North Carolina TASC Clinical Series Training Module Seven: Clinical Skills

Client-Centered Clinical Work Client’s Hope and Expectancy 15% Model and Technique 15% Therapeutic Relationship 30% Extra Therapeutic Factors 40%

Clinician Attitudes 1. Congruence 2. Unconditional Positive Regard 3. Empathy 1. Congruence 2. Unconditional Positive Regard 3. Empathy

Effective Motivating Counseling Skills A Giving Advice B Removing Barriers C Providing Choice D Decreasing Desirability E Practicing Empathy F Providing Feedback G Clarifying Goals H Actively Helping A Giving Advice B Removing Barriers C Providing Choice D Decreasing Desirability E Practicing Empathy F Providing Feedback G Clarifying Goals H Actively Helping

Effective Brief Counseling (FRAMES) F Feedback R Responsibility A Advice M Menu E Empathy S Self-efficacy F Feedback R Responsibility A Advice M Menu E Empathy S Self-efficacy

Dysfunctional Motivators Emotional Distress Vicarious Coping Loneliness and Isolation A Desire for Power A Need for Love Vicarious Rebellion Emotional Distress Vicarious Coping Loneliness and Isolation A Desire for Power A Need for Love Vicarious Rebellion

Functional Characteristics Curiosity and Inquisitiveness Ability to Listen Comfort with Conversation Empathy and Understanding Introspection Capacity of Self-denial Tolerance of Intimacy Comfort with Power Ability to Laugh Curiosity and Inquisitiveness Ability to Listen Comfort with Conversation Empathy and Understanding Introspection Capacity of Self-denial Tolerance of Intimacy Comfort with Power Ability to Laugh

13 Clinical Techniques 1.Establish a helping relationship with the client. 2.Facilitate the client’s engagement in the treatment and recovery process. 3.Work with the client to establish realistic, achievable goals. 4.Promote client knowledge, skills, and attitudes that contribute to a positive behavior change. 5.Encourage and reinforce client actions determined to be beneficial. 6.Work appropriately with the client to recognize and discourage all inconsistent behaviors.. 7.Recognize how, when, and why to involve the client’s significant others. 1.Establish a helping relationship with the client. 2.Facilitate the client’s engagement in the treatment and recovery process. 3.Work with the client to establish realistic, achievable goals. 4.Promote client knowledge, skills, and attitudes that contribute to a positive behavior change. 5.Encourage and reinforce client actions determined to be beneficial. 6.Work appropriately with the client to recognize and discourage all inconsistent behaviors.. 7.Recognize how, when, and why to involve the client’s significant others.

13 Clinical Techniques cont. 8.Promote client knowledge, skills, and attitudes consistent with the maintenance of health and prevention of infectious diseases. 9.Facilitate the development of basic and life skills associated with recovery. 10.Adapt clinical strategies to the individual characteristics of the client. 11.Make constructive therapeutic responses when client’s behavior is inconsistent with stated recovery goals. 12.Apply crisis management skills. 13.Facilitate the client’s identification, selection, and practice of strategies needed for maintaining treatment, progress, and preventing relapse. 8.Promote client knowledge, skills, and attitudes consistent with the maintenance of health and prevention of infectious diseases. 9.Facilitate the development of basic and life skills associated with recovery. 10.Adapt clinical strategies to the individual characteristics of the client. 11.Make constructive therapeutic responses when client’s behavior is inconsistent with stated recovery goals. 12.Apply crisis management skills. 13.Facilitate the client’s identification, selection, and practice of strategies needed for maintaining treatment, progress, and preventing relapse.

Clinical Skills Confrontation Empathy Leading Reinforcement Punishment Rehearsal Extinction Environmental Planning Confrontation Empathy Leading Reinforcement Punishment Rehearsal Extinction Environmental Planning Modeling Termination Reframing Self Disclosure Contracting Establishing Rapport Humor

Supportive Helping Behaviors - Verbal Uses understandable words Reflects back and clarifies client’s statements Appropriately interprets Summarizes for helpee Responds to primary message Uses verbal reinforcers (for example, “mm-mm”, “I see”) Calls Client by first name or “you” Uses understandable words Reflects back and clarifies client’s statements Appropriately interprets Summarizes for helpee Responds to primary message Uses verbal reinforcers (for example, “mm-mm”, “I see”) Calls Client by first name or “you” Appropriately gives information Answers questions about self Uses humor occasionally to reduce tension Is nonjudgmental Adds greater understanding to client’s statement Phrases interpretations tentatively so as to elicit genuine feedback from client

Supportive Helping Behaviors - Nonverbal Tone of voice similar to client’s Maintains good eye contact Occasional head nodding Facial animation Occasional smiling Tone of voice similar to client’s Maintains good eye contact Occasional head nodding Facial animation Occasional smiling Occasional hand gesturing Close physical proximity to client Moderate rate of speech Body leans toward client Occasional touching

Non-helping Behaviors - Verbal Advice giving, preaching Placating, blaming Cajoling, exhorting Extensive probing and questioning Directing, demanding Patronizing attitude Advice giving, preaching Placating, blaming Cajoling, exhorting Extensive probing and questioning Directing, demanding Patronizing attitude Over-interpreting Using words s/he doesn’t understand Straying from topic Intellectualizing Overanalyzing Talking about self too much

Non-helping Behaviors - Nonverbal Looking away from client, sitting far apart or turned away from client Sneering Frowning Scowling Tight mouth Looking away from client, sitting far apart or turned away from client Sneering Frowning Scowling Tight mouth Shaking pointed finger Distracting gestures Yawning Closing eyes Unpleasant tone of voice Rate of speech too slow or too fast

Acronym SOLER S Squarely show interest and involvement with the client O Open posture, no crossed arms and legs L Lean toward the client E Eye contact R Relax S Squarely show interest and involvement with the client O Open posture, no crossed arms and legs L Lean toward the client E Eye contact R Relax