Crisis is a state of emotional imbalance and in an inability to cope. This short video takes a closer look at the nature of crisis and what it entails. Please also review AIHCP’s Crisis Intervention Specialist Certification and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification.
Substance Abuse Counseling
The Role of Mental Health in Youth Rehab
Written by Mark San Juan
Can you even imagine a teenager, who is actually a child, locked away in a detention center, struggling with not just the mistake they made, but also the emotional scars they carry? It’s a tragic picture, but it’s the reality of so many of these young people that face a lot more than just legal battles. They fight against trauma, anxiety, and issues with mental health that might have even caused them to be there in the first place.
Sometimes, we think of mental health care as a bonus, especially in rehabilitation, but it’s not a perk; it’s an essential part of the process. If you don’t address the deeper issues, then what chance do these young offenders have of breaking the cycle and being a valuable part of society? Slim to none, that’s what. Current statistical analysis data supports this and reveals the scale of the issue.
The Office of Juvenile Justice and Delinquency Prevention (OJJDP) has reported that more than 70% of youth in the juvenile justice system experience some form of mental disorder. But only approx. 15% of them receive appropriate/effective treatment.
Youth detention centers absolutely must focus on mental health because it’s the way to heal the offenders and to give them a chance to take control of their future – outside the bars.
2 Reasons Why Mental Health Support Is So Important in Juvenile Rehabilitation
Taking care of mental health is important for everyone, even if you live a normal life, but it’s especially important for those that are vulnerable, like the young people in detention centers.
The Illinois Juvenile Court Act of 1987 (statute) outlines procedures for how to handle juvenile cases, and emphasizes rehabilitation over punishment while mandating consideration of a minor’s mental health needs.
Furthermore, Public Act 102-0193 (signed into law in 2021) amends the Juvenile Court Act to enhance court reviews and oversight. This act has the aim of improving outcomes for minors (especially those with mental health concerns/issues).
If issues with mental health are handled on time, then there’s less chance of future offenses and young offenders have a foundation for a healthier life.
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Common Mental Health Issues in Youth Detention
Anxiety and Depression
These are the most common issues and they’re often the consequence of trauma they’ve experienced in the past, being uncertain about their future, and the stress of being in a detention facility.
If they’re not treated, these conditions can result in withdrawal, aggression, and negative behaviors in the future.
Trauma and PTSD
A lot of people in youth detention centers have experienced abuse, violence, and neglect. This can lead to PTSDs, which manifests in flashbacks, serious anxiety, and not being able to trust others.
Anyone in this situation, whether they’re in jail, detention center, or free, has to get help through therapy to work through the trauma and start to heal.
Behavioral Disorders
Conditions like ADHD and ODD (oppositional defiant disorder) can worsen in environments like youth detention centers and as a result, you get conflicts with the staff and other detainees.
Proper mental health support can help with managing these conditions and provide young people with healthier coping mechanisms.
Substance Abuse
Approximately 50% of detained youth have a history of drug/alcohol use. These addictions/dependencies are often masking deeper underlying mental health issues and require specialized treatment approaches to address both the addiction and what’s underneath.
Based on the report by the Substance Abuse and Mental Health Services Administration (SAMHSA), facilities that have adopted trauma-informed practices have reported a 25% reduction in recidivism rates.
Ignoring substance abuse can worsen the youth’s chances of successfully integrating back into society, and is increasing the risk of recidivism.
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What Happens When Mental Health Issues Go Untreated
Increased Risk of Recidivism
With no mental health support, young offenders are far more likely to commit a crime again, and the way to break this cycle is to address the underlying mental health issues.
In fact, According to Mental Health America, youth with untreated mental health issues are far more likely to re-offend. While the data varies from region to region, it still supports this data point.
Let’s take a look at some worldwide data:
| Region | Recidivism Rate (%) | Access to Mental Health Treatment (%) | Impact of Treatment on Recidivism Reduction (%) |
| United States | 60 | 40 | 25 |
| Canada | 50 | 50 | 30 |
| Europe | 35 | 70 | 40 |
| Asia | 50 | 30 | 15 |
| Africa | 70 | 20 | 10 |
| Australia | 40 | 65 | 35 |
If you take Europe and Africa as an example, you can see a correlation between the rate of reoffending and access to mental health treatment. The data shows that high access to mental health treatment results in a low recidivism rate, and vice-versa.
Of course, other factors (e.g., socio-economic status, exposure to violence/trauma, substance abuse, availability of community resources, family structure, education, etc.) could also be contributing to this, but it goes to show how treatment (or the lack of) can affect reoffending rates at a significant rate.
This way, these young people can develop skills to make better decisions and to control themselves.
Challenges with Rejoining the Society
Untreated mental health issues make life hard in general, but when you have an offender, they’ll also struggle with reintegrating into society, relationships, education, and getting a decent job.
Rehabilitation programs that are actually effective and not just a formality can improve their chances of being a functioning member of the community.
Effects on Relationships with Family and Community
When you deal with mental health issues, you’re not the only one affected; the people around you go through it, too.
If the issues aren’t treated, then the relationships with everyone suffer, and reintegration becomes much more difficult.
(Long-Term) Benefits of Mental Health Support
Today, mental health is being recognized and prioritized in youth rehabilitation at a much larger rate than in the past. And beyond simply helping the youth in question, the correct treatment can have a positive ripple effect on others, as well.
For example, their families, their friends, communities, and society as a whole.
Reduced Crime Rate
As we can see from the table above, effective mental health programs reduce recidivism rates. In the U.S., about a quarter of (future) offenders are being steered off their paths, and are being reintegrated into society.
And that is a good thing. Both for the youth that’s been rehabilitated, so that they can have better lives (outside of detention or correctional facilities), plus there’s also the benefit for the whole society, as they won’t need to experience crime that would’ve otherwise happened.
Community Integration
Rehabilitated youths who’ve received mental health support are more likely to contribute towards their communities (e.g., education, employment, etc.).
Breaking Generational Cycles
When you address mental health issues and correct them, especially in young offenders, you’re helping break cycles of trauma that (possibly) were occurring in preceding generations, but more importantly, pave a brighter future for the next generation.
Legal Support and Advocacy for Survivors of Abuse
There are cases that need more than just mental health support; those that are the most vulnerable and that have suffered abuse. Along with therapists, they need legal representatives to find justice and hold those responsible accountable.
Here’s a deeper dive into this.
Seeking Justice and Accountability
Legal professionals can get justice for detained youth who have gone through abuse.
For example, a youth detention center sexual abuse lawyer can represent these young people and take legal action against those that are responsible. This legal process will hold the guilty party accountable, but it will also help with survivors’ healing because it will show them that they are heard and protected.
Creating Safe Spaces for Disclosure (to Speak Up)
Support also means creating an environment where people feel safe to talk about their experiences.
In 2020, a survey by the PREA Resource Center revealed that juvenile facilities across the U.S. that established confidential reporting systems, saw a 50% increase in abuse disclosures.
Legal representation is here to protect their rights so they can openly share their stories and start to heal.
Working Together for Recovery
Therapists and attorneys can join forces to support the people in juvenile detention centers. Therapy and legal representation can address trauma and also give directions on rights and options.
The Juvenile Justice and Delinquency Prevention Act (JJDPA) is a Federal Law (established in 1974) that mandates that standards are being enforced for the treatment of juveniles in the U.S. justice system.
This approach makes rehabilitation much more effective and compassionate.
Conclusion
A youth detention center doesn’t hold just young offenders, but also stories of trauma, survival, and hope for change. It’s supposed to be a rehabilitation institution, so the key is to look past the offenders’ mistakes and focus on helping them heal and grow. This can’t happen without addressing mental health issues and for those who have gone through extreme trauma, competent legal representation.
We should all keep in mind that true rehabilitation isn’t serving time but giving people a way to take control of their future and make changes.
