 Hey everybody and welcome to the addiction counselor exam review. This one isn't technically one of those topics that's in your addiction counselor exam review booklet. So it's probably not going to be on the exam, but I did have a request from somebody who is getting ready to start working as an addiction counselor and getting ready to get certified who wanted to know a little bit more about how to start individual counseling sessions and group counseling sessions and maybe kind of some tips on how to facilitate them. So that's what I'm going to do this week is just kind of share with you some tips that I do. Now there are a lot of different ways to facilitate individual and group counseling sessions. So the way I tell you isn't necessarily the be all and all way. It's just what works for me and you'll find your own rhythm and your own method as you get into it. So let's get started. We're going to talk about techniques to start and facilitate individual sessions first. And then we're going to move on to ways to facilitate process groups, random and planned psychoeducational groups. So remember process groups are those groups where we really talk about feelings and work through the process, hence the name. And psychoeducational groups are what teaches skills and tools. And that'll become a little bit more clear as we go through the presentation. So in general, how you start and manage individual and group sessions depends largely on your own counselor theoretical approach. A psychoanalytic therapist is going to approach it differently than a cognitive behavioral than a humanistic therapist. So your approach is really going to have a great effect on the way you choose to facilitate things. The other major impact that's going to affect how you do individuals and groups are the personal characteristics of the client such as age, you're not going to do as long or in depth of a session with someone who is maybe a young adolescent, or with someone who is advanced in age and maybe experiencing some cognitive decline, you're going to be looking at cognitive functioning. People who are impaired in some way are going to need a different approach than people who aren't. So anybody who's recently out of detox or in detox, anybody who is experiencing any sort of cognitive malfunction, whether it be due to traumatic brain injury or organic issues or whatever, or just age, I mean, children function cognitively differently than we do. And that is true for adolescents too. We don't want to just think that high school kids are little adults. We do need to pay attention to their cognitive functioning needs. Other things that are going to impact how you facilitate the session include distracting factors and that can be anything from something that's going on with the client. Maybe they have a cold that day or chronic pain. I've worked with clients who have maybe chronic back issues or other things, and they can't sit down for an entire hour. So the way I facilitate the sessions differs with those people because we take frequent breaks, we get up, we move around, we do other things in order to maintain their comfort so they can focus cognitively on what we're talking about. And then the presenting issue, you're probably going to do a much different group or individual session if you're talking about PTSD than if you're talking about relationship skills or self esteem development. So all of these things are going to impact the way you really carry out the entire session. But there are some general tenants that we can look at in terms of structure. So for individual sessions, regardless of your theoretical approach, in the first session, you're developing rapport and empowering the client. You want the client to feel like they have a say in what happens. They have a say in their treatment and that you are taking what they have to say seriously. It's not this expert and client role. They're the expert on themselves. They've lived in their body for, you know, 15, 30, 45 years. So they are the experts on themselves. We're the experts on book learning. So both of us, if you want to think about it that way, are experts and we bring different information to the table. So we want to ask the client from jump, what is it that you want to accomplish? You're here, you know, that tells me there's something that you want to accomplish. And it doesn't matter what kind of program you're in. If you're in a substance abuse program, you can pretty well guess that the person may be struggling with some substance abuse issues. But that may not be where they're focused right now. Maybe what they want to accomplish is to avoid divorce or avoid going to jail or avoid getting violated on their probation. That's what they want to accomplish. They're not really ready to address some of the other stuff. So let's start with a strength based, brief approach and figure out what do they want to accomplish? Because even if you're, you know, we'll take keeps with substance abuse right now. Even if they're coming to you and they're on probation, and they have to come to counseling as a condition of their probation, their goal may be just to get off probation and not get violated. They may have no intention right now of ever stopping using. Okay, that's fine. You know, I'm not going to look that far in advance. What I'm going to say is, All right. Well, in order for you to not get violated, you have to stay clean while you're on papers. So let me help you figure out how to stay clean while you're on papers. What you do after that, that's your decision. And you can decide from there. But what we're going to do is work on mutually agreeable goals. Share your understanding of the person's situation to make sure you're on the same page. So if you're going through it and you're saying, Okay, you've