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
