Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Supported Employment
Workbook
Chapter 9: Skills: Working effectively with consumers
Chapter overview
There are some specific interpersonal skills that will help you to support the work life of the consumers you are serving. This chapter reviews some approaches that will help you to connect with and support consumers over time.
Why these skills?
Our aim is to facilitate recovery which involves
- Promoting hope
- Helping consumers in their effort to take personal responsibility for health and life choices
- Supporting consumers in getting on with life beyond illness
Supervisor’s note
Adults learn best when they are actively involved in solving a real life situation that is right before them. In supervision, ask the employment specialists to describe some of their challenges and role-play responses using the skills reviewed in this chapter.
Promoting hope
Hopefulness can be enhanced by:
- Voicing positive statements
- Expressing empathy
Voicing positive statements
Having gone through a lot, consumers sometimes loose track of their strengths. As part of developing a working relationship with a consumer, you can build rapport by making positive statements. Positive comments about the consumer can address the individual’s appearance, motivation for work, past efforts to find work, prior job experiences, social skills, or any other attribute worthy of praise. Expressing heart-felt positive statements to a consumer may remind the consumer of their strengths. The positive tone set by these comments early in the relationship can contribute to a sense of optimism and good will that helps the process of job search and maintenance.
Positive statements are important over time
There is a natural tendency among many people to focus more on their negative qualities than their positive qualities. This tendency can be even greater in individuals with psychiatric disabilities, due to personal setbacks they may have experienced, and negative emotions such as anxiety and depression. For example, when describing one’s work history, a consumer may tend to focus more on his job failures and difficulties holding down a job than personal successes. For another example, when describing how things are going at a current job, a consumer may focus more on problems she is experiencing than areas in which she is being successful.
Focusing only on the negatives, and ignoring the positives, can result in consumers being discouraged and pre-occupied by their sense of “failure.” By pointing out positive examples of personal strengths and job success to consumers, you can counter the natural tendency to focus only on the negative. Pointing out positives can be beneficial to consumers by creating a more balanced picture of the consumer, which can neutralize, or even make positive, the consumer’s overall impression of the situation. Pointing out positives can also help consumers become more aware of their personal strengths, which can be capitalized upon in order to maximize job performance and functioning at work.
Examples of positive statement
- “You’ve showed some real determination by going out and getting a new job each time you lost an old one.”
- “I understand that you had to leave work early because you found the noise too loud to bear. I really think you were very responsible in talking to your supervisor about your difficulties before going home.”
Eliciting positive statements
In addition to pointing out positives, employment specialists can elicit from consumers in their own words positive statements about themselves
Examples of eliciting positive statements
- “Can you tell me about some of the things that you think you did really well in the last job that you worked?”
- “You’ve mentioned a few things that you are unhappy about in terms of your recent job performance. What are your strengths, and what do you do best at this job?”
Expressing empathy
Many consumers report that the faith and caring of their employment specialist was critical to their vocational success. One way to communicate that you care about the consumer you are serving is through expressing empathy. Empathy involves the process of conveying to another person that a person understands, and feels what another person’s experience is like. Empathy demonstrates an emotional understanding of another person and not just a factual understanding.
Expressing empathy is an important skill for enhancing the working relationship between the employment specialist and the consumer. Typically, many consumers have experienced a range of setbacks in the process of pursuing their personal goals, and the memories of these “failures” may interfere with pursuing their vocational goals. In addition, consumers often experience a variety of obstacles to success in the workplace including the stigma of mental illness, socializing with co-workers, responding to criticism, dealing with unclear assignments, arranging for reasonable accommodations due to their psychiatric disability, and concern about the adequacy of their job performance. Empathizing with the difficult emotions consumers have experienced either in the past or currently, is a powerful way for you to show the consumer you care, and to facilitate that human connection that is critical to the process of supported employment. Sometimes expressing empathy may lead to problem solving, but not other times. Regardless of whether concrete steps are identified to deal with the feelings, showing empathic understanding facilitates the working relationship.
Examples of empathic statements
- “How difficult!” or “How painful!” or “How irritating” or “How wonderful!”
- “What a disappointment to lose that job after working so hard to get it.”
- “What a mess! How confusing to expect to do one job and to come in and be assigned a different task!”
- “Lord knows you’ve put up with a lot!”
