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Clinician’s Training Package

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Presentation on theme: "Clinician’s Training Package"— Presentation transcript:

1 Clinician’s Training Package
Responding to Mental Health Issues Within Drug & Alcohol Treatment Clinician’s Training Package These training resources were funded by Drug Strategy Branch, Australian Government Department of Health and Ageing through the National Comorbidity Initiative

2 Exercise 1: Who Here Do You Think…
Loves The Simpsons? Can change a flat tyre? Exceeds the speed limit? Snores? Is kind to dogs? Would tell you that you have bad breath? Is trustworthy?

3 Exercise 2: How Are You Thinking-Feeling-Doing?
What are your THOUGHTS about working with clients with comorbidity? What are your FEELINGS about this training? Notice how you BEHAVE when I say we have 2 days to get this on board?

4 A Snapshot: Training Modules
Introduction to comorbidity Module 2 CBT Module 3 Pre session preparation Module 4 Implementation of Brief MH Intervention PsyCheck Mental Health Screen Context Development Implementation Scoring Theory of CBT Principles & application CBT in practice Assessment Case Formulation Treatment planning Psychoeducation Introduce CBT model Self monitoring Identify thoughts Manage thoughts Relapse planning Termination

5 Introduction to Comorbidity & PsyCheck Mental Health Screen
Module 1 Module 1 Introduction to Comorbidity & PsyCheck Mental Health Screen

6 Aims of Module 1 To provide a context for the PsyCheck Screening Tool
To understand the development and psychometric properties of PsyCheck To gain skills in implementation, scoring and interpretation of PsyCheck

7 Overview of Components of Module 1
Introduction to Comorbidity Development of PsyCheck Psychometric properties of the PsyCheck Screening Tool Negotiating the Users Guide Administering the PsyCheck Screening Tool Mental Health Screen Suicide/Self-Harm Risk Assessment Self Reporting Questionnaire Tool Interpreting the PsyCheck Screening

8 Introduction to Comorbidity
Module 1 Up to a third of mental health clients have an AOD problem May be referred in to AOD services Up to 80% of AOD clients also have a co-occurring mental health problem Many more may have subclinical symptoms Rule rather than the exception in treatment settings

9 Introduction to Comorbidity
Module 1 Those that have comorbid AOD and mental health problems have Poorer prognosis Higher risk of harm Greater likelihood of relapse to both disorders Greater use of health services

10 Models of Comorbidity Secondary Psychopathology Model
Module 1 Secondary Psychopathology Model Secondary Substance Use Model Bidirectional Model

11 Models of Comorbidity Common Factor Model No Relationship Model
Module 1 Common Factor Model No Relationship Model

12 Comorbidity in Practice
Module 1 Comorbidity is the norm In both mental health and alcohol and drug services BUT Client group is very different in each service

13 Comorbidity in Practice
Module 1 In Mental Health Services Mostly psychotic disorders with range of alcohol and other drug issues In Alcohol and Drug Services Mostly high prevalence disorders: anxiety and depression Often not able to refer to Mental Health Services Often have subclinical symptoms: often go undetected

14 Treatment for Comorbidity
Module 1 Sequential Treat one problem first Parallel Simultaneous treatment in different service provider Integrated Integrated treatment by same service provider Best empirical support Client and clinician preference

15 Comorbidity Training Many AOD clinicians report training is
Module 1 Many AOD clinicians report training is Concentrated on acute low prevalence disorders Focused on relationship building with Mental Health Services

16 PsyCheck Developed to Address Gaps
Module 1 Designed for AOD clinicians with little or no experience in mental health interventions But can still be used by experienced clinicians Focused on the disorders most commonly encountered in AOD Services Anxiety, depression, some somatic symptoms Offers a screening tool and articulated intervention Offers options for training and support through clinical supervision

17 PsyCheck Overview Module 1 Screening and intervention for anxiety and depression among AOD clients Brief screening 4 session intervention Youth modifications Extension material Accompanying resources PsyCheck Screening Tool PsyCheck Screening Tool User’s Guide PsyCheck Clinical Treatment Guidelines

