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V. COUNSELING

A collaborative process that facilitates the client’s 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 client’s 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 client’s 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. Client’s culture.

Skills

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

Attitudes

1. Respect for the client’s 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.

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 client’s 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. Client’s 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.

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.

1. Monitoring the client’s 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 client’s 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 client’s family and social systems .
2. Recognizing the impact of the client’s 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 client’s 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 counselor’s 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.

1. Teaching life skills appropriate to the client’s situation and skill level.
2. Applying assessment tools to determine the client’s 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 client’s treatment plan.
6. Client’s family and social systems and relationships between each.
7. Client and system’s 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 client’s characteristics.
3. A non-judgmental, respectful acceptance of cultural, behavioral, and value differences.

11. Make constructive therapeutic responses when client’s behavior is inconsistent with stated recovery goals.

Knowledge

1. Client behaviors that tend to be inconsistent with recovery.
2. The client’s 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 client’s stage of change.
6. Client’s usual coping strategies.
8. 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.

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 client’s 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 client’s 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.

B. GROUP COUNSELING

1. Describe, select, and appropriately use strategies from accepted and culturally appropriate models for group counseling with clients with substance use disorders.

Knowledge

1. A variety of group methods appropriate to achieving client objectives in a treatment population.
2. Research concerning the effectiveness of varying models and strategies for group counseling with general populations.
3. Research concerning the effectiveness of varying models and strategies for populations with substance use disorders.
4. Research and theory concerning the effectiveness of varying models and strategies for group counseling with members of varying cultural groups.
5. Therapeutic use of humor.

Skills

1. Designing and implementing strategies to meet the needs of specific groups.
2. Recognizing and accommodating appropriate individual needs within the group.
3. Leading therapeutic groups for clients with substance use disorders.
4. Using humor appropriately.

Attitudes

1. Openness and flexibility in the choice of counseling strategies that meet needs of the group and the individuals within the group.
2. Recognition of the value of the use of groups as an effective therapeutic intervention.

2. Carry out the actions necessary to form a group, including, but not limited to: determining group type, purpose, size, and leadership; recruiting and selecting members; establishing group goals and clarifying behavioral ground rules for participating; identifying outcomes; and determining criteria and methods for termination or graduation from the group.

Knowledge

1. Specific group models and strategies relative to client’s age, gender, cultural context.
2. Selection criteria, methods, and instruments for screening and selecting group members.
3. General principles for selecting group goals, outcomes, and ground rules.
4. General principles for appropriately graduating group members and terminating groups.

Skills

1. Conducting screening interviews.
2. Assessing individual client’s appropriateness for participation in group.
3. Using group process to negotiate group goals, outcomes, and ground rules within the context of the individual needs and objectives of group members.
4. Using group process to negotiate appropriate criteria and methods for transition to the next appropriate level of care.
5. Adapting group counseling skills as appropriate for group type.

Attitudes

1. Recognition of the importance of involving group members in the establishment of group goals, outcomes, ground rules, and graduation and termination criteria.
2. Recognition of the fact that the nature of the specific group model should depend on the needs, goals, outcomes, and cultural context of the participants.

3. Facilitate the entry of new members and the transition of exiting members.

Knowledge

1. Developmental processes affecting therapeutic groups over time.
2. Issues faced by individuals and the group as a whole upon entry of new members.
3. Issues faced by individuals and by the group as a whole upon exit of members.
4. Characteristics of transition stages in therapeutic groups.
5. Characteristics of therapeutic group behavior.

Skills

1. Using group process to prepare group members for transition and to resolve transitional issues.
2. Effectively dealing with different types of resistant behaviors, transference, and countertransference issues.
3. Recognizing when members are ready to exit.

Attitudes

1. Recognition of the need to balance individual needs with group needs, goals, and outcomes.
2. Appreciation for the contribution of new and continuing group members in the group process.
3. Maintaining non-judgmental attitudes and behaviors.
4. Respect for the emotional experience of the entry and exit of group members on the rest of the group.

4. Facilitate group growth within the established ground rules and movement toward group and individual goals by using methods consistent with group type.

Knowledge

1. Leadership, facilitator, and counseling methods appropriate for each group type and therapeutic setting.
2. Types and uses of power and authority in therapeutic group process.
3. Stages of group development and counseling methods appropriate to each stage.

1. Applying group counseling methods leading to measurable progress toward group and individual goals and outcomes.
2. Recognizing when and how to use appropriate power.
3. Documenting measurable progress toward group and individual goals.

Attitudes

1. Recognition of the value of the use of different group counseling methods and leadership or facilitation styles.
2. Appreciation for the role and power of the group facilitator.
3. Appreciation for the role and power of various group members in the group process.

5. Understand the concepts of process and content, and shift the focus of the group when such an intervention will help the group move toward its goals.

