clinical skills 1 dy 11 15 01

Clinical Skills

Training

Developed By Stephen F. GrinsteadCopyright, CENAPS Corporation, 2002

Session OneBuilding A Conceptual Pyramid

CST-1DY1 V01 Slide 2Copyright CENAPS 2002CENAPS GORSKI

GORSKI-CENAPS Mission

By The Year 2010All People Will Have Access ToAffordable Resources For Developing Effective Recovery And Relapse Prevention Plans

This Mission Is Part Of A Bigger Vision


GORSKI-CENAPS Vision

• All People Will Have the Opportunity to Recover• No One Will Be Thrown Away To Contain Costs• Better Treatment Will Be Available

To More People, At A Lower Cost• 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

This Vision Is Part Of A Bigger Philosophy


1. Assessment & Treatment Planning (ATP) Identify Problems

2. Denial Management Counseling (DMC) Manage Denial And Resistance

3. Primary Recovery Counseling (PRC) Learn Recovery Skills

Treatment Model Components


Treatment Model Components

4. Relapse Prevention Counseling (RPC) Manage High Risk Situations

5. Relapse Prevention Therapy (RPT) Manage Core Personality and

Lifestyle Problems

6. Dual Disorder Counseling (DDC) Manage Personality & Mental Disorders


Treatment Delivery Systems

• Psychoeducational Groups

• Individual Counseling/Therapy

• Group Counseling/Therapy

• Combination Of All Three Is Best


Building A Conceptual Pyramid

• Selecting A Title

• Developing A Description

• Building A Situation Map

• TFUAR Analysis

• Identifying The Foundation— Attitudes, Values, And Beliefs


Selecting A Title

• Finding A Trigger Phrase

• Generating A Hot Emotional Response

• Is Emotionally Loaded


Developing A Description

• The Programming Sentence— Uncovers Automatic And Habitual Commands

• Describes — Something People Do That Causes Pain

— Describes What They Do To Manage The Pain

— Describes What Happens As A Result

— Can Lead To Urges To Use Alcohol/Drugs


Building A Situation Map

• Analyzing A High Risk Situation By— Develop A Concrete Sequence Of Behaviors

— Identifying Thoughts, Feelings, And Behaviors

— Selecting Intervention Points

— Developing Intervention Strategies


TFUAR Analysis

• Thoughts (T) Cause Feelings (F)

• Thoughts Plus Feelings Cause Urges (U)

• Urges Plus Decisions Cause Actions (A)

• Actions Cause Social Reaction (R)

• Two Types Of TFUAR Sequences— Self-Defeating

— Addictive


Training Exercise

1. Small Group Exercise

A. Who Are You? What do You Do?B. Past Counseling Experience?B. What Obstacles Do You Foresee Using This Model?C. What Is Your Primary Goal For This Training?