18 PsyCheck Overview Comprehensive capacity building
Module 1 Comprehensive capacity building 4 module workshop Clinical supervision Part of a whole organisation approach to improving comorbidity services for our clients Managers resources (Implementation Guidelines) Clinical supervisors resources (Training and Clinical Supervision Guidelines)

19 PsyCheck Screening Tool
Module 1 PsyCheck Screening Tool scientifically validated A general mental health screen, including history of treatment A suicide/self harm risk assessment The Self Reporting Questionnaire (SRQ) World Health Organization instrument Assesses current symptoms of anxiety, depression and somatic disorders

20 PsyCheck Intervention
Module 1 Evidence based: drawn from empirically supported treatment Intervention is designed to be integrated into routine AOD practice CBT principles used in both AOD and mental health Best practice in both sectors Easily integrated Easily manualised Focus on scientist-practitioner approach Hypothesis testing Reflective practice

21 Psychometric Properties
Module 1 120 newly engaged AOD clients PsyCheck Screening Tool compared to General Health Questionnaire (GHQ) Both compared to a diagnostic instrument (CIDI) Results SRQ superior to GHQ in predicting anxiety and depressive disorder Cut-off identified that indicates presence of disorder General mental health screen good indicator of psychosis

22 Negotiating the PsyCheck User’s Guide
Module 1 About the PsyCheck Screening Tool Statistical properties Decision tree Administration and scoring General mental health screen Suicide risk/self harm assessment Self Reporting Questionnaire PsyCheck Screening Tool Sample contingency plan

23 Administering the Screening Tool
Module 1 Designed for routine screening (all clients) Administer the whole SRQ Other parts only if information not already collected Suicidality monitored over time Suicide assessment a framework not a checklist Clinical judgement is required Assess risk of harm to others in same way

24 Exercise 3: Celebrity Squares
Module 1 Work in groups of 3 Select a celebrity square One person plays the celebrity 2 clinicians assist each other in administering the PsyCheck Screening Tool Group Discussion

25 Interpreting the PsyCheck Screening Tool
Module 1 Intervention or further assessment is required if The client reaches 5 or more on the SRQ The client is at risk of suicide/self-harm The client has a mental health history Consider Readiness to change Current symptoms

26 SRQ Interpretation 1-4 5 or above Module 1 Total Score Interpretation
Action No symptoms present. Re-screen using the PsyCheck after 4 weeks 1-4 Some symptoms of depression, anxiety and/or somatic complaints indicated. Offer Session 1 Re-screen after 4 weeks Provide self-help material 5 or above Considerable symptoms of depression, anxiety and/or somatic complaints indicated Offer Sessions 1-4 Re-screen after 4 If no improvement after re-screening, consider referral

27 Decision Tree Module 1

28 Exercise 4: Celebrity Squares - What Next?
Module 1 Work in the same groups of 3 From the information you’ve collected refer to the Decision Tree and determine what the next steps would be for your celebrity client Think about Past mental health questions Suicide assessment, and SRQ score (and the types of answers endorsed) Group Discussion

29 What’s on Your Mind – Is It This…?
Module 1 I’m never going to get this I may as well give up now I’m useless

30 Or This …? Module 1 I’m getting some of this
If I hang in it will fall into place I feel confident I will get it

31 I’ll think about how I can use it in my practice
Or Maybe This …? Module 1 This is too easy… What if I get bored… I’ll think about how I can use it in my practice

32 Cognitive Behaviour Therapy
Module 2 Cognitive Behaviour Therapy

33 Aims: Module 2 To understand the theory of CBT
To understand the principles of application underpinning the PsyCheck intervention To understand of the practice of CBT

34 Overview: Module 2 Introduction to CBT CBT in practice
Theoretical underpinnings CBT Model Evidenced based practice CBT in practice Standard sessions Self-monitoring

