V. COUNSELING

A collaborative process that facilitates the clientís progress toward mutually determined treatment goals and objectives. Counseling includes methods that are sensitive to individual client characteristics and to the influence of significant others, as well as the clientís cultural and social context. Competence in counseling is built upon an understanding of, appreciation of, and ability to appropriately use the contributions of various addiction counseling models as they apply to modalities of care for individuals, groups, families, couples, and significant others.

A. Individual Counseling

 

1. Establish a helping relationship with the client characterized by warmth, respect, genuineness, concreteness, and empathy.

Knowledge

1. Theories, research, and best-practice literature.
2. Approaches to counseling that have demonstrated effectiveness with substance use disorders.
3. Definitions of warmth, respect, genuineness, concreteness, and empathy.
4. Role of the counselor.
5. Therapeutic uses of power and authority.
6. Transference, counter-transference, and projective identification.

Skills

1. Active listening, including paraphrasing, reflecting, and summarizing.
2. Conveying warmth, respect, and genuineness in a culturally appropriate manner.
3. Demonstrating empathic understanding.
4. Using power and authority appropriately in support of treatment goals.

Attitudes

1. Respect for the client.
2. Recognition of the importance of cooperation and collaboration with the client.
3. Professional objectivity.

 

2. Facilitate the clientís engagement in the treatment and recovery process. 

Knowledge

1. Theory and research related to client motivation.
2. Alternative theories and methods for motivating clients in a culturally appropriate manner.
3. Theory, research, and best practice literature.
4. Counseling strategies that promote and support successful client engagement.
5. Stages-of-change models used in engagement and treatment strategies.
6. Clientís culture.

Skills

1. Implementing appropriate engagement and interviewing approaches.
2. Assessing client readiness for change.
3. Using culturally appropriate counseling strategies.
4. Assessing the clientís responses to therapeutic interventions.

Attitudes

1. Respect for the clientís frame of reference.

 

3. Work with the client to establish realistic, achievable goals consistent with achieving and maintaining recovery.    

Knowledge

1. Assessment and treatment planning.
2. Stages of change and recovery.

Skills

1. Formulating and documenting concise, descriptive, and measurable treatment outcome statements.
2. Teaching the client to identify goals and formulate action plans.

Attitudes

1. Appreciation for the clientís resources and preferences.
2. Appreciation for individual differences in the treatment and recovery process.

 

4. Promote client knowledge, skills, and attitudes that contribute to a positive change in substance use behaviors.    

Knowledge

1. The information, skills, and attitudes consistent with recovery.
2. Clientís goals, treatment plan, prognosis, and motivational level.
3. Assessment methods to measure progress toward positive change.

Skills

1. Motivational techniques.
2. Recognizing client strengths.
3. Assessing and providing feedback on client progress toward treatment goals.
4. Assessing life and basic skills and comprehension levels of client and all significant others associated with the treatment plan.
5. Identification and documentation of change.
6. Coaching, mentoring, and teaching.
7. Recognizing and addressing ambivalence and resistance.

Attitudes

1. Genuine care and concern for client, family, and significant others.
2. Appreciation for incremental change.
3. Patience and perseverance.

 

5. Encourage and reinforce client actions determined to be beneficial in progressing toward treatment goals.   

Knowledge

1. Counseling theory, treatment, and practice literature as it applies to substance use disorders.
2. Relapse prevention theory, practice, and outcome literature.
3. Behaviors and cognition consistent with the development, maintenance, and attainment of treatment goals.
4. Counseling treatment methods that support positive client behaviors consistent with recovery.

Skills

1. Using behavioral and cognitive methods that reinforce positive client behaviors.
2. Using objective observation and documentation.
3. Assessing and re-assessing client behaviors.

Attitudes

1. Therapeutic optimism.
2. Patience and perseverance.
3. Appreciation for incremental changes.

 

6. Work appropriately with the client to recognize and discourage all behaviors inconsistent with progress toward treatment goals.   

Knowledge

1. Client history and treatment plan.
2. Client behaviors and cognition that are inconsistent with recovery process.
3. Behavioral and cognitive therapy literature relevant to substance use disorders.
4. Cognitive, behavioral, and pharmacological interventions appropriate for relapse prevention.

Skills

1. Monitoring the clientís behavior for consistency with preferred treatment outcomes.
2. Presenting inconsistencies between client behaviors and goals.
3. Re-framing and redirecting negative behaviors.
4. Conflict resolution, decision-making, and problem solving skills.
5. Recognizing and addressing underlying client issues that may impede treatment progress.

Attitudes

1. Patience and perseverance during periods of treatment difficulty.
2. Accepting relapse as an opportunity for positive change.
3. Recognizing the value of a constructive helping relationship.

 

7. Recognize how, when, and why to involve the clientís significant others in enhancing or supporting the treatment plan.   

Knowledge

1. Theory, research, and outcome-based literature demonstrating the importance of significant others, including families and other social systems, to treatment progress.
2. Social and family systems theory.
3. How to apply appropriate confidentiality regulations.

