Counselor Toolbox Podcast

Mental Health and Mental Illness Fundamentals Part 2 Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counseling Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Review Prevention strategies for mental illness ~ Identify the fundamentals, benefits and drawbacks of the most common treatments: Psychodynamic, behavioral, humanistic, and pharmacological ~ Identify the factors that can enhance utilization of services including providing culturally responsive services addressing unique coping styles, the role of the family in treatment, ways to address cultural barriers including mistrust and stigma. ~ Explore the recovery concept and its impact on mental health and mental illness across the lifespan Prevention ~ Prevention has been conceptualized as ~ Primary: Stopping a problem behavior from ever occurring delaying the onset of a problem behavior ~ Secondary: Preventing recurrence or worsening ~ Tertiary: Reducing the impact of a problem behavior ~ Strengthening knowledge, attitudes, and behaviors that promote emotional and physical well-being ~ Promoting institutional, community, and government policies that further physical, social, and emotional well-being of the community Prevention Premises ~ Theory and research based ~ Address the individual as well as the micro, macro and exosystem ~ Focus on strengths development ~ Enhancing protective factors ~ Reducing risk factors ~ Many mental health problems share some of the same risk factors for initial onset, so targeting those factors can result in positive outcomes in multiple areas ~ Abuse and neglect (direct or indirect) ~ Family discord (hostility, domestic violence divorce) ~ Low self-esteem ~ Lack of supportive family or peers ~ Lack of school or work success ~ Lack of involvement in prosocial activities Protective Factors ~ Self regulation ~ Secure attachment ~ Effective communication skills ~ Effective interpersonal skills ~ Supportive family and peers ~ Consistent discipline and rules ~ Responsiveness of caregivers ~ Safe environment ~ Support for learning ~ School engagement ~ Positive parent and teacher expectations ~ Access to wrap around services ~ Good coping and problem solving skills ~ Opportunities for engagement in prosocial activities ~ High self-esteem and self-efficacy ~ Appropriate empathy ~ Future orientation Risk Factors ~ Neurophysiological deficits (autism, epilepsy, cerebral palsy) ~ Difficult temperament ~ Chronic illness ~ Below-average intelligence or learning disability ~ Family dysfunction ~ Abuse or neglect ~ Social disadvantage ~ Overcrowding or large family size, ~ Family member with mental health or addictive disorder ~ Admission into foster care ~ Living in an area with a high rate of disorganization ~ Inadequate schools Approaches to Treatment ~ Psychodynamic ~ The role of the past in shaping the present is emphasized ~ Belief in the unconscious, so that there is much from the past that influences our behavior of which we are not aware ~ Important part of psychodynamic psychotherapy is to make the unconscious conscious Approaches to Treatment ~ Behavioral ~ Focuses on current behavior and observable actions ~ General principles of learning are applied to the learning of maladaptive as well as adaptive behaviors ~ The environment provides reinforcements and punishments that shape behavior (direct and vicarious) Approaches to Treatment ~ Cognitive Behavioral ~ Explores how thoughts and environmental stimuli shape behavior and learning and how learning shapes thoughts ~ Cognitive-behavioral therapy strives to alter faulty cognitions and replace them with thoughts and self-statements that promote adaptive behavior Approaches to Treatment ~ Humanistic ~ Central focus of humanistic therapy is the immediate experience of the client. ~ The emphasis is on the present and the potential for future development rather than on the past, and on immediate feelings rather than on thoughts or behaviors

Based on Doc Snipes' upcoming book 100+ Practical Tools to Defeat Depression. Read the whole book for FREE with Amazon Kindle Unlimited CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/904/c/ Social Interventions Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counseling Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Identify the benefits of social support ~ Explore the characteristics of healthy relationships ~ Identify ways to improve relationships ~ Baggage ~ Temperament ~ Assertiveness ~ Nurturing ~ Discuss the concepts of forgiveness and acceptance ~ Learn about how pets can provide an element of social support Benefits of Social Support ~ Sense of belonging. Spending time with them helps ward off loneliness. Whether it's other new parents, dog lovers, fishing buddies or siblings, just knowing you're not alone can go a long way toward coping with stress. ~ Increased sense of self-worth. Having people who call you a friend reinforces the idea that you're a good person to be around. ~ Feeling of security. Your social network gives you access to information, advice, guidance and other types of assistance should you need you. It's comforting to know that you have people you can turn to in a time of need. Healthy Relationships ~ Cookies ~ Start by discussing cookies and how many different variations there are for sugar cookies. ~ Then discuss all the different stand-alone foods you can put in a sugar cookie to make it even better. (chocolate chips, caramels, candy corn, dates/raisins, peanut butter, walnuts, zucchini, carrots, Rice Krispies, oatmeal…) ~ Then talk about stand-alone foods you wouldn’t add to a sugar cookie. (Not everyone will agree (like chocolate covered fruit)) Examples: sardines (salty), hot pepper flakes (spicy), black licorice (funky), oysters (slimy), lemon slices (sour), kale (bitter), popcorn (would dissolve)) ~ Then ~ Make a “recipe” for a good person ~ Create a “recipe” for a friend that would bring out the best in the good person ~ Identify characteristics of people that would not combine well with the good person (pet peeves and deal breakers) Characteristics of Healthy Relationships ~ Characteristics ~ Honesty ~ Faith/Trust ~ Compassion ~ Respect ~ Boundaries ~ Openness/Willingness ~ Mutual Support ~ Unconditional Positive Regard Characteristics of Healthy Relationships ~ Activity ~ Start by defining each characteristic and having participants identify examples. ~ Write each characteristic on a piece of flip-chart paper and post them around the room. ~ Have people go from station to station and write how they nurture that quality in themselves and others. Baggage Claim ~ Too often we carry baggage from relationship to relationship and make the new person carry the old baggage. ~ Healthy relationships require understanding what you feel, why you feel that way and who triggered that feeling, then deciding if you want to continue to carry that with you (Baggage fees are EXPENSIVE!) Baggage Claim ~ Activity ~ List the influential you in your life: Parents, friends, past loves (and current ones). ~ Identify what each of you has taught you about relationships (good and bad). ~ Compare that to the Skills Required for Healthy Relationships above. ~ Decide what baggage you have from each relationship that you are going to choose to carry and what you are going to learn from and let go. (It is not fair to hold everyone hostage because a parent could not openly express affection or one of your friends is not encouraging and supportive, for example) ~ Identify what skills you need to work on. ~ Focus on improving one area each week. Assertive Communication ~ Being assertive means that you express yourself effectively and stand up for your point of view, while also respecting the rights and beliefs of others. ~ Define ~ Passive ~ Aggressive ~ Passive-aggressive ~ Assertive behavior Assertive Communicati

