Analysis of Emerging Practices in Counseling and Psychotherapy

The provided assignment is a comprehensive analysis of emerging practices in counseling and psychotherapy. It includes a discussion on ethical dilemmas in dual relationships, the integration of self-affirmation and motivational interviewing to reduce resistance and increase efficacy in alcohol interventions, and the factors influencing suicide within Chinese culture. The assignment also touches upon sensitive questioning techniques in conservation and the detection of co-occurring mental health concerns. Furthermore, it reviews specialized questioning techniques for conservation and provides an analysis of sleep-related beliefs associated with alcohol relapse following residential alcohol detoxification treatment.

Running head: PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
Psychoactive substance and mental health
Name of the Student
Name of the University
Author note

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
Introduction
There are different tools when assessing for substance use disorder and mental health
symptoms. Screening and assessment is necessary as there is evidence from recent and old
literature that people with substance use disorder are at risk of developing other disorders. It is
known as co-occurring disorder and it is imperative to recognise early. With early recognition
most effective treatment can be developed (Krill, Johnson and Albert 2016). The essay deals
with the critique of the substance-use interview video, “sensitive questioning to detect co-
occurring mental health questionnaires” by Logan (2018). The video demonstrates the use of
Sensitive questioning strategies in an interview to detect the mental health substance use. The
essay critiques the sensitive questioning approach of the interviewer during the initial contact
with the client, building rapport, assessment of the interviewee, and identification of the impact
of substance abuse, identification of stressors and overall engagement. The critique of the
interview will be supported with the recent literature.
Critique of the interview-
Initial contact
The initial contact of the interviewer with the patient was positive and the communication
process involved effective use of verbal and non-verbal skills. The initial contact showed that the
interviewer was attuned to client, attending, was open and honest. The interviewer maintained
the clarity of services offered and that it would be assessment process of one hour. The initial
contact appeared to follow the “SOLER” approach as mentioned by Stickley (2011). It includes

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
squarely facing the client, maintaing open posture, leaning towards client to show involvement,
covey messages through eye-contact and use of relaxed body language.
Rapport and respect
The interviewer was respectful towards the client and to build rapport systematically
moved from less personal to more personal questions. The interviewer demonstrated
understanding of the illness experienced by the patient using active listening skills. The
communication was effective in fostering the egalitarian relationship with patients. The
interviewer had built rapport with the client by taking client’s perspective on issues with the
alcohol. The sensitive questioning involved questions that allowed the client to fully explore the
relevant issues of his life. The questions were asked cautiously, with empathy and centered on
relevant and important issues associated with alcohol. According to Chapman (2012) active
listening without judgment and development of empathy are key communication skills to build
rapport with the client.
Assessment of readiness to change
The interviewer conducted the assessment of readiness to change by questioning
interviewee about his perceptions on issues with alcohol, and the amount taken. The questions
were sensitive to detect the current problem due to alcohol. For instance the interviewer asked
“what do you think” on issues with alcohol, where the client answered, “not like it’s a problem”.
It helped interviewer to gauge the motivation and readiness of client to engage in change (Nuno
and John 2015). These open ended questions are effective to identify if the client is receptive to
treatment (Gutierrez et al., 2018). It is an important dimension to change among people with
substance abuse disorder. At the end of interview the client requested to help with getting his

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
children back. However, he showed no interest in seeking treatment for alcohol addiction as he
has no insight of his illness.
Identification of the impact of substance use on health
To identify the impact of alcohol on health the interviewer directly asked about the health
issues where the client said he had waking troubles and lack of sufficient sleep. The interviewer
questioned about increase in drinking alcohol before and after separation with wife, affect on
sleep, and appetitite. Further, questioning led to identification of poor appetite. The interview
was successful in identifying the impact of alcohol use on both physical and mental health.
Eventual it helped the client recognise the impact of alcohol on his health, although at the
beginning he considered no problems associated with substance abuse. Sensitive questioning
was affective in making client perceive his illness (Miller 2014).
It was justified for counsellor to ask if the client attempt to end life or has such thoughts
earlier. When the client confessed about taking sleeping pills, the counsellor questioned if it was
taken with intention of not waking up. According to Yuodelis‐Flores and Ries (2015) addiction
patients are frequently found with suicide behaviour and hence the questions were well framed.
Taking the history of suicide if any among family members further gave insights into patients
vulnerability and risk of injury due to sleeping pills. This phase of interview aligns with the
research that highlights history of suicide in family as risk factor for suicide in people (Law
2016)

