Ethical Decision-Making Model in Substance Counseling

Ethical Decision-Making Model in Substance Counseling

by | Aug 17, 2025 | 12 Core Functions, Counselor Ethics, IC & RC Review, Professional Development

A thoughtful woman stands in front of a chalkboard with arrows pointing in different directions, symbolizing decision-making. The text overlay highlights the importance of ethical decision making for substance use counselors. This educational image promotes the NAADAC ethical decision-making model and emphasizes what every CASAC, CAC, or CADC should know to strengthen professional integrity.

What Every CASAC, CAC, or CADC Needs to Know About the NAADAC 10-Step Ethical Decision-Making Model

Key words 6X: ethical decion making; NAADAC ethical descision making; CASAC, CAC, or CADC; substance use counselor

Let’s get real for a minute.

You can memorize the Code of Ethics from start to finish. You can write a damn dissertation on confidentiality and informed consent. But none of that matters when you’re sitting in your office, looking at a client who just handed you a mess you weren’t ready for. That’s when ethical decision making stops being a theory and becomes a blood-pressure-spiking, sweat-dripping, gut-check reality.

If you’ve been in the field long enough, you know what I’m talking about.

And if you’re newer to the work, buckle up because ethical dilemmas in this field aren’t rare. They’re regular.

Whether you’re a CASAC in a chaotic outpatient program, a CAC working inside a correctional facility, or a CADC navigating client care in rural recovery deserts, the NAADAC 10-step ethical decision-making model isn’t just a worksheet. It’s a lifeline.

Let’s walk through it—not like an ethics professor, but like a counselor who’s seen what happens when we don’t stop and think before we act.

Step 1: Identify

Start with what’s in front of you. What’s the actual concern? What’s the risk? Is it legal? Clinical? Moral? All three?

If you’re feeling uneasy, that’s your first signal.

Example: A client discloses they’re using fentanyl again, but they beg you not to tell probation. Your gut knows this isn’t just about privacy but safety. Time to zoom in.

Step 2: Apply

Pull out the NAADAC Code of Ethics. This is your foundation, not just a box to check.

Ask yourself: What standards apply here? Are there state laws that contradict your gut? What’s your agency’s policy?

If you don’t know where to look, stop pretending you do. Find out.

Ethical decision-making starts with owning what you don’t know.

Step 3: Determine

Is this situation big enough to need backup?

Don’t wait until you’re drowning. Talk to your clinical supervisor. Phone a colleague who’s been around the block. If it’s looking hairy, bring it in legally.

This step isn’t about passing the buck. It’s about protecting yourself and the client. You don’t get a trophy for going it alone.

Step 4: Generate

Now we brainstorm.

Make a list of laws, policies, and ethical principles that apply. Get honest about the scope of the issue. What could go right? What could go very, very wrong?

Start imagining the outcomes of different actions. Don’t filter yet—get it all on the table.

This is where ethical decision-making becomes proactive instead of reactive.

Step 5: Evaluate

Now that you’ve got your list, dig in.

What are the consequences of each possible decision? Who benefits? Who’s at risk? What kind of precedent does this set?

This is where you have to get out of your ego. Ethical decision-making isn’t about being the hero. It’s about doing the most responsible thing, even when uncomfortable.

Maybe you want to protect the client’s privacy, but reporting might be what protects their life. That’s the kind of tension you’re working with.

A group of people walk buy a sign that shows a sign for an online addiction counselor ethical decision making training

Embrace Effective Change! 

Counselor Ethics Training 

Are you a CASAC, NAADAC provider, social worker, or justice-involved counselor? This 15-credit-hour online ethics course is built for YOU.

Gain clear, practical guidance on:

✔ Counselor-client boundaries

✔ Confidentiality challenges

✔ Ethical dilemmas in real-world settings

✔ Professionalism in clinical and correctional environments

Grounded in national codes and healthcare ethics, this course delivers exactly what you need to meet renewal requirements and strengthen your ethical decision-making.

👉 Perfect for CASAC & NAADAC Renewal

👉 Self-paced and 100% online

👉 Certificate issued upon completion

Register Now

Step 6: Implement

Choose a path. Own it.

You’ve researched, consulted your people, and weighed the options. Now you act.

Whether you report, intervene, document, or set a boundary—it’s time to follow through.