Addiction Counselor Exam Review Podcast Episode 21 Ethics Host: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review Objectives ~ Define ethics ~ Review the rationale for ethics ~ Explore ethical issues that counselors need to be aware of ~ Learn a model of ethical decision making. Professional and ethical responsibility ~ Ethics is designed for the protection of four distinct groups: ~ The client ~ The clinician ~ The profession ~ The community ~ When they are unclear or conflicting needs between the four groups ethical conflicts arise ~ The primary responsibility for ethical practice and for identifying ethical breaches rests with the addiction counselor in the clinical supervisor Ethics ~ Scope of Practice ~ Activities and procedures that can be performed legally by members of a licensed or certified profession Professional and ethical responsibility ~ Addiction professionals have a responsibility for self governance ~ Many questions of professional ethics rely on subjective interpretation ~ Clear communication is essential in the counseling relationship to avoid ethical problems ~ Ethical standards both prescribed and prohibit specific behaviors on the part of a professional ~ Often more attention is paid to the ethical breaches that deal with prohibited behavior than to prescribe behaviors ~ Counselors have a professional responsibility to seek in utilize appropriate supervision and complete continuing professional education Ethics continued ~ The code of ethics defines a standard of expected behavior ~ Codes are helpful for giving clients and the public in a sense of the level of professional behavior ~ Codes may not provide a practical or detailed guidance needed ~ Simply following a list of specific rules of conduct is not ensure that a counselor will practice and ethical manner Ethics continued ~ Contracts defined provider duties and responsibilities ~ Negligence is a failure to uphold ones contractual duties ~ Requirements must be treated in the following order of precedence: ~ Law ~ Precedent by case law ~ Reasonable person test ~ Regulations or administrative rules ~ Contracts ~ Use of public funds creates an obligation to fulfill the public trust and result in higher standards than those required in private industry Ethics continued ~ Ethics can be thought of as a set of principles that define our actions ~ Seven criteria for defining ethics ~ Require other people, they’re about relationships ~ Intense makes a difference ~ Ethics and result the lemons ~ Thinking is necessary for ethics and morality ~ Ethics ask you to be impartial ~ Ethics require us to care about the suffering of others ~ Ethics judge human behavior ~ Columns reflect what most members of the profession have agreed on in some kind of formal process rather than reflecting ideal standards Ethics Principles ~ Autonomy ~ Fidelity ~ Justice ~ Beneficence ~ Including efficiency and effectiveness ~ Nonmalfesience Personal Qualities ~ Empathy ~ Sincerity ~ Integrity ~ Resilience ~ Respect ~ Humility ~ Competence ~ Fairness ~ Wisdom ~ Courage ~ Commitment ~ Concern Ethics continued ~ Published codes of ethics may lag behind the needs and demands of dated a practice this is why it’s important for professionals to understand the principles that lie behind their respective codes ~ Most code to general in nature and reflect the consensus of professionals in a given field and a single point in time ~ There may be inconsistencies within code of ethics or between codes of ethics that govern the same profession ~ While there is no universally accepted code of ethics for the addiction field clinician should be familiar with the ethics codes from his or her state territory or tribe Ethics continued ~ Foundations of ethics ~ Ethics are based on moral values, a sense of what is right and wrong ~ Professional ethics focus is on the intersection between client rights and professional d

Based on Doc Snipes' upcoming book 100+ Practical Tools to Defeat Depression. Read the whole book for FREE with Amazon Kindle Unlimited CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/904/c/ Physical Interventions Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counseling Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Identify why physical interventions are important to recovery and happiness ~ Explore different physical interventions Intro ~ There are a myriad of reasons why physical interventions are so helpful in treating depression and anxiety. ~ They release endorphins, serotonin, dopamine and norepinephrine (all happy chemicals) ~ They increase the available oxygen in your blood (helps with confusion and ”foggy head” ~ They have been linked to improvements in self-esteem ~ They help you get your mind/thoughts and bodily reactions more in synch. ~ They often put you in a place where you can engage with other positive people ~ They can help with general aches and pains which can disrupt your sleep and put you in a bad mood. ~ They can help you turn down the stress response, so you sleep better ~ They can help increase your energy Relaxation ~ Yoga ~ Your calming brain chemical, GABA, increases after a session of yoga ~ Produces significant improvements in tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, and confusion-bewilderment. ~ Group or individual activity: Breath focus; Cued progressive muscular relaxation ~ Meditation ~ Quiets the mind ~ Singular, all-encompassing present focus ~ 20-30 minutes of meditation per day produces consistent effects on anxiety and depression ~ Consider adding a fish tank or similar to your waiting room ~ Experiment with different types of meditation over several sessions Relaxation ~ Exercise ~ Physical activity helps balance muscles, release muscle tension, increase oxygen flow, increase serotonin and improve sleep. ~ Activity: Identify 10 ways to make exercise fun ~ Group activity: balloon toss, learn a dance, nature walk ~ Stretching ~ Muscle imbalances cause additional pain and can impair sleep and mood as well as keep stress chemicals high. ~ Imbalances between front and back or right and left can cause pain. ~ Group activity: Stretch Relaxation ~ Hobbies ~ Can help you use up some of the “nervous energy” ~ Enable you to get into a calm mind space ~ Cooking ~ Building ~ Planting ~ Crocheting ~ Reading/writing ~ Can help you get “out” some of your stress ~ Painting ~ Yardwork ~ Construction (demolition) ~ Activity: Share hobbies, Hobby stations or segments Nutrition ~ Your body needs building blocks to make the brain chemicals that help you feel motivated, happy, and, yes, even stressed. ~ It gets these building blocks from good healthy food. ~ Taking vitamins is not a replacement for a healthy diet, but some people on restrictive diets may need supplements. (Consult a physician.) ~ Malabsorption syndromes, such as celiac disease, Crohn's disease, and ulcerative colitis can cause vitamin B6 deficiency which impairs serotonin production ~ Some biological causes of depression can be linked to poor nutrition which keeps the body from being able to make the brain chemicals to support your mood ~ Activity: Create a menu ~ Activity: Identify creative ways to sneak in green vegetables ~ Activity: Potluck Sleep ~ Sleep is the time when your body rests and rebalances ~ Lack of sleep results in your body being under stress and releasing extra cortisol ~ Activity: Develop a sleep routine ~ Activity: What helps you sleep ~ (Note: Dispel myths about antihistamines and alcohol) Pain Management ~ Pain causes increased cortisol levels, impairs sleep and often creates an irritable mood ~ Pain can be caused by ~ Injury/illness ~ Muscle imbalances and pain ~ Purse/backpack ~ Incorrect exercise habits ~ Repetitive physical labor ~ Poor ergonomics ~ Stress Pain Management

