How Do We REALLY Work with Clients: Redefining the Helping Process

BACKGROUND AND PURPOSE: Fully conceptualizing and understanding the helping process with individuals, families, groups and communities is useful for building skills in social workers and setting goals and objectives for each phase of work with clients. Traditionally, the helping process has been defined in a time sequence that starts with the preliminary phase that encompasses preparing to work with clients by building a positive working relationship. These phases continue with the beginning/contracting phase, work/middle phase, and concluding with the ending/termination phase (Gitterman & Salmon, 2009; Schulman, 2009). As part of a larger inquiry into the cultural competence of evidence-based practice, a qualitative study was conducted to more completely understand the construct of the helping process. METHODS: A systematic qualitative review of interventions listed on SAMHSA's National Registry of Evidence-based Practices and Programs (NREPP) was conducted. A purposeful stratified sample was taken to represent prevention and treatment interventions that considered the fields of mental health and substance abuse, target age groups, inclusion of racial/ethnic minorities, and setting of interventions (e.g., rural, urban). Listed interventions were also selected based on availability of materials for review. Thirty interventions were identified for close analysis. Two researchers identified all the components that were distinguishable from all available intervention materials. The identified components were then categorized as belonging to one or more of the known phases of the helping process, if possible. Those unable to be categorized into known phases were grouped thematically. Findings were then reviewed by outside researchers and known experts in either the field of cultural competence or direct clinical practice for accuracy and completeness. RESULTS: Specific components were identified for each of the traditionally identified phases of the helping process. Three components were identified that related to the preliminary and beginning phases, seven components were identified that related to the work or middle phase, and three components were identified that related to the ending/termination phase. An additional phase, access, was identified that precedes the preliminary phase in time. Access was identified as having both structural and operational components that impact clients' abilities to reach or receive services. In all, nine components were identified that comprise access. These include location, transportation, and building as structural components and hours, language, payer, provider, intervention-specific training and materials, and clients in treatment as operational components. CONCLUSIONS AND IMPLICATIONS: The recognition of an access phase is important to comprehensively understanding the helping process. This recognition gives the profession an opportunity to build applicable skills in social workers. Additionally, recognition of this phase enables agency administrators to identify and manipulate relevant components in a manner that may enable potential clients to access services previously unavailable to them.