Therapeutic Relationship

This section will begin with a brief overview of the history and development of the therapeutic relationship between the social worker and the client. The importance of client engagement is examined, followed by a short case example. Relationship ruptures, how these might serve to strengthen the therapeutic relationship, and what social workers need to be aware of when working with their clients are discussed. Lastly, awareness in regard to how clients may feel or react towards a CPS report is considered, as well as how these reports may impact the clinical relationship and the work that is being done. 

Click on the different sub-sections below to navigate the page!

• History of the Therapeutic Relationship
• Engagement
• Therapeutic Relationship Ruptures
• Client Feelings and Reactions to a CPS Report
• Impact on the Clinical Relationship and Clinical Work
• Strategies to Maintain the Relationship

History of the Therapeutic Relationship 

     Historically, social work authors have characterized the relationship as the “soul” (Biestek, 1957), the “heart” (Perlman, 1957), and the “major determinant” (Hollis, 1970) of social work intervention. Roger’s seminal book, Client-Centered Therapy (1951), bestowed the relationship with healing and restorative functions, which are predicated on the qualities of congruence, acceptance, empathy, warmth, and unconditional positive regard. Within Cognitive Behavioural Therapy, the relationship is posited as one of teamwork (Raue & Goldfried, 1994), which involves clients and clinicians working together to identify problems and solve client concerns. A postmodern approach to alliance formation emphasizes a relationship based on collaboration and mutual respect (Richert, 2010) whereby the client is both invited to co-construct new meanings and behaviours (Sexton & Whiston, 1994) and is viewed as the expert on their life and concerns. 

     Edward Bordin (1979) is credited with the term “therapeutic alliance” and put forth the existence of three, inter-related components of the alliance: bond, goals, and tasks. Empirical studies show that the therapeutic alliance plays an integral role in the interactions between social worker and client and is one of the most consistent and strongest predictors of treatment success (Horvath, 2001; Horvath & Symonds, 1991; Lambert & Barley, 2001; Martin et al., 2000) independent of social worker adherence to specific therapeutic approaches (Bickman et al., 2004; Chatoor & Krupnick, 2001; Horvath & Bedi, 2002; Karver et al., 2006; Luborsky, 2000; Martin et al., 2000; Sexton et al., 2005). For the purposes of clarity, the term “relationship” will be used to refer to qualities which encompass both the concepts of “relationship” and “therapeutic alliance.” 

Engagement 

     Engagement begins from the first point of contact, whether this occurs in the traditional waiting room or with the rise of electronic technologies, via email or text message (Mishna et al., 2012). This will include introductions and brief social talk and should be predicated on Rogers’ (1951) time honoured principles of warmth, genuineness, and non-judgmental regard. In this way, the social worker creates an inviting space for clients to tell their story (Bogo, 2018). The adage of “starting where the client is” in the engagement stage enables social workers to understand the situation from the perspective of the client and allows the client to feel heard in their distress. Although engagement is most pressing in the initial stage of therapy, engagement is an on-going process which must be re-established with succeeding sessions or contact. Early relationship formation can lessen the negative impact of a report to CPS. 

     Within the engagement stage, it is essential that mandatory reporters are transparent regarding the limits of confidentiality and their legal obligation to report suspected child maltreatment. By being honest as to their reporting obligations, an atmosphere of trust is created (Smith, 2001). This discussion, undertaken in the early stages of the therapeutic relationship, also empowers the family by allowing them a measure of control over what information they wish to share in session (Bean et al., 2011; Davidov et al., 2012; Tufford, 2012, 2014). 

     Jasmine, a social worker at a children’s mental health centre, is meeting parents Juan and Yolanda for the first time, who immigrated to Canada three months ago. Their five-year-old son Jorge is reportedly socially withdrawn at school. After inquiring if they found the centre easily and engaging in some initial pleasantries regarding the weather, Jasmine produced the centre’s informed consent document. She outlined the limits to confidentiality to ensure Juan and Yolanda understood this information clearly prior to beginning the session. 