2. Group Leader ReportsWhat Are Group Members Primary Goals For This Training?

Clinical Skills

Training


Session TwoClinical Process Procedures: Part One


Focused Questioning

1. Goal For The Session

2. Sequence Of Open Ended Questions

3. Meaning Of Each Question

4. Restate Each Question In Different Words

5. Understand Sequencing Of Questions


Focused Questioning

6. Contract To Review Questions

7. Process Question With Active Listening

8. Repeat Process With Each Question

9. Use A Bundling Technique

10. Switch From Specific To Chain Of Logic


Goals Of Active Listening

• Focus Attention On A Specific Issue

• Listen, Understand, Take Serious, & Affirm

• Clarify, Challenge, Or Redirect Thinking

• Manage Denial If Activated


Active Listening Process

• Ask An Open Ended Question

• Listen To The Answer

• Give Same Word Feedback

• Do An Accuracy Check

• Use Different Word Feedback

• Do An Accuracy Check


Common Problems

• One Or Two Word Answers— Repeat Exact Words, Tell Client You Don’t

Understand, And Ask For Clarification

• The Very Long Answer— Listen Without Interruption And When They

Stop Ask To Go Over It Point By Point


Cognitive Restructuring

• What’s The Best If Continue A/D Use

• What’s The Worst If Continue A/D Use

• What’s The Worst If Choosing Recovery

• What’s The Best If Choosing Recovery

• What’s The Most Likely If Continue A/D Use


Training ExerciseDyad Role Play

1. Decide Client and Therapist Roles

2. Use Interview Guide And Practice Active Listening

3. Client Role Use Realistic Type Client Responses

4. Giving Feedback To Therapist Role

a. What was effective

b. What was a problem

c. What could have been more effective

Clinical Skills

Training


Session ThreeClinical Process Procedures: Part Two


Relaxation Response Training

• Understanding The Stress Thermometer

• Integrate Thermometer To Life Experiences

• Keep Stress Below Level 7 At All Times

• Set Up Mutual Time Out Signal

• Teach Immediate Relaxation Response


The Stress Thermometer

• Level 1: Deeply Relaxed-Nearly Asleep

• Level 2: Very Relaxed-Not Focused

• Level 3: Relaxed-Not Focused

• Level 4: Becoming Focused And Active

• Level 5: Free Flow Activity Without Effort


The Stress Thermometer

• Level 6: Free Flow Activity With Effort

• Level 7: Space Out

• Level 8: Get Defensive

• Level 9: Overreact

• Level 10: Lose Control


Relaxation Response Methods

• Muscle Stretching, Tensing, Relaxing

• Deep Breathing

• Guided Imagery

• Hypnotic Language— Count Backwards From 10

• Identify Focal Points For Relaxation— i.e., Relax Jaw Or Notice Warmth In Fingers


Feeling Identification

• Strong Or Weak• Angry Or Caring• Happy Or Sad• Safe Or Threatened • Fulfilled Or Frustrated• Proud Or Ashamed• Agitated Or Peaceful• Lonely Or Connected


Feeling Management

• Help Clients Accurately Identify Feelings

• Normalize Feelings

• Evaluate Clients’ Feeling Management Skills

• Teach Clients New Management Skills


Training Exercise

• Small Group Exercise

— What Works Well

— What Are Some Problem Areas

— How Do You Need To Adapt It For Your Clients

• Group Leader Reports

— What Adaptations Did You Develop

Clinical Skills

Training


Session FourClinical Process Procedures: Part Three


Bookmarking Hot Issues

• Goals Of Bookmarking

— Keep Clients Focused On Immediate Issues

— Stop Clients From Prematurely Focusing On Issues That Need To Be Addressed At A Later Point In The Treatment Process


Bookmarking Hot Issues

• Purpose Of Bookmarking— Teach Clients To Identify And Manage High

Risk Situations Without Drinking/Using

— Teach Clients They Must Do This Before They Can Successfully Resolve Other Issues

— Allows Clients To Identify And Clarify Core Issues, Write It Down And Work On It At The Appropriate Time In The Treatment Process


Bookmarking Sequence

• Allow Client To Explain Problem Or Issue

• Use Active Listening To Validate Client

• Write Down Issue On Card Or Paper

• Explain To Client Their Issue Is Important

• Ask Client About Impact Of Alcohol/Drugs

• Refocus Client On Current Task

• Assure Client You Will Return To Issue


Inner Dialog Process

• Used To Clarify Internal Dissonance

• Most People Have An Inner Conflict Between— The Irresponsible Self

— The Responsible Self

• Process Teaches People To Dialog With Both Parts Of Self


Inner Dialog Process

• Steps Of The Inner Dialog Process

— Look For Signs Of An Inner Conflict

— Ask Client “What’s Happening”

— Identify Strength Of Each Inner Position

— Get Client To Identify Both Sides Of Argument

— Ask Client Which Side They Need To Listen To


Training ExerciseDyad Role Play

1. Decide Client and Therapist Roles

2. Use Interview Guide And Practice All Clinical Skills

3. Client Role Use Realistic Type Client Responses

4. Giving Feedback To Therapist Role

a. What was effective

b. What was a problem

c. What could have been more effective


Closure Exercise

1. Small Group Exercise

— A. What Is The Most Important Thing That You Learned Today?

— B. What Are You Going To Do Differently As A Result Of What You Learned?

2. Group Leader Reports— A. Three Most Important Things Learned By

Group?— B. Three Things That Will Be Done Differently?

clinical skills 1 dy 11 15 01

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