35 Exercise 5: What Works for You?
Module 2 Working individually complete the worksheet, identifying which models you have an affinity with Then circle the main model you work with Now find someone else in the room that uses a DIFFERENT model to the one you typically work with and discuss with your partner Why you use this model/strategies you do? How you know it’s working ? Group discussion

36 Cognitive Behavioural Approach
Planned Approach Module 2 There is emerging evidence that a single theory planned approach is more effective than an ad hoc one Most effective to have a single framework or philosophy about treatment and incorporate a range of techniques and strategies that fit with your philosophy Cognitive Behavioural Approach

37 Evidenced Based Practice
Module 2 Best evidence for CBT compared to other types of therapies Most high level research (RCTs) and the most positive research Effective for a wide range of mental health problems including AOD, anxiety and depression BUT Whatever framework you use, you can create your own evidence through measuring individual outcomes – CBT emphasises this

38 What is CBT? Module 2 Umbrella term for a range of therapies with a cognitive and/or behavioural focus Therapy examples Cognitive Therapy (Aaron Beck) Relapse Prevention (G. Alan Marlatt) Coping Skills Therapy (Peter Monti) Mindfulness Therapy (Mark Williams) Schema Therapy (Jeff Young) Dialectical Behaviour Therapy (Marsha Linehan) Strategy examples Problem Solving Goal Setting Cue Exposure Therapy Thought stopping Urge surfing Activity scheduling…

39 In Comparison… Solution-Focused Therapy Narrative Therapy
Module 2 Solution-Focused Therapy An understanding of the past and cause of problem not necessary for resolution of the problem Change occurs as a result of a focus on the future without the problem Narrative Therapy Focus is on meaning, narrative and power Talking about the influence of problems enables talk about their defeat via the new stories

40 In Comparison… Gestalt Therapy Psychodynamic Therapy
Module 2 Gestalt Therapy Focus is on the present rather than past or future  Central aim is awareness-raising and creating conditions to de-construct dysfunctional fixed or habitual patterns of interaction   Change occurs through understanding and acceptance of what is Psychodynamic Therapy Focus is on initial underlying causes Understanding and having insight into the problem leads to change Therapeutic relationship is the key to change

41 What is CBT? ‘Self-help’ oriented Skills oriented
Module 2 ‘Self-help’ oriented Clinician provides tools and framework for change Client’s responsibility to create and maintain change Skills oriented Attention to therapeutic process vital but not sufficient in itself for change to occur Structured but not inflexible Clinical judgement necessary

42 CBT Principles Module 2 CBT… is based on an ever-evolving formulation of the client in cognitive terms requires a sound therapeutic alliance emphasises collaboration and active participation is goal oriented and problem focused initially emphasises the present

43 CBT Principles Module 2 CBT… is educative, aims to teach the client to be their own therapist, and emphasises relapse prevention is time limited sessions are structured teaches clients to identify, evaluate and respond to their dysfunctional thoughts and beliefs uses a variety of techniques to change thinking, mood and behaviour

44 Exercise 6: Mix ‘n’ Match
Module 2 From the cards you have been given, keep the ones that represent the way you work (in the majority) and trade unwanted cards for wanted cards with other participants Either Line up on the cognitive/behavioural continuum to show whether you work more in a cognitive or behavioral approach, or Place your cards on the grid (cognitive/behavioural vs skills/process) Group discussion Why did you put your card or yourself where you did? Did the cards fall in a pattern?

45 The CBT Model Module 2 Early Experience Core beliefs Trigger
Core beliefs Trigger Unhelpful thoughts Behaviour Feelings

46 Bruce: Eating Disorder
Module 2 Absent father, poor role models I’m unlovable and need food to make me happy Smell of restricted food Eating makes me feel better Over-eating, relapse Craving

47 Bruce: Simplified CBT Model
Module 2

48 Bruce: ABC Model Module 2

49 Exercise 7: The Cognitive Model
Module 2 In pairs take it in turns to use the CBT model worksheet, choose a simple target problem for example, eating chocolate, public speaking, learning a new skill Use a recent real example or a made up one Complete the CBT model sheet with thoughts feelings and behaviours.

