I Am Not Sure How To Tell You This: Delivering Unwelcome News
By: Misty L. Wall, Ph.D., MSSW, LCSW
Many times, social workers are called upon to deliver unpleasant news to clients and families. Some of the most difficult discussions have to do with death, dying, long-term care placement of a loved one, loss of custody or removal of children, and placement in foster care. There are a few simple steps you can take to facilitate the conversations that no one really wants to have.
Let’s look at an all-too-common experience for social workers specializing in child protection. Consider this: As a social worker, you have been working with a family for several months to alleviate risk of injury to their child while living in a home that is full of safety and sanitation hazards. To date, the family has been unable, or unwilling, to make the necessary changes that will allow their child to safely remain in the home. No suitable family members have been located who can provide care for the child while the family makes the necessary changes, so the child will be removed from her biological parents and placed into a foster home.
PREPing for the Conversation
If you are entering the field of social work, you can safely assume that at some point you will have to deliver news that is not going to be easily received, like the situation mentioned above, when you must tell a family that their child will be placed in foster care. A great deal of work happens before you actually meet with the client to deliver the bad news, and you can use four simple steps (pause, react, evaluate, plan—or PREP) to prepare to deliver challenging news.
Pause. It is important to pause before the delivery of unwelcome news, because the focus of the delivery should be the client(s) rather than the social worker. New social workers may feel overwhelmed with feelings surrounding self-doubt, including mistrusting their ability to convey the unwanted news, being unsure of their ability to stay in the moment, fear of the client’s reaction, or alarm about their personal safety. Pausing allows you, the social worker, to take a personal inventory of your fears, emotional triggers, and physical reactions before you meet with the client.
React. Taking inventory of your fear, emotional triggers, and physical reactions is not enough to ensure you are able to stay present and focused on the client during the delivery of unwelcome news. After taking a breath, social workers should give themselves permission to react emotionally or physically, consciously allowing whatever physical and emotional reaction simmers to the surface to happen. Stuffing or refusing to acknowledge emotional and physical reactions can lead to burnout, compassion fatigue, or somatic complaints. Everyone’s reactions will be different—it may mean crying, screaming, venting to a trusted peer, or any number of things. Only after you allow this initial reaction can you refocus yourself on your goals.
Evaluate. Evaluation while PREPing to deliver unwelcome news includes consideration of the client’s perspective and planning to reduce the impact of trauma resulting from negative news to the greatest extent possible. Considering the task before the child protection social worker described earlier, we may feel limited in our ability to empathize with the parents who have been unable, or unwilling, to make the necessary changes to allow their child to remain in their care. However, many of us can imagine a time that we have received painful news that changed our lives forever.
Reflect on the setting where you first learned there had been an attack on the Twin Towers on September 11, 2001. Chances are that when you think about that time, you can remember everything about where you were, what the room looked like, who was with you, what they were wearing, what you heard, and how you felt.
When preparing to deliver unwanted news to a client, it can be beneficial to acknowledge the pain associated with receiving such news. Potential ways in which social workers may be able to reduce the stress caused by receiving hurtful news may include considering location and physical setting, ensuring there are adequate chairs for everyone, and providing for small comforts such as water or tissues. Also, it is important to take into consideration who will be present, who will be excluded, and timing.
Reflect on the chore before our child protection worker. Although there is likely never a good time to convey the decision to remove a child from his/her parents, there are times when such information may be received with less difficulty. Contemplate the difference between delivering the news of a foster care placement at the client’s place of employment and delivering the same news at the client’s home or trusted family member’s home. Likewise, imagine that you are delivering the decision to remove a child from the parents in the lobby of your office versus in a visiting room with a bottle of water, a chair, and tissues available for the client. Your empathy for the client’s experience will be evident in the setting you choose for the delivery of undesirable information.
Plan. After you have paused, reacted, and evaluated the situation objectively, it is time to actively plan your delivery. At the least, you should know the reasons leading up to the “news” and be able to respond concisely to your client’s concerns and questions. This is not a time to have to review the file or ask someone else.