Mental Health and Mental Illness Fundamentals: Part 1 Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery, Addiction Counselor Exam Review Objectives ~ Explore the neuroscience of mental health ~ Explore how mental illness manifests itself ~ Learn about the prevalence (epidemiology) and costs of mental illness ~ Explore the biological, psychosocial and individual risk factors for mental illness and review the difference between correlation, causation and consequences Neuroscience of Mental Health ~ Creation of emotions and our ability to think and perceive things occurs in the brain ~ The workings of the brain depend on the nerve cells being able to communicate with each other ~ Structural ~ Nutritional ~ Each neuron makes over 1000 connections ~ The frontal lobe is involved with motor behavior ~ The prefrontal cortex is responsible for planning and integrating cognitive and emotional streams of information ~ The brain continues to develop until about age 25 Neuroscience Cont. ~ Electrical signals from the neuron are converted to chemicals called neurotransmitters ~ Neurotransmitters are released from the sending neuron into the space between neurons. They attach like a key into a “lock” called a receptor. This triggers the receiving neuron to pass on the signal. ~ The more receptors that are stimulated the more intense the reaction ~ Excitatory Neurotransmitters include norepinephrine and glutamate ~ Inhibitory neurotransmitters include GABA and to some extent serotonin (14). ~ Other neurotransmitters include dopamine (5), acetylcholine, endorphins (natural opiates), substance P (pain, anxiety, stress) Neuroscience cont… ~ Neurotransmitter availability is impacted by ~ The presence of other neurotransmitters and hormones ~ Quality and quantity of the neurotransmitter ~ Vitamins and minerals help break down amino acids (proteins) to make neurotransmitters. ~ Without proper nutrition and adequate stress management the neurons will not be able to function effectively. Manifestation of Mental Illness ~ Rapid heart rate ~ Muscle tension ~ Light headedness ~ Fatigue ~ Appetite changes ~ Dysregulation of mood ~ Fear/anxiety ~ Irritability/anger ~ Depression ~ Cognitive dysfunction (difficulty with memory or concentration as in depression or dementia) ~ Disturbances of thought and perception (hallucinations and delusions) Anxiety ~ Triggers the fight or flight response ~ OCD, panic disorder and phobias are in this family ~ OCD has components of ~ Anxious emotions ~ Obsessional thinking ~ Behavioral compulsions Epidemiology ~ About 20% of the US struggles with a mental illness in any given year (both adults and children). ~ In 1996 over 100 billion dollars was spend as a direct cost of mental illness in the US ~ It is estimated that >45% of people will experience an addiction in their lifetime ~ Risk and protective factors ~ Individual ~ Biological ~ Psychosocial ~ Correlation, causation leading to consequences Epidemiology cont… ~ Causes of health and disease are generally viewed as a product of the interplay or interaction between biological, psychological, and sociocultural factors ~ Biopsychosocial model ~ One factor by itself may not weigh heavily, but the combination of factors are exponentially additive Biological Factors ~ Mental disorders arise in part from defects not in single genes, but in multiple genes ~ No single gene or even a combination of genes dictates whether someone will have an illness or a particular behavioral trait. Rather, mental illness appears to result from the interaction of multiple genes that confer risk ~ No gene is equivalent to fate for mental illness. This gives us hope that modifiable environmental risk factors can eventually be identified and become targets for prevention efforts ~ Even with a high level of heritability, however, it is essential to point out that environmental factors (e.g.,

Addiction Counselor Exam Review Episode 20 Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Podcast Host: Addiction Counselor Exam Review, Counselor Toolbox and Happiness Isn’t Brain Surgery Specific population considerations ~ Aspects of the client’s identity may influence the client’s substance using behavior, the responsiveness to treatment, and the recovery process ~ These factors include race, ethnicity, age, sexual orientation, and the presence of co-occurring disorders including trauma ~ Rather than placing a person and established treatment slot treatment providers are learning the importance of modifying in adapting services to meet an individual client’s needs ~ SAMHSA has produced multiple publications that dealt in depth into the treatment needs and recommended practices for specific types of disorders and or populations Specific populations continued ~ Substance abuse treatment programs typically reported 50 to 75% of their clients have co-occurring disorders ~ Medical settings site proportions of 20 to 50% ~ The term co-occurring disorders replaces the terms dual disorder or dual diagnosis ~ Co-occurring disorders refers to co-occurring substance use and mental disorders ~ A diagnoses of a co-occurring disorder occurs when at least one disorder of each type can be established independent of the other ~ Review SAMHSA TIP 42 for more information Specific populations continued ~ Criminal justice ~ For many people in need of substance abuse treatment contact with a criminal justice system is the first acknowledgment of the need for treatment or opportune did you receive services ~ Longstanding patterns of poor coping skills, criminal values and beliefs, lack of education, and minimal job skills may require an intensive treatment approach particularly among offenders with a prolonged history of substance abuse and crime ~ Addiction professionals must be able to communicate effectively with judges, probation officers, and other criminal justice system personnel functioning as a community treatment team ~ Leaders in both criminal justice and treatment systems need to develop shared goals and clear systems of care for addicted offenders both while they are incarcerated in after their release Specific populations continued ~ HIV and AIDS ~ HIV is most efficiently transmitted through the exposure to contaminated blood ~ injection drug users represent the largest HIV infected substance abusing population in the United States ~ Sexual contact is another route of HIV transmission ~ Substance use treatment can play an important role in helping individuals reduce risk taking behavior ~ Substance use treatment serves as a HIV prevention ~ HIV and AIDS, substance abuse disorders, and mental disorders interact in a complex fashion, each acting as a potential catalyst or obstacle in the treatment of the other two ~ Treatment goals include living substance free, slowing or halting the progression of the disease, and reducing risk taking behavior Specific populations continued ~ HIV and AIDS ~ Treating HIV and AIDS is extremely complex ~ Individuals with substance use disorders whether or not they are HIV infected are subject to the higher rates of mental disorders than the rest of the population ~ Counseling is an important part of treatment ~ Risk reduction allows for a comprehensive approach to HIV and AIDS prevention which promotes changing the substance-related and such related behaviors ~ Substance use treatment programs can help reduce the spread of other blood borne infections including hepatitis B and C viruses ~ Counselor should be familiar with Federal and state laws protecting information about client and substance abuse treatment, and state laws protecting HIV and AIDS related information Specific populations continued ~ Physical and cognitive disabilities ~ People with physical and cognitive disabilities are more likely to have a substance use disorder and are less likely to ge

