Clinician’s Training Package

Responding to Mental Health Issues Within Drug & Alcohol

Treatment

These training resources were funded by Drug Strategy Branch, Australian Government Department of Health and Ageing through the National Comorbidity Initiative

Exercise 1: Who Here Do You Think…

• Loves The Simpsons?• Can change a flat tyre?• Exceeds the speed limit?• Snores?• Is kind to dogs?• Would tell you that you have bad breath?• Is trustworthy?

Exercise 2: How Are YouThinking-Feeling-Doing?

• What are your THOUGHTS about working with clients with comorbidity?

• What are your FEELINGS about this training?

• Notice how you BEHAVE when I say we have 2 days to get this on board?

A Snapshot: Training Modules

Module 1

Introduction to

comorbidity

Module 2

CBT

Module 3

Pre session preparation

Module 4

Implementation of Brief

MH Intervention

•PsyCheck Mental Health Screen

•Context

•Development

•Implementation

•Scoring

•Theory of CBT

•Principles & application

•CBT in practice

•Assessment

•Case Formulation

•Treatment planning

•Psychoeducation

•Introduce CBT model

•Self monitoring

•Identify thoughts

•Manage thoughts

•Relapse planning

•Termination

Module 1

Introduction to Comorbidity &PsyCheck Mental Health Screen

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Aims of Module 1

• To provide a context for the PsyCheck Screening Tool

• To understand the development and psychometric properties of PsyCheck

• To gain skills in implementation, scoring and interpretation of PsyCheck

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Overview of Components of Module 1

• Introduction to Comorbidity• Development of PsyCheck • Psychometric properties of the PsyCheck

Screening Tool• Negotiating the Users Guide• Administering the PsyCheck Screening Tool

• Mental Health Screen• Suicide/Self-Harm Risk Assessment• Self Reporting Questionnaire Tool

• Interpreting the PsyCheck Screening

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Introduction to Comorbidity

• Up to a third of mental health clients have an AOD problem• May be referred in to AOD services

• Up to 80% of AOD clients also have a co-occurring mental health problem• Many more may have subclinical symptoms

• Rule rather than the exception in treatment settings

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Introduction to Comorbidity

• Those that have comorbid AOD and mental health problems have• Poorer prognosis• Higher risk of harm• Greater likelihood of relapse to both disorders• Greater use of health services

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1. Secondary Psychopathology Model

2. Secondary Substance Use Model

3. Bidirectional Model

Models of ComorbidityM

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Models of Comorbidity

4. Common Factor Model

5. No Relationship Model

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Comorbidity in Practice

• Comorbidity is the norm• In both mental health and alcohol and drug

services

BUT• Client group is very different in each

service

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Comorbidity in Practice

• In Mental Health Services• Mostly psychotic disorders with range of

alcohol and other drug issues

• In Alcohol and Drug Services• Mostly high prevalence disorders: anxiety and

depression• Often not able to refer to Mental Health

Services• Often have subclinical symptoms: often go

undetected

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Treatment for Comorbidity

• Sequential• Treat one problem first

• Parallel• Simultaneous treatment in different service

provider

• Integrated• Integrated treatment by same service

provider• Best empirical support• Client and clinician preference

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Comorbidity Training

• Many AOD clinicians report training is• Concentrated on acute low prevalence

disorders• Focused on relationship building with Mental

Health Services

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PsyCheck Developed to Address Gaps

• Designed for AOD clinicians with little or no experience in mental health interventions• But can still be used by experienced clinicians

• Focused on the disorders most commonly encountered in AOD Services• Anxiety, depression, some somatic symptoms

• Offers a screening tool and articulated intervention

• Offers options for training and support through clinical supervision

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PsyCheck Overview

• Screening and intervention for anxiety and depression among AOD clients• Brief screening• 4 session intervention

