North Carolina TASC Clinical Series Training

Module Seven: Clinical Skills

Client-Centered Clinical Work

Client’s Hope and Expectancy 15%

Model and Technique 15%

Therapeutic Relationship 30% Extra Therapeutic Factors 40%

Clinician Attitudes

1. Congruence2. Unconditional Positive Regard3. Empathy

Effective Motivating Counseling SkillsA Giving AdviceB Removing BarriersC Providing ChoiceD Decreasing DesirabilityE Practicing EmpathyF Providing FeedbackG Clarifying GoalsH Actively Helping

Effective Brief Counseling (FRAMES) F FeedbackR ResponsibilityA AdviceM MenuE EmpathyS Self-efficacy

Dysfunctional Motivators • Emotional Distress• Vicarious Coping• Loneliness and Isolation• A Desire for Power• A Need for Love• Vicarious Rebellion

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

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.

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.

Clinical Skills• Confrontation• Empathy• Leading• Reinforcement• Punishment• Rehearsal• Extinction• Environmental

Planning

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

Rapport• Humor

Supportive 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”

• 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 - Nonverbal• 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

Non-helping Behaviors - Verbal• 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

Non-helping Behaviors - Nonverbal• 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

Acronym SOLERS Squarely show interest and

involvement with the clientO Open posture, no crossed

arms and legsL Lean toward the client E Eye contact R Relax