Based on Doc Snipes' upcoming book 100+ Practical Tools to Defeat Depression. Read the whole book for FREE with Amazon Kindle Unlimited CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/904/c/ Cognitive Interventions Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counseling Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Define cognitive interventions ~ Explore activities to address ~ Perceptions ~ Attributions and Locus of Control ~ Cognitive Distortions ~ ABCs ~ Shoulds ~ Optimism and Cognitive Restructuring ~ Affirmations ~ Time Management ~ Goals Setting Overview ~ Cognitive interventions are things you do to change how you think about things ~ Is the glass half full? Is it partly sunny? ~ Is this really important to having a rich and meaningful life? ~ What is the yang to this yin? ~ How can this make me stronger, or what can I learn? Question ~ How do you help clients recognize the impact of their thoughts on their mood? Perceptions “Life is 10% reality and 90% what you make of it.” ~ Your past experiences created your schemas ~ Dog charging the fence barking ~ Flying ~ Angry faces ~ Creaking floorboards ~ Individual activity: Coin flip ~ Group activity: ~ On a beachball write 20 things that can be irritating or scary ~ Toss the beachball to a group member. They have to find at least one optimistic or non-threatenting way to look at whatever item they see when they look down at the ball ~ Repeat… Attributions and Locus of Control ~ Attributions are how you perceive things ~ Internal vs. External ~ Locus of control is where you perceive that your life is controlled from. ~ Do you control your own destiny (internal locus) or does everything just happen to you (external locus)? ~ Which is better? ~ Global or specific. ~ Give examples ~ Stable or changeable ~ Give examples ~ Dialectics: There is nearly always good and bad in everything. Attributions and Locus of Control ~ Activity ~ Apply those principles to the following statements ~ I believe that I control my own destiny ~ I blame other people for making me unhappy. ~ When I fail at something it means I am stupid ~ I am depressed Cognitive Distortions ~ What are they? ~ Arbitrary inference: Making assumptions without all the facts ~ Selective abstraction: Only seeing what you want (or don’t want) to see ~ Over generalization: Generalizing things about one situation to all similar situations ~ Magnification and exaggeration: Blowing something out of proportion ~ Personalization: Feeling like everything is your fault or a personal attack. ~ Polarized thinking: All-or-nothing. ~ Activities ~ Individual: Examine current stressors for cognitive distortions ~ Group: Define and identify interventions; Flip chart stations; Apply the solution Cognitive Distortions Emergency Card ~ Do I have all the facts? ~ Am I seeing the whole situation? ~ Am I using moderate words like sometimes, occasionally or often? ~ Am I making sure not to devote too much attention and energy to something that really won’t matter in a few days or weeks? ~ Have I considered possible explanations besides it being all about me? ABCs ~ The basic structure is as follows: Fill in “A” activating event and “C” consequence first. ~ A= Activating event or the stimulus (What happened?) ~ B= Your automatic (and often unrealized unhelpful Beliefs) ~ C= The consequence of those beliefs (What was your reaction?) ~ D= Determine if your beliefs and your consequences are rational/constructive. ~ E= Evaluate whether the situation is worth the energy of continuing the reaction ~ Activity (Individual= worksheet, Group= Discussion or Belief stations) ~ Have each person share something that makes them happy or proud, and apply the ABCs ~ Have each person share something that makes them angry or afraid and apply the ABC-DEs Who Says? Addressing Shoulds & Shouldn’ts ~ People can be miser

