Counseling
This domain tests counseling skills and evidence-based models. The exam asks you to match the model to the assessment, the client's stage, and the substance involved, and to demonstrate skills that build alliance rather than shame.
Core counseling models
- MI: directive and client-centered; use OARS; elicit change talk and roll with sustain talk.
- CBT: identify triggers, thoughts, and behaviors; conduct functional analysis; practice skills and relapse prevention.
- Contingency management: structured incentives for verified abstinence; strongest evidence for stimulant use disorder.
- 12-step facilitation: active referral, sponsorship, and meeting engagement; complementary, not a replacement for treatment.
- Medications for OUD and AUD: buprenorphine, methadone, naltrexone, acamprosate, disulfiram; counseling supports adherence.
Counseling skills
Active listening, empathy, genuineness, unconditional positive regard, summarizing, and immediacy. Confrontation should be tentative and used to raise discrepancy, not to shame.
Worked example
A client with cocaine use disorder, 21 days abstinent, says, 'I can use on weekends now.' Reasoning: this is sustain talk, not a fact to debate. Use CBT functional analysis of prior use and a contingency plan for high-risk weekends; reinforce the 21 days; explore the discrepancy between his goal and his history. Do not discharge or label him 'in denial.'
Traps
- Arguing with sustain talk.
- Using one model for every client.
- Ignoring co-occurring disorders or culture.
- Giving advice instead of building skills.