Mental Health Targeted Case Management Training
Lesson 8
Advocacy and Communication Skills
Reference: The Skilled Helper: A Problem-Management and Opportunity-Development
Approach to Helping – Seventh Edition - by Gerard Egan
Advocacy
1. The purpose of this lesson is to provide you with a basic understanding of
client advocacy and communication skills.
2. Helping clients get what they want and need:
a. Case managers must take care when advocating for a client, in that
there is a fine line between advocating and making them dependent
on the case manager.
b. Case managers must assist clients in becoming more independent,
thus advocating for the client also means teaching the clients to
advocate for themselves.
3. As case managers, you can teach the clients in the implementation phase,
strategies for accomplishing goals need to be complemented by tactics
and logistics. A strategy is a practical plan to accomplish some objective.
Tactics is the art of adapting a plan to immediate situation.
4. Since many well-meaning and motivated clients are simply not good
tacticians, case managers can add value by using the following principles
to help them engage in focused and sustained goal-accomplishing action.
a. Help clients develop “Implementation Intentions.” Commitment
to goals must be followed by commitment to courses of action. The
most prevalent problem clients experience is failing to get started,
becoming distracted, reverting to bad habits, etc. Strong
commitment to goals is not enough. Equally strong commitment to
specific actions to accomplish goals is required.
1) Implementation intentions are subordinate to goal
intentions and specify the when, where, and how of
responses leading to goal attainment. They have structure
of” “When situation X arises, I will perform Y!” and thus link
anticipated opportunities with goal-directed responses.
b. Help Clients Avoid Imprudent Action. For some clients, the
problem is not that they refuse to act but that they act imprudently.
Rushing off to try to first “strategy” that comes to mind is often
imprudent.
c. Help Clients Develop Contingency Plans. If case managers help
clients brainstorm both possibilities for a better future (goals) and
strategies for achieving those goals (course of action), then clients
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Mental Health Targeted Case Management Training
will have the raw materials, as it were, for developing contingency
plans. Contingency plans answer the question, “What will I do if the
plan of action I choose is not working?” Contingency plans help
make the clients more effective tacticians.
d. Help Clients Overcome Procrastination. At the other end of the
spectrum are clients who keep putting action off. There are many
reasons for procrastination.
e. Help Clients Identify Possible Obstacles to and Resources for
Implementing Plans.
1) Obstacles. The identification of possible obstacles to the
implementation of a program helps make clients
forewarned. The assumption here is that if the clients are
aware of some of the “wrinkles” that can accompany any
given course of action, they will be less disoriented when
they encounter them. Obstacles can come from within the
clients themselves, from others, from the social settings of
their lives, and from larger environmental forces.
2) Facilitating forces. In a more positive vein, case managers
can help their clients identify unused resources that can
facilitate action. Brainstorming resources that can counter
obstacles to action can be very helpful for some clients.
Helping clients brainstorm facilitating forces raises the
probability that they will act in their own interests.
f. Help Clients Find Incentives and Rewards for Sustained
Action. Clients avoid engaging in action programs when the
incentives and the rewards for not engaging in the programs
outweigh the incentives and the rewards for doing so.
1) New incentives have to drive out the old incentives. The
incentives and the rewards that help a client get going on a
program of constructive change in the first place may note
the ones that keep the client going.
2) Constructive-change activities that are not rewarded tend
to over time lose their vigor, decrease, and even
disappear. This process is called extinction.
3) Incentives cannot be put in place and then be taken for
granted. Incentives have to be attended.
g. Help Clients Develop Action-Focused Self-Contracts and
Agreements. Self-contracts are useful in helping clients both
initiate and sustain problem-managing action and the work involved
in developing opportunities. Agreements can also act as drivers of
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Mental Health Targeted Case Management Training
action in many different kinds of problem-managing and
opportunity-developing situations.
h. Help Clients be Resilient after Mistakes and Failures. Clients
like the rest of us stumble, fall and as they try to implement their
constructive-change programs. However, everyone has some
degree of resilience within them that t enables him or her to get up,
pull him or her together, and move on once more. The ability to
bounce back is an essential life capability.
