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LCDC Checklist: Eligibility and CI Registration

Applying for registration as a counselor intern (CI) is the first step towards becoming a Licensed Chemical Dependency Counselor (LCDC)

To be eligible for a CI registration, a person must:

(1) be at least 18 years of age…read more Counselor Interns HeadQuaters: LCDC

The First Interview – Addictions Counseling

1.  Goals in a first interview

a.  Allow the client to tell you her/his story in her/his own words

b.  Let the client know that you understand what she/he believes, even when it includes that she/he does not need to be there.

c.   This is not the moment to express that you may disagree with client.

2.  The first interview with the self-referred adult

a.  The client feels the need to explore the possibility of getting therapy.

3.  Prepare yourself  in advance

a.  Has the client been in the therapy before?

b.  Review documentation

    • Medical history
    • Psychiatric evaluation
    • Biopsychosocial assessment
    • Previous clinician’s notes

c.    Ask yourself

    • What don’t I know that I need to know?
    • Write down notes and questions you want to ask before calling the client to set up an appointment
    • Add a healthy dose of skepticism to everything you find out

4.  What to ask your supervisor before the first interview

a.  Any questions you have after reading documents provided on the client

b.  Whom to include in the interview

c.   How long the session should last

d.  How often should you see the client

e.  How to introduce your self

f.    When and how to record sessions

5.  When calling the client, remember that

a.  Your relationship with the client starts right there

b.  How should you introduce yourself to the client

c.   Be professional and concerned

d.  Remember that this is NOT a therapy session

e.  Maintain confidentiality from this moment on

    • Find out if, and under what circumstances, you are required by law not to maintain confidentiality.
    • Except in those circumstances (above), always get written consent from the client to share identifying information to other agencies
    • Telephone calls: remember that even the fact that the individual is a client is confidential information.
    • When necessary use fictious names and situations

6.  The room set up is important

a.  Keep it comfortable and simple

b.  How would YOU feel coming here?

7.  Before you start the interview

a.  Select an assessment instrument, based on

    • Your agency
    • The age of the client
    • Reliable
    • Valid

b.  Explain the assessment process to the client

8.  Ask your supervisor how you should gather information during the session

a.  Taking notes?

b.  Just listening?

c.   Audiotaping?

d.  Videotaping?

e.  Using a computer?

9.  During the interview/session

a.  Start where the client is

b.  Your concern is the client’s feelings

c.   Keep self-disclosure to the minimum

d.  The focus is on the client, not on you

e.  Practice active listening

f.    Do not put words or feelings into your client’s mouth

g.  Ask who, what, when, where, and how

h.  Don’t ask WHY

    • It assumes client knows the answer to his/her problem
    • Client might feel attacked and therefore act defensive
    • They might tell you more than they are ready to share
    • If client tells you more than they meant to, they might never come back

10. Presenting problem

a.  Why is the client here now?

    • Basic data

11. At the end of the session

a.  Leave enough time to ask your client if there are any questions

b.  Ask client if she/he would like to come back

c.   Give the client a card with information about her/his next appointment

d.  Walk your client to the door

e.  Be aware of the door-knob syndrome

    • Client waits to tell you something very important until there is not time left to discuss it
    • You can end the session by saying “That sounds like something we should talk about. Let’s begin with that next week.
    • You NEVER let a client leave your office if you have a sense that she/he might hurt her/himself or others.

Reference: Where to Start and What to Ask – Susan Lukas 

Counselor Developmental Levels

From one of my favorite SAMHSA Publications

TIP 52 – Clinical Supervision and Professional Development of the Substance Abuse Counselor

Each counselor goes through different stages of development. The movement through these stages is not always linear and can be affected by changes in assignment, setting, and population served.

Go to my Downloads page to download this table and TIP 52.

15 Types of Distorted Thinking

Contributor: Yvette McBride Thomas

Thought Distortions

  1. Tunnel vision
  2. Awfulising
  3. Black & White Thinking
  4. Generalization
  5. Assumption
  6. Projection
  7. Negative Thinking
  8. Self-consciousness
  9. Blame
  10. Unfairness
  11. Emotional Reasoning
  12. Manipulation
  13. Shoulds
  14. Got To Be Right
  15. Heaven’s Reward

1. Tunnel vision :

Example: “I expect it’ll be another boring party”.

It is being stuck in a mental groove. In particular you look for that which confirms your fear or prejudice, remember it from the past and expect it in the future. You ignore other points of view or the possibility of alternative solutions.

2. Awfulising :

Example: “I can’t bear going on these awful buses”.