Addiction Counselor Exam Review Episode 19 Therapeutic Approaches Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Podcast Host: Addiction Counselor exam review, Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ Review different therapeutic approaches including CBT, MET, Contingency Management and Trauma Informed ~ Types of treatment (individual, group, family) and benefits and drawbacks of each ~ Culturally appropriate strategies ~ Family Engagement ~ Overview of Crisis Intervention ~ Relapse Prevention Therapeutic Approaches ~ Behavioral and cognitive behavioral approaches are grounded in social learning theories and principles of operant conditioning ~ Emphasis is on ~ Functional analysis of behaviors to understand them within the context of their antecedents and consequences ~ Skills training through which people recognize the situations or states in which they are most vulnerable and how to avoid high-risk situations ~ Using a range of behavioral and cognitive strategies to cope effectively with those situations if they cannot be avoided ~ Cognitive behavior therapy is based on the idea that feelings and behaviors are caused by a person’s thoughts ~ People may not be able to change their circumstances but they can change how they think about them and therefore change how they feel and behave ~ The goal of cognitive behavioral therapies to teach the person to recognize situations with their most likely to use, avoid these circumstances if possible, and cope with other problems and behaviors which may be to use Therapeutic approaches continued ~ Contingency management therapy uses motivational incentives to facilitate behavior change and has improved treatment retention and abstinence rates ~ Motivational enhancement therapy is a client centered counseling approach for initiating behavior change and has successfully been used with people with alcohol and marijuana use disorders Therapeutic approaches continued ~ Trauma Specific ~ Trauma Specific Models are an essential part of treatment as misidentified or misdiagnosed trauma related symptoms interfere with help seeking and hamper engagement in treatment, lead to early drop out, and make a relapse more likely ~ Trauma-Informed and Trauma specific approaches take into account knowledge about the trauma, its impact, interpersonal dynamics, and relation to recovery. ~ The primary goals of trauma specific services are focused to address directly the impact of trauma on people’s lives and to facilitate trauma recovery and healing ~ The Addictions and Trauma Recovery Integration Model or ATRIUM, seeking safety, and trauma recovery and empowerment model are all examples Therapeutic approaches continued ~ Couples and family approaches ~ The defining feature couples and families treatments is that they’re treating substance using individuals in the context of the family and social systems in which the substance use may develop or be maintained ~ Prevailing models: ~ Brief strategic family therapy ~ Structural or strategic family therapy ~ Multidimensional family therapy ~ Multi systemic therapy ~ Behavioral and cognitive behavioral family therapy ~ Solution focused brief therapy Culturally appropriate strategies ~ Two areas of concern with regard to cultural competence in addiction counseling are ~ the competence of the individual practitioner ~ the cultural appropriateness of specific intervention strategies ~ Culture includes much more than race and ethnicity ~ Culturally appropriate treatment can include the language used, the format of the program, the goals set for produce events, and specific program activities ~ Additionally, risk in protective factors may not be relevant for all cultural groups Culturally appropriate strategies ~ Programs and practices that have been tested and found effective with one cultural group can be modified to fit other groups ~ These modifications take two forms: ~ cultural accommodation: mo

Based on Doc Snipes' upcoming book 100+ Practical Tools to Defeat Depression. Read the whole book for FREE with Amazon Kindle Unlimited CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/904/c/ Objectives Define emotional interventions Discuss why it is important to add-in happiness experiences Discuss solution focused methods for helping clients identify emotional interventions Define mindfulness and how it can help clients tap into happiness and gratitude and develop hardiness Explore types of emotional interventions that can be used in individual and group counseling Emotional interventions address the emotions that keep you feeling depressed. Accept unpleasant emotions and improve the next moment Prevent unnecessary unpleasantness Add pleasant emotions Turn off the autopilot. Individual activity Lists Collages Daily journals Group Activity Collages Beach ball or Jenga Charades How would you feel if… Fear is a natural threat response. There are 6 basic threats: Rejection, isolation, failure, loss of control, the unknown and death Individual: Have clients answer the questions in the book between sessions Group: Brainstorm types of situations that make people in the group experience a particular type of fear Discuss as a group why this is fear-provoking Explore how addressing this fear will impact depression Identify strategies that have been (or could be) effective Use the challenging questions (in the book) to address the fear Guilt Define guilt and explore its impact on mood and self esteem Have clients identify the things they feel guilty for on a sheet of paper. Let them share whichever ones they choose Explore why they are angry at themselves (feel guilty) about this Create a guilt pack. Get a bunch of stones or bricks. Have clients count how many guilts are on their list and add that many weights to their pack. Talk about how much guilt weighs them down and zapps their energy. Grief Grief indicates you lost something important to you (rejection, isolation, failure, loss of control, the unknown and death) Anger is a part of the grief process, as is depression Denial, Anger, Bargaining, Depression, Acceptance Have clients define acceptance Identify the types of things that can be grieved. Loss of… Group activity: Brainstorm the loss list. For each type of loss, identify how to deal with it (radically accept it, get it back, etc…) Grant me the serenity to accept the things I cannot change The courage to change the things I can, and The wisdom to know the difference. Activity Review the list of your current stressors and irritants Identify which ones of those you have the power to change, and what you can do to change them. For those you cannot change, how can you change the way you feel about them? Let it go? Look at the bright side? View it as a learning experience? Remove that stressor from your life? Now do it. This takes courage. What are you afraid of? What is holding you back from changing those things you can? Activity: Group Brainstorm or Individual List What did you like to do as a kid? (swing, catch fireflies, paint, slip n slide, board games, hula-hoop, rollerskate, knock knock jokes…) What was your favorite show/cartoon? What was your favorite food? What was one of your favorite songs? What was different when you were little that you miss now? Have a play date with your inner 10-year old! The next day, write a journal entry about the effect being a kid for a day had on you. Did it help you unblock your creativity? Did it give you a new perspective on something? Do you just feel more relaxed? Make a plan to deal with at least one thing on your list each day. (Keep this list going forever to be mindful of your feelings.) Then have them identify which guilts they can either forgive, fix or let go (and how (hint: See book activities)). They can take those weights out of their pack. Summary When people are depressed, they often feel helpless and hopeless and nothing

