1. Module 5A Introduction Strategies for Working with Clients with Co-Occurring Disorders: Guidelines for a Successful Therapeutic Alliance

2. 12 Step Assessment Process 1. Engage the client 2. Identify & contact collaterals to gather additional information 3. Screen for & detect COD 4. Determine quadrant & locus of responsibility 5. Determine level of care 6. Determine diagnosis 7. Determine disability & functional impairment 8. Identify strengths & supports 9. Identify cultural & linguistic needs & supports 10. Identify problem domains 11. Determine stage of change 12. Plan treatment

3. In This Module . . . • Module 5A • Review guidelines for maintaining a successful therapeutic relationship with a client who has COD • Module 5B • Examine techniques for working with clients with COD

4. TIP Exercise—Advice to the Counselor With your partner(s): 1. Imagine you are a person with COD receiving services. 2. Review your assigned Advice to the Counselor text box. 3. Which two (2) recommendations would you most want your provider to follow? Why? (8 minutes)

5. TIP Exercise—Report Out • State the Guideline you examined. • Read aloud all of the recommendations. • State which two (2) your group chose. • Give reasons for your group’s choice and summarize any discussion that took place. (2 minutes)

6. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support

7. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support

8. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support

9. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support

10. Potential for Harm • Ask explicitly about suicide or the intention to do harm to someone else when the client assessment indicates that either is an issue. • Monitor clients who express such thoughts closely. • Ask about suicidal thoughts and plans as a routine part of every session with a suicidal or depressed person. • Immediately follow up appointments missed by an acutely suicidal person. • Review discussion of suicidality in Chapter 8 and in Appendix D of TIP 42.

11. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support

12. Confrontation “The heart of confrontation is not the aggressive breaking down of the client and his or her defenses, but feedback on behavior and the compelling appeal to the client for personal honesty, truthfulness in interacting with others, and responsible behavior.” TIP 42, p. 110

13. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support

14. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support