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Knowing Your Treatment Team Role Helps Build Client Rapport

Employment specialists have a unique role on the treatment team. Review of a few core precepts can help these specialists strengthen their relationships with clients who have co-occurring disorders.

Interacting with clients is a central task of IPS supported employment. Let's start with a few basics. Effective practitioners believe the following:

  • It is important to know each person as an individual.
  • Clients benefit from relationships with people who are hopeful.
  • Every person deserves to be treated with respect.
  • Most people struggle when they try to make a big change in their lives, whether or not they have a mental illness.

In your interactions with the people on your caseload, several specific steps are critical:

  1. Developing a good working relationship
  2. Using effective interviewing skills
  3.  Incorporating interview skills into your daily work

The first step is helping the person feel comfortable with you. Clients are probably wondering what it will be like to work with you. They may have attended other social service programs in the past, and it is doubtful that all of those experiences were positive. Some practitioners talk down to clients, ignore things that clients feel are important, and even blame clients instead of helping. Your job now is to earn the person's trust.

First impressions are important. Introduce yourself and describe your role in a friendly way. For example, "Hi, I'm Juanita Arnett, and I am an employment specialist. I work closely with Emily, and she told me that you are thinking about going back to work. I’m interested in talking to you about work and figuring out how I can help."  The tone is straightforward, down to earth, and earnest. Use your own words, but try to convey from the beginning that the person is in charge of determining his or her goals and that you are here to help the person reach those goals.

Next, ask the person to tell you about his or her hopes for a job. For example, "Please tell me your thoughts about a job."  Here the key is to be a good listener. Try to get the person to do most of the talking. One way to do that is to ask open-ended questions—the kind that can't really be answered with a "yes" or "no."  For example, instead of asking, "Do you want to get another job in construction?" you could ask, "What kind of job are you thinking about?"  …

As you develop a relationship, remember that if you are an employment specialist, you should not attempt to provide services for which the case manager or therapist is responsible. Employment specialists often wonder what to do about symptoms of mental illness when they come up. For example, what if the person says something that does not make sense or asks about how to handle symptoms of mental illness? "What if I have a panic attack on the job?" "I lost my last job because I started preaching to the customers—I guess I was getting manic."  It's helpful to acknowledge that these may be important areas of concern but not ones on which you are an expert. This is why you work as part of a team, and the client needs to understand the different roles."

You might say, for example, "Sounds like it's stressful to have voices. I think it would be a good idea to invite your case manager and psychiatrist to join us in this discussion since they know more about these symptoms than I do. Maybe we can all come up with a plan together to help you manage those symptoms when you're at work." Team meetings are a great place to brainstorm coping mechanisms or job accommodations that will help the person feel more comfortable on the job. However, don’t wait for the next treatment team meeting to get new information about symptoms to the rest of the team. It’s possible that the team will wish to quickly offer options such as a medication change or other intervention if the person's symptoms worsen.

Some people have developed coping mechanisms to deal with symptoms. This information is good to know in advance so that you can better plan a job. For example, some people know that they are likely to hear voices when they are alone and others know they'll hear voices when they are in a crowd. Some people might even have strategies to control the voices such as focusing on a task or starting a conversation. In other words, to the extent that symptoms are relevant to employment, you need to try to understand them. To the extent that symptoms are relevant to treatment, you need to let other members of the team address them. If you’re not sure about a particular situation, check it out with the team.

Excerpted and adapted from Supported Employment: Applying the Individual Placement and Support (IPS) Model to Help Clients Compete in the Workplace. Dartmouth, 2008, 2011. Published by Hazelden.

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