50 Typical Session Format
Module 2 I: Review and feedback from last session II: Information and practice of session topic III: Summary and feedback from this session

51 CBT in Practice I: Review and Feedback
Module 2 Check-in past week, mood/drug use, homework ‘What’s been happening this week?’ ‘How’s your [mood] been this week?’ ‘How did you go with your homework?’ Bridge from previous session ‘Remember last week we talked about [x]… did you have any more thoughts about it?’ ‘Were you able to get any practice of [skill]’

52 CBT in Practice II: Info & Practice
Module 2 Information about skill ‘last week we talked about [identifying thoughts] this week I thought we’d talk about how to manage those thoughts…’ ‘Remember the cognitive model…the way I like to think about it is…’ Practice of skill in session ‘let’s try to do this together…’ [use whiteboard]

53 CBT in Practice III: Summary & Feedback
Module 2 Summary and feedback ‘so what we talked about today was…’ ‘how does that fit with you…?’ Set homework tasks ‘it’s really important to practice these things between sessions so they become second nature… what do you think you could do that would help you remember what we did?’

54 Exercise 8: CBT Demonstration I
Module 2 A. Watch video demonstration of basic elements of a session Discussion about the elements as a group B. Practice the elements in pairs Feedback to each other good aspects and an area for improvement

55 Stepped Care Approach Module 2 Interventions are applied from the least to most intensive Each step is incremental based on the client's response to the previous one A stepped care approach can add flexibility to treatment and improve outcomes CBT (and PsyCheck) facilitates the stepped care approach

56 The Therapeutic Relationship
Module 2 Therapeutic alliance vital Basis of ALL therapy Requires good counselling skills Necessary but not sufficient condition for change Collaboration and active participation by client and clinician essential Requires good active and empathetic listening skills CBT builds therapeutic alliance through collaboration and encouraging client involvement in their own therapy

57 Clinical Judgement Module 2 Clinical judgement is required, even though the therapy is manualised Use PsyCheck as guidelines – follow steps only as closely as you need to Use flexibly with extension material to tailor to client’s needs Consider client’s needs Consider existing clinical practices and pathways

58 Integrated Treatment Module 2 PsyCheck designed to be integrated into routine AOD treatment Techniques are deliberately similar to those in AOD treatment Emphasise to the client the link between AOD use and mental health problems Consider ways in which you can integrate into what you already do

59 Exercise 9: Therapeutic Process
Module 2 In small groups (3-4) discuss how therapeutic processes can be used in CBT What makes a good therapeutic alliance - list as many elements as you can? What could happen if you don’t have a good therapeutic alliance? Think about the client, the practitioner and the therapy relationship Group discussion

60 What have we learned so far…..?
Let’s Take a Breather… Module 2 What have we learned so far…..?

61 Homework Module 2 What brief practice at home would assist you to consolidate the knowledge you gained in this module? eg. Use the CBT model on your self eg. Further reading about CBT eg. Practice explain the CBT model to a client/colleague Next session you will be asked to share your experience of self practice if you are willing, (but not of the actual target problem itself if you used yourself as a client)

62 Module 3 Pre-Session Preparation: Assessment, Formulation and Treatment Planning

63 Before We Start… What did we do last time?
Module 3 What did we do last time? What is your feedback about what we covered? Homework feedback Challenges in completing the homework? What was the effect of self-practice? Next step…?