got three DUIs and you've been fired from your job for being drunk at work and yada, yada, yada. So I'm what I'm seeing is you're here for treatment for alcoholism. And the client may say, No, I'm here because I have to be. They're not ready maybe to work on their alcoholism. Or they may say, You know what, I've got really bad depression. And that's the reason I drink because I'm depressed all the time. And, you know, I think I really need to work on my depression and then I wouldn't drink as much. Okay. Well, you know, again, mutually agreeable goals. But I want to understand what is the client motivated to work on? Ask the client to prioritize which problems he or she wants to address first. That is, you know, what's most important to you? Some of them maybe want to work on relationship issues, some mood issues, some chronic pain, you know, clients come in in various stages of readiness for change for every single problem. So I want to know, What are you motivated to work on right now? Ask the client what he or she thinks might be helpful to approach the issue. They've probably tried things. So they know sort of what doesn't work. Or they have a pretty good idea what doesn't work. So I don't want to rehash things that don't work. Let's start out with what do you think might work? And if they don't know, Okay, you know, that gives us a place to start from. But if they've tried before to deal with this issue, they've probably had at least limited success with some strategies. So we want to build on those. That's that strength based approach. Help the client think back and figure out when you've gone half a day, or a whole day without having this problem, or even two hours, you know, some clients that's as far as we're going to get. What were you doing differently? And, you know, obviously sleep is one of them. So people aren't drinking if they're sleeping. People aren't sometimes using if they're playing with their kids. You know, we want to find out what are the exceptions to when this problem occurs, and start making a list of this because that'll empower the person to start feeling like, Hey, you know, I've been doing some things, right? You know, maybe this isn't a lost cause. And finally, during this first session, you want to share your theoretical approach. If you're cognitive behavioral like I am, we're going to explain what that means to the client and figure out, you know, if they think that that makes sense or not, if they don't agree with that theoretical approach, or they, you know, want something else, you've got to figure out if you're the right fit. A lot of times you can adjust and they can adjust and you can find a workable compromise. Based on the client's responses and your theoretical approach, you want to outline a proposal for the next steps. I always hedge this when I propose to the client, you know, so what I'm thinking here is, you know, over the next few weeks, we might look at this, this and this. How does that sound to you? And that gives the client an opportunity to go Yeah, you know, that makes sense. Or no, I think you're totally on the wrong path here that I don't think that's going to work. And we can have a dialogue at that point. So the first session really doesn't accomplish a lot, except for develop rapport and connection and get a direction. This is where you're kind of doing that initial treatment plan to working with the client. So in subsequent sessions, we're going to talk about two basic approaches, humanistic and cognitive behavioral, there are many, many others. But these are kind of the two prevailing approaches. So humanistic approach acknowledges that people have within themselves, the answers to improving their own lives. If you remember back to psych 101, the human humanistic approach says that people will solve their own problems and move towards self actualization. If we help them remove the blocks in their way, we naturally move towards self actualization. Humanistic approaches recognize and respect the ability of people to use reason, science, intuition and creativity as tools for achievement of goals. So this is one of the reasons in humanistic approaches, we don't do a lot of directive stuff with clients, we use a lot more Socratic questioning. So we ask them, you know, what do you think would help in this situation? In similar times before, what has worked, what hasn't helped, you know, thinking about people that you know, who've had this similar problem, what what's worked for them to help them start thinking and learning how to solve their problems on their own learning how to clear their own roadblocks. One key thing with humanistic approaches is to not get unnecessarily sidetracked. You want to let the client talk, you want to let the client do the majority of the talking in the session, but you want to stay on this path. So there's an issue at hand, whatever issue you've decided you've worked on, you want to make sure what you're talking about is on point, because it's really easy when the client gets to a place that's uncomfortable for him or her to kind of sidetrack and start telling you about something else or going down to Oh, let me tell you what happened last week. And you want to bring them back gently and say, let's stay focused on this issue right now. You know, we need to clear this roadway. And then we can go over there, I'll make a note of it and we can talk about it in a few minutes. Assert that wellness and health is best achieved through personal growth. You know, a lot of the things that people are struggling with when they come to see us indicate that maybe their coping skills aren't strong enough. Or maybe this is a unique situation and they've never been exposed to coping skills to deal with it. Or maybe there's something physically going on with them