Clinical Skills 1 Dy 11 15 01

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Terence T. (Terry) Gorski\'s slide presentation that reviews the basic clinical skills used by addiction and mental health professionals.

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  • Focus Attention On A Specific Issue By: Asking Probing Open Ended Questions Listening Carefully to the answers Listen, Understand, Take Serious, & Affirm By Using Same Word Feedback Checking to see if you got it right Accuracy Check Clarify, Challenge, Or Redirect Thinking By: Using Different Word Feedback (paraphrasing) Accuracy Check Manage Denial If Activated By: Apologizing for misunderstanding Stepping out of power struggle Asking Client to explain what they really meant Denial management tools to come tomorrow
  • Trainer Does a BRIEF demo role play Remember! Goal is to practice the focused questioning and active listening--not fill in the blanks. If Time Switch Roles and Repeat Make sure client roles do not play CLIENT FROM HELL!! Have this be an initial meeting Therapist role may want to develop a few open ended questions in addition to the ones on the worksheets. i.e., why now, why not last week or tomorrow; what are some of the consequences you are experiencing; why do you believe this is a problem
  • 1
  • 1
  • Trainer Does a BRIEF demo role play Remember! Goal is to practice the focused questioning and active listening--not fill in the blanks. If Time Switch Roles and Repeat Make sure client roles do not play CLIENT FROM HELL!! Have this be an initial meeting Therapist role may want to develop a few open ended questions in addition to the ones on the worksheets. i.e., why now, why not last week or tomorrow; what are some of the consequences you are experiencing; why do you believe this is a problem
  • Clinical Skills 1 Dy 11 15 01

    1. 1. <ul><li>Developed By Stephen F. Grinstead </li></ul><ul><li>Copyright, CENAPS Corporation, 2002 </li></ul>C linical S kills T raining Session One Building A Conceptual Pyramid
    2. 2. GORSKI-CENAPS  Mission <ul><li>By The Year 2010 </li></ul><ul><li>All People Will Have Access To </li></ul><ul><li>Affordable Resources </li></ul><ul><li>For Developing Effective </li></ul><ul><li>Recovery And Relapse Prevention Plans </li></ul>This Mission Is Part Of A Bigger Vision
    3. 3. GORSKI-CENAPS  Vision <ul><li>All People Will Have the Opportunity to Recover </li></ul><ul><li>No One Will Be Thrown Away To Contain Costs </li></ul><ul><li>Better Treatment Will Be Available To More People, At A Lower Cost </li></ul><ul><li>A Unified Biological, Cognitive, Affective, Behavioral, and Social (B-CABS) Model Will Be Fully Operational & The Recognized Standard in the Treatment of Addiction and Related Disorders </li></ul>This Vision Is Part Of A Bigger Philosophy
    4. 4. <ul><li>1. Assessment & Treatment Planning (ATP) </li></ul><ul><ul><li>Identify Problems </li></ul></ul><ul><li>2. Denial Management Counseling (DMC) </li></ul><ul><ul><li>Manage Denial And Resistance </li></ul></ul><ul><li>3. Primary Recovery Counseling (PRC) </li></ul><ul><ul><li>Learn Recovery Skills </li></ul></ul>Treatment Model Components
    5. 5. Treatment Model Components <ul><li>4. Relapse Prevention Counseling (RPC) </li></ul><ul><ul><li>Manage High Risk Situations </li></ul></ul><ul><li>5. Relapse Prevention Therapy (RPT) </li></ul><ul><ul><li>Manage Core Personality and Lifestyle Problems </li></ul></ul><ul><li>6. Dual Disorder Counseling (DDC) </li></ul><ul><ul><li>Manage Personality & Mental Disorders </li></ul></ul>
