11 Stages of Readiness for Change Building Rapport | Addiction Counselor Exam Review Podcast


Hey everybody and welcome to today’s
installment of the Review for the Alcohol and Drug Counselor Exam. Today
we’re going to be talking about understanding readiness for change and
stage appropriate interventions, so we’re going to start out with
readiness for change. A lot of us have heard of those pre contemplation preparation yada yada… Okay, so that means a person may not be a
hundred percent ready to do what they need to do and one of the things that we
want to do as clinicians and I learned the hard way is move them from one stage
or phase of readiness for change to the next don’t expect in 30 days or even
less if they’re in detox for three days don’t expect to move them from
contemplation into action it’s not going to happen so we want to focus on trying
to nurture that seed the seed is the need for treatment and we want to
nurture that to grow so they’ve become ready to act treatment planning and
placement must take into account how ready the client is for change for all
aspects of every single problem so for example if one of my issues is I’m
unhealthy and I want to get healthy and that’s a pore problem statement anyway
but we’re just gonna go with it okay great
so there that’s one aspect of something that I need to work on and maybe I’m
also having sleep problems and I’m depressed so those are three different
problems maybe I’m really ready to work on the depression and getting healthier
okay that’s great but then when it comes down to getting
healthy you know maybe I’m ready to start exercising a little bit but I am
NOT ready to start changing my diet so my readiness for change for that aspect
of getting healthy is going to be different so we need to pay attention to
readiness for change and enhance readiness for change for every aspect of
every problem so the transtheoretical model of change was proposed by
Prochaska and DiClemente and it’s great its enduring it works for mental health
as well as substance abuse issues as well as physical issues the one thing
you want to remember it is it’s not linear that means you don’t go from pre
contemplation to contemplation to prepper
to action in this nice sequential step people will go from pre contemplation to
contemplation and then back to pre contemplation and then they may work all
the way up to action and it gets really uncomfortable so then they jump back to
contemplation they’re like you know maybe it wasn’t that big of a deal so
it’s more of a jumping around sort of thing it’s not a straight progressive
line readiness for change differs for each goal and issue tip 35 put out by
the substance abuse and mental health services administration called enhancing
motivation for change provides concrete stage appropriate intervention so if
this is something that you’re a little weak on in your training it’s really
important to go review tip 35 and it is a very well-written easy to read
treatment improvement protocol another part of readiness for change is to
remember that relapse is the rule not the exception
and some of you may be like oh my gosh I can’t believe you just said that it
doesn’t mean people have to go and go into a full-blown relapse they can have
an attitudinal relapse they can have a part of the behavioral relapse they can
have a slip they can have a lapse there’s a lot of things in there but
very rarely is somebody going to go into treatment and go through the entire
process and not backslide at all so we want people to recognize that relapses
whether it’s a small one or a big one are opportunities to learn and
opportunities to strengthen and opportunities for us to understand why
that behavior was more rewarding than the recovery behavior we were presenting
when people revert to old behaviors their readiness for change drops back
into contemplation or even pre contemplation so we’re going to need to
nudge them forward again and go help them see why it’s worth the effort and
why it’s important relapse or recurrence does not equal
failure or that the client has abandoned efforts for change it means there was a
hiccup something they didn’t expect think about when you’re driving and
you’ve got this beautiful course laid out and you’re driving along and all of
a sudden you hit this unexpected traffic jam and so you’re like well do I really
want to go to the mall if I’m gonna have to sit through this or do I want to turn
around and go back well that’s kind of what we’re talking about with relapse
here it’s something that you didn’t really expect probably or you didn’t
have the tools to deal with so you’ve got to figure out whether you want to
push through it or go back so this is an opportunity to learn if the person
decides to go back if they relapse we can say all right well when that
situation happens again what are some other options what tools do you need to
strengthen so the trance that their theoretical model of change starts with
pre contemplation this is when the person’s not considering change
they usually have not experienced any adverse consequences they may be unaware
that a problem exists or may be unwilling or too discouraged to attempt
change and I’ve seen this in a lot of smokers especially who have tried to
change so many times and it just didn’t work and they’re like why should I try
again it’s just it’s not even going to work you know I’ll just take my lumps
