THE CARING HELPER

WORKBOOK
Dale G. Larson, Ph.D.

Contents

Using This Training Program ..............................................................................ii

1: You as a Helper ..............................................................................................1

2: Grief and Loss.................................................................................................3

3: Communication Skills for Effective Helping .................................................5

4: Guidelines for Listening and Helping.............................................................8

5: Making Support Groups Work .......................................................................10

6: The Helper’s Journey......................................................................................13

Resources and Bibliography ................................................................................16

Special Credits and References............................................................................18

 Using This Training Program

The Caring Helper Workbook

This workbook is designed to enhance learning for viewers of the Caring Helper
videos. It contains introductions to each of the six units in the series, preparation
questions to stimulate thought and to help prepare the viewer for the content of
each session, review questions for group discussion and individual reflection,
exercises for skill development, and a list of resources and selected bibliography.

The workbook can serve as a personal guide and reference book for each learner.
Participants can use the workbook to record personal notes, ideas, experiences,
and observations while taking the course. These notes will serve as a personal
reference and reminder long after learners have completed the training course.

Suggestions for Groups

Read the Introduction, Pre-Work Questions, and Highlights before watching the
video. Allow one-half to one hour following each unit for Review Questions and
Activities. You can review segments of the video for discussion.

Suggestions for Individuals

Read the Introduction, Pre-work Questions, and Highlights before watching the
videotape. Individual viewers can privately reflect on the Review Questions and
Activities and can experiment with helping and self-care skills outside the
viewing room. All viewers are encouraged to think critically about the ideas
presented and to be patient and persistent when initiating change in their helping
and self-care skills.

Copies of this workbook may be printed by purchasers of The Caring Helper videotapes, soley for
the personal use by participants who view the videotapes for training purposes. The material in
this workbook may not be modified or reproduced in any other manner. This limited license for
reproduction does not forfeit any copyright protection of this workbook.

ii The Caring Helper

1: You as a Helper

Introduction
This session focuses on the caregiver as an idealistic, empathetic, and altruistic
person with unique helping goals and motivations, struggling to meet the
challenge of being emotionally involved as a helper without burning out. A
model of helping as a natural process is presented and experienced helpers share
the rewards they experience as caregivers. The importance of maintaining
psychological balance⎯in the moment and over the course of one’s career⎯is
emphasized, and the hazards of the Helper’s Pit are explored.

Pre-Work Questions
What are your motivations in helping and your purpose as a helper? Think back
to when you initially decided to become involved in the helping work you’re now
doing. What was going on for you? What did you want to achieve as a helper?
What was your purpose? Has this purpose changed since you first became
involved?

Personal Notes
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1: You as a Helper 1
 Highlights
1. Program introduction 5. Feel good⎯do good
2. The helper as a person 6. The need for skills
3. The rewards of helping 7. The challenge of caring
4. Helping as a natural process 8. The Helper’s pit

Review Questions and Activities

What does it feel like to help others? Do you ever have any of the positive
experiences described in this session? How does caring for others impact on
you?

Does the “feel good⎯do good” hypothesis make sense to you? Does it match
your experience? How or how not?

What keeps your “caring flame” burning brightly? Identify specific uplifting
events at work and at home that enhance your mood and support your helping.

Have you ever been overly involved with the people you help? Think of the most
difficult experience you have had as a helper, one that definitely pulled you into
the “helper’s pit.” What happened? What does this experience teach you about
your vulnerabilities, your coping skills, and your coping resources (i.e., your “tree
limbs”)?

Discuss the challenge of caring as you experience it. What is trying to meet this
challenge like for you?

2 The Caring Helper

2: Grief and Loss

Introduction
This unit explores the dynamics and impact of grief and loss. Topics include the
stages of grief, the “tasks” of grieving, and signs of complicated grief. Specific
intervention techniques and goals with grieving individuals and families are
presented. Interviews with bereaved family members illustrate the stages and
tasks of grieving.

Pre-Work Questions
Discuss or reflect on what grief and loss are for you. Identify all the different
kinds of losses we can experience in life. What emotions do you have when you
confront loss in your own life? How have your own loss experiences affected
your work with grieving persons?

