social skills, and assertiveness) while managing high-risk trigger situations (or supplement with “Aftercare Plan Components” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
2. DIAGNOSIS
| ICD-10-CM | DSM-5 Disorder, Condition, or Problem |
|---|---|
| F10.20 | Alcohol Use Disorder, Moderate |
ADULT-CHILD-OF-AN-ALCOHOLIC (ACA) TRAITS
BEHAVIORAL DEFINITIONS
1 Has a history of being raised in an alcoholic home, which resulted in having experienced emotional abandonment, role confusion, abuse, and a chaotic, unpredictable environment.
2 Has a history of unresolved childhood trauma caused by family addiction.
3 Reports an inability to trust others, share feelings, or talk openly about self.
4 Demonstrates an overconcern with the welfare of other people.
5 Passively submits to the wishes, wants, and needs of others; is too eager to please others.
6 Verbalizes chronic fear of interpersonal abandonment and desperately clings to relationships that can be destructive.
7 Tells other people what they think the other persons want to hear, rather than telling the truth.
8 Verbalizes persistent feelings of worthlessness and a belief that being treated with disrespect and shame is normal and to be expected.
9 Verbalizes feeling unwanted, unimportant, or unloved due to experiences of abandonment and abuse.
10 Reports strong feelings of panic and helplessness when faced with being alone.
11 Tries to fix other people before concentrating on his/her/their own needs.
12 Takes on the parental role in a relationship.
13 Reports feeling less worthy than those who have more stable lives.
LONG-TERM GOALS
1 Implement a plan for recovery from addiction that reduces the impact of Adult-Child-of-an-Alcoholic (ACA) traits on sobriety.
2 Decrease dependence on relationships while beginning to meet his/her/their own needs.
3 Reduce the frequency of behaviors that are exclusively designed to please others.
4 Choose partners and friends who are responsible, respectful, and reliable.
5 Create recovery skills that reduce fears of abandonment, loss, and neglect.
6 Understand the feelings that resulted from being raised in an ACA environment and reduce feelings of alienation.
7 Create a spiritual program that allows for acceptance by a higher power.
| SHORT-TERM OBJECTIVES | THERAPEUTIC INTERVENTIONS |
|---|---|
 |
Establish rapport with the client toward building a strong therapeutic alliance; convey caring, support, warmth, and empathy; provide nonjudgmental support and develop a level of trust with the client toward him/her/their feeling safe to discuss his/her/their ACA behavior issues and their impact on his/her/their life. |
|
Strengthen powerful relationship factors within the therapy process and foster the therapy alliance through paying special attention to these empirically supported factors: work collaboratively with the client in the treatment process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see Psychotherapy Relationships That Work: Vol. 1 by Norcross & Lambert and Psychotherapy Relationships That Work: Vol. 2 by Norcross & Wampold). |
|
| Acknowledge the feelings of powerlessness that result from ACA traits and addiction. (3) | Probe the feelings of powerlessness that the client experienced as a child in the alcoholic home and explore similarities to his/her/their feelings when abusing chemicals (or assign the client to complete the Step 1 exercise in The Alcoholism and Drug Abuse Client Workbook by Perkinson). |
| Verbalize the relationship between being raised in an addictive family and how this behavior is repeated in addiction. (4) | Teach the client the relationship between his/her/their childhood experience in an addictive family and how this increased the likelihood of repeating the addictive behavior pattern as an adult (or assign the client to complete the “Understanding Family History” exercise in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma). |
| Complete psychological testing or objective questionnaires for assessing traits associated with being an adult child of an alcoholic. (5) |
Administer to the client psychological instruments designed to objectively assess the strength of traits associated
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