1. Dr. George Kolodner February, 2014 Kolmac Clinical Model “Continued”

2. Now Let’s Take A Pre-Assessment…

3. Agenda Pre-Assessment Review Learning Objectives Follow-up: ▫ Limit Setting ▫ Motivational Interviewing New: ▫ Counseling vs. Psychotherapy ▫ General Group Related Issues ▫ Rounds ▫ Group Therapy (Begin) Post-Assessment

4. Learning Objectives At the end of this session you will be able to: 1.Identify the difference between adversarial and non-adversarial confrontation. 2.Compare and contrast counseling versus psychotherapy approaches to treatment. 3.Understand the purpose of Rounds. 4.Recognize when the group therapy process is optimal.

6. Limit Setting: Avoiding Extremes Examples Too loose -Bringing in Antabuse Too rigid - 3 relapses and you’re out

7. Motivational Interviewing: Confrontation Goal: to shift an external conflict to an internal one o Having patients come “face to face” with themselves rather than with the clinician, i.e. “self-confrontation” Strategy o Listen for discrepancies between stated values and behavior o Supportively encourage patient to explore these discrepancies

8. Motivational Interviewing: Types of Talk With ambivalence, expect a mixture of: 1.“Change talk”: any self-expressed language that is an argument for change Strategy: elicit and support 2.“Sustain talk”: the person’s own arguments for not changing Strategy: do not elicit o Respond to its appearance with reflection

9. Counseling vs. Psychotherapy Clinician is Actively Engaged in Both CounselingPsychotherapy Leading, more directiveFollowing StructuredLooser External focusInternal focus Listen for, elicit, and support “change talk”

10. Counseling vs. Psychotherapy You have someone who says they wants to go to a meeting but hasn’t gone yet. What do you do? So you have provided an intervention and they are back in group, but they still haven’t gone to a meeting. Now what do you do?

11. Counseling Examples Committing to attending a community recovery support group Analyzing relapses using Relapse Sequence Model

12. Rounds How do you do it? What if someone says, “I don’t have anything to say today?” What do you say? Does the staff member who is not leading rounds, make comments during rounds? How do you finish an interaction during rounds? How do you handle timing in rounds?

13. Rounds Aim for a genuine, individualized interaction -Avoid routine, repetitive questions and comments -Leader should have been in group the previous day to know details Pace and timing - Adjust to group size -Be alert to rambling. Listen for repetitions -Designate staff member as timekeeper? Other staff should feel free to add questions or comments about issues unknown to leader

14. Group Therapy How do you know when the group is on track?

16. Group Therapy: Color Zones Broad Participation, Recovery Relevant Red: neither Yellow: broad participation OR high relevance Green: both broad participation AND relevant - After getting to green: strive for optimal emotional depth

17. Questions and Answers

18. Post-Assessment