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MOVING BEYOND ASSESSMENT
MOVING BEYOND
ASSESSMENT
A PR ACTICAL GUIDE FOR BEGINNING
HELPING PRO FESSIONAL S

Melissa D. Grady
and
Eileen A. Dombo

1
1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2016
First Edition published in 2016
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-​i n-​P ublication Data
Grady, Melissa D.
Moving beyond assessment : a practical guide for beginning helping professionals /​Melissa D. Grady
and Eileen A. Dombo.
pages cm
Includes bibliographical references and index.
ISBN 978–​0 –​19–​936701–​6 (alk. paper)
1. Social service—​Practice. 2. Social service. 3. Counselor and client. I. Dombo, Eileen A. II. Title.
HV10.5.G695 2016
361—​dc23
2015030193
9 8 7 6 5 4 3 2 1
Printed by Sheridan, USA
We dedicate this book to our students and our clients, past, present,
and future. We have learned and continue to learn a great deal from
them, and are honored to be part of their learning and growing
experiences. Thank you to our families, without whose unwavering
support over the years our work would not be possible. And finally,
to our colleagues who continue to inspire us with their dedication to
improving our world around us.
CONTENTS

1. Introduction 1

2. What to know before you start 4

3. Cultural and identity issues in practice 21

4. Your role and relationship with your clients 29

PART I BEGINNINGS

5. The first session 41

6. Assessment 50

7. Asking the difficult questions: What to ask and how to respond 63

8. Assessing the safety of the client 73

9. Assessing safety of others in relation to the client 84

PART II PLANNING AND IMPLEMENTING
INTERVENTIONS

10. Evidence-​based practice and how to use research in treatment planning 95

11. Role of theory in social work practice 107

12. The middle phase of treatment 123

13. Planning for change and setting goals 135

PART III ENDING WITH CLIENTS

14. Endings 147

15. Evaluation of practice 158

PART IV ONGOING ISSUES FOR CONSIDERATION

16. Supervision 171

17. Technology and social media 183

18. Beginning knowledge of the brain and its functions 191

19. Final thoughts 201

References 205
Index 217

viii • Contents
MOVING BEYOND ASSESSMENT
 CHAPTER 1

INTRODUCTION

A client walks into the room. He looks sad, disheveled, and hopeless.
He has come to you for help—​to “fix the problem.” He states he wants you to help him
“make his life better and to feel better.” Your job, or so you feel, is to alleviate his struggles
and instill in him hope and a sense of empowerment, right? Or so you ask yourself.
Most new practitioners feel an overwhelming sense of pressure to know what to do
in every practice situation. Whether it is meeting with an individual client in an agency
setting, engaging with a family for a home visit, or working in the community, new prac-
titioners often feel that they ought to know exactly what to do, even at the beginning of
their training. People choose to enter professions like social work, psychology, counseling,
nursing, medicine, and other helping professions because they want to help people and, in
turn, make the world better and more just. Yet, the feeling of being at a loss regarding how
exactly to accomplish those goals comes quickly, often right at the beginning of graduate
school. Good intentions only go so far. In addition to having good intentions and a pas-
sion for and commitment to the work, practitioners need to have skills and knowledge and
be able to use them appropriately and discriminately depending on the situation at hand.
We want to emphasize from the start of this book that you will develop the capacities
described through a lifelong learning process. We know you have heard that before, and
that does not help you now as you are starting out and need some tools to succeed today.
Yet, we feel compelled to mention it here because often beginning practitioners feel frus-
trated by the pace of this learning process and want to gain knowledge more quickly. Part
of what makes working with people so engaging is their complexities. When these com-
plexities are then paired with individual, family, group, or community circumstances, it
can feel overwhelming to believe that you will ever have adequate skills and knowledge to
help create a change in someone’s life or community. However, with each iteration of your
training, you will continue to gain more knowledge. By pairing your knowledge with an
increased understanding of how to mobilize and utilize this ever-​g rowing set of skills, you
will feel more confident in your professional capacities.
This book was designed to be part of the beginning phase of this lifelong learning pro-
cess. It is written to assist new helping practitioners feel less anxious and more prepared to
approach and work with the clients and communities they desire to help. It is not designed
to be a comprehensive guide to your training as a practitioner but rather to help you take
the initial steps in your own journey.
As practitioners and professors, we have received numerous requests from students
and novice practitioners to find a book that is clear and easy to understand and helps them
feel more prepared for the initial stages of working with clients. As such, we have written
each chapter to be a reference guide that is easily readable and accessible. Combined, we
