COUNSELING BASICS

The role of the counselor in addiction counseling is to provide support, education, and non – judgmental assistance to enables change. Counselors must establish a good rapport with their clients. A client recovering from addiction deserves to feel understood and that he or she has an ally. Counselors should convey that they appreciate the difficulty of their clients’ struggle and their need for support through – out the recovery process.

Consider the metaphor of a hiker and a guide. While the guide helps the hiker to know where to go, the hiker still climbs the mountain on her own. The counselor guides the client through the early stages of recovery, but the recovery process ultimately belongs to the client. The client alone is responsible and accountable for his or her recovery. The counselor must emphasize this point to facilitate personal responsibility.

Counselors must find a balance between being directive and allowing the client to be self – directed. Striking a balance will be easier if the counselor imposes a structure on the session that includes giving the client feedback about the client’s progress in recovery, and evaluating any episodes of use or near use. The counselor identifies the relevant topic for discussion, based on what the client seems to need, and introduces that topic. At times, the counselor may directly pressure the client to change certain behaviors.

However, the client should be encouraged to be self-directed. For example, when counseling on a certain topic like “social pressure to use,” your client may explore how best to manage this problem, and you will respond to the client’s exploration. If the client seems unable to change some aspect of addictive behavior – for example, going to risky environments – the counselor should accept where the client is at and assist the client to explore those perceptions or situations in a way that might allow himself or herself to do it differently, (i.e. in a better way the next time).

A balance needs to be struck so there is respect for the client and acceptance of where he or she is, and consistent pressure to help the client move in a direction that will help him/her achieve his/her counseling goals.

Counselors should not be harshly judgmental of clients’ addictive behaviors. After all,  if the client did not suffer from addiction, he or she would not need drug addiction counseling, so blaming the client for exhibiting these symptoms is not helpful. Also, clients often feel a great deal of shame associated with their addictive behaviors. In order to help resolve those feelings of shame and guilt, the counselor should encourage the client to speak honestly about drug use and other addictive behaviors and be accepting of what is said.

Counselors should be respectful of their clients. They should always be professional, including not being late for appointments and never treating or talking to the client in a derogatory or disrespectful manner. Moreover, counselors should avoid too much self disclosure. While occasional appropriate self-disclosure can help the client to open up or motivate the client by providing personal examples, too much self-disclosure removes the focus from the client’s own goals. A good rule for when to self-disclose, if the counselor is inclined, is for the counselor first to have a clear purpose or goal for the intervention and then to analyze why he or she is choosing to self-disclose at this particular time. If there is any doubt based on this analysis, it may make sense to save self-disclosure until there remains no doubt.

Lastly, counselors need to refrain from responding from the context of their own personal issues. For example, consider the case where a counselor is having marital problems with his spouse and is going to separate. Suppose this counselor is working with a particular client who has an addicted spouse or partner but does not want to separate from his or her partner. It is imperative that the counselor be flexible and respond creatively to the client’s own perception of the problem. In this case, the counselor must not rigidly adhere to the notion that breaking ties is the only acceptable path to recovery. In general, projection of the counselor’s own needs or experiences onto that of the client’s situation can be damaging and/or counterproductive.

CONTEXT FOR COUNSELING

First of all, we need to know the context for counseling.

• Who are the kinds of people who come for counseling?
• What are the kinds of things that individuals returning from drug rehabilitation centers feel?
• What are some the attitudes of the community towards these people?
• What are individuals’ concerns when they seek counseling?
• How might they expect you to help them? 

Why drug users come to seek counseling?

• They are forced by parents, the community, and/or law enforcement agencies.
• They come for methadone treatment, not for counseling, but counseling was a part of treatment, so they joined.
• They come to please someone such as a spouse partner, family member etc.
• They want to quit or reduce their drug use.
  

Why drug users do not seek counseling?

• Many of them think/believe that only they know their problems and no one else can help.
• They deny that they have a drug problem.
• They are too proud to talk about their personal issues, faults or weaknesses.
• They are afraid of breach of confidentiality.
• They have failed many times before and do not want to try again.
• They had a bad experience with a previous counselor who dictated terms or orders for them.
• Counselors have not used drugs so drug users think they won’t understand.

In their daily lives, drug users experience discrimination, stigmatization and rejection.

They are often viewed as criminals and outcasts and a target for the community’s anger and fear.

What do drug users worry about?

• Further discrimination
• Their future
• Others talking about their drug use
• Lack of treatment access
• Counseling won’t work
• Lack of treatment (HIV)

As a counselor, it is important for you to understand drug users’ worries. So, when clients come to you for counseling, you have an opportunity to help them understand how counseling can help relieve many of the worries that they may have. You will learn many techniques and skills throughout this training to assist your clients and alleviate their worries.

MYTHS ABOUT DRUG USE

Although in recent years there is an increasing number of community education programs to raise awareness and understanding about drug use, drug users and community health, there remain many myths about drug users.

• “People who use drugs are always morally weak.”
• “Addicts are beyond help.”
• “All drug users are drug addicts.”
• “All drug users are criminals.”
  

Drug users often resort to crime to pay for their drugs. Some drug users are criminals before they start using drugs. Many people in the community feel that drug addiction is a moral weakness and do not understand that it is a chronic relapsing disorder that involves changes in the brain, body, and spirit of the drug user. They do not understand that these changes make it difficult for some individuals to avoid using drugs.