Skills

1. Identifying the clientís family and social systems .
2. Recognizing the impact of the clientís family and social systems on the treatment process.
3. Engaging significant others in the treatment process.

Attitudes

1. Appreciation for the need of significant others to be involved in the clientís treatment plan, within the bounds of confidentiality.
2. Respect for the contribution of significant others to the treatment process.

 

8. Promote client knowledge, skills, and attitudes consistent with the maintenance of health and prevention of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), tuberculosis (TB), sexually transmitted diseases (STDs), and other infectious diseases. 

Knowledge

1. Client and system worldviews relative to health..
2. How infectious diseases are transmitted and prevented.
3. The relationship between substance-abusing lifestyles and the transmission of infectious diseases.
4. Harm reduction concepts, research, and methods.

Skills

1. Using a repertoire of techniques that, based on an assessment of various client and system characteristics, will promote and reinforce health-enhancing activities.
2. Coaching, mentoring, and teaching techniques relative to the promotion and maintenance of health.
3. Demonstrating cultural competence in discussing sexuality.

Attitudes

1. Openness to discussions about health issues, lifestyle, and sexuality.
2. Recognition of the counselorís potential to model a healthy life-style.

 

9. Facilitate the development of basic and life skills associated with recovery. 

Knowledge

1. Basic and life skills associated with recovery.
2. Theory, research, and practice literature that examines the relationship of basic and life skills to the attainment of positive treatment outcomes.
3. Tools used to determine levels of basic and life skills.

Skills

1. Teaching life skills appropriate to the clientís situation and skill level.
2. Applying assessment tools to determine the clientís level of basic and life skills.
3. Communicating how basic and life skills relate to treatment outcomes.

Attitudes

1. Recognizing that recovery involves a broader life context than the elimination of symptoms.
2. Accepting relapse as an opportunity for learning and/or skills acquisition.

 

10. Adapt counseling strategies to the individual characteristics of the client, including but not limited to, disability, gender, sexual orientation, developmental level, culture, ethnicity, age, and health status. 

Knowledge

1. Impact of culture on substance use.
2. Cultural factors affecting responsiveness to varying counseling strategies.
3. Current research concerning differences in drinking and substance use patterns based on the characteristics of the client.
4. Addiction counseling strategies.
5. How to apply appropriate strategies based on the clientís treatment plan.
6. Clientís family and social systems and relationships between each.
7. Client and systemís cultural norms, biases, and preferences.
8. Literature relating spirituality to addiction and recovery.

Skills

1. Individualizing treatment plans.
2. Adapting counseling strategies to unique client characteristics and circumstances.
3. Practicing cultural communication.

Attitudes

1. Recognition of the need for flexibility in meeting client needs.
2. Willingness to adjust strategies in accordance with clientís characteristics.
3. A non-judgmental, respectful acceptance of cultural, behavioral, and value differences.

 

11. Make constructive therapeutic responses when clientís behavior is inconsistent with stated recovery goals. 

Knowledge

1. Client behaviors that tend to be inconsistent with recovery.
2. The clientís social and life circumstances.
3. Relapse prevention strategies.
4. Therapeutic interventions.

Skills

1. Monitoring client progress.
2. Using various methods to present inconsistencies between client's behaviors and treatment goals.
3. Re-framing and redirecting negative behaviors.
4. Utilizing appropriate intervention strategies.

Attitudes

1. Therapeutic optimism.
2. Perseverance during periods of treatment difficulty.

 

12. Apply crisis management skills.   

Knowledge

1. Differences between crisis intervention and other kinds of therapeutic intervention.
2. Characteristics of a serious crisis and typical reactions.
3. Post-traumatic stress and other relevant psychiatric disorders.
4. Roles played by family and significant others in the crisis development and/or reaction.
5. Relationship of crisis to clientís stage of change.
6. Clientís usual coping strategies.
7. Steps to aid in crisis resolution, including determination of what client can do on his/her own and what must be done by counselor, family, or significant others in client system.

Skills

1. Carrying out steps in crisis resolution.
2. Assessing and engaging client and client system strengths and resources.
3. Assessing for immediate concerns regarding safety and any potential harm to others.
4. Making appropriate referrals as necessary.
5. Assessing and acting upon issues of confidentiality that may be part of crisis response.
6. Assisting the client to ventilate emotions and normalize feelings.

Attitudes

1. Recognize crisis as an opportunity for change.
2. Confidence in the midst of crisis.
3. Recognize personal and professional limitations.

 

13. Facilitate the clientís identification, selection, and practice of strategies that help sustain the knowledge, skills, and attitudes needed for maintaining treatment progress and preventing relapse. 

Knowledge

1. How the client and clientís family, significant others, mutual-help support groups, and other systems can enhance and maintain treatment progress, relapse prevention, and continuing care.
2. Relapse prevention strategies.
3. Skills-training methods.

Skills

1. Using behavioral techniques to reinforce positive client behaviors.
2. Teaching relapse prevention and life skills.
3. Motivating the client toward involvement in mutual-help support groups.

Attitudes

1. Recognize that clients must assume responsibility for their own recovery.

 

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Email: no@nattc.org | Revised March 1998