where they come so pre contemplation the person doesn’t think there’s even a
problem I try to make the analogy of getting into a cold pool and it’s
summertime and pre contemplate errs are laying out on a on a chair beside the
pool they’re not hot they’re not ready to get in the pool they are just fine
there is no problem you know you may see some sweat bubbling up on them and you
know that the UV rays are high but they don’t feel a problem yet so what we want
to do is provide pre-con to players pre contemplate information linking
problems with current behaviors or issues and we can do this through
education motivational interviewing and family and peer commentary specifically
about the client so for a pre contemplate ER we may them about you
know when we’re talking about substances how
much do people actually use how regular how how much does the average person
actually use cocaine how much problem could it cause you let’s look at your
assessment and see how many different areas this problem this issue is
impacting you in your life motivational interviewing would ask the person okay
so you’re telling me you know you’ve been using you really don’t see any
problems I’m wondering if you can identify five ways that the problem has
impacted your life and family and peer commentaries is when you know kind of
like interventions when people say you know I know you don’t see a problem but
when you drink you become very angry or very violent or very reclusive or
depressed or whatever it is that’s when loved ones are providing feedback not
emotional feedback just factual when you do use drugs or alcohol this is the
influence it has on me or this is the effect that I see it having on you it is
what it is and the person who is struggling with the issue is either
gonna take it or leave it so like I said some pre contemplate errs are reluctant
so we need to increase their knowledge of the problem and the personal impact
they may not want to give up drinking they may not want to think about the
fact that they can never drink again or they may not be ready to address it
because it just sounds way too hard and you know I really don’t have enough of a
problem where I need to do anything about it it’s kind of what you’re gonna
hear from them rebellious pre contemplate errs are using are afraid of
losing control they’re afraid that if they stop doing this but they’re gonna
be miserable and life’s not gonna be the same anymore and yada yada yada so we
want to shift their energy away from this fear of losing control to improving
the next moment so let’s not do anything drastic let’s not do anything rash you
know let’s just try experimenting you know maybe try going a week without
drinking or smoking or gambling or whatever
is and have them experiment with it have them try it out we’re not saying you
can’t do it forever you know so they are in the driver’s seat they’re in control
the resigned pre contemplate er is the one who’s tried before and just kind of
given up so we want to rekindle hope and optimism by highlighting successes that
they’ve had maybe they didn’t use for a week or for
six months or whatever it was and the strengths that they have and we can also
provide more information we can talk about you know what did you try and
learn about what triggered the relapses so then we can provide more information
maybe they maybe there are new treatments out or new medications out or
new approaches to help the person deal with it or maybe they’ve got a
co-occurring disorder that has never been diagnosed and you can see it plain
as day and you’re like well it’s not surprising you have a hard time staying
clean and sober because you’ve got it appears you’ve got bipolar disorder so
you know we need to get both of those under control contemplation the person
begins to see a cause for concern and reasons to change they’re becoming
ambivalent they may seek relevant information reevaluate their behaviors
or seek support so back to that pool metaphor in contemplation the person
starts feeling like they’re getting hot and they look over at the pool and they
go yeah every time I get in the pool it’s really cold and the kids are
splashing and it just no not worth it right now I will you know fan myself or
move over into the shade a little bit but I’m not ready to get in the pool yet
it’s not that bad so what we want to do is increase their awareness of the
consequences of the current problem you know if you keep on this path what do
you think the results are gonna be explore and address ambivalence by
tipping the decisional balance scales and tip 35 helps you learn how to do a
decisional balance exercise by helping them see the pros and cons of change yep
there are drawbacks to change we need to acknowledge those and address them and
the pros and cons of staying the same and again yes
our benefits to doing what they’re doing now or they wouldn’t be currently doing
it so we need to address those you know they’re serving a purpose so how else
can you meet those needs if alcohol or cigarettes help you relax because you’re
just way too stressed or way too anxious or depressed all right it’s a serving a
function it’s got a purpose so what else can we do to help you deal with those
feelings so you don’t feel like you have to drink
or smoke or use we also want to help clients address anxiety and grief about
change it’s scary especially if they’ve tried it before
