Client Worker Relationship

Question 1

“Not-knowing stance”

Answer 1

A) not trying to provide clients with “insight”
B) focusing on and validating the clients experience in the here-and-now (vs. pointing out connections to the past, including early childhood experiences)

Question 2

Collaboration

Answer 2

Between client and worker is the key (metaphor of sitting side-by-side)

Question 3

“Elephant in the room”

Answer 3

Watch out for the feeling bored, perceiving clients statements as trivial, operating on autopilot, feeling flat, rigid, out of contact

Question 4

“Quick fix thinking”

Answer 4

Wishing to DO something (lists, coping strategies), giving practical advice (to soothe workers own anxiety)

Question 5

“Inside-out thinking”

Answer 5

Puzzlement, confusion, excessive nodding, not sure what to say, anger at the client

Question 6

Mentalizing response

Answer 6

A) to be authentic

B) to openly admit ones own feelings and responses in the moment (Irwin- spirit of curiosity)

Question 7

Realistic attitudes and responses

Answer 7

Fear, involuntary clients, effects of prior knowledge, expectations based on differences between client and worker, workers manner, workers reactions, diagnosis understanding, understanding suffering, counter therapeutic responses, sharing worker reactions, worker reactions as a diagnostic tool, hard to counter therapeutic slips, positive feelings

Question 8

Unrealistic attitudes and responses

Answer 8

Early life transferences, displacement reactions, transference, counter transference, importance of worker self-awareness of own issues

Question 9

Early life transferences

Answer 9

Clients unrealistic or transference reactions mean that the client displaces on to the worker feelings or attitudes originally experienced during early childhood toward a family member - usually a mother or father - and act as if he or she were the therapist.

Question 10

Attachment Theory

Answer 10

Although attachment theory is not a theory of psychotherapy in and of itself it has several important implications

Secure and insecure attachments

The developmental consequences of biological differences at birth (temperament)

Parenting can over-ride temperament

Question 11

Borderline disorders

Answer 11

Disorganized attachments

Question 12

Conduct disorders, substance abuse, narcissistic, and anti-social

Answer 12

Dismissing attachments- cognitive/thought-related

Question 13

Affective, OCD

Answer 13

Pre-occupied attachment- affective/feelings-related

Question 14

Attachment issues in the therapeutic relationship

Answer 14

• pay particular attention to transference issues
• be aware of the therapists own attachment style on the therapeutic process
• be tuned in to any kind of attachment style in male and female clients, but very few gender differences found (secure, avoidant, ambivalent)
• very few wide ranging studies have been done on culture and attachment

Question 15

Displacement reactions

Answer 15

Are you looking for me to tell you what you should do?

Question 16

Identifacatory transfer

Answer 16

The client treats the therapist the way they were treated by a central figure in their early lives

Question 17

Transference

Answer 17

Negative or positive feelings transference can play an important role in the treatment if addressed properly

Question 18

Transference

Answer 18

• exists whenever there is a relationship
• expectational set derived from earliest experiences of the infant with the crackers
• it may be continuously enriched and strengthened so that the individual responds to new relationship with hope and the capacity for productive interchange or ..
• it may be based on deprivation and inconsistency, resulting in despair and distorted expectations leading to conflict and disruption

Question 19

Transference and the client

Answer 19

“It is one thing that an individual to achieve increased awareness of his transference needs and wishes. It is another to be able to communicate these needs and wishes in place of responding to hurts and slights with feeling states and behaviors which distance him/her from others”

Question 20

Countertransference

Answer 20

• the therapists reaction to the realistic and unrealistic transference of the client
• the playing out of intra-psychic conflicts in the therapeutic relationship constitutes the transference…
• the therapists reactions to being the target of expectations, wishes, and fantasies derived from past experiences constitute the countertransference

Question 21

Importance of workers awareness of own issues

Answer 21

Irrational reactions can interfere in the therapeutic process. It is important to get supervision, consultation, peer support to find your issue areas. It may even be necessary to consider your own personal therapy.

Question 22

10 things of which every social worker should be self-aware

Answer 22

Vulnerabilities, triggers, prejudices, urges to rescue, deny pain, over-identity with trauma, intolerance of the symbiotic urge to merge, irrational fear of clients, imposing own agenda, loss of interest when client progress is lacking or slow

Question 23

Mentalizing

Answer 23

“Holding heart and mind in heart and hand” (Peter Fonagy); or being aware of ones own thoughts and feelings and another’s thoughts and feelings (Jon Allen) – and this is the foundation of all good human connection, including all good therapy.