have over 30 years of practice experience plus over 15 years of teaching social work gradu-
ate students about practice, theory, and research. In writing this book, we used knowledge
from our own practice experiences in conjunction with years of working with graduate
students to address here what beginning practitioners need at the initial stages of working
with clients. The book is meant to be user friendly and to address many of the issues of
concern for beginning practitioners, as well as address other practice-​related issues that
they have yet to ponder. This book is primarily intended to help practitioners who will be
working in direct practice settings rather than in communities or macro practice. While
some of the concepts and principles may apply, this book is aimed at helping those begin-
ning practitioners who will be working with individuals, families, or groups. In addition,
although we include a chapter on the diagnosis of mental health disorders, this book is
meant to extend beyond mental health or clinical practice. We hope that the book will be
applicable to multiple practice settings.
We believe that before individuals can even start to think about working with clients
in a direct practice way, the first step is to think about developing their professional style
and way of working. Therefore, Chapter 2 addresses the working alliance as well as the
professional self and issues related to taking care of the self in doing this work. Chapter 3
focuses on exploring and understanding the role of cultural and identity issues in practice.
Chapter 4 addresses the context in which practice occurs and understanding how the set-
ting guides your role. Following Chapter 4, the book is divided into three sections. The
first section focuses on assessment and the beginning stages of working with clients. The
chapters in this section address the first session, assessment, the importance of asking
difficult questions, and safety assessment for both the client and others involved with the
client, including the worker.
The second section focuses on issues related to preparing for and implementing inter-
ventions with clients. It is designed to help you prepare thoughtfully for your work with
clients, including the use of the evidence-​based practice process, the role of theory in
treatment planning, preparation of a treatment plan, preparation for termination, and how
to create an ongoing assessment process of your work with clients. In other words, how
will you know whether what you are doing with your client is working? This section also
includes chapters on how to work with clients in the “middle phase” of an intervention.
It is not designed to be a toolkit on how to work with every client, and it will not provide
examples of practice models. These issues are beyond the scope of this book. This section
is meant to provide some guiding principles and to address some basic issues related to
intervention.
Finally, in the third section we address the changing landscape of practice. The chap-
ters in this section address finding a supervisor and getting the most out of your supervi-
sion; provide considerations related to the use of technology and social media; and provide
a beginning understanding of some of the biological, medical, and neurobiological issues

2 • Moving Beyond Assessment

related to practice. These chapters provide some guidelines on these complex issues that
will certainly evolve over time as the world changes—​and you change as a professional.
We conclude the book with some parting advice and tools that will be useful as you
begin your journey as a helping professional. We include well-​established resources in
these areas with the hope that they will remain helpful to you throughout your career.
However, we encourage readers to remain aware of new and evolving resources in their
particular areas of practice.
In the end, we hope that this book provides you with a bit more confidence and knowl-
edge as you enter the first stages of your training and career. Working with clients pro-
vides an exciting journey but can be a bit daunting at the same time. Our intention is
to help keep the excitement about the work alive, simultaneously helping to reduce the
anxiety so that you can be present and available to your clients as you join them on their
own journey, which has the potential to enhance your own as well. After all, this journey
is what keeps us engaged in this work.

Introduction • 3
 CHAPTER 2

WHAT TO KNOW BEFORE

YOU START

It is the first day of your internship or the first day of your new job in social
work or a related helping profession. You are getting ready to begin a new stage of your
career. You may have a number of questions about what you should wear or how you
should introduce yourself. You may also have a number of concerns about what others
will think of you or how you will answer tough or personal questions from your clients.
In addition, there may be other issues that you may not have even thought of that are
important to consider, such as how this work will have an impact on you or change you
in some way. This chapter is designed to help you think through some important pre-
liminary issues so that you are as prepared as possible when you start this new phase of
your career.

