Serenity House offers extended residential care to twelve women. We also have an Independent Living Program/Recovery Home in Naperville which serves the special needs of nine recovering women. Many women attend our various outpatient programs for a variety of substance-related issues. Women have special needs in treatment, and it is important that we address these in order to improve the chances for sustained recovery and self-sufficiency.

Jan Licht, MA, LCPC, CADC runs the women's halfway house program and is assisted by Donna Lareau, BGS, CADC. They have taken some time to explain some of the special issues they encounter while treating a female population for this article. Unresolved grief and trauma issues tend to be the primary concern of these clients. Most of the women in our program have a history of trauma or past physical, sexual, or emotional abuse. The assessment of these issues is difficult due to the shame which usually accompanies them. Coming to terms with the past and learning to cope without the numbing drugs they once relied on is a predominant theme at this level of care. In addition to therapy groups and individual counseling, the women are referred to private practitioners, the local health department, related support groups, as well as experts in treating issues such as childhood sexual abuse and posttraumatic stress disorder (PTSD).

The counselors state that women who have dependent children need help focusing on self while in recovery. The needs of the children tend to pull the women away from this focus while in treatment, a natural consequence of motherhood. Many women are fighting custody battles as they work to clean up their lives, form new bonds, and heal old wounds. Defining self outside of the realm of "mother" is extremely challenging. Many of these clients come from abusive homes and never learned appropriate parenting skills. Coming to terms with societies' expectations of what it means to be a mother can be devastating. The mission at Serenity House is to support the woman in the strengthening of her self and her recovery so that she is better able to face the daunting task of parenthood.

Learning to take care of self and to live independently is another major concern for most women in treatment. These women have found themselves in a series of controlling and abusive relationships. They have little or no sense of what to do to take care of themselves. It is not uncommon to hear the term "codependent" used to describe this sense of lost self. These clients are aware of their unhealthy desire to care for others at the expense of their own needs.

How women relate to other women is a common treatment theme. Many women have not had the opportunities to build meaningful relationships with members of the same sex. Issues of trust are frequently incorporated into treatment plans. A female caretaker may have ignored women who were victims of childhood sexual trauma at the time of the abuse. For instance, a female caretaker may have ignored the woman during childhood when the abuse occurred. This further serves to make forming new relationships with women troublesome.

Many women have not been given the opportunities to develop educational and employment skills. These obstacles will hinder a stable recovery. Once employment is gained, women struggle with the issues of fair wages and discrimination. Sexism at all levels of society is a common theme.

Low self-esteem is a common problem with many women in treatment. The basic Twelve-Step program is focused on ego-deflation and humility. For women with low self-esteem this approach is counterproductive. Methods to improve self-esteem and assertiveness are incorporated into many treatment plans. Women are encouraged to display their feelings, get in touch with their anger, and to speak out when they believe they are being treated unfairly. We frequently promote empowerment and personal responsibility as the female clients work toward physical, emotional, and spiritual health.

Another area of concern is dual-diagnosis. Rarely does a client come into treatment these days with solely a diagnosis of substance abuse. Women present with a higher percentage of co-occurring disorders and bring the various medications and treatment plans to treat these into the residential program. Issues of mental illness and substance abuse can become confusing and overwhelming for the newly recovering individual. Medication adjustments and mood changes, mixed messages and multiple opinions make for some challenging times. Problems are compounded when a woman who abused prescription drugs must now incorporate medications into her recovery program. We work closely with the client, outside therapists, and members of support systems in order to ensure that the best possible care is received.

The many special needs facing the female clients present several challenges in treatment. While utilizing gentle approaches when addressing issues such as abuse or trauma, the counselors must also provide direction and structure in a program that strives to teach self-sufficiency. It is a complex balancing act ever weighing the needs of the individual against the well being of the treatment community. Understanding these complexities, the special needs of women, and the unique treatment approaches at their disposal provides Jan Licht and Donna Lareau endless challenges and rewards.

We recommend A Woman's Way Through the Twelve Steps by Stephanie S. Covington, Ph.D. for all women in recovery.