Again, remember where you were when you heard of the first and second attacks on the Twin Towers. Remember the agony you experienced, as so many questions remained unanswered? Imagine the agony of the mother who has been told she is unable to provide a safe home for her child and the questions that would swirl through your mind after hearing such news. What can I do to have my child returned? What about a relative? How long will she be gone? Can I see her? Imagine a social worker retorting to your concerns with uncertainty, ambiguity, or disinterest.
Additionally, consciously determine your goal for the delivery. Take a deep breath and think about what you want your client to remember at the end of this conversation. This is the goal. It should be short, specific, and clear.
SOARing Through the Delivery
The actual delivery of a hard-hitting announcement is generally over very quickly. In fact, when you have prepared yourself thoroughly as described above, the actual delivery of bad news should not take more than a few minutes. Many beginning practitioners feel they must stay with the client while he or she processes the worrisome information. This is not true. The actual processing and making meaning of bad news is the responsibility of the client. If we stay, we can actually prevent the client from beginning this important work. Consider the following suggestions to SOAR (stay present, observe reactions, acknowledge reactions, restate and refocus) through the actual delivery of difficult news.
Stay present. Stay present in the room with your client and help the client stay present. Remember that you have taken considerable time to plan for this moment. You have a solid plan that is client-focused. If you feel the conversation is getting beyond your control, take a break, refocus on your goal, and trust in your ability.
Observe reactions. Your client will undoubtedly give you the clues you need. Pay attention. If someone appears lightheaded, offer water or a place to sit. If your client appears to need some time alone, offer to step away for a moment. Your reaction to your client is important to maintaining your working relationship, because the delivery of unwanted news is often the beginning of a social worker’s relationship with a client.
Accept reactions. It does not matter if your client should have seen this coming; his or her initial reactions will be genuine and emotion-focused. Think about our child protection social worker once again. Comments from the social worker such as, “You have had several warnings and could have prevented this if you wanted to,” put your client in a defensive stance and make you the enemy rather than a teammate. Validate immediate emotional reactions without judgment. Another way our child protection social worker may respond, this time with the focus being on acceptance and empathy, may be, “I can see you are extremely upset by this news. I imagine you have questions.” This is not the time to make connections between behavior and consequences.
Restate and refocus. After you paraphrase the news and the client’s reactions, point out any strengths you have seen in your client, and convey that you will work with the client to sort out the pieces and that you are confident that you and the client will be able to work together to find a path of action. Our child protection social worker may close with something such as, “You seem very upset and tearful at the thought of your child being in foster care tonight. I have seen you face many difficult situations during our work together, and I am confident we will make a plan that will help keep your child safe.”
PREPing For Next Time
Remember again your reaction when you found out about the terrorist attack on New York City. Just hearing the story and subsequent news coverage was simply the beginning. The real processing or sorting out of the events happened later. The same is often true of delivering bad news to a client. We may relive or replay the scenario in our heads, have difficulty sleeping, doubt or second-guess our decisions, or have other physicial or psychological reactions.
Understanding that your work does not end with the actual delivery of arduous information is critical to your ability to provide the best services to your client, remain healthy, and avoid burnout or compassion fatigue. When you finish delivering the bad news, it is time to revisit the original PREP (pause, react, evaluate, plan) process previously discussed, this time with an eye toward your future work with this client and many more to come. The following are a few suggestions for managing your reactions to delivering bad news and preparing for the inevitable time when you find yourself in a position to deliver trying news again.
Pause. As quickly after the delivery as possible, pause. Take a few deep breaths.
React and refocus. Allow whatever physical and emotional reaction simmers to the surface to happen. Only after you allow this initial reaction can you refocus yourself on your goal.
Evaluate. After you have given yourself the opportunity to feel the emotions that simmer up, it is time to start sorting out your professional performance. Is there something that seemed to help the client? Is there something you think was ineffective or even unhelpful? How can you improve next time?
Plan. After you have given yourself time to pause, react, and evaluate, it is time to plan for next time. Respect the fact that you are an important vehicle for effecting change for your client. Take the reactions of you and your client and plan to increase the positive experiences next time and reduce the negative impacts when possible.
Misty L. Wall, Ph.D., MSSW, LCSW, is an assistant professor in the School of Social Work at Boise State University.
From The New Social Worker, Winter 2012, Vol. 19, No. 1.