Elements Of Psychological Treatment

VOLUME BElements ofPsychological Treatment

Module 1Drug dependence and basic counselling skillsBiology ofdrugdependencePrinciples ofdrugdependencetreatmentBasiccounsellingskills for volvingfamilies indrugdependencetreatment

Workshop 1Basic counselling skillsfor drug dependencetreatment

Training objectivesAt the end of this workshop you will be able to: Identify a minimum of 4 counsellingstrategies useful in drug abusetreatment Conduct a minimum of 3 counsellingstrategies Structure a regular counselling session Understand the importance of clinical supervision Conduct a minimum of 3 listening strategies and 3responding and teaching strategies to be used incounselling for drug abuse treatment

Introduction toCounselling

What is counselling?Counselling involves the following: Interactive relationship Collaboration Set of clinical skills & teaching techniques Positive reinforcement Emotional support Formal record6

What is counselling?In counselling, it is important to establish thefollowing: Goals of treatment Treatment modality Treatment plan Scheduling of sessions Frequency and length of treatment Potential involvement of others Termination of treatment7

Principles of counsellingAn addiction treatment professional should Respect the client Be a role model Control the therapeutic relationship Emphasise the client’s personal responsibility forrecovery Provide direction and encourage self-direction Be conscious of his or her own issues8

Basic counsellingskills

Basic counselling skillsACTIVE LISTENINGPROCESSINGRESPONDINGTEACHING10

Active listeningActive listening by the clinicianencourages the client to shareinformation by providing verbal andnonverbal expressions of interest.11

Active listening skillsActive listening includes the following skills: Attending Paraphrasing Reflection of feelings Summarizing12

AttendingAttending is expressing awarenessand interest in what the client iscommunicating both verbally andnonverbally.13

AttendingAttending helps the clinician Understand the client through careful observation Attending helps the client Relax and feel comfortable Express their ideas and feelings freely in theirown way Trust the counsellor Take a more active role in their own sessions14

AttendingProper attending involves the following: Appropriate eye contact, facial expressions Maintaining a relaxed posture and leaningforward occasionally, using natural hand and armmovements Verbally “following” the client, using a variety ofbrief encouragements such as “Um-hm” or “Yes,”or by repeating key words Observing the client’s body language15

Example of attending1I am so tired, butI cannot sleep soI drink somewine.2Um-hm3When I wake upit is too latealready.4I see5Too late forwork.my bossfired me6Please16

Let‘s practice!How should the clinician respond?The client asked the clinician aboutthe availability of medical help to dealwith his withdrawal symptoms. Theclinician noticed that the client iswringing his hands and looking veryanxious.17

ParaphrasingParaphrasing is when the clinicianrestates the content of the client’sprevious statement Paraphrasing uses words that aresimilar to the client’s, but fewer The purpose of paraphrasing is tocommunicate to the client that youunderstand what he or she issaying18

ParaphrasingParaphrasing helps the clinician Verify their perceptions of the client’sstatements Spotlight an issueParaphrasing helps the client Realise that the counsellor understandswhat they are saying Clarify their remarks Focus on what is important and relevant19

Example of paraphrasing1My mum irritatesme. She pickson me for noreason at all.We do not likeeach other.3Yes!2So you are havingproblems gettingalong with yourmother. You areconcerned aboutyour relationshipwith her.20

Reflection of feelingsReflection of feelings is when theclinician expresses the client’sfeelings, either stated or implied. Thecounsellor tries to perceive theemotional state of the client andrespond in a way that demonstratesan understanding of the client’semotional state.21

Reflection of feelingsReflection of feelings helps the clinician Check whether or not the clinician accuratelyunderstands what the client is feeling Bring out problem areas without the client beingpushed or forcedReflection of feelings helps the client Realise that the counsellor understands what they feel Increase awareness of own feelings Learn that feelings and behaviour are connected22

Example of reflection of feelings1When I get home inthe evening myhouse is a mess. Thekids are dirty myhusband does notcare about dinner Ido not feel like goinghome at all.2Your are notsatisfied with theway the housechores are.3Yes!23

SummarisingSummarising is an important way forthe clinician to gather together whathas already been said, make surethat the client has been understoodcorrectly, and prepare the client tomove on. Summarising is puttingtogether a group of reflections.24

SummarisingSummarising helps the clinician Provide focus for the session Confirm the client’s perceptions Focus on one issue while acknowledging the existenceof others Terminate a session in a logical waySummarising helps the client Clarify what they mean Realise that the counsellor understands Have a sense of movement and progress25

Example of summarising12Yes, that is it!We discussed your relationshipwith your husband. You said therewere conflicts right from the startrelated to the way money washandled, and that he often felt yougave more importance to yourfriends. Yet on the whole, thingswent well and you were quitehappy until 3 years ago. Then theconflicts became more frequentand more intense, so much so thathe left you twice and talked ofdivorce, too. This was also thetime when your drinking was at itspeak. Have I understood thesituation properly?26

