Trust and Credibility
Natalia J. Garland
It takes courage to be a social worker. The professional
qualities of trust and credibility are always at stake. During
this 2004 election year, these qualities have become major debate
issues for the presidential candidates. For social workers,
however, every day is election day. Every time we encounter a
patient, we must demonstrate these essential qualities in order to
build and maintain the therapeutic relationship. As a refresher
course for myself, I sketched out some basic steps in developing
trust and credibility.
Be a listener
Therapists tend to do more listening than talking.
Listening involves an active and intense focus on the needs of the
patient. The patient, especially mandated patients, must see you
as someone who is for them and not against them. Listen to the
patient's priorities. What do they want? Can you help
them get it? Patients have a right to self-determination.
That is, they can say no to our suggestions and recommendations.
They can do things which are self-defeating or which we might not
agree with. Part of being a good listener is to re-frame the
information they give us. In other words, we can offer a
different and enlightening perspective. If this is done with tact,
the patient can then see the advantages of changing some of their
priorities and choices.
Therapists have to manage appointments. This
may sound simple, but it is not uncommon to over-book and have to
work through lunch, or juggle two patients who were mistakenly
scheduled for the same hour. Good bookkeeping is necessary. An
area of some disagreement is whether to accept walk-in's,
or to see patients by appointment only. My preference is to
accept a walk-in if possible. If someone is seeking help, I do
not like to turn them away. If I do not have the time to see them
in my office, I will at least personally greet them and schedule
an appointment for another time. It is also important to
return phone calls promptly, whether to a patient or to
another professional. Not returning phone calls is tantamount to
Therapists must treat all patients with a consistent
demeanor. Foremost, confidentiality must be maintained
(unless the patient is a danger to self or others).
Confidentiality is what enables patients to disclose sensitive
information. Betrayal is a devastating experience. Therapists
also need to show acceptance of the patient's feelings
and situation. (Acceptance does not imply agreement, and we do not
condone antisocial or self-destructive behaviors.) Without
acceptance, the patient could experience or re-experience rejection
and abandonment. Like betrayal, these are powerfully damaging
emotional states. The therapist also needs to view the patient in
a non-judgmental manner. We do not condemn the person, but
try to promote positive change and growth for a happier future.
It is impossible to keep up with all
the professional literature. It is minimally necessary to
read as much as is useful to your work area. Select books,
journals, and websites that can help you to help others.
Attending educational conferences can be helpful, and it
also gives you a chance to meet other professionals. Conferences
provide an opportunity to be intellectually fed. All you have to
do is to get yourself there and listen to the presentors. Keep a
list of everything you read, and keep all your conference
completion certificates. You might also try giving an
in-service training seminar at your workplace or for a local
community organization. The preparation involved in teaching
others will help to solidify your knowledge base.
policy and procedure manual
Read the policy and
procedure manual of the agency you work for. Stay within your
job description and within your state certification, and
stay within your departmental scope-of-work statement. If you are
the overly responsible type, learn to refuse assignments that are
beyond your expertise. Do not feel obligated to attempt to do
what you are not qualified to do. If you are being trained, make
sure everything you do is approved by your supervisor. Contribute
to the revision of policy and procedure as needed. This
will ensure that your duties stay relevant to changes in patient
population and to any agency changes. Be aware of your own
values and whether they conform to your agency's policies and
procedures. If you are against abortion, for example, you probably
would not want to work for a family planning clinic.
Make the time to go back over your progress
notes and reflect on patient progress. Notice patterns and
obstacles. Make sure you also record any phone calls or
discussion of cases with other professionals (assuming you have
consent forms). It is easy to forget verbal information, and your
notes can protect you from being misquoted. Maintain current
treatment plans. Documentation of goal achievement can
help you measure patient progress and plan for successful
termination or referral. If you rely on insurance reimbursement,
good notes and plans will aid you in advocating for your patients.
Be sure you understand your patient's diagnosis and culture.
These areas intertwine, and they could be very different from your
No one is perfect. You are expected to be
competent, but you cannot possibly know everything. If a patient
takes you to unfamiliar territory, it is okay to say, "I
don't know, but I'll find out." In other words, it is
time to update your knowledge base again. Never bluff a patient.
If a case exceeds your capacity, talk to your supervisor about
transferring it to someone else. Be sure to correct errors
immediately. By error I mean things such as having chosen a fair
response as opposed to a good response, or good as opposed to best.
You can most likely make corrections of this type in the next
Finally, I will say
a few words about patients who deceive and lie. No matter how
qualified we are, no matter how much job experience we have,
we are all going to be fooled sometimes. We are not
mind-readers. This is a built-in limitation and we should not
feel embarrassed or discouraged. If you work with addicts and
certain personality disorders, you are going to be lied to. If
you work with people carrying feelings of guilt and shame, it will
take time for them to feel comfortable enough to talk about the
related behaviors. Do not be surprised if people do not tell you
the whole truth. As patients open up and reveal more information,
you will need to go back and adjust goals and refine your
There are many
responsibilities involved in social work. No matter how far I
advance, I find there is no substitute for getting back to basics.
(Written 03/01/04: bibliography available.)
Until we meet