• Youth modifications• Extension material

• Accompanying resources• PsyCheck Screening Tool• PsyCheck Screening Tool User’s Guide• PsyCheck Clinical Treatment Guidelines

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PsyCheck Overview

• Comprehensive capacity building• 4 module workshop• Clinical supervision

• Part of a whole organisation approach to improving comorbidity services for our clients• Managers resources (Implementation

Guidelines)• Clinical supervisors resources (Training and

Clinical Supervision Guidelines)

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PsyCheck Screening Tool

• PsyCheck Screening Tool scientifically validated

• A general mental health screen, including history of treatment

• A suicide/self harm risk assessment• The Self Reporting Questionnaire (SRQ)

• World Health Organization instrument• Assesses current symptoms of anxiety,

depression and somatic disorders

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PsyCheck Intervention

• Evidence based: drawn from empirically supported treatment

• Intervention is designed to be integrated into routine AOD practice

• CBT principles used in both AOD and mental health• Best practice in both sectors• Easily integrated• Easily manualised

• Focus on scientist-practitioner approach• Hypothesis testing• Reflective practice

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Psychometric Properties

• 120 newly engaged AOD clients• PsyCheck Screening Tool compared to

General Health Questionnaire (GHQ)• Both compared to a diagnostic instrument (CIDI)

• Results• SRQ superior to GHQ in predicting anxiety and

depressive disorder• Cut-off identified that indicates presence of

disorder• General mental health screen good indicator of

psychosis

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Negotiating the PsyCheck User’s Guide

• About the PsyCheck Screening Tool• Statistical properties

• Decision tree• Administration and scoring

• General mental health screen• Suicide risk/self harm assessment• Self Reporting Questionnaire

• PsyCheck Screening Tool• Sample contingency plan

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Administering the Screening Tool

• Designed for routine screening (all clients)

• Administer the whole SRQ• Other parts only if information not already

collected• Suicidality monitored over time

• Suicide assessment a framework not a checklist• Clinical judgement is required• Assess risk of harm to others in same way

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Exercise 3: Celebrity Squares

• Work in groups of 3

• Select a celebrity square• One person plays the celebrity• 2 clinicians assist each other in administering

the PsyCheck Screening Tool

• Group Discussion

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Interpreting the PsyCheck Screening Tool

• Intervention or further assessment is required if• The client reaches 5 or more on the SRQ• The client is at risk of suicide/self-harm• The client has a mental health history

• Consider• Readiness to change• Current symptoms

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SRQ Interpretation

Total Score

Interpretation Action

0 No symptoms present. Re-screen using the PsyCheck after 4 weeks

1-4 Some symptoms of depression, anxiety and/or somatic complaints indicated.

Offer Session 1Re-screen after 4 weeksProvide self-help material

5or above

Considerable symptoms of depression, anxiety and/or somatic complaints indicated

Offer Sessions 1-4Re-screen after 4If no improvement after re-screening, consider referral

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Decision TreeM

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Exercise 4: Celebrity Squares - What Next?

• Work in the same groups of 3• From the information you’ve collected

refer to the Decision Tree and determine what the next steps would be for your celebrity client

• Think about• Past mental health questions• Suicide assessment, and• SRQ score (and the types of answers endorsed)

• Group Discussion

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What’s on Your Mind – Is It This…?

I’m never going to get this

I may as well give up now

I’m useless

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Or This …?

I’m getting some of

this

If I hang in it will fall into place

I feel confident I will get it

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Or Maybe This …?

This is too easy… What if I get

bored…

I’ll think about how I can use it in my practice

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Module 2

Cognitive Behaviour Therapy

Aims: Module 2

• To understand the theory of CBT

• To understand the principles of application underpinning the PsyCheck intervention

• To understand of the practice of CBT

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Overview: Module 2

• Introduction to CBT• Theoretical underpinnings• CBT Model• Evidenced based practice

• CBT in practice• Standard sessions• Self-monitoring

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Exercise 5: What Works for You?

