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Competency 3: Treatment Strategies for Working with Clients with an FASD

Issues Related to Professional Values and Ethics

Teenage girl with counselor

Working with clients with an FASD can raise many issues. The addiction professional might resent being "stuck" with such challenging clients. He or she might harbor negative attitudes toward women who drink while pregnant. The client with an FASD can trigger feelings of guilt and shame in a counselor who drank while pregnant or has a child with an FASD.

Understanding how to cope with clients with an FASD can help the addiction professional serve such clients more effectively. Malbin and Schmucker offer suggestions2,4:

  • Be good to yourself. Even with a realistic plan and an established routine, nothing is perfect. Things change and setbacks occur. By expecting bumps in the road of a person’s journey through life, we can learn to not take these dips personally. By offering the person with an FASD nonjudgmental and informed support, we offer hope.
  • Expect that the person with an FASD cannot generalize information or skills from one setting to another situation. Prepare and practice multiple scenarios with the person. Be patient and avoid looking bored going over the same information multiple times.
  • Use a written journal or goal sheets to remind people how far they’ve come and where they are headed. Due to their memory difficulties, clients with an FASD will not always remember what supports or programs have been developed with them or their goals. Keep a positive attitude and focus on what the person has accomplished, rather than on goals yet to be met.
  • Expect to repeat things many times in many ways. Clients with an FASD may ask the same question every time you see them. Remember that these clients have cognitive deficits. They are not asking just to test your patience.
  • Realize there is no set approach and what works one time may not always work for the client. As part of her dysfunction, the person may experience things differently day to day or even hour to hour and variability is the norm for her. Keep an open mind and be flexible. Avoid statements such as "But it worked last time."
  • Reframe your perception of the person’s behavior. He or she is not trying to make you mad or cause trouble. He or she has brain damage and may have a history of abuse or other family dysfunction. You need to explore behaviors, stay patient, and tolerate ambiguity. Malbin describes it as challenging to unravel the acting out behaviors from the many layers of family and personal dysfunction the person carries.2

    • Understand that FASD involves permanent brain changes.
    • The client is not refusing to do things. He or she can’t do them or does not understand what you are asking him or her to do.
    • Clients often are not lying purposely. They are trying to fill in gaps in memory with their own information.
    • Perseverating behaviors are an attempt to control or make sense of their own world.
    • Transition and change are very difficult for the person with an FASD. Acting out when things change may be a reaction to fear of transitions or difficulty processing change.
  • Know yourself, and take the time to reflect on your comfort level in dealing with issues surrounding FASD. Gain knowledge if needed. Gain comfort in tackling the subject by role playing with colleagues. Know your limits and get outside help or referrals as required. Plan to connect to appropriate community resources.

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