Counseling Psychology Skill

Cognitive Distortions (Common Patterns)

Dialectical Behavior Therapy (DBT)

Four skill modules:

Motivational Interviewing (MI)

Spirit: Partnership, Acceptance, Compassion, Evocation (PACE)

OARS skills: Open questions, Affirmations, Reflections, Summaries

Solution-Focused Brief Therapy (SFBT)

• Miracle question: "If you woke up tomorrow and the problem was solved, what would be different?"
• Scaling questions: "On a scale of 1–10, where are you now? What would one step up look like?"
• Exception finding: "When was the problem absent or less severe? What was different?"
• Coping questions: "How have you managed to cope despite these difficulties?"

Person-Centered Therapy (Rogerian)

Three core conditions:

1. Unconditional Positive Regard — Non-judgmental acceptance
2. Empathy — Understanding the client's internal frame of reference
3. Congruence — Therapist authenticity and transparency

Assessment

Clinical Interview Structure

1. Presenting problem — Chief complaint in client's words
2. History of present illness — Onset, duration, severity, triggers, coping
3. Mental status exam — Appearance, behavior, speech, mood, affect, thought process/content, cognition, insight, judgment
4. Risk assessment — Suicidal ideation (plan, means, intent), homicidal ideation, self-harm
5. Psychosocial history — Relationships, work, education, housing, substances, trauma
6. Treatment history — Prior therapy, medications, hospitalizations
7. Strengths and resources — Protective factors, support systems, coping skills

Standardized Measures

Risk Assessment Framework

Treatment Planning

SMART Goals for Therapy

Treatment Plan Template

1. Problem statement — Specific, behavioral description
2. Long-term goal — Desired end state
3. Short-term objectives — Measurable stepping stones
4. Interventions — Specific techniques and modalities
5. Timeline — Session frequency, review dates
6. Discharge criteria — What "done" looks like

Ethical Practice

APA Ethics Code — Key Principles

Confidentiality Exceptions

Boundaries

• No dual relationships (therapist + friend, employer, romantic partner)
• Social media: no friending/following clients
• Gifts: generally decline; consider cultural context
• Self-disclosure: therapeutic purpose only, brief, redirects to client
• Termination: planned, with referral if needed, not abandonment

Documentation

Progress Note Formats

DAP Format:

• D — Data: What happened in session (observations, client statements)
• A — Assessment: Clinical interpretation, progress toward goals
• P — Plan: Next steps, interventions, homework

SOAP Format:

• S — Subjective: Client's report
• O — Objective: Clinician observations, test results
• A — Assessment: Diagnosis, clinical formulation
• P — Plan: Treatment next steps

Documentation Standards

• Document within 24 hours of session
• Factual, behavioral descriptions (not judgments)
• Record interventions used and client response
• Avoid jargon clients wouldn't understand in their records
• Include risk assessment at every contact when risk is present

AI in Mental Health — Guardrails

Critical: AI must never provide therapy, diagnose mental health conditions, or replace clinical judgment.

• AI can assist with: psychoeducation materials, symptom tracking tools, scheduling, documentation templates
• AI must not: interpret assessment scores, make diagnostic impressions, recommend specific interventions
• Always include: "This is informational. If you're in crisis, contact 988 Suicide & Crisis Lifeline or go to your nearest emergency room."
• Client data is PHI — all HIPAA protections apply
• AI suggestions are decision support, never decision replacement