This part gets real. Clients might get mad, and systems might push back. But this is why ethical decision-making matters. It’s not about being liked; it’s about being accountable.

Step 7: Document

This one saves your ass.

Write it all down. Every step. Every conversation. Every reference to the Code of Ethics or law. Why did you choose this path and not that one? Who did you speak to?

Documentation isn’t just paper. It’s protection. For you, for the client, for your agency.

I’ve seen people get shredded in court because they didn’t write it down. Don’t be that person.

Step 8: Analyze

Take a breath and look back.

Was the decision you made solid? Did it hold up under pressure? Were there unintended consequences?

Ethical decision-making doesn’t stop once you act. It evolves. You must be willing to re-examine your choices, especially if things didn’t go as expected.

Step 9: Reflect

This part? It’s where the growth happens.

What did you learn? What would you do differently next time? What support or training were you missing that could’ve helped?

Reflecting isn’t about regret. It’s about getting sharper. If you’re not reflecting, you’re not growing.

I’ve made calls I still think about, not because they were wrong but because they taught me what this work costs.

Step 10: Reassess

If the outcome didn’t serve the client, the team, or the ethics you stand by, go back to step one.

Start over. Adjust. Don’t double down just because you picked a lane.

Ethical decision-making is a living process. It changes when new information comes in, and it’s okay to pivot.

What’s not okay? Digging in your heels out of pride or fear.

Why This Matters for Substance Use Counselors

Let me be crystal clear.

You cannot wing this stuff.

You’re holding people’s lives as a CASAC, CAC, or CADC. And not just metaphorically. You’re in the middle of court mandates, MAT access, domestic violence disclosures, suicidal ideation, system failures, and raw, unfiltered trauma.

You’re risking more than your license if you’re not using a structured process like the NAADAC ethical decision-making model. You’re endangering people’s safety.

This model isn’t a formality. It’s the difference between reacting and responding, playing defense and showing up like a real professional.

A Personal Note

I once had a client who told me their partner was abusing them. They begged me not to say anything, swore they’d be fine.

My gut told me they weren’t.

I ran the NAADAC ethical decision-making process from top to bottom. I consulted two colleagues, called the DV hotline, documented every move, and made the call.

The client was pissed.

Three weeks later, they said, “I didn’t like what you did. But I think it saved my life.”

That’s ethical decision-making in action. It’s not clean, and it’s not easy, but it’s how we keep showing up with integrity when everything’s on the line.

So, if you’re in the field, print the model, post it by your desk, and burn it into your brain.

Because the next time you get hit with an ethical crisis, you won’t have time to figure it out from scratch.

You’ll need a compass. The NAADAC ethical decision-making model is that compass.

Use it. And keep doing the work that matters.

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Ethical Considerations in Substance Use Counseling Essentials

Ethical Considerations in Substance Use Counseling Essentials

by | Jul 3, 2025 | Addiction Counseling, Counselor Ethics, Professional Development

A purple notebook titled “CODE OF ETHICS” rests on top of a teal book against a wooden background. Bold text reads: “Ethical Considerations in Substance Use Counseling: Ethical Relativism & Ethical Absolutism.” This image highlights key ethical frameworks—ethical relativism and ethical absolutism—that CASACs, CADCs, and CACs must understand when navigating substance use counseling ethics.

Navigating Ethical Landscapes in Substance Use Counseling

Ethical considerations are paramount in substance use counseling. Counselors often find themselves at the crossroads of moral relativism and absolutism, each presenting unique challenges and insights. Understanding these ethical frameworks is crucial for professionals seeking to deliver effective and compassionate care to their clients. This article delves into the nuances of moral relativism and absolutism, exploring their implications in the context of substance use counseling.

Understanding Ethical Relativism

Ethical relativism asserts that moral principles are not universal; instead, they are shaped by cultural, societal, and individual perspectives. This viewpoint implies that concepts of right and wrong can vary significantly across different contexts. For counselors, particularly in substance use counseling, ethics play a critical role in guiding their practice. Counselors must navigate diverse backgrounds, respecting clients’ values and beliefs while adhering to professional ethical standards. Key ethical principles such as confidentiality, informed consent, and non-maleficence are essential in providing effective substance use counseling. By understanding ethical relativism, counselors can better appreciate the complexities of their clients’ experiences, ensuring a culturally sensitive and ethically sound approach to treatment.

