Table 2.

The technical practices of the skills training process.

Skill	Description
Client-Centered Goal Setting
Set goals on immediate needs	Therapist sets a clear goal based on client-identified and imminent/near-term needs.
Set goals in incremental steps	Therapist and client identify a task or series of tasks that will facilitate goal achievement; these tasks are highly feasible and likely to result in client success.
Set goals with an emphasis on client agency	Therapist makes explicit effort to instill and reinforce a sense of personal autonomy when setting goals in pursuit of behavior change.
Set goals using ‘we language’	Therapist is thoughtful about collaborative language use, including the use of the pronoun “we” to reinforce an egalitarian climate and a shared goal.
Get a clear commitment on goals and steps	Therapist is very explicit and consistent in seeking client verbal commitment to agreed-upon goals and tasks.
Set goals while attending to client ambivalence	Therapist recognizes that motivation and commitment are dynamic, and influenced by intrapersonal and environmental factors; as such, the therapist attends closely to signs of client ambivalence related to agreed-upon goals and promptly explores client concerns.
Create a detailed plan to reach goals	Therapist facilitates creation of an action plan with measurable goals and tasks, timelines for completion, and an explicit plan for progress monitoring.
Query barriers and resources to reaching goals	Therapist explores both barriers and resources for pursuit of the agreed-upon action plan, and does so each time goals or tasks are discussed.
Building Self-Efficacy
Build self-efficacy through optimism	Therapist communicates genuine optimism about client capacity for behavior change.
Build self-efficacy through affirmation	Therapist consistently affirms client qualities, efforts, and progress; these affirmations are thoughtful and genuine.
Build self-efficacy through questions	Therapist, where possible, evokes rather than instills client self-efficacy via targeted questions about client qualities, efforts, and progress.
Build self-efficacy through incremental gains	Therapist creates opportunities for client success and incremental goal achievement; when these moments occur, the therapist reinforces them via affirmations or evocation.
Engaging in Teaching Teach with an agreed-upon agenda	Therapist and client pursue an explicit and agreed-upon skills training agenda.
Teach with a clear, informed, and client-centered rationale	Therapist provides a well-informed, clear, and client-relevant rationale that is described in plain language.
Teach with structure and time management	Therapist provides structure and time-management to ensure that attention to teaching content is thorough.
Teach with successive difficulty	Therapist teaches skills that increase in difficulty; this ensures client early success and scaffolding early skills to learn later skills.
Teach with personally-salient content	Therapist uses evocation and reinforcement of client-derived material to underscore all teaching points.
Teach with plain language	Therapist always uses simple language when explaining skills training content.
Teach with questions	Therapist most often uses questions when teaching such that the teaching process then functions as a dialogue rather than a lecture.
Teach with repetition	Therapist often repeats and reinforces skills training content; this may occur through actual repetition, but most often occurs via targeted questions and reflections that serve to thread teaching content throughout the skills training dialogue.
Teach with specific teaching strategies	Therapist uses teaching strategies such as a teach back, normalizing, use of hypothetical scenarios, use of metaphors and imagery and slow processing of teaching content.
Teach with specific teaching materials	Therapist uses teaching materials such as a white broad, handouts, journals, or worksheets; all materials function to make teaching content more understandable and memorable.
Engaging in Practice
Practice with a clear rationale specific to treatment benefit	Therapist always provides a practice rationale; the rationale is clear, succinct, and underscores the role of practice in achieving agreed-upon goals and tasks.
Practice with feasibility	Therapist provides opportunities for practice and practice assignments that are highly feasibly and likely to lead to client success.
Practice with compassion	Therapist explicitly recognizes the risks, barriers, and discomfort involved in practice.
Practice with attention to ambivalence	Therapist attends closely to signs of client ambivalence related to agreed-upon practice exercises and promptly explores client concerns.
Practice with modeling	Therapist always demonstrates skill enactment so that the client has a clear model to follow.
Practice with consistency and depth	Therapist utilizes practice consistently and always devotes sufficient time, attention, and resources to practice content.
Practice with performance feedback	Therapist provides specific, constructive feedback on client skill demonstration; therapist them provides opportunity for the client to apply feedback in subsequent practice.
Practice with review and debrief	Therapists always allots time for review and debrief of in and outside of session practice exercises.