This attitude is saying that it’s unacceptable if things aren’t as you would prefer them to be. You take the negative aspect of a situation and magnify it. To handle this, recognize when you use words like terrible, awful, disgusting, etc. and in particular the phrase “I can’t stand it”. Examine their rationality.

3. Black & White Thinking :

Example: “You’re either for me or against me”.

Things are black or white, wonderful or terrible, a great success or a total failure, brilliantly clever or really stupid, a certainty or a complete mystery, friend or enemy, love or hate – there is no middle ground, no room for improvement, no room for mistakes. judgments on self and others swing from one emotional extreme to another and are easily triggered. It is important to remember that human beings are just too complex to be reduced to dichotomous judgments, and that all qualities fall somewhere along a continuum, containing elements of either extreme.

4. Generalization :

Example: “I’ll never be any good at tennis” (after one poor game).

In this distortion you make a broad, generalized conclusion, often couched in the form of absolute statements, based on a single piece of evidence. If something bad happens once, you expect it to happen over and over again. If someone shows evidence of a negative trait, this is picked up on and exaggerated into a global judgment. This inevitably leads to a more and more restricted life and your view of the world becomes stereotyped. Cue words that indicate you may be over-generalizing are: all, every, none, never, always, everybody and nobody. To become more flexible use words such as: may, sometimes and often, and be particularly sensitive to absolute statements about the future, such as “No one will ever love me”, because they may become self-fulfilling prophecies.

5. Assumption :

Example: “Nothing can change the way I feel”.

Making an assumption, presupposes knowledge that you do not have. Assumptions are often popular beliefs that have been adopted without examining their basis in fact, such as “I’m over the hill now that I’m forty”. Making decisions based on assumptions may lead to disaster, as when an executive assumes that a new product will sell well, having made no market research. Often, taking things for granted causes people to be blind to possible solutions – assuming no-one can help them, a couple’s marriage may go on the rocks, when they could seek counseling. Question: What leads you to believe this? Why do it this way? Who says? What alternatives are there? What would happen if you did? What would happen if you didn’t? As a practical matter, all of us must proceed with the business of living by relying on “maps” of the world which we have taken on trust and which we have not tested and often cannot test. To supplement personal experience, we absorb a constant stream of reports, descriptions, judgments, inferences and assumptions coming from a multitude of sources. From this abundance of stored information, you piece together a mental “model” of the world and its workings that literally becomes your world view. However, people do vary considerably in the extent of their misinformation and in the degree to which they actively seek out new information, take opportunities to correct or update their mental models, and expose themselves to new experiences.

6. Projection :

Example: “I know he doesn’t like me”.

Making false assumptions about what other people think depends on a process called projection. It is like mind-reading – putting words into peoples’ mouths. You imagine that people feel the same way you do and react to things the same way. If you get angry when someone is late, you assume that another will feel the same way about you or others, in that situation. If you don’t like yourself, you assume others also think that way. The answer is not to jump to conclusions about what other people think and feel.

 7. Negative thinking :

Example: “We haven’t seen each other for two days – I think the relationship is falling apart”.

You read a newspaper article about some misfortune and wonder if that could happen to you. Predicting negative consequences is a defense, to protect oneself from disappointment by expecting the worst. Consider, what are the realistic odds of that happening?

8. Self-consciousness :

Example: “Quite a few people here seem smarter than I am”.

This is the introverted tendency to relate everything around you to yourself, to think people must be judging you, or to think that everything they do or say is a reaction to something about you. It is the habit of continually comparing yourself to other people, based on the underlying assumption is that your worth is questionable. You are therefore continually forced to test your value as a person by measuring yourself against others. If you come out better you have a moment’s relief; if you come up short, you feel diminished. Your worth doesn’t depend on being better than others, so why start the comparison gamble?

9. Blame :

Example: “It’s your fault we’re in debt”.

If you see yourself as externally controlled, you see yourself as helpless, a victim of fate or “the system”. You don’t believe you can really affect the basic shape of your life, let alone make any difference in the world, so you try and manipulate others to take care of your interests. Someone else is to blame and is responsible for your pain, your loss, your failure. The truth is that we are constantly making decisions and every decision affects and steers our lives. It is your responsibility to assert your needs, to say no or go elsewhere for what you want. In some way we are responsible for nearly everything that happens to us, including our distress and unhappiness. Taking responsibility means accepting the consequences of your own choices. Ask yourself: What choices have I made that resulted in this situation? What decisions can I now make to change it? The opposite distortion is also very common – the fallacy that makes you responsible for the pain or happiness of everyone around you. You carry the world on your shoulders. You have to right all wrongs, fill every need and balm each hurt; if you don’t you feel guilty and turn the blame on yourself. Blaming yourself means labeling yourself inadequate if things go wrong. With this viewpoint you are very easily manipulated. The key to overcoming this fallacy is to recognize that each person is responsible for himself – taking responsibility doesn’t imply that you are also responsible for what happens to others. Remember, part of respecting others includes respecting their ability to overcome or accept their own pains, make their own decisions and be in control of their own lives.