and they failed it usually dings their self-esteem a
little bit so they may be anxious about trying it again they may fear that they
just can’t do it but it’s gonna be too hard and grief
they’ve got to give up something that has basically been their lifeline for a
little while it is a solution to a addictions are a solution to a problem
but a bad solution so they may have some grief about having to give that up
because they have some good memories and feelings associated with it in addition
to a whole bunch of bad ones so we want to help clients visualize change just
like after we lose someone important or something important to us we’re closing
that chapter on our life but we want to visualize life without that person or
thing in our life so we want to help them visualize what they’re working
towards and what’s what it’s going to be and what’s good about it even if they
don’t have that substance or activity in their life in preparation the person’s
gone okay you’re right it’s a problem the if we could stay with the pool
metaphor the person’s going alright you know what I’m getting pretty
uncomfortable so I’m gonna go sit on the edge of the pool and I’m gonna dangle my
feet in and see how that feels see if it’s too cold or if I think I can think
I can tolerate it so in preparation clients
are deciding that yeah it’s time to do something their commitment to change is
strengthened and more specific change planning begins they start examining
their self-efficacy for change which means they start thinking about how
capable am I of changing can I even do this they still may be using but they’re
also probably experiencing with experimenting with ways to cut back so
they’re trying some things they’re trying to figure out what treatment
program they might go to they’re getting their ducks in a row so to speak in
preparation we want to help clients identify the benefits of treatment and
there are going to be some drawbacks you know it can be money it can be time it
can be child care it can be a lot of things we need to help them address
those – in preparation we need to help them get those ducks in a row so
treatment is something they can do and there’s not a yes but that’s going to
get in their way identify and address fears and
apprehensions about treatment some people fear they’re gonna lose control
some people fear that they’re gonna be locked up you know whatever their
concerns are let’s address them give the client a list of options for treatment
and that includes not only different treatment centers but also different
treatment approaches and different treatment levels even if somebody scores
out on the a sam as needing residential treatment they may not be ready for
residential treatment they may not be willing for whatever reason maybe
they’ve got three kids at home and they don’t have anybody to take care of them
for 90 days while they’re in treatment so you know there may be reasons that
residential is not a good fit for them right now
so okay preparation let’s look at what are some other options that you can look
at including intensive outpatient Plus meetings or something clarify goals and
strategies help them identify and address barriers to change if they are
living in a house where three other people live there and are actively using
that’s going to be a barrier to change if they are incarcerated because the
milieu tends to have a lot of criminogenic addictive type
thinking that’s going to be a barrier to change so we want to identify anything
that might get in this person’s way from achieving their goals highlight their
strengths and past successful strategies so they’re preparing to make this huge
step we want to build them up let them know they can do it just like a coach
says you know you remember you beat this team you beat this team you’ve been you
know practicing and all your game tapes look excellent so this is what a coach
is gonna do this is what we’re going to do we’re preparing people to go in for
this fight of their life help them garner social support you know get
social support from people that are out there that can send them letters and
keep them company that can help help them by watering their plants keeping
their bills paid whatever it is continue to have them envision change and find
motivating stories from other people you know who do you know who’s gone through
recovery who is doing really well and you know I
golly I probably have two dozen people that I can name off the top of my head
who’ve gone through the program gone through recut the recovery process and
different treatment centers but they’ve gone through recovery and they’re still
clean they’re still sober and they are thriving and those are the people that I
draw on and you know obviously I have their their consent they’re they’re
fully open about what they’ve been through and I can share those if the
person doesn’t have any people that he can reflect on himself identify
motivations in each area and create small successes four components of the
goal you know we don’t want to say okay your first goal is to be remain
abstinent henceforth and forevermore that’s not realistic your first goal is
to stay abstinent today and then tomorrow we’ll address tomorrow and the
next day we’ll address the next day and before you know it you’ll have been
clean for a week so you want to make small changes you want