that they need to address in order to help their mind and body be as healthy and operational as possible. So for an individual session, begin by summarizing what was covered in the last session. So if the last session was your initial session, you know, you'll start by saying, okay, so last time when we talked, you said this was the problem that was most pressing. And we identified that these might be the next logical steps. Does that still sound like a good plan? They'll say yes or no. And then you move on to asking the client to share what's happened in the last week, pointing out and emphasizing positive changes. And then when they talk about problems or what I call stuck points or challenges, I try to avoid the word problems. Well, we'll stop for a second. And I'll say, Okay, that sounds like it was really frustrating. In retrospect, what do you think brought that on? What do you think might have been a better way to handle it, etc. So I'm going to start asking them questions, you know, there was this challenge back here. And you don't feel like you solved it very well, or caused you a lot of upsetness. Okay, so let's look at that. And let's see if we can figure out how to prevent that from happening again, or how to deal with it in a way that can help you. But I want the client to really be the one that's doing most of the heavy lifting. The re the way we do this is using Socratic questioning to draw connections between last week's events, and current presenting issues and current skills. So if the client is working with you on depression, for example, and they start telling you about how the week went, and then they tell you about five or six unfortunate events that happened that kind of stressed them out. And they're feeling pretty depressed today. We want to help them draw the connection between Well, can you see how the high level of stress last week may have impacted your mood? What do you think are some options that you might be able to do to reduce stress in the future and explore it from that perspective? Cognitive approaches assert that issues are caused by unhelpful thoughts and or unhelpful behaviors. When you look at the cognitive triangle, you have thoughts, behaviors and feelings. In cognitive approaches, we seek to identify those thoughts and behaviors that are unhelpful and help the client become more mindful about how these things impact their mood. So if they're in a negative frame of mind, how does that affect how they feel and their urges their behavioral actions? If they are in pain or they're tired, how does that affect their thought processes and their mood and their attitude? And likewise, how do both of those things affect their feelings? So we want them to really constantly look at this triad and understand how all these things interact. Cognitive approaches tend to be more structured. And I like structure, so I tend to go with cognitive more than anything else. Begin by summarizing what was covered in last week's session. This is always a great, great way to get people, you know, started get them up to speed again, kind of like when you watch a television show. At the beginning, they say, you know, in in previous episodes, and they catch you up on what happened. That's what we're doing here. We're kind of catching people up. Now, yeah, they were there. But we may need to refresh their memory because a lot of time is lapsed in a week. We'll review their homework. Cognitive behavioral therapy is really heavy on homework. So we want to review these. If you don't review them, it tells the client there's no point to do them. So we want to make sure we review them because we're going to be referring to them throughout the session. So I want to make sure that clients are really starting to learn how to use these tools. Ask the client to share what's happened in the past week, just like with humanistic, we want to find out, you know, okay, so how did last week go? What happened? Emphasize positive changes and explore stuck points and challenges. So same basic principle of what we're doing in cognitive versus humanistic, but the way we do it is different. When they start talking about those stuck points or challenges in cognitive behavioral will stop and we'll say, okay, let's look at any unhelpful thoughts you're having cognitive distortions, irrational thoughts, and or any unhelpful behaviors that you were doing that were keeping you feeling stuck and miserable. So we'll go back and we'll analyze each situation and help people identify habits and behaviors they have that may be keeping them stuck. And then we wrap it up from there in process. So those are two different ways that you want to look at doing individuals. And like I said, there are lots of different ways. But those are two ways that I found that are really pretty easy for new counselors to start off with. They can choose one or the other and kind of go from there depending on whether they prefer Socratic questioning and going with the flow a little bit more, or they prefer more structure and worksheets and tangible things. Again, you also want to consider your clients. Some clients are not going to be as structured. And they're going to want a little bit more latitude. So you may have to move more towards the humanistic approach. So it's good to be a little bit flexible in the application of techniques. So let's move on to groups, process groups, process things, psycho educational groups can be structured. And that means they follow a syllabus or what I call unstructured. And that means we're going to do a topic. But what we do, what topic we do today is pretty much undetermined until the clients get there. So let's talk about how those work. Process groups, central to the group process is the opportunity for members to talk as openly as they possibly