• Working individually complete the worksheet, identifying which models you have an affinity with

• Then circle the main model you work with• Now find someone else in the room that uses

a DIFFERENT model to the one you typically work with and discuss with your partner• Why you use this model/strategies you do?• How you know it’s working ?

• Group discussion

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Planned Approach

• There is emerging evidence that a single theory planned approach is more effective than an ad hoc one• Most effective to have a single framework or

philosophy about treatment and incorporate a range of techniques and strategies that fit with your philosophy

Cognitive Behavioural Approach

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Evidenced Based Practice

• Best evidence for CBT compared to other types of therapies• Most high level research (RCTs) and the most

positive research• Effective for a wide range of mental health

problems including AOD, anxiety and depression

BUTWhatever framework you use, you can create your own evidence through measuring individual outcomes – CBT emphasises this

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What is CBT?

• Therapy examples• Cognitive Therapy (Aaron Beck)• Relapse Prevention (G. Alan

Marlatt)• Coping Skills Therapy (Peter

Monti)• Mindfulness Therapy (Mark

Williams)• Schema Therapy (Jeff Young)• Dialectical Behaviour Therapy

(Marsha Linehan)

• Strategy examples• Problem Solving• Goal Setting• Cue Exposure Therapy• Thought stopping• Urge surfing• Activity scheduling…

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• Umbrella term for a range of therapies with a cognitive and/or behavioural focus

In Comparison…

• Solution-Focused Therapy• An understanding of the past and cause of

problem not necessary for resolution of the problem

• Change occurs as a result of a focus on the future without the problem

• Narrative Therapy• Focus is on meaning, narrative and power• Talking about the influence of problems

enables talk about their defeat via the new stories

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In Comparison…

• Gestalt Therapy• Focus is on the present rather than past or

future • Central aim is awareness-raising and creating

conditions to de-construct dysfunctional fixed or habitual patterns of interaction  

• Change occurs through understanding and acceptance of what is

• Psychodynamic Therapy• Focus is on initial underlying causes• Understanding and having insight into the

problem leads to change• Therapeutic relationship is the key to change

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What is CBT?

• ‘Self-help’ oriented• Clinician provides tools and framework for

change• Client’s responsibility to create and maintain

change

• Skills oriented• Attention to therapeutic process vital but not

sufficient in itself for change to occur

• Structured but not inflexible• Clinical judgement necessary

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CBT Principles

CBT…• is based on an ever-evolving

formulation of the client in cognitive terms

• requires a sound therapeutic alliance• emphasises collaboration and active

participation• is goal oriented and problem focused• initially emphasises the present

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CBT Principles

CBT…• is educative, aims to teach the client to

be their own therapist, and emphasises relapse prevention

• is time limited• sessions are structured• teaches clients to identify, evaluate and

respond to their dysfunctional thoughts and beliefs

• uses a variety of techniques to change thinking, mood and behaviour

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Exercise 6: Mix ‘n’ Match

• From the cards you have been given, keep the ones that represent the way you work (in the majority) and trade unwanted cards for wanted cards with other participants

• Either• Line up on the cognitive/behavioural continuum

to show whether you work more in a cognitive or behavioral approach, or

• Place your cards on the grid (cognitive/behavioural vs skills/process)

• Group discussion• Why did you put your card or yourself where you

did?• Did the cards fall in a pattern?

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The CBT ModelM

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Early Experience

Feelings

Core beliefs

Unhelpful thoughts

Trigger

Behaviour

Bruce: Eating DisorderM

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Absent father, poor role models

I’m unlovable and need food to

make me happySmell of

restricted food

CravingOver-eating, relapse

Eating makes me feel better

Bruce: Simplified CBT ModelM

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Bruce: ABC ModelM

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Exercise 7: The Cognitive Model

• In pairs take it in turns to use the CBT model worksheet, choose a simple target problem for example, eating chocolate, public speaking, learning a new skill• Use a recent real example or a made up one

• Complete the CBT model sheet with thoughts feelings and behaviours.

