19 -Therapeutic Approaches
Addiction Counselor Exam Review

 
 
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Addiction Counselor
Exam Review
Episode 19
Therapeutic Approaches
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counselor Education
Podcast Host: Addiction Counselor exam review, Counselor Toolbox and Happiness Isn’t Brain Surgery
Objectives
~ Review different therapeutic approaches including CBT, MET, Contingency Management and Trauma Informed
~ Types of treatment (individual, group, family) and benefits and drawbacks of each
~ Culturally appropriate strategies
~ Family Engagement
~ Overview of Crisis Intervention
~ Relapse Prevention
Therapeutic Approaches
~ Behavioral and cognitive behavioral approaches are grounded in social learning theories and principles of operant conditioning
~ Emphasis is on
~ Functional analysis of behaviors to understand them within the context of their antecedents and consequences
~ Skills training through which people recognize the situations or states in which they are most vulnerable and how to avoid high-risk situations
~ Using a range of behavioral and cognitive strategies to cope effectively with those situations if they cannot be avoided
~ Cognitive behavior therapy is based on the idea that feelings and behaviors are caused by a person’s thoughts
~ People may not be able to change their circumstances but they can change how they think about them and therefore change how they feel and behave
~ The goal of cognitive behavioral therapies to teach the person to recognize situations with their most likely to use, avoid these circumstances if possible, and cope with other problems and behaviors which may be to use
Therapeutic approaches continued
~ Contingency management therapy uses motivational incentives to facilitate behavior change and has improved treatment retention and abstinence rates
~ Motivational enhancement therapy is a client centered counseling approach for initiating behavior change and has successfully been used with people with alcohol and marijuana use disorders
Therapeutic approaches continued
~ Trauma Specific
~ Trauma Specific Models are an essential part of treatment as misidentified or misdiagnosed trauma related symptoms interfere with help seeking and hamper engagement in treatment, lead to early drop out, and make a relapse more likely
~ Trauma-Informed and Trauma specific approaches take into account knowledge about the trauma, its impact, interpersonal dynamics, and relation to recovery.
~ The primary goals of trauma specific services are focused to address directly the impact of trauma on people’s lives and to facilitate trauma recovery and healing
~ The Addictions and Trauma Recovery Integration Model or ATRIUM, seeking safety, and trauma recovery and empowerment model are all examples
Therapeutic approaches continued
~ Couples and family approaches
~ The defining feature couples and families treatments is that they’re treating substance using individuals in the context of the family and social systems in which the substance use may develop or be maintained
~ Prevailing models:
~ Brief strategic family therapy
~ Structural or strategic family therapy
~ Multidimensional family therapy
~ Multi systemic therapy
~ Behavioral and cognitive behavioral family therapy
~ Solution focused brief therapy
Culturally appropriate strategies
~ Two areas of concern with regard to cultural competence in addiction counseling are
~ the competence of the individual practitioner
~ the cultural appropriateness of specific intervention strategies
~ Culture includes much more than race and ethnicity
~ Culturally appropriate treatment can include the language used, the format of the program, the goals set for produce events, and specific program activities
~ Additionally, risk in protective factors may not be relevant for all cultural groups
Culturally appropriate strategies
~ Programs and practices that have been tested and found effective with one cultural group can be modified to fit other groups
~ These modifications take two forms:
~ cultural accommodation: modifying the way practices delivered to that it can be utilized with a particular culture or community
~ cultural adaptation: reviewing in changing the structure of the programmer practice to more appropriately fit the needs and preferences of a particular cultural group or community
Levels of Treatment: Benefits and Drawbacks
~ Family Counseling
~ Effects of SUD go beyond the nuclear family
~ Feelings of abandonment, fear, anger, embarrassment or guilt
~ Requires knowledge about the effects of family interactions on SUD and SUD on family interactions
~ Assists members in identifying and interrupting harmful interaction patterns
~ Presents an opportunity for members to focus on their own goals and issues to create a healthier system
Engaging the family
~ A change in any part of the system may bring about changes and other part of the system
~ Family counseling in addiction treatment has two main purposes:
~ To use family strengths and resources to help find or develop ways to live without substances of abuse
~ To ameliorate the impact of addiction on both the client and family
~ The person of using substances is regarded as a subsystem within the family
~ The familial relationships within this subsystem are the point of therapeutic interest and intervention
Engaging the family
~ Goals of family counseling include
~ Helping families become more aware of their own needs
~ Providing genuine and during healing for family members
~ Working to shift power to the parental figures in a family
~ To improve communication
~ Helping the family make interpersonal, intrapersonal, and environmental changes
~ Keeping substance abuse and mental health issues from moving from one generation to another.
Engaging the family continued
~ Co dependency refers to people who are in a close relationship with the addicted individual and are overly involved with the other person and the other persons problematic behavior, sometimes to their own detriment
~ Enabling is when the co dependent person unintentionally helps an addict to continue in their addiction by repeatedly putting out little fires for the addicted person
~ Addiction treatment programs that involve family generally use family interventions that differ from those used by family counselors or therapists
~ An intervention refers to confrontations that a group of family and friends have with the person abusing substances in order to convey the impact of the substance abuse and to urge entry into treatment
Levels of Treatment: Benefits and Drawbacks
~ Individual Counseling
~ Privacy
~ Elicitation of strong emotions
~ Flexible pacing
~ Individualized to the client
~ Brief Interventions
~ Typically 3 – 6 sessions (less than 90 days); generally effective
~ FRAMES
~ Feedback
~ Responsibility
~ Advice
~ Menu
~ Empathy
~ Self-efficacy
Levels of Treatment: Benefits and Drawbacks
~ Group Counseling
~ Most effective for treating SUD
~ Clients learn about themselves by interacting with others
~ Provides peer support
~ Helps many clients at once
~ Reinforces discipline
~ Inspires hope