can about their interactions and experiences of each other, as well as any aspects of the group experience that may come to mind. So for example, if we're in a process group, and we're talking about abandonment, and the clients are going to share their experiences of abandonment, what that means to them, they're going to find connections with other people who've had similar experiences. So they feel less isolated. But they also may have some transference reactions or feel abandoned or rejected by other people that are in the room. And they are going to usually bring the way they interact in the outside world into the group room. So we can help them identify patterns and habits and communication styles that may be helping or hindering them. So they're really recreating and a microcosm of their life in this session. So we can help them become more effective personally and interpersonally. Process groups can also be excellent adjuncts to psycho educational groups. When we teach clients things, there are three aspects if you will to teaching knowledge, the book learning skills, that means taking the book learning and being able to do something with it and abilities. So let's talk about cooking, for example, knowledge is knowing how to read a cookbook and knowing that, you know, what sauteing is in theory, you know, that's just knowing it from the book never having done it or anything skills means being able to look at a recipe and go, Okay, I need to saute. So I'm going to practice and figure out how to do this. Now you're following a recipe or following a very narrow set of instructions. So there's not a whole lot of room for error. Abilities is when you take those skills and you generalize and you start creating your own recipes and go, Hey, let me try to saute this. Or, you know, I think this would be really awesome braised or whatever the case may be. So process groups, take skills that we teach knowledge that we teach in psycho educational groups and helps people really make it their own. You can ask clients, for example, if they were in a psycho educational group about assertiveness skills. In the process group, you can talk about interpersonal communication and ask them, how did it feel last week when you practiced being assertive? Or what came up for you when you practiced being assertive last week? And what was that like? How did it feel? You know, some people will feel apprehensive, some people will feel terrified. A lot of times in psycho educational groups, the next week after people have learned this skill and practiced it a little bit, we don't have time to process it, which is why process groups are really awesome. And if you're doing the process group, sort of, as part of the psycho educational group, then, for example, on Monday, they may meet with you at 9am for psycho ed, and then they may have a process group at 11am that processes what they did last week. So they're always going to be a week out of sync. But it's a way to help clients really drive home what we talked about. So techniques for process groups, theme your modules, you know, whenever you have a process group, you don't want to just go in and sit down and go, All right, what do y'all want to talk about? It's probably not going to be nearly as productive as if you say, All right, today, we're going to talk about abandonment, or grief and loss, or shame and guilt, mothers, fathers, empowerment, whatever topic. And it's you want to choose something that's pretty broad. You can even consider choosing a book to help give you structure, seeking safety, toxic parents, growing up with a borderline parent and journey to recovery are all books that I've used in process groups. And we talk about a general topic like abandonment. And then I have clients share how that they've had those experiences. How have they experienced grief and loss? What does that mean to them? How is it impacting their current presenting issues? And then again, have members draw connections between experiences so they can say, Oh, yeah, I felt that way. Or I had that same experience. They can bring hope to one another and support to one another, one another, sometimes in the process groups, they'll even share, you know, when I experienced that situation, what worked for me was, you know, and then they share what that is. And the person who's receiving the information can hear it. And if it's useful for them, they take it. And if not, they leave it, but it allows people to open a dialogue and support one another. Now, psycho education is just what it sounds like is education. But it's not just lecture. If all you do in psycho education is lecture, people are going to hate coming to your groups. So let's talk about some broad concepts first in terms of adult and adolescent education. This is different for children. But we're going to talk about what a lot of us work with. The first thing you want to consider is some people learn in terms of details, and some people learn in terms of broad concepts. Think about doing a puzzle. If you can open a puzzle, dump it out, and then you start putting pieces together, just randomly, you're probably more of a detailed oriented person. Broad concept people are the ones who dump the puzzle pieces out, we want the frame. And then we're probably going to look at the picture while we're trying to put it together. So we're seeing how all these little pieces fit into the big scheme of things, whereas the other people are seeing how all these little things grow to become something. What does that mean in terms in terms of teaching? It means that you're probably going to have both types of people in your group, which is why it's important to provide an overview at the beginning of group. Today, we're going to talk about self esteem and how it impacts our relationships