Chapter 6: Clarifying Who Owns The Problem

In any scenario, key to fixing a problem is knowing exactly what the problem is; part of knowing what the problem is is knowing to whom the problem belongs. According to the author of the text, this is the easy part: It is the person whose needs are not being met.

Aside from the obvious, there are 3 main reasons that knowing who owns the problem is a good idea:

1. You will know who is responsible for solving the problem:  By having a clear understanding from the beginning of who is responsible for solving the problem, you prevent yourself from taking responsibility and setting in on trying to solve everyone else's problems.  The job as a helper, therapist or case manager is to facilitate change, not to further hinder the client by solving their problems for them.  
2. Meddling is disrespectful:  When you try to take over and solve the problem for the client, you send the message to the client that you do not trust their ability to solve their problems.  It also conveys the message that you are the only person with great enough insight to understand them and know what is best for them.  This is, at the very least, disrespectful, but it also further hinders the process of change and greater independence.
3. The client loses opportunity to grow:  If you take over the situation and solve all of the problems for them, you rob the client of the opportunity to experience real growth and change; there is a difference in an ability to say "I did this" and "my case manager did this..." Which one seems the most empowering to you?  A no-brainer, huh?

When your client comes to you, be a sounding board; offer insight, ideas, and even alternative points-of-view but allow the client to remain in charge.  It is essential to their healing process that retain authority over their lives and their decisions.  As a good case manager, therapist or helper, while it may seem counter-intuitive, your job is to work yourself out of a job.  Clients should,

 eventually  learn to problem solve on their own and gain the power. strength, insight and

wisdom to be able to do so rather than relying on you to solve their every problem.

If the client owns the problem:

Hands off is not the answer.  Just because the client is the one owning the problem does not mean that we are not to offer any help at all.  In fact, a "wise" case manager, helper, therapist will know when to help less and when to help more.  it is a delicate boundary, but one that must be tended to carefully to ensure that we are providing the most help possible to our clients without causing any further damage.  It is easy to feel as though we are not doing enough or that we are insensitive or uncaring.  But frame the concept correctly:  we are not refusing to help the client because it is their problem not ours; we are utilizing a little bit of tough love.  We allow the client to participate in the planning and execution of their solutions; we allow them growth potential and independence while all the while respecting their privacy and self-determination.  The process is collaborative and the level of help given needs to be a strategic decision; based on the individual client, determine to what extent the client is able to handle their problems alone.  Remember that this will not be set in stone, the client will likely prove you wrong by needing either more or less hands on help; but keep in mind through this dance that above all, you need to ensure that the growth potential for the client is not being hindered because of the amount you are helping.  Your job, at the very least, is to be a valuable resource to your client; know the system and what is available within the system to help your client.
If you own the problem:

As in all human relationships, including helper/client or case management relationships, we are not immune to having a problem.  What if you are a stickler to schedule keeping and you have one client that always comes in 10 minutes late, throwing your whole schedule off?  Who owns the problem?  The person whose needs are not being met. The problem, then belongs to you, the case manager, because you are the one feeling the negative effects.  Because it is your problem to own, it is your responsibility to fix the problem.  Talk to the client about the problem that you are experiencing as a result of their behavior.  The client my not take steps to implement the change that you are requesting, but you have taken the first step in solving the problem by owning the problem!

But what if both you AND the client share joint-ownership?

There are situations that can arise in which both you and the client have needs that are not being met, at which point you both own stake in the same problem.  In this situation, collaboration with one another is very important, as is your willingness to negotiate and find some middle ground.  Never view this situation as a win-lose scenario and help the client view it in alternative ways as well.  There are solutions and compromises out there to help in every situation, you just have to be willing to step back and find them.  You will both have to own your part of the problem but solving the big picture can be done.

What are other's saying about this?