    6. 6. Treatment Delivery Systems <ul><li>Psychoeducational Groups </li></ul><ul><li>Individual Counseling/Therapy </li></ul><ul><li>Group Counseling/Therapy </li></ul><ul><li>Combination Of All Three Is Best </li></ul>
    7. 7. Building A Conceptual Pyramid <ul><li>Selecting A Title </li></ul><ul><li>Developing A Description </li></ul><ul><li>Building A Situation Map </li></ul><ul><li>TFUAR Analysis </li></ul><ul><li>Identifying The Foundation </li></ul><ul><ul><li>Attitudes, Values, And Beliefs </li></ul></ul>
    8. 8. Selecting A Title <ul><li>Finding A Trigger Phrase </li></ul><ul><li>Generating A Hot Emotional Response </li></ul><ul><li>Is Emotionally Loaded </li></ul>
    9. 9. Developing A Description <ul><li>The Programming Sentence </li></ul><ul><ul><li>Uncovers Automatic And Habitual Commands </li></ul></ul><ul><li>Describes </li></ul><ul><ul><li>Something People Do That Causes Pain </li></ul></ul><ul><ul><li>Describes What They Do To Manage The Pain </li></ul></ul><ul><ul><li>Describes What Happens As A Result </li></ul></ul><ul><ul><li>Can Lead To Urges To Use Alcohol/Drugs </li></ul></ul>
    10. 10. Building A Situation Map <ul><li>Analyzing A High Risk Situation By </li></ul><ul><ul><li>Develop A Concrete Sequence Of Behaviors </li></ul></ul><ul><ul><li>Identifying Thoughts, Feelings, And Behaviors </li></ul></ul><ul><ul><li>Selecting Intervention Points </li></ul></ul><ul><ul><li>Developing Intervention Strategies </li></ul></ul>
    11. 11. TFUAR Analysis <ul><li>Thoughts (T) Cause Feelings (F) </li></ul><ul><li>Thoughts Plus Feelings Cause Urges (U) </li></ul><ul><li>Urges Plus Decisions Cause Actions (A) </li></ul><ul><li>Actions Cause Social Reaction (R) </li></ul><ul><li>Two Types Of TFUAR Sequences </li></ul><ul><ul><li>Self-Defeating </li></ul></ul><ul><ul><li>Addictive </li></ul></ul>
    12. 12. Training Exercise <ul><li>1. Small Group Exercise </li></ul><ul><li>A. Who Are You? What do You Do? </li></ul><ul><li>B. Past Counseling Experience? </li></ul><ul><li>B. What Obstacles Do You Foresee Using This Model? </li></ul><ul><li>C. What Is Your Primary Goal For This Training? </li></ul><ul><li>2. Group Leader Reports </li></ul><ul><li>What Are Group Members Primary Goals For This Training? </li></ul>
    13. 13. <ul><li>Developed By Stephen F. Grinstead </li></ul><ul><li>Copyright, CENAPS Corporation, 2002 </li></ul>C linical S kills T raining Session Two Clinical Process Procedures: Part One
    14. 14. Focused Questioning <ul><li>1. Goal For The Session </li></ul><ul><li>2. Sequence Of Open Ended Questions </li></ul><ul><li>3. Meaning Of Each Question </li></ul><ul><li>4. Restate Each Question In Different Words </li></ul><ul><li>5. Understand Sequencing Of Questions </li></ul>
    15. 15. Focused Questioning <ul><li>6. Contract To Review Questions </li></ul><ul><li>7. Process Question With Active Listening </li></ul><ul><li>8. Repeat Process With Each Question </li></ul><ul><li>9. Use A Bundling Technique </li></ul><ul><li>10. Switch From Specific To Chain Of Logic </li></ul>
    16. 16. Goals Of Active Listening <ul><li>Focus Attention On A Specific Issue </li></ul><ul><li>Listen, Understand, Take Serious, & Affirm </li></ul><ul><li>Clarify, Challenge, Or Redirect Thinking </li></ul><ul><li>Manage Denial If Activated </li></ul>