Levels of Treatment
~ Group Counseling—Types of Groups
~ Psychoeducational
~ Skills development
~ Cognitive behavioral
~ Support
~ Interpersonal process
~ Relapse Prevention
~ Cultural focus groups
~ Art therapy
~ Specific issue groups (depression, self-esteem)
Medicaton Assisted Treatment: Who Benefits from Meds
~ Clients who face health risks as part of withdrawal
~ Clients who will not quit using because of withdrawal
~ Clients who have tried everything else, keep returning to treatment, but continue to relapse
~ Clients who believe they are unable to quit using on their own
~ Clients who often feel overwhelmed by cravings
~ Clients who believe that medication will help them engage or benefit from psychosocial treatment
~ Clients without medical, addiction, or family history risks
Crisis Prevention and Intervention
~ The crisis is a situation in which there’s a risk of harm to the client and less intervention occurs
~ Crisis can be emotional or physical
~ The crisis has five components:
~ A stressful traumatic event
~ A vulnerable or unbalanced eight
~ The precipitating factor
~ An active crisis state-based on the person’s perception
~ The resolution of the crisis
Crisis Intervention
~ A stressful event alone does not constitute a crisis
~ Crisis is determined by the individual’s view of the event, encompassing a personality and temperament, life experiences, physical state, and varying degrees of stress and coping skills, and the response to it
~ Crisis represents a time of danger and opportunity
~ In all models of crisis intervention involve constructs of safety, stabilization, processing a crisis event, and drawing conclusions from the process that the individual can integrate is a learning experience
Crisis Intervention
~ The best way to handle a crisis situation is to prevent it
~ Early assessment of clients for their potential for agitated or assaultive behavior is essential
~ Client should be taught strategies aimed at helping them manage their own behavior such as stress and anger management groups
~ Prevention of violent and aggressive behavior needs to started admission
~ Clients need to be assessed and asked about past violent incidents, whether they’ve been put in seclusion a restraint, and whether they’d ever experienced abuse as a child or adult
~ One of the most recommended intervention strategies is verbal crisis the escalation which is aimed at meeting the agitated persons immediate needs and calming the situation
Crisis Intervention
~ Steps in crisis intervention
• Assess the severity of the crisis
• Form a connection demonstrating and that they
• Explore the problem focusing on the immediate situation using active listening and paraphrasing. The goal is to restore the person to his or her previous level of functioning
• Deal with feelings and emotions including not only the content of the material presented but also the feelings
• Generate alternative solutions and summarize your understanding of the situation
• Develop an action plan which is very specific regarding time. The personal crisis is desperately looking for some relief to give them hope
• Develop a specific follow-up plan
Understanding and preventing relapse
~ Relapse certainly can be a type of crisis
~ A lapse or a recurrence of use is thought to have a cognitive and behavioral processes that are different from relapses.
~ Interventions designed to stop a lapse may prevent a full blown relapse
~ Lapsing back into use indicates the treatment needs to be reinstated or adjusted or that another treatment should be tried
~ Similar drug and alcohol addiction treatment, treatment for chronic illnesses are effective but require strict adherence to medical and behavioral regimens. Clients with these diseases often do not comply with their treatments.
Relapse continued
~ Three key points forming a comprehensive view of relapse
~ Relapses are common and clients should understand that they are likely to be vulnerable. Merely mentioning the R word will not cause a client to relapse
~ Relapse is reasonably predictable when examining general precipitants as well as people’s own personal triggers including social situations, HALT, personal emotions and situations that will be danger zones and need to be anticipated
~ Relapses are preventable with the use of self monitoring and abstinence maintenance activities including AA or other self help groups, personal counseling, and active involvement with the recovery community, religious congregation, health club for fitness group, or any lifestyle that is inconsistent with use (remember this for treatment planning)

Relapse continued
~ Relapse prevention is an umbrella term encompassing most skills based treatments that incorporate cognitive behavioral, skills building and coping responses
~ The overall goal of relapse prevention is to help people create more positive habits and positive changes in their lives in order to prevent relapse and sustained recovery
~ Relapse prevention therapy, or RPT is a behavioral self control program which teaches clients to:
~ Understand relapse is a process
~ Identifying cope effectively with high-risk situations
~ Cope with urges and craving
~ Implement the damage control procedures during the lapse
~ Stay engaged in treatment even after relapse
~ Identify when and how to create a more balanced lifestyle

Relapse continued
~ Cognitive techniques provide clients with a way to reframe the habit change process as a learning experience with errors and setbacks expected
~ Behavioral techniques include the use of lifestyle modifications such as meditation, exercise, and spiritual practices to strengthen a client’s overall coping capacity
~ The CENAPS model of relapse prevention therapy is also based on the belief that total abstinence plus personality and lifestyle changes are essential for full recovery
~ 5 components
~ Assessment
~ Warning sign identification
~ Warning sign management
~ Recovery planning
~ Relapse early intervention training
Summary
~ There are many approaches to treatment including cognitive, behavioral, motivational, trauma informed, relapse prevention and family approaches.
~ These approaches can be applied in individual, group or family settings
~ Counselors must constantly remain aware of the impact on culture in choosing treatment settings and interventions
~ Family engagement is crucial in the recovery process
~ Crisis has 5 components and what causes a crisis can be different for each person, but counselors need to be aware of the 7 steps in crisis intervention
~ Most relapse prevention theories address relapse triggers, unpleasant emotions, interpersonal conflict, and social pressure.
~ These triggers account for almost ¾ relapses.
~ Antecedents to relapse can be found within an individual such as a person’s mood or coping style, or may be triggered by interpersonal events
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