The Case of Michael

Case example of a Non-Traumatized Client’s Treatment:  Cognitive therapy to an alcoholic in early recovery to supplement his AA experience.

When Michael came to treatment he had been sober for 21 days and fearful that this attempt at sobriety would end as ten others had-in relapses. Consequently he was going to 5 AA meetings a week. As a supplement to this I early on taught him the flash card relapse prevention technique.*

After this we discussed many issues. The first was his rationalizations to drink- “that others have it worse so why not”, “one won`t hurt”, and “that I can`t make it through life without my best friend.”

Rational discussion diminished the impact of there.

There were fears that needed to be cognitively reframed i.e. when he looked in the mirror saw a liar, hypocrite, and a two faced person .We came to an agreement that there was no basis for thinking this way now but it was previously when he was drinking. And there was also the fear he will fail as person and a husband and again an agreement was reached between us there was a far greater probability of both if he was drinking.

But one fear that was especially difficult to deal with was his fear of being seen emotionally by people-being seen for who he was. This was probably tied to his resentment that “I never got to discover who I was before I grew up.”

However, the key to resolving this fear was his core issue-poor, self-esteem. By helping him stop comparing himself to others and simply say thank you when complemented by others some progress was made. The intervention that brought about the biggest change in his self-esteem was help him learn to AFFIRM HIMSELF* and concurrently using the Serenity Prayer to detach from his need for the approval of others.

As a consequence of our work Michael said that he took a job promotion-”something I would not be taking if it wasn`t for you.” Also he referred two of his son`s for counseling.

* The flash card relapse prevention technique is simply having a client write down all the negative consequences of their addiction, then write each consequence on an index card, and carry them wherever they go .When the client starts to think about using their drug of choice reading the cards interrupts the thinking process before they begin to crave their drug and most often leads to relapse.

* Self-affirmation has been a useful tool for over 50% of my clients. This speaks to the reality that many suffer from affirmation deprivation or not getting the acceptance they needed. In Michael`s case this was due both parents working long hours in addition to his father`s drinking therefore not being available emotionally for Michael in his early development.


If you have a situation similar to Michael’s, call me, I can help you.


Hal C. Steinhart, L.I.S.W.
Licensed Clinical Social Worker
15305 Triskett Road
Cleveland, Ohio 44111
(440) 554-8912 (440) 779-2949