THE DEVELOPMENT AND CARE

OF THE PROFESSIONAL SELF
For most of us, when we are with certain individuals or groups we act in a particular way;
we share more or less compared to when we are with others, we let down our guard or put
it up, and we even dress in a particular way based on who we are with at the time. In each
situation, we have a way that we act or present a different “self,” which is often dependent
on a variety of factors.
A professional social work setting is no different, as there are different ways that we
should and do act in such contexts. Social workers need to present a professional self in
their work with clients and in their interactions with colleagues. While this statement
may seem obvious, in our experience as professors and supervisors, the concept of a
professional self is not always adequately explored by social work students. As such, we
believe it is essential that future social workers think through what it means to have a
professional self and what this self would “look like” for them. We believe there are several
essential components to a professional self, namely: dress and physical appearance, how
to work with interdisciplinary teams and other professionals, communication factors, and
consideration of how the National Association of Social Workers’ (NASW, 2008) Code of
Ethics informs how social workers should behave as professionals.

DRESS AND PHYSICAL PRESENTATION

Whether someone has completed training or is still in the midst of it, social workers must
present themselves professionally. We do not in any way mean to imply that social workers
or trainees should run out and buy an extensive or expensive wardrobe. It also does not
mean that your personal style needs to be altered significantly. We simply mean that the
way you dress should reflect the respect you have for your role and for those with whom
you work. Table 2.1 provides some general guidelines to consider as you are thinking
through how to present yourself in a professional setting.
Remember that everything you have on your body is a form of self-​disclosure and may
be a topic of interest to your clients. Items such as jewelry (e.g., a cross or star-​of-​David
necklace, a wedding/​commitment ring), a tattoo, and piercings might all be topics that
are of interest to your clients. We are in no way suggesting that you do not wear them
or show them; we are simply encouraging you to be prepared to hear questions about
such items. We suggest that you speak to your supervisor before you start about what is

TABLE 2.1: Dress Guidelines

Guideline Explanation
Clean clothes—​not clothes that May communicate to the client that you cannot take care
are stained or have marked holes of your own clothes, so how will you take care of them?
For women: skirts that are at least This is especially if you will be sitting down on the
to the knees floor, such as with young children.
For women: ensure that the tops Many social workers will be bending over paperwork or
you wear do not show inside doing other related activities, and you should wear a
your shirts when you bend over camisole or closer-​fi tting clothing if this applies.
Be cognizant of the setting with Professional does not have to mean fancy or
regard to the expense of the expensive. Be conscious of what message it sends
clothing or other accessories to clients in your setting to appear in expensive
clothing or jewelry.
Wear clothes that consider safety In some settings, safety may be a factor. Consider
shoes that allow for easy running or clothes that are
not too loose and could be grabbed.
Avoid clothing with messages Clothes that communicate your affiliation with a
on them particular group other than the agency should be
avoided, as it is a form of self-​disclosure and could
send unintended messages to the client(s).
Avoid clothing inappropriately Tight-​fi tting clothes can be distracting and too
tight revealing.
Wear clothing that is consistent Use your colleagues as your guide in terms of
with those of the other workers appropriate clothing. Observe others and try to
follow their lead as much as possible.

What to Know Before You Start • 5

appropriate attire for your setting and to plan how to respond to clients when they do ask
questions about your personal appearance. It is best to be clear about the expectations and
norms before you start and to feel prepared for such questions or comments from clients
ahead of time. When deciding what to wear, whether it is clothing, jewelry, or other items,
reflect on the balance between the importance of the item to you and the potential of its
distraction of others from the work at hand. This process can help you discern which items
are essential to your authentic presentation of self and which you may want to choose to
bring out in a different setting.