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Typical Session Format

• I: Review and feedback from last session

• II: Information and practice of session topic

• III: Summary and feedback from this session

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CBT in Practice I: Review and Feedback

• Check-in past week, mood/drug use, homework• ‘What’s been happening this week?’• ‘How’s your [mood] been this week?’• ‘How did you go with your homework?’

• Bridge from previous session• ‘Remember last week we talked about [x]… did

you have any more thoughts about it?’• ‘Were you able to get any practice of [skill]’

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CBT in Practice II: Info & Practice

• Information about skill• ‘last week we talked about [identifying

thoughts] this week I thought we’d talk about how to manage those thoughts…’

• ‘Remember the cognitive model…the way I like to think about it is…’

• Practice of skill in session• ‘let’s try to do this together…’ [use

whiteboard]

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CBT in Practice III: Summary & Feedback

• Summary and feedback• ‘so what we talked about today was…’• ‘how does that fit with you…?’

• Set homework tasks• ‘it’s really important to practice these things

between sessions so they become second nature… what do you think you could do that would help you remember what we did?’

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Exercise 8: CBT Demonstration I

• A. Watch video demonstration of basic elements of a session• Discussion about the elements as a group

• B. Practice the elements in pairs• Feedback to each other good aspects and an

area for improvement

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Stepped Care Approach

• Interventions are applied from the least to most intensive

• Each step is incremental based on the client's response to the previous one

• A stepped care approach can add flexibility to treatment and improve outcomes

• CBT (and PsyCheck) facilitates the stepped care approach

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The Therapeutic Relationship

• Therapeutic alliance vital• Basis of ALL therapy• Requires good counselling skills• Necessary but not sufficient condition for change

• Collaboration and active participation by client and clinician essential• Requires good active and empathetic listening

skills• CBT builds therapeutic alliance through

collaboration and encouraging client involvement in their own therapy

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Clinical Judgement

• Clinical judgement is required, even though the therapy is manualised• Use PsyCheck as guidelines – follow steps

only as closely as you need to• Use flexibly with extension material to tailor

to client’s needs• Consider client’s needs• Consider existing clinical practices and

pathways

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Integrated Treatment

• PsyCheck designed to be integrated into routine AOD treatment• Techniques are deliberately similar to those

in AOD treatment

• Emphasise to the client the link between AOD use and mental health problems

• Consider ways in which you can integrate into what you already do

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Exercise 9: Therapeutic Process

• In small groups (3-4) discuss how therapeutic processes can be used in CBT

• What makes a good therapeutic alliance - list as many elements as you can?

• What could happen if you don’t have a good therapeutic alliance? Think about the client, the practitioner and the therapy relationship

• Group discussion

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Let’s Take a Breather…

What have we learned so far…..?

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Homework

What brief practice at home would assist you to consolidate the knowledge you gained in this module?• eg. Use the CBT model on your self• eg. Further reading about CBT• eg. Practice explain the CBT model to a

client/colleague

Next session you will be asked to share your experience of self practice if you are willing, (but not of the actual target problem itself if you used yourself as a client)

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Module 3

Pre-Session Preparation: Assessment, Formulation and

Treatment Planning

Before We Start…

• What did we do last time?• What is your feedback about what we

covered?• Homework feedback

• Challenges in completing the homework?• What was the effect of self-practice?

• Next step…?

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Exercise 10: The Young and The Restless

• Work in groups of 3, you have just interviewed your celebrity. Write a few lines using the following criteria as if you were writing for a trash magazine• Their current problem • Their presenting mood/feelings• Thoughts • Behaviour• What’s driving the behaviour• Consequences of behaviour

• Present to the large group

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Example: Jen X

Jen X 38, an actor made a rare appearance in public today after husband Y, a singer was admitted to the famous Betty Ford clinic. X hasn’t been seen for weeks. Sources close to the actor say she has been increasingly worried about the singer’s behaviour. ‘She’s looking really drawn and a bit depressed’ says a close friend. ‘She says she can’t bear to go out of the house and it’s really starting to get to her’. It is thought that X’s two adopted children are being cared for by family.

