Section 2 Practice Dimensions

PD 5 Counseling

Elements

 

Definition

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 on 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.

Element: Individual Counseling

Competency 75

Establish a helping relationship with the client characterized by warmth, respect, genuineness, concreteness, and empathy.

Knowledge

  • Theories, research, and evidence-based literature.
  • Approaches to counseling that are person centered and have demonstrated effectiveness with substance use disorders.
  • Definitions of warmth, respect, genuineness, concreteness, and empathy.
  • The role of the counselor.
  • Transference and countertransference.

Skills

  • Active listening, including paraphrasing, reflecting, and summarizing.
  • Conveying warmth, respect, and genuineness in a culturally appropriate manner.
  • Validating.
  • Demonstrating empathic understanding.
  • Using power and authority appropriately in support of treatment goals.

Attitudes

  • Respect for the client.
  • Recognition of the importance of cooperation and collaboration with the client.
  • Professional objectivity.

Competency 76

Facilitate the client’s engagement in the treatment and recovery process.

Knowledge

  • Theory and research related to client motivation.
  • Alternative theories and methods for motivating the client in a culturally appropriate manner.
  • Theory, research, and evidence-based literature.
  • Counseling strategies that promote and support successful client engagement.
  • Stages-of-change models used in engagement and treatment strategies.

Skills

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

Attitudes

  • Respect for the client’s frame of reference and context.

Competency 77

Work with the client to establish realistic, achievable goals consistent with achieving and maintaining recovery.

Knowledge

  • Assessment and treatment planning.
  • Stages of change and recovery.
  • Strategies to support recovery.

Skills

  • Formulating and documenting concise, descriptive, and measurable treatment outcome statements.
  • Facilitating the client’s ability to determine goals and formulate action plans.
  • Knowing one’s limitations with respect to the therapeutic relationship.

Attitudes

  • Appreciation for the client’s resources and preferences.
  • Appreciation for individual differences in the treatment and recovery process.

Uses of The Competencies

In Idaho, the State certification board and the Idaho Educators in Addiction Studies collaborated to establish a new entry-level counselor certification for the State. Educational requirements for certification were based on The Competencies. To facilitate the process, college faculty members were trained in competency-based teaching methods to enhance student proficiency.

 

Competency 78

Promote client knowledge, skills, and attitudes that contribute to a positive change in substance use behaviors.

Knowledge

  • Information, skills, and attitudes consistent with recovery.
  • The client’s goals, treatment plan, prognosis, and motivational level.
  • Stages-of-change model.
  • Assessment methods to measure progress in achieving treatment goals and objectives.

Skills

  • Implementing motivational techniques.
  • Recognizing the client’s strengths.
  • Assessing and providing feedback on client progress toward treatment goals.
  • Assessing life and basic skills and comprehension levels of the client and all significant others involved in the treatment planning process.
  • Identifying and documenting change.
  • Coaching, mentoring, teaching, and validating.
  • Recognizing and addressing ambivalence and resistance.

Attitudes

  • Genuine care and concern for the client, family, and significant others.
  • Appreciation for incremental progress in completing treatment goals.
  • Appreciation of strengths-based principles that emphasize client autonomy and skills development.

Competency 79

Encourage and reinforce client actions determined to be beneficial in progressing toward treatment goals.

Knowledge

  • Counseling theory, treatment, and practice literature as it applies to substance use disorders.
  • Relapse prevention theory, practice, and outcome literature.
  • Behaviors and cognition consistent with the development, maintenance, and attainment of treatment goals.
  • Counseling treatment methods that support positive client behaviors consistent with recovery.

Skills

  • Using behavioral and cognitive methods and other interventions that reinforce positive client behaviors.
  • Using objective observation and documentation.
  • Assessing and reassessing client behaviors.

Attitudes

  • Recognition of the importance of continued support, encouragement, and optimism.
  • Appreciation of strengths-based principles that emphasize client autonomy and skills development.
  • Appreciation for incremental progress in completing treatment goals.

Competency 80

Work appropriately with the client to recognize and discourage all behaviors inconsistent with progress toward treatment goals.