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
Identification of the impact of substance use on lifestyle
The interviewer did ask several questions earlier on work life and amount of time spent in
pub. Further, the interviewer questioned if income and pay was satisfactory. To identify the
impact of alcohol on lifestyle, the interviewer asked questions if partner complained of alcohol
earlier. The interviewee then revealed that he had “couple of blues” with his partner and that she
moved away taking his kids. These questions were effective in recognise the impact of alcohol
on personal and social life. It was observed in the interview that questioning eventually
progressed towards assessing any source of mental support. These questions were effective as
per Smith et al. (2014) because negative impact of alcohol abuse is manifested in relationship
problems, failure to meet social obligations, legal problems (license issue in client). Further, the
interviewer did identify the problem of recurring the substance throughout the day. It was
evident from client’s response in spending more time at pub. In addition, emotional and
psychological difficulty is significantly observed in people addicted to alcohol. Therefore,
sensitive questioning helped recognise these signs of chemical dependence and its impact on
overall lifestyle (Sommers-Flanagan and Sommers-Flanagan 2015).
Identification of stressors
The interviewer summarised the factors that may be the cause of stress for the
interviewee. It includes not working of license, lack of sound income earning, and separation
with wife and kids. It resembles an important element of counselling called, “summaries”. In
this process the counsellor attends to verbal and nonverbal messages and pulls the key portion of
the extended communication (Geldard and Geldard 2012). In the concerned interview the
counsellor based on the identification of impact of alcohol health and lifestyle had figured out
the stressors. Followed this interviewer emphasised that the events can “still be stressful”. These

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
questioning was effective as alcohol use exacerbate symptoms of mental illness, such as anxiety
and depression, which in run trigger alcohol dependency to relive symptoms of mental illness
(Lehman and Dixon 2016). At this phase of interview, the term dual diagnosis can be considered
as the interview led to successful identification of both stress disorder and alcohol affecting the
individual (Tirado-Munoz et al., 2018).
Overall level of engagement and conclusion
The overall engagement showed the clear goals of the interviewer in mind and indicates
interactive communication skills. The interviewer maintained the objectivity without allowing
the patient’s beliefs, attitudes and prejudices to influence thinking as also highlighted by Deng et
al. (2016). Therefore, it helped to grasp the big picture of the client needs. The interviewer did
not jump to the conclusion without hearing all the facts and demonstrated empathy. The
conversation did shift from one subject to other when each subject has been followed through,
which is the strength of interview process. It was affective in removing the client’s defensiveness
(Ehret et al., 2015).
Using both verbal and non-verbal skills a therapeutic alliance was built that allowed
meeting mutually understood goals of therapy. Each question was framed in manner that it
sequentially led to detection of physical, social, mental, emotional and psychological problems in
client. Asking the questions in step-by-step fashion, considering the relationship with new client,
eventually led the client to recognise the severity of alcohol addiction and its linkage with health
issues and poor lifestyle (Lewis, Dana and Blevins 2014). At the end of the interview the
counsellor recommended to get the client an appointment with the mental health clinician.
Referral was made at the end of the interview where the client was in agreement with alcohol

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
impact on his life, health and co-occurring stress and was ready to restore his normal
functioning.
The interview was overall effective as no recommendations were made during the
informations-gathering phases. Further, interview met the ethical obligation by taking informed
consent for meeting mental health clinicians (Lewis et al., 2014).
Conclusion
In conclusion the critique of the substance-use interview video has been useful in
developing valuable insight into interpersonal skills required to interview patient with substance
abuse disorder. It helped learn the technique of framing questions logically to lead towards
identification of any co-occurring disorder in addition to alcohol addiction. The interview and its
critique helped in learning the concept of sensitive questioning as part of dual diagnosis in
counselling. The method of sensitive questioning teaches about technique to start from less
sensitive to more sensitive questions during interview. The communications strategy to move
from less personal to more personal issues during counselling ensures client’s assertiveness. It
allowed the dialogue between the both to be honest and open.