I came across an article just today that I thought was pretty relevant to this topic.  While we have focused on owning the problem in a therapeutic setting, we have neglected to discuss the idea of owning the problem as a life lesson that should be taught by parents to children.  This article, Teach Kids Problem Solving Skills, discusses the importance of teaching our children to own their own problems.  There is undeniable growth potential in teaching children how to recognize, own and remedy a problem.  That is not to say that they have to go it alone.  No, the real beauty in this article lies beyond the surface concept of owning and solving a problem; the real beauty is that it teaches children to seek out resources, use collaborative relationships (parents, teachers, uncles, aunts, pastors...) to help find solutions to problems.  This empowers them and helps them grow!

Now let me ask you this...

This chapter of the textbook and the outside article referenced make the idea of problem ownership and solving seem fairly cut and dry, but anyone that has lived outside of a bubble and dealt with the  public, children, spouses or in-laws at any point in their life knows that it is anything but easy.  If we are able to take steps in our part of the problem, how do we effectively handle the situation where the other party is not willing to own their part?  Yes, we could just cut ties with that person, but would that not just create more problems?  Personally, my bigger concern is my tendency to own other people's problems.  It seems that there is a fine line between compassion or caring and owning a problem that belongs to someone else.  Especially for those with "bigger hearts" how do we care for the person, and what happens with them, without taking on the problem as our own -- how do you know when enough is enough or too much?

Chapter 5: Attitudes and Boundaries

There are two key components that can either help or hurt any relationship, especially a therapist-client relationship: attitudes and boundaries.  In this chapter of our text, Fundamentals of Case Management Practice, we explore both the boundaries that we put in place and the existing boundaries that we fail to observe.

What are attitudes?
Attitudes relate to how we see other people, feel about them and interact with them. Try as you might to hide a negative attitude, your client will eventually figure out how you really feel.  It is imperative that you, as a helper, learn your own fears, sensitivities and errors in judgement; knowing these and being able to forgive them will put you as the helper in a better position to see the good that comes out of mistakes.  And the next logical step of course would then be being better able to understand other people that are making mistakes.  The moral of the story is that being able to accept life's struggles as important lessons and recognize that it is the essence of being human gives us new insight and growth potential that is second to none.

There are three key helping attitudes that, even when lacking much in the way of formal training, are essential to being an effective therapist: warmth, genuineness, and empathy.

• Warmth refers to being friendly, nonjudgmental, and receptive.  Through action, body language, and listening skills, the client feels that they are worthy of your attention and are valued by you.  Make no mistake; warmth is not dominating; it is respectful and facilitates growth and change.  
• Genuineness is just as it sounds - presenting the authentic person that you are at all times; being open, honest, and true to yourself.
• Empathy refers to the ability to relate to how the person is feeling, from their point of view, even if you have never experienced the same situation.  It goes beyond hearing what the client says and involves hearing the meaning behind the words' this is sometimes referred to listening with a "third ear".  It is important to remember that empathy is not synonymous with sympathy.  While they are similar they are also very different.  With empathy you are not feeling sorry for the person, as you would a friend that is pain.

To be effective in these three attitudes, one must remain nonjudgmental; as humans this is certainly easier said than done!  In psychology, as a therapist, there is no room for judgment or transference of morals and beliefs.  When looking at the world through our own moral lenses, we set the stage for a helping relationship that is anything but!  Be aware, up front, that you are entering a field that's expecting to deal with upset or dissatisfied people.  They will act out, they will be uncooperative and they won't always want to see things your way.  Like it, lump it, or chose another career path.

How Clients Are Discouraged

Discouraging a client can have serious repercussions in terms of the clients self-esteem, confidence or move toward independence; and there are more ways to discourage a client that by simply telling them that they are not capable:

• Push, force, or in some way shame the client into moving toward a goal
• Compare the client to someone else, including yourself
• Too much time focusing on the mistakes of the client
• Demand that the client work harder and harder, despite their best efforts
• Insist that the client do things your way
• Dominate the client
• Demand perfection or unrealistic outcomes
• Threaten the client
• Being insensitive in your interactions: failing to notice or praise any positive step forward or accomplishment made by the client.

Most helpers are not intentionally discouraging. in fact some are put into a position of direct contact with clients whom they have no experience in working with and to combat the fear they feel in themselves about the uncertainty of the situation, they become dominating which leads to a false sense of control.  This false sense of control is from where many of the discouraging actions listed above stem.