And such institutions, with their access to mental health treatments (therapy, support), can surely be life-changing.
Author’s Bio
Mark San Juan is a distinguished author and health care professional with a passion for transforming health care delivery through innovative approaches. With over two decades of experience in the field, Mark has established himself as a leading voice in health care reform and patient-centered care.
Please also review AIHCP’s Substance Abuse Practitioner Certification programs and see if it meets your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
Suicide and Crisis of Lethality
Crisis Intervention specialists deal with an array of issues. Usually issues of self harm, harm of others and suicide are a very common theme. In crisis, logical thinking and hope are erased and the person can sometimes do things out of character that are very lethal in nature. Understanding suicide, suicide assessment, prevention and intervention are key components of helping individuals in crisis not make a permanent and fateful decision.
It is critical for crisis counselors, grief counselors, pastoral care givers and ministry, licensed mental health professionals, as well as those in healthcare to have a strong training and educational background in suicide and crises of lethality. AIHCP offers certifications in Grief Counseling but also in Crisis Intervention to help train members in those fields with the additional knowledge and abilities to handle crisis of lethality.
Suicide
While in the past, AIHCP has offered blogs, as well as video content on the nature of suicide, this particular blog will focus on the crisis element of it. It will identify suicidal signs, assessments, but also focus on intervention in particular.
James points out that a person in suicidal crisis is engaged in an expressive act of homicide where emotional state looks to reduce psychological pain (2017, p. 203). According to statistics, James point out that 600, 000 to 100, 000 suicides are attempted each year in the United States and 30, 000 to 60, 000 die each year in those attempts, with 19, 000 permanently injured (2017, p. 204). While different groups within the US have different rates of suicide as compared to others, the leading group is older white males.
Theories surrounding suicide share many common features but also have different emphasis on certain reasons why one attempts to kill oneself. Freud’s psychodynamic theories saw suicide as a reaction of some inner conflict with external stressors (James, 2017, p. 206). Erickson saw reasons for suicide correlated with developmental issues that prevented the person from advancing and reaching certain goals in life. Individuals who become stagnant and unable to develop sometimes choose suicide as an option to escape (James, 2017, p. 206). Escapist theory views suicide as the only way out of a bad situation during fight or flight. Within this theory, individuals feel they fell short, blame themselves, focus on narrow deficits only, and only see a view of perfectionism that if not met can only end in suicide due to the hopelessness perceived (James, 2017, p. 206). Hopelessness remains a common theme in all situations where the person feels they have no power over the situation.
Another important theory was developed by Edwin Shneidman, the founder of suicidology. In understanding suicide he measured one’s psycheache or pain in the mind, one’s perturbation or the degree of the pain, and the press or stress due to external factors (James, 2017, p. 206), With the combination of these things, Shneidman saw how psycheache frustrates or blocks psychological needs leading to hopelessness and suicide and reaching the state of critical mass to activate suicide.
Durkeim in the 19th Century proposed the sociological theory which looks at a person’s connections to society and how social norms and society based on a person’s integration with those norms plays a large role. Egoistical suicide refers to one’s lack integration with any group. Anomic suicide refers to when economic and financial systems of society break down all around the person. Altruistic suicide refers when a person commits suicide for cultural reasons or the perceived better good according to the society. Fatalistic suicide refers to if a person is an intolerable or unescapable situation such a concentration camp (James, 2017, p. 207). According to Van Orden interpersonal states are also key in the mind of those contemplating suicide. Suicidal individuals may acquire capability by decreasing innate fear of pain and death gradually. In their personal views, they perceive themselves as burdensome to others as well as failing to belong to anyone or find attachment to anything (James, 2017. p. 207). Existentialism and meaning also play an important role in suicide theory. Ideas on death, existential isolation, meaning and meaningless in making sense of the world and the freedom of existentialist thought to make choices all play a role in the construction of existentialist thought. When challenges to existence and death are overwhelmed and an existentialist anchor is lost, then many individuals can fall into hopelessness without any reason to exist (James, 2017, p. 208).
Another interesting theory follows a basic suicide trajectory model based on various risk factors that correlate with suicide. This includes, biological, substance abuse history, genetic predispositions, gender, self esteem, psychological maladies, cognitive thinking and environmental stressors (James, 2017, p. 207). Psychology also points to imbalances within the brain, neurochemical reactions that do not allow a person to better respond to a situation (James, 2017, 208).
From these theories and multiple other ones, one has a better understanding that suicide is rarely a free choice but is committed in a state of emotional turmoil without true cognitive reasoning. This is why so many religious views on suicide as a choice or sin have been replaced with a better recognition that most if not all are victims of it.
Characteristics of Suicidal Individuals
For the most part, those thinking of suicide exist in an acute state of crisis or a chronic state of depression that leads to certain characteristics that manifest emotionally, socially, mentally and physically.
Situationally, individuals face an endurable pain they cannot overcome. A stressor frustrates the psychological need (James, 2017, p. 209). Hence situations involving trauma, death, loss, finances, relationship or anything that creates a perceived unbearable loss appears. Motivation wise, individuals look to seek a solution and that solution entails to remove the stressor via cessation of consciousness. Accompanied with this are the affective emotions of hopelessness and helplessness. Cognitively, individuals see solutions in a very narrow scope with out any alternatives to think their way out of the situation. Relationally, an individual wishes to communicate intent and find mutual justification in it and acknowledgement of that right to do so. Serially, characteristics reveal a long history of trying everything else but no other option remains (James, 2017,p. 209).
Within these characteristics of the suicidal mind, it important to dismiss certain myths that distort. First, one needs to dismiss fears of discussing suicide as if it will cause it. In fact, discussing suicide and being very upfront is key. Second, one needs to dismiss the notion that those who say they will commit suicide rarely carry through with it. In fact, many who say they are contemplating are very high risk of attempting it. To the individual suicide is perceived as a very rational act. Third, individuals who commit suicide are insane. Most who commit or attempt suicide are only acutely affected with emotional issues. Fourth, suicide is only impulsive. In fact, most suicides are planned and plotted outside acute crisis. Fifth, suicide is painless. Many suicides can be very gruesome and some go awry and very wrong. Sixth, suicidal thoughts are rare. In fact, they are more common than one may think with 8.3 million have some type of suicidal ideation (James, 2017. p. 212).
Suicide Assessment is Key
Assessment is critical in saving a life. While some crisis specialists deal with suicidal individuals in an acute and heated moment, many suicides are well planned and plotted. Counselors need to be aware of the possibility and assess the lethality
James points out that there are a variety of verbal clues, statements and written letters. As well as behavioral clues such as self harm or isolation. Also situational clues that involve death of another person, financial woes, loss job, or divorce should be acknowledged. In addition, syndromatic clues such as depression, hopelessness and unhappiness with life can play key indicators in possible suicidal. This is why it is so important to also ask someone in assessment (2017, p. 212).
Another tool to utilize is PATHWARM. This is an acronym from the American Association of Suicidology. It utilizes the letter within the acronym to better identify various warning signs. Within the acronym is: Ideation, Substance Abuse, Purposefulness, Anxiety, Trapped, Hopelessness, Withdraw, Anger, Recklessness and Mood.
There are many, many assessment keys, questions, or triages one can utilize. We will briefly go over a select few.
First, the basic clinical interview is essential in determining suicidal ideation. Within it is a long laundry list of observations and questions. Here are a few: Does the person exhibit suicidal intent or tendencies? Does the person have a family history of suicide? Does the person have past suicide attempts? Does the person have a specific plan? Has the person experienced a death recently? Does the person have a history of drugs and substance abuse? Does the person display radical changes in mood and behavior? Does the person display hopelessness? Has the person experienced past trauma? Has the person discontinued medication? Does the person exhibit extreme emotions? Has the person faced financial troubles or loss of job? Does the person feel threatened? Does the person see everything as all or nothing? Does the person feel as if he or she does not belong? Does the person struggle with identity and self esteem? Does the person have access to firearms? Has the person explored suicide through online search or literature? Has the person not seen a medical professional within the last 3 to 6 months? (James, 2017, p. 215).