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Trigger

Behaviour

Thoughts

Feelings

Consequences of behaviour

Presenting issue

Aims: Module 3

• To understand how to screen for mental health issues and prepare feedback

• To understand how to undertake a cognitive behavioural assessment

• To understand how to collect sufficient information to develop a cognitive behavioural formulation

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Overview: Module 3

• Negotiating the PsyCheck Intervention & Clinical Treatment Guidelines

• Undertake screening and preparing feedback

• Undertake a cognitive behavioural assessment

• Prepare a preliminary case formulation

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Negotiating the PsyCheck Clinical Treatment Guidelines

• Designed for a range of experience and background• Manualised for new clinicians• Use flexibly for experienced clinicians

• Use with• Introduction to PsyCheck package• PsyCheck Screening Tool and User’s Guide

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Negotiating the PsyCheck Clinical Treatment Guidelines

• Three sections• Principles of intervention• Practice Guidelines• Extension material

• Worksheets

• Modifications for young people

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Practice Guidelines

• Pre-session preparation: Reflection• Prepare feedback from the PsyCheck Screening

Tool• Cognitive behavioural assessment• Cognitive behavioural formulation• Treatment planning

• PsyCheck intervention• Session 1: Introduction• Session 2: Identifying unhelpful thoughts• Session 3: Managing unhelpful thoughts• Session 4: Relapse prevention

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Screening in Context

• PsyCheck screening• Snapshot of potential need

• Feedback• Results of PsyCheck Screening Tool• Any other information gathered

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Cognitive Behavioural Assessment

• Also known as ‘functional’ assessment

• Occurs during an assessment session and continues through therapy

• Functional vs structural/diagnostic analysis• Drivers vs descriptors of behaviour/problem

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Cognitive Behavioural Assessment: 7Ps

• Presenting issues• Pattern (onset and course)• Predisposing factors• Precipitating factors• Perpetuating factors• Protective factors• Prognosis• Other factors

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Exercise 11: Something Fishy

Bruce• Discussion

• Identify elements of the functional assessment for Bruce

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CBT Case Formulation

• Case formulation is• Theory driven• An interpretation - more than a case summary

or summary of presenting problems• A working hypothesis to be reviewed• Dynamic - as new information comes to hand,

your formulation is reviewed, added to, changed

• The case formulation puts the 7Ps into a context

• Always present it to your client and ask for their response

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The Purpose of Case Formulation

• Clarifying hypotheses and questions• Understanding the overall picture• Prioritising issues and problems• Planning treatment strategies• Predicting responses to interventions• Identifying barriers to progress

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Assessment, Formulation and Treatment Planning

ScreeningCognitive

Behavioural Assessment

Case formulation

Treatment Plan

AOD Assessment

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Exercise 12: Fishy Formulation

• Identify the components of formulation as a group

• In small groups, use the information from the earlier exercise, Something Fishy• Write a formal formulation from this

information• Use the formal formulation to ‘translate’ this

into language suitable for a client

• Group discussion

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Exercise 13: Gummy Shark

• Return to your small groups, use the previous case formulation and develop the treatment plan for Bruce including:• Immediate strategies• Longer term strategies• Referral options

• One person in your group to role play Bruce and share presenting the formulation and treatment plan to him• Think about the stage of change, insight and

the way you present it to him. Notice how he responds.