Understanding Boundaries

As a helper, your mission, should you chose to accept it, is to erect and maintain useful boundaries while refusing those that are not.  Boundaries are set in place to protect both us as helpers and the clients.  To protect the helper, whoa?! What would the helper need to be protected from?  Sometimes the helper will encounter a situation that stirs up emotions that they themselves have not completely dealt with.  When we encounter such a situation, sometimes we protect ourselves by becoming the superior participant in the helping relationship.  The boundaries that result as we wield our power is prohibitive to any therapeutic change.  At other times, we will encounter clients that remind us in some form or fashion of ourselves or a situation that we have been in.  When we allow ourselves to view the client in this way, we become a problem for the client rather than part of the solution.  

Seeing yourself and the Client as Completely Separate Individuals

What happens when:

1. The client reminds you of you?
• We tend to get aggravated at their excuses for not being as strong as we were in the same situation
• The client threatens our sense of self, especially if the client presents a weakness that we too struggle with
• In either situation, we tend to push steps and courses of action on the client that worked for us, without regard for what may or may not work for the client
2. The client reflects on you (how the client makes you look as a professional)?
• Some therapists think that their clients must be "cured" and live happy, healthy lives in order for them (the therapists) to look good as professionals.
• We feed our own professional ego by allowing the success of the client to feed our competence or imagined importance.  Therapist know better but therapist are human and want to make a positive impression like workers in any other profession.

Erecting Detrimental Boundaries

1. False Attributions
• 2 common but false assumptions about people
1. People who look like me will think and act like me: just because we share a common race or culture with another person does not mean that we will share the same set of values, opinions or way of life.
2. People who do not look like me are not like me at all, but very different: Just as it is untrue that people from the same background are the same, it is also not true that people from different backgrounds are different.  I know; take a minute to process that circular logic for a moment.  But think about it.  The color of your skin or your place of origin does not define your brain.  You may encounter someone from another part of the world that is very similar to you in every aspect.  
• The point is to keep an open mind and remove stereotyped thinking from your mindset.  Take the client as an individual without assumptions based on who you think they are by looking at them.
2. False Power
• This is a boundary that serves more as a brick wall and is fueled by our own desires to exert:
1. Authority
2. Power
3. Competence
• As a result, we stop talking with the client and start talking to the client, barking orders instead of collaborating for success.  This runs the risk of intimidating the client and offsetting any potential for positive gain.

What is Transference? 

Transference is a collection of feelings and attitudes the client holds about you as a result of your reminding them of someone else from their life.  There are 2 types:

1. Positive Transference: occurs when the client likes you
2. Negative Transference: occurs when the client does not like you

There are a few key things to remember about transference:

1. A client can go cycle between positive and negative transference throughout the therapeutic relationship; This is especially true when maintaining professional boundaries: the client may start with positive feelings that become negative.
2. accept transference whenever it exists: It is neither good nor bad.
3. The ability to accept transference behaviors while maintaining healthy professional boundaries is important in order for the client to continue to feel safe.
4. When clients reacts to you in inappropriate ways, use reflexive listening to show the client that you are listening, you want to understand, and that you are not judging them.  This further maintains the safe environment.

What is Countertransference?

Countertransference (CT) is similar to transference except that it is the therapist that is projecting attitudes and emotions onto the client.  This happens for a couple of different reasons:

1. the client reminds the therapist of someone from his or her past
2. the issue and/or situation that the client presents with reminds the therapist of a similar situation in the therapists life.  

Also similar to transference, there are two types of CT:

1. Positive CT occurs when the client reminds the therapist of someone held in regard from the therapist's life, such as a deceased elderly aunt very loved by the therapist.  This could lead the therapist to give preferential treatment and/or special favors to this client.
2. Negative CT occurs when the client reminds the therapist of someone that was a source of angst in the therapist at some point, such as a younger brother that was always bullying the therapist.  This could lead the therapist to be inappropriately harsh or demanding to the client.

It is important to be aware of our feelings, acknowledge them, and accept them in order to overcome them.  CT feelings serve as a good indication that we have issues that we have issues we have not yet resolved and that we need to seek help in that area (yes, therapists seek therapy too!) so that we can continue to benefit our clients.