ITDS 3 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Addiction Counselor Exam Review and Happiness Isn’t Brain Surgery Objectives ~ Define the issues and trends related to assessment of young children with disabilities ~ Describe characteristics of and various formats for effective observation ~ Describe the critical role the family plays in the screening, evaluation and assessment processes ~ Identify strategies to establish a collaborative partnership with the family and engage them in the assessment process ~ Describe effective communication principles and techniques with families including consideration of cultural and linguistic differences ~ Demonstrate knowledge of home based and group-care based curriculum strategies for infants and toddlers with special needs. ~ Identify the relationship of an infant/toddler's functional outcome goals on his/her IFSP created by the family and other team members with integrated interventions. ~ Assist the family in accessing services in the most natural service delivery environments Measurement Processes and Issues ~ Challenges and Opportunities ~ Children have short attention spans, limited expressive skills, struggle with separation issues, fatigue easily, adapt slowly to new surroundings, and exhibit a wide range of typical behaviors. (McLean, 2004) ~ The continuity and stability of the behavior of infants and toddlers varies from hour to hour or day to day. (Mindes 2003; Overton, 2003) ~ Many providers have difficulty accepting the role of the family in the evaluation and assessment process ~ The child is seen in the context of the familial, cultural and community systems which change as the child develops. (stationary to mobile; quiet to talking) ~ Consider transaction and reciprocity between the child, family, culture, community. ~ Be observant of the secondary effects of the disability on the child ~ Assessment of English Language Learners (ELLs*) and children from different cultures should focus on observation and informal procedures Using Observation as a Strategy ~ 3 major purposes of observation: ~ to understand children's behavior ~ to evaluate children's development ~ to evaluate progress. ~ For young children who have not mastered the use of language and cannot explain the reasons for their behavior, observers gain a great deal of insight by watching and taking detailed notes. ~ A good observer pays attention to the context as well as the frequency of the behavior, facial expressions of children, their actions, and their reactions. ~ While observing, the observer records information about the child's strengths and perhaps areas of skill that have not been attained. ~ Observation is an excellent tool to determine progress and accomplishment of certain milestones and goals. Types of Observation ~ An anecdotal record is a written episodic description of a child's behavior, event or incident (parent report) ~ Running records an effort is made to record everything that was said or happened within the observational period (transcription) ~ Event sampling is when the observer records the frequency of occurrence of the behavior of interest (tally) ~ A checklist is a list of sequential behaviors. The observer can use the checklist to determine whether the child exhibits the behaviors or skills listed. (greeting someone) ~ Rating scales are used to determine the degree to which the child exhibits a certain behavior or the quality of the behavior. (anxiety, attention, motivation) Assessment and Observation ~ Information gathering should be viewed as an on-going process ~ Dangers in this form of assessment ~ Observer bias…a preconceived idea of the behavior ~ Children’s behavior may not be the same when being watched. ~ The early intervention provider should be continually modifying his/her understanding of a family's resources, priorities and concerns in relation to ~ Their child (child’s needs, child’s be

ITDS Module 2 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Addiction Counselor Exam Review and Happiness Isn’t Brain Surgery Note • This presentation is designed for counselors as well as early intervention specialists and family team members. Some information may be review for some people. Objectives • Define teams and teaming • Describe the basic tenets of systems theory, as applied to early intervention teams • Discuss the teaming process in all stages of early intervention, from first contacts to transition • Understand the importance of ‘enablement' • Discuss the five components of the early intervention model • Understand how ecomaps can be used as relationship-building tools • Appreciate the ‘The Goose Story' as a metaphor for teams and systems • Discuss how preconceptions, attitudes and beliefs influence team behavior • Discuss barriers to effective communication • Describe the components of a successful team meeting • Describe the stages of team development • Identify qualities of effective teams/families 5 Components for Early Intervention • Understanding family ecology using an ecomap • Functional intervention planning using a routines-based interview • Functional child outcomes are those that address participation or engagement needs, that address independence needs, and that address social-relationship needs • Routines are naturally occurring activities happening with some regularity • Integrated services with a primary service provider • Effective, support-based home visits • Collaborative consultation to child care Principles • All the intervention with the child occurs between specialists’ visits. • Therapy and instruction are not golf lessons. • Children cannot transfer skills well from one learning setting, especially a decontextualized one, to everyday life, where they need the skills. • Caregivers need to own the goals, and are not likely to address target behaviors in which they have little investment • Caregivers influence the child. Professionals influence the family. • Children learn throughout the day • When parents provide interventions in daily routines, they are more likely to feel empowered. • It is maximal intervention the child needs, not maximal services. Ecomap (Brofenbrenner) 5 Stages of Functional Intervention Planning • Five stages were delineated: • Family and staff preparation for the interview • The routines-based interview itself • Outcome selection by the family • Writing of objectives and strategies by professionals with family input • Review in subsequent months 6 Questions for the Routine-Based Interview • What does everyone else do? For home routines, this means other family members; for classroom routines, it means other children. • What does the child do? • What is his or her engagement like how and how much does the child participate in the routine? • What is his or her independence like? How much can the child do by him or herself? • What are his or her social relationships like? How does the child communicate and get along with others? • How satisfied is the caregiver with the routine? During the Implementation Stage • Use a child's strengths to enhance learning in the natural environment • Remember that the relationship with the family is the context for intervention • Offer appropriate anticipatory guidance with respect to social, emotional and behavioral issues • Work cooperatively across disciplines. Be partners, not competitors Questions for Visits • Remember he 4 Es: Ears (listen), Elicit (ask), Empathize, Encourage • Questions • How have things been going? • Do you have anything new you want to ask me about? • How have things been going with each IFSP outcome, in priority order? • Is there a time of day that’s not going well for you? • How is [family member] doing? • Have you had any appointments in the past week? Any coming up? • Do you have enough or too much to do with [your chi