Which coping strategies have been most and least effective for you as you
struggled to cope with these losses? What have you seen as most and least
helpful for the grieving people you work with?

Personal Notes
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2: Grief and Loss 3

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Highlights
1. Grief and loss 5. Tasks of grieving
2. The stages of grief 6. Complicated grief
3. Suffering and disorientation 7. Intervention goals
4. Recovery 8. Grief attacks

Review Questions and Activities

What are the benefits and risks of using a conceptual model like “stages of grief”
in our work as helpers? When have you found it helpful? When have you found
it not helpful?

Many issues important in bereavement counseling are not addressed here (e.g.,
the age of the grieving person, the nature of the death, anticipatory grief,
“unfinished business” between the griever and the deceased, etc.). Discuss
helping situations in which these and other issues have been or might be
significant factors.

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3: Communication Skills for Effective Helping

Introduction
This unit presents a microskills approach to communication skills and skill
development. Specific nonverbal (attending) and verbal communication
microskills are identified. The skills of paraphrasing, summarizing, reflecting
feelings, and the client-frame-of-reference response are demonstrated in
interviews with bereaved persons. Directiveness and nondirectiveness in
counseling are discussed, and specific interventions based on an understanding of
grief as an existential, questioning process are outlined and illustrated.

Pre-Work Questions
What “talk tools” do you use most frequently as a helper? Do you ask questions?
Give advice? Try to reflect the feelings that you’re hearing? Self-disclose?
Which of these “talk tools” seem to work best for you? Which seem to be less
helpful, maybe even counterproductive?

Personal Notes
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3: Communication Skills for Effective Helping 5

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Highlights
1. Stages of skill development 5. Closed and open questions
2. Helping microskills 6. Frame of reference
3. Paraphrase and summarize 7. Grief’s questions
4. Emotional communication 8. Who am I now?

Review Questions and Activities

Discuss the use of silence as a communication skill. Passivity and the use of
silence are often confused. How are they different?

Consider your use of questions as a helper. Are there any other ways you can
gather information? Discuss how questions can often be used to give advice and
to share our own opinions about things.

6 The Caring Helper

Discuss directiveness as a dimension in your helping interventions. How could
you be more directive with regard to process and less directive with regard to
content?

Discuss the client-frame-of-reference response as a nondirective mirroring

response. What effect does this skill have on the helper?

Exercises
Try doing things differently⎯like asking open rather than closed questions, or
asking no questions for 15 to 30 minutes at a time.

During the next week carefully monitor your own use of advisement as a helper.
Take a close look at how often you advise and the kinds of advisement you give.

Practice closed and open questions and the client-frame-of-reference response

with others in your group. Form dyads and have one person disclose stressful
experiences he or she is having as a helper. Have the other person (the helper)
first use only closed questions, then only open questions, then no questions, and
then no questions plus one or two client-frame-of-reference responses during four
three-minute periods. Stop and have the entire group discuss the impact (on both
the discloser and the helper) of the different microskills on the helping
interaction. Then switch roles and repeat the exercise.

3: Communication Skills for Effective Helping 7

 4: Guidelines for Listening and Helping

Introduction
Unit four presents general guidelines for listening and helping, including:
enhancing self-esteem, suspending judgments, resisting outside distractions,
recalling content while listening, creating two-way intimacy through appropriate
self-disclosure, using a wide range of communication microskills, and helping
people tell their stories. Common errors and myths in helping grieving persons
are discussed, including the trivialization of distress.

Pre-Work Questions
As you think about your helping interventions in the past, what are some of the
“bloopers” you can think of? What did you do that made helping go awry?

All caregivers are occasionally judgmental or critical of the people they help.
When are you most likely to be critical or judgmental? What kinds of situations
and behaviors evoke the most judgmental parts of you?

What are some of the ways you enhance the self-esteem of the people you help?
What have you tried that has worked well?

Personal Notes
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Highlights
1. Listening and helping 5. Social expectations
2. Suspending judgment 6. Trivializing distress
3. Creating intimacy 7. Pain and moving forward
4. Myths and mistakes 8. Things to remember

Review Questions and Activities

Discuss some of the ways that judgmental thoughts and behaviors creep in for you
as a helper. Is it ever OK to be critical of the behavior of the people you help?