SIMPLE STEPS is another acronym that can utilized in assessment during interview. Again it emphasizes the importance of asking the question are you thinking of killing oneself? Within the acronym are the following points. Suicidal? Ideation? Method? Pain? Loss? Earlier attempts? Substance abuse? Troubleshooting for alternatives? Emotions? Parental history? Stressors? (James, 2017, p. 216-17). This triage captures the basic essence again of all assessment in that it asks the difficult question and looks to identify potential lethality and danger of a plan. Not all cases may present an immediate acute threat while others may require immediate intervention and reference to medical professionals or notification of authorities and family.
Suicide Intervention
In intervention, whether in acute setting or discussing possible plans of a person to commit suicide, professionals need to not judge the person, or demean the person’s perceived tragic nature of life. Instead, crisis professionals are encouraged to gain an understanding, form a bond and offer alternative options.
The Three “I”s are essential to know if looking to defuse suicidal situations. The person feels the situation is inescapable, intolerable and interminable (James, 2017,p. 218). Hence it is important to help the person feel secure, less painful, and offer hope with solid solutions. When a person is facing crisis, they may feel there is no other way out and may need alternatives presented and applied to the situation. In addition, the crisis counselor may try to help the person reframe the situation with attributes of CBT to see the situation from a different light. The crisis counselor must also help the individual face the pain and discover that is not forever. Helping focus on not so much the lethality but the perturbation of the person can help the person see more clearly, utilize problem solving abilities, and offer alternatives to the current issue. Addressing stressors and helping the person see hope is the biggest key. At this core, Crisis Management looks to help the person plan a response to suicidal issues (James, 2017, p. 222).
In counseling, professionals should help clients reframe. This involves not only a new line of thinking but also validating emotions and discussing future suicidal behaviors and how to counter them. It is important to help the person learn real problem solving skills for issues but also address teaching individuals how to cope with pain and emotions in better ways. In addition, counselors can help clients find better social connections to prevent isolation as well as play an important role in life coaching with positive thoughts, plans and goals. Importantly as well, a counselor should obtain from the person a no harm commitment through a suicide “Do not Harm Contract” or “Stay Alive” contract which the individual signs. It is important to let the person know he or she is not alone and can reach out or call when certain triggers may appear that seem unbearable (James, 2017, p. 227)> In some cases, calls to the authorities may be needed, or a person may need observed for a period of time before the crisis has subsided.
Conclusion
Suicide is not simply a call for help but a true crisis situation that demands attention. Through warning signs, assessment and proper intervention, crisis counselors can save lives. It is also important to note that suicide is not something rationally chosen but one that is mentally and emotionally chosen when in a illogical state of mind. Hence negative social stigmas need removed and professionals as well as society need to see these individuals who attempt or complete suicide as victims. This is why it is so important to be educated on the subject and listening and observing with empathy for those who shows signs of suicidal ideation.
Please also review AIHCP’s Crisis Intervention Program and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification. Counselors, first responders, clergy and other mental health professionals can play a key role crisis intervention and saving lives from suicide.
Resources
James, R & Gilliland, B. (2017). “Crisis Intervention Strategies”. (8th). Cengage
Additional Resources
Clay, R. (2022). “How to assess and intervene with patients at risk of suicide”. APA. Access here
Are you thinking about suicide? How to stay safe and find treatment. Mayo Clinic. Access here
Ryan, E. & Oquendo, M. (2020). “Suicide Risk Assessment and Prevention: Challenges and Opportunities”. Psychiatry Online. Access here
Suicide and suicidal thoughts. Mayo Clinic. Access here
Suicide Prevention Tools for Public Health Professionals. CDC. Access here
988 Life Line Access here
Crisis Counseling Vs Traditional Counseling Settings
Obviously crisis counseling is sometimes on the scene of the event. It is emotional first aid that attempts to restore equilibrium and mobility to the person. It is short term in its plan and it briefs the individual and carries through necessary tasks to help the person return to pre-crisis state. It also looks to help the person find orientation and resources to help avoid future crisis and find resolution to what caused the crisis reaction.
In this blog, we will look at crisis counseling in settings where intake occurs and how counselors work to help individuals leave the state of crisis. In these cases, the individual is brought in by the police, or rescue and the person requires mental care until able to be released. These types of counseling sessions differ greatly from traditional counseling settings. They still are not long term but they do look to alleviate crisis as much as any work on the scene itself. In addition to reviewing these types of crisis counseling settings, we will look at the efforts to better concert the police with mental health professionals in ensuring mutual safety of first responders and those in crisis.
Please also review AIHCP’s Crisis Intervention Specialist Program, as well as its Substance Abuse Specialist Program for qualified professionals in Human Services and first response.
Crisis Counseling in Facilities
Many mental health community centers are equipped to handle walk-ins, police escorted individuals in crisis, family admitted or social service recommended cases (James, 2017, p. 100). Like the crisis specialist in the field and on the scene, these professionals provide the same type of de-escalation model to help the person find equilibrium and mobility. They can also keep the person a few days if necessary and later coordinate with case managers to ensure the person receives continued observation, medication, or future counseling. Some facilities are 24 hour facilities, while others have emergency call centers beyond the regular hours (James, 2017, p. 102).
Upon entry into a facility, a person is assessed across the range of the triage scale to determine if someone is mildly or severely impaired. For more severe cases, a senior technician is called upon to help the person. Crisis specialists will also try to receive a case history of the person to better determine the onset of crisis. If mental pathology is present, a psychiatrist may be called to better meet the needs of the person (James, 2017, p. 100). James also references that those who face more severe mental fragmentation will be committed until safe to self and others (2017, p. 100).
The initial intake interview is a key process where questions and basic crisis intervention tasks can be completed. If the person is appraised negatively with a high level of lethality as well as drug use, then the person will need to stay longer. The clinician or team following the intake interview, prepares a disposition that describes the case as well as suggestions for treatment. In some cases, the facility will supply the person with a psychological anchor. This refers to a professional who will serve as their case worker, advocate or contact person (James, 2017, p. 101). In some cases, the individual will need short term disposition which meets the immediate physical needs of food, water or shelter. The Department of Family Services plays a big role with social workers to ensure the proper government entities meet the needs of the person. However, sometimes, long term disposition occur where the person needs long term care plan which includes counseling abd medication to help the person deal with future issues and crisis (James, 2017, p. 101).
Crisis and Short Term Vs Counseling and Long Term Cases
Since crisis is about mental and emotional first aid that looks to stop emotional bleeding, its goals and procedures to reach those goals differ greatly from long term counseling and cases. James lists numerous differences between these two types of mental health models. In regards to the initial tasks themselves, there is a large difference. Crisis counseling looks to ensure client safety and assess lethality initially, while long term looks to prevent future problems. Where crisis counselors look in the first task to form a bond with the person in crisis, long term counselors look to correct issues with sound and tested evidence based treatments. Where crisis counselors help the person define the immediate problem, long term counselors help provide systematic support for that problem. Where crisis counselors provides support to help calm the person in crisis, long term counselors help facilitate growth in the healing process. Where crisis counselors look to help those in crisis see alternate options and develop a plan, long term counselors look to re-educate and help clients express and clarify emotions. Where crisis counselors resolve with commitment to plan and follow up, long term care counselor continue treatment with resolving issues, accepting realities, reorganizing attitudes and working on maximizing intellectual resources to deal with issues (2017, p. 98).