Review for the Alcohol and Drug Counselor Exam Episode 18: Counseling Skills Objectives ~ Identify the purpose and function of counseling ~ Define skills a counselor needs ~ Identify necessary attitudes for counselors ~ Explore how to develop the therapeutic alliance ~ Discuss motivation and how to increase it Counseling—Purpose & Functions ~ Develop therapeutic relationship with clients, families and significant others to facilitate transition into the recovery process ~ Provide information regarding the structure, expectations and purpose of counseling ~ Continually evaluate the client’s safety, relapse potential and need for crisis intervention ~ Apply ebps to facilitate progress ~ Document counseling activity and progress ~ Provide information on issues of identity, ethnic background, age etc as they influence behavior, prevention and recovery ~ Provide information about addiction and related health and psychosocial consequences Counseling —Purpose & Functions ~ Counseling is a collaborative, professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals ~ Competence is built on understanding various models of treatment, an ability to implement appropriate EBPs with individuals, families, and SOs ~ Counselors facilitate self-exploration, disclosure, problem solving and behavioral change ~ Counselors help clients ~ Explore and enhance motivation ~ Set appropriate treatment goals ~ Understand structure, expectations, purpose and limitations of the counseling process ~ Mobilize resources to resolve problems and modify attitudes ~ Counselors respond to crisis situations by identifying and practicing ways to avoid and cope with high risk situations Therapeutic Allicance ~ Strength of the TA depends on the facilitative qualities of the counselor and the strategies used to create a positive environment for exploration and change ~ Facilitative qualities ~ Empathy ~ Genuineness ~ Respect ~ Self-Disclosure ~ Warmth ~ Immediacy “Focus on the here and now” ~ Concreteness: Identify specific problems and interventions ~ Cultural Sensitivity Counseling: Therapeutic Alliance ~ Components of the Therapeutic Alliance ~ Bond between therapist and client characterized by warmth, genuineness and respect ~ Consensus between counselor and client regarding ~ Treatment approaches ~ Goals of treatment ~ Primary responsibility for developing and maintaining the TA rests with the counselor ~ 80% of positive outcomes are due to TA ~ TA must be continually monitored and nurtured to prevent premature discharge and enhance treatment effectiveness ~ Adapting the relationship to several patient characteristics, not just dx, enhances the TA Counselor Skills ~ Engage the client ~ Develop and individualize treatment and recovery plans ~ Effectively describe and negotiate access to the continuum of care ~ Adapt counseling strategies ~ Apply culturally and linguistically responsive communication styles ~ Provide nonjudgmental, respectful acceptance of cultural, behavioral and value differences ~ Elicit client’s perspectives on progress ~ Maintain contact with referral services ~ Assist the client in monitoring and maintaining motivation ~ Document all relevant aspects of treatment clearly and concisely ~ Provide education regarding how to change risk behaviors, adopt protective, healthy practices and make appropriate use of service systems Counseling Skills—Active listening ~ Helps the client and counselor clarify what is going on ~ Clear listening—listen without judgement and without immediately trying to correct the client’s thoughts ~ Reflecting—Summarizing and repeating ~ Asking open-ended questions ~ Using effective body language (SOLER) ~ Watching for nonverbal cues Counselor Attitudes ~ Appreciation of strengths-based approaches which emphasize client autonomy and skills development ~ Respect for the client’s right to self-determination ~ Appreciation of the roles of th

Infant Toddler Developmental Training Part 1 Objectives • Define child development and atypical development • Describe each of the major domains of child development • Describe the typical sequences of child development • Differentiate between qualitative and quantitative development • Explain how culture impacts development • Identify factors that may lead to atypical development • Identify developmental signals that indicate a possible developmental delay or problem from birth to three years of age • Identify things that make it difficult to pinpoint a possible delay • Explain the effect of developmental disorders on child development (e.g., sensory impairments, chronic illness, genetic syndromes, and cognitive delays) and the family Child Development Assessment • Child development is a normal progression by which children change as they grow older by acquiring and refining knowledge, behaviors, and skills. • Assessment involves five specific areas: • Motor/physical • Cognitive • Social/emotional • Communication/language • Self-help/adaptive (toileting, feeding, dressing, initiative) Principles of Development • Three generally accepted principles of child development are that • The rate of development differs among children • Development occurs in a relatively orderly process • Development takes place gradually • Atypical child development is used to describe children whose differences in development are to a marked degree or whose development appears to be significantly inconsistent with normal child development • Many variations in child development may be explained by cultural life experiences (cultural differences), because parental beliefs, child-rearing practices vary across cultures Differences in Development • Quantitative differences in child development refer to the changes children encounter as they acquire more knowledge and grow physically. (What they know and can do physically) • Qualitative differences focus on changes in the way children think, behave, and perceive the world differently as they mature.(concrete to formal operational thought) • Nature refers to heredity and characteristics remaining stable through the years • Nurture refers to the day to day interactions children encounter in their environment. • If parents or caregivers believe that environment has a large influence throughout a child's life, then they would make sure children would have high quality experiences past their primary years Prenatal Development • When considering child development, one has to consider the prenatal period • Exposure to teratogens • Nutrition • Having mom on psychotropics risk/benefit Factors Leading to Atypical Development • Teratogens (in the child and in utero) • Illicit and OTC Drugs • Pesticides • Heavy metals: Mercury and Lead (exhaust, paint, contaminated fish) • Poor nutrition • Stress • Maternal Behaviors • Smoking • Alcohol • Maternal diseases • Rubella • AIDS • Toxoplasmosis (cat feces OR undercooked meat) • Cytomegalovirus Factors Leading to Atypical Development • Abuse or neglect: Physical, Psychological, Sexual • Heredity: Down syndrome, spina bifida, vision impairment, hearing loss, cystic fibrosis, muscular dystrophy, Tay-Sachs disease, and Fragile X syndrome, scoliosis, heart defects, sickle cell anemia • Birth Complications • Oxygen Deprivation >3min: Cerebral Palsy, intellectual and motor delays • Low Birth Weight (<5lb 11oz): Immature lungs and breathing, mild/severe cognition problems, cerebral palsy, delayed speech, and sensory impairments • Post-Term Birth: After 40 weeks a decrease of amniotic fluid will cause the infant to squeeze the umbilical cord, extra size may cause difficulty moving through the birth canal leading to increased risk for oxygen deprivation and head injuries Factors Leading to Atypical Development • Birth Complications • Prematurity (before 37 weeks): Respiratory issues, brain bleed, immature immune system, deficits in motor coordination, inattentiveness, overacti

