee (the normal reactions to stress), may manifest itself in physical or emotional illness or addiction, in anger

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toward clients and/or the bureaucracy or supervisory staff who make demands, or in inefficiency in one’s work life and problems in one’s personal life. Workers experiencing burnout may end up abandoning the job and seeking other employment, often regardless of their commitment to it. As always, prevention is better than cure. Workers should start out by being aware of the unique sources of stress their chosen work holds. hey must be alert to the onset of such problems and prepared to cope with them. hey must be receptive to both comments and behaviors on the parts of clients, colleagues, and family members who may perceive the beginning symptoms early. These sensitivities are a part of the ongoing self-awareness essential to human service practice. here are specfiic things that workers can do to armor themselves against burnout and to deal with it, if and when it comes:

1. Maintain awareness of the changing social climate and a realistic evaluation of its impact on people—including themselves.

2. Be committed to securing both basic and ongoing learning about their work.

3. Select the field of practice that interests them, that they enjoy, and about which they are motivated to learn more.

4. Learn to manage their individual workloads efficiently and responsibly and to work with their colleagues.

5. Possess and maintain a personal value system consistent with the value system of human service, even if its tenets may run contrary to accepted social values.

6. Find a personal lifestyle sufficiently satisfying to enable them to distance themselves from their work. he cultivation of these six areas in the lives of workers provides what, for lack of a better word, can be described as professionalization—the process of learning and being imbued with the method, manner, and spirit of a particular kind of work.

Without such professionalization, workers are much more vulnerable to burnout, to being ineffective and feeling powerless, to leading the “lives of quiet desperation” that come from being caught in jobs that have no real meaning for them.

Being Aware of Social Change

There are two kinds of social change to which human service workers need to be alert. The first consists of those trends described in Chapter 1 that are a part of the developing social order. Workers must be sufficiently in touch with what is happening to assess realistically its meaning and its impact on the lives of their clients—as well as on themselves. These changes affect social values, attitudes and behaviors, the existence or nonexistence of resources, and the sanction of the service being provided. Sanction of human service is expressed through clients by their use of the services, by the society at large that licenses them, and through private and public funds that support their operation. Such sanctioning changes with the changing society. The second kind of change is that which workers themselves attempt to bring about in order that the needs of the people they serve will be better met. This includes

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attempts to change policies and programs in specific areas; to educate people about what is needed and what is possible; and to develop and use power through political, professional, and social organizations to facilitate changes. In attempting to bring about changes in the status quo, there is always an element of personal risk involved. One student commented, “The bottom line is my responsibility to my wife and child. I’m not going to rock the boat and lose my job.” But there must be boat rockers if we are not going to stagnate. Workers must be very realistically oriented in approaching this aspect of their work, first assessing needs, alternatives, and methods, as well as risks. It is important to survive in order to fight another day.

Securing Basic and Ongoing Learning

Regardless of the level of education and practice to which workers aspire, it is essential that they be committed to both basic and ongoing learning. Earlier it was stated that workers must bring to the job both generalized and specialized knowledge, the generalized being that which all people in human service work need to possess and the specialized being the specific knowledge and skill needed in a particular field. Regardless of the level, workers should be committed to the development of knowledge and the improvement of practice. Creative thinking does not require a PhD; the ward orderly whose responsibilities and rewards—and educational requirements—are probably low on the totem pole is as capable of coming up with ideas and procedures that will improve service as is the highly trained researcher. Creative thinking can be visualized as a four-step process:

1. Laying the groundwork. his involves acquiring the essential tools of knowledge and skill that provide the how-to for thinking and the means to stimulate ideas. his must be a continuing process, for knowledge changes and accrues. It is important that workers know how to use research to find the many good ideas that lie hidden behind terminology understandable only to other researchers. Workers should also become competent in use of modern technical apparatuses, such as computers, that have enabled us to stretch our reach and consider alternatives on a much broader level.

2. Mulling over the possibilities. In this, the thinker steps back from the assumptions made earlier and tries to look at the totality with new eyes. his is a dynamic activity, as new input from knowledge and experience is constantly being added and must be considered in various combinations.

3. Achievement of insight into new possibilities for dealing with old problems. Oftentimes this occurs in an instant lash while engaged in some apparently unrelated activity, such as playing, doing routine tasks, or reading unrelated material.