WHAT IS COUNSELING?

what is counseling? Counseling is the purposeful act of providing professional guidance. It utilizes various psychological methods and techniques to guide the client in a constructive direction.

Counseling is an interactive exchange process between counselors and clients to help clients confidentially explore their problems and enhance their capacity to solve their own problems.

There are some key words that I want to discuss in more detail with you.

One is the word intervention. Counseling is an intervention. When you provide guidance or assist a client in making a decision, you intervene in order to help that person to achieve a desired outcome.

Although individuals may come to talk to a counselor about their problems, they often want to be sure that their visit and information is kept confidential. Remember: counseling deals with sensitive issues and breaking confidentiality could cause serious problems.

In order to be effective, counseling must be client – centered, based on individual needs.

The goal and objectives of counseling should be negotiated between the client and the counselor. Ultimately, clients should feel empowered to solve their problems on their own. The counselor assists clients to understand what options are available to them, and to make informed decisions on how best to proceed.

AIM OF COUNSELING

Counseling is catered to the specific needs, issues and circumstances of each individual client. It is an interactive, collaborative and respectful process that helps clients develop autonomy and responsibility for themselves. Counseling should also be focused, with specific goals obtained by asking questions, eliciting information, reviewing options and developing action plans. It takes into account an individual’s social and cultural context, and readiness to change.

Counseling can be provided to individuals, couples, groups or families.

Counseling is most effective when it is voluntary. It is not possible to direct individuals to change their behavior. The use of motivational interviewing, which will be covered later in this training course, provides a mechanism for encouraging change.

Conversations are a mechanism for exchange of information, but they are not purposeful in changing behavior. Counseling provides more than just a conversation in that it provides direction and guidance for behavior change.

Collaboration in effective counseling is essential; it is important to remain open- minded and flexible in your approach. If you appear to be too intrusive into clients’ thoughts and behaviors, they may react by refusing to cooperate with you.

Remember that counseling is an interactive process through which both counselor and client cooperate on achieving agreed upon short-term goals. You place your faith in each other, rather than in a higher being.

Counseling is not: Telling or directing, a conversation, an interrogation, a confession and praying.

DIFFERENCE BETWEEN COUNSELING AND HEALTH EDUCATION

Counseling : 

1. Usually “one-to-one” or Small or large groups of people
2. Evokes strong emotions in both client and counselor
3. Counselor listens attentively and reflects
4. Focused, specific and goal-oriented
5. Information used to change attitudes and motivate behavior change
6. Issue-oriented
7. Based on needs of the clients

Health Education : 

1. Not usually confidential
2. Small or large groups of people
3. Emotionally neutral in nature
4. Health educator talks more
5. Generalized
6. Information used to increase knowledge and to educate
7. Content-oriented
8. Based on public health needs

A person can be both a counselor and a health educator. But the most important thing is that the person knows which job he/she is doing. Former health educator counselors may often confuse the 2 roles. Remember to set some ground rules with

your client before you start the session. It is appropriate to say that you can provide both education and counseling during a counseling session.

Let’s consider an example of the difference between counseling and health education. In conducting a session on safe sexual practices, health education would entail describing the correct use of a condom, while counseling might entail discussing a client’s concern about why his penis may not stay hard while using a condom.

WHAT ATTRIBUTES MAKE AN IDEAL COUNSELOR

A good counselor is creative and imaginative and can help clients identify linkages between their thoughts, feelings and behaviors. Many clients will appreciate counselors who can help them organize and articulate their thoughts around specific goals they would like to achieve. A good counselor is flexible and can give practical guidance on ways that clients can achieve their goals.

A mutually respectful relationship will lead to shared communication and agreement on how best to proceed. It’s critical not to impose your views or concerns on your client, but rather to understand his/her views and concerns.

THINGS TO AVOID

These are things that you need to avoid when providing drug counseling:

• Moralizing. Remember, the goal of your work is to help clients solve their problems. Never moralize their experience.
• Ordering. You are their counselor, not their supervisor or employer. You have no right to tell your clients what to do.
• Threatening. Try to avoid attitudes or language that make your clients feel that they are threatened. You should provide a supportive environment for your clients to share their problems.
• Arguing. Clients may not heed your advice and may use words that hurt you. Stay calm and help them understand that they have the right to make their own decisions and that you will respect those decisions.
• Disagreeing. Your task is not to determine what is wrong and what is right. This may lead to disagreement between you and your client, which can stall the counseling process.
• Over-interpreting. A counselor’s job is to understand his/her clients and to link their thoughts and goals with a coherent plan. Counselors must avoid over interpreting what clients are telling them. Over-interpreting may lead to misunderstandings of or inappropriate focus on, some of the factors that are critical in influencing behavior change.
• Sympathizing. We will discuss empathy and sympathy later. A professional counselor should not become emotionally involved during the counseling session.
• Judging. Counseling assists clients to identify what puts them at risk. Judging your client may lead to mistrust and denial of problems. You should listen without judging, criticizing or blaming, and try to gain a better understanding of your client from his/her view point.

COUNSELING

• Helps individuals to take charge of their lives by:
• helping them to develop the ability to make wise and realistic decisions
• altering their behavior to produce desirable consequences
• providing them useful information for informed decision making
• Can be for individuals, couples or families
• Should be provided by counselors who are creative and imaginative, use a practical approach, are able to show respect for their clients, are action-oriented, and do not impose their own views or concerns
• Is different from health education

Compiled By – Dr. Valsalan Nair