Crisis intervention specialists utilize diagnosis via the triage method looking at the affective, behavioral and cognitive issues on the spot and face to face, while long term counselors work with a detailed case history as well as observation throughout a period of time with most patients not experiencing a state of acute crisis. Where crisis specialists treat acute trauma and help to stabilize, long term counselors look at the underlying causes for issues over an extended period of time. Where a crisis specialist’s plan is to meet the immediate physical and emotional needs to stabilize a person, a long term counselor’s plan is a comprehensive effort that covers time and numerous personal and social environments that looks to help alleviate a non acute issue. (James, 2017, p. 98). Hence crisis intervention specialists deal with individuals who are affectively in an impaired state, cognitively unable to think logically and behaviorally out of control and pose a threat to themselves and others, while a long term counselor deals with individuals not in impairment emotionally and is able to think and socially behave (James, 2017, p. 99). This means that crisis professionals whether on the scene, or in a facility helping a person in crisis are working at a mental emergency level where decisions and observations must be quicker and plans may need be adjusted quickly due to safety issues (James, 2017, p. 99)
Types of Issues with Crisis
Obviously dealing with those in crisis requires quick thinking and assessment but it also entails dealing with individuals who are a lethal threat to self and others, as well as many times on multiple types of drugs. Crisis professionals deal with chronic mental illness, acute interpersonal problems due to relationships and other social factors, and combinations of both (James, 2017, p. 97). While long term care counselors deal with these type of issues, usually the person is not actually intoxicated, or in a state of mania, or suicidal with gun in hand during a session. Many crisis counselors deal with an array of acute issues that include those who are constantly in a transcrisis state that can be activated at any moment. Those facing multiple stressors or anxiety or depression can easily fall into a state of acute crisis in these cases. In addition to transcrisis, many individuals in chronic crisis will face regression and fall back into old issues that led to crisis. Others may face issues with possible termination of future sessions with counselor since the counselor has become an anchor (James, 2017, p. 108). In addition to dealing with those in transcrisis, many counselors deal with individuals with addiction issues and psychotic breaks with reality. One common type of malady that corresponds with crisis in Borderline Personality Disorder. This disorder prevents the person from past trauma to achieve stable moods from hour to hour, day to day or month to month. They can erupt into anger or sadness over minor things they perceive as slights. Many are also impulsive, self destructive, confused with goals, unable to maintain self esteem, possess suicidal ideation, and have destructive choices in relationships (James, 2017, p. 111). Obviously this type of disorder is a chaotic recipe for crisis calls for the police and later mental health intervention.
These types of issues can lead to big problems with counselors and those in crisis as well as those who offer long term counseling. It can lead an array of issues where the client is suicidal, deals with abuse, or problems with finances or the law, as well as one who frequently misinterprets a therapist’s statements, reacts strongly to advice, fears resistance and follow through of treatments, as well as transgressing professional boundaries with calls and insults (James, 2017, p. 111). James points out that when dealing with individuals in chronic crisis or facing other mental maladies, one needs to set ground rules that apply for everyone. Sessions need to start and end on time. Sessions need to be void of threats. Everyone speaks for oneself and is fully heard. Everyone faces all issues discussed and does not have the option to abruptly leave. The session will not include gaslighting or avoiding the subject. No one is to arrive drunk or intoxicated. The crisis counselor or counselor will not take sides. Time will be respected outside the office and the needs of other clients will not be dismissed for another’s immediate demands (James, 2017, p. 114). Obviously dealing with those that face multiple issues and chronic crisis is a heavy task. It involves professionalism, boundaries and sometimes a place to vent for the counselor afterwards.
Crisis Facilities and Law Enforcement
Since the closing of mental asylums in 1963, law enforcement and prisons have picked up the slack of dealing with those in mental crisis. This has led to many unfortunate incidents of police shootings, or police brutality cases. While most police officers and law enforcement are good people, the job of dealing with those in mental crisis is exhausting and can trigger a sane individual into actions not normal for fear of safety of self or frustration. Most police historically have dealt with criminals in the true sense. Upon apprehending of a thief, the thief understands to drop the weapon or the stop. Unfortunately in heated situations of mental crisis, people sometimes cannot emotionally understand or comprehend orders. Due to equilibrium and immobility of a person in crisis, an officer has to show constraint and avoid authoritative and aggressive commands or he/she may escalate the situation. Some officers are not able to handle this type of mental health interaction but modern policing requires it. As more and more unfortunate death by cop whether intentional or intentional occurs, the more police need trained in crisis intervention and de-escalation. Police officers who cannot handle this adjustment either need to find a new profession or soon risk the chance of ending up in prison, sued, or fired themselves.
James mentioned the change in policing from instrumental crimes to more expressive crimes where officers are required to adjust their approach in dealing with the person in crisis (2017, p. 102). James illustrated one of the first joint task teams of law enforcement and mental health and crisis centers with the Memphis Police Department in 1987 (James, 2017. p. 103). The Crisis Intervention Team or CIT was designed to train police when dealing with those in crisis as well as to coordinate with mental facilities instead of prisons. James pointed out that the model was not just about training police but also to help create better coordination with the mental health community and consumer advocates promoting mental health awareness (2017, p. 104). James pointed out that the program covered 40 hours of CIT training that covered cultural awareness of mental illness, substance abuse, developmental disabilities, treatment strategies and mental health resources, patient and legal rights in crisis intervention, suicide intervention, use of mobile crisis teams, education on psychotic meditations and effects, verbal defusing and de-escalating techniques and education on borderline personality disorder and other mental issues (2017, P. 105).
According to James, the program has been a success and a model for other law enforcement agencies in other communities and cities. Within its first 16 months of operation in 1987 to 1988, Memphis CIT trained officers responded to 5, 831 mental disturbance calls, transported 3, 424 cases to proper mental health facilities without patient fatality (2017, p. 106). In the 20 and more years since, more calls are received to the hotline differentiating crime and mental crisis and there has been a reduction in the use of force and more individuals being sent to mental facilities instead of jail (James, 2017, p. 106).
This is an important issue and the success shows that modern policing can meet the needs of mental crisis. Some departments also receive additional aid from social workers, chaplains and other crisis professionals on calls related to mental disturbance. This does not mean that danger and risk exists both for the person in crisis as well as the first responders but it does reduce the chance for unnecessary and tragic fatality. This should be an issue every person cares about because anyone can become a victim of crisis and police when called need to be able to de-escalate and not escalate.
Conclusion
Crisis intervention care is not for the faint of heart. It requires quick thinking and decisions which need to be adjusted on the fly as danger and possible death loom with every call. Crisis cases whether on scene or in a facility deal with acute crisis. Individuals are facing dis equilibrium and immobility. They are affected emotionally, behaviorally and cognitively. This leads to a different type of response than long term care. Crisis counselors understand the different nature of their calling and profession. In addition, mental health facilities, the public, and police are all beginning to incorporate better crisis response to negate police brutality or illegal shootings of those in crisis. This involves understanding that modern policing is more about arresting bad guys but also helping sick people find balance and the proper treatment.
Please also review AIHCP’s Crisis Intervention Specialist Certification as well as its Substance Abuse Specialist Certification. Both programs are online and independent study with mentorship as needed. The program is open to qualified professionals in law enforcement, healthcare, mental health, human services and chaplaincy.
Source
James, R. & Gilliland, B. (2017). “Crisis intervention Strategies” (8th). Cengage
Additional Resources
Crisis Centers by State and U.S. Territory. Access here
Crisis Text Line. Access here
If You or Someone You Know is in Crisis and Needs Immediate Help. National Institute of Mental Health. Access here
National Hotline for Mental Health Crises and Suicide Prevention. NAMI. Access here
988 Suicide & Crisis Lifeline. Mental Health America. Access here
Tich, B. (2023). “What Works in De-Escalation Training”. National Institute of Justice. Access here
Zeller, S. & Kircher, E. (2020). “Understanding Crisis Services: What They Are and When to Access Them”. Psychiatric Times. Access here
What Role Does Continuing Education Play in Combating Substance Abuse?
Written by Veronica Turner.