What are your experiences with self-disclosure as a helper? When has it worked
or not worked as a helping intervention? Discuss the relationship between
genuineness and self-disclosure in helping.

Share examples of the trivialization of distress⎯by yourself as a helper, by family

members, and by the culture at large.

In this tape the group makes many recommendations concerning what not to do as
a helper working with grieving persons. Discuss these and add mistakes you have
made as a helper to this list. What do these mistakes teach you?

When you review your current communication skills usage, what areas need the
most attention and development? How can you expand and strengthen your
helping skills repertoire?

4: Guidelines for Listening and Helping 9

 5: Making Support Groups Work

Introduction
This unit begins with a look at the role of social support in coping and stress
management. Then it describes support groups and how they help. Guidelines
for developing and enhancing support groups, and strategies for an open-ended
approach to support group facilitation are then discussed. Next, typical problems
that occur in support groups are identified and specific group exercises for
enhancing the effectiveness of support groups are presented and then modeled by
a group of experienced helpers. Finally, the issue of evaluation and feedback in
the support group is addressed.

Pre-Work Questions
What have you found makes support groups work or not work? Give examples of
specific problems that you have found in current or past groups.

What is the difference between a psychotherapy group and a support group?

What is the role of the facilitator or leader in a support group? How directive
should the leader be?

Personal Notes
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Highlights
1. The need for support groups 5. Support group exercises
2. How support groups help 6. Helper’s secrets
3. Ground rules for groups 7. Disclosing helper’s secrets
4. Facilitating a support group 8. Typical problems in groups

Review Questions and Activities

Discuss the importance of social support for both grieving persons and the helpers
who assist them.

Discuss the open-ended approach to support group facilitation.

5: Making Support Groups Work 11

 Discuss the “distress-disclosure dilemma” in terms of your own disclosure of
difficult experiences as a helper. What kinds of responses from others encourage
the development of helper secrets in yourself and in other group members?

Discuss the different kinds of support groups (e.g., support only; support with an
educational component) and support group leadership (e.g., self-led with rotating
leadership among group members; facilitation by a person(s) from outside the
group).

Discuss the value and techniques of ongoing evaluation and feedback in support
groups. Practice the evaluation techniques discussed in this tape in your own
group.

Exercises
Practice the moodcheck, all-for-one, and helper secrets exercises in your training
group or other ongoing support group you lead or participate in.

12 The Caring Helper

6: The Helper’s Journey

Introduction
This unit presents a model of stress and coping incorporating the helper’s and
goals. Different “invisible stressors” are identified and the key characteristics of
burnout are presented. Next, specific antidotes to stress and burnout are
discussed. The series ends with a reminder of the importance of self-care for the
caregiver and vignettes of bereaved persons talking about their grief experiences
and what was most helpful for them in their grief work.

Pre-Work Questions
Write out a detailed list of the stressors you experience as a caregiver. After
generating this list, put a 1 next to the most stressful item, a 2 for the next most
stressful item, and so forth.

Burnout often results from frustrated idealism and having one’s goals as a helper
blocked. Do you see any relation between what is stressful for you as a helper
and the motivations that led you to become involved as a caregiver (look at your
list of motivations from Session One)?

What kinds of support for you as a helper do you or don’t you receive from
family, friends, coworkers, and society?

Personal Notes
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6: The Helper’s Journey 13

 Highlights
1. Stress and coping 5. Setting limits
2. Social support issues 6. Exercise and relaxation
3. Burnout, cost of caring 7. Building and developing
4. Antidotes to burnout 8. The helper’s journey

Review Questions and Activities

Discuss any problems you have setting limits as a helper. What has and hasn’t
worked for you?

What emotional buttons get pushed in your work? How do you cope with them?
Notice how your way of coping is the same or different from other that of other
group members.

What is burnout like for you? What feelings and experiences do you have in
those days and weeks when you’re feeling “burned out”?

What helps you maintain balance and prevent burnout as a helper? Which of the
antidotes identified in this session are already useful to you? Which others might
be worth exploring?

14 The Caring Helper

As you begin practicing new stress management behaviors, how can you enlist the
support of others (at home, in a support group, etc.) in maintaining these new
behaviors?