4. Testing of the idea with the intent of verifying it and putting it to use. If the idea proves to be valid, it must then be made available to the people who can use it. his kind of thinking adds to our knowledge of people and how to work with them and to the creation of new resources for the betterment of the human condition. This

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kind of thinking is vital not only to the practice of human services but also to the welfare of all. It can be used by workers on all levels of education and practice.

Selecting a Field of Practice

Selection of a field of practice with which the worker is most compatible is of great importance in preventing burnout—and just as human problems are endless, so are practice opportunities. Sometimes, the choice can be made after workers have gotten their basic training and perhaps some experience, but there are those who know from the beginning where their interests lie and plan their study accordingly. A major part of the decision is choosing whether to work toward the creation, administration, and maintenance of essential social resources or to work directly with people in dealing with personal concerns. On either level, the work can involve finding solutions for existing problems or the enrichment of the quality of lives that are already fairly adequate. Many workers choose to go into private practice and become counselors, therapists, or consultants after securing additional specialized training. Many prefer to work with an established agency or group. Opportunities exist for both, and change is always possible as new areas open up with both additional learning and social changes. the challenge for workers is to find the place that suits them best and to try to avoid getting locked into a situation that is not satisfying.

Managing Workload

The most important factor in managing workload is that workers place themselves at the level of expectation where they can be most comfortable and competent. The human services are rampant with ineffectual administrators who have the capability of being effective clinicians, therapists, direct service practitioners, technicians, or support personnel. It is understandable that they move into administration because of its greater rewards and prestige, but hypertension is a high price to pay for such achievement. Mature workers who are self-aware will not put themselves in a position where they are good candidates for burnout. Learning to manage workload efficiently is one of the best ways to avoid burnout or to deal with its existence. Workers must step back and take a look at their workload, reevaluate and reorganize it so they can handle it better, and feel that they are in control. Realistically, in human services there will be emergencies that will throw the best of schedules into disorganization and take all available time in any given work period. Sufficient flexibility must be built in to handle these crises, but looking at the totality will make such upsets not only less likely but also less taxing and disturbing. he best way to handle workload is to use the management-by-objectives model, which is nothing more than a common sense, orderly way of thinking and planning, much like the problem-solving process. his is generally visualized in six steps:

1. Setting of goals: What you would like to do—the ideal attainment in your job

2. Setting of objectives: he visible, tangible, concrete, and doable things

3. Activities that must be done: Tasks—what must be done to reach these objectives 4. Working out a plan: Strategy for performing these tasks

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5. Budget needed for these tasks: he numerical needs in terms of time, people, and resources

6. Evaluation of what has been done: How things are working—well or badly—and how they can be changed

Workers are prone to say they do not have time to go through this process—actually, they do not have time not to. In the long run it is not only a tremendous time-saver, but it also pushes workers to establish priorities by looking at what is most important and the order in which things needs to be done. In addition to the practical usefulness of such thinking ahead, it helps deal with that intangible psychological downer that is the source of so much fatigue and ineffectiveness.

One aspect of the workload that is a frequent source of frustration for workers committed to human service and who want to be up and doing involves accountability for what is being done. his usually assumes the form of some kind of ongoing record. his is not only a practical necessity; it is also an ethical responsibility. Good practice and good recording are inseparable. Agencies and institutions providing human services are constantly in the process of developing new instruments for collection, storage, and retrieval of data, but in spite of this, it remains a time-consuming aspect of the job.

ACCOUNTABILITY AND SANCTION

Accountability in human services involves being responsible not only for what is actually being done but also for improving the quality of what is done. Implementation of this need for accountability requires constant evaluation and reevaluation of the structure, program, and policy of the various social institutions planning and delivering service, of the practice of the workers delivering the service, and of the results, both short- and long term, of the service. It requires the development of forms, instruments, and procedures used in collection and evaluation of data; it involves critical analysis of the forms, procedures, and instruments themselves; it requires a flexibility of workers and institutions that enables them to both know and use new ideas and procedures that are being developed. Accountability in human service exists on three levels: (1) to the clients, users, or consumers of the service; (2) to colleagues and to the organization or agency; and (3) to the society that sanctions the entire operation. Clients who use the services, laws authorizing the existence and support of programs, and lay people who help to support and serve on boards and committees and act as volunteers in the programs are all expressing sanction. Sanction is also expressed through licensing, certification, and membership in professional organizations, which are designed to ensure competence of workers and responsibility of institutions and to protect both the consumer and the public at large. Here, there is a possibility of conflict of interests, particularly if professional standards and agency practices do not jibe. For example, some of our large public welfare program workers may be called upon to use procedures that they perceive as detrimental to the interests of the client. A consultant at the local Social Security office, called in to deal with the low morale of the staff, learned that when a computer error on a national level caused delay in mailing of checks, workers were instructed to make calls for clients to