and our mood or whatever. Something real general, one or two sentences. Also provide for those detailed people, provide an outline about the specific bullet points you're going to talk about. It doesn't have to be super detailed. But if you're in a 90 minute group, you know, give them four or six bullet points so they can anticipate what's coming up. Overview and outline. After you do that, you need to communicate effectively. In groups, you're going to have different types of learners. Some people learn well by hearing. So lecture works well for them. But also discussion does as well. Anything they hear, they tend to stick better. Visual people really struggle in groups because they tune out, they zone out, they don't remember as much of what they hear. They remember what they see and what they read. So provide handouts for those people, books for them to look at. And if you can't do that because of budget, they don't want you making that many copies, at least try to write as much as possible on the whiteboard and encourage them to bring a notebook to take notes so they can see what's going on. The third type of learning is called kinesthetic. And that means manipulating the information. Some people do better when they try to apply the information. They may not really remember it until they've made it theirs in some way. So kinesthetic learners do better if you're asking them questions. You know, what do you think about this? Give me an example of that. What would you do in this situation? Kinesthetic learners can also do really well when they teach. So if you break your therapy group up into, you know, let's see if there's nine people, three groups of three. And each group of three teaches a concept. You give them the information and they figure out how they're going to present that concept to their group members. Kinesthetic learners do really well with that because they've had to manipulate it and figure out, you know, how to best communicate that information. So you want to make sure that everything you present, you present so people can hear it, people can see it and people can work with it. We'll talk about different ways to make that happen. Respect the process. I know you're going, Oh my gosh, there's more. Yep, there's more. This slide is probably the most information dense. So just kind of bear with me. Active and reflective learners. So some people learn as they go. And this tends to be your extroverts. We learn as we talk and we think as we talk and we have these aha moments as we talk. Reflective learners tend to be more introverted. And they're the ones who take in all the information, put it together, and then they have that light bulb moment. So you may have some people in your group that don't seem overly participatory. It could be that they're reflective learners. So it's good if you give them, especially if you give them handouts, to have them write things down. So every, you know, 10 minutes or so, take a break, have them write something down, either notes or answer a question on a worksheet or something. So they have some quiet time when nobody's talking that they can process all the information they've gotten over the last 10 minutes and have that aha moment. So overview. When you start the group, provide everybody an outline, provide information. So people can hear it, see it and work with it and make sure to take frequent breaks. So reflective learners have a chance to solidify chunks of information and have that aha moment. The next part, you know, once they get that information in there and have that aha moment, it's great. It's in short term memory. But for them to really learn it and remember it, they need to know why it's important to them. It has to be relevant to them. And if you've got nine, 15 people in a group, what's relevant is going to be different for different people. Now, there are two broad groups. Some people, what's relevant is what's right, what's just, what's factual. Other people, what's relevant is what's going to make everybody feel good. So or what's going to help them best get along with other people or improve their relationship with their kids. So people are feeling better. So you want to present information to both camps, so to speak. This is why it's important. This is the data behind it. Don't go too far into data because you'll lose people. Not because they can't understand, but because they get bored. And then this is why it's important. Sometimes making it relevant, you don't have to do all the heavy lifting. You can ask clients after you've presented the topic, you can ask them, you know, why do you think this topic is important to your recovery? So they can make it relevant for themselves. One tip when you're teaching psycho-educational groups or any kind of educational situation, if you ask for volunteers, you may only get about 20%, if that, of the people volunteering. So the best way to get people to actually really work with the information and stay with you is to call on people or have everybody go around the circle and everybody has to say something. And finally, make it engaging. And this is where the kinesthetic learners really shine. Gamify it. Make it into trivial pursuit, taboo, Jenga is another game that I use sometimes where clients, I have questions or facts written on a particular Jenga block. And when they pull out that Jenga block, they have to answer the question that's on there. That's a little bit harder to do for psycho-education, but you can. What's that other show with Alex Trebek? I can't think of it right now. Jeopardy. Jeopardy is always an easy one to do in order to teach a particular concept. And it doesn't require a lot of props and supplies. You can have clients do skits if they are, and this can also be scenario-based things. If they're modeling