Processing

ProcessingProcessing is the act of the clinicianthinking about his or her observationsabout the client and what the client hascommunicated.28

ProcessingProcessing allows the counsellor to mentallycatalogue the following data: Client’s beliefs, knowledge, attitudes andexpectations Information given by his or her family Counsellor’s observations29

Responding

RespondingResponding is the act of communicatinginformation to the client that includes providingfeedback and emotional support, addressingissues of concern, and teaching skills.31

Expressing empathyEmpathy is the action ofunderstanding, being aware of, beingsensitive to, and vicariouslyexperiencing the feelings, thoughts,and experiences of another.32

Example of expressing empathy13I am so tired, butI cannotsleep so I drinksome wine.2When I wakeup I am alreadytoo late for work.Yesterday myboss fired me 5 but I do nothave a drinkingproblem!I see.4I understand, Iam sorry aboutyou job.33

ProbingProbing is the counsellor’s use of aquestion to direct the client’s attentionto explore his or her situation ingreater depth.34

Probing A probing question should be open-ended Probing helps to focus the client’s attentionon a feeling, situation or behaviour Probing may encourage the client toelaborate, clarify or illustrate what he or shehas been saying Probing may enhance the client’sawareness and understanding of his or hersituation and feelings Probing directs the client to areas that needattention35

Example of probing1I was always knownto be a good worker.I even received anaward. Lately I hadsome issues myhusband is just nothelping that is whyI am always late.3Actually I havehad lots ofproblems, notonly being late.2Tell me about theproblems youhave beenhaving at thework place.Work problemsrelated to use?36

InterpretingInterpreting is the clinician’s explanation of theclient’s issues after observing the client’sbehaviour, listening to the client andconsidering other sources of information.37

InterpretingEffective interpreting has three components: Determining and restating basic messages Adding ideas for a new frame of reference Validating these ideas with the client38

Example of interpreting1I alwaysthought I couldcontrolYou say you had difficulty in gettingalong with your boss. Once youmentioned that sometimes yousimply broke he rules for the sakeof breaking them. You also saidthat you are always late, evenwhen your husband had everythingready for the children. In the past,you said it was because of thenegative behaviour of your boss.This time you blamed yourhusband. Is it possible that yourproblems at work, like beinglate, are related to your alcoholuse?39

SilenceSilence can encourage the client toreflect and continue sharing. It alsocan allow the client to experience thepower of his or her own words.40

Let‘s practice! Practice with your colleague thenew counselling skills you havelearned. A third colleague will be anobserver. After 10 minutes switchroles. Each observer should providefeedback at the end of eachsession.41

Teaching clientsnew skills

Teaching clients new skillsTeaching is the clinician’s transfer of skills tothe client through a series of techniques andcounselling strategies.43

Use repetitionRepetition entails counsellorsrestating information. It also helpsclients practise new/important skills,which they need to upscaleknowledge and to control their druguse.44

Encourage practiceMastering a new skill requires time andpractice. The learning process oftenrequires making mistakes and beingable to learn from them. It is criticalthat clients have the opportunity to trynew approaches.45

Give a clear rationale Clinicians should not expect a client topractise a skill or do a homeworkassignment without understanding why itmight be helpful Clinicians should constantly stress howimportant it is for clients to practise newskills outside of the counselling session andexplain the reasons for it46

Let‘s think!What teaching strategies does thisclinician employ?“It will be important for us to talk about andwork on new coping skills in our sessions, butit is even more important to put these skillsinto use in your daily life. It is very importantthat you give yourself a chance to try newskills outside our sessions so we can identifyand discuss any problems you might haveputting them into practice. We’ve found, too,that people who try to practise these skillstend to do better in treatment. The practiseexercises I’ll be giving you at the end of eachsession will help you try out these skills.”47

Monitoring and encouraging Monitoring: to follow-up by obtaininginformation on the client’s attempts topractise the assignments and checking ontask completion. It also entails discussingthe clients’ experience with the tasks so thatproblems can be addressed in session Encouraging: to reinforce further progressby providing constructive feedback thatmotivates the client to continue practisingnew skills outside of sessions48

Use the assignmentsUse the information provided by the patients inresponse to their assignments to give themconstructive feedback and motivate them.Focus on the client’s: Coping style Resources Strengths and weaknesses49

Explore resistanceFailure to implement skills outside ofsessions may be the result of a varietyof factors, e.g. feeling hopeless. Byexploring the specific nature of aclient’s difficulty, clinicians can helpthem work through it.50

Praise approximationsCounsellors should try to shape the patients’behaviour by praising even small attempts atworking on assignments, highlighting anythingthey reveal as helpful or interesting.51

Let‘s think!What teaching strategies does thisclinician employ?“I noticed that you did not fully complete yourhomework, but I am really impressed with thesection that you have completed. This isgreat in this section you wrote that onMonday morning you had cravings but youdid not use. That is terrific! Tell me a littlemore about how you coped with this situation.In this other section, you wrote that you usedalcohol. Tell me more about it let’s analysetogether the risk factors involved in thissituation.”52