Verbalize an acceptance of powerlessness and unmanageability over antisocial behavior and addiction. (3, 4)
Help the client to understand the self-defeating nature of antisocial behavior and addiction (or assign the Step 1 exercise in The Alcoholism and Drug Abuse Client Workbook by Perkinson).
Help the client to see the relationship between antisocial behavior and addiction.
Complete psychological testing or objective questionnaires for assessing antisocial behavior. (5)
Administer to the client psychological instruments designed to objectively assess antisocial behavior, impulsivity, and/or aggression rating instruments (e.g. Psychopathy Checklist-Revised; Aggressive Acts Questionnaire; Barratt Impulsiveness Scale-11); give the client feedback regarding the results of the assessment and test again, if necessary, to assess treatment progress.
State how antisocial behavior and addiction are associated with irrational thinking (Alcoholics Anonymous's “insanity”). (6)
Help the client to understand how doing the same things over and over but expecting different results is irrational—what Alcoholics Anonymous calls “insanity.”
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. (7, 8, 9, 10)
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. oppositional defiant behavior 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).
Consistently follow all rules. (11)
Assign appropriate consequences when the client fails to follow rules or expectations.
Identify and verbalize the negative consequences that failure to comply with the rules/limits has had on self and others. (12, 13, 14)
Review with the client several examples where his/her/their rule and/or limit breaking led to negative consequences to self and others.
Use role reversal techniques to sensitize the client to his/her/their lack of empathy for others by revisiting the consequences of his/her/their behavior on others (or assign “How I Have Hurt Others” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Teach the client that many negative consequences are preceded by decisions that are based on criminal thinking; ask the client to list five times when antisocial behavior led to negative consequences and list the many decisions that were made along the way.
List the ways dishonesty is self-defeating. (15)
Assist the client in understanding why dishonesty results in more lies, loss of trust from others, and, ultimately, rejection.
List the reasons why criminal activity leads to a negative self-image. (16)
Help the client understand why criminal activity leads to feelings of low self-esteem (e.g. loss of respect from others, broken relationships, legal problems, lack of achievement).
Verbalize how criminal thinking is used to avoid responsibility and to blame others. (17)
Teach the client how criminal thinking (e.g. super-optimism, little empathy for others, power orientation, sense of entitlement, self-centeredness) avoids personal responsibility and leads to blaming others.
Decrease the frequency of statements blaming others or circumstances while increasing the frequency of statements accepting responsibility for one's own behavior, thoughts, and feelings. (18, 19, 20)
Help the client to understand how blaming others results in a failure to learn from one's mistakes and, therefore, making the same mistakes over again (or supplement with “Taking Inventory of Destructive Behaviors” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
Explore with the client the reasons for blaming others for one's own problems and behaviors, and how he/she/they may have learned this behavior in a punishing family environment.
Confront the client's projection of blame for his/her/their behavior, feelings, and thoughts; reinforce his/her/their acceptance of personal responsibility (or supplement with “Letter of Apology” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Develop a list of prosocial behaviors and practice one of these behaviors each day. (21)
Teach the client the difference between antisocial and prosocial behaviors, then help him/her/them develop a list of prosocial behaviors (e.g. helping others) to practice each day (or supplement with “Benefits of Helping Others” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma or “Three Acts of Kindness” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Write a list of typical criminal thoughts; then replace each thought with one that is respectful of self and others. (22, 23)
Confront the client's antisocial beliefs about his/her/their lack of respect for the rights and feelings of others, and model thoughtful attitudes and beliefs about the welfare of others
Assist the client in identifying his/her/their typical antisocial thoughts; list an alternate, respectful, and trusting empathic thought.
List five ways Alcoholics Anonymous/Narcotics Anonymous (AA/NA) meetings and a higher power can assist in overcoming antisocial behavior and addiction. (24)
Discuss with the client the various ways recovery groups and a belief in a higher power can assist him/her/them in recovery (e.g. provide emotional support, provide social relationships, relieve anxiety, reinforce self-worth, provide guidance) (or assign the Step 3 exercise in The Alcoholism and Drug Abuse Client Workbook by Perkinson).
Receive feedback/redirection from staff/therapist without making negative gestures or remarks. (25)
Confront the client when he/she/they break the rules, blame others,