Cultural Sensitivity

One of the primary advantages of ethical relativism is its emphasis on cultural sensitivity and respect. Counselors who adopt this perspective are more likely to appreciate the unique experiences and values of their clients. This understanding fosters a therapeutic environment where clients feel respected and validated.

  • Promoting Tolerance: Ethical relativism encourages counselors to embrace diverse cultural practices, thereby enhancing the therapeutic alliance.
  • Flexibility in Practice: Counselors can adapt their approaches to align with the cultural norms of their clients, leading to more effective interventions.

Challenges of Ethical Relativism

While ethical relativism promotes understanding, it also presents challenges. The absence of universal moral standards can complicate decision-making for counselors.

  • Moral Inconsistency: Ethical relativism may lead to situations where harmful practices are justified based on cultural norms, making it difficult for counselors to advocate for clients’ well-being.
  • Critique Difficulties: Counselors may struggle to critique harmful behaviors within a client’s cultural context without appearing judgmental or imposing their values.

Exploring Ethical Absolutism

Ethical absolutism posits that there are universal moral standards that apply consistently, regardless of context. This viewpoint can offer a clear framework for counselors, aiding in their ethical decision-making. In the realm of substance use counseling, ethics becomes even more critical. Counselors must navigate complex situations that involve confidentiality, informed consent, and the duty to protect clients. Adhering to these ethical standards ensures that clients receive the support they need while maintaining their rights and dignity throughout the therapeutic process.

Universal Standards

Ethical absolutism offers the advantage of universal standards that can simplify ethical dilemmas. Counselors can rely on established ethical codes to navigate complex situations.

  • Consistency in Practice: Adhering to universal ethical principles ensures that counselors maintain a consistent approach across different cases.
  • Clear Accountability: Ethical absolutism provides a solid foundation for holding counselors accountable for their actions, thereby fostering trust in the therapeutic relationship.

Limitations of Ethical Absolutism

Despite its strengths, ethical absolutism can also be limiting. Rigid adherence to fixed principles may overlook the complexities of individual circumstances.

  • Lack of Flexibility: Counselors may struggle to adapt their approaches to meet the unique needs of clients, which can potentially alienate them.
  • Cultural Insensitivity: Ethical absolutism may inadvertently dismiss the cultural contexts that shape clients’ beliefs and behaviors, leading to misunderstandings.

Clinical Pragmatism: A Middle Ground

By analyzing the strengths and weaknesses of ethical relativism and absolutism, clinical pragmatism emerges as a practical framework for substance use counseling ethics. This approach focuses on context, individual circumstances, and the real-world consequences of decisions made during treatment. Substance use counseling ethics require counselors to navigate complex situations with empathy and understanding, ensuring that clients receive personalized care. By considering these factors, counselors can provide more effective support to their clients, leading to more successful outcomes in recovery.

Consensus-Oriented Decision-Making

Clinical pragmatism encourages counselors to engage in consensus-oriented decision-making, considering the perspectives of all stakeholders involved.

  • Interpersonal Assessment: Counselors assess the unique circumstances of each case, allowing for tailored interventions that respect clients’ values.
  • Cultural Diversity Consideration: This approach acknowledges the importance of cultural diversity, enabling counselors to navigate ethical dilemmas with sensitivity.

Critiques of Clinical Pragmatism

While clinical pragmatism offers a balanced approach, it is not without its critics. Some argue that it may rely too heavily on empirical evidence, potentially neglecting the emotional and subjective aspects of ethical decision-making.

  • Overreliance on Evidence: Critics contend that an excessive focus on empirical data may overshadow the nuanced understanding of clients’ experiences.
  • Potential for Ambiguity: The emphasis on context can lead to ambiguity in ethical standards, making it challenging for counselors to establish clear guidelines.

Humanistic Ethics in Counseling

Humanistic ethics highlights individual autonomy, self-actualization, and respect for clients’ dignity and worth. This ethical framework aligns with the objectives of substance use counseling. Substance use counseling ethics are essential in providing a supportive environment where clients feel valued and empowered. By adhering to these ethical principles, counselors can build trust and foster open communication, ultimately guiding clients toward positive change and recovery. It is vital for professionals to continually reflect on their ethical practices to ensure they provide the highest level of care and respect in their work.