What are others saying about the matter?
In surfing the internet, there is no shortage of articles discussing the importance of boundaries and attitudes in therapeutic relationships and/or case management settings. I stumbled upon a little gem of an article that I found to be pretty interesting, but it did not fit the same mold of the majority of the search results.  Instead, in "Misuses and misunderstandings...", Gutheil and Gabbard take the stance of devils advocate, acknowledging how a good thing can be taken to the extreme.  The article gives excellent examples and really illustrates the importance of their use but the tender balance that must be maintained by not going too far.  While written in 1998, it draws to my mind the recent incident where the little boy was suspended from school for assault with a deadly pastry when he ate his pop tart into the shape of a gun.  I think the article is certainly worth your time to explore:   Gutheil, T. G., & Gabbard, G. O. (1998). Misuses and misunderstandings of boundary theory in clinical and regulatory settings. American Journal of Psychiatry, 155, 409-414.

Ask and ye shall... be confused!
The topic matter on the surface seems fairly cut and dry, but as with all things, interpretation opens quite the gateway.  To be honest, from the chapter alone I did not have a question to consider posting.  Once I found read and re-read the article from Gutheil and Gabbard, I looked back over the chapter reading and something occurred to me; What is the line between confronting a client in a therapeutic setting to encourage change and discouraging a client?  The textbook lists several different ways that we could inadvertently discourage our clients, but some of them are also techniques used (in moderation of course) to confront a client in a therapeutic way.  Isn't part of our job to help "push" (push sounds harsh, perhaps nudge is a better word choice) our clients toward goals and change?  How do we know that their "best efforts" have been exerted (as indicated in the How Clients Are Discouraged section above); if we do not nudge them along and facilitate change then aren't we ethically failing them or taking their money to merely enable them to continue their behave (and thus continue to pay us)?

Resource Notebook

Food Assistance

• 2nd Harvest Mobile Food Pantries - are just supposed to go to once a month, preferably the one closest to your neighborhood. 
• 1st Thursdays - Mountain Vision - 10:00  155 Black Road Greeneville 37743 
• 1st Thursdays - Chuckey Presbyterian - 12:30  8250 AJ Hwy Chuckey 37641 
• 1st Wednesdays - Hardins Chapel - 11:00  3320 Baileyton Road Greeneville 37745 
• 1st Wednesdays - Baileyton Terrace - 1:00 7600 Horton Hwy. Greeneville 37745 
• 3rd Mondays - St. James Community Center- 10:30 3220 St. James Road Greeneville 37743 
• 3rd Mondays - Camp Creek VFD- 12:30 700 Greystone Rd. Greeneville 37743 
• 3rd Thursdays - Open Door Tabernacle- 11:00 70 Tabernacle Road Chuckey 37641 
• 3rd Thursdays - South Central Ruritan- 1:30 2634 Hwy 107 Chuckey 37641
• Greeneville-Greene Co. Food Bank - M-F 9:00-11:00, 12:30-2:00; 107 N. Cutler St.  638-1667  (SS card, proof of income)
• Tabernacle Mission Soup Kitchen 715 Wesley Avenue Free meals on Wed. 11:30-1:30 (no proof of ID, no carryouts) 
• Mosheim Community Outreach 1030 Main St., Mosheim Mon 9-12, Thurs 1-4 (Food and clothing) 620-2199 ID and proof of address)
• Mountain Vision Ministries 155 Black Road 383-9448 Tues, Wed, Thurs 10:00 - 3:00 Photo ID 
• Greeneville 7th Day Community Service Center 120 Idletime Dr. 470-4483 or 639-7127 Tuesdays 9:00a - 1:00p ID, SS card, proof of address 
• Northern Greene Co Churches 1145 Smith Mill Rd. Chuckey 37641 278-0267 or 329-4381 Sat 9:00a - 1:00p (mainly for people in that community) 