Knowledge

1. Definitions of the concepts of process and content.
2. Difference between the group process and the content of the discussion.
3. Methods and techniques of group problem solving, decision-making, and addressing group conflict.
4. How process variables affect the group’s ability to focus on content concerns.
5. How content variables affect the group’s ability to focus on process concerns.

Skills

1. Observing and documenting process and content.
2. Assessing when to make appropriate process interventions.
3. Using strategies congruent with enhancing both process and content in order to meet individual and group goals.

Attitudes

1. Appreciating the appropriate use of content and process interventions.

6. Describe and summarize client behavior within the group for the purpose of documenting the client’s progress and identifying needs and issues that may require a modification in the treatment plan.

Knowledge

1. How individual treatment issues may surface within the context of group process.
2. Situations in which significant differences between individual and group goals require changing either the individual’s goals or the group’s focus.

Skills

1. Recognizing that a client’s behavior can be, but is not always, reflective of the client’s treatment needs.
2. Documenting client’s group behavior that has implications for treatment planning.
3. Recognizing the similarities and differences between individual needs and group processes.
4. Redesigning individual treatment plans based on the observation of group behaviors.

Attitudes

1. Recognition of the value of accurate documentation.
2. Appreciation of individual differences in rates of progress towards treatment goals and use of group intervention.

C. COUNSELING FAMILIES, COUPLES, AND SIGNIFICANT OTHERS

1. Understand the characteristics and dynamics of families, couples, and significant others affected by substance use.

Knowledge

1. Dynamics associated with substance use, abuse, and dependence in families, couples, and significant others.
2. Impact of interaction patterns on substance use behaviors.
3. Cultural factors related to the impact of substance use disorders on families, couples, and significant others.
4. Systems theory and dynamics.
5. Signs and patterns of domestic violence.
6. Impacts of substance use behaviors on interaction patterns.

Skills

1. Identifying systemic interactions that are likely to affect recovery.
2. Recognizing the roles of significant others within the client’s social system.
3. Recognizing potential for and signs and symptoms of domestic violence.

Attitudes

1. Recognition of non-constructive family behaviors as systemic issues.
2. Appreciation of the role systemic interactions plays in substance use behavior.
3. Appreciation for diverse cultural factors that influence characteristics and dynamics of families, couples and significant others.

2. Be familiar with and appropriately use models of diagnosis and intervention for families, couples, and significant others, including extended, kinship, or tribal family structures.

Knowledge

1. Intervention strategies appropriate for systems at varying stages of problem development and resolution.
2. Intervention strategies appropriate for violence against persons.
3. Laws and resource regarding violence against persons.
4. Culturally appropriate family intervention strategies.
5. Appropriate and available assessment tools for use with families, couples, and significant others.

Skills

1. Applying assessment tools for use with families, couples, and significant others.
2. Applying culturally appropriate intervention strategies.

1. Recognition of the validity of viewing the system as the client, while respecting the rights and needs of individuals.
2. Appreciation for the diversity found in families, couples, and significant others.

3. Facilitate the engagement of selected members of the family, couple, or significant others in the treatment and recovery process.

Knowledge

1. How to apply appropriate confidentiality regulations.
2. Methods for engaging members of the family, couple, or significant others to focus on their own concerns when the substance abuser is not ready to participate.

Skills

1. Working within the bounds of confidentiality regulations.
2. Identifying goals based on both individual and systemic concerns.
3. Using appropriate therapeutic interventions with system members that address established treatment goals.

1. Recognition of the usefulness of working with those individual systems members who are personally ready to participate in the counseling process.
2. Respect for confidentiality regulations.

4. Assist families, couples, and significant others to understand the interaction between the family system and substance use behaviors.

Knowledge

1. The impact of family interaction patterns on substance use.
2. The impact of substance use on family interaction patterns.
3. Theory and research literature outlining systemic interventions in psychoactive substance abuse situations, including violence against persons.

Skills

1. Describing systemic issues constructively to families, couples, and significant others.
2. Teaching system members to identify and interrupt harmful interaction patterns.
3. Helping system members practice and evaluate alternate interaction patterns.

Attitudes

1. Appreciation for the complexities of counseling families, couples, and significant others.

5. Assist families, couples, and significant others to adopt strategies and behaviors that sustain recovery and maintain healthy relationships.

Knowledge

1. Healthy behavioral patterns for families, couples, and significant others.
2. Empirically based systemic counseling strategies associated with recovery.
3. Stages of recovery for families, couples, and significant others.

Skills

1. Assisting system members to identify and practice behaviors designed to resolve the crises brought about by changes in substance use behaviors.
2. Assisting family members to identify and practice behaviors associated with long-term maintenance of healthy interactions.

Attitudes

1. Appreciation for a variety of approaches in working with families, couples, and significant others.

Last Updated 11-7-02