64 Exercise 10: The Young and The Restless
Module 3 Work in groups of 3, you have just interviewed your celebrity. Write a few lines using the following criteria as if you were writing for a trash magazine Their current problem Their presenting mood/feelings Thoughts Behaviour What’s driving the behaviour Consequences of behaviour Present to the large group

65 Consequences of behaviour
Example: Jen X Module 3 Trigger Jen X 38, an actor made a rare appearance in public today after husband Y, a singer was admitted to the famous Betty Ford clinic. X hasn’t been seen for weeks. Sources close to the actor say she has been increasingly worried about the singer’s behaviour. ‘She’s looking really drawn and a bit depressed’ says a close friend. ‘She says she can’t bear to go out of the house and it’s really starting to get to her’. It is thought that X’s two adopted children are being cared for by family. Behaviour Feelings Presenting issue Thoughts Consequences of behaviour

66 Aims: Module 3 Module 3 To understand how to screen for mental health issues and prepare feedback To understand how to undertake a cognitive behavioural assessment To understand how to collect sufficient information to develop a cognitive behavioural formulation

67 Overview: Module 3 Module 3 Negotiating the PsyCheck Intervention & Clinical Treatment Guidelines Undertake screening and preparing feedback Undertake a cognitive behavioural assessment Prepare a preliminary case formulation

68 Negotiating the PsyCheck Clinical Treatment Guidelines
Module 3 Designed for a range of experience and background Manualised for new clinicians Use flexibly for experienced clinicians Use with Introduction to PsyCheck package PsyCheck Screening Tool and User’s Guide

69 Negotiating the PsyCheck Clinical Treatment Guidelines
Module 3 Three sections Principles of intervention Practice Guidelines Extension material Worksheets Modifications for young people

70 Practice Guidelines Pre-session preparation: Reflection
Module 3 Pre-session preparation: Reflection Prepare feedback from the PsyCheck Screening Tool Cognitive behavioural assessment Cognitive behavioural formulation Treatment planning PsyCheck intervention Session 1: Introduction Session 2: Identifying unhelpful thoughts Session 3: Managing unhelpful thoughts Session 4: Relapse prevention

71 Screening in Context PsyCheck screening Feedback
Module 3 PsyCheck screening Snapshot of potential need Feedback Results of PsyCheck Screening Tool Any other information gathered

72 Cognitive Behavioural Assessment
Module 3 Also known as ‘functional’ assessment Occurs during an assessment session and continues through therapy Functional vs structural/diagnostic analysis Drivers vs descriptors of behaviour/problem

73 Cognitive Behavioural Assessment: 7Ps
Module 3 Presenting issues Pattern (onset and course) Predisposing factors Precipitating factors Perpetuating factors Protective factors Prognosis Other factors

74 Exercise 11: Something Fishy
Module 3 Bruce Discussion Identify elements of the functional assessment for Bruce

75 CBT Case Formulation Case formulation is
Module 3 Case formulation is Theory driven An interpretation - more than a case summary or summary of presenting problems A working hypothesis to be reviewed Dynamic - as new information comes to hand, your formulation is reviewed, added to, changed The case formulation puts the 7Ps into a context Always present it to your client and ask for their response

76 The Purpose of Case Formulation
Module 3 Clarifying hypotheses and questions Understanding the overall picture Prioritising issues and problems Planning treatment strategies Predicting responses to interventions Identifying barriers to progress

77 Assessment, Formulation and Treatment Planning
Module 3 Cognitive Behavioural Assessment AOD Assessment Screening Case formulation Treatment Plan

78 Exercise 12: Fishy Formulation
Module 3 Identify the components of formulation as a group In small groups, use the information from the earlier exercise, Something Fishy Write a formal formulation from this information Use the formal formulation to ‘translate’ this into language suitable for a client Group discussion

79 Exercise 13: Gummy Shark Module 3 Return to your small groups, use the previous case formulation and develop the treatment plan for Bruce including: Immediate strategies Longer term strategies Referral options One person in your group to role play Bruce and share presenting the formulation and treatment plan to him Think about the stage of change, insight and the way you present it to him. Notice how he responds.

