Last Christmas I had the opportunity to shop in one of the most famous toy stores in the world, FAO Schwarz in New York City. As I walked around in circles feeling overwhelmed by the choices, I resolved not to leave the store until I had three toys — one for each of my children.

After searching high and low and considering many options, I became acutely aware that this shopping stuff is stress. I was actually fearful of choosing a gift — it was becoming a test and I was nervous about making a bad choice. But being a counselor, I talked myself down and removed this irrational line of thinking. Finally, after bit more looking I ended up buying a classic toy for each of my children — the Rubik’s Cube.

On Christmas morning my children began to play with their Rubik’s Cubes, but then became frustrated. After some discussion with them I discovered their frustration resulted from not having a clear path to follow. I made this brilliant insight because they asked me for the cheat sheets, to which I responded, “What is a cheat sheet?”

Clearly there are generational differences here, as my children are accustomed to video games, which apparently have cheat sheets to assist a player who is having trouble with a new game. After all, I never asked for a cheat sheet when I got my first Rubik’s Cube. After much effort and frustration I somehow managed to figure out how to put the cube back together.

As I watched my children, I recognized that their frustration was quite similar to what my current addiction counseling students feel. Like the children, my students often seek out the short cut for becoming seasoned addiction counselors.

My 2005/2006 class is a wonderful group of young professionals who are preparing to become addiction workers. I have a total of 18 students, 12 of whom already have degrees from some of the top universities in Canada. These students are keen to learn, but the sheer volume of learning in this program is great. Students must navigate many courses and pull them together to become addiction counselors, hence the Rubik’s Cube of addiction counseling.

They need to process and understand the following: addiction counseling theory, addiction counseling, crisis intervention, prevention, addictive disorders, introduction to substance abuse, ethics, family counseling, group counseling and so forth. It really is a challenge for them to put all the pieces together. They ask me nearly every day to help them determine the right kinds of questions to ask, seeking approval to find out if it is alright to say this or do that.

All of this is coming from the same place I was when I was trying to pick out the right toy for my children — a fear of not doing the right thing. I think this is healthy, as it shows a clear conscious of wanting to do the right thing. But in the end, even noble fear is fear, and fear can prevent growth and learning.

This article will be the first of a series of articles to provide both the new and old addiction counselor with what my son Tommy would call cheat sheets. However, unlike a video game, the stakes are higher for addiction counseling. The focus of this first article is setting the stage for addiction counseling that prepares the client for the counseling process. I am sure there are other cheat sheets out there that could achieve the same mean. I am suggesting my version of a cheat sheet to prepare the client for treatment.

Seven steps for setting the stage
The seven steps for setting the stage for addiction counseling will outline seven stages that should be addressed before the addiction counseling session begins. The following steps assume that the client has been screened formally or informally.

This cheat sheet points out important elements I recommend to be in place before getting into addiction counseling. With this in mind, I make it clear to my students, the counseling process starts as soon as we engage the client. Each of the following steps has been designed to build on one other and should be completed prior to beginning the counseling session. This model has been created for working with a person face to face. However, some of the steps also would be applicable for telephone counseling.

If you have ever tried a Rubik’s Cube you will know that it must be well put together and functional before you can begin working to figure out the right pattern for solving the puzzle. Similarly, addiction counseling needs to have a solid foundation that is functional for both the counselor and client, and these steps are the foundation of trust and the counseling environment. The addiction counselor will, throughout the entire process, tune in to core counseling skills, such as empathy, non-judgment, listening skills, positive body language and so forth to help move the client through each step.

Step 1: Preparation for New Client — From the time an addiction counselor sees the client in person and starts to communicate, there is a set of first impressions that are being formed by both client and addiction counselor. To help my students understand self-awareness and the impact of their behavior on the counseling process, I teach them to be aware of several details, as it will help them mentally prepare for each new client. These steps can be used to get the counseling process underway.
• Internal preparation — Before meeting any new client it is important to change channels and refocus to get ready for the next client. Every client is important and deserves your best. Also, most clients, to some degree, are counting on you to help them find a new path. It is critical for the addiction counselor to mentally tune in and be ready for each client before proceeding with the session. This internal preparation ensures that your mind is cleared of issues and ideas that are not relevant to the next client. To do this you must first acknowledge the value and importance of clearing your mind and reserving your energy to the next client. Clients are intuitive and they know if you are mentally in the room, or not.
• Body language and face expression — From first eye contact with a client it is important to start assessing the client’s body language and facial expressions. Also, it is important to be mindful of your own body language and expressions. NLP teaches mirroring and matching to assist in building rapport. If you are not very familiar with body language, NLP may be helpful.

They say a picture is worth a thousand words, and what the client sees will influence how comfortable they feel. Skilled addiction counselors understand the impact of body language and face expression.

• Monitor Safety — From the first time you approach a client it is valuable to analyze and assess for any potential safety or risk factors, such as whether the client: has any obvious medical issues (e.g., open sores); appears functional (e.g., neurological orientated in time and space and/or any obvious physical or mental concerns; and appears to be healthy and groomed.

Addiction counselors must be aware of potential danger to the client or themselves. Addictions can lead to high risk behaviors, therefore this is paramount. As my old football coach told me, “Keep your head on a swivel and pay attention.”

• Moving Towards a New Client — For safety it is advisable to not walk straight on toward a client. Greet the client at an angle. Since most people shake right-handed, I recommend you keep your right eye aligned with the client’s right eye as you move toward them. You will notice that this naturally creates an offset angle for moving out of the way quickly, if necessary. I used to walk straight towards my clients, often with a smile and my arm sticking out to shake hands. One day a rather large client came into my office, and as I got up and walked toward the client, I heard a voice behind him say, “Please, stop and turn around slowly sir.” The request came from a police officer who was there to arrest the client for a parole violation. I am still unsure how he knew the client was in my office, but when the client heard the police officer, he started running forward and looking backwards. I was knocked into the wall and the rest is history.