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Checking in Again…

Let’s go back over what we’ve done so far…

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Module 4

Implementation of Brief Mental Health Intervention

Exercise 14: First Response

• Write down your immediate response to the following• Standing in a long line at the supermarket• A heavily tattooed woman• Someone throwing a cigarette out of a car• Running late• The beach• Case formulation

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Aims: Module 4

• Understand cognitive behavioural practice to undertake the PsyCheck Intervention

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Overview: Module 4

• Negotiating the step-by-step guide to the 4-session PsyCheck Intervention

• Session 1: Psychoeducation• Session 2: Identifying unhelpful thoughts• Session 3: Managing unhelpful thoughts• Session 4: Relapse prevention

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A Snapshot: Practice Guidelines

Session 1

Psychoeducatio

n

Session 2

Identifying unhelpful thoughts

Session 3

Managing unhelpful thoughts

Session 4

Relapse prevention

•Present case formulation to client

•Provide info on symptoms

•Explain CBT

•Homework

•Links between thoughts & feelings

•Identifying unhelpful thoughts

•Homework

•Challenging unhelpful thoughts

•Homework

•Identifying triggers

•Identify early warning signs

•Breaking the rule effect

•Termination

•Rescreening

Pre PsyCheck Preparation

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Session 1Presenting the Case Formulation and Beginning Psychoeducation and Self

Monitoring

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Session 1: Psychoeducation

• Psychoeducation can be about:• Current symptoms• What’s going on for the client (formulation)• CBT model

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Session 1: Psychoeducation

1. Present case formulation to the client• Get feedback and modify as appropriate

2. Provide information about current symptoms• Use worksheets 1, 2 and 3

3. Explain CBT model to the client• Alternatively, use simplified version

(extension material)• Work through an hypothetical or personal

example depending on readiness to change

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Session 1: Treatment Planning

• Link the formulation and treatment• Explain in detail how they are linked using

personal examples

• Develop a treatment plan with the client• Identify areas for intervention and priorities

based on the formulation• Emphasise revisiting both formulation and

treatment plan regularly

• Finalise and record treatment plan• Give client a copy

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Session 1: Introduce Self-Monitoring

• Use Worksheet 4: Self monitoring• Explain the role of self monitoring

• A temporary tool until it becomes automatic

• Explain the process of self monitoring• Work through example with client• Give client a copy to take home

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Exercise 15: Self Monitoring

• Large group discussion• What assists clients to understand self

monitoring?• What can clinicians do to get in the way of

effective self monitoring?• How do you know if you are being effective or

obstructive?

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Session 1: Session Summary

• Summarise content and ask for feedback from the client

• Emphasise the importance of take home tasks

• Set homework – Self Monitoring• Identify any difficulties with content• Identify easiest method

• Immediate recording, once a day etc

• Emphasise importance

• Prepare for next step• Outline next session topic• Organise next appointment or discharge

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Session 1: Extension Material

• Simplified explanation of the CBT model• Alternative explanation of CBT model:

ABCs

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Exercise 16: Please Explain…

• Work in groups of 3• One person plays the client, one the

practitioner and one the observer• Use the celebrity’s PsyCheck Screen and other

information you have gathered to inform this session

• Together develop a formulation for your celebrity and the practitioner then explains it to the client; integrate any other psychoeducation material that the client would benefit from

• Group discussion

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Session 2Identifying Unhelpful Thoughts

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What’s That Noise?

Must be a cat

OH NO! There’s someone out there

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Exercise 17: Spot the Unhelpful Thought

• Use the Unhelpful Thoughts Worksheet• What are your thoughts?

• Are you a black and white thinker?• Do you jump to negative conclusions?• Do you catastrophise?• Are you a personaliser?• Are you a should/ought person?