increase self-efficacy there that can-do attitude and their hardiness we want
them to commit to this we want them to feel like it’s a challenge but a
challenge that they can do just like when people start training for a
marathon you start thinking oh my gosh 24 miles that is a long way to run but
they commit to it they’re like alright I can do this and I want people to have
that I can do this attitude and I want them to be committed to doing it because
of all those other amazing things in their life that are important to them so
we say you want to do this change you want to get in recovery because you want
to hold on to or draw closer to all these other really awesome things in
your life strengthen their commitment to the process and begin learning about
their issues and they can begin learning about their issues they can start
learning about the effects of abandonment or the effects that
substances have on their neurotransmitters that create sort of a
downward spiral mood wise and finally they’re in action they are in treatment
they are ready to do it so encourage them to choose a strategy for change and
pursue it and this involves a little education may involve a little bit of
experimentation to figure out what they think is going to work for them
especially if they haven’t been in treatment before but let’s go they are
ready to go and that’s kind of like at the beginning of a football game where
the coach decides okay this is going to be a passing game or this is going to be
a running game at the beginning of treatment the client needs to decide how
am I going to approach this in order to win we start actively modifying habits
and the environment if they’re in residential that’s pretty easy to do if
they’re an outpatient then we want to start talking about their habits getting
dangers and triggers out of there in their environment we want to start
making a relapse prevention plan from the very beginning so they can start
working and living that recovery lifestyle they may be faced with
challenges related to withdrawal and a changing environment so we need to make
sure we buffer against the if they start feeling cravings really
bad we need to have some method to help them out whether that’s going to
meetings or you know coming to a drop-in center or whatever it is encourage them
to reevaluate their self-image now this whole process this action phase usually
takes three to six months following termination of use so if there’s a
extended paper period there you know three to six months after that when they
start developing new skills but it also takes the brain that long to rebalance
the neurotransmitters so they can think more clearly they can remember they can
learn easier all those things that get mucked up when your dopamine and
serotonin and everything get out of whack so the person is tired
of being hot they are ready in action they are ready to jump in that pool and
make it happen they’re ready to cool off and and feel more comfortable so we want
to help them implement their plan help them identify ways to ensure motivation
and progress is maintained and one of the best ways to do this is mindfulness
and I we talked about mealtime mindfulness in my practice breakfast
lunch and dinner I want people checking in with
themselves and saying how am i doing what am i needing at this point and you
know emotionally how am I feeling what is my attitude does anything need to be
adjusted to keep me on the right path we want people to be aware of how they
feel physically mentally and emotionally we’ll help them identify triggers how
those triggers could cause relapse and how to deal with them and triggers can
be holidays they can be something people said they can be certain people whatever
the trigger is for for people sometimes it can be as is innocent if you will as
a commercial on TV so what are the triggers for you and how do you deal
with them provide practical tools in each session and discuss and roleplay
application so for example if one of your triggers is the
I’m a day maybe in the evening right before bed is when one of the times that
you’ve always used so if that’s a trigger okay what do we need to do or
what can you do in the evening right before bed so you don’t use let’s
roleplay that let’s identify a list of three alternatives that you can do
address obstacles to change such as lack of transportation scheduling conflicts
with their job finances whatever it is and acknowledge the clients feelings and
experiences as a normal part of recovery there are going to be good days and
there going to be some really crappy days and that’s normal one of the
greatest things about recovery is people start feeling feelings and one of the
worst things about recovery is people start feeling feelings and you know
they’re not used to some of those intense dysphoric feelings anymore
the next stage is maintenance or vigilance the person wants to sustain
the gain gains made prevent vulnerabilities that means live that
recovery lifestyle eat a healthy diet so the body can make the neurotransmitters
it needs to keep the mood adequate so they’re getting enough sleep so they’re
not feeling like they need to you know overcharge on nicotine or caffeine or
something else so plenty of sleep good nutrition good sunlight you know we want
to make sure their circadian rhythms are set a lot of vulnerabilities are there
and on all CEUs education YouTube channel we have an entire series of