Helping consumers in their effort to take personal responsibility for life choices
You can help consumers in their effort to take personal responsibility for life choices by:
- Eliciting consumer preferences through the use of open-ended questions
- Respecting expressed preferences
- Avoiding giving excessive advice
Using open-ended questions
Open-ended questions
Open-ended questions refer to questions that cannot be answered with a “yes” or a “no.” When interviewing consumers, asking open-ended questions often yields much more useful information than asking closed-ended questions that can be answered yes/no. Open-ended questions are very useful for learning more about consumers, including their job preferences, work history, perceived difficulties on the job, and desire for support.
Examples of open-ended questions
- “I’d like to hear about the kinds of jobs you’ve worked in the past.”
- “What sort of things do you enjoy doing?”
- “When you think of the kinds of work you’d like to do, what types of work do you find most interesting and would most prefer?”
- “What types of problems have you been encountering on your job?”
Open-ended questions are superior to close-ended questions because they require the consumer to elaborate in responding to the question, thereby giving you more information about what the consumer wants or is thinking. In addition, by asking open-ended questions, you can have a greater assurance that the consumer has understood the question, since the response must make sense given the question asked. Closed-ended questions can be easily answered yes/no even without truly understanding the question, resulting in an incorrect understanding of consumer preference.
In addition to open-ended questions being useful for obtaining basic information and preferences from a consumer, these types of questions are also helpful in checking the understandings you have with a consumer. With some consumers, it is important to periodically establish that you have a mutual understanding of the conversation by pausing and asking open-ended review questions. For example, asking the open-ended question, “Let’s go over what we’re going to do together when we meet with the manager of this restaurant about a possible job. What is our plan going to be?” is more useful in checking a consumer’s understanding than asking the closed-ended question, “Do you understand our plan for what we are going to do when we meet with the manager of the restaurant about a possible job for you?”
Respecting consumer preferences
Respecting consumer preferences is a core principle of supported employment. Conflict can occur when consumer preferences are not well understood or are not fully respected.
Conflict occurs when tension arises between the consumer and employment specialist, usually with respect to some aspect of the consumer’s vocational plan or problem experienced at work. Conflict should be distinguished from disagreement. The consumer and employment specialist may have different perspectives on a problem, and may disagree about it, without this disagreement leading to tension. It is best to avoid conflict with the consumer at all times, since the emotional tension inherent in conflict may jeopardize their working relationship and undermine the employment specialist’s ability to provide support. Honest disagreements, on the other hand, need not be avoided, as they pose no threat to the working relationship, provided they are conveyed in a manner demonstrating mutual respect.
When conflict exists, it is usually because the employment specialist strongly believes the consumer “should” do something (or not do something) whereas the consumer disagrees, and the employment specialist is actively trying to push the consumer in that direction. Trying to make a consumer do something he or she does not want to do is contrary to the emphasis on consumer preferences in supported employment, since it implies that the employment specialist knows better than the consumer does what is best for that person. Rather than trying to force consumers to do things that they do not want to do, creating conflict, it is better to try and understand the consumer’s perspective, and to identify and deal with the obstacles perceived by the consumer. If the consumer refuses to do something that seems logical and straightforward to the employment specialist, it usually means that the consumer has a concern that has not yet been addressed, and an effort needs to be directed towards understanding and addressing the concern. Involving someone else in resolving a disagreement, such as a case manager or family member, can be helpful.
Risks of giving excessive advice
Giving excessive advice is contrary to the aim of supporting consumer efforts to take personal responsibility for life but it is easy to fall into the habit. Giving advice often sets up a dynamic in which the person giving the advice expects the other person to follow it, and the person receiving the advice often perceives it as expectation. This dynamic often complicates your working relationship with the consumer by creating a possible tension when unrequested advice is not followed. In addition, when advice is followed, the advice-giving can lead the consumer to rely too much on you or to blame you if the advice does not lead to an effective solution.
It is best to avoid giving advice whenever possible, and to seek to work collaboratively with the consumer to identify solutions to problems and goals. By asking frequent questions, you can help consumers consider possible steps to achieving goals without directly giving advice. Furthermore, helping consumers identify and choose their own solutions to problems and goals creates more ownership for those solutions by the consumer, and a greater sense of self-efficacy.