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
References
Chapman, J., 2012. Interviewing & Counselling. Routledge. Retrieved from:
https://books.google.co.in/books?
hl=en&lr=&id=gHvjezRiXX4C&oi=fnd&pg=PT12&dq=Chapman,+J.,
+2012.+Interviewing+%26+Counselling.+Routledge.&ots=-
r_3Tnr8Vu&sig=CobG4kfUg-vywpZxSK3BH1F4Iwg#v=onepage&q&f=false
Deng, J., Qian, M., Gan, Y., Hu, S., Gao, J., Huang, Z. and Zhang, L., 2016. Emerging practices
of counseling and psychotherapy in China: Ethical dilemmas in dual relationships. Ethics
& Behavior, 26(1), pp.63-86.
Ehret, P.J., LaBrie, J.W., Santerre, C. and Sherman, D.K., 2015. Self-affirmation and
motivational interviewing: integrating perspectives to reduce resistance and increase
efficacy of alcohol interventions. Health psychology review, 9(1), pp.83-102.
Geldard, K. and Geldard, D., 2012. Personal Counselling Skills: An Integrative Approach.(Rev.
Charles C Thomas Publisher.
Gutierrez, D., Fox, J., Jones, K. and Fallon, E., 2018. The Treatment Planning of Experienced
Counselors: A Qualitative Examination. Journal of Counseling & Development, 96(1),
pp.86-96.
Krill, P.R., Johnson, R. and Albert, L., 2016. The prevalence of substance use and other mental
health concerns among American attorneys. Journal of addiction medicine, 10(1), p.46.

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
Law, C., 2016. The factors influencing suicide within Chinese culture. British Journal of Mental
Health Nursing, 5(4), pp.154-158.
Lehman, A.F. and Dixon, L. eds., 2016. Double jeopardy: Chronic mental illness and substance
use disorders. Routledge.
Lewis, J.A., Dana, R.Q. and Blevins, G.A., 2014. Substance abuse counseling. Cengage
Learning.
Logan, G. (2018). Sensitive Questioning to detect co-occurring mental health concerns. [online]
YouTube. Available at: https://www.youtube.com/watch?v=0pXFY3xWbl4 [Accessed
19 Mar. 2018].
Miller, G., 2014. Learning the language of addiction counseling. John Wiley & Sons.
Nuno, A. and John, F.A.S., 2015. How to ask sensitive questions in conservation: A review of
specialized questioning techniques. Biological Conservation, 189, pp.5-15.
Smith, N., Hill, R., Marshall, J., Keaney, F. and Wanigaratne, S., 2014. Sleep related beliefs and
their association with alcohol relapse following residential alcohol detoxification
treatment. Behavioural and cognitive psychotherapy, 42(5), pp.593-604.
Sommers-Flanagan, J. and Sommers-Flanagan, R., 2015. Counseling and psychotherapy theories
in context and practice: Skills, strategies, and techniques. John Wiley & Sons.
Stickley, T., 2011. From SOLER to SURETY for effective non-verbal communication. Nurse
education in practice, 11(6), pp.395-398.

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PSYCHOACTIVE SUBSTANCE AND MENTAL HEALTH
Tirado-Munoz, J., Farre, A., Mestre-Pinto, J., Szerman, N. and Torrens, M., 2018. Dual
diagnosis in Depression: treatment recommendations. Adicciones, 30(1).
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Yuodelis‐Flores, C. and Ries, R.K., 2015. Addiction and suicide: a review. The American
journal on addictions, 24(2), pp.98-104.
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journal on addictions, 24(2), pp.98-104.