or doing a skit showing assertive versus passive versus aggressive behavior. Those things can be fun and encourage clients to have fun with it. And like I said earlier, group teaching is another option. Breaking your group up into smaller groups and having each subgroup teach a particular aspect. Now structured psycho-education is the first type of psycho-ed groups we're going to talk about. These follow a syllabus or a workbook. When I first started doing group counseling, we had a manual that we went by. And each week we knew what group we were going to do because that's what was in the manual. And it was pretty plug-and-chug, but it made sure we covered everything. So structured groups are great for beginners. And what I do when I do these groups, and again you want to keep people engaged, begin by reviewing what was discussed last week and any homework. So maybe last week we talked about the ABC's activity in cognitive behavioral, or we talked about cognitive distortions. And ask if there are any questions. Spend about 10 minutes on that. Then present the topic for the week. Give them that overview and that handout. Talk about the topic. Make sure they have, you know, something with bullet points on it for the main points that you want them to get and they can take notes if they want to. Then have the clients practice the new skill. You can use scenarios. You can do anything creative to practice this new skill. And then the last 30 minutes of group obviously this is a 90 minute group. The last 30 minutes of group go around the room three times. The first time you say how would this skill, how would this skill have been useful to you last week? Think about a situation where you could have used it. And what would you have done differently? What would the outcome have been? Then go back around the room and ask them how do you think this can benefit you next week? You know what types of things do you think might be coming up that you might use this skill with? And finally ask clients how they're going to remember to use it or integrate it. If you've ever been to a conference, which I think all of us have, you know that you're when you're in there you're learning these tools and you think of this really great stuff and it's awesome and you can't wait to use it with your clients and then you get into session with your clients and it's back to everything is normal because you completely forget about that. You're focused on the client and not on the technique. Okay well the same thing is true in real life. We want to help people remember okay this is tool is new. You've got to remember to use it. How are you going to do that? Homework is a great way to do it if you encourage people to keep a log to do a worksheet you know once a day or more then it can help them start developing the habit of using that particular tool. Now the other type of psycho educational group is what I call random and this is when we begin with a check-in and I would have everybody come in and sit down generally this was the first group of the morning we check in and ask people how they were doing and I would listen to everybody's status and I would listen for a common theme that might tie all these presenting issues together and I call it the Roomba philosophy because the Roomba vacuum the one that goes around kind of automatically the theory is that it's going to bunch bump off walls and stuff but eventually it will cover all the areas of the floor even though it just kind of goes through the room randomly. That's kind of how random psycho education is. What I like to do is I have a list of I think I'm up to 73 topics now that I think are important for people to have and I listen to my group and if they indicate that you know maybe they have great skills self-esteem skills already because for whatever reason then I'll mark that one off that's probably not one that we need to focus on and then when I listen to their check-in I will identify a theme like assertiveness or grief or whatever it is stress management and then after a brief little break I will come back and I will present them and outline and overview some information and then we'll talk about it. I start by identifying the topic that people are going to be just discussing so we do our check-in take a little break then I come back and I say all right so when I listen to everybody one of the things that I heard was it sounds like a lot of you are struggling with issues of setting boundaries and relationships. Okay so then I'll talk for 15 or 20 minutes about setting boundaries and then again the last part of the group is going around the circle and having clients share how the skill would have been useful last week to prevent whatever problem they talked about at check-in how they think they can use it next week and forever more and how they will remember to use it or integrate it. So those are two very different ways of doing group psychoeducational groups but they can be very effective and it kind of depends on your facility as well as your own personal style which approach fits better for you. My suggestion is that you want to pick one way and stick with it. So if you've got a group on at 9 o'clock every Monday morning and you decide to do random psychoeducation then you want to stick with that format until that group is gone. If you decide you want to change and use something more structured you know pick that up after the current group graduates. A couple more notes because after we do group or individual we have to do progress notes. So at the beginning when you're doing individual sessions have the client identify what goals he or she achieved and the progress made over the prior week. You're probably going to do that anyway. Write that down when the client is telling you and then you can put your