Substance abuse continues to plague the public health sector by affecting millions worldwide and straining healthcare systems.
Actually, according to the Department of Health and Human Services (HHS) through the Substance Abuse and Mental Health Services Administration (SAMHSA), about 48.7 million Americans aged 12 and above struggled with a substance use disorder in 2022.
This stark statistic highlights the need for effective addiction treatment and underscores the importance of ongoing education for professionals dealing with and delivering addiction treatment.
Continuous learning helps addiction recovery practitioners stay updated with evolving methodologies and improve patient outcomes. Let’s explore the role of continuing education in addressing substance abuse.
We will examine the importance of structured certification courses, key examples of structured certification courses, how addiction recovery professionals should evaluate certification courses, the role of continuing education in promoting advanced addiction recovery methods, and key challenges and opportunities in continuing education for mental health and addiction recovery professionals.
Importance of Continuing Education in Addiction Treatment
Let’s start our discussion by focusing on how continuing education helps practitioners deliver better addiction treatment to those in need.
Staying Current with Advancements
Advancements in almost everything are happening by the day, and addiction treatment is no exception. New research on the matter, treatment methods, and regulatory changes are emerging regularly.
For professionals delivering addiction treatment, not getting with the program means getting left behind, and this doesn’t just hurt your reputation but your patients as well. Keeping up with the latest advancements enables you to provide effective care and adapt to diverse patient needs.
For instance, certifications can help you understand advanced treatment options like rapid detox treatment, the Waismann Method, and other methods that may improve your ability to provide cutting-edge care.
Enhancing Expertise and Skills
Continuous education helps practitioners involved in addiction treatment learn about new treatment techniques, ethical practices, and emerging trends. This enhanced expertise translates into more effective treatment strategies, improved patient interactions, and better overall outcomes.
Regular updates to knowledge ensure professionals can adjust their approaches to meet the evolving challenges in addiction treatment, which helps them provide more personalized and impactful care.
Navigating Ethical Complexities
Continuous education is not just about keeping up with the latest treatment methods; it also reinforces the importance of adhering to ethical standards.
Addiction treatment is full of moral complexities, and ongoing training helps professionals navigate these challenges in ways that ensure they can provide effective and ethically sound addiction recovery care.
Building Professional Networks
As an addiction counselor, participating in continuing education courses allows you to interact with like-minded people in your field. This networking can lead to collaborative efforts, sharing of best practices, and even mentorship opportunities, all of which contribute to a more comprehensive approach to addiction treatment.
Continuing Education Credits
Many certification programs offer continuing education credits, not just to meet licensure requirements but also to expand your expertise. Think of it as earning bragging rights, signaling that you are on top of the food chain in your field. This dual benefit ensures that substance abuse counselors remain compliant with regulatory standards while staying ahead in the ever-evolving landscape of addiction treatment.
Boosting Credibility and Trust
If you are still not convinced that continuous learning is important, how about the credibility and trust you get to build with your patients and colleagues?
When pursuing advanced certifications and education, you demonstrate a commitment to the field and providing high-quality care. This dedication can significantly impact your reputation and foster trust among patients who are often vulnerable and seeking reliable guidance in their recovery-from-substance abuse journey.
Let’s now look at how professionals dealing with addiction treatment can go about getting this continuing education:
Key Examples of Structured Certification Courses Addiction Counselors Can Take
Structured certification courses are pivotal in the professional development of addiction treatment practitioners because they offer specialized training needed by substance abuse counselors professionals. These programs cover various topics, including addiction theories, treatment strategies, ethical practices, and more.
Some notable certifications include:
- Certified Addiction Counselor (CAC): This certification equips professionals with essential counseling skills and addiction treatment principles. It empowers addiction therapists with the tools to conduct assessments, create treatment plans, and deliver counseling that addresses the complex nature of addiction.
- Certified Clinical Supervisor (CCS): The CCS certification prepares professionals to supervise other counselors and manage treatment programs. It enhances leadership skills by emphasizing ethical supervision, program development, and effective management strategies to elevate the quality of addiction services.
- Certified Peer Specialist (CPS): This certification provides training for individuals with lived experience in addiction to support others in recovery. It empowers those who have navigated their recovery journey to use their experiences to mentor and guide others by fostering a sense of community and shared understanding in the recovery process.
Take, for example, the hypothetical case of Mark, who was struggling with opioid addiction and had faced multiple failed attempts at recovery. He almost lost hope as nothing was working out for him.
That was until he met Sarah, a Certified Addiction Counselor (CAC). Thanks to the advanced counseling skills she acquired through certification training, Sarah approached Mark’s situation differently than previous therapists had.
She conducted a thorough assessment that uncovered underlying issues, including co-occurring and previously missed mental health conditions. Sarah’s in-depth knowledge of addiction treatment principles enabled her to craft a personalized recovery plan using evidence-based therapies tailored to Mark’s unique needs.
Her expertise in motivational interviewing, a vital component of the CAC program, helped Mark feel understood and engaged, leading to significant progress in his recovery. This case highlights how specialized skills from certification can directly improve client outcomes, providing more effective and compassionate care.
How Addiction Recovery Professionals Should Evaluate Certifications and Continuing Education Courses
When selecting addiction recovery certifications and Continuing Education Courses, mental health professionals should evaluate several factors to ensure they meet high standards and effectively enhance professional practice.
Here’s a guide to help you understand what makes a substance abuse certification program valuable and how to choose the right one for your needs.
Program Accreditation
Ensure that reputable organizations accredit the certification program. Accreditation ensures the program adheres to recognized quality and relevance standards. Look for endorsements from recognized bodies such as the National Board for Certified Counselors (NBCC) or the International Certification & Reciprocity Consortium (IC&RC).
Curriculum Quality
Assess the curriculum to determine if it covers various topics relevant to addiction recovery and rehabilitation. A high-quality program should include evidence-based practices, contemporary treatment methodologies, and ethical considerations.
Check if the program offers practical components like case studies, simulations, supervised practice, and other elements that help apply theoretical knowledge to real-world scenarios.
Comparative Analysis
Compare programs by their completion requirements, including coursework, exams, and practical experience. More rigorous programs provide more profound training and expertise. Different certifications may cover clinical counseling, recovery coaching, or rehabilitation management.
Select a program that matches your career goals and interests. Evaluate outcomes reported by previous graduates. Programs with higher success rates in treatment effectiveness and professional advancement are generally more valuable.
The Role of Certifications In Promoting Advanced Addiction Recovery Methods
Continuing addiction treatment education enhances practitioners’ knowledge and equips them with the latest techniques and methodologies. Certifications in addiction treatment emphasize the importance of integrating advanced substance abuse recovery methods into clinical practice. Here is how:
Transparent Communication of Options
Certifications often focus on the importance of clear and transparent communication with patients. This approach enables practitioners to:
- Informed decision-making: By thoroughly outlining all available treatment options, including their benefits, risks, and potential outcomes, practitioners enable patients to make well-informed choices about their recovery journey.
- Building trust: Effective communication fosters trust between patients and practitioners. Well-informed patients generally participate more in their treatment, which is vital for a successful therapeutic relationship.
- Customized treatment plans: Clear communication allows for a more personalized treatment plan that aligns with patients’ preferences and needs, resulting in improved adherence and better outcomes.
How Practical is this?
A prime example of applying specialized certification knowledge is in rapid detox treatment. The Waismann Method is a spot-on example of an innovative approach to addiction recovery.
This method demonstrates how advanced training leads to cutting-edge treatment solutions. Implementing such methods allows practitioners to provide state-of-the-art care, showing the importance of continuing education in addiction treatment. Integrating addiction recovery and rehabilitation counseling certifications boosts professional expertise and improves treatment practices.
