Counseling and Service Coordination
Counseling applies evidence-based approaches-motivational interviewing, cognitive behavioral therapy, contingency management, 12-step facilitation-matched to the client's stage of change. Candidates should understand motivational interviewing's spirit (collaboration, evocation, autonomy) and techniques (open questions, affirmations, reflections, summaries), and recognize change talk versus sustain talk. Know the stages of change (precontemplation, contemplation, preparation, action, maintenance, relapse) and that interventions differ by stage-confrontation is inappropriate for a precontemplative client.
Service coordination means linking the client to medical, psychiatric, housing, vocational, and legal services, and monitoring progress across providers with appropriate releases. Traps: choosing confrontation when the client is not ready; confusing empathy with agreement; ignoring the difference between lapse and relapse; and failing to coordinate care or obtain consent for information sharing. Also watch for boundary issues in dual relationships and for the counselor imposing personal values.
Rule of thumb: meet the client where they are-match the intervention to the stage of change. In MI, roll with resistance rather than arguing; arguing creates more resistance.
Worked example: A client in precontemplation says, 'I don't have a problem.' Arguing is a trap. Reflective listening ('You don't see your drinking as a problem right now') and exploring ambivalence are appropriate; a detailed relapse-prevention plan is premature.