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Trust and Credibility

Natalia J. Garland

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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.

Be available
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 not caring.

Be faithful
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.


Update your knowledge base
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.

Follow the 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.

Study your cases
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 own background.

Recognize your limits
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 session.

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 diagnostic impressions.

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 again..............stay sane.

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Copyright 2004 Natalia J. Garland