I'd have to say 110%. Actually, in some ways I think he might be better at this than
my spouse. Not that I haven't hurt or worried him, but my spouse has really suffered
with this. Maybe I should think about asking him.
THERAPIST: Well, before you make your decision let's complete the list. Remember, you still have
important people in your life, this particular person should be able to attend 3-19
sessions and you should be able to rate them pretty highly on these categories. So do
you want to continue now or do you have any questions first?
Let's finish this now. Maybe when we are done I'll have some questions.
THERAPIST: Good enough.
If your client is reluctant to have a SSO attend, follow a motivational interviewing style to encourage
SSO involvement. Particularly helpful are open-ended questions followed by reflective listening. Ask the
client about specific concerns she or he has about having someone attend the sessions with him/her. Ask
about what the benefits and costs are of having a SSO attend the sessions - e.g., what is the worst and best
thing that could happen if your (SSO) attends? Reflect back the unfavorable and favorable responses about
SSO attendance. For example:
On the one hand you are concerned that your (SSO) may end up policing your drinking. On the other
hand, having your (SSO) involved might enable you to stay away from alcohol. Would you be willing
to give it a try at least for a session or two?
Using the aforementioned motivational techniques can help resolve the client's ambivalence with
regard to SSO attendance. If the client still refuses, don't push. Acknowledge the client's autonomy ("Okay,
that's how you feel for now. It's really your choice"), and indicate that you may come back to the issue (i.e.,
SSO involvement) later on in treatment. Then do keep trying periodically to encourage the client to involve a
SSO in treatment.
If the client agrees to involve a SSO, the simplest way to initiate this is to have the client ask the SSO
to come. It might be useful to rehearse how the client would approach and ask the SSO. It is also permissible
for the client to telephone the SSO from the office during the session. If the client prefers, however, or if the
client's own invitation does not get the SSO to come on the first try, offer to make the contact. This requires
written permission from your client.
Before the client leaves the session ask him or her to give a letter to the SSO. Mention that the letter
defines a role for the SSO, and provides important information on how the SSO can contribute to the
therapeutic process. Show the letter to the client and ask if he or she has any specific concerns about it's
contents. If the client has serious reservations, postpone handing out the letter until you have had a chance to
resolve their concerns. Here is suggested language for the letter:
This letter is to introduce and invite you to participate in a treatment program, in support of [client],
who believes you could be particularly helpful. I am currently working with [client] in our program,
which is one of a number of treatment centers in the United States participating in the development of
state-of-the-art treatment for alcohol problems. This treatment works best when a supportive person
participates in the treatment sessions.
[Client] values your help and has named you as a trusted person who could fulfill this important role.
He (or she) views you as someone who is available and supportive, as well as positive about [his/her]
seeking treatment for alcohol problems. [His/her] treatment will involve up to 18 further sessions over
a maximum period of 16 weeks, based on progress towards goals agreed upon at the beginning of
This letter is to ask whether you would be willing to participate in a supportive role in some of
[client’s] treatment. We can discuss the amount of your participation, and reach a decision that is
acceptable to all involved. The treatment sessions last about an hour and are scheduled at everyone¹s
convenience. They are held at [location].
What would be involved? As we work together, [client] will be developing specific plans for
change. If you agree to participate, you could be helpful to [client] by giving encouragement, offering
helpful ideas, and supporting [his/her] own efforts toward treatment goals. You would not be on your
own; We will discuss in session how best you can support [client] toward positive change.
I hope that you will agree to come to at least one session, to explore how you might support
[client’s] efforts toward change. If you have any questions, please feel free to call me at the number
listed above. Otherwise, [client] can just tell you the date and time of [his/her] next appointment so
that you may attend.
Thank you for considering to help in this way. Your support could make a big difference.
2.6b.3. Summary of SSO Recruitment Process
Step One: Clinician initiates involvement of a Supportive Significant Other. If client agrees, clinician proceeds
to review of Important People questionnaire (Form LL) and selection of SSO.
Step Two: If client disagrees, clinician elicits concerns and responds with motivational interviewing style as
outlined in Involving the SSO in treatment, page 2:22 and in box on 2:23
Step Three: If client continues to be reluctant to discuss SSO involvement, therapist may delay further
discussion of this issue, but must query again in Phase II and Phase III.
2.6c. Completing Assessment Needed for Phases 1 and 2. There are three questionnaires that all
clients need to complete in preparation for the second session and for Phase 2 of treatment. Allow enough
time to administer these at the end of the first session, so that you can obtain a few additional scores you will
need for feedback (PFR) in session 2. Do not proceed with session 2 until these assessments have been
completed (about 15-20 minutes needed). Do not send these questionnaires home with your client. They must
be completed in the office, under more standard and controlled conditions. The three questionnaires are:
Desired Effects of Drinking Questionnaire
(used in 3.2b)
What I Want From Treatment
(used in 3.5b)
Client Services Request Form
(used in 4.3c)
Begin with a transitional statement such as:
As I mentioned earlier, there are some you’ll need to
complete in preparation for our next session together. I
have three questionnaires here that I need you to complete,
and then I’ll tell you briefly about what we’ll be doing next
time. You can fill these out right here. If you have any questions, I’ll
be [right outside, in the next office, etc.], and let me know when you’re
Before moving on, scan the questionnaires to make sure that all items have been completed.
Client Services Request Form
Desired Effects of Drinking
What I Want From Treatment
2.6d. Ending the First Session. Allow at least ten minutes to close the session. Conclude the first
session with a summary statement, drawing together all that has happened in it, including self-motivational
statements offered during the session.
