299 Special Series -Counseling People with Co-Occurring Disorders SAMHSA TIP 42 Part 5

Summary: Treatment of Persons with Co-Occurring Disorders Based on SAMHSA TIP 42 Part 5 Host: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review Objectives ~ Guidelines Working With a Client Who Has COD ~ Develop and Use a Therapeutic Alliance To Engage the Client in Treatment ~ Maintain a Recovery Perspective ~ Manage Countertransference ~ Monitor Psychiatric Symptoms ~ Use Supportive and Empathic Counseling ~ Employ Culturally Appropriate Methods ~ Increase Structure and Support ~ Provide Motivational Enhancement Consistent With the Client's Specific Stage of Change ~ Design Contingency Management Techniques To Address Specific Target Behaviors ~ Use Cognitive-Behavioral Therapeutic Techniques ~ Use Relapse Prevention Techniques ~ Use Repetition and Skills-Building To Address Deficits in Functioning ~ Facilitate Client Participation in Mutual Self-Help Groups Develop and Use a Therapeutic Alliance To Engage the Client in Treatment ~ Therapeutic alliance may be impacted by counselor’s discomfort with MH or SA issues due to a lack of experience, training, or mentoring ~ Clinicians who experience difficulty forming a therapeutic alliance should consider if it is related to ~ The client's difficulties ~ A limitation in experience and skills ~ Demographic differences between the clinician and the client (cultural, gender, age) ~ Issues involving countertransference Develop and Use a Therapeutic Alliance To Engage the Client in Treatment ~ Demonstrate an understanding and acceptance of the client. ~ Help the client clarify the nature of his difficulty. ~ Indicate that you and the client will be working together. ~ Communicate to the client that you will be helping her to help herself. ~ Express empathy and a willingness to listen to the client's formulation of the problem. ~ Assist the client to solve some external problems directly and immediately. ~ Foster hope for positive change. Maintain a Recovery Perspective ~ Consumers with mental disorders may see recovery as the process of reclaiming a meaningful life beyond mental disorder, with symptom control and positive life activity. ~ While “recovery” has many meanings, generally, it is recognized that recovery does not refer solely to a change in substance use, but also to a change in an unhealthy way of living ~ The recovery perspective has two main features: ~ It acknowledges that recovery is a long-term process of internal change ~ It recognizes that these internal changes proceed through various stages Recovery Perspective ~ Assess the client's stage of change (see section on Motivational Enhancement below). ~ Ensure that the treatment stage (or treatment expectations) is (are) consistent with the client's stage of change. ~ Use client empowerment as part of the motivation for change. ~ Foster continuous support. ~ Provide continuity of treatment. ~ Recognize that recovery is a long-term process and that even small gains by the client should be supported and applauded. Manage Countertransference ~ Countertransference now is understood to be part of the treatment experience for the clinician. ~ Clinicians are vulnerable to the same feelings of pessimism, despair, anger, and the desire to abandon treatment as the client. ~ The clinician should be aware of strong personal reactions and biases toward the client. ~ The clinician should obtain further supervision where countertransference is suspected and may be interfering with counseling. ~ Clinicians should have formal and periodic clinical supervision to discuss countertransference issues with their supervisors and the opportunity to discuss these issues at clinical team meetings. Monitor Psychiatric Symptoms ~ Monitor symptoms ~ Do a brief mental status and safety exam at every meeting ~ Document changes in symptoms ~ Monitor medication compliance and side effects ~ Consult with physicians Use Supportive and Empathic Counseling ~ Communicate respect