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of the client's impairment was assessed to determine the appropriate level of care.The client was assessed in regard to impairment in social, relational, vocational, and occupational endeavors.It was reflected to the client that their impairment appears to create mild to moderate effects on the client's functioning.It was reflected to the client that their impairment appears to create severe to very severe effects on the client's functioning.The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.

      14 Explore Reaction to Parent's Chemical Abuse (14)The client described experiences of parental chemical abuse and was assisted in relating how these experiences had a negative impact, including the fear of violence, abandonment, unpredictability, and embarrassment.The client was supported while expressing increased insight into how parental chemical abuse has affected their emotional functioning.The client was reinforced for beginning to identify the inappropriateness of parental abuse of chemicals.The client was noted to be in denial regarding the negative impact of parental substance abuse.

      15 Probe Abandonment/Rejection Fears (15)The client was asked to identify specific childhood situations in which they experienced a fear of abandonment, mental or physical abuse, and/or feelings of rejection.Active listening skills were used as the client explained what it was like to grow up in the alcoholic home environment, focusing on situations in which fear of abandonment, mental or physical abuse, and/or feelings of rejection occurred.The client has begun to be more open about childhood experiences but was noted to remain rather guarded.The client was supported while describing, in detail, the facts and feelings associated with painful childhood experiences.The client denied any fears of abandonment, mental or physical abuse, and/or rejection, and this was accepted at face value.

      16 Explore Childhood Experience's Effect on Intimate Relationships (16)The client was assisted in becoming more aware of fears of abandonment, rejection, neglect, and the assumption of the caretaker role and how these fears are connected to past experiences of being raised in an alcoholic family.The client was assisted in expressing insight into the historical and current sources of fears of abandonment, rejection, neglect, and the assumption of the caretaker role.The client was helped to identify ways in which growing up in an alcoholic family have led to detrimental intimate relationships.The client denied any connection between childhood experiences and problems in intimate relationships and was urged to monitor this area.

      17 Identify Parental Role of Caretaker (17)The client was assisted in identifying ways in which the client takes on the parental role of caretaker.The client was assisted in developing a plan for meeting emotional needs without adopting the parental/caretaker role.The client was noted to have begun to reduce the adoption of the parental/caretaker role and to increase healthy relationship skills.The client denied taking on the parental role but has continued in the role of caretaker; additional feedback was provided.

      18 Explore Feelings of Worthlessness and Shame (18)The client was probed to describe feelings of worthlessness/shame and level of functioning when compared with others.The client was supported while acknowledging feelings of worthlessness/shame and feeling less competent than others.The client was assisted in identifying parental substance abuse as a factor in low self-esteem issues.The client denied feelings of worthlessness or shame; this was accepted at face value.

      19 Teach Low Self-Esteem Precursors (19)The client was taught about the connection between low self-esteem and how the alcoholic home causes experiences of emotional rejection, broken promises, abuse, neglect, poverty, and loss of social status.The client acknowledged a connection between low self-esteem and experiences of emotional rejection, broken promises, abuse, neglect, poverty, and loss of social status because of parental chemical dependence; this insight was reinforced.The client reported beginning to increase self-esteem by moving beyond the effects of being raised in an alcoholic home; this progress was highlighted.

      20 List Positive Traits (20)The client was asked to list their positive traits and accomplishments.The client has identified several positive traits and accomplishments; these were reinforced as a foundation for building self-esteem.The client struggled to identify their own positive traits and accomplishments and was provided with tentative examples.The client was assigned “Acknowledging My Strengths” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client has not listed positive traits and accomplishments and was redirected to do so.

      21 Emphasize Self-Worth (21)An emphasis was placed on the client's inherent self-worth as a human being.The connection between the client's inherent self-worth and acceptance of a higher power was emphasized.The client was reinforced as they displayed an understanding of self-worth and how this is related to the acceptance of a higher power.The client continues to display poor self-worth; positive self-worth was reemphasized.

      22 Explore Family Response to Sharing Feelings (22)The client was asked to identify how the family responded to expressions of feelings, wishes, and wants.The client was assigned “Understanding Family History” from the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).It was noted that the client identified negative responses from family members during childhood regarding the expression of feelings.It was noted that the client identified a connection between learning in childhood that it was dangerous to share feelings with others and current problems with sharing feelings with peers.The client did not complete the assignment to help understand family history and was redirected to do so.The client denied the family's history of negative responses to sharing feelings; this was accepted.

      23 Identify Trustworthiness Traits (23)The client was asked to list a set of character traits in others that qualify them as trustworthy.The client was assisted in identifying several traits that they would expect from others that would identify them as trustworthy (e.g., honesty, sensitivity, open-mindedness, kindness).The client was reinforced as they identified situations in which they saw others being trustworthy.The client was unable to list a set of character traits in others that qualify them as trustworthy and was redirected to do so.

      24 Teach Honest Communication Skills (24)The client was taught that the tendency to tell others what we think they want to hear is based on fear of rejection, commonly learned in an alcoholic home.The client was provided with modeling, role playing, and behavior rehearsal to teach more honest communication skills.The client was reinforced for more honest communication in place of telling others what the client thinks they want to hear.The client struggled to understand the techniques or usefulness for honest communication skills; remedial feedback was provided in this area.

      25 Assign a Journal of Honest Communication (25)The client was asked to keep a journal to record incidents in which they told the truth rather than saying only what others want to hear.The client presented a journal of situations in which they told the truth rather than saying only what others want to hear; these situations were processed.The client was reinforced in acknowledging a healthier pattern of communication through reviewing journal entries regarding honest communication rather than saying what others want to hear.The client did not journal honest communication and was redirected to do so.

      26 Teach Problem-Solving Skills (26)The client was presented a specific problem-solving technique (i.e., identify the problem, brainstorm alternate solutions, examine the advantages and disadvantages of each solution, select an option, implement a course of action, evaluate the results).The client was assigned “Applying Problem-Solving to Interpersonal Conflict” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client and therapist role-played examples of implementing problem-solving techniques.The client was helped to recount instances of using problem-solving techniques in day-to-day situations.The client has completed the assignment regarding how to resolve interpersonal conflict, and the answers were reviewed.The client has not completed the assignments regarding applying problem-solving to personal conflict, and this resistance was processed.

      27 Explore Family Response to Sharing Feelings (27)The client was asked to identify how the family responded to expressions of feelings, wishes, and wants.It was noted that the client identified negative responses from family members during childhood regarding the expression of feelings.It was noted that the client identified a connection between learning in childhood that it was dangerous to share feelings with others and current problems with sharing feelings with peers.The client did not complete the assignment to help understand family history and was redirected to do so.The client

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