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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 |
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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. |
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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). |
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| 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
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