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. Author manuscript; available in PMC: 2011 Jun 8.
Published in final edited form as: J Gerontol Soc Work. 2009 Apr;52(3):250–260. doi: 10.1080/01634370802609247

How Social Workers Demonstrate Respect for Elderly Clients

Kyu-taik Sung 1, Ruth E Dunkle 2
PMCID: PMC3110652  NIHMSID: NIHMS295177  PMID: 19308830

Abstract

Although respect is a crucial aspect of social work practice, few studies have examined how social workers convey their respect for elderly clients. This study explored the various forms of respect demonstrated by social workers when they were with older clients. Fifty social workers serving elderly clients were surveyed by a questionnaire with closed- and open-ended questions. Based on data on the way the social workers respected their elderly clients, the study identified seven forms most frequently practiced and considered most important. They are linguistic respect, care respect, acquiescent respect, salutatory respect, presentational respect, spatial respect, and consultative respect. The key expressions of these forms are introduced in quantitative data and a narrative form. This finding provides insights as to how social workers exhibit respect for elderly clients in their practice. The results of this exploration may be useful in developing a more comprehensive typology of the forms signifying respect for elderly clients.

Keywords: Elder respect, social workers and clients, forms of respect, expressions of respect, culture and respect

Many seniors have a variety of social and psychological problems. To resolve these problems, they most often depend on social service providers. Hence, social workers become a significant part of the social world of the elderly in their later years. While elderly persons need food, shelter, health care, and social services, they also need to be treated with respect. The extent to which the service providers treat elderly persons with respect, therefore, becomes a significant psychosocial factor that affects the quality of their later life (Cassel, 1990; Noelker & Harel, 2000; Sung & Kim, 2008).

In social work, respect for the client has, in fact, been considered to be the very beginning of the service process (NASW, 1996; Mayeroff, 1971). That is, respect is to precede all forms of care and service (Gambrill, 1983; Reichel, 1995; Rogers, 1961). With respect, service providers can demonstrate a positive attitude toward their clients, treat them with propriety, and serve them as dignified persons. Clients treated with respect by a provider will increase their own sense of self-esteem and life satisfaction, and also their sense of usefulness and involvement in community and significant others (Applegate & Morse, 1994; Ghusn et al., 1996; Damon-Rodriguez, 1998).

Thus, respect becomes an important message to the clients that brings about a sound and productive provider-client relationship. In a helping situation, whenever the provider demonstrates to her clients by her actions that she respects them, a relationship grows. The clients treated with respect will be more likely to freely discuss difficult topics, explore their own contributions, and involve themselves in a cooperative effort to achieve desired service outcomes (Gambrill, 1983). A study found that the way in which a client was shown respect was often more important to the client than what the therapist did to help her solve her problems (Gibbard, 1990). As an evidence of this, clients’ perception of the therapist's level of regard for them was significantly related to their ratings of their change at completion of treatment (Rogers, 1961: 36). Respect, although important throughout all phases of service, it is particularly appropriate to interactions among newcomers or strangers (Dillon, 1992: 107). Carkhuff and Pierce (1976) suggested that respect, along with empathy and warmth, is essential in the first interview. And, the initial contact is important as providers often use it to establish an ongoing relationship with the client.

In practice, however, social workers have difficulty in specifying expressions of this essential message; they often struggle to operationalize respect for clients (Campton & Gallaway, 1984). One of the least discussed issues in social work has been respect paid to persons receiving the services. Consequently, little has been known how social workers show respect for their clients.

Respect is a benevolent, altruistic, or sympathetic expression of regard for other persons (Downie & Telfer, 1969). To respect a person, we treat that person in a certain manner or act in a particular way. Dillon (1969) describes that a person who respects another person pays careful attention to that person and takes the person seriously. Respect, however, calls for more than our attention. As Gibbard (1990) states, respect requires certain actions or forms of conduct. Respect, then, needs to be manifested in concrete behavioral expressions oriented toward caring for and serving others (Silverman & Maxwell, 1978). Such expressions would include vocal sounds (ex. greeting, calling), physical movements (ex. serving, guiding), bodily movements (acknowledging, polite posture), appearance (ex. proper dressing, grooming), and so forth (Sung, 2001). A respectful person exhibits such explicit gestures or expressions that connote respect. Both the respecter and the respected would perceive these gestures as significant symbols (Hewit, 1988), allowing the meaning of respect to be shared with others who make the same gestures or expressions.