videos on vulnerabilities that people can look at during maintenance they’re
going to become more adept at identifying and addressing triggers
there is no way we can identify every single trigger for every single person
so we need to help them become aware of things that might trigger them or become
more self-aware of when they’re feeling triggered and how to deal with it they
need to have some general strategies if I start feeling triggered for some
reason the first thing I need to do is and one of the things I have a lot of
clients do is keep a note card with them or on their mobile device that has the
number of their sponsor or somebody that they can rely on and two other
interventions that they can use if they start feeling triggered in order to
maintain safety the maintenance phase lasts a minimum of six months and in my
philosophy the maintenance phase really lasts a lifetime it takes six months for
all this stuff to become a habit but then ideally the person still
prevents vulnerabilities and sustains their gains and you know is aware and
mindful after that we’re going to work in maintenance on relapse prevention
reassuring the client that occasional ambivalence is normal that some of those
dreams they may have are normal we’ll help them evaluate their present actions
and redefine long-term recovery plans so you know by the time they get to
maintenance they’ve been going through treatment for about a year when they
started treatment they probably couldn’t even envision being clean for a year
well now they’re there and it’s like oh my gosh look how far you’ve come you did
something that is so hard and you’ve accomplished it so that’s awesome you
know give yourself a pat on the back you didn’t think you could accomplish this
so now let’s look at what do you think long-term recovery looks like what do
you hope for the future now that you know how powerful and strong you really
are educate them about the relapsing nature of mental health and addictive
disorders especially if they’ve got a co-occurring mental health issue it may
they may have a recurrence of that even though they’re they’re not using so we
want to make sure that they’re aware of the warning signs the early warning
signs of an impending mental health relapse because if they start to get
depressed anxious if they have a bipolar episode they are going to be more likely
to relapse in their addiction as well and likewise if they use again they’re
probably going to trigger a mood I sewed so we want to let them know that
it’s not uncommon to go back to stinking thinking for a little bit and you just
have to pull yourself out of it and let’s talk about some ways to do that
and it is not uncommon to have a mood episode sometimes whether it’s out of
the clear blue or whether you know maybe somebody that you really cared about
died and you get depressed that’s normal but how are you going to deal with it
develop a list of circumstances that may require a return to treatment review
problems that emerged during treatment but weren’t addressed and help the
client develop a plan for addressing them in the future you know 90 days is
not very long so if you’re talking about the initial phase of treatment we can’t
nearly cover everything but if they’ve been in the program for a year or more
then they’ve probably addressed a lot of stuff but there may be other issues that
are still hanging out there like maybe their relationship with their one of
their siblings is still on the rocks and they want to address that and then
develop strategies for identifying and coping with high-risk situations because
they’ll happen so we want to make sure that people have a really good relapse
prevention plan in place teach the client how to capitalize on their
personal strengths and emphasize their self-sufficiency encourage them to
develop a plan for support including family and community support so when you
need to reach out because you’re not meant to bear everything on your own
shoulders when you need to reach out who is there and family doesn’t have to be
blood relatives family can be anybody the person feels they can rely on but
who are those people and in the community where can you go to get
support you know it can be meetings it can be Church it can be you know any
place the person identifies where they feel like they are supported prepare the
client to maintain positive changes through difficult times and identify
potential stressors and challenges that lay in front of them I’ve worked with a
lot of clients that go through treatment you know and you know a year year and a
half down the road they are still dealing with open
warrants and legal stuff or financial stuff or divorce stuff so we want to
talk about those potential stressors and challenges and make a plan for how the
person’s going to deal with it prepare them for changes to the environment
because you know while they were changing the environment it may not have
changed with them so they may have to change their environment
or deal with people not knowing how to work with them quite as well you know
it’s a whole learning process to engage with somebody who is now in recovery you
know it’s it’s a different person at the end of treatment ask the client to look
into the future and describe where he or she intends to be six months a year or
maybe even three years from now encourage the client to enjoy their