Child and Adolescent Development Objectives • Define theories of child development and identify how they can be useful in working with young children and their families • Explore how knowledge of developmental theories can guide you in your interactions with children (and parents) • Identify the thought leaders in developmental psychology • Identify the major psycho-social milestones for each age group • Learn about things that may thwart development • Identify protective factors for healthy development • Conceptualize behaviors as goal-driven in order to better understand their purpose and provide appropriate redirection Approach • Feelings are accompanied by physiological responses and behavioral urges which are mediated by • Parenting and getting needs met (biological, safety, belonging(Maslow & Erikson)) • Social learning (Home, school, media (Bandura, Watson and Skinner)) • Cognitive development (Piaget) • The environment (Brofenbrenner & Vygotsky) Psychosocial Theory • Erikson • Believed that development is life-long. • Emphasized that at each stage, the child acquires attitudes and skills resulting from the successful negotiation of a psychological conflict. • Basic trust vs mistrust (birth – 1 year) • Autonomy vs shame and doubt (ages 1-3) • Initiative vs guilt (ages 3-6) • Industry vs inferiority (ages 6-11) • Identity vs identity confusion (adolescence) • Intimacy vs isolation (young adulthood) • Generativity vs stagnation (middle adulthood) • Integrity vs despair (the elderly) Erickson's Stages Psychosocial Development • The stages • Hope: Trust vs. Mistrust (Infants, 0 to 1 year) • Interferences • Child does not have basic food, shelter, safety, love needs met • Manifestations • Inability to trust self or others • Reliance on others to tell them what they need • Lack of a sense of worthiness for basics • Discomfort with and craving of attention • Irritability/anxiety • Establishment/Re-Establishment • Consistency • Compassion • Care (Ensure basic needs are met) Psychosocial Development cont… • Will: Autonomy vs. Shame & Doubt (Toddlers, 2 to 3 years) • Interferences • Overly permissive or overly strict parents • Lack of praise for exploration and experimentation • Manifestations • Low self-esteem/need for external validation • Lack of motivation • Establishment/Re-Establishment • Encourage child to explore and experiment • Praise child for trying even if he fails • Reassure child that you love him for who he is Psychosocial Development cont… • Purpose: Initiative vs. Guilt (Preschool, 4 to 6 years) • Interferences • Overly strict/enmeshed parents • Lack of encouragement to take risks • Manifestations • Low self-esteem/need for external validation • Difficulty making or maintaining friends • Unclear what he likes, wants, feels • Establishment/Re-Establishment • Encourage child to explore and experiment • Praise child for trying even if he fails • Reassure child that you love him for who he is • Encourage children to develop friendships with a variety of people Psychosocial Development cont… • Competence: Industry vs. Inferiority (Childhood, 7 to 12 years) • Interferences • Lack of consistent support and encouragement • Manifestations • Low self-esteem/need for external validation • Lack of motivation • Establishment/Re-Establishment • Encourage child to develop skills in areas in which he can excel • Praise child for trying even if he fails • Reassure child that you love him for who he is Psychosocial Development cont… • Fidelity: Identity vs. Role Confusion (Adolescents, 13 to 19 years) • Interferences • Lack of support for individual wants, needs or goals • Lack of stable, consistent relationships • Manifestations • Low self-esteem/need for external validation • Lack of motivation • Establishment/Re-Establishment • Encourage child to develop skills in areas in which he can excel • Provide support when the child’s world seems chaotic • Reassure child that you love him for who he is Behaviorism • Developed as

Addiction Counselor Exam Review Treatment Approaches & Settings Instructor: Dr. Dawn-Elise Snipes Executive Director AllCEUs.com Podcast Host: Addiction Counselor Exam Review, Counselor Toolbox and Happiness Isn’t Brain Surgery ~ This presentation is available on our youtube channel at allceus.com/youtube or you can subscribe to the Addiction Counselor Exam Review Podcast on your favorite podcast app. Objectives ~ Learn ASAM Dimensions ~Review Self help approaches ~ Identify different approaches to and levels of treatment ~ Define evidence based practices and clinical guidelines and identify where you can find them ASAM Dimensions ~ Acute Intoxication/Withdrawal Potential (consider protracted withdrawal (PAWS)) ~ Opioids, methamphetamine, marijuana, benzodiazepines and cocaine ~ Biomedical Conditions ~ Emotional, Behavioral and Cognitive Conditions ~ Readiness for Change ~ Relapse and Continued Use Potential ~ Recovery Environment Self- Help Approaches ~ Types ~ 12-Step (Emotions, Alcohol, Schizophrenics…)/Double Trouble ~ Admitting that one cannot control one's alcoholism, addiction or compulsion; ~ Recognizing a higher power that can give strength; ~ Examining past errors with the help of a sponsor (experienced member); ~ Making amends for these errors; ~ Learning to live a new life with a new code of behavior; ~ Helping others who suffer from the same alcoholism, addictions or compulsions. Self-Help ~ Key Features of 12-Step Programs ~ Accessibility ~ Anonymity ~ Social support and mutual aid ~ Promotion of self-esteem and efficacy ~ Introspection and insight ~ Spiritual recovery ~ Advocacy to promote social and legal remediese Self-Help AA ~ Founded by Bill W and Dr. Bob ~ 1 million people estimated to have achieved recovery through AA ~ Main purpose to stay sober and help others ~ Abstinence is the only treatment ~ 3 legacies of AA ~ Recovery ~ Unity ~ Service Self-Help Al-Anon ~ For SOs of people with addictions ~ Lessons ~ Not to suffer because of the actions or reactions of others ~ Not to allow ourselves to be used or abused by others ~ Not to do for others what they can do for themselves ~ Not to cover up for other’s mistakes ~ Not to create a crisis not to prevent a crisis if it is the natural order of events Self- Help Approaches ~ Types ~ Rational Recovery ~ The primary force driving an addict's predicament is what Trimpey calls the “addictive voice”. When the desires of this “voice” are not satiated, the addict experiences anxiety, depression, restlessness, irritability. ~ The RR method is to first make a commitment to planned, permanent abstinence from the undesirable substance or behavior, and then equip oneself with the mental tools to stick to that commitment Self- Help Approaches ~ Types ~ Women for Sobriety ~ Positive reinforcement (approval and encouragement) ~ Cognitive strategies (positive thinking) ~ Letting the body help (relaxation techniques, meditation, diet and physical exercise) ~ Dynamic group involvement. Self- Help Approaches ~ Types ~ SMART Recovery ~ Teaches self-empowerment and reliance by ~ Point 1: Building and Maintaining Motivation ~ Point 2: Coping with Urges ~ Point 3: Managing Thoughts, Feelings and Behaviors ~ Point 4: Living a Balanced Life Self- Help Approaches ~ Types ~ Celebrate Recovery ~ Realize I’m not God; I admit that I am powerless to control my tendency to do the wrong thing and that my life is unmanageable. (Step 1) ~ Earnestly believe that God exists, that I matter to Him and that He has the power to help me recover. (Step 2) ~ Consciously choose to commit all my life and will to Christ’s care and control. (Step 3) ~ Openly examine and confess my faults to myself, to God, and to someone I trust. (Steps 4 and 5) ~ Voluntarily submit to any and all changes God wants to make in my life and humbly ask Him to remove my character defects. (Steps 6 and 7) ~ Evaluate all my relationships. Offer forgiveness to those who have hurt me and make amends for ha