Therapeutic Relationship Ruptures 

     Despite the importance and centrality of the therapeutic relationship, every social worker experiences from time to time “relationship ruptures,” also known as “deteriorations in the relationship between clinician and client” (Safran & Muran, 1996, p. 447). Safran and Muran (1996) note that relationship ruptures emerge from both social worker and client contributions. Clients may demonstrate behaviours or communications requiring exploration in session while social workers may become caught in maladaptive, interpersonal cycles similar to clients’ other interpersonal interactions that serves to confirm clients’ beliefs about how they relate to others (Safran, 1990). 

     Relationship ruptures may waver in intensity, duration, and frequency and may go undetected by either social worker or client (Safran & Muran, 2000). Intense relationship ruptures can lead to a weakened relationship, thus resulting in dropout or treatment failure (Samstag et al., 1998). However, when a mandatory reporter manages a relationship rupture well, it can serve as the basis for therapeutic change and provide clients with a “new constructive interpersonal experience” (Safran, 1993). Given that clients may be neither willing nor able to voice their concern regarding a lack of comfort or disagreement with their social worker, it thus becomes critical for the social worker to recognize when the relationship is in jeopardy and address the rupture in a sensitive fashion to allow exploration and a minimum of client anxiety (Safran et al., 2001). The relationship may improve if social workers can respond to clients in a non-defensive fashion, adjust their behaviour accordingly, and address ruptures as they arise (Rhodes et al., 1994). 

Client Feelings and Reactions to a CPS Report 

     Returning to the framework earlier in the manual, when a client is told that a report will be made to CPS, clients can have many feelings and reactions. Some clients feel relief and appreciate the support they will receive from the CPS because they do not have access to resources. Some clients also understand the reason for the report and the duty and obligation on the part of the social worker to report. Some parents are able to understand that the report is made in the best interests of the child. 

     Some clients may also experience negative feelings such as anger and defensiveness that they are not receiving the assistance they expected to receive from the social worker (Tufford, 2012, 2014). Some clients may feel anxious that a report will be made. The child may also feel anxious that they are to blame for the family’s involvement with CPS. Fear is another negative feeling and may centre on the child being removed from the home (Asnes & Leventhal, 2010; Tufford, 2012, 2014), fear of the unknown, or fear that the perpetrator now knows a report has been made. Some clients may feel shame that a secret has now been revealed while others feel suspicious of the social worker’s motives upon hearing of the report and that the social worker has taken the side of the CPS. Feeling violated and judged are other negative feelings in addition to families feeling alienated and betrayed. Finally, some clients will deny the occurrence of maltreatment and blame the social worker for the involvement of CPS. 

     Social workers are advised to prepare themselves for a range of feelings and reactions on the part of the client. From a clinical perspective, social workers should understand the distinction between primary and secondary emotions (Fosha, 2000; Greenberg, 2002). Clients facing a report to the CPS may experience primary emotions such as shame or embarrassment which can be quickly covered by anger used as a defense against these more primary and vulnerable internal feelings. Secondary emotions, such as anger should be first validated and then explored to uncover the primary emotions (Greenberg, 2002). 

Impact on the Clinical Relationship and Clinical Work 

     A report to CPS can impact the clinical relationship and clinical work. The relationship may be maintained or strengthened through the social worker’s honest explanation of the reason for the report and for stating that the first priority is safety for the child. If social workers can demonstrate their desire to improve family functioning this often maintains the relationship. 

     However, the opposite may also be true. The relationship can become strained and tense and there can be a loss or diminishment of trust in the relationship. The loss of trust often centers on the breaking of confidentiality. Negative impacts on the clinical work include the family withdrawing from treatment altogether or families continuing in treatment but sharing decreasing amounts of information. This may depend on the presence and strength of the therapeutic relationship with the family, how long the social worker has known them and been working with them. These impacts can vary from family to family. 