Then explain what happens in treatment from there on. Here is an example of what you might say:
Next time I will be giving you some feedback from the interviews and questionnaires you completed,
answering any questions you may have about it. Then we’ll be taking a closer look together at how
you have used alcohol, and how it has fit into your life thus far. That will take us a session or two.
From there we’ll start to think together about where you want to go from here. We have between 12
and 20 sessions to work together during the next sixteen weeks.., and you will have a lot to say about
what we do here during that time. We’ll work out together an individualized treatment plan that
makes sense for you, that deals with things that seem important to you. Again, you are the expert on
you, and no one else can decide what you are going to do. How does that sound to you?
2.6e. Scheduling the Next Session. Schedule the next session, usually within a few days of the first
session. During the first four weeks of treatment it is recommended that sessions be held at least twice weekly
(permissible range: 1-3 times weekly during the first four weeks in which treatment is delivered). Thereafter
sessions will normally be reduced to once weekly (permissible range: 1-2 times weekly during Weeks 5-12).
The maximum number of CBI sessions with a single client is 20, including any emergency sessions that may
be used to deal with crises.
Reference: Form F
Reference: Form G
Reference: Form H
2.6f. Sending a hand-written note. After the first session, prepare a handwritten note to be mailed to
the client. This is not
to be a form letter, but rather a personalized message in your own handwriting. [If your
handwriting is illegible, make other arrangements, but the note should be handwritten, not typed.]
There are several elements that can be included in this note, which are personalized to the individual:
1. A "joining message." ["I was glad to see you,” etc.]
2. Affirmations of the client.
3. A reflection of the seriousness of the problem.
4. A brief summary of highlights of the first session, especially self-motivational statements that
5. A statement of optimism and hope.
6. A reminder of the next session.
Here is an example of what such a note might say:
Dear Mr. Robertson:
This is just a note to say that I'm glad you came in today. I agree with you that you have some serious
concerns to work on, and I appreciate how openly you are exploring them. You are already seeing
some ways in which you could make a healthy change. I think that together we will be able to find a
way through these problems. I look forward to seeing you again on Tuesday the 24th at 2:00.
Place a photocopy of this note in the client's clinical file.
2.6g. Completing the Session Record Form. The Session Record Form must be completed for every
client contact including regular sessions, emergency sessions, telephone contacts, canceled sessions, and no-
show sessions. Begin the form by entering the client’s case number and printing your own name and therapist
number. [If for any reason a different therapist assumes responsibility for a case or delivers a session, a new
Session Record Form must be started.] Also record the 16 week date which is the last possible session date.
Staple the Session Record Form inside the front cover of the client’s chart. If one form is filled and a
continuation page (same form) is required, staple the new form on top of the previous form.
Log each session on this form at the time of the session. Do not wait until later to fill in the
information needed. Enter one of the following codes in the correct column for each and every client contact
(including missed sessions and telephone contacts with client or SSO):
S-___ To indicate that an actual face-to-face treatment session was completed, regardless of its
length. Give each completed session a sequential number (S-1, S-2, etc.)
Client had positive BAC (>.05), and session was rescheduled.
To indicate a session that was scheduled but missed because the client canceled it (whether or
not it was rescheduled) more than four hours before the time. (A time stamped answering
machine message constitutes prior notice.)
To indicate a session that was scheduled but missed (no show) because the client failed to
appear and either gave no notice or gave notice within less than 4 hours of the scheduled time.
Face-to-face counseling session with SSO only; client not present.
To indicate a telephone contact with the client, regardless of length, and regardless of whether
initiated by therapist or client. This code is also used if a telephone contact included both the
client and the significant other in the same call.
Session was canceled by the therapist (e.g., due to illness).
To indicate a telephone contact with the significant other but not the client, regardless of
length, and regardless of whether initiated by therapist or significant other.
Unscheduled contact, face to face (e.g., walk-in).
Record the date of the session (month/day/year) and the time that the session actually began. The latter is the
time when you began talking with your client in session, not the time at which you were scheduled to begin.
When the session is over, enter “time ended” as the actual time when the client left the session, not the time
when the session had been scheduled to end. Then use the “time began” and “time ended” values to determine
the number of minutes that the session lasted (do not round). For CA and NS codes, enter the date on which
the session had been scheduled, but do not enter any values for “time began” and “time ended.” Also indicate
whether a significant other participated in any portion of the session by checking either “Yes” or “No”.
(Accompanying the client to a session does not count unless the SSO was present in the treatment room for at
least part of the time.) For the TS code, this box will always be marked “Yes.” Do not check Yes or No for
missed sessions (CA or NS codes).
Finally, indicate the correct Phase for the session (I-IV) and which modules you delivered, at least
partially, during the session by designating the two letter module codes. These codes are contained on the
2.6h. Completing the Therapist Session 1 Checklist. In addition to the Session Record Form which
you keep throughout the course of treatment, also use the appropriate Therapist Checklist during each and
every session. There is a special Therapist Session 1 Checklist to be completed during each client’s first
session. The checklist helps you to remember important elements of treatment, and also allows you to
document whether you have delivered each of them. (Supervisors and tape raters will use similar forms to
parallel your own entries.) Use a check mark [Υ] to indicate each element of treatment that you deliver,
marking them during the session as you complete them. When the session has ended, make sure you have
checked all of the boxes corresponding to procedures that you delivered. Also note that there is a procedure
(hand-written note) to be completed after Session 1.
Reference: Form A
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