• Meeting A New Client — When approaching a new client in the busy waiting room I share with several other professional helpers, my first task is to find the right person. I am not a fan of yelling names out in my office for obvious confidentiality reasons. I get a sense of who my client is from eye contact, and then I walk towards them. At around six to eight feet away I say the client’s first name to make sure I have the correct person, and then I move one or two feet closer, stopping at around four feet to offer a more formal greeting. This step accomplishes two things: first, it empowers my client; and second, it is a test to ensure it is safe to shake the client’s hand. I do not assume it is alright, therefore I ask something like, “Would you like to shake hands?” Amazingly, most clients simply nod and shake hands.

Once I get permission I stabilize myself to shake hands by using a T-stance to create a nice strong base and provide me a good center of balance. I then give a quick, firm, confident handshake, ensuring that I keep my hand parallel with my thumb straight up, so it is neutral, safe and professional. A top hand turned down is a controlling hand shake and palm up is a passive hand shake.

• Giving Directions to the Office —After the handshake I step to the right and back out of the way and encourage the client to walk past as I give directions to the my office. I follow the client staying a full person length to the left or right of the client, but never directly behind. I verbally direct the client where they need to go. This is a good opportunity to study the client’s gait as he or she walks. Since neurological damage can negatively influence how a person moves, it is useful to notice events that are outside the realm of normal.

• Offering a Seat — Once we are both in the office I encourage the client to sit first, ensuring that the chair I am offering to the client is at least as nice as mine, or better. Before seating myself, I will check to see if there is anything the client needs before we begin, such as a glass of water. If you could look at my office you would see the client sits the farthest from the door.

Step 2: Building Rapport — The art of communication is so important for a counselor to understand. I teach all of my students a communication model. I do not assume they have strong communication skills, and we work on developing both intra- and interpersonal skills, as well as developing their own communication models so they are equipped with necessary conversational skills to build rapport with clients.

Rapport is, in essence, helping a client see that you are human and trustworthy. A client must feel safe and trust that you, as a counselor, are not a threat. Rapport-building allows you to find some common ground, and to assist in the client transition — preparing you to talk about the client’s problems. Another goal of rapport is to reduce anxiety in the client by provide an environment that makes the client as comfortable as he/she can be, and taking away any feeling the client may have that he/she is being judged.

Step 3: Client Matching — Without delving into the problem, it is important to ensure the client is aware of what your current facility or organization does, and your role in the organization, as well as how long you normally work with clients. This helps to promote the end of the process, which is the goal of treatment — to assist a client in graduating to the next level of independence.

Once the client is clear on everything you have said, verify that it all makes sense to them and that they are in the right place. Also, for the client’s safety and treatment success as well as your safety in this step ensures you are comfortable with the level of interaction thus.
The kinds of questions you want to consider are:

• Is the client currently on chemicals? If so, is he/she functional?
• Is the client in crisis? If so, what is his/her current level of equilibrium (emotional stability)?
• Is the client in the right place? If not, provide as much meaningful direction to assist him/her in finding the appropriate service. Whenever you are in this position and it is appropriate, provide a referral and/or recommendations.

Step 4: Disclosing Professional Education & Competencies — With every new client it is important to disclose your professional education and competencies so the client is aware of your level of training, and your function as a profesisonal. Clients often do not know or fully understand the various levels of professional addiction counselors (e.g., one trained in a community college, or one who is trained in a masters program). This often is an excellent education frame for the client that assists them in understanding the hierarchy and where you fall in this hierarchy. It is very important that the client is clearly aware of your exact role in the care continuum.

Step 5: Confidentiality Statements and Other Paper Work — Once you and your client are confident and comfortable that he/she is in the right place, the next thing to be addressed is the limitations of confidentiality, as well as the pre-assessment paper work including: release of information, signing confidentiality form, etc. This is a major administrative part of the addiction counseling process that is addressed before counseling can begin. Also, in this section I will ensure that the client is aware of all formal and informal ground rules relevant to the client’s situation and your counseling situation. It is important to make sure the client is clear on everything that has happened to this point, before moving on.

Step 6: Consent — Once the client understands the limitations of confidentiality and has completed all the pertinent paper work, it is important to do one more efficacy check — obtain permission from the client to continue with the needs assessment, which will outline the primary and secondary issues that need to be addressed in the client’s treatment plan. The treatment plan is the addiction counselor’s blue print for determining the kinds of recovery tools and addiction counseling strategies that will be employed to assist the client in moving forward and taking control of his/her life.

Step 7: Needs Assessment — Everything that has been done to this point has set the stage, clearing the way for the addiction counselor to do a needs assessment with the client. The needs assessment will determine what the individual needs and wants, as well how motivated the client is to take action. All of these variables will come into play to determine the client treatment plan.

The above seven steps set outline some cheat sheet material for assisting the counselor set the stage for addiction counseling. I often wish I was provided with this kind of information and level of detail before I started to work as an addiction counselor. Understand once again this is my cheat sheet. You may have your own. I encourage you to write out your cheat sheet.

The next article in this series will provide a cheat sheet for doing a structure clinical need assessment and treatment plan.

William A. Howatt, PhD, EdD, ICADC, serves on the faculty of Nava Scotia Community College and is co-editor (with Robert H. Coombs) of the Wiley Book Series on Treating Addictions. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

This article is published in Counselor,The Magazine for Addiction Professionals, June 2006, v.7, n.3, pp.66-70.

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