| SHORT-TERM OBJECTIVES | THERAPEUTIC INTERVENTIONS |
| Work cooperatively with the therapist toward agreed-upon therapeutic goals while being as open and honest as comfort and trust allow. (1, 2) | 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 with being an adult child 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. |
| | Educate the client about healthy interpersonal relationships based on openness, respect, and honesty; explain the necessity of sharing feelings to build trust and mutual understanding (or assign the client to complete the honesty exercise in The Alcoholism and Drug Abuse Client Workbook by Perkinson). |
| | Explore the client's pattern of resistance to sharing personal problems and preferring, instead, to focus on helping others with their problems. |
| Verbalize an understanding of how ACA traits contribute to choosing partners and friends that have problems and need help. (16, 30) | 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. |
| | Help the client to understand that his/her/their strong need to help others is based on low self-esteem and the need for acceptance, which was learned in the alcoholic family of origin; relate this caretaking behavior to choosing friends and partners who are chemically dependent and/or psychologically disturbed. |
| Initiate the encouragement of others in recovery, to help reestablish a feeling of self-worth. (31, 32) | Teach the client that active involvement in a 12-step recovery group can aid in building trust in others and confidence in oneself (or assign the client to complete the Step 12 exercise in The Alcoholism and Drug Abuse Client Workbook by Perkinson). |
| | Assist the client in developing an aftercare plan that is centered on regular attendance at Adult Children of Alcoholics, Alcoholics Anonymous, and Narcotics Anonymous (ACA/AA/NA) meetings. |
| List reasons why regular attendance at recovery group meetings is necessary to arrest ACA traits and addiction. (33) | Assist the client in listing reasons why 12-step recovery group attendance is helpful to overcome ACA traits. |
| Discuss fears that are related to attending recovery group meetings and develop specific written plans to deal with each fear. (34) | Probe the relationship between ACA traits and the fear of attending recovery group meetings; assist the client in developing coping strategies to cope with the fear (e.g. give self-positive messages regarding self-worth, use relaxation techniques to reduce tension, use meditation to induce calm and support from a higher power [or assign “Safe and Peaceful Place Meditation” exercise in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma or “Progressive Muscle Relaxation” in the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, McInnis, & Bruce]). |
| Verbalize how a recovery group can become the healthy family that one never had. (35, 36, 37) | Teach the client that active involvement in a recovery group can aid in building trust in others and confidence in oneself. |
| | Discuss how the home recovery group of ACA/AA/NA can function as the healthy family the client never had; help him/her/them realize why he/she/they need such a family to recover (or assign the client to complete the Step 12 exercise in The Alcoholism and Drug Abuse Client Workbook by Perkinson). |
| | Educate the client about the family atmosphere in a home ACA/AA/NA recovery group, and how helping others can aid in recovery and reestablish a feeling of worth. |
| List five ways in which belief in, and interaction with, a higher power can reduce fear and increase self-worth in recovery. (38, 39) | Teach the client how faith in a higher power can aid in recovery and arrest ACA traits and addiction (or assign the client to complete the Step 2 exercise in The Alcoholism and Drug Abuse Client Workbook by Perkinson). |
| | Assign the client to read the Adult Children of Alcoholics Red Book and the Alcoholics Anonymous Big Book on the topic of spirituality and the role of a higher power; process the material in an individual or group therapy session. |
| Verbalize the feeling of serenity that results from turning out-of-control problems over to a higher power. (40) | Review problematic circumstances in the client's life that could be turned over to a higher power to increase serenity (or supplement with “Understanding Spirituality” or “Finding a Higher Power That Makes Sense” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma). |
| Practice assertiveness skills and share how these skills were used in interpersonal conflict. (41, 42) | Use modeling, behavior rehearsal, and role-playing to teach the client healthy, assertive skills (or assign “Becoming Assertive” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce); apply these skills to several current problem situations, and then ask the client to journal his/her/their assertiveness experiences. |
| | Teach the client the assertive formula of “I feel ____ when you ____. I would prefer it if ____”; role-play several applications in his/her/their life and then assign him/her/them to use this formula three times per day. |
| Share the personal experiences of each day with one person that day. (43, 44) | Teach the client the share check method of building trust, in which the degree of shared information is related to a proven level of trustworthiness; use behavior rehearsal of several situations in which the client shares feelings. |
| | Review and reinforce instances when the client has shared honestly and openly with a trustworthy person. |
| Cooperate with a physician's evaluation for psychopharmacological intervention. (45) | Refer the client to a physician to evaluate whether psychopharmacological interventions are warranted. |
| Take medications as prescribed, and report on their effectiveness and side effects. (46, 47) | Medical staff administers medications to the client as prescribed. |
| | Monitor the client's medications for effectiveness and side effects. |
| Develop a five-year plan to recover from substance abuse and ACA traits. (48) | Assist in the client developing a five-year plan to recover from substance abuse and ACA traits (or assign the client to complete the Personal Recovery Plan exercise in The Alcoholism and Drug Abuse Client Workbook by Perkinson). |
| Complete a survey to assess the degree of satisfaction with treatment. (49) | Administer a survey to assess the client's degree of satisfaction with treatment. |
| | |
| | |
| | |
| | |
| | |
| | |