Strategies to Maintain the Relationship 

This section will focus on the different strategies that social workers can take to maintain the relationship between worker and client when a CPS report is involved. These strategies are separated into reporting strategies, information strategies, affect regulation strategies (mandatory reporter), affect regulation strategies (family), advocacy strategies, resource strategies, and cultural strategies. Each of these will be expanded upon with specific examples of ways in which social workers can implement these strategies. 

Reporting Strategies 

     Reporting strategies involve how the report is made to CPS. It is important to note that Canadian law does not require mandatory reporters to inform the client prior to making a report. Some mandatory reporters may choose to discuss the duty to report with the client before reporting or tell them afterwards to remove a sense of betrayal (Tufford, 2012, 2014). Mandatory reporters may also try to involve the client in the reporting process and there are several ways to do this. One option is to have the client present when the mandatory reporter calls CPS. Another option is to encourage clients to self-report with the mandatory reporter present or having stepped out of the room. A third option is for the mandatory reporter and the client to call together. These options promote transparency, allow the client some control over the reporting process and reduce the sense of isolation felt by the client (Pietrantonio et al., 2013; Steinberg et al., 1997). 

     Chris, a social worker at a children’s hospital, listened to Jennifer’s account of how her three-year-old daughter was sexually molested last week by a daycare worker. After briefly consulting with his interprofessional team, Chris relayed to Jennifer that the CPS needed to be called. Jennifer was frightened at this turn of events so Chris suggested they contact CPS together where both could be on the phone. This helped Jennifer feel more supported. 

Information Strategies 

     There are many information strategies. Revisiting the signed consent form from the start of treatment can remind clients of the original agreement and the obligation to report suspected child maltreatment. Mandatory reporters can also provide important information to clients about CPS such as the process of reporting and the process of a CPS investigation in that the protection worker may come to the residence. However, this last point is not akin to coaching clients on what to say to CPS should an investigation occur. Mandatory reporters can also explain the role of CPS as a protector of children as well as the benefits of involvement with CPS such as in-home assistance with parenting struggles. It is important to note that not all CPS across Canada offer these services to families, but for those that which do, this may help parents see CPS in a supportive rather than punitive light. 

     Mandatory reporters can maintain contact with CPS throughout the process of an investigation and support clients. Finally, mandatory reporters who work in the mental health field may offer psychoeducation to clients to assist them in deepening their familial connections, decreasing shame, and exploring how family of origin disciplinary practices impact present disciplinary decisions. 

Affect Regulation Strategies (Mandatory Reporter) 

     Mandatory reporters may feel intense, negative feelings after reporting to CPS as well as when facing families’ anger. In order to stay focused and calm, it may be helpful to explore these negative feelings with a colleague or supervisor. By remaining composed and attuned to one’s feelings in the face of a client’s emotional reaction, mandatory reporters may help the client to “down regulate,” thus promoting dialogue and the management of negative emotions (Tufford, 2012, 2014). 

     Sajedeh, a social worker at a family counseling center, found herself on the receiving end of the Gonzales family’s anger at a report she made to the CPS. She took deep breaths and planted both feet on the floor to remain calm while validating Ramone Gonzales’ anger and shock. After the family left, Sajedeh spoke to her colleague Daphne about the situation who reassured her that she took the appropriate action and validated her stressful feelings. 

Affect Regulation Strategies (Family) 

     In addition to practicing sound affect regulation strategies of a personal nature, allowing the family time to process their emotions regarding the report and validating negative emotions, are respectful behaviours and send the message that negative emotions are normal at this time. Mandatory reporters can explore and validate family’s feelings of shame, fear, blame, and anger, with the family. Validating parenting struggles is also a means by which parents can feel heard and understood by the mandatory reporter. Mandatory reporters can also openly and directly acknowledge the impact of reporting on the relationship in terms of trust. 

