of an alcoholic (e.g. Symptom Checklist-90-Revised, Children of Alcoholics Screening Test); give the client feedback regarding the results of the assessment and readminister if necessary to assess treatment progress.
Verbalize the rules of “don't talk, don't trust, don't feel,” which were learned as a child, and how these rules have made interpersonal relationships more difficult. (6, 7)
Explore how the dysfunctional family rules led to chronic fear and an escape into addiction.
Educate the client about the ACA rules of “don't talk, don't trust, and don't feel”; explain how these rules make healthy relationships more difficult.
Verbalize an understanding of how ACA traits contributed to addiction. (8, 9)
Have the client list five ways that ACA traits led to addiction (or supplement with “Addressing ACA Traits in Recovery” from the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
Assist the client in identifying his or her ACA traits and the relationship between ACA traits and addiction.
Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship. (10, 11, 12, 13)
Assess the client's level of insight (syntonic versus dystonic) toward the presenting problems (e.g. demonstrates good insight into the problematic nature of the described behavior, agrees with others' concern, and is motivated to work on change; demonstrates ambivalence regarding the problem described and is reluctant to address the issue as a concern; or demonstrates resistance regarding acknowledgment of the problem described, is not concerned, and has no motivation to change).
Assess the client for evidence of research-based correlated disorders (e.g. antisocial behavior, oppositional defiant disorder with attention-deficit/hyperactivity disorder [ADHD], depression secondary to an anxiety disorder) including vulnerability to suicide, if appropriate (e.g. increased suicide risk when comorbid depression is evident).
Assess for any issues of age, gender, or culture that could help explain the client's currently defined problem behavior and factors that could offer a better understanding of the client's behavior.
Assess for the severity of the level of impairment to the client's functioning to determine appropriate level of care (e.g. the behavior noted creates mild, moderate, severe, or very severe impairment in social, relational, vocational, or occupational endeavors); continuously assess this severity of impairment as well as the efficacy of treatment (e.g. the client no longer demonstrates severe impairment but the presenting problem now is causing mild or moderate impairment).
Identify the causes of the fear of abandonment that were experienced in the alcoholic home. (14, 15)
Probe the client's fear of violence, abandonment, unpredictability, and embarrassment when the parent was mentally unstable or abusing chemicals.
Explore specific situations when the client experienced fear of abandonment, mental or physical abuse, and/or feelings of rejection during childhood.
Identify how the tendency to take care of others in interpersonal relationships is related to maintaining a feeling of security and control. (16, 17)
Assist the client in understanding how his/her/their early childhood experiences led to fears of abandonment, rejection, neglect, and an assumption of the caretaker role, which is detrimental to intimate relationships.
Assist the client in identifying the many ways in which he/she/they take on the parental role of caregiver.
Share the feeling of worthlessness that was learned in the alcoholic home, and directly relate this feeling to abuse of substances as a coping mechanism. (18, 19)
Explore the client's feelings of worthlessness and shame, assessing specific painful situations.
Teach the client how low self-esteem results from being raised in an alcoholic home, due to experiencing emotional rejection, broken promises, abuse, neglect, poverty, and lost social status.
List 10 reasons for increased feelings of self-worth. (20, 21)
Assign the client to list his/her/their positive traits and accomplishments; reinforce these as a foundation for building self-esteem (or supplement with “Acknowledging My Strengths” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Emphasize to the client his/her/their inherent self-worth as a human being and show the benefits of using a higher power in recovery.
Identify the pattern in the alcoholic family of being ignored or punished when honest feelings were shared. (7, 22)
Educate the client about the ACA rules of “don't talk, don't trust, don't feel”; explain how these rules make healthy relationships more difficult.
Probe how the client's family responded to expressions of feelings, wishes, and wants and why it became dangerous for the client to share feelings with others (or assign the client to complete the “Understanding Family History” exercise in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
List five qualities and behaviors that should be evident in others before interpersonal trust can be built. (23)
Assist the client in developing a set of character traits to be sought in others (e.g. honesty, sensitivity, open mindedness, kindness) that qualify them as trustworthy.
Increase the frequency of telling the truth rather than saying only what the client thinks the other person wants to hear. (24, 25)
Teach the client that the behavior of telling other people what we think they want to hear rather than speaking the truth is based on fear of rejection, which was learned in the alcoholic home; use modeling, role-playing, and behavior rehearsal to teach the client more honest communication skills.
Assign the client to keep a journal of incidents in which he/she/they told the truth rather than saying only what others wanted to hear.
List the steps to effectively and independently solving problems. (26)
Teach the client problem-solving skills (e.g. identify the problem, brainstorm alternate solutions, examine the advantages and disadvantages of each option, select an option, implement a course of action, and evaluate the result); role-play solving a current problem in his/her/their life (or assign “Applying Problem Solving to Interpersonal Conflict” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Acknowledge the resistance to sharing personal problems; share at least one problem in each therapy session. (7, 27, 28, 29)
Educate the client about the ACA rules of “don't talk, don't trust, don't feel”; explain how these rules make healthy relationships more difficult.
Probe how the client's family responded to expressions of feelings, wishes, and wants and why it became dangerous for the client to share feelings with others.
of an alcoholic (e.g. Symptom Checklist-90-Revised, Children of Alcoholics Screening Test); give the client feedback regarding the results of the assessment and readminister if necessary to assess treatment progress.