successes and step back and look how far they’ve come stay mindful of continuing
to work their program whatever that means for them it doesn’t necessarily
mean a a it doesn’t necessarily mean medication it’s different for every
person that’s why it’s called your program and remain vigilant for relapse
triggers making minor adjustments as needed relapse you know we said it’s the
rule not the exception you jump in the cold pool it is uncomfortable so you
jump back out relapse means falling back into old ways of thinking and acting the
earlier you catch your relapse the better it’s an opportunity for learning
about what triggered it and what things need to be addressed to keep recovery
the most rewarding choice like I said relapse doesn’t necessarily
mean that the person has to go full-blown back into use it can mean
that they drove to the liquor store and they sat in the parking lot thinking
about going in or they started getting agitated and withdrawn and expressing
some of those behavioral symptoms or emotional symptoms that they have when
they’re in their addiction but catching it then makes it a lot easier to
get back on track a good relapse prevention plan will have strategies for
identifying early relapse warning signs triggers and solutions so that’s great
you know now we know pre contemplation we know some of the techniques and
things we want to use for clients at different stages of readiness for change
but the first thing we got to do is engage them so how do we do that well
first impressions are lasting so you want to have a professional presentation
you don’t want to walk in and all rumpled stuff and smelling and looking
like you haven’t taken a bath in three days so have a professional presentation
it doesn’t have to be fancy it just has to be professional be prompt everybody
deserves promptness because everybody’s time is valuable be courteous and handle
paperwork smoothly don’t be shuffling your papers and
seeming like you don’t know what’s going on or having to run and get additional
addendums have your paperwork ready and be ready to go through it smoothly that
communicates a sense of competence and develops a sense of confidence in the
client the environment that you do your assessment in should be calm clean and
comfortable and if you share an office with somebody this could be a little bit
challenging sometimes but you want to have at least your area be presentable
you know you don’t want to have seven stacks of papers all over the place and
you know you’re constantly looking for a pencil and half this stuff has coffee
stains on it that doesn’t communicate competence you don’t want it to be too
formal but you also don’t want it to be too informal you don’t want to be in
there and shorts and a t-shirt but you also probably don’t want to be in a
three-piece suit avoid interruptions and provide appropriate privacy all of these
things will help the client develop a sense of confidence in you as the
clinician and encourage them to engage with you because they’re like hey this
person knows what they’re doing maybe they can really help me in engagement we
establish rapport and an effective working reliant alliance in which
client feels heard and understood which means we need to be respectful
non-judgmental and attentive attentive let’s let’s focus on that in this first
session you don’t want to spend your entire session looking at a computer or
looking at your papers as you write and just ask in question after question
where the client feels like they’re nothing but a number you want to be
attentive to them make eye contact smile be genuine think about how you would
feel if you were sitting in their place motivate and engage the client in
identified service needs so help them get motivated to get their physical and
to get on the waiting list and whatever they need to do engagement puts the
clinician in the best position to negotiate with the client about what to
do and how to do it so if they feel confident that you are competent then
they are going to be more likely to listen to your advice we can present
that information if the client is engaged and you know has faith in us we
have a lot more leverage engaged clients are more willing to participate
willingly be treatment compliant and successfully complete treatment it’s
important in the engagement process to create a welcoming environment remember
I said not too casual not too formal but you also want to be sensitive to the age
gender disability sexual orientation religion and socioeconomic status so
again on all CEUs education YouTube channel we have several videos on
culturally responsive counseling services that you probably want to
review if you’re not sure how to create a physical environment that is welcoming
to people of varying cultures stigma can also impact engagement so we want to
make sure we dispel any stigma about the diagnosis or about help seeking be open
about welcoming people be open about the problems that are there and help people
understand that okay so you have an addiction it doesn’t mean you’re a bad
person it means you chose um
method for solving a problem it was not a great solution but you wanted to live
and that got you here so now let’s figure out a better solution to that
problem expectations can also affect engagement if they don’t think it’s
going to be effective they’re not going to engage so we want them to have the