Knowledge

  • The client’s history and treatment plan.
  • The client’s behaviors and cognition that are inconsistent with the recovery process.
  • Behavioral and cognitive therapy literature relevant to substance use disorders.
  • Cognitive, behavioral, and pharmacologi- cal interventions appropriate for relapse prevention.
  • Strengths-based models that build on strengths of the client.

Skills

  • Monitoring the client’s behavior for consistency with established treatment outcomes.
  • Presenting inconsistencies between the client’s behaviors and goals.
  • Reframing and redirecting negative behaviors.
  • Teaching conflict resolution, decision- making, and problemsolving skills.
  • Recognizing and addressing underlying client issues that may impede treatment progress.
  • Engaging client to discover and use personal strengths and resources to achieve goals.

Attitudes

  • Appreciation of strengths-based principles that emphasize client autonomy and skills development.
  • Acceptance of relapse as an opportunity for positive change.
  • Recognition of the value of a constructive helping relationship.

Competency 81

Recognize how, when, and why to involve the client’s significant others in enhancing or supporting the treatment plan.

Knowledge

  • Theory, research, and outcome-based literature demonstrating the importance of significant others, including families and other social systems, to treatment progress.
  • Social and family systems theory.
  • How to apply appropriate confidentiality rules and regulations.

Skills

  • Identifying the client’s family and social systems.
  • Recognizing the effect of the client’s family and social systems on the treatment process.
  • Engaging significant others in the treatment process.

Attitudes

  • Appreciation for the need of significant others to be involved in the client’s treatment plan, within the bounds of confidentiality rules and regulations.
  • Respect for the contribution of significant others to the treatment process.

Competency 82

Promote client knowledge, skills, and attitudes consistent with the maintenance of health and prevention of HIV/AIDS, tuberculosis, sexually transmitted diseases, hepatitis C, and other infectious  diseases.

Knowledge

  • The client’s and system’s worldviews relative to health.
  • How infectious diseases are transmitted and prevented.
  • The relationship among substance- abusing lifestyles, risky sexual behaviors, and the transmission of infectious diseases.
  • Health enhancement concepts, research, and methods.
  • Available community health care, support, and prevention resources.

Skills

  • Using a repertoire of techniques that, based on an assessment of various client and system characteristics, promote and reinforce health-enhancing activities and safe sex practices.
  • Coaching, mentoring, and teaching techniques relative to the promotion and maintenance of health.
  • Demonstrating cultural and overall competence in discussing sexuality.
  • Facilitating client referral to available community resources.

Attitudes

  • Openness to discussions about health issues, lifestyle, and sexuality.
  • Recognition of the counselor’s potential to model a healthy lifestyle.

Competency 83

Facilitate the development of basic and life skills associated with recovery.

Knowledge

  • Basic and life skills associated with recovery.
  • Theory, research, and practice literature that examines the relationship of basic and life skills to the attainment of positive treatment outcomes.
  • Tools used to determine levels of basic and life skills.

Skills

  • Teaching and facilitating the adoption of life skills appropriate to the client’s situa- tion and skill level.
  • Applying assessment tools to determine the client’s level of basic and life skills.
  • Communicating how basic and life skills relate to treatment outcomes.

Attitudes

  • Recognition that recovery involves a life context broader than the elimination of symptoms.
  • Acceptance of relapse as an opportunity for learning and/or skills acquisition.

 

Competency 84

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

  • The effect of culture on substance use.
  • Cultural factors affecting responsiveness to various counseling strategies.
  • Current research concerning differences in drinking and substance use patterns based on the characteristics of the client.
  • Addiction counseling strategies.
  • How to apply appropriate strategies based on the client’s treatment plan.
  • The client’s family and social systems and relationships between each.
  • The client’s and system’s cultural norms, biases, and preferences.
  • Literature relating spirituality to addiction and recovery.

Skills

  • Knowing how to individualize treatment plans.
  • Adapting counseling strategies to unique client characteristics and circumstances.
  • Applying culturally and linguistically responsive communication styles and practices.