• How do you manage these unhelpful thoughts

• Group discussion

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Homework Non-Completion

• Client didn’t understand the task• More explanation AND practice

• Task was too difficult• Simplify

• Task was too time-consuming• Do in stages or in parts• Do on some days

• Readiness to change• Motivational approach

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Session 2: Information

• Reiterate the CBT model• Explain negative bias/interpretation• Use monitoring to identify areas of

(mis)interpretation of events• Make personal link between thoughts and

feelings and behaviours

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Session 2: Practice

• Identify unhelpful thoughts• Use self monitoring sheets as examples• The aim is to raise awareness about when

unhelpful thoughts occur• Focus is on catching thoughts as they occur

rather than allowing them to create negative mood

• Label unhelpful thoughts• Use Worksheet 5

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Session 2: Extension Material

• Behavioural activation• Very important especially for depression

when people often withdraw and lose interest in usual activities

• Focus both on pleasant activities and usual daily activities (showering, washing up)

• Guidelines for better sleep• Especially important for those with anxiety

and depression who often have difficulty sleeping

• Relaxation• Helpful for anxiety and depression

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Exercise 18: CBT Demonstration II

• Watch the video of Richard and Lynn discussing the thinking-feeling-doing cycle

• In small groups, one person plays the celebrity while the others explain the thinking-feeling-doing cycle using the celebrity’s information that you have gathered previously and to identify some of their unhelpful thinking

• Group discussion

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Session 3Managing Unhelpful Thoughts

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Session 3: Information

• How to challenge unhelpful thoughts• Go through Worksheet 6 with examples

• Two main strategies for challenging thoughts:• Is this a misinterpretation?

• Is there another way to think about this?

• If not, is it helpful to think this way?• Even if it is true perhaps it doesn’t help me if I think

this way

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Session 3: Practice

• Practice challenge unhelpful thoughts• Use monitoring sheets completed for

homework• Assist client to practice the process from

monitoring sheet• Use Worksheet 6 as a reference

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Session 3: Extension Material

• Communication skills• Assertive communication skills are important

for those who are anxious in social situations and for those who are depressed and have withdrawn from public

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Exercise 19: Celebrity Challenge

• Work in groups of 3• One person plays the client, one the

practitioner and one the observer• Use the celebrity’s previous CBT model to

assist• Help the celebrity identify and challenge one of

their unhelpful thoughts • Use Worksheet 4 & 7 to assist you

• Group discussion

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Session 4Preventing Relapse

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Session 4: Information

• Discuss triggers and early warning signs• Use Worksheet 8 to explain the ‘breaking

the rule effect’• Use Worksheet 9 to emphasise looking

after yourself

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Session 4: Practice

• Develop a relapse prevention plan• Explore ways the client can regulate thoughts

and feelings• Emphasise the need for additional skills and

supports• Remind the client to self-reward• Encourage the client to take care of themself

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Session 4: Termination

• Summarise content of sessions 1-4 and ask for feedback from the client

• Reinforce gains and effort• Re-emphasise the importance of

continued practice• Reminder about tasks to continue with

• If continuing AOD treatment check homework in subsequent sessions

• Prepare for next step• Manage concerns using a motivational

approach• Consider and discuss referral options• Boosters/continued intervention

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Session 4: Extension Material

• Problem solving• Seemingly irrelevant decisions

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Exercise 20: Celebrity Survivor

• Work in groups of 3• One person plays the celebrity client, one the

practitioner and one the observer – swap roles from last exercise

• Summarise for the client and develop a relapse prevention plan

• Group discussion

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Rescreening

• Rescreening has benefits for both the clients and clinician:• Monitoring client progress with the client can

assist to build the client’s self efficacy as they see themselves improving

• Clinicians can monitor and reflect on their own practice using objective ‘data’

• Clinicians can reorient therapy if no improvement and reflect on potential gaps in treatment

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Support: Clinical Supervision

• Optimal supervision:• A single consistent supervisor to build a

relationship• Weekly or fortnightly supervision preferable• Individual supervision as a minimum• Group and/or peer supervision as an adjunct

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Lights… Camera… ACTION…

• What aspects of the training do you feel comfortable with?

• What areas will you need to work on?

• What will you do differently in your practice• In the next few weeks?• In the next year?

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