Exercises
Look over the list of stressors you made before viewing the video and write a “B”
next to those stressors that you consider Beyond your control⎯you think there’s
absolutely nothing you can do to change them or reduce their impact. After you
do this, go through your list a second time and put a “W” next to all the remaining
stressors; these are, by process of elimination, at least somewhat Within your
control. Then present your list of stressors and ratings to each other (large group
or dyads) and try to think creatively about how one might move specific “B’s”
into the “W” category. Explore all the ways that you can possibly have control
over your stressors even if they seem beyond your control at first glance.

Conclusion
This training program is only a small input to your development as a helper. As a
group, or as an individual, consider what may still be lacking in your knowledge
or skills as a caregiver. What additional information and training do you need?

If you have viewed the Caring Helper as a member of a training group, take some
time to discuss how your learning and experiences in this group have helped you.
In what ways are you different as a result of this training? Be sure to take a few
minutes to share appreciations with each other and to say good-bye if the group
will not be meeting again.

6: The Helper’s Journey 15

 Resources and Bibliography

Becker, E. (1973). The denial of death. New York: Free Press.

Bowlby, J. Attachment and loss. Volume I (1969), Volume II (1973), Volume III
(1980). New York: Basic Books.
Brammer, L. (1979). The helping relationship. Englewood Cliffs, N.J.: Prentice-Hall.
California Self-Help Center, UCLA, Los Angeles, CA, 90024, (213) 825-1799. Source
for Common Concern program, an audiotape and manual training program which can
help turn a group of five to ten people with a common concern (recently widowed,
children of aging parents, breast cancer, etc.) into a fully-functioning support group.
Dr. Larson contributed a specializing tape for this series making it applicable to
hospice and oncology staff support groups. The Common Concern program and Dr.
Larson’s Hospice and Oncology Specializing Tape can also be obtained through New
Harbinger Publications, Oakland, CA, (415) 652-0215.
Carkhuff, R. R. (1977). The art of helping III. Amherst, MA: Human Resource
Development Press.
Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York:
Harper and Row.
Egan, G. (1982). The skilled helper: A model for systematic helping and interpersonal
relating (2nd ed. ). Monterey, CA: Brooks/Cole.
Gazda, G., Childers, W., & Walters, R. (1982). Interpersonal communication: A
handbook for health professionals. Rockville, MD: Aspen.
Gendlin, E. T. (1981). Focusing. New York: Bantam.
Goodman, G. (1988). The talk book: The intimate science of communicating in close
relationships. Emmaus, Pennsylvania: Rodale Press.
Ivey, A. E. (1980). Counseling and psychotherapy: Skills, theories, and practice.
Englewood Cliffs, NJ: Prentice-Hall.
Kirschenbaum, H., & Glaser, B. (1978). Developing support groups: A manual for
facilitators and participants. LaJolla, CA: University Associates.
Larson, D. G. (1993). The Helper’s Journey: Working with people facing grief, loss, and
life-threatening illness. Champaign, IL: Research Press. (Selected as a Book of the
Year by The American Journal of Nursing) Research Press: (217) 352-3273
Larson, D. G. (1993). Self-concealment: Implications for stress and empathy in
oncology care. Journal of Psychosocial Oncology, 11, 1-16.
Larson, D. G. (1992). The challenge of caring in oncology nursing. Oncology Nursing
Forum, 19, 857-861.
Larson, D. G. (1991, Summer). The codependent caregiver: A dangerous myth?
Hospice, pp. 17-19.
Larson, D. G., & Chastain, R. L. (1990). Self-concealment: Conceptualization,
measurement, and health implications. Journal of Social and Clinical Psychology, 9,
439-455.
Larson, D. G. (1987). Helper secrets: Internal stressors in nursing. Journal of
Psychosocial Nursing and Mental Health Services, 25, 20-27.
Larson, D. G. (1986). Developing effective hospice staff support groups: Pilot test of an
innovative training program. Hospice Journal, 2(2), 41-55.
Larson, D. G. (1985). Helper secrets: Invisible stressors in hospice work. American
Journal of Hospice Care, 2, 35-40.
Larson, D. G. (Ed.). (1984). Teaching psychological skills: Models for giving
psychology away. Monterey, CA.: Brooks/Cole.