Accordingly, social workers should be able to say by what concrete gestures and expressions they can demonstrate respect for their clients (Hugman & Smith, 1995). Only when the general concept of respect is specifically defined and related actions implemented on a daily basis, would respect become meaningful to the service provider as well as the client (Gambrill, 1983). .

The present study will explore expressions of respect for elderly clients that pervade social workers’ attitudes and behaviors toward elderly clients. (In this paper, we refer to those expressions ‘elder respect’.) The paper addresses the following questions: 1. What are the kinds of expressions that social workers show in their interaction with elderly clients in order to connote respect for them?; 2. What forms of elder respect are most often practiced and considered important to social workers? The focus of the present study is on the identification of the expressions of elder respect and forms thereof demonstrated by social workers. It is not the purpose of this study to discuss the philosophy of respect or to conduct a causal analysis of respect-related variables.

This exploration, therefore, will provide information on specific forms of expressions connoting social workers’ respect for elderly clients and the extent to which the social workers give importance to the forms. This information could be useful to the future development of a more comprehensive typology of forms of respect that social workers practice in their services for elderly clients.

Different Forms of Elder Respect

To date, little research has been done on the forms of elder respect. The review of the literature uncovered four empirical studies which reported forms and expressions by which people respect older persons. Silverman and Maxwell (1978) identified seven forms of elder respect based on qualitative data from a sample 34 societies selected from Murdock and White's (1969) cross-cultural sample of 186 world areas. The seven forms are service respect (housekeeping), victual respect (serving drinks and foods), gift respect (presenting gifts), linguistic respect (using respectful language), presentational respect (showing courteous manners), spatial respect (furnishing honorable seats or places), and celebrative respect (celebrating birthdays). Other studies led by social work researchers--two in Asia and one in the United States—also reported expressions of elder respect (Ingersoll-Dayton & Saengtienchai, 1999; Mehta, 1997; Sung, 2002). Ingersoll-Dayton and Saengtienchai (1999), using a focus group approach and individual interviews, distinguished various expressions of elder respect based on their study in four Asian countries. Mehta, based on her sample of Singaporeans only, reported expressions of elder respect similar to what Ingersoll-Dayton and Saengtienchai discovered. Sung (2002), based on data from a survey of American college students, identified 12 forms of elder respect. Although the four studies were conducted in different cultural contexts and in non-social work settings, they taken together yielded parallel results, identifying similar expressions of elder respect forms thereof as shown below:

  • Care/service respect (providing care and services for elders),

  • Acquiescent respect (assenting, listening to elders),

  • Consulting respect (seeking elders for advice),

  • Precedent respect (providing services to elders first),

  • Salutatory respect (greeting and saluting elders),

  • Linguistic respect (using proper language in addressing to elders),

  • Victual respect (serving drinks and foods of elders’ choice),

  • Gift respect (presenting gifts to elders),

  • Presentational respect (holding proper manners before elders),

  • Celebrative respect (celebrating elders’ birthdays),

  • Spatial respect (furnish elders with comfortable seats), and

  • Public respect (serving neighborhood elders and elders at large).

These 12 forms, all important corollaries of elder respect, replicated and added to the seven forms which were cross-culturally distinguished by Silverman and Maxwell (1978).

Building upon the above findings, the present study explored specific forms of respect most often practiced and considered most important by social workers.

Method

We used a convenience sampling strategy to identify social workers providing services to elderly clients. Data were collected from a sample of 50 social workers in two different locations: 25 in a town in the Midwest and 25 from a city on the West Coast. The participating social workers met the following criteria: 1) licensed professional social workers, 2) currently providing direct services to elderly clients, and 3) had practiced for 3 years or longer.

In each of the two areas, 20 social workers were selected from two community health clinics, two state and county agencies, a mental health clinic, and a senior day care center, and a family service agency. In addition, five solo-practitioners serving elderly persons were selected. From each one of the agencies or clinics (sizes ranging from 1 to 30 social workers), one to five social workers were selected at random from those willing to respond to the questionnaire with a pre-addressed envelope with a stamp on it. The social workers who agreed to cooperate were met by the researcher and were given a copy of the questionnaire. They were asked to mail it after answering all the questions.

