of staff members' interactions with clients, as well as review of staff members' client
charts.
Case presentations. Weekly or monthly group case presentations conducted by a different
staff member each time can be effective for building skills and monitoring quality. Case
simulation, in which each staff member has an opportunity to ask the "client" a question,
is a highly useful training tool. At the end of the presentation, everyone attending can
provide feedback about the activity.
Experiential skills-building exercises. Many activities can be used to sensitize staff to the
client's experiences. Activities can include encouraging staff members to go to a
confidential and anonymous HIV/AIDS test site, or anonymously sit in the waiting room
of the local food stamp office, HIV/AIDS clinic, or county jail. Staff must use different
avenues to maintain a keen sensitivity to and awareness of the client's issues.
Assessment instruments. Use specific assessment tools, such as substance abuse and
sexual history questionnaires (e.g., the Addiction Severity Index [ASI]).
Formal conferences, training, consultations with clinicians. Often agency budgets are
tight, and the first expense to be cut is staff development. This is a major problem for
many programs. Programs must establish that improvement and excellence are serious
goals and that attending treatment-oriented conferences is a part of building staff
competency and moving toward these goals.
Attitudes
It is important that counselors be aware of any of their own attitudes that might interfere with
helping a client. By learning to put aside personal judgments and focus on client needs, staff
members can build trust and rapport with the client. When a counselor can deal with a client in a
sensitive, empathic manner, there is a much greater chance that both will have a positive and
successful encounter.
Countertransference is a set of thoughts, feelings, and beliefs experienced by a service provider
that occurs in response to the client. Although sometimes these beliefs and feelings are
conscious, generally they are not. It is thus unrealistic to expect counselors, usually untrained in
addressing unconscious mental processing, to be aware of countertransference. Regular clinical
supervision, which should be integrated into the staffing of the program, can help raise their
awareness. If such resources exist, counselors may, with caution, address this issue.
In order to deal with countertransference issues, counselors must be willing to examine their
skills and attitudes. Working with clients who have HIV/AIDS and substance abuse disorders
brings up issues for treatment staff that can be both physically and emotionally demanding.
Counselors see a broad range of diverse clients from all walks of life. To work in both these
fields, providers must learn to be comfortable in discussing topics they may never have talked
about openly--sex, drug use, death, grief, and so on. To effect positive change, counselors also
must be willing to seek additional specialized training and support.
Examining attitudes and skills
