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Review for the Alcohol and Drug Counselor Exam
Episode 18: Counseling Skills
~ Identify the purpose and function of counseling
~ Define skills a counselor needs
~ Identify necessary attitudes for counselors
~ Explore how to develop the therapeutic alliance
~ Discuss motivation and how to increase it

Counseling—Purpose & Functions
~ Develop therapeutic relationship with clients, families and significant others to facilitate transition into the recovery process
~ Provide information regarding the structure, expectations and purpose of counseling
~ Continually evaluate the client’s safety, relapse potential and need for crisis intervention
~ Apply ebps to facilitate progress
~ Document counseling activity and progress
~ Provide information on issues of identity, ethnic background, age etc as they influence behavior, prevention and recovery
~ Provide information about addiction and related health and psychosocial consequences
Counseling —Purpose & Functions
~ Counseling is a collaborative, professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals
~ Competence is built on understanding various models of treatment, an ability to implement appropriate EBPs with individuals, families, and SOs
~ Counselors facilitate self-exploration, disclosure, problem solving and behavioral change
~ Counselors help clients
~ Explore and enhance motivation
~ Set appropriate treatment goals
~ Understand structure, expectations, purpose and limitations of the counseling process
~ Mobilize resources to resolve problems and modify attitudes
~ Counselors respond to crisis situations by identifying and practicing ways to avoid and cope with high risk situations
Therapeutic Allicance
~ Strength of the TA depends on the facilitative qualities of the counselor and the strategies used to create a positive environment for exploration and change
~ Facilitative qualities
~ Empathy
~ Genuineness
~ Respect
~ Self-Disclosure
~ Warmth
~ Immediacy “Focus on the here and now”
~ Concreteness: Identify specific problems and interventions
~ Cultural Sensitivity
Counseling: Therapeutic Alliance
~ Components of the Therapeutic Alliance
~ Bond between therapist and client characterized by warmth, genuineness and respect
~ Consensus between counselor and client regarding
~ Treatment approaches
~ Goals of treatment
~ Primary responsibility for developing and maintaining the TA rests with the counselor
~ 80% of positive outcomes are due to TA
~ TA must be continually monitored and nurtured to prevent premature discharge and enhance treatment effectiveness
~ Adapting the relationship to several patient characteristics, not just dx, enhances the TA
Counselor Skills
~ Engage the client
~ Develop and individualize treatment and recovery plans
~ Effectively describe and negotiate access to the continuum of care
~ Adapt counseling strategies
~ Apply culturally and linguistically responsive communication styles
~ Provide nonjudgmental, respectful acceptance of cultural, behavioral and value differences
~ Elicit client’s perspectives on progress
~ Maintain contact with referral services
~ Assist the client in monitoring and maintaining motivation
~ Document all relevant aspects of treatment clearly and concisely
~ Provide education regarding how to change risk behaviors, adopt protective, healthy practices and make appropriate use of service systems
Counseling Skills—Active listening
~ Helps the client and counselor clarify what is going on
~ Clear listening—listen without judgement and without immediately trying to correct the client’s thoughts
~ Reflecting—Summarizing and repeating
~ Asking open-ended questions
~ Using effective body language (SOLER)
~ Watching for nonverbal cues
Counselor Attitudes
~ Appreciation of strengths-based approaches which emphasize client autonomy and skills development
~ Respect for the client’s right to self-determination
~ Appreciation of the roles of the SOs
~ Appreciation of the difficulties families and SOs face in seeking help
~ Appreciation of cultural differences
~ Willingness to be flexible

Counseling- Setting Expectations
~ The counselor generates curiosity and engagement by being honest and open and setting the frame and expectations for treatment
~ Areas of Expectations
~ What outcomes does the client expect
~ What proportion of clients report their issues improve at this level of treatment
~ What will treatment involve
~ What are the rules and responsibilities
~ Client rights
~ What specific outcomes can the client expect
Counseling- What is Motivational Interviewing
~ Treatment is a process of intentional change
~ MI uses specific techniques that engender engagement and empowerment
~ MI is more effective than intervention

Counseling—Motivation Assumptions
~ Ambivalence about change is normal and creates a significant obstacle to the recovery process
~ Ambivalence can be resolved by working with intrinsic motivations and values
~ In the collaborative partnership between client and counselor each brings own expertise
~ An empathic, supportive, directive style provides the conditions for change
~ Direct argument and confrontation increase client defensiveness
Counseling- 5 Motivational Principles
• Express Empathy
• Develop Discrepancy
• Avoid Argument
• Roll with Resistnace
• Support Self-Efficacy and Optimism
Counseling Motivational Elements
~ Partnership/collaboration
~ Avoid the expert role
~ Acceptance/Autonomy
~ Respect client autonomy and strengths
~ Compassion
~ Keeping the client’s best interests in mind
~ Evocation
~ Best ideas come from the client
~ MI techniques are designed to “get at” internal ambivalence providing a place for discussion of the pros and cons of change
Counseling Motivational Strategies
~ Open ended questions
~ Affirmation
~ Reflective Listening
~ Summarize
~ Elicit self-motivational statements
Other Videos
~ Motivational Interviewing
~ Counseling Skills