     During the investigation process, mandatory reporters can try to maintain contact with the family by reaching out to them via telephone or asking the family to attend further sessions. This shows interest in their well-being and reduces feelings of abandonment and judgment in the investigation process. If possible, mandatory reporters can meet with CPS worker and the family together to demonstrate transparency and so the family can hear them communicate openly with the investigation worker. which helps the family. 

Advocacy Strategies 

     In terms of advocacy strategies when children are maltreated, they often need a mandatory reporter to advocate on their behalf. One advocacy strategy is to express concern for the child’s safety and well-being as often the child does not have a “voice” per se and needs the social worker to speak on their behalf. Mandatory reporters need to be transparent with the reality of how the child is being treated or what is lacking in the child’s care. A second advocacy strategy is to reinforce parenting skills and strengths. Mandatory reporters can remind parents of times when they have shown strength in handling difficult situations with their child. They can also communicate to parents their belief that the family desires and has the ability to do better. Finally, a third advocacy strategy involves advocating on behalf of the family with CPS. Mandatory reporters can reassure parents that the fact they are seeking help speaks volumes about their strength as a family and that this message would be shared with CPS. 

     Ivy, a social worker on a family health team, reported a situation of emotional abuse as the parents belittled, name called, and used profanity towards their eight-year-old son around his fear of medical appointments. Ivy noted to the CPS intake worker that although the parents’ approach to their son’s fears was maladaptive, the parents were clearly concerned about their son’s health and sought medical attention for their son when the need arose. 

Resource Strategies 

     Mandatory reporters may find that parents lack the necessary resources to look after their children appropriately and safely. It is important to ask if extended family, friends, or neighbours could assist in helping parents to care for their children. Community supports such as food banks, clothing depots, walk-in medical services, or interim housing may also be a means of providing concrete necessities the family may not currently possess. Mandatory reporters may also have a network of professional supports that could assist families. In a situation where the parents are too upset about the report to continue working with the mandatory reporter, offering families the option of working with another professional may keep the family engaged in treatment. However, this may be more challenging in rural or remote communities where there are fewer social workers available to service clients. 

Cultural Strategies 

     Some families, particularly those who are new to Canada, may not be aware of mandatory reporting legislation and that the laws governing the treatment of children may be entirely different from those in their home country. Explaining mandatory reporting legislation and acknowledging possible cultural differences in the views of discipline may help clients to understand accepted disciplinary practices in Canada. Other strategies that are mindful of culture include referring families to culturally specific resources whereby the family could begin to develop a social support system. Another strategy involves consulting with a colleague or supervisor knowledgeable of the client’s culture, particularly as it relates to disciplinary strategies specific to that culture or to cultural norms or expectations. Reporters may utilize the services of a translator when faced with significant language challenges. Mandatory reporters are encouraged to practice “cultural humility” and receive training in anti-oppressive/anti-racist strategies. Finally, it is important for mandatory reporters to build relationships with cultural organizations. 

Linking Strategies to Client Need 

     Although the above strategies are presented as separate and discrete, in reality, social workers practice a multiplicity of strategies in tandem. For example, social workers provide information about the CPS while concurrently validating family feelings regarding the report. It is also imperative that strategies be used in a purposeful fashion according to client need. 

     Tamika, a social worker in a family counseling centre, reported a case of child maltreatment. The father, mother, and seven-year-old son are recent immigrants to Canada with few economic or social resources. In addition to explaining mandatory reporting legislation in Ontario and discussing alternative disciplinary strategies, the social worker in this situation provided the family with the name and location of a nearby food bank as well as a local cultural centre where the family could meet people from their home country. 

Positive Impact on Relationship 

Through using the various relationship repair strategies described above, this will hopefully have a positive impact on the therapeutic relationship. It will become stronger, and the family continues in treatment. 

Reference: Tufford, L., Lee, B., Bogo, M., & Wenghofer, E. (2022). Maintaining a working relationship with clients when reporting suspected child maltreatment: Using simulation in education. Laurentian University, University of British Columbia, & University of Toronto.