expectation that this is going to be an effective program they want to have the
expectation that they’re going to have a certain amount of power in the treatment
process that everything’s not going to be done to them that they’re going to
have a voice in their treatment and their expectations about the treatment
process if they know what to expect an individual a week nine hours of group
whatever that will help them engage because it’s not scary or ominous or
anything like that they know exactly what’s going to happen and they’re like
okay I can wrap my head around this and likable miss is another factor that
impacts engagement and this can vary based on the client social skills
attentiveness and attractiveness it can be hard for us to engage with some
clients but it can also be hard for them to engage with us if they’ve got poor
social skills hopefully ours are pretty good if we’re not attentive you know
they may not engage with us as well and to a certain extent if we are not
attractive in their eyes they may not engage with us as well
and you don’t have to be a beauty queen again you just have to be presentable
so building a helping relationship once you engage then you need to develop
rapport or that sense of connection where both parties are contributing to
the relationship you’re actively listening you’re actively and regularly
demonstrating credibility and dependability if you say you’re gonna do
it you do it if you say that this is the way it is that needs to be the way it is
if you don’t know be willing to say you know that’s a good question I don’t know
the answer I’ll check on it and get back with you so be credible and dependable
and respectful and responsive respectful doesn’t really need an explanation
responsive is more when the client says I need an appointment now I’m in crisis
or if the client says that you know they’re having difficulty getting their
medication you don’t say well you know send me a note and I’ll try to look at
it later today or sometime this week that’s not real responsive you want to
give them a date you know send it over to me and I’ll take a look at it and
I’ll call you back by 5:00 p.m. that’s responsive the client feels like okay
I’m important I made it on to the calendar support the client by
encouraging him or her to develop and build self-esteem appropriately express
feelings and validate and recognize but don’t encourage negative feelings or
behaviors so what does that mean that means clients are going to be angry
sometimes or sad or feel guilty or any of those dysphoric emotions validate
them I can see how this would make you really angry but don’t encourage these
feelings or behaviors we don’t want to stoke the fire and go oh I’d be angry
too and let me tell you you need to do this this and this now we want to say
all right I can tell that you’re really angry and I’d be really angry too if I
were in your position so what is the next step in order to improve the
situation we don’t want to stoke the fire of unhappiness we want to help them
improve the next moment provide empathy that communicates shared feelings of
hope you know I’m down there with you and I see how much you’re struggling
and I will be here to you know help you along your journey so the client has
hope that they’re not doing it by themselves and that you have faith in
them and provide acceptance an unconditional positive regard clients
are going to do things just as everybody does that will occasionally make you
angry or not be the right thing but okay if
the client relapses if the client no-shows for an appointment if the
client you know whatever they do that’s a behavior we can dislike behaviors but
we need to accept the client and we really need to focus on communicating
that there’s one client I can remember was just relapsed so many times and it
broke my heart every time he relapsed and but he was a really good person and
it frustrated me that he kept making these sometimes the same mistake over
and over again and I communicated that to him I said you know what you are an
awesome person but you know I have to tell you I’m feeling really frustrated
that you did the same thing again and I’m wondering how you got to that place
I’m wondering why you chose to go down that road again because until you get to
the root cause that behavior is not going to stop so accept the person
validate them be genuine with them when you communicate use active listening
reflect what they say so what I so what you’re telling me is clarify anything
that seems unclear you know if they say well yesterday you said that this
happened but now today it seems like you’re saying something different so I’m
wondering if you can clarify that for me focus and direct the client to a
particular topic when you’re talking so you’re reflecting
and you’re clarifying but maybe this session is about self esteem so you’re
going to keep bringing it back to self esteem and summarizing along the way a
lot of clients especially in the recovery process that first year or so
have difficulty with memory so you want to frequently some
okay so so far we’ve talked about this this and this and made these decisions
now the next thing you know I think is prudent to talk about would be to look
at this other issue and help them gradually move along when you question
clients try to make them open-ended which means not yes-or-no questions so