WORKING WITH INTERDISCIPLINARY TEAMS

The majority of practice settings will require social workers to work with profession-
als from other disciplines. These professionals could be individuals with similar train-
ing as you (i.e., a psychologist or other mental health worker) or completely different
training from you (i.e., a vocational trainer or teacher). Regardless of the composition
of the team, there are two key points we want to make about social workers’ roles on
these teams.
The first point is that social workers should be active members of the team. Our mes-
sage here is that if you do not speak up, then neither the profession nor the needs of your
clients are represented. It may seem intimidating to speak up in a group with others who
appear to be or who actually are more experienced or educated than you. However, the
fact that they have more experience does not mean that they should be the only members
to have an opinion or a perspective. It is possible that the social worker knows something
that the other team members do not. It may be that the client has shared something
with the social worker that he or she has not shared with the rest of the team (i.e., the
client does not like taking his medicine because it makes him feel nauseous). In addition,
some teams may be focused on the struggles or deficits of the client and not as focused
on the strengths or capacities of the client. Because social work training emphasizes the
strengths perspective, social workers can bring this important perspective to the team.
For these reasons, we encourage you to be a vocal presence on the teams in which they
are involved.
The second point we want to make is that, as team members, social workers should
present themselves as professional and competent. Again, just as with dress, this state-
ment might appear obvious. However, we have some specific points we feel are important
to consider. The first is that while we believe social workers should be a presence on the
team, they should provide relevant feedback as opposed to speaking only to have some-
thing to say. Therefore, be thoughtful about what information you want to share before
you share it. If possible, take some time to plan what you want to say so that your thoughts
are organized and clear.
Next, with whatever ideas you have that you want to present, provide a rationale for
those ideas. It is important that these opinions be based on research, theory, client feedback,
or some other credible source. There have been studies that have reported that social work-
ers are perceived by their colleagues as not having a strong basis for their opinions and have
even been referred to as “airy-​fairy” in their approach to working with clients (McCracken &

6 • Moving Beyond Assessment

Marsh, 2008, p. 134). Therefore, it is important that social workers explain the rationale for
their professional opinions and that these points are based on credible sources.

COMMUNICATION
One of the ways of expressing and presenting the professional self is through oral and
written communication. With written communication, social workers may use multiple
methods to communicate with colleagues, other professionals, clients, and family mem-
bers, such as paper or electronic means. We spend more time in Chapter 17 discussing
social media and other issues related to technology, but we want to discuss a few issues
here concerning communication in general and to offer some general guidelines to follow
with regard to how to communicate in a professional manner.

WRITTEN COMMUNICATION
What is essential to remember about written communication is that once you write it, it is
available for everyone to see. Check with a supervisor about rules concerning communi-
cation. Otherwise, remember the following:

• Anything posted online can be sent to anyone or anywhere else.

• Write everything as if you know that the client will be reading it.
• If writing is not a strength of yours, make sure you have someone review/​edit your
work. You are representing the social work profession, and the work should be
professional. Anything you write can be part of a permanent record that could be
around for years.
• In any form of written communication, use a professional style of writing, such
as opening with “Dear Ms. Jones” or “Dear Dr. Jones.” Remember the tone of
e-​mails should be as if you were writing a formal letter and not just an e-​mail to
an acquaintance.
• Think about the clients and whether they are more likely to respond to one form of
communication compared to another.

ORAL COMMUNICATION
• Be sure that with oral communication you ask others to repeat back to you what
they have heard because often your meaning can be misunderstood.
• It is often prudent to follow up on oral communication with a written note in the
file or email to document that the communication took place and the message that
was conveyed.
• Speak clearly and avoid fillers such as “um” and “like” as they detract from the
message and the professionalism of the communication.
• Use formal communication unless instructed to address the person informally.
• Be aware of your nonverbal communication, which may contradict your message.

What to Know Before You Start • 7

 HOW THE NASW CODE OF ETHICS INFORMS
THE PROFESSIONAL SELF
Finally, social workers on teams and in professional settings need to be always cognizant
that they are representing a profession that has a core mission and values. Therefore, the
comments and opinions expressed by the workers on teams and in meetings should be
consistent with the profession’s values and ethics. In addition, the actions of the worker
should be in keeping with the principles that guide the profession, such as maintaining
boundaries and the roles to which they are assigned. We have unfortunately been on
teams where some of our social work colleagues, in their desire to help their clients,
have made suggestions that cross boundaries (e.g., by the workers offering to provide
a service outside of his or her role). We have also witnessed our colleagues describe a
conversation to other professionals in which they have disclosed confidential informa-
tion from the client—​indicating that they do not uphold confidentiality agreements.
Therefore, we strongly recommend that the readers be familiar with the NASW (2008)
Code of Ethics to better understand the behaviors associated with our professional
standards. We encourage you to review them as soon as possible if you have not already
done so. They can be easily accessed online (https://​w ww.socialworkers.org/​pubs/​
code/​default.asp).