Both areas combined, 50 percent of all social workers were practicing in public agencies and the rest in private agencies (30%) and in solo practice (20%). The average years practiced was 9 years; 72 percent of the respondents had an MSW degree and the rest had a BSW degree; and 84 percent were female. In terms of ethnicity, 68 percent were White, 12 percent African American, 12 percent Latino, and 8% Asian American.

A 12-item questionnaire consisting of closed-ended and open-ended questions was administered to the social workers. The close-ended questions related to the 11 forms of elder respect--care, acquiescent, consultative, precedent, salutatory, linguistic, victual, gift, presentational, celebrative, and spatial—were included. Each form was accounted for by two questions. (Of the 12 forms previously described, public respect for neighborhood elders and elders at large was excluded as the elderly under study were all served within the setting of agency or clinic).

The following are examples of questions.

  1. Please, list two or more behaviors or gestures by which you most often express your respect for older clients. (A list of the 11 forms of respect was provided.) ___________________ ___________________ ___________________ ___________________

  2. Please, indicate the degree of importance you give to this form of respect. (Choose one.) __very important __important __fairly important __not so import

  3. Please, comment on your practice of this form of respect. ______________________________________________ ______________________________________________

Thus, two measures of elder respect were used on each form: (1) frequency with which a form was cited and (2) the degree of importance given to the form. As shown above, the levels of importance were rated on a 4-point scale (1=very important...4=not so important). In addition, on each form of respect, the respondent gave free, unstructured comments on the practice of the form.

Analysis and Findings

Responses to The Closed-End Questions

In response to the closed-end questions, the social workers cited a variety of forms by which they demonstrated elder respect. Table 1 highlights an overview of these forms: descriptive statistics based on frequency with which the forms were cited and the rating of importance given to the form, and the ranking of the forms by frequency size and the rating.

Table 1.

Frequency and Importance of Forms of Elder Respect

Forms of Elder Respect Frequency Importance
% Rank Mean(SD) Rank
Linguistic respect 82% 1 3.78 (.46) 1
Salutatory respect 78% 2 3.73 (.45) 2
Care respect 74% 3 3.57 (.53) 4
Acquiescent respect 72% 4 3.37 (.93) 5
Presentational respect 68% 5 3.61 (.63) 3
Spatial respect 64% 6 2.97(.72) 7
Consultative respect 62% 7 3.35 (.82) 6
Precedential respect 42% 8 2.73 (.80) 8
Celebrative respect 28% 9 2.33 (.86) 9
Victual respect 16% 10 2.18 (.79) 10
Gift respect 12% 11 1.84 (.73) 11
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The forms are ranked from the 1st to 11th according to frequency (percent size) and importance (rating by the 4-point scale) (Table 1).

First, in terms of frequency, social workers indicated that they most often demonstrated respect linguistically. Specifically, 82 percent of them reported that they used this form. The second most often cited form was salutatory respect, the third, care respect, the fourth, acquiescent respect, the fifth, presentational respect, the sixth, spatial respect, the seventh, consultative respect, the eighth precedential respect, the ninth, celebrative respect, the tenth, victual respect, and the last, gift respect.

Thus, seven forms of respect—linguistic, salutatory, care, acquiescent, presentational, spatial, and consultative—whose frequencies ranging from 82% to 62%, were clearly more frequently demonstrated than the rest of the forms ranging from 42% to 12%).

Next, in terms of importance, linguistic respect is the highest or the most important form (m=3.78), and salutatory respect is the second most important one. The third-ranking form was presentational respect, and the fourth is care respect. These four forms were given ratings ranging from m=3.78 to m=3.57, which are nearly “very important” according to the four-point scale. These are followed by acquiescent respect (the fifth), consultative respect (the sixth), and spacial respect (the seventh). These three forms, ranging from m=3.37 to m=2.97, are “important to fairly important. The rest--precedential, celebrative, victual, and gift ranging from m=2.73~m=1.84—are rated fairly “important” to “not so important.”

In Table 1, the two rankings are compared--one based on frequencies with which the forms were cited and the other based on the ratings of importance of the forms. Spearman rank-order correlation between the two rankings [.67, RHO(.05)] for the 11 categories suggests similarity or comparability between the two rankings.

Results of these analyses clearly suggest that the following seven forms of respect were more frequently practiced and considered more important than other forms: ‘linguistic’, ‘salutatory’, ‘care’, ‘acquiescent’, ‘presentational’, ‘spatial’, and ‘consultative’.