    17. 17. Active Listening Process <ul><li>Ask An Open Ended Question </li></ul><ul><li>Listen To The Answer </li></ul><ul><li>Give Same Word Feedback </li></ul><ul><li>Do An Accuracy Check </li></ul><ul><li>Use Different Word Feedback </li></ul><ul><li>Do An Accuracy Check </li></ul>
    18. 18. Common Problems <ul><li>One Or Two Word Answers </li></ul><ul><ul><li>Repeat Exact Words, Tell Client You Don’t Understand, And Ask For Clarification </li></ul></ul><ul><li>The Very Long Answer </li></ul><ul><ul><li>Listen Without Interruption And When They Stop Ask To Go Over It Point By Point </li></ul></ul>
    19. 19. Cognitive Restructuring <ul><li>What’s The Best If Continue A/D Use </li></ul><ul><li>What’s The Worst If Continue A/D Use </li></ul><ul><li>What’s The Worst If Choosing Recovery </li></ul><ul><li>What’s The Best If Choosing Recovery </li></ul><ul><li>What’s The Most Likely If Continue A/D Use </li></ul>
    20. 20. Training Exercise <ul><li>Dyad Role Play </li></ul><ul><li>1. Decide Client and Therapist Roles </li></ul><ul><li>2. Use Interview Guide And Practice Active Listening </li></ul><ul><li>3. Client Role Use Realistic Type Client Responses </li></ul><ul><li>4. Giving Feedback To Therapist Role </li></ul><ul><li>a. What was effective </li></ul><ul><li>b. What was a problem </li></ul><ul><li>c. What could have been more effective </li></ul>
    21. 21. <ul><li>Developed By Stephen F. Grinstead </li></ul><ul><li>Copyright, CENAPS Corporation, 2002 </li></ul>C linical S kills T raining Session Three Clinical Process Procedures: Part Two
    22. 22. Relaxation Response Training <ul><li>Understanding The Stress Thermometer </li></ul><ul><li>Integrate Thermometer To Life Experiences </li></ul><ul><li>Keep Stress Below Level 7 At All Times </li></ul><ul><li>Set Up Mutual Time Out Signal </li></ul><ul><li>Teach Immediate Relaxation Response </li></ul>
    23. 23. The Stress Thermometer <ul><li>Level 1: Deeply Relaxed-Nearly Asleep </li></ul><ul><li>Level 2: Very Relaxed-Not Focused </li></ul><ul><li>Level 3: Relaxed-Not Focused </li></ul><ul><li>Level 4: Becoming Focused And Active </li></ul><ul><li>Level 5: Free Flow Activity Without Effort </li></ul>
    24. 24. The Stress Thermometer <ul><li>Level 6: Free Flow Activity With Effort </li></ul><ul><li>Level 7: Space Out </li></ul><ul><li>Level 8: Get Defensive </li></ul><ul><li>Level 9: Overreact </li></ul><ul><li>Level 10: Lose Control </li></ul>
    25. 25. Relaxation Response Methods <ul><li>Muscle Stretching, Tensing, Relaxing </li></ul><ul><li>Deep Breathing </li></ul><ul><li>Guided Imagery </li></ul><ul><li>Hypnotic Language </li></ul><ul><ul><li>Count Backwards From 10 </li></ul></ul><ul><li>Identify Focal Points For Relaxation </li></ul><ul><ul><li>i.e., Relax Jaw Or Notice Warmth In Fingers </li></ul></ul>
    26. 26. Feeling Identification <ul><li>Strong Or Weak </li></ul><ul><li>Angry Or Caring </li></ul><ul><li>Happy Or Sad </li></ul><ul><li>Safe Or Threatened </li></ul><ul><li>Fulfilled Or Frustrated </li></ul><ul><li>Proud Or Ashamed </li></ul><ul><li>Agitated Or Peaceful </li></ul><ul><li>Lonely Or Connected </li></ul>
    27. 27. Feeling Management <ul><li>Help Clients Accurately Identify Feelings </li></ul><ul><li>Normalize Feelings </li></ul><ul><li>Evaluate Clients’ Feeling Management Skills </li></ul><ul><li>Teach Clients New Management Skills </li></ul>