ask them questions like tell me what your childhood was like not did you have
a good childhood you’ll get a lot more information focus on one one thing at a
time don’t ask six questions and then have
the client okay this is what I want to know one thing at a time tell me about
how you’re sleeping all right you’re not sleeping very well
tell me about what that’s life do you have difficulty getting to sleep staying
asleep not sleeping enough tell me what that looks like go all the way through
sleep and then move on to the next thing which may be nutrition or something try
to avoid the word why because that can be perceived as confrontational why did
you do that part of it is in your tone but try to avoid why questions when
you’re communicating with people you can say you know I’m wondering what made you
think of that option focus more on your intonation and your nonverbals then
getting really hung up because sometimes you just can’t think of a way around the
word why but try not to use why unless you really have to and observe
nonverbals if clients are getting bored or they’re feeling like you’re not
hearing them they’re gonna close off or they’re gonna start looking at the door
so call out those nonverbal so you know it seems like we’re not connecting
really well I’m wondering what’s going on or you know what I’m missing
help me understand observe not nonverbals communicate 80% of what the
client is trying to communicate so that will give you a lot more information if
you look at their entire body and figure out what’s
going on nonverbals you’re looking for information and congruence so nonverbals
can tell you if the person is feeling unheard or they’re closing off but it
can also we also want to look for congruence if if you ask them a question
like do you plan to use this weekend and they say no well obviously that shaking
your head yes says yes and saying no that’s not congruent and it’s generally
not going to be that obvious but we want to look for information their rate of
speech if somebody is talking really quickly it could indicate anxiety or
anger apprehension if they’re speaking really quietly or really loudly it could
indicate you know either that they’re feeling intimidated or they’re getting
angry look at their posture is it open is it closed is it slumped down and
depressed look for gestures you know I talk with my hands a lot so I make a lot
of gestures eye contact is another good thing to look at if suddenly their eye
contact goes to nothing that may give you an idea that there’s a shame issue
or you’re not connecting in some way and you need to address it and then facial
expressions give you a lot of information you can tell a lot about how
a person’s feeling by their facial expressions when you observe nonverbals
you want to look at their dress and presentation because this can
communicate their state of mind for example if they are dressed cleanly and
you know maybe not pressed and starched but you know they’re put together that
indicates that they’re probably feeling kind of okay if they are on the other
hand they look like they rolled out of bed and showed up and what they slept in
that could indicate that they may be in the midst of clinical depression or
relapse or something Dressen presentation can
so communicate cultural values some cultures don’t believe in showing any
skin so be cognizant of that it can communicate body image people with poor
body image some of them will you know we’re really boxy clothing in order to
hide how they look other people who are more on the histrionic and may wear
clothing this is excessively provocative so look at what that’s communicating
about the clients self-esteem and sense of self look for bodily signs of drug
use such as needle tracks or jaundice when the eyes the whites of the eyes
start getting yellow it can indicate the liver is starting to fail physical abuse
and poor nutrition so these are all non verbals that we want to look for when
we’re talking to clients not just during assessment but every single opportunity this has been an introduction if you
will into the stages of change and kind of developing engaging with a client and
developing rapport review the stages of change and motivational interviewing in
tip 35 and brief interventions which is tip 34 both are available on the
substance abuse and mental health services administration website be
familiar with basic communication techniques including active listening
and observation of non verbals those will be important on your test and
understand the importance of empathy and acceptance in developing rapport and
engagement all of us at all CEUs wish you great success on your exam once
you’re certified or licensed please remember to visit all CEUs for all of
your continuing education needs we offer unlimited CEUs for $59 for addiction and
mental health counselors social workers and marriage and family therapists if
you’re still thinking about becoming an addiction counselor all CEUs offers the
training you need in three different formats you can choose online multimedia
self-study self-study + live webinars or even face to face weekend intensives
which meet one weekend per month for 12 months
we can even present a training series at your facility just email support at all
CEUs com2 schedule it to learn more you can also visit all CEUs comm /a sir
that’s all CEUs comm /a c e are thank you

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