Responses to The Open-Ended Question

The social workers’ answers to the open-ended question provided the following qualitative information on the practice of the forms (in order of the number of the respondents answered). Their responses to seven forms, which were practiced by more than a half of the respondents and rated either “very important” or “important” are presented in the following.

With respect to linguistic respect (using proper and respectful language in addressing the client), 14 social workers made comments. Four social workers shared their comments.

When using the forms of linguistic respect, social workers used specific words depending on cultural background of the client. Words connoting age and status are particularly important to Latino and Asian clients. The following are the comments.

“When we are in doubt about how to address elderly clients, we usually consider using their surname along with their title, e.g., Mr., Mrs., Dr., or Miss. After elderly clients become familiar with us, some of them insist on being called by their first name.”

“It is important to consider differences in age and status when addressing Latino and Asian clients. For example, the head of the family (e.g., the father or the mother) should always be addressed using his or her last name and any title.”

“In Asian American families, it is often more respectful to refer to their members by their roles, such as father, mother, old sister, or brother than by their first name.”

With regard to care respect (being kind and considerate to the client; having attention to and concern for the client), 10 social workers made comments. Four social workers shared their comments.

On this form of respect, the workers responses were short and clear.

One of them said,

“Naturally, we need to have caring minds and attitudes toward elderly clients.”

While another said,

“The elderly deserve our attention and support.”

Still other mentioned of how they practice the form,

“I make phone calls to them occasionally and try to check on if they are all right.”

One worker gave a culture-related comment,

“I do my job in a multi-cultural setting. Elderly clients, many being immigrants, tend to carry on values and family orientation they brought from their motherland. I have to provide services that fit into their cultural backgrounds.”

On acquiescent respect (listening to the client's opinion and suggestions; following rules and proceedings mutually agreed upon; honoring the client's ideas, beliefs, and values), nine social workers made comments.

In responding to this form, the workers gave descriptions of specific measures through which they practiced this type of respect.

One worker stated,

“I let my elderly clients do story telling. I listen and follow their wishes.”

Another added,

“I let my clients participate in setting the goals of services to be attained. Once the goals are set, I pursue those goals in cooperation with them.”

Still other worker said,

“I listen to them. But, I do not blindly agree. Sometimes, I disagree in a nice manner and by speaking moderately.”

With regard to salutatory respect (greeting the client, exhibiting proper body language of respect), the focus of eight social workers’ comments was on the importance of appropriately greeting their clients. Three respondents shared their comments.

“Saluting and greeting my clients is the first action I take to develop a positive relationship with my client.”

“I usually say to my elderly client ‘How are you?’ looking at her with an expression of intimacy.”

“I shake hand with my client and hug her when she comes to my office.”

On presentational respect (exhibiting polite and courteous manners to the client; wearing appropriate dress when meeting with the client), six social workers commented. The following shared seven social workers’ comments.

“I think it is important for us to show proper postures and manners as these reflect our interest and concern for clients.

“We need to dress in the way the client's culture says is appropriate to a helping professional.”

On spatial respect (furnishing the client with a comfortable seat; securing a comfortable atmosphere for the client), five social workers gave comments. The concern of the social workers was over seating arrangement in terms of the need to offer provide the client with a comfortable seat in a distract free space and to position the client's seat taking into consideration of his or her status in the family.

The following shared their comments:

“I usually furnish my client with a comfortable chair and provide services in a quiet room for privacy and confidentiality.”

“I try to secure a distract-free environment for my clients.”

“I pay attention to the arrangement of seats in a family or group treatment situation, particularly in dealing with Asian American elderly clients. I let the father, who has authority, occupy a center seat and the mother next to him.”

On consulting respect (seeking out the client's opinion or suggestion; consulting over procedures for services), five social workers gave comments and the following shared their comments.

“Clients should always be consulted.”

“I try to give the client the feeling that she or he is important part of my decision.”

“I try to find out my client's frame of reference and values.”

“In services for Latinos and Asian Americans, who generally place great emphasis on the individual -- family relationship. I often consult the members of their family on my treatment plan.”

Discussion

The present study was undertaken to determine what forms of elder respect social workers most often use in their interaction with elderly clients and which forms of respect they consider to be more important. Based on quantitative and qualitative data from a questionnaire survey, this study provided a set of specific forms of respect that social workers demonstrated and their views and opinions on the practice of these forms.