Empowering Clients

Humanistic ethics empowers clients by promoting their autonomy and encouraging self-exploration.

  • Self-Efficacy: Counselors who adopt a humanistic approach help clients recognize their strengths and capabilities, fostering a sense of agency in their recovery journey.
  • Respect and Dignity: This ethical perspective emphasizes treating clients with respect and dignity, thereby creating a safe space for open and honest dialogue.

Critiques of Humanistic Ethics

While humanistic ethics is widely embraced, it also faces criticism for its potential to overlook the complexities of ethical dilemmas.

  • Idealism vs. Reality: Critics argue that humanistic ethics may be overly idealistic, failing to account for the harsh realities faced by individuals struggling with addiction.
  • Cultural Limitations: The emphasis on individualism may not resonate with clients from collectivist cultures, where community and family play a significant role in decision-making.

Situational Ethics: A Flexible Approach

Situational ethics, which are based on relativism, emphasize evaluating each ethical dilemma on an individual basis. This approach is particularly well-suited to the evolving context of substance use counseling ethics, where practitioners must effectively consider diverse client backgrounds, circumstances, and needs. By applying situational ethics, counselors can navigate challenging decisions, ensuring that they provide compassionate and tailored support to individuals struggling with substance use issues. This adaptability enhances the ethical framework within which they operate, ultimately benefiting clients in their recovery journey.

Case-by-Case Evaluation

Counselors employing situational ethics assess the specific circumstances surrounding each client, allowing for flexible and context-sensitive decision-making.

  • Promoting the Greater Good: Situational ethics prioritizes actions that promote the greater good, even if it means sacrificing rigid moral principles.
  • Love and Justice: The guiding principles of love and justice encourage counselors to act with compassion while considering the broader implications of their decisions.

Challenges of Situational Ethics

While situational ethics offers flexibility, it can also lead to ethical ambiguity.

  • Potential for Moral Relativism: Critics argue that situational ethics may blur the lines between right and wrong, leading to moral relativism.
  • Difficulties with Consistency: Counselors may struggle to maintain consistency in their ethical decision-making, which can potentially undermine their credibility.

Religious Ethics in Counseling

Religious ethics, rooted in spiritual teachings, offer a moral framework for many counselors. These principles guide their interactions with clients and shape their understanding of right and wrong. The Golden Rule, emphasizing treating others as you would like to be treated, serves as a fundamental guiding principle in fostering empathy and compassion in counseling practices. This approach not only enhances the counselor-client relationship but also promotes a sense of mutual respect and understanding.

Compassion and Empathy

Religious ethics promote compassion and empathy, encouraging counselors to engage with clients in a spirit of understanding and kindness. In substance use counseling, ethics play a crucial role. They guide practitioners to respect client autonomy, maintain confidentiality, and provide non-judgmental support. By integrating ethical principles, counselors can create a safe environment where clients feel empowered to discuss their challenges and work towards recovery. Ultimately, a strong moral foundation fosters trust and facilitates the development of meaningful therapeutic relationships in substance use counseling.

  • Humility and Gratitude: Counselors who embrace religious ethics often embody humility and gratitude, creating a supportive environment for clients.
  • Moral Guidance: Religious principles can offer counselors a clear moral compass, guiding their actions in challenging situations.

Limitations of Religious Ethics

Despite its strengths, religious ethics may not resonate with all clients, particularly those from diverse cultural and religious backgrounds.

  • Cultural Sensitivity: Counselors must be mindful of clients’ beliefs and values, ensuring that religious ethics do not impose on their autonomy.
  • Potential for Judgment: The application of religious ethics may inadvertently lead to judgmental attitudes, which can hinder the therapeutic relationship.

Conclusion: Finding Balance in Ethical Decision-Making

In the complex landscape of substance use counseling, navigating ethical dilemmas requires a nuanced understanding of moral relativism and absolutism. Counselors must strike a balance between cultural sensitivity and the need for universal standards, tailoring their approaches to meet the unique needs of each client. By embracing clinical pragmatism, humanistic ethics, situational ethics, and religious ethics, counselors can create a comprehensive ethical framework that fosters trust, respect, and effective care.

