Facilitation: Treatment Skills

Treatment skills gained through appropriate training and preparation to work with client populations are critical to the success of the treatment process. Facilitation using these treatment skills in an informed manner supports client progress toward treatment goals.

Establishing Engagement with Treatment Process and Goals 

During the first meeting with the client, the practitioner is already establishing client engagement in the treatment process and clarifying client's treatment goals. Primary efforts include establishment of therapeutic alliance with the client and attending to diagnosis, presenting client issues, and cultural factors that may impact the treatment process. Practitioners prepare clients for engaging in treatment by building client understanding of the process, expectations for client participation, and knowledge of the purpose of client involvement in the process. Often it is helpful to frame goals in the client's own language. After this, practitioners continue to assess client needs relative to treatment goals. Practitioners choose activities that highlight verbalization of treatment goals and facilitate opportunities for reflection that focuses on these goals and the treatment process. Client engagement can be enhanced by providing client choices related to activity, level of participation, rules for activities, and development of their own treatment contract (Kimball & Bacon, 1993; Lung, Stauffer & Alvarez, 2008; Priest & Gass, 1997; Schoell & Maizell, 2002).

Listening to and Responding to Clients 

When listening to clients, practitioners use opportunities to reflect client observations, to explore content shared by clients and to use empathic responses to assist clients in increasing understanding of their experience, responses, strengths, and struggles. Practitioners empower clients by affirming what they are saying, allowing clients to make their own choices, and asking useful questions to help clients determine solutions on their own. Allowing natural consequences can help to aid a clients' learning processes and it is a useful tool in responding to client actions. When responding to clients, interventions are relevant to a client's diagnosis and can be manifestations of those issues are presented in the treatment context. Knowledge of diagnoses and correlating interventions are imperative to respond appropriately in this dynamic process. The manner in which the practitioner listens and responds to clients directly affects the client's engagement in the treatment process and the likelihood that positive outcomes will be achieved (Knapp, 1993; Priest & Gass, 1997; Lung, Stauffer & Alvarez, 2008; Smith, 1993).

Verbal Interventions 

The use of verbal interventions is an important treatment skill. The choice of language directly impacts the effectiveness of adventure-based interventions. Develop a common language with clients and consciously choose inclusive language free of personal bias. From this non-judgmental stance, practitioners use strength-based and empowering language that highlights client choice. Additionally, practitioners appropriately use confrontation to assist clients in identifying patterns and consequences related to client beliefs and choices. When considering verbal interventions, take into account how to frame activities, feedback, body language, tone of voice, and other means of communication in a manner that is most effective in meeting client needs. Assist clients in connecting what is happening in the session to intrapersonal and interpersonal dynamics, as well as stated treatment goals. Furthermore, manage the use of self in an appropriate way, considering aspects such as self-disclosure, emotional responses, participation, boundaries, ethics, transference, counter-transference, and dual relationships. This may be affected by theoretical perspective or professional codes of ethics. In adventure therapy, the active participation with the client increases opportunities for boundaries infractions and for productive self-disclosure, engagement with the client, and deepening the therapeutic alliance (Gass, 1993a; Gass, 1993b; Itin, 2003Knapp, 1999; Luckner & Nadler, 1997; Lung, Stauffer & Alvarez, 2008; Priest & Gass, 1999; Mitten, 1994; Peeters, 2003; Priest & Gass, 1997; Priest, 1999; Schoell & Maizell, 2002).

Process Interventions 

Practitioners often intervene verbally to move the treatment process forward, but process interventions are just as important to support client change. Assess and make intentional decisions about the need for structure, boundaries, use of directives (clear or ambiguous) and maintaining appropriate levels of challenge. Consider timing when intervening to change the activity, stop the process, reframe the process, increase or decrease the level of challenge, and when discussing current client interactions or process. Adventure interventions rely on the use of the activity as the intervention, highlighting the importance of using activity selection in making decisions related to process. Physical interventions, including placing a hand on a shoulder, using touch to maintain safety in trust activities, or standing near a client or between two clients during an activity, play an important role in the process as well. Use physical interventions purposefully and carefully. Make decisions that balance empowering client choice with allowing clients to make mistakes. The decisions that practitioners make in regards to process interventions are not formulaic and rely upon effective assessment and intentional choices (Bowne, 1993; Itin, 2003; Lung, Stauffer & Alvarez, 2008; Priest & Gass, 1997; Priest, 1999; Rohnke, 1999).