Challenges and Opportunities in Continuing Education for Addiction Professionals
As for the challenges and opportunities in continuing education for addiction professionals, here are some main ones:
Keeping Up with Rapid Advancements
The addiction treatment field evolves quickly. Continuing education through online platforms and webinars allows professionals to stay updated without disrupting their practice.
Diverse Learning Needs and Preferences
Mental health and addiction recovery professionals have varying backgrounds and learning styles. That’s why structured certification courses should offer a range of formats, such as workshops, online courses, and case studies, to address different preferences and enhance engagement.
Funding and Access
Limited resources can restrict access to quality continuing education, particularly in under-resourced areas or smaller practices. Seek funding through grants and subsidies, and develop low-cost or free educational resources. Online platforms can also increase accessibility, making high-quality training available to a broader audience.
Conclusion
As the addiction treatment field evolves, ongoing learning remains essential for staying current and delivering high-quality care. Addiction treatment professionals should endeavor to pursue certification programs, stay informed about emerging trends and technologies, and seek continuous opportunities for growth. By doing so, they can better support their patients and contribute to the ongoing battle against substance abuse.
Frequently Asked Questions (FAQs)
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Why is continuous education important for addiction treatment professionals?
Continuous education helps professionals stay updated with the latest treatment methods and advances, which ensures effective patient care and improved outcomes.
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What are structured certification courses, and how do they benefit addiction treatment?
Structured certification courses are formal training programs that provide in-depth addiction treatment knowledge and skills. They benefit substance abuse professionals by equipping them with current practices and evidence-based techniques.
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What should professionals look for when evaluating certification programs?
Key factors to look out for include the program’s credibility, relevance to current practices, comprehensiveness of content, and support for continuing education.
About the Author: Veronica Turner is a health and lifestyle writer with over 10 years of experience. She creates compelling content on nutrition, fitness, mental health, and overall wellness.
Please also review AIHCP’s Substance Abuse Practitioner Certification programs and see if it meets your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
Multicultural Counseling Video Blog
Multicultural counseling competency is important in counseling. Counselors need to be diverse in understanding how culture, race , creed, age and gender play a role in how a client will respond to them. Counselors need to be also aware of their own internal biases. With good cultural understanding, the counseling relationship can become enhanced and help the client heal and grow. Please review the video above to learn more about multicultural counseling,
Please also review AIHCP’s Grief Counseling Certification, as well as its numerous behavioral health certifications in Christian Counseling, Spiritual Counseling, Anger Management, Crisis Intervention and Stress Management, as well as Life Coaching, ADHD Consulting and Meditation Instructor.
The Problem Management Model Video
A key part of counseling involves helping the client identify the problem, propose solutions and execute those plans into action with assessment of progress. This is the core of the Problem Management Model in counseling and is key in helping track a client’s progress.
Please also review AIHCP’s multiple behavioral health certifications ranging from Grief Counseling and Christian Counseling to Crisis, Stress, Life Coaching and Anger Management Programs. The programs are online and independent study and open to qualified professionals in both the behavioral health and health field areas.
Addiction and Compulsion in Substance Abuse Counseling
Substance Abuse Counseling, as well as general counseling can help individuals better control urges, change habits and live more productive lives with healthier choices and non-maladaptive practices. Substance Abuse Counselors play key role in helping clients find ways to change, become resilient, and live healthier lives.
Please also review AIHCP’s Substance Abuse Practitioner Certification and see if it meets your professional needs in counseling
Acknowledging a Problem in Substance Abuse
Unfortunately, many individuals who suffer from addiction need first to wish to change. The process of change is the key. The Change Scale in Psychology looks at the challenges of helping a client see the need for change. Only until a client acknowledges a problem can a client truly change. Even after intellectually identifying a problem, one must become unified emotionally in the deeper yearning to change. Once the need for change is identified, a client can begin to explore the problem, find solutions and execute the necessary changes to transform. Unfortunately, this is a long process, with setbacks, but ultimately, it is direction that pushes forward.
Addiction and Compulsions
The addictive act is habitual in itself. It was not initially habitual but merely an isolated act. The act was initially committed out of curiosity, randomness, or a maladaptive act to deal with trauma, grief, depression, anxiety or various stressors. The randomness of the act overtime evolved from merely an isolated event to a consistent series of act which eventually became habitual. In all human acts, certain responses and acts to stress can turn to habit. A person whether it involves substance abuse, drugs, or even particular actions such as gambling, or porn addictions, eventually enters into a pattern of actions in response to various stressors. Some habits in fact can be healthy such as exercise, but even when exercise becomes a habit that is damaging the body or dominating time within a day can become an issue. Maladaptive coping is not only wrong within itself but also excessive, even if good. If coping is not at least moderate to a stressor, then habits can form that lead to addicting behavior. Of course, in regards to substance, there exists more than a mental need to reframe, but also a physical addiction. For some, fortunately, chemical addiction does not occur to genetics, but for others, they can become fiercely dependent not only mentally but also physically to function. Addiction hence is not only persistent and habitual without thought but also a necessary state to function for the person.
Compulsions to act upon a substance or behavior are also powerful drives. A compulsion is not necessarily persistent but it is a powerful and overwhelming urge to engage in an activity or take a particular substance. A compulsion is usually preceded by obsessive and intruding thoughts while addiction exists within a natural habit of acting. Counselors, especially Substance Abuse Counselors can help clients better control compulsions through various therapies and help produce change and transformation through these therapies. They can also help clients fight through the never ended battle of addiction.
Good Therapy states
“Symptoms that suggest a compulsive behavior has become problematic include:
- Interpersonal and professional relationship problems
- Concealment of the behavior
- Denial of a problem
- Inability to stop the behavior
- Alternating feelings of anxiety, confusion, shame, or elation that revolve around the behavior
- Withdrawal from or a lack of enjoyment in other activities
- Desire only for the company of others who pursue the activity or, to an opposite extreme, the urge to conduct the activity only in isolation
- Fear surrounding the potential repercussions associated with discontinuing the activity”
“Addictions and Compulsions”. Good Therapy. 2019. Access here
Rewiring Oneself and Substance Abuse
Obviously, those who are not addicted but facing compulsions can escape the demon of maladaptive coping via substances or practices, but those who are chemically dependent face a life long battle. After acknowledging the necessity of change, individuals need to dedicate themselves to more adaptive coping strategies and removing themselves from the temptations. The occasion of sin is a powerful pull not only for the addicted but also those who face serious compulsions and temptations with a particular substance, activity or vice. How one rewires and reframes the nature of the addiction is key. Understanding first and foremost that it is maladaptive, excessive and unhealthy starts the important process of detesting what it is and what it does to the individual. This turning away from habit though requires not only removing oneself from the situation and bad occasions and “friends” or places, but also working on rewiring oneself in how one responds to triggers and stressors that previously pushed one to the activity or substance.
Hence in counseling, a Substance Abuse Counselor will help a client discuss the urges, what the client feels and what other coping strategies one may employ. For instance, if someone who feels stressed turns to smoking, a counselor may suggest when these urges arise, what are some other ways to calm down that you may be comfortable utilizing to help reduce stress other than smoking. The key is to help the client rewire oneself and instead of using the addictive maladaptive habit and to begin to find other ways to find relief from the particular trigger.
Therapies in Counseling for Addiction
Many of the therapies that exist in general counseling can be applied for addiction as well. Obviously first and foremost, a Rogerian and Humanistic Approach is key. Empathy to the suffering of the individual is key. This is involves helping the person identify one’s feelings and find ways for one change. This involves helping the person see where he/she exists and where one wishes to be. This involves one’s perceived self and then the person’s real self. Helping a person cross the bridge from real self to ideal self involves the entire empathetic process of Rogerian therapy. It also involves non-judgmental attitudes that allow the client to express his/her addictions in a safe place. Furthermore it involves empathetic confrontations when necessary to help the client recognize the necessity for change and how the client’s addiction and behaviors is not only destroying oneself but also that of his/her family, friends, social life, professional career and overall health. Rogerian therapies can also show the necessary empathy in helping those who relapse and help one move forward in developing better resiliency.