10. Unfairness :

Example: “It’s not fair, he should take me out more often”.

The consideration of unfairness results from resentment that the other person does not want or prefer the same as you, or that events do not turn out in your favour. The person gets locked into his or her own point of view, with a feeling of ever-growing resentment. Be honest with yourself and the other person. Say what you want or prefer, without getting involved in the fallacy of unfairness: that people and situations shouldn’t be the way they are.

11. Emotional reasoning :

Example: “I feel depressed, life must be pointless”.

You believe that what you feel must be true – automatically. If you feel stupid then you must lack intelligence. If you feel guilty then you must have done something wrong. If you feel angry, someone must have taken advantage of you. However, there is nothing automatically true about what you feel – your feelings can lie to you, they can be based on misconceptions. If your feelings are based on distorted thoughts, then they won’t have any validity. So be skeptical about your feelings and examine them as you would a used car.

12. Manipulation :

Example: “If we had sex more often, I’d be more affectionate”.

The only person you can really control or have much hope of changing is yourself. When you pressure people to change, you are forcing them to be different for your own benefit. Strategies for manipulating others include blaming, demanding, withholding and trading – in order to make the other feel obliged. The usual result is that the other person feels attacked or pushed around and resists changing at all, or feels resentful if they do. The underlying fallacy of this thinking style is that your happiness depends on controlling the behavior of others. In fact your happiness depends on the many thousands of large and small decisions you make during your life.

13. Shoulds :

Example: “You should never ask people personal questions”.

In this distortion, you operate from a list of inflexible rules about how you and other people should act. The rules are right and indisputable. Any particular deviation from your particular values or standards is bad. As a result you are often in the position of judging and finding fault. People irritate you, they don’t act properly or think correctly. They have unacceptable traits, habits and opinions that make them hard to tolerate. They should know the rules and they should follow them. Of course, the answer is to focus on each person’s uniqueness: his or her particular needs, limitations, fears and pleasures, and consequently different values. Personal values are just that – personal. You are also making yourself suffer with shoulds, oughts and musts (or their negatives). You feel compelled to do something or be a certain way and feel guilty if you don’t, but you never bother to ask objectively if it really makes sense. Some people beat themselves up constantly for being incompetent, insensitive, stupid, too emotional, etc. They are always ready to be wrong. The psychiatrist Karen Horney called this the “tyranny of the shoulds”.

14. Got to be right :

Example: “I’ve been doing this longer than you, so I know what I’m talking about”.

In this very common distortion you are usually on the defensive, needing to prove to yourself and others that your views, assumptions and actions are all correct. You never make mistakes! If you’ve got to be right, you don’t listen. You can’t afford to – listening might reveal that you are wrong sometimes. Your opinions rarely change because if the facts don’t fit what you already believe you ignore them. This makes you lonely, because being right seems more important than an honest, caring relationship. The key to overcoming being right, is active listening – making sure you really understand what’s been said to you, to appreciate the other’s point of view and what you can learn from it, which is effort better spent than in devising rebuttals and attacks. Remember that other people believe what they are saying as strongly as you do, and there is not always just the one right answer.

15. Heaven’s reward :

Example: “I worked and raised these kids and look what thanks I get”.

This distorted thinking style accepts pain and unhappiness because “those who do good are rewarded in the end”. You expect all your sacrifice and self-denial to pay off, as if there was someone keeping score. You feel hostile and bitter when the reward doesn’t come. In reality the reward is now. Your relationship, your progress toward your goals, and the care you give to those you love, should be intrinsically rewarding. If not, you need to rearrange your activities to provide some here-and-now reward, dropping or sharing the activities that chronically drain you – Heaven is a long way off and you can get very tired waiting.

Rationalizations

The best way to practice identifying Thought Distortions in everyday life is to take particular notice of one of the distortions for one day, and notice whenever it is used – by others or by yourself! Frequently, several Distortions are combined in a statement, or a statement fits into several categories of Distortion. These are commonly rationalizations – i.e. seemingly plausible explanations, excuses or justifications, which in fact are ignoring or fudging the real issue. For example. “I don’t need to work hard on this job because no one else will,” is an assumption, a generalization, negative thinking, tunnel vision, projection, and so on.

