ABSTRACT
Introduction Sheryl was a client with an overwhelming set of serious problems. Deaf, mildly mentally retarded, linguistically dysuent in her best language of American Sign Language (ASL) and illiterate in English, she had life-threatening medical problems, a major psychotic disorder, and a long history of alcohol abuse. Although she was not normally violent, she would become so when intoxicated. For Sheryl, the consequence of continuing to abuse alcohol was death. Her parents and the agency service providers overseeing her care insisted that the group residential treatment program supervise her at all times. ey also insisted that she be in counseling for all her problems. Because so much was at stake and people had so little faith in Sheryl’s own motivation and skills for recovery, the system of people working with her collectively assumed a one-up stance with her of insisting on sobriety and full participation in her treatment. Family and agency sta took the same oneup posture with the community residential treatment program, insisting that they make Sheryl comply with these expectations. If this program could not keep Sheryl safe and engaged, they would pull the funding for her placement.
