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 opportunit