Substance use counseling ethics play a crucial role in guiding professionals to navigate complex situations while maintaining the dignity and respect of clients. Counselors must balance client autonomy with their duty to ensure safety, confidentiality, and appropriate intervention, fostering an environment that promotes trust and recovery. Effective counseling also requires ongoing education about ethical standards to adapt to evolving societal norms and practices.

A counseling session in progress: a male client sits on a couch, leaning forward with hands clasped near his face in contemplation, while a female counselor takes notes with a clipboard and pen. The text “Counselor Ethics” appears on the left side of the image. This visual represents the importance of ethical decision-making and professionalism in counselor-client relationships.

Embrace Effective Change! 

Counselor Ethics Training 

Are you a CASAC, NAADAC provider, social worker, or justice-involved counselor? This 15-credit-hour online ethics course is built for YOU.

Gain clear, practical guidance on:

✔ Counselor-client boundaries

✔ Confidentiality challenges

✔ Ethical dilemmas in real-world settings

✔ Professionalism in clinical and correctional environments

Grounded in national codes and healthcare ethics, this course delivers exactly what you need to meet renewal requirements and strengthen your ethical decision-making.

👉 Perfect for CASAC & NAADAC Renewal

👉 Self-paced and 100% online

👉 Certificate issued upon completion

Register Now

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Stay up-to-date with changes in the addiction recovery field, new illicit drug trends, treatment modalities, and new addiction counselor training opportunities.

Conveying Counselor Empathy: Key to Successful SUD Counseling

Conveying Counselor Empathy: Key to Successful SUD Counseling

by | Jul 3, 2025 | 12 Core Functions, Addiction Counseling, Counselor Ethics, Professional Development

Alt text: A pair of older hands gently cradles a red heart-shaped object against a soft pink background. Overlaid text reads: “Conveying Counselor Empathy: Key to Successful SUD Counseling.” The website educationalenhancement-casaconline.com appears at the bottom. This image symbolizes the importance of counselor empathy and compassionate care for CASACs, CADCs, or CACs working in substance use disorder (SUD) treatment, reinforcing why conveying empathy is critical to effective counseling outcomes.

If you’re a CASAC, CADC, or CAC, you already know this work isn’t just about treatment plans or clinical hours. It’s about connection. And at the core of that connection? Counselor empathy. When empathy is lacking, the entire process falls short. Clients shut down. Trust evaporates.

But when you’re conveying empathy in counseling—tuning in and hearing them—you’re not just doing your job. You’re offering something that can change everything.

This article explores what it means to practice empathy as a counselor, why it’s more complex than it sounds, and how to make it a reality in the room with every client, every time.

 

The Heart of Healing: Conveying Empathy in Substance Use Counseling

 

Empathy is a cornerstone of effective therapeutic relationships in substance use counseling. It’s not merely about understanding a client’s struggles; it’s about immersing oneself in their emotional landscape, feeling their pain, and reflecting that understanding to them. This article delves into the nuances of conveying empathy in counseling, particularly for individuals grappling with substance use disorders (SUD).

Understanding Empathy in Counseling

What is Empathy?

Empathy is the ability to connect profoundly with another person’s feelings and experiences. It transcends mere sympathy, which often involves feeling pity for someone else’s misfortune. Instead, empathy requires a counselor to approach the client from their perspective, experiencing their emotions and perspectives without judgment. This connection fosters a safe space where clients can express their vulnerabilities.

The Importance of Empathy in Substance Use Counseling

For individuals facing addiction, the journey to recovery is often fraught with guilt, shame, and societal stigma. Empathy is a balm for these wounds, allowing clients to feel understood and accepted. Counselors who demonstrate genuine empathy build trust and rapport, which are essential for a successful therapeutic alliance. This trust encourages clients to share their struggles, facilitating deeper exploration and healing.

The Neuroscience Behind Empathy

Mirror Neurons and Emotional Resonance

Research suggests that our brains are wired for empathy through a network of neurons known as mirror neurons. These neurons activate when we act and observe someone else performing that same action. This neurological phenomenon enables counselors to empathize with their clients’ emotional states, fostering a shared experience that deepens understanding.

The Role of Emotional Intelligence

Emotional intelligence is crucial in a counselor’s ability to convey empathy. It involves recognizing one’s own emotions and those of others, allowing for more nuanced interactions. Counselors with high emotional intelligence can navigate complex emotional landscapes, responding appropriately to clients’ needs and feelings.