In addition, CBT or Cognitive Behavioral Therapies can be employed to help the client reframe life and reframe addiction and how maladaptive practices are only ruining one’s life. This may involve returning to the initial issue of depression, trauma, PTSD, or anxiety that prompted the maladaptive coping. Understanding the source and reframing it through CBT strategies can help the client start anew with a new meaning about the primary issue and ways to better deal with it.
Finally, group therapies and support groups are key in helping clients with addiction move forward. This is especially true with those with little social or family support at home. Support groups can help individuals share stories and find strength with similar persons. It can help one see others who understand oneself as well as see the success of others. Furthermore, such programs as AA 12 Step Program can help clients take responsibility for one’s actions can help one develop the skills necessary to move past addiction.
Beyond psychological interventions, some cases require deeper and more drastic interventions which require detox and short or long term facilities, out patient care or even hospitalization. Interventions may also require various medications to help a person. Ultimately, the disease of addiction has its extremities. Some require more drastic measures to become clear of the substance so that true therapy can begin.
Conclusion
Addiction is disease that destroys lives. Whether it is behavioral, chemical, or substance, addiction tears a person away from the real problem through maladaptive practices that harm the person. It leads the person down a darker path that merely alleviates the primary issue only temporarily but leads to longer lasting health, mental and social problems. The habitual hold on the person requires professional, spiritual and empathetic help which also in many cases includes support from others. Ultimately, the person must acknowledge the problem at all levels and search to find a solution. Substance Abuse Counselors as well as Mental Health Counselors can play key roles in helping individuals live with addiction and transform one’s live.
While there are different professional levels of substance abuse counseling, some human service professionals are trained but only certified working under a licensed director, while others are also licensed professional counselors. AIHCP’s Substance Abuse Practitioner Certification looks to help human service professionals attain a certification in addictions to help them better help those afflicted with addiction. Please also review AIHCP’s Substance Abuse Practitioner Certification Program and see if it meets your academic and professional goals. The program is online and independent study and open to qualified healthcare and human service professionals looking to help others in the area of addiction. Whether it is working in a call center, or applying a certification with an existing licensure, AIHCP’s Substance Abuse Practitioner Program can help enhance one’s knowledge and professional background.
Additional Resources
Pederson, T. (2021). “How Are Substance Use Disorders (SUDs) Treated?”. PsychCentral. Access here
“Treatment of Addiction”. Psychology Today. Access here
“Treatment of Substance Use Disorders”. (2024). CDC. Access here
“Drug Addiction”. Mayo Clinic. Access here
Webster, A. (2024). “Cognitive-Behavioral Therapy (CBT) for Addiction and Substance Abuse”. American Addiction Centers. Access here
Focusing and Empathetic Confrontation in Counseling
Like in previous blogs, attending to the client, empathetically listening and observing, properly responding and encouraging are key elements in basic counseling. Like a coach training a player or athlete, challenging and encouraging a client to change is like coaching. It involves the counselor helping the client push forward, and like in coaching, this sometimes involves more than just challenging, but to also focus on the issue that needs addressed and then properly fix it. A good coach will focus and see a flaw in the mechanics of a player and then challenge and confront the player and help guide the player to fixing it. Counselors focus on the client’s story and then discover the core issues. After finding the core issues, they offer empathetic confrontations to help push forward. These skills represent later measures after basic attending, listening, observing and responding and look in later sessions to help the client find real and true change. In this blog, we will first look at focusing and then conclude with empathetic confrontation.
Focusing in Counseling
According to Ivey, the skill of focusing is a form of attending of the client that enables a counselor to discover multiple views of the client’s story (2018, p. 221). It helps the client think of new possibilities during the restory and call to action (Ivey, 2019, p. 221). A counselor goes well beyond merely the “I” in the story but looks to broaden the story beyond merely the client but into other aspects of the client’s life. How the counselor responds to the client hence can play a key role in where the story proceeds in the counseling sessions. Counselors who direct the conversation through selective attention skills can take the “I” conversation into other social and cultural spheres of the client. These other spheres of influence can be key clues into the client’s mindset. Ultimately, focusing is about helping the client address emotional issues. It is client based and humanistic in approach.
Ivey lists seven focus dimensions that counselors can utilize in responding and discussing issues. The first is to focus on the client him/herself. This involves direct questions regarding the client’s feelings. The second involves focusing on the theme . It involves asking the client about the issue itself and discovering details regarding the theme of the issue and how the client feels in the immediate moment. The third dimension shifts focus to others within the client’s life. It delves into questions about significant others, family members, friends or others involved in the issue. The fourth dimension of focusing looks at mutual aspects of how the client and counselor can work together. It emphasizes “we” and how the counselor and client can find ways to deal with the issue. The fifth dimension focuses on the counselor. It involves how the counselor can paraphrase and share appropriate and similar experiences with solutions. The sixth focus puts into perspective the issue in regards to the client’s cultural or environmental background and how they may play into the current issue. Finally, focusing on the here and now delves into identifying how the client feels at the moment itself (Ivey, 2018, p. 221).
Focusing on a client’s cultural/religious/ethnic background can play a key in discovering issues that exist in the person. It can help explain why a particular client responds and reacts a certain way. It can also be used to find strengths for the person. Ivey illustrates the importance of Community and Family Genograms that help map out the client’s background (2018, p.212). A good family genogram will help clients identify issues from a cultural standpoint and understand better their relationship to their surrounding environment and its stressors. In addition, it can also help clients discover new hidden strengths that exist within their family and culture. Helping the diverse client take pride in their past and heritage can help build resiliency. When stressors or issues occur, a client can utilize a term referred to as “body anchoring” where the client reflects upon a voice of a relative, famous individual, or cultural icon to help him/herself find confidence and strength to face the issue (Ivey, 2018, p. 220). This also helps multicultural clients have the power to name issues that are effecting them. Using focus on culture can be a very helpful tool when utilized correctly during a counsel session. This type of focusing helps many diverse populations deal more effectively against microaggressions (Ivey, 2018, p. 248).
Ways to help find a client’s particular cultural awareness during focusing is through the Cross five stage model, named after William Cross (Ivey, 2018, p. 244). Also referred to as the five stages of cultural identity, Cross identified how diverse populations recognize themselves and respond to confrontation. Focusing on the stage of a particular client hence can be very beneficial. The first stage involves the conformity stage. The individual may be unaware of racial identity and merely conforms to societal expectations. The second stage involves dissonance where the individual realizes that something does not match or fit. This can lead to self-appreciation or self doubt. The third stage results in resistance or emersion. An individual may become more angry at the injustice or immerse oneself more in one’s own culture. The fourth phase involves introspection where the individual sees oneself as an individual and part of the cultural group. The final phase of integrative awareness is the full sense of caring for oneself and one’s cultural heritage. This leads to appreciation and action but more so due to pride and awareness (Ivey, 2018, p. 245). Through identification of these phases or stages, counselors can help clients better utilize the client’s heritage and culture to empower the client in various interventions.
Empathetic Confrontation
A counselor, like a coach, uses a variety of encouragement and challenging strategies to help a client find change. Within the Problem Management Model, a client is shown the present, perceived view and ways to find the new view. This involves identifying internal as well as external conflicts. Sometimes, clients may become stuck in a way of thinking. They lack intentionality to change or lack creativity (Ivey, 2018, p. 229). Within this state, the client becomes immobile, experiences blocks, cannot achieve goals, lacks motivation and has reached an impasse (Ivey, 2018, p. 229). In these, cases, like a coach, the counselor needs to help the client face these issues and move forward. This involves a type of confrontation but this confrontation is not meant to imply aggression or hostile or argumentative behavior but is an engagement for change. According to Ivey, Carl Rogers pushed for the ideal of Empathetic Confrontation, which espouses a gentle listening to the client and then encouraging the client to examine oneself more fully (2018, p. 2029). Summaries are an excellent way to help confront a client with empathy. In this way, the counselor can present a two-part summary which states both positions with the connecting phrase “but on the other hand” (Ivey, 2018, p. 229-230). This presents both views of feelings and allows the client to digest the statement and see any discrepancies or issues of conflict within his/her logic.