Communication:
5. Communication with the client is the foundation of good case
management. Conversations between case managers and their clients
should be a helping dialogue. Interpersonal communication competence
means not only being good at the individual communication skills, but also
marshaling them at the services of dialogue. There are four requirements
for true dialogue (Egan, in press):
a. Turn taking. Dialogue is interactive. You talk, and then I talk. In
case management, this means that, generally speaking,
monologues on the part of either client or case manager do not add
value. On the other hand, turn taking opens up the possibility for
mutual learning.
b. Connecting. What each person says in the conversation should be
connected in some way to what the other person has said. The
case manager’s comments should be connected to the client’s
remarks and ideally, vice versa.
c. Mutual influencing. Each party in a dialogue should be open to
being influenced by what the other person says. Case managers
influence their clients and the best-case manager learns from and
is influenced by their clients. Therefore, case managers need to be
open-minded and help their clients to be open to new learning.
d. Co-creating outcomes. Good dialogue leads to outcomes that
benefit both parties. The job of the case manager is neither to tell
clients what to do nor merely to leave them to their own devices.
The case manager should act as a catalyst for the kind of problemmanaging dialogue that helps clients find their own answers.
6. Nonverbal Behavior as a Channel of Communication. The face and
body are extremely communicative. We know from experience that even
when people are together in silence, the atmosphere can be filled with
messages. Sometimes the facial expression, bodily motions, voice
quality, and physiological responses of clients communicate more than
their words do. The following factors, on the part of both case managers
and clients play an important role in effective case management:
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Mental Health Targeted Case Management Training
a. Bodily behavior. Such as posture, body movements, and
gestures.
b. Eye behavior. Such as eye contact, staring, and eye movement.
c. Facial expressions. Such as smiles, frowns, raised eyebrows, and
twisted lips.
d. Voice-related behavior. Such as tone of voice, pitch, volume,
intensity, inflection, spacing of words, emphases, pauses, silences,
and fluency.
e. Physical characteristics. Such as fitness, height, weight, and
complexion.
f. Space. That is, how close or far a person chooses to be during a
conversation.
g. General appearance. Such as grooming and dress.
7. The Skill of Visibly Tuning in to Clients. You can use certain key
nonverbal skills to visibly tune in to clients. These skills can be
summarized in the acronym SOLER. Since communication skills are
particularly sensitive to cultural differences, care should be taken to
adapting what follows to different cultures:
a. Face the client Squarely. That is, adopt a posture that indicates
involvement. The point is that your bodily orientation should
convey the message that you are involved with the client.
b. Adopt an Open posture. Crossed arms and crossed legs can be
signs of lessened involvement with or availability to others. An
open posture can be a sign that you are open to the client and to
what he or she has to say.
c. Remember that it is possible at times to Lean toward the other.
Watch two people in a restaurant who are intimately engaged in
conversation. Very often, they are both leaning forward over the
table as a natural sign of their involvement.
d. Maintain good Eye contact. In North American culture, steady eye
contact is not unnatural for people deep in conversation. This is not
the same as staring. Maintaining good eye contact with a client is
another way of saying, “I’m with you; I’m interested; I want to hear
what you have to say.”
e. Try to be relatively Relaxed or natural in these behaviors.
Being relaxed means two things: First, it means not fidgeting
nervously or engaging in distracting facial expression; the client
might not wonder what is making you nervous. Second, it means
becoming comfortable with using our body as a vehicle of personal
contact and expression. Your being natural in the use of these
skills helps put the client at ease.
8. Active Listening. Effective listening is not a state of mind, like being
happy or relaxed; it’s not something hat just happens. It’s an activity. In
other words, effective listening requires work. Listening involves:
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Mental Health Targeted Case Management Training
a. Listening to the Clients Stories. Most immediately, case
managers listen to clients’ stories – that is, their account of their
problem situations and unused opportunities. These stories tend to
be a mixture of the clients’ experiences, behaviors, and emotions.
b. Listening to Clients’ Point of View. As the client tells their stories,
explore possibilities for a better future, set goals, make plans, and
review obstacles to accomplishing these plans, they often share
their points of view.
c. Listening to Clients’ Intentions or Proposals. Clients state their
intentions, offer proposals, or make a case for certain courses of
action. Develop a framework for listening that can help you zero in
on the key messages your clients are communicating and help you
identify and understand the feelings, emotions, and moods that go
with them.
d. If you listen only for problems, you will end up talking mainly about
problems. Every client has something going for him or her. Your
job is to spot clients’ resources and help them invest these
resources managing problem situations and opportunities.
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