16 The Caring Helper

Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York:
Springer.
Lazarus, R. S. (1984). The trivialization of distress. In B. L. Hammonds and C. J.
Scheirer (Eds), Psychology and health: The master lecture series, Vol. 3 (pp. 125-
144). Washington, D. C.: American Psychological Association.
Lattanzi-Licht, M. E., Kirschling, J. M., & Fleming, S. (Eds.). (1989). Bereavement
care: A new look at hospice and community based services [Special issue]. The
Hospice Journal, 5(1).
Levine, S. (1982). Who Dies: An Investigation of Conscious Living and Dying. New
York: Doubleday.
Lewis, C.S. (1961). A grief observed. New York: Bantam Books.
Maslach, C. (1982). Burnout: The cost of caring. Englewood Cliffs, NJ: Prentice-Hall,
Inc.
National Hospice Organization, 1901 N. Moore Street, Ste. 901, Arlington, VA, 22209,
(703) 243-5900.
Nouwen, H. (1979). The wounded healer: Ministry in contemporary society. New
York: Doubleday.
Pines, A. M., Aronson, E., & Kafry, D. (1981). Burnout: From tedium to personal
growth. New York: The Free Press.
Rando, T. A. (1984). Grief, dying, and death: Clinical interventions for caregivers.
Champaign, IL: Research Press Company.
Vachon, M. L. (1987). Occupational stress in the care of the critically ill, the dying, and
the bereaved. Washington: Hemisphere Publishing.
Williams, D. R., & Sturzl, J. Grief ministry: Helping others mourn. San Jose, CA:
Resource Publications.
Worden, W. J. (1982). Grief counseling and grief therapy. New York: Springer.
Wortman, C., & Silver, R. (1989). The myths of coping with loss. Journal of
Consulting and Clinical Psychology, 57, 349-357.
Yalom, I. (1980). Existential psychotherapy. New York: Basic Books.
Young, V. (1984). Working with the dying and grieving. Davis, CA: International
Dialogue Press.

Resources and Bibliography 17

 Special Credits and References

The Caring Helper Videotapes:

Session 2: The “tasks of grieving” are based on the model presented by William
Worden, Ph.D. in Grief counseling and grief therapy, Springer, 1982.
Session 3: 1) SOLVER acronym from Egan, G. (1982). The skilled helper: A
model for systematic helping and interpersonal relating (2nd ed.). Monterey,
CA: Brooks/Cole. 2) Grief’s questions lecture based on a presentation by
Marcia Lattanzi-Licht, R.N., M.A., at Clemson University, Clemson, SC, 9/11/88.
Session 4: For a more complete discussion of the trivialization of distress, see
Lazarus, R. S. (1984). The trivialization of distress. In B. L. Hammonds and C.
J. Scheirer (Eds), Psychology and Health: The Master Lecture Series, Vol. 3 (pp.
125-144). Washington, D. C.: American Psychological Association.
Session 5: 1) The Moodcheck, All-for-One, and Helper Secrets exercises are
described in greater detail in the Common Concern training program available
from The California Self-Help Center, UCLA, Los Angeles, CA, 90024, (213)
825-1799, and in Larson, D. G. (1985). Helper secrets: Invisible stressors in
hospice work. American Journal of Hospice Care, 2, 35-40. 2) The approach to
support group facilitation taken here is strongly influenced by the work of Dr.
Leta Adler and Michael Boreing, (Boreing, M. L., & Adler, L.M. (1982).
Facilitating support groups: An instructional guide. Unpublished NIMH
Training Grant.

Dr. Dale G. Larson Requests Your Feedback

Since I’m not able to be there in person, I’d love to hear from you about your
experiences with this training program. Please write or call me at:

Dale G. Larson, Ph.D.

Santa Clara University
500 El Camino Real
140 Loyola Hall
Santa Clara, CA, 95053
phone: 1-408-554–4320 email: dlarson@scu.edu

The Caring Helper videotapes may be ordered from:

Applied Vision, LLC
P.O. Box 1245 © 1991, 2010
San Carlos, CA 94070 Dale G. Larson, Ph.D.
phone: 1-888-250–4226 email: info@appliedv.com All Rights Reserved
web: www.appliedv.com

18 The Caring Helper