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The second factor is that the qualities needed in these counseling relationships are not unlike those required for most helping relationships. Lewis et al. (1988) noted that empathy, genuineness, warmth, and immediacy must be paired with effective helping skills, such as questioning, confronting, self-disclosing, clarifying, and other skills common to the counseling process. Although these qualities and skills are identical to those expected in other types of helping relationships, their use must be tailored to the unique needs of the chemically dependent client.
The abusing client is characterized by various social and psychological factors that "differentially predict initiation of different kinds and levels of drug use" (Marlatt & Baer, 1988, p. 229). Frequently, abusers who are affected by external events, such as the loss of a loved one to drugs, will attempt to change and may make a successful internal commitment to stop the destructive behavior. Those who are unsuccessful with self-change commitments continue their abusive behaviors or seek assistance from counselors and other professional helpers.
No definitive treatment research has shown which strategies and approaches are most successful. Marlatt and Baer (1988) indicated that many of the treatment modes chosen by counselors are inconsistent with current research findings. To some extent, procedures that match treatments with clients show promise, but much more research is needed. Counselors and other professionals need to keep up with the current thinking and most recent information in this area.
Relapse prevention and after-care monitoring, as noted in an earlier section of this article, are essential components of treatment for substance abuse (Daley, 1987; Marlatt & Gordon, 1985). Marlatt and others (Daley, 1987; Marlatt, 1988; Marlatt & Baer, 1988; Marlatt & Gordon, 1985) have identified specific intervention strategies to prevent relapse, including self-monitoring, imagery, relaxation training, skill development, and cognitive restructuring. Effective use of these approaches is possible when counselors and agencies design cooperative and flexible services that offer education, training, and support for clients, their families, and the institutions that will interact with this clientele.
Cohen (1985) proposed that prevention services complete the range of treatment alternatives, particularly in terms of what is available in school settings. As noted earlier, he suggested that prevention includes peer assistance programs with student helpers trained and supervised by counselors. This belief that prevention is a vital approach to treatment is echoed by the Tennyson Center in its Student Assistance Guide for Chemical Dependency (1987). This guide states that procedures for supporting teens who are being treated for chemical dependency may be more important than any other direct interventions. Modifying academic expectations, educating the school staff about chemical dependency, respecting student confidences, and becoming familiar with community programs are a few supportive measures that schools can take to help students who are receiving direct treatment for substance abuse.
The Student Assistance Program (SAP) model, developed in Westchester County, NY, evolved from the employee assistance model used in business and industry. According to Milgram (1989), a SAP has six functions:
Organization of SAPs varies from program to program and can be coordinated by a part-time or full-time school counselor, another educator in the school who is assigned to SAP during certain periods of the day, or by a team consisting of a counselor, principal, nurse, teachers, and others. Some schools contract with community agencies who assign their counselors to the school on a regular schedule to facilitate the program (Milgram, 1989). Referrals to the SAP can come from the individual experiencing the problem, another student, or an adult who has observed a need.
Caudill, Kantor, and Ungerleider (1990) reported on another school intervention program called Project Impact. This program is based on a social learning-community intervention model that includes a wide range of professionals and resources to help school administrators deal effectively with drug use. In addition to social learning and other interventions with at-risk students, Project Impact establishes a "core team" of school personnel to deal with future substance abuse issues. Caudill et al. (1990) surveyed high school principals in five states and six school districts who had implemented Project Impact, and their results showed that administrators perceived the program as a highly effective intervention with at-risk students and as a preventive approach to use at the high school level.
SAPs and other approaches in which schools cooperate with agency counselors and community professionals incorporate ingredients that all counselors should include in substance abuse prevention and intervention services. Clear policies and procedures are essential as are the assessment, intervention, and support for the student during and after participation in the program.
Reflection Exercise #2