Commentary: How to Better Equip Counselors to Help Clients

With an explosion of science suggesting that treatment can work, including laboratory-demonstrated evidence based practices (EBPs), how do we get those treatments into the hands of our treatment counselors? By using strategies that complement counselors’ existing skill sets, and in formats that are immediately useful to counselors’ day-to-day job demands,  I’m betting the outcome would be better for clients.

For many years we’ve been concentrating on that at the Treatment Research Institute, and it looks like we’re on the right track.

Our strategy is called Toolkits. As the name implies, Toolkits are a simple combination of tools that counselors can use to enhance the amount of evidence-based content they introduce to group therapy patients. Our team built a “Relapse Prevention” Toolkit that consists of a number of helping tools – reusable interactive posters, linked assignment sheets and an engaging, humorous video – that counselors can use to model, explain and engage their patients around the laboratory tested principles of relapse prevention. After all, in a chronically relapsing disease, teaching clients about relapse is essential.

Another Toolkit focuses on 12-Step Facilitation, an important EBP. All patients undergoing treatment for a substance use disorder should know about and be encouraged to consider engaging in this continuing care strategy that can be a cornerstone of recovery. The Toolkit is inspired by the corresponding EBP; the difference is in the delivery, as the Toolkit consists of props a treatment counselor can learn on his/her own and, more importantly, can teach to his/her clients easily, without supervision, extensive preparation or lots of funding.

Regardless of the EBP the Toolkit corresponds to, the approach is to empower the counselor through modeling and using a “learning-by-teaching” strategy that assumes that counselors can and will teach themselves how to deliver and use the EBP as they prepare for group. Above all, each Toolkit assumes that clients need to learn about, sample, and incorporate the EBP through practice into their everyday lives, or it won’t work. Toolkits embody the approach that counselors help clients, but that some investment in equipping counselors can improve their consistency and effectiveness in delivering EBPs.

At TRI we extensively tested the Toolkits concept at each stage of development, including acquiring expert input, using client focus groups and having counselors use the Toolkit in actual practice and provide feedback. Early results indicate that counselors like this new approach, and so do clients. Our research also suggests when counselors employed the Toolkit in their relapse prevention groups, their adherence in delivering EBP content increased by a statistically significant amount, with minimal training.

As a researcher, I’m inclined toward evidence-based practices. Yet having been a clinician in a former life, I sincerely come by my bias for approaches that work in real-world, actual conditions under which a counselor operates and a patient is treated. If science can “point the way” in treatment, why not apply science in a way that brings out the best in our clinicians – the front-line agents in our field?

Adam C. Brooks, PhD

Adam C. Brooks, PhD is a research scientist at the Treatment Research Institute in Philadelphia, an independent, non-profit research and development group specializing in science-driven transformation of treatment, practice and policy in substance use and abuse.

12 Responses to Commentary: How to Better Equip Counselors to Help Clients

  1. Roger Macauley | October 21, 2011 at 2:40 pm

    So how does one get a toolkit? I’m interested. Could someone let me know?

  2. Hazel F. | October 21, 2011 at 3:57 pm

    You can go to their website at Treatment Research Institute. Looks like the cost is $750.00

  3. Nna Smart-Dixon | October 21, 2011 at 4:11 pm

    I do I purchase a toolkit

  4. Nna Smart-Dixon | October 21, 2011 at 4:12 pm

    How do I purchase a toolkit of the ones spoken of in the article

  5. Wajiw | October 21, 2011 at 5:01 pm

    You need science to tell you that tx works?

    • Joshua | October 26, 2011 at 4:21 pm

      yes, otherwize it’s called faith healing, and you get into strange practices like AA; which people believe works, but actually has the same success rate as no treatment at all.

  6. Ben House | October 21, 2011 at 8:46 pm

    The article suggests TRI drew from evidenced based practice and developed their own tool kits. That makes more sense to me; your tools might not work for me, but EBP makes sense. Is there a user friendly listing of the components of an EBP?

    • Bonnie Catone | October 25, 2011 at 11:11 am

      That’s a good question. These particular Toolkits we’ve designed are useful in a particular situation – group therapy for individuals with substance use disorders that focuses on cognitive-behavioral relapse prevention or 12-Step facilitation. These evidence based practices won’t be appropriate for every situation.

      Unfortunately, I am not aware of a list of basic components of an EBP, because EBPs are different and come in various formats to address various problems. A list of comparable components would not be easy to put together. For example, buprenorphine and naltrexone medication protocols are evidence based, but their basic components would be very different from the basic components of CBT. However, what EBPs do have in common is that they have been demonstrated in randomized clinical trials to bring some clinical benefit to clients relative to clients not receiving the EBP.

      A broad resource we can refer you to is SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP), which is at http://nrepp.samhsa.gov/. This is a clearinghouse of interventions that have been demonstrated to have some evidence base, and they are broad and fit many different clinical situations. Each intervention will include a write-up of how it works, components of the intervention, and a write-up of the evidence supporting it. With all registries, you should still be a savvy shopper, as there are still stronger and weaker EBPs on this list.

      Thanks for your question

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