80 Let’s go back over what we’ve done so far…
Checking in Again… Module 3 Let’s go back over what we’ve done so far…

81 Implementation of Brief Mental Health Intervention
Module 4 Implementation of Brief Mental Health Intervention

82 Exercise 14: First Response
Module 4 Write down your immediate response to the following Standing in a long line at the supermarket A heavily tattooed woman Someone throwing a cigarette out of a car Running late The beach Case formulation

83 Aims: Module 4 Module 4 Understand cognitive behavioural practice to undertake the PsyCheck Intervention

84 Overview: Module 4 Module 4 Negotiating the step-by-step guide to the 4-session PsyCheck Intervention Session 1: Psychoeducation Session 2: Identifying unhelpful thoughts Session 3: Managing unhelpful thoughts Session 4: Relapse prevention

85 A Snapshot: Practice Guidelines
Module 4 Pre PsyCheck Preparation Session 1 Psychoeducation Session 2 Identifying unhelpful thoughts Session 3 Managing unhelpful thoughts Session 4 Relapse prevention Present case formulation to client Provide info on symptoms Explain CBT Homework Links between thoughts & feelings Identifying unhelpful thoughts Homework Challenging unhelpful thoughts Homework Identifying triggers Identify early warning signs Breaking the rule effect Termination Rescreening

86 Module 4 Session 1 Presenting the Case Formulation and Beginning Psychoeducation and Self Monitoring

87 Session 1: Psychoeducation
Module 4 Psychoeducation can be about: Current symptoms What’s going on for the client (formulation) CBT model

88 Session 1: Psychoeducation
Module 4 Present case formulation to the client Get feedback and modify as appropriate Provide information about current symptoms Use worksheets 1, 2 and 3 Explain CBT model to the client Alternatively, use simplified version (extension material) Work through an hypothetical or personal example depending on readiness to change

89 Session 1: Treatment Planning
Module 4 Link the formulation and treatment Explain in detail how they are linked using personal examples Develop a treatment plan with the client Identify areas for intervention and priorities based on the formulation Emphasise revisiting both formulation and treatment plan regularly Finalise and record treatment plan Give client a copy

90 Session 1: Introduce Self-Monitoring
Module 4 Use Worksheet 4: Self monitoring Explain the role of self monitoring A temporary tool until it becomes automatic Explain the process of self monitoring Work through example with client Give client a copy to take home

91 Exercise 15: Self Monitoring
Module 4 Large group discussion What assists clients to understand self monitoring? What can clinicians do to get in the way of effective self monitoring? How do you know if you are being effective or obstructive?

92 Session 1: Session Summary
Module 4 Summarise content and ask for feedback from the client Emphasise the importance of take home tasks Set homework – Self Monitoring Identify any difficulties with content Identify easiest method Immediate recording, once a day etc Emphasise importance Prepare for next step Outline next session topic Organise next appointment or discharge

93 Session 1: Extension Material
Module 4 Simplified explanation of the CBT model Alternative explanation of CBT model: ABCs

94 Exercise 16: Please Explain…
Module 4 Work in groups of 3 One person plays the client, one the practitioner and one the observer Use the celebrity’s PsyCheck Screen and other information you have gathered to inform this session Together develop a formulation for your celebrity and the practitioner then explains it to the client; integrate any other psychoeducation material that the client would benefit from Group discussion

95 Session 2 Identifying Unhelpful Thoughts
Module 4 Session 2 Identifying Unhelpful Thoughts

96 What’s That Noise? Module 4 Must be a cat
OH NO! There’s someone out there Must be a cat

97 Exercise 17: Spot the Unhelpful Thought
Module 4 Use the Unhelpful Thoughts Worksheet What are your thoughts? Are you a black and white thinker? Do you jump to negative conclusions? Do you catastrophise? Are you a personaliser? Are you a should/ought person? How do you manage these unhelpful thoughts Group discussion

98 Homework Non-Completion
Module 4 Client didn’t understand the task More explanation AND practice Task was too difficult Simplify Task was too time-consuming Do in stages or in parts Do on some days Readiness to change Motivational approach

99 Session 2: Information Reiterate the CBT model
Module 4 Reiterate the CBT model Explain negative bias/interpretation Use monitoring to identify areas of (mis)interpretation of events Make personal link between thoughts and feelings and behaviours