Of the 11 forms explored, the following seven forms were most often demonstrated and considered more important than other forms.

  • Linguistic Respect (using proper language)

  • Salutatory Respect (greeting and saluting)

  • Care Respect (providing care and services)

  • Acquiescent Respect (assenting and listening)

  • Presentational Respect (holding proper manners)

  • Spatial Respect (furnishing with comfortable seas)

  • Consulting Respect (seeking for advice)

The distinctions between the various forms highlight specific ways in which older clients were respected by social workers. In the description of the holistic meaning of respect for the client, all these forms would have to be considered as they portray elder respect in combination. The forms may be interrelated in their meanings and practices. However, each of them seems to reflect an action or a behavior of the service provider that demonstrates a particular way in which older clients are respected.

The specific forms identified in this exploratory study provide us with insights into the respect for elderly clients that has, heretofore, been discussed in invariably abstract or unspecific terms. These behavioral forms could be useful in developing a comprehensive typology of elder respect that can assess the propriety of the provider and the quality of the relationship between the client and the provider. By practicing these forms, a provider could treat his or her elderly clients with benevolence and altruism imbued with a sense of humanity and professional ethic.

In addition, the qualitative data provided useful information on the practice of certain forms of respect. Some of the social workers commented that such forms as victual respect, gift respect, and celebrative respect were not appropriate to practice or not practiced, while others gave importance to practicing these and other forms. At least two factors seemed to explain such a variation in the social workers’ views.

The first reason was cultural. Some social workers took into consideration the ethnic background of the client in the practice of those forms of respect.

There was a noticeable variation in their responses; some gave greater importance to the following points in serving clients with Latino and Asian ethnic backgrounds:

  • * Using respectful language and calling by title when addressing the client

  • * Properly greeting the client

  • * Taking into consideration of the status of a client in his or her family or group

  • * Making arrangement of seats according to the client's status in his or her family

  • * Consulting with family members to find out the client's relations with them

Giving importance to these points reflect the diversity not only of the elderly clients but also the social workers in terms of their awareness of cultural differences among the clients they serve (Gomez et al., 1985; McInnis-Dittrich, 2002: 313-314).

To many Asian clients, the respect they receive from a therapist is often more important than what the therapist does to help them solve their problems (Berg & Jaya, 1993; Leininger, 1990). Similarly, for Hispanic Americans, respeto (respect) dictates the appropriate behavior toward persons, particularly parents and those who are older (Paniagua, 1998).

The second factor was organizational constraint. As some respondents commented, certain forms, such as victual respect (serving coffee and tea), gift respect (gift giving), and celebrative respect (celebrating birthdays or events), are difficult to practice due to the absence of agency approval or resources. Thus, in this case, some providers’ respecting expression is defined and limited by the employing agency. In other agencies, however, the use of such forms seemed tacitly or informally approved, to the extent that the resources needed to practice the forms were available.

As the practitioners’ comments suggest, the practice of elder respect needs to be consistent with the lifestyles and values of the client being served. Social work has historically been based on values that appreciate differences among clients including cultural backgrounds, race, and ethnicity (NASW, 1996). The social worker who deals with specific ethnicity will need to understand the relevant subtleties inherent in the practice of respect for the elderly. In this context, considering social work solely in terms of technical competencies would fail to do justice to the value complexity of social work practice.

The finding of this exploratory study provides preliminary information as to the way in which social workers respect their elderly clients. The general concept of respect is defined in the forms of specific behavioral expressions, which can be implemented on a daily basis. Thus, the forms of elder respect provide us with insights into how social workers practice elder respect that has been discussed in an invariably abstract form.

The findings of the present study are based on the result of an exploration of a delimited set of eleven forms of elder respect. Data were drawn from a convenience or purposive sample of social service agencies. Therefore, the findings need to be carefully used in a discussion of elder respect among social workers. Further research, based on a larger sample representative of social workers in a variety of practice settings, is needed to develop a more comprehensive typology of forms of elder respect. As the findings suggest, it is important to investigate the extent to social workers’ practice of the forms vary by their ethnic background and agency setting. Furthermore, it is necessary to explore appropriate forms of respect for elderly clients with diverse ethnic backgrounds.

Contributor Information

Kyu-taik Sung, School of Social Work University of Michigan.

Ruth E. Dunkle, Wilbur Cohen Collegiate Professor School of Social Work University of Michigan

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