Occasionally, consumers will directly ask you for advice, in which case you must make a decision as to whether providing the advice will be in the best interest of the consumer. Sometimes consumers will request advice and then reject it when it is given. Sometimes consumers request advice because they lack confidence in their own ability to identify and evaluate solutions. Sometimes advice is requested because the consumer has already considered many possibilities, and is eager to entertain as many others as possible. In determining whether to give advice, you need to weigh the likelihood that the advice will be beneficial to the consumer both in the short-term and in the long-term. More often than not, directly providing advice to consumers does not serve their long-term interest.
Examples of avoiding giving excessive advice
Examples of ways to keep focused on client preferences when asked to give advice
- “I agree that that is a tough decision you are facing. I am not sure what I would do it I were you. What are you considering?”
- “Sounds like a very difficult situation. I’d hate to make it worse by offering you advise that might not be consistent with what you really want. Let’s put our heads together and try to sort it out.”
- “ How confusing! Let’s list out the pros and cons of this decision to get a clearer idea of what you want to do.”
Supporting consumers in getting on with life beyond illness
Supported employment can directly help a consumer get on with life beyond illness by helping him or her with the healthy adult role of worker. Being a worker involves devoting time to a non-illness related activity and often improves how a consumer sees him or herself. As there is always a lot going on in people’s lives, supporting employment takes real focus.
You can support consumers in getting on with life beyond illness by:
- Focusing interactions so that they succeed in developing the work life of each consumer
- Staying clear about the goal of the work
- Avoiding self-disclosure that shifts the topic of discussion to you
Focusing interactions on consumer work goal
Focusing interactions on the work goals of consumers
To be effective, interactions with consumers need to be focused on what the consumer is interested in and what you, as the employment specialist, need to know to help him or her pursue work-related goals. You will be more likely to keep the interview focused, if you have at least one or two objectives in mind when you meet with a consumer. Consumers may shift the focus of the interaction to another relevant topic, in which case you may either proceed to a change in topic or steer the consumer back to the original topic. Professional encounters may naturally meander off the topic, but it is your role to keep bringing the consumer back to the topic at hand in order to accomplish the work that needs to be done.
The most important reason for keeping the interaction focused is to ensure that it promotes the work goals of the consumer. Conversations that meander a great deal off of the topic may be difficult for some consumers to follow, and may mean that you do not get needed information. While maintaining the focus of the interview, it is also important for the conversation to be comfortable, relaxed, and to allow some deviations from the topic. Such deviations may provide you with useful information that you might not otherwise get.
Staying clear about the goal of the work
Remain friendly and professional
As an employment specialist you are a professional. In other words, you are paid to support the work life of the consumers you are serving. Meeting this goal involves being friendly to consumers while remembering that you are not being paid to be a friend.
As an employment specialist it is very important for you to keep your paid role firmly in mind because some consumers may loose track of it or not understand it, particularly when you are meeting in community settings such as consumers’ homes, restaurants, and other public places. While your role continues to be that of a professional, other activities may take place ordinarily associated with friendship, such as having a cup of coffee or taking a walk. Consumers may interpret these activities as signifying that the relationship is a friendship, and could change the interaction away from a focus on the consumer’s worklife. You need to be aware of these possible interpretations, and work to maintain the distinction between professionalism and friendship, while striving to create a comfortable and effective working relationship. Discussion of how to do this optimally is a great topic for regular supervision.
Avoiding distracting self-disclosure
Avoid self-disclosure that turns the attention to you and away from the direct focus on the work life of the consumer
Sometimes a consumer’s dilemma, such as experiences with depression, anxiety, or conflicts on the job, reminds you of something that you have struggled with yourself. In general, it is not helpful for you to use personal disclosure when working with consumers. While careful strategic self-disclosure may occasionally be helpful, in many cases such disclosure shifts the focus away from the consumer to the employment specialist, and detracts from addressing the problem at hand.
Chapter summary
Supported employment can play an important role in facilitating the recovery of a consumer. This chapter introduced some interpersonal skills that can be used to promote hope, help consumer in their effort to take personal responsibility for life choices, and support consumers get on with life beyond illness. The interpersonal skills required to be a more effective employment specialist (such as communicating empathy and staying focused on the goal of helping the consumer obtain and maintain competitive employment) can be learned and practiced.
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