Carl Rogers points out that even when presented in these terms, sometimes, the client may feel attacked or confronted. In these cases, he suggests to also hold tight to nonjudgmental attitudes, keeping one’s own beliefs to the side. Rogers emphasized that individuals with issues who come to counseling do not need judged or evaluated but guided (Ivey, 2018, p. 230). Within any issue, the counselor confronts but also supports. This involves first a relationship that must exist. Without a relationship of trust, the client will not accept any advice from a sterile stranger who he/she may merely see as a paid listener. When confronting, it is essential when summarizing to state the client’s point of view first, before comparing the opposing view. In addition, the client must remain in charge of outcomes. The counselor when confronting is not telling the client what to do but offering suggestions (Ivey, 2018, p. 232). In conclusion, the counselor must listen and observe for mixed messages and then respond with empathy in a summary that clarifies any internal or external issues. This should resolve with actions towards resolution of the issue (Ivey, 2018, p. 235).
Egan points out that are multiple ways to challenge and confront clients to life enhancing actions. Egan differentiates between goals but also strong intention and commitments to a course of action. The importance of understanding the value of action intentions is key in helping a client carry out a particular again (2019, p, 234-235). Implementing these instructions, with strong phrases such as “I strongly intend to do x when y occurs” can help clients find tools necessary to incorporate the necessary change (Egan, 2019, p. 235). Sometimes, a self contract to do a certain thing can be a powerful tool in helping clients galvanize towards change (Egan, 2019, p. 239).
Egan also points out that counselors need to help their clients overcome procrastination. Egan lists numerous excuses that can include competing daily agendas or short term pains (2019, p. 236). It is important to guide one’s client between conscious deliberation and procrastination that prevents true change.
Egan reminds counselors to also help clients identify unused resources that can help facilitate change. Replace “I can’t” with “I can” phrases by helping the client discover unused talents and resources to help one overcome negative thoughts of failure. (Egan, 2019, p.237).
When aiding clients with life enhancing actions, it is important to provide sometimes confirmatory feedback as well as corrective feedback. Obviously, confirmatory feedback acknowledges progress, but corrective feedback looks to help clients who wandered off from the course of action (Egan, 2019, p. 244). The spirit of empathy and nonjudgment are again essential in how this is accomplished. In many ways, it is confronting but in a non hostile way. Counselors can help clients stay on track through multiple ways via checklists, identification of possible obstacles and helping them identify damaging attitudes. Such attitudes can be due to a passivity not to take responsibility, a learned helplessness, disabling self talk, or disorganization (Egan, 2019, p. 245-248). Egan also warns that while helping clients, be aware of entropy and how initial change can gradually break down. Egan lists false hopes and the natural decay curve as two things that can occur in clients (2019, p.249-250). Within each, clients may have too high of expectations, or consider mistakes to destroy the entire process. Give clients the power to make mistakes throughout the process.
Sometimes, as noted, some clients are more resistant to confrontation and change. Some may become visibly upset if confronted with a discrepancy in life. Different clients respond to different challenges in different ways. The Client Change Scale or CCS is a way to measure a client’s reaction to empathetic confrontation (Ivey, 2018, p. 237). Level 1 involves denial of the issue. Within this level, the story is distorted and the client will look to blame others unfairly. Level 2 consists of bargaining and partial acceptance of the story. In this reality, the story is finally changing in a more true direction. Level 3 involves acceptance of the reality. The truth is recognized and the story is finally complete. Level 4 incorporates new solutions to make the story better and finally Level 5 refers to transcendence and the incorporation of the new story into the client’s life (Ivey, 2018, p. 246). The CCS helps the counselor track each session and see if progress or regression occurs from one session to the next in regards to change.
Egan points out that many individuals are reluctant to change due to variety of issues including fear of intensity of it, lack of trust in the process, extreme shame, loss of hope, or even the cost of the change itself (2019, p. 253-255). In dealing with these things, counselors need to be realistic and flexible and look to push the client beyond resistance by examining incentives of change (Egan, 2019, 259). In some cases, when change is identified and the need for it accepted, clients may need time in adjusting or implementing it. Egan points out that change can exist on two levels. He refers to these types of changes as first order changes and second order changes. First order change is operational and a short term solution, while second order change is more strategic and long term. Egan compares the two with first and second as being compared in these ways. First order utilizes adjustments to the current situation, while second is systematic, first monitors, while second creates new, first creates temporary, while second creates to endure. First changes look sometimes to deal with the symptoms while second attacks the causes (Egan, 2019, p. 308).
In some clients, the situation to change may not permit a new paradigm but may requires coping skills. For instance, a stressed employee may be forced to keep a stressful job but may need to tinker with it due to the financial a loss of finding a new job would incur with a more lasting change, while a battered spouse would require a permanent change and would not be able to cope with the existing abuse.
An interesting model is the GROW model. John Whitmore, creator of the model utilized the acronym to produce change and to assess one’s willingness to change. G represents goal or what one wishes to accomplish. R stands for reality and where the client currently exists. O stands for options and what one can possibly do. Finally W stands for will, or what one is willing to do.
This model as well the Problem Management Model are ways to help move the sessions and help identify issues and assess how to empathetically confront and challenge individuals to productive change.
Conclusion
How a counselor attends to a client also involves sometimes more than listening but also focusing on particular aspects of the client’s life. This involves the other aspects of the clients life and in many cases includes cultural and social issues that affect the client. This can be merely family but also take upon the broader cultural aspect of a person. Someone of European descent may react quite differently than someone of Asian descent to the same issue. Hence focusing in on these issues is an essential attending skill. It is also important to understand where one cultural exists within oneself. The Cross model can help counselors better gauge one’s cultural awareness and how that plays in one’s particular situation.
In addition, this blog discussed the importance of Empathetic Confrontation. Carl Rogers understood the importance of helping individuals identify problems that were internal or external but he also understood that is was critical to approach confrontation with nonjudgment and empathy. Employing a two part summary with “on the other hand” can help expose issues and offer good solutions but different individuals react to confrontation to change differently. The Client Change Scale is an excellent way to gauge and monitor a client’s willingness to change. Through Empathetic Confrontation, the counselor looks to challenge past themes or schemas of a client’s life and help them find new ways to correct negative behaviors.
Please also review AIHCP’s many mental health certification programs. AIHCP offers a Grief Counseling Certification, as well as a Christian Counseling Certification. In addition, AIHCP offers programs in Crisis Intervention, Healthcare Life Coaching, Stress Management and Anger Management Consulting. The programs are online and independent study and open to qualified professionals seeking a four year certification.
Reference
Ivey, A. et, al. “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society” (9th Ed( (2018). Cengage.
Additional Resources
Williams, M. (2018). “Ethnic and Racial Identity and the Therapeutic Alliance”. Psychology Today. Access here
Sutton, J. (2022). “How to Assess and Improve Readiness for Change”, PositivePsychology.com. Access here
“Focusing” (2016). Good Therapy. Access here
“The Technique of Confrontation in Counseling” (2022). Optimist Minds. Access here
Stages of Addiction Video
Addiction does not happen overnight. One who becomes addicted goes through a variety of phases that usually begins due to poor coping via escapism or through experimentation. Some individuals may not become addicted, others may have genetic predisposition. Others may be chemically addicted while others may be behaviorally addicted. There are many different aspects. This video looks at the most common stages of addiction and how to fight it.
Please also review AIHCP’s Substance Abuse Practitioner Program and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification
Please review the video below