EP95 Workshop 13 - Working With A Client Raised in Chemically Dependent Family - Claudia Black, PhD

Description:

Those who grow up in chemically dependent families have strong survivorship skills. Unfortunately, for too many, they continue to present to the world a false self often becoming our "closeted" depressed, angry and addicted client. This workshop focuses on 1) treatment orientation and priorities, and 2) core clinical issues. Due to the managed care environment, experiential focus will be on homework assignments.

Educational Objectives:

1. To list key foundation recovery issues for a client.
2. To recognize treatment orientation to meet many managed care/newer health care expectations. 

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Workshop Introduction

• Focus: Working with adults from chemically dependent families.

• Goals: Identify foundational recovery issues, align with managed care, and understand family dynamics.

• Covers adult child dependency, co-dependency, shame, compulsive behaviors, and treatment planning.

Family Dynamics & Case Study

• Clients often identify as “adult children of alcoholics” or “co-dependent.”

• Case: Jan, 34, raised in an alcoholic household, becomes addicted, bulimic, and suicidal by 18.

• Historical parallels highlight generational trauma in addicted families.

Treatment Framework

• Use affective, cognitive, and behavioral methods.

• Validate client experiences, avoid shame-based approaches.

• Focus on subjective experience, grief work, and skill-building.

Core Issues: Shame & Denial

• Shame = internal belief of unworthiness; drives denial, control, and self-blame.

• “Closeted depression” common—clients appear functional but feel deep despair.

• Goals: Build self-worth, shift from external to internal validation.

Addiction & Compulsive Behaviors

• S.A.F.E. acronym: Secretive, Abusive, Feelings, Emptiness.

• Compulsions include shopping, sex, work—often masking pain.

• Address both genetic and emotional predispositions to addiction.

Therapeutic Process & Trust

• Steps include identifying losses, naming shame, and challenging beliefs.

• Create a safe psychological and physical space.

• Build trust in therapist and self through empathy, validation, and consistency.

Group Work & Co-Facilitation

• Group therapy builds connection and is financially accessible.

• Co-facilitators are helpful but not required; clinicians should be trained for solo group work.

• Promote collaboration among providers and share resources with clients.

Practitioner Self-Awareness

• Therapists must be aware of their own issues and stay engaged in personal therapy.

• Practitioners should take responsibility for their growth to prevent countertransference.

Dual Identity & Marginalization

• Gay/lesbian adult children may face dual identity issues, isolation, and lack of role models.

• Treatment must acknowledge added complexity, societal messages, and internalized shame.

Cultural and Racial Trauma

• Clients of color may experience compounded trauma due to racism, generational poverty, and systemic neglect.

• Healing must integrate both addiction and cultural factors to be effective.

Abuse in Addicted Homes

• Homes with two addicted parents increase the risk of physical and sexual abuse.

• These children may begin substance use earlier and develop anger or depression at a younger age.

• Sibling abuse is also more common; clinicians should remain alert to these patterns.

Family System Disruption

• Dual-addicted households often create broken boundaries and deep self-esteem wounds.

• Clients may struggle with magical thinking, perfectionism, and internalized self-hate.

Eclectic Treatment for Complex Clients

• Combine affective, cognitive, behavioral, and grief-focused strategies.

• Help clients recognize past losses, challenge beliefs, and learn sustainable coping skills.

Managed Care Integration

• Use terms like “impairment,” “severity,” and “repair potential” to meet documentation standards.

• Support recovery through group work, bibliotherapy, and skills-based homework.

Grief Work & Emotional Honesty

• Help clients release attachment to past losses and find meaning in the present.

• Encourage new, healthy attachments and support systems.

• Tie past trauma to present-day beliefs and behaviors to enable change.

Self-Validation & Emotional Regulation

• Use emotional tracking tools (e.g., anger or loss graphs).

• Teach difference between false vs. true guilt, and help clients tolerate sadness.

• Address fear of feelings, boundary-setting, and identifying emotional needs.

Parts Work & Inner Critic

• Help clients identify their inner critic and reduce its influence.

• Teach clients how to self-validate and recognize emotional progress.

• Encourage awareness of when they feel stronger and what health looks like post-therapy.

Letting Go of Control

• Teach the concept of “some control” using the Serenity Prayer.

• Clients fear losing control; help them process fears and vulnerability.

• Use 4-step process: identify childhood roots, connect to present, challenge beliefs, build skills.

Foundational First, Then Intimacy

• Don’t jump into complex topics like intimacy before addressing shame, grief, and trust.

• Review core issues regularly to ensure deep and lasting therapeutic progress.

• End by encouraging therapist self-care and balance between personal and professional lives.