Barriers to Empathy in Counseling

Personal Biases and Stereotypes

Despite the innate capacity for empathy, various barriers can hinder its expression. Personal biases, stereotypes, and preconceived notions about addiction can cloud a counselor’s judgment. For instance, viewing addiction solely as a moral failing can prevent a counselor from fully understanding the complexities of a client’s situation.

Societal Stigma

The stigma surrounding substance use disorders can also obstruct empathy. Clients may internalize societal judgments, leading to feelings of shame and isolation. Counselors must be aware of these dynamics and actively work to create a non-judgmental environment that fosters open communication.

Strategies for Conveying Empathy

Self-Reflection and Awareness

Counselors should engage in regular self-reflection to identify and address their biases. Understanding one’s own beliefs and attitudes towards addiction can help mitigate their impact on the counseling relationship. This self-awareness enables counselors to approach clients with a clear perspective, free from preconceived notions.

 

Active Listening Techniques

 

Active listening is a fundamental skill for conveying empathy. It involves fully concentrating on what the client is saying verbally and non-verbally.

Counselors can enhance their active listening skills by:

  • Maintaining eye contact shows clients that they are valued and heard.
  • Nodding and Using Affirmative Gestures: Simple gestures can encourage clients to continue sharing.
  • Paraphrasing and Reflecting: Restating the client’s words demonstrates understanding and validates their feelings.

Learn more about motivational interviewing.

Creating a Safe Space

Establishing a safe and welcoming environment is crucial for effective counseling. Counselors should strive to create a space where clients feel comfortable expressing their thoughts and emotions without fear of judgment. This can be achieved through:

  • Warmth and Openness: A friendly demeanor can help clients feel at ease.
  • Confidentiality Assurance: Clients must be assured that their disclosures will remain confidential, thereby fostering trust.

The Role of Cultural Competence

Understanding Cultural Differences

Cultural competence is essential in conveying empathy, especially in diverse populations. Counselors must recognize and respect cultural differences that may influence a client’s experience with addiction. This understanding allows for a more tailored approach to counseling, enhancing the empathetic connection.

Adapting Counseling Approaches

Counselors should be flexible in their methods, adapting their approaches to align with their clients’ cultural backgrounds. This may involve incorporating culturally relevant practices or understanding specific cultural stigmas associated with substance use disorders.

The Impact of Empathy on Recovery Outcomes

Building Trust and Rapport

Empathy is instrumental in building trust and rapport between counselors and clients. When clients feel understood, they are more likely to engage in the therapeutic process, leading to better outcomes. This trust can motivate clients to be more open about their struggles, facilitating deeper exploration and healing.

Enhancing Client Engagement

Empathetic counseling can significantly enhance client engagement. When clients feel their counselor genuinely cares about their well-being, they are more likely to participate actively in their recovery journey. This engagement is crucial for developing effective coping strategies and achieving long-term sobriety.

Challenges in Practicing Empathy

Emotional Burnout

Due to the intense nature of their work, counselors often face emotional burnout. Constantly engaging with clients’ pain can take a toll on a counselor’s emotional well-being. Counselors must practice self-care and seek supervision or peer support to effectively manage their emotional health.

Balancing Empathy with Professional Boundaries

While empathy is vital, counselors must also maintain professional boundaries, among other skills. Over-identifying with a client’s struggles can lead to countertransference, where a counselor’s unresolved issues interfere with the therapeutic process. Counselors should strive to balance empathy with professionalism, ensuring that their emotional involvement does not compromise the effectiveness of the counseling relationship.

Conclusion: The Transformative Power of Empathy

In substance use counseling, empathy is not just a skill; it is a transformative force that can lead to profound healing. Counselors can create a supportive environment that fosters trust and engagement by understanding and addressing the barriers to empathy, employing effective strategies, and recognizing the importance of cultural competence. Ultimately, the ability to convey empathy in substance use counseling can significantly impact recovery outcomes, paving the way for clients to reclaim their lives and find hope in their journey toward sobriety.

 

Two students practice an individual counseling session while in school for online addiction counselor training

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Unlock your full potential with our cutting-edge Individual Counseling Course. The training features these counseling interventions:

  • Cognitive Behaviorial Therapy
  • Motivational Interviewing
  • Person-Centered Care
  • Trauma Informed Care
  • Harm reduction, 
  • and more.
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