USE OF SELF
Throughout your professional career, you will most likely hear the term use of self. The
definition is somewhat elusive, in that it is used differently to describe various aspects of
how you use yourself in your work with clients. These aspects can refer to personality or
behaviors, such as sense of humor, body language, and others (Dewane, 2006; Edwards &
Bess, 1998). In these instances, the phrase is used to capture what many people think of
the art of the work you do with clients (Cameron, 2014; Graybeal, 2014). Just like a cook,
musician, or painter, for example, the personal style influences how you execute whatever
task you are doing with your clients. In this way, you will be developing your own style or
fine-​t uning the “instrument” you will be using in the relationship with the client: your-
self. (See Chapter 4 for more information on the relationship.) If you think about different
medical care doctors you have had, there may be some who had a great “bedside manner”
compared to others who did not. Those who you liked may have shared a bit about them-
selves, leaned in when they talked to you, asked you questions that appeared to go beyond
your “presenting problem,” or had other characteristics that you noticed. Two different
providers can be providing the same “intervention,” but their styles may be quite differ-
ent; these examples represent one interpretation of the use of self.
Another way of defining use of self is derived from the theoretical orientation that is
used by the social worker. Different models of intervention in micro, mezzo, and macro
social work as well as different modalities of treatment (i.e., individual, group, or family
interventions) describe the role or stance of a social worker in those contexts. We discuss
more about how different theories inform our work with clients in Chapter 11. For now,

8 • Moving Beyond Assessment

it is important to know that, depending on which theory you are using to help inform
your work with a client, theory may guide you to be slightly different with the client than
if you were using a different theory. For example, let us compare two different individual
models. One might have you focus more on your reactions to the client and what those
reactions tell you about the client and then purposefully and with careful intent articulate
to the client those reactions to help facilitate change. Another model might have you be
more of a coach to the client, with your focus on teaching skills. Using this model, your
reactions to the client are irrelevant to the skill-​building focus and would not be shared
at any time with the client. Each of those stances asks something different of the worker.
These differences are driven primarily by the underlying assumptions of the model and
what is assumed will facilitate change.
For us, the phrase use of self is a combination of both of these definitions. Social work-
ers need to attend to, notice, and use their personalities to engage with clients. As social
workers evolve professionally, their own styles and comfort levels with what they bring to
the relationship with clients grow and change (Schneider & Grady, 2015). Good supervi-
sion can be a useful tool in helping newer social workers reflect on how their own styles
have an impact on all clients as well as with certain subgroups. This topic is covered in
more detail in Chapter 16. In addition, social workers need to be aware of the assumptions
of the model they are using and how those assumptions lead to a particular stance or style
of working with clients. Both of these definitions or descriptions of the use of self are
essential for workers to attend to in their work.

SELF-​AWARENESS
A key factor in the ability to purposefully use ourselves with clients is our own level of
self-​awareness. One of the most critical aspects needed for a competent social worker is
being self-​aware. If we are unaware of how we come across to others, such as how our
sense of humor can be “off-​putting,” our discomfort with eye contact, or the tone of our
voice, then we will not be cognizant of how those personality styles or traits are affect-
ing our clients. We also need to know our own triggers for when we might be upset or
offended or when we might be more likely to cross a boundary with a client. We need to
be aware of which clients we are more likely to avoid versus those we eagerly seek out.
We need to think about what we gain by doing this kind of work with clients and what
toll it might be taking on us. Without self-​awareness, we can make professional judg-
ment errors that can have lasting consequences, both for ourselves and for our clients
(Safran, 2011).
There are many ways to gain self-​awareness. Some social workers have advocated for
all students studying for the master’s in social work to participate in therapy (Mackey &
Mackey, 1993) as a way to have future workers gain some insight regarding who they are
and what their vulnerabilities are as well as their strengths. However, requiring social
work students to attend therapy has garnered criticisms, including the associated costs
and that some students may identify a preference for a path to self-​awareness (Mackey &
Mackey, 1993). Other methods to increase self-​awareness besides therapy include journ-
aling, spiritual guidance or counseling, use of supervision, or personal relationships. We

What to Know Before You Start • 9

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