100 Session 2: Practice Identify unhelpful thoughts
Module 4 Identify unhelpful thoughts Use self monitoring sheets as examples The aim is to raise awareness about when unhelpful thoughts occur Focus is on catching thoughts as they occur rather than allowing them to create negative mood Label unhelpful thoughts Use Worksheet 5

101 Session 2: Extension Material
Module 4 Behavioural activation Very important especially for depression when people often withdraw and lose interest in usual activities Focus both on pleasant activities and usual daily activities (showering, washing up) Guidelines for better sleep Especially important for those with anxiety and depression who often have difficulty sleeping Relaxation Helpful for anxiety and depression

102 Exercise 18: CBT Demonstration II
Module 4 Watch the video of Richard and Lynn discussing the thinking-feeling-doing cycle In small groups, one person plays the celebrity while the others explain the thinking-feeling-doing cycle using the celebrity’s information that you have gathered previously and to identify some of their unhelpful thinking Group discussion

103 Session 3 Managing Unhelpful Thoughts
Module 4 Session 3 Managing Unhelpful Thoughts

104 Session 3: Information How to challenge unhelpful thoughts
Module 4 How to challenge unhelpful thoughts Go through Worksheet 6 with examples Two main strategies for challenging thoughts: Is this a misinterpretation? Is there another way to think about this? If not, is it helpful to think this way? Even if it is true perhaps it doesn’t help me if I think this way

105 Session 3: Practice Practice challenge unhelpful thoughts
Module 4 Practice challenge unhelpful thoughts Use monitoring sheets completed for homework Assist client to practice the process from monitoring sheet Use Worksheet 6 as a reference

106 Session 3: Extension Material
Module 4 Communication skills Assertive communication skills are important for those who are anxious in social situations and for those who are depressed and have withdrawn from public

107 Exercise 19: Celebrity Challenge
Module 4 Work in groups of 3 One person plays the client, one the practitioner and one the observer Use the celebrity’s previous CBT model to assist Help the celebrity identify and challenge one of their unhelpful thoughts Use Worksheet 4 & 7 to assist you Group discussion

108 Session 4 Preventing Relapse
Module 4 Session 4 Preventing Relapse

109 Session 4: Information Discuss triggers and early warning signs
Module 4 Discuss triggers and early warning signs Use Worksheet 8 to explain the ‘breaking the rule effect’ Use Worksheet 9 to emphasise looking after yourself

110 Session 4: Practice Develop a relapse prevention plan
Module 4 Develop a relapse prevention plan Explore ways the client can regulate thoughts and feelings Emphasise the need for additional skills and supports Remind the client to self-reward Encourage the client to take care of themself

111 Session 4: Termination Module 4 Summarise content of sessions 1-4 and ask for feedback from the client Reinforce gains and effort Re-emphasise the importance of continued practice Reminder about tasks to continue with If continuing AOD treatment check homework in subsequent sessions Prepare for next step Manage concerns using a motivational approach Consider and discuss referral options Boosters/continued intervention

112 Session 4: Extension Material
Module 4 Problem solving Seemingly irrelevant decisions

113 Exercise 20: Celebrity Survivor
Module 4 Work in groups of 3 One person plays the celebrity client, one the practitioner and one the observer – swap roles from last exercise Summarise for the client and develop a relapse prevention plan Group discussion

114 Rescreening Module 4 Rescreening has benefits for both the clients and clinician: Monitoring client progress with the client can assist to build the client’s self efficacy as they see themselves improving Clinicians can monitor and reflect on their own practice using objective ‘data’ Clinicians can reorient therapy if no improvement and reflect on potential gaps in treatment

115 Support: Clinical Supervision
Module 4 Optimal supervision: A single consistent supervisor to build a relationship Weekly or fortnightly supervision preferable Individual supervision as a minimum Group and/or peer supervision as an adjunct

116 Lights… Camera… ACTION…
Module 4 What aspects of the training do you feel comfortable with? What areas will you need to work on? What will you do differently in your practice In the next few weeks? In the next year?

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