notepad down and you can talk to them. Let them know ahead of time what you're doing. You know I want to keep track of all the great progress that you make and set that aside and you're going to fill that in at the end of session because remember our therapy hours tend to be 50 minutes so we have 10 minutes to do our paperwork. Towards the end of the hour 45 minutes 50 minutes you know we start wrapping up and I have the client summarize and pick my pad up again. Have the client summarize what he or she thinks the most salient points were in the session and how they will help the person meet their individualized goals. So we talked about X Y and Z and the client thinks this will help him address his relationship issues or whatever. Then have the client identify any tasks or goals for next week. So the old way of doing it is me saying okay so in this session we talked about all of these things and you agreed that you would do this that and the other. When you work with a client and this is more the Socratic questioning you want to ask them okay so what is it that what tasks and things are you going to be working on remind me what tasks you're going to be working on over the week and you write that down. And then remind the client of any referrals that were made during the session. So you know I generally say and you know you remember we talked about you know going to get food stamps getting your annual physical and whatever else. By the time you're finished with that you have your entire progress note written for the most part. You still have to do the many mental status but you have the brunt of your paperwork done. The nice thing is you can take that make a copy and give it to the client. So then the client can have a record of what they talked about what their achievements were and what their goals and tasks tasks are for the next week. So it's a win-win-win-win all the way around. In groups that's not really practical to sit down and do this for every single client. So one thing you can do is have clients fill out a worksheet. What I do on mine is I have a check sheet or a check block area at the beginning where they can identify their mood. Depressed, anxious, angry whatever it was most of the time last week. And there's a little section for them to explain if they want. And then I have area under that for the client to summarize the three most important points for that client in this session and how those points will help them meet their identified goals. This is encouraging clients again to make it relevant to them and it's also helping me make sure that I've got relevant documentation. Have the client identify tasks or goals for the next week with regard to the topic. Remember we said have clients identify how is it you're going to remember to use this particular tool. Well that's what they put here. And then have the client identify any necessary resources or problems he or she is having. So that way when you get the sheet you know if referrals need to be made if they need an individual. If you're not that person's primary counselor you can pass off information to the primary and say well John said that he's having difficulty getting his medication filled. You know just wanted to let you know. So it facilitates discussion. It gets the notes done. Auditors like to see things in clients handwriting. It's again a win all the way around. It takes five minutes. It doesn't take very long at the end of group. But that if clients come to expect that that's what they're going to do and you explain to them it's so they can see their progress and so we can make sure that you know we're keeping in communication. Because sometimes when clients are in group based programs they feel forgotten about or feel just kind of like a number. So I want to make sure that clients feel special. I want to make sure that we have a really good finger on the pulse so to speak of every client. So translating everything that we learned in class in graduate school into working with clients can be a really daunting task. So be good to yourself. One of the things that I found out during my first couple practicums is clients are really resilient. If you're there and you care and you're trying even if you flub usually no harm no foul. I remember one group I did. I had a client come up to me afterwards and say that was really boring and went way over most of our heads. I felt bad but you know I recognize that that was good constructive feedback because I was doing group like I taught at the university instead of doing group like we just talked about. So it's important to get feedback from your clients. Pay attention during group. If you see they're starting to not offer get antsy switch gears. Always have some sort of activity or something sort of in your back pocket that you can do to rally the troops so to speak. So those are some suggestions for working in individuals and groups and kind of getting started opening the session and feeling like you've got a rhythm and a direction. All of us at all CEUs wish you great success on your exam. Once you're certified or licensed please remember to visit all CEUs for all of your continuing education needs. We offer unlimited CEUs for $59 for addiction and mental health counselors, social workers and marriage and family therapists. If you're still thinking about becoming an addiction counselor all CEUs offers the training you need in three different formats. You can choose online multimedia self-study, self-study plus live webinars or even face-to-face weekend intensives which meet one weekend per month for 12 months. We can even present a training series at your facility just email support at allceuse.com to schedule it. To learn more you can also visit allceuse.com slash Acer. That's allceuse.com slash A-C-E-R. Thank you.