North Carolina TASC Clinical Series Training

North Carolina TASC Clinical Series Training

Module Seven: Clinical Skills

Client-Centered Clinical

Work Client-Centered Clinical

Work Client’s Hope and Expectancy

15%Model and Technique 15%

Therapeutic Relationship 30% Extra Therapeutic Factors 40%

Clinician AttitudesClinician Attitudes

1. Congruence

2. Unconditional Positive Regard

3. Empathy

1. Congruence

2. Unconditional Positive Regard

3. Empathy

Effective Motivating Counseling SkillsEffective 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) 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 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 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 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.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 SkillsClinical 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

• Modeling• Termination• Reframing• Self Disclosure• Contracting• Establishing

Rapport• Humor

Supportive Helping Behaviors - VerbalSupportive 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

• 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 - NonverbalSupportive 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

• Occasional hand gesturing

• Close physical proximity to client

• Moderate rate of speech

• Body leans toward client

• Occasional touching

Non-helping Behaviors - VerbalNon-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

• Over-interpreting

• Using words s/he doesn’t understand

• Straying from topic

• Intellectualizing

• Overanalyzing

• Talking about self too much

Non-helping Behaviors - NonverbalNon-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

• Shaking pointed finger

• Distracting gestures

• Yawning

• Closing eyes

• Unpleasant tone of voice

• Rate of speech too slow or too fast

Acronym SOLERAcronym SOLERS 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