Attitudes

  • Recognition of the need for flexibility in meeting the client’s needs.
  • Willingness to adjust strategies in accordance with the client’s characteristics.
  • A nonjudgmental, respectful acceptance of cultural, behavioral, and value differences.

Competency 85

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

Knowledge

  • Client behaviors that tend to be inconsistent with recovery.
  • The client’s social and life circumstances.
  • Relapse prevention strategies.
  • Therapeutic interventions.

Skills

  • Monitoring the client’s progress.
  • Using various methods to present inconsistencies between the client’s behaviors and treatment goals.
  • Reframing and redirecting negative behaviors.
  • Using appropriate communication and intervention strategies.

Attitudes

  • Recognition of the importance of continued support, encouragement, and optimism.
  • Perseverance during periods of treatment difficulty.

Competency 86

Apply crisis prevention and management skills.

Knowledge

  • Differences between crisis prevention, crisis intervention, and other kinds of therapeutic intervention.
  • Characteristics of a serious crisis and typical reactions.
  • Posttraumatic stress and other relevant psychiatric conditions.
  • Roles played by family and significant others in the crisis development or reaction.
  • Relationship of crisis to the client’s stage of change.
  • The client’s usual coping strategies.
  • Steps to aid in crisis resolution, including determination of what the client can do and what the counselor, family, or significant others in the client system should do, in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

Skills

  • Carrying out steps from crisis prevention to crisis resolution.
  • Assessing and engaging the client’s and cli- ent’s system’s strengths and resources.
  • Assessing for immediate concerns regarding safety and potential harm to others.
  • Possessing the ability to contract for safety.
  • Making appropriate referrals as necessary.
  • Assessing and acting on issues of confidentiality that may be part of a crisis response.
  • Assisting the client in expressing emotions and normalizing feelings.

Attitudes

  • Recognition of crisis as an opportunity for change.
  • Confidence in the midst of crisis.
  • Recognition of personal and professional limitations.
  • Recognition of the need to practice crisis responses, particularly team interventions.

Competency 87

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

  • How the client and client’s family, significant others, mutual-help groups, and other systems enhance and maintain treatment progress, relapse prevention, and continuing care.
  • Relapse prevention strategies.
  • Skills-training methods.

Skills

  • Using behavioral techniques to reinforce positive client behaviors.
  • Teaching relapse prevention and life skills.
  • Motivating the client toward involvement in mutual-help groups.

Attitudes

  • Recognition that clients must assume responsibility for their recovery.

 

Element: Group Counseling

Competency 88

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

Knowledge

  • A variety of group methods appropriate to achieving client objectives in a treat- ment population.
  • Research concerning the effectiveness of various models and strategies for group counseling with general populations.
  • Research concerning the effectiveness of various models and strategies for populations with substance use disorders.
  • Research and theory concerning the effectiveness of various models and strategies for group counseling with members of varying cultural groups.

Skills

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

Attitudes

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

Uses of The Competencies

In July 1999 a new mandatory Chemical Dependency Professional credentialing process was adopted in Washington State. Proficiency in specific addiction counseling competencies derived from The Competencies came to be required. Subsequently, college and university curricula within the State were required to be consistent with The Competencies.

 

Competency 89

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

  • Specific group models and strategies relative to the client’s age, gender, and cultural context.
  • Selection criteria, methods, and instruments for screening and selecting group members.
  • General principles for selecting group goals, outcomes, and ground rules.
  • General principles for appropriately graduating group members and terminating groups.
  • Principles of confidentiality rules and regulations.

Skills

  • Conducting screening interviews.
  • Assessing a client’s appropriateness for participation in group.
  • Using the group process to negotiate group goals, outcomes, and ground rules within the context of the individual needs and objectives of group members.
  • Using the group process to negotiate appropriate criteria and methods for transition to the next appropriate level of care.
  • Adapting group counseling skills as appropriate for the group type.
  • Considering environmental factors that facilitate group interactions, such as room setup and privacy issues.