Unclear Thinking

Without us being aware of it, the way we usually think serves to riddle our minds with inconsistencies and irrationalities. This unclear thinking then leads to the Thought Distortions listed above. This occurs because language is a representation of human experience and not the experience itself. Language is an abstraction and in many cases a person will delete, distort or generalize in his verbal thoughts or statements about the actual experience. We can’t speak all of the meaning underlying our thoughts or every statement would be too long and pedantic but there is a danger in simplifying our thoughts too much. This is usually done to avoid confronting the whole truth about a situation. A situation can be seen as final and fixed rather than ongoing and changeable, so that responsibility is avoided and nothing can be done about it. For example:

I’m angry“. About whom? About what?

That’s not right“. What specifically is not right?

I realize I’m stupid“. How specifically do you realize you’re stupid?

I want love“. Who do you want loving from?

Nobody loves me“. Who specifically does not love you?

I have to clean the house before my husband gets home“. What would happen if you didn’t?

It’s impossible to talk to my boss“. What stops you?

My wife makes me angry“. How specifically does your wife make you angry?

I handled that meeting badly“. Badly compared with what?

I know he dislikes me“. How do you know he dislikes you?

It’s wrong to love two people at the same time“. It’s wrong for whom to love two people at the same time?

“I have a bad memory“. What do you have trouble memorizing and how do you go about it?

I can’t relax“. What prevents you? What would happen if you did?

I can’t cry“. Is that can’t or won’t?

“Without us being aware of it, the way we usually think serves to riddle our minds with inconsistencies and irrationalities.” The idea is to shift one’s state of being to at least acknowledge the possibility of choice, and to revise one’s fixed ideas. This is not to say one should question one’s every word, but if you find yourself feeling dissatisfied, look out for what you are deleting, distorting or generalizing about your experience, and how are you reducing your choices.

Each day, take one of the above Thought Distortions and spot when you find yourself or a person you are talking to using the Distortion. Also note on TV when this occurs. Just recognizing it as such – i.e. that it is an irrational thought – will enable you to be free of the Distortion or will enable you to better understand your fellow man.

8. Professional and Ethical Responsibilities

Professional and ethical responsibilities are the obligations of an addiction counselor to adopt ethical and behavioral standards of conduct and continuing professional development. Our competencies in this area, are:

1. To adhere to established professional codes of ethics that define the professional context within which the counselor works to maintain professional standards and protect the client.

Knowledge, skills, and attitudes:

  • Federal, State, agency, and professional codes of ethics.
  • Clients’ rights and responsibilities.
  • Professional standards and scope of practice.
  • Boundary issues between client and counselor.
  • Difference between the role of the professional counselor and that of a peer
  • counselor or sponsor.
  • Consequences of violating codes of ethics.
  • Means for addressing alleged ethical violations.
  • Nondiscriminatory practices.
  • Mandatory reporting requirements.
  • Openness to changing personal behaviors and attitudes that may conflict with ethical guidelines.
  • Willingness to participate in self, peer, and supervisory assessment of clinical skills and practice.
  • Respect for professional standards.

2. To adhere to Federal and State laws and agency regulations regarding the treatment of substance use disorders.

Knowledge, skills, and attitudes:

  • Federal, State, and agency regulations that apply to addiction counseling.
  • Confidentiality rules and regulations.
  • Clients’ rights and responsibilities.
  • Legal ramifications of noncompliance with confidentiality rules and regulations.
  • Legal ramifications of violating clients’ rights.
  • Grievance processes.

3. To interpret and apply information from current counseling and psychoactive substance use research literature to improve client care and enhance professional growth.

Knowledge, skills, and attitudes:

  • Professional literature on substance use disorders.
  • Information on current trends in addiction and related fields.
  • Professional associations.
  • Resources to promote professional growth and competency.
  • Read and interpret current professional and research-based literature.
  • Apply professional knowledge to client-specific situations.
  • Apply research findings to clinical practice.
  • Apply new skills in clinically appropriate ways.
  • Commitment to life-long learning and professional growth and development.
  • Willingness to adjust clinical practice to reflect advances in the field.

4. To recognize the importance of individual differences that influence client behavior, and apply this understanding to clinical practice.