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regional offices with full knowledge that such calls were ineffectual. Such procedures, born perhaps out of desperation and efforts to bring pressure for change, were directly contrary to the ethics of the workers and not of help to the clients. Equally, referring clients for mandatory job training programs to develop skills in areas where there are no jobs would be considered unprofessional and poor practice.

ACCOUNTABILITY WITHIN THE SYSTEM

Accountability to colleagues, the employing agency, and the total service system of which the worker is a part involves responsibility for cooperative endeavor within the system itself. It cannot be emphasized too strongly that this overall concept of accountability involves not only responsibility for things as they are but also for improving the quality of what exists and what is being done. his means that data must be collected that can be used in research to enable better understanding of the human condition and more effective practice methods. he individual worker is responsible for maintaining a record of the basic data needed to evaluate what is being done and what needs are unmet. Such data can be secured by (1) observation, (2) interviewing or discussion, and (3) use of questionnaires or some other devices for securing valid information. For many workers, except those actively engaged in research, the day-to-day recording of information is the bête noire of practice. he whole question of how best to secure and store data so that they are not only valid but also usable is yet an unanswered one. In order to serve their purpose, data must be brief (the cost of maintaining records is a large portion of any budget), accurate (although allowances must always be made for the fact that data are filtered through the recorder), and available without too much effort or the consumption of too much time; they must also possess a degree of uniformity that allows for comparison and statistical accounting. A major concern in the collection of data and the keeping of records about people is the individual’s right to privacy and the whole question of confidentiality, of which people are properly assured when they are involved with one of the human services. he legal right to see personal files is assured. here is increasing openness about the fact that information is recorded, and there is shared knowledge of the manner in which it is to be used. Clients are entitled to this knowledge and to the assurance that such information will not be used irresponsibly, without their knowledge and consent, or for purposes other than those agreed on either tacitly or by written contract. It is important to remember, however, that because of the extensive review process inherent in managed care, confidentiality is not an absolute. Many different helping persons and services are involved, review committees are an increasing part of the effort to assure quality of service, and information must be shared widely. While there is currently much greater openness in discussing personal problems, most people still have a need to keep certain information private. his again is one of those issues in which individualization of the client—helping the client to understand and accept the need to give certain information, how it will be collected, and how it will be used—is a basic essential of good practice. Involvement of the client in the collection of data is important for another reason— the meaning of the data to the client—which is often just as important as the bare facts

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themselves. he extent to which it will be necessary for the worker to know this meaning will depend, to a large degree, on the nature of the problem and the kind of service needed. Feeling is fact, but the amount of feeling that must be shared varies greatly. For example, the fact of a divorce shared with a lawyer will be quite different from that fact shared with a marriage counselor. his again is an area where we can say that the client has the right and need to be involved to the extent that is necessary in the individual instance. In addition, the worker must learn to differentiate between observation and inference in gathering and recording data. One definition of observation (Britannica World Language Dictionary) is “scientific scrutiny . . . the record of such examination and the data connected with it.” Inference, on the other hand, is defined as a “deduction,” a “conclusion,” a “conjecture.” Too often, workers record inferences based on what they think observation means rather than the actual observation itself. At this stage in the development of our knowledge regarding the human condition, inferences can be little more than “scientific guesses.” Whether the material recorded is being used for evaluation, for diagnosis, or for research, it needs to be an accurate observation rather than an inference of the meaning of that observation. To attain the maximum degree of efficiency in the use of self in working with people, workers will usually need to record on two levels: (1) for personal use; and (2) for use by the employing agency and through it by the overall social system. Some of the major uses of recording are for personal improvement, for education, and for supervision of workers. For this purpose, the worker may choose to record the actual content of the interview, discussion, or meeting either on tape with the client’s permission or by dictation so that it can be scrutinized and evaluated to improve both understanding and practice methods. While the form of such recording may vary, content should generally include:

1. Data identification

2. Purpose

3. Observation

4. Interaction

5. Evaluation

6. Worker’s role

7. Future plan

Obviously, this recording tends to be lengthy and expensive, and except for teaching agencies, it is rarely used for an entire caseload for permanent files. It is extremely useful, however, for both beginners and experienced workers, particularly if they have good consultation available, as a way of looking at the reality of what is happening between worker and client—whether the client is an individual, a family, or a group. In the management of the job, workers usually opt to keep a day sheet or log. his is mandatory in some agencies. Sometimes printed forms are developed for this purpose; sometimes the individual worker devises a personal form. These can be used to plan work, as a basis for the preparation of permanent records, as a source of agency statistics and reports that serve to justify programs and expenditures, and for improving the

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quality of work as well as keeping people informed of what is being done. he human services depend on public support, and such support can only be secured and maintained if the public is accurately informed in a way that they can understand and appreciate. he worker supplies the raw material from which such interpretation is made, as well as information from which studies are planned and carried out. Workers not only need to record their material accurately and usably, but they must also be sufficiently aware of these two programmatic needs—evaluation and public information—to be constantly alert to trends, problems, and possibilities that can be used for either of these purposes.

Maintaining a Personal Value System

Each individual has a personal value system that serves to define what is important, determines goals toward which efforts are directed, and sets standards for acceptable ways in which these goals can be realized. Human service is based on its own set of values, which have both a moral and a pragmatic connotation. For example, not only do we value as a moral imperative the integrity of individuals and their right to self-determination, we also know that this is the most effective basis for enabling people to realize their full potential for development and contribution to the welfare of a democratic society. People entering human service need more than to be aware of their personal value systems; they also need to be able to assess the consistency of their value systems with those on which the human services are based. The harboring of internal inconsistencies does not lead to personal or job satisfaction or to mental health. he best human service workers are whole people who can then work with others to help them attain wholeness. Achievement of such wholeness, such internal consistency, is possible and attainable. Workers may not start out with this integrated, interrelated entirety, but through the acquisition of knowledge and experience, through sensitization to a real understanding of the human condition, they can develop it. hen, instead of working in order to survive, they can find the joy and personal fulfillment in their jobs that is the unearned increment of the human services (see Figure 12.2).

Developing a Healthy Personal Life

Since Selye did his original work with the concept of stress some 60 years ago, the idea has grown and developed extensive ramifications. We know that stress is a normal part of life and that the changes that accompany it serve the purpose of gearing us up to deal with a demanding life situation. We also know that stress makes heavy demands on the total person and can require adaptations that may be overwhelming. We know that stress in one life area—physical, intellectual, emotional, social, or spiritual—affects the total person. We know that ordinary events in daily life can be stressful. Job burnout that is the result of stresses that workers are unable to cope with cannot be confined to the workplace—it affects the personal life as well. A healthy personal life is the best armor possible for enabling workers to deal with stresses on the job. Attaining it is a lifelong process because people change, develop, and grow as the years pass. Modern thinking about people puts great emphasis on the concept of total health. We have stress medicine, which emphasizes prevention of illness and the relationship

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among illness, stress, and the adaptation process. We have to work toward the healthy body through exercise, yoga, meditation, and proper nutrition. We ascribe importance to the examination and development of the emotional and spiritual life as a part of this totality, and we know that lack of intellectual stimulation can be as stressful as too much. Awareness of these trends is sufficiently a part of the total public thinking so that there are resources available to individuals who wish to work toward better adaptive ability. Workers who are caught in the familiar modern dilemma—where they can neither effectively fight job pressures that are intolerable nor lee from them due to personal or economic reasons—will need to develop the strength of their total healthy selves in order to cope. Summary The human condition ensures that we will never attain a problem-free existence, but in the struggle, itself lies opportunity for growth and development. There are no greater challenges or satisfactions than those derived from work with people. There is no occupation that has greater importance. Workers who continue to study, to learn, and to use the insights they gain will

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