Attitudes

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

Competency 90

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

Knowledge

  • Developmental processes affecting therapeutic groups over time.
  • Issues faced by individuals and the group as a whole on entry of new members.
  • Issues faced by individuals and the group as a whole on exit of members.
  • Characteristics of transition stages in therapeutic groups.
  • Characteristics of therapeutic group behavior.

Skills

  • Using the group process to prepare group members for transition and to resolve transitional issues.
  • Effectively addressing different types of resistant behaviors, transference issues, and countertransference issues.
  • Recognizing when members are ready to exit.

Attitudes

  • Recognition of the need to balance individual needs with group needs, goals, and outcomes.
  • Appreciation for the contribution of new and continuing group members in the group process.
  • Maintenance of nonjudgmental attitudes and behaviors.
  • Respect for the emotional experience of the entry and exit of group members on the rest of the group.

Competency 91

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

Knowledge

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

Skills

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

Attitudes

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

Competency 92

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

Knowledge

  • Concepts of process and content.
  • Difference between the group process and the content of the discussion.
  • Methods and techniques of group problemsolving, decisionmaking, and addressing group conflict.
  • How process variables affect the group’s ability to focus on content concerns.
  • How content variables affect the group’s ability to focus on process concerns.

Skills

  • Observing and documenting process and content.
  • Assessing when to make appropriate process interventions.
  • Using strategies congruent with enhancing both process and content to meet individual and group goals.

Attitudes

  • Appreciation of the appropriate use of content and process interventions.

 

Competency 93

Describe and summarize the client’s behavior within the group to document the client’s progress and identify needs and issues that may require a modification in the treatment plan.

Knowledge

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

Skills

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

Attitudes

  • Recognition of the value of accurate documentation.
  • Appreciation for individual differences in progress toward treatment goals and use of group intervention.

Uses of The Competencies

The University of California–San Diego School of Medicine Forensic Certificate is based on The Competencies, criminology issues, and penology. The Competencies also serves as the minimum standard for the California Association of Addiction Certifying Organizations, a quality assurance body for the State.

Element: Counseling Families, Couples, & Significant Others

Competency 94

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

Knowledge

  • Dynamics associated with substance use, abuse, dependence, and recovery in families, couples, and significant others.
  • The effect of interaction patterns on substance use behaviors.
  • Cultural factors related to the effect of substance use disorders on families, couples, and significant others.
  • Systems theory and dynamics.
  • Signs and patterns of domestic violence.
  • Effects of substance use behaviors on interaction patterns.

Skills

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

Attitudes

  • Recognition of nonconstructive family behaviors as systemic issues.
  • Appreciation of the role systemic interactions play in substance use behavior.
  • Appreciation for diverse cultural factors that influence characteristics and dynamics of families, couples, and significant others.

 

Competency 95

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

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

Skills

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

Attitudes

  • Recognition of the validity of viewing the system (i.e., family, significant others, and extended kinship or tribal family structures) as the client views it, while respecting the rights and needs of individuals.
  • Appreciation for the diversity found in families, couples, and significant others.

Competency 96

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

Knowledge

  • How to apply appropriate confidentiality rules and regulations.
  • Methods for engaging members of the family or significant others to focus on their concerns.

Skills

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

Attitudes

  • Recognition of the usefulness of working with those individual system members who are ready to participate in the counseling process.
  • Respect for confidentiality rules and regulations.

Competency 97

Assist families, couples, and significant others in understanding the interaction between the family system and substance use behaviors.

Knowledge

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

Skills

  • Describing systemic issues constructively to families, couples, and significant others.
  • Assisting system members in identifying and interrupting harmful interaction patterns.
  • Helping system members practice and evaluate alternative interaction patterns.

Attitudes

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

Competency 98

Assist families, couples, and significant others in adopting strategies and behaviors that sustain recovery and maintain healthy relationships.

Knowledge

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

Skills

  • Assisting system members in identifying and practicing behaviors to resolve the crises brought about by changes in substance use behaviors.
  • Assisting clients and family members with referral to appropriate support resources.
  • Assisting family members in identifying and practicing behaviors associated with long-term maintenance of healthy interactions.

Attitudes

  • Appreciation for a variety of approaches to working with families, couples, and significant others.

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Group Counseling

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