Medical Care - PCP

• Rural Medical Services – Family – TennCare Accepted; Sliding Scale
• Baileyton – 580 Van Hill Road Greeneville 37745; (423) 234-1020
• Kinder Klinic – Pediatric- 265 Burger Drive Chuckey 37743; (423) 257-6966
• Dr. Swarner
• Tenncare Accepted

Medical Care – OB/GYN

• Greeneville Women’s Clinic - 1410 Tusculum Blvd Greeneville 37743; (423) 787-050
• Dr. Reardon
• Women Center of Greeneville – 1021 Coolidge Street Greeneville 36643; (423) 636-2300
• Dr. Small, Dr. Nelson

Dental – Family (TennCare Accepted)

• ABC Family Dentistry – 1018 Tusculum Blvd 37743; (423) 639-2176
• Dr. Gamble – 112 Spencer Street Greeneville 37743; (423) 639-9131
• Sliding Scale
• Payment Plans Available

Housing

• Greeneville Housing Authority – 100 Cox Circle Greeneville 37743; (423) 639-3111
• Greeneville Terrace – 406 Elk Street Greeneville 37743; (423) 639-5291
• Heatherwood Apts – 100 Heatherwood Loop Greeneville 37743; (423) 638- 2614

Child Care

• Migrant/Seasonal Head Start – Telamon Corporation – 100 Erin Lane Bulls Gap 37711; (423) 235-9301
• Children’s Center – 119 Fairgrounds Circle Greeneville TN 37743; (423) 638-5589

Mental Health/Counseling Services

• Nolichucky Mental Health – 401 Holston Drive Greeneville 37743; (423) 639-1104
• Drug counseling, family therapy, individual therapy, crisis management, anger management
• TennCare accepted
• Sliding Scale Available
• Child Advocacy Center – 200 Main Street Mosheim 37818; (423) 422-4446

Domestic Violence

• Safe Harbor Home – 112 Austin Street Greeneville, TN 37743 (423) 218-0774
• CHIPS – 247 Orchard Road Greeneville 37745; (423) 546-4139
• Safe Passage Domestic Violence Shelter and Outreach – 2203 McKinley Road Johnson City 37605; (423) 232-8920

Miscellaneous

• Department of Child Services (DCS) – 130 Serral Drive Greeneville 37745; (423) 787-2550
• Department of Human Services (DHS) – 128 Serral Drive Greeneville 37745; (423) 639-6181
• Legal Aide – 50 Vantage Way, Suite 250 Nashville 37228; (615) 627-0956
• Child Support Office – 124 Austin Street, Suite 2 Greeneville 37745; (423) 787-1458
• Social Security Office – 1618 Old Tusculum Road Greeneville 37745; (877) 405-0416

So Tell Me A Little About Yourself...

"There is in every child at every stage a new miracle of vigorous unfolding" - Erik Erikson

My Name is Jackie and I have a blogging problem!  haha!  Actually, this is my first blog; I have been looking for an excuse to dabble in the art so I am very excited about the next six weeks and, who knows, maybe an addiction will ensue! I am in my final year of the Bachelor's Psychology Program at Tusculum but hope to go on to earn at least a Masters.  Yea, I know... but I think all Psych majors are crazy!

So why did I choose psychology? When I declared my major, a large part of me was screaming “ Whoa!  What are you doing?!?” but  there has always been that draw to help people.  But even that cliche draw was not enough to decide my educational fate; instead it was a very raw, personal experience which I choose to share to enlighten others:

Three years ago, my (then) six year old daughter was sexually assaulted by my (then) 19 year old nephew.  Yes, she was a minor and he was an adult, and you know what?  The DA still has not decided on her case...three years already!  I digress.  My daughter went through pure hell and is only just now beginning to return to some version of her old self.  She still doesn't sleep or sit near a window, refuses to sleep in a room alone or go outside alone (even in broad daylight).  While the stages of hate and coping that she has cycled through are normal, there has been very little (actually no) support for her father and I on how to help her.  We have her in therapy, but there is no guidance on what we should expect or how to handle certain eccentricities.  We have literally stumbled our way though the darkness of her healing process.  I entered psychology to help change that.  I do not want parents to have to feel like they are going though this healing process alone and while there are some resources available, they are not they readily available to the average person.

That's my story.