    28. 28. Training Exercise <ul><li>Small Group Exercise </li></ul><ul><ul><li>What Works Well </li></ul></ul><ul><ul><li>What Are Some Problem Areas </li></ul></ul><ul><ul><li>How Do You Need To Adapt It For Your Clients </li></ul></ul><ul><li>Group Leader Reports </li></ul><ul><ul><li>What Adaptations Did You Develop </li></ul></ul>
    29. 29. <ul><li>Developed By Stephen F. Grinstead </li></ul><ul><li>Copyright, CENAPS Corporation, 2002 </li></ul>C linical S kills T raining Session Four Clinical Process Procedures: Part Three
    30. 30. Bookmarking Hot Issues <ul><li>Goals Of Bookmarking </li></ul><ul><ul><li>Keep Clients Focused On Immediate Issues </li></ul></ul><ul><ul><li>Stop Clients From Prematurely Focusing On Issues That Need To Be Addressed At A Later Point In The Treatment Process </li></ul></ul>
    31. 31. Bookmarking Hot Issues <ul><li>Purpose Of Bookmarking </li></ul><ul><ul><li>Teach Clients To Identify And Manage High Risk Situations Without Drinking/Using </li></ul></ul><ul><ul><li>Teach Clients They Must Do This Before They Can Successfully Resolve Other Issues </li></ul></ul><ul><ul><li>Allows Clients To Identify And Clarify Core Issues, Write It Down And Work On It At The Appropriate Time In The Treatment Process </li></ul></ul>
    32. 32. Bookmarking Sequence <ul><li>Allow Client To Explain Problem Or Issue </li></ul><ul><li>Use Active Listening To Validate Client </li></ul><ul><li>Write Down Issue On Card Or Paper </li></ul><ul><li>Explain To Client Their Issue Is Important </li></ul><ul><li>Ask Client About Impact Of Alcohol/Drugs </li></ul><ul><li>Refocus Client On Current Task </li></ul><ul><li>Assure Client You Will Return To Issue </li></ul>
    33. 33. Inner Dialog Process <ul><li>Used To Clarify Internal Dissonance </li></ul><ul><li>Most People Have An Inner Conflict Between </li></ul><ul><ul><li>The Irresponsible Self </li></ul></ul><ul><ul><li>The Responsible Self </li></ul></ul><ul><li>Process Teaches People To Dialog With Both Parts Of Self </li></ul>
    34. 34. Inner Dialog Process <ul><li>Steps Of The Inner Dialog Process </li></ul><ul><ul><li>Look For Signs Of An Inner Conflict </li></ul></ul><ul><ul><li>Ask Client “What’s Happening” </li></ul></ul><ul><ul><li>Identify Strength Of Each Inner Position </li></ul></ul><ul><ul><li>Get Client To Identify Both Sides Of Argument </li></ul></ul><ul><ul><li>Ask Client Which Side They Need To Listen To </li></ul></ul>
    35. 35. Training Exercise <ul><li>Dyad Role Play </li></ul><ul><li>1. Decide Client and Therapist Roles </li></ul><ul><li>2. Use Interview Guide And Practice All Clinical Skills </li></ul><ul><li>3. Client Role Use Realistic Type Client Responses </li></ul><ul><li>4. Giving Feedback To Therapist Role </li></ul><ul><li>a. What was effective </li></ul><ul><li>b. What was a problem </li></ul><ul><li>c. What could have been more effective </li></ul>
    36. 36. Closure Exercise <ul><li>1. Small Group Exercise </li></ul><ul><ul><li>A. What Is The Most Important Thing That You Learned Today? </li></ul></ul><ul><ul><li>B. What Are You Going To Do Differently As A Result Of What You Learned? </li></ul></ul><ul><li>2. Group Leader Reports </li></ul><ul><ul><li>A. Three Most Important Things Learned By Group? </li></ul></ul><ul><ul><li>B. Three Things That Will Be Done Differently? </li></ul></ul>

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