Knowledge, skills, and attitudes:

  • Differences found in diverse populations.
  • How individual differences affect assessment and response to treatment.
  • Personality, culture, lifestyle, and other factors influencing client behavior.
  • Culturally sensitive counseling methods.
  • Dynamics of family systems in diverse cultures and lifestyles.
  • Client advocacy needs specific to diverse cultures and lifestyles.
  • Signs, symptoms, and patterns of violence against persons.
  • Risk factors that relate to potential harm to self or others.
  • Hierarchy of needs and motivation.
  • Assess and interpret culturally specific client behaviors and lifestyles.
  • Convey respect for cultural and lifestyle diversity in the therapeutic process.
  • Adapt therapeutic strategies to client needs.
  • Willingness to appreciate the life experiences of individuals.
  • Appreciation for diverse populations and lifestyles.
  • Recognition of one’s biases toward other cultures and lifestyles.

5. To use a range of supervisory options to process personal feelings and concerns about clients.

Knowledge, skills, and attitudes:

  • The role of supervision.
  • Models of supervision.
  • Potential barriers in the counselor–client relationship.
  • Transference and countertransference.
  • Resources for exploration of professional concerns.
  • Problem-solving methods.
  • Conflict resolution.
  • The process and effect of client reassignment.
  • The process and effect of termination of the counseling relationship.
  • Phases of treatment and client responses.
  • Willingness to accept feedback.
  • Acceptance of responsibility for personal and professional growth.
  • Awareness that one’s personal recovery issues have an effect on job performance and interactions with clients.

6. To conduct self-evaluations of professional performance applying ethical, legal, and professional standards to enhance self-awareness and performance.

Knowledge, skills, and attitudes:

  • Personal and professional strengths and limitations.
  • Legal, ethical, and professional standards affecting addiction counseling.
  • Consequences of failure to comply with professional standards.
  • Self-evaluation methods.
  • Regulatory guidelines and restrictions.

7. To develop and use strategies to maintain one’s physical and mental health.

Knowledge, skills, and attitudes;

  • Rationale for periodic self-assessment regarding physical health, mental health, and recovery from substance use disorders.
  • Available resources for maintaining physical health, mental health, and recovery from substance use disorders.
  • Consequences of failing to maintain physical health, mental health, and recovery from substance use disorders.
  • Relationship between physical health and mental health.
  • Health promotion strategies.
  • Carry out regular self-assessment with regard to physical health, mental health, and recovery from substance use disorders.
  • Use prevention measures to guard against burnout.
  • Employ stress-reduction strategies.
  • Locate and access resources to achieve physical health, mental health, and recovery from substance use disorders.
  • Model self-care as an effective treatment tool.
  • Recognition that counselors serve as role models.
  • Appreciation that maintaining a healthy lifestyle enhances the counselor’s effectiveness.

TAP 21

Professional Readiness

Professional readiness is an ongoing process. It should not be understood as something you get done one time and you don’t look at it again. Professional readiness is directly linked to continuing education.

Understanding Diverse Cultures

A competent substance abuse counselor  is constantly learning about:

  • Information and resources in regards to diverse cultures, lifestyles, gender and age.
  • Information and resources to provide quality care to people with special needs and disabilities.
  • How culture, lifestyle, gender, etc. influence behavior.
  • How culture, lifestyle, and values influence substance use.
  • Assessment and intervention methods that are appropriate to culture and gender.
  • Counseling methods that match the needs of people from multicultural backgrounds, and people with disabilities.
  • Legislation related to human, civil, and client’s rights.

Self-awareness is Important

If we want to become competent substance abuse counselors, we must be open to evaluation, supervision, and change. In order to grow both personally and professionally, we need to:

  • Be aware of our personal and professional strengths and limitations.
  • Be aware of cultural, ethnic, and gender biases.
  • Look for resources available for continuing education.
  • Make a commitment to continuing professional education.
  • Know the benefits of self-assessment, clinical supervision, and consultation with other professionals.
  • Find ways to enhance our personal and professional growth.

Substance Abuse Prevention

Addictions professionals are not only involved with treatment and recovery. We also have the obligation to participate in prevention programs.

Substance abuse treatment and substance abuse prevention are two different fields. Research shows that for every dollar spent on prevention, 7 to 18 dollars are saved on treatment and recovery.

What we need to learn about substance abuse prevention includes:

  • Research-based prevention models and strategies.
  • The relationship between prevention and treatment.
  • Environmental strategies and prevention campaigns.
  • Benefits of working with community coalitions.

I recommend this book Substance Abuse Prevention: The Intersection of Science and Practice, by Julie Hogan et al. I am currently reading this book for my class on substance abuse prevention.

Setting-specific Policies and Procedures

It is our responsibility to learn, understand, and apply our agency’s (the place in which we are currently working) policies and procedures to handle crisis and dangerous situations, such as safety measures for clients and self.

TAP 21

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