1

A Clown’s Prayer

A Clown’s Prayer: A Chris Farley Case Study

Elizabeth Holloway

Wake Forest University

CNS 765: Addictions Counseling

Dr. Phil Clarke

August 4, 2021
2
A Clown’s Prayer

Client Conceptualization

The client is a Caucasian, Irish Catholic male in his early 30s. Client graduated from a

local university with a double major in communications and theater. He is one of five children;

he has three brothers and one sister. His father owns an oil company and his mother is a home

maker. Client presents as well-dressed but is obese, nervously sweaty and actively fidgets; he

avoids eye contact and continues to make attempts to make counselor laugh and break away

from the serious conversation. Client is a famous comedian and has recently had success in

television, standup, and in movies. C.F. recently experienced being suspended from his main job,

again, for his struggle with alcohol and drug usage. Client previously performed on said show

and was met with severe criticism and worry due to him appearing flushed, having a hoarse

voice from strained vocal cords, and heavy wheezing. Ultimately, the producers decided to pull

this from circulation and gave the hosting job to another actor. Following this, C.F’s manager

sent him to rehabilitation for his drug and alcohol abuse. The client prides himself on his faith

and regularly attends services to get him through difficult times. Client also claims that

philosophy and theology also helped him during these times in addition to his faith. His family

and parents support his dream to be famous as long as he finished his undergraduate degree.

According to the client, his friends and loved ones describe him as intelligent, engaging and

giving. The client reports that he has struggled with addiction his entire adult life. Client reports

that his usage has increased as he becomes more famous and feels the pressure to “one-up”

himself in his comedy and is currently taking anti-depressants. The client has gone to

rehabilitation centers 17 times for his drug and alcohol abuse as well as for his increased weight

and eating habits. This counseling is mandated by his rehabilitation program and strongly

suggested by his management team (Engel, J, 2009).

The presenting concern for C.F. includes his use of morphine, cocaine, and alcohol.

Morphine is an opiate used commonly as a pain reliever that provides a user with a euphoric

feeling and is highly addictive. Tolerance to morphine develops quickly because the side effects

are pleasurable and it is easily accessible due to its medicinal purposes. Also known as “Miss

Emma” this substance is also known to relieve pain, cause sleepiness, decrease anxiety, provide

a false sense of well-being, and provide feelings of calmness. A central nervous system

depressant, it is incredibly dangerous to mix with other depressants because it may result in

extreme sedation, respiratory failure, or it may result in a coma. Unlike morphine, cocaine is a

stimulant that was originally used to help block pain. This substance, previously an active

ingredient in over the counter retail and medication, is highly addictive and is known to alter

brain structure after repeated use. A Schedule II substance, cocaine’s short-term effects include

pain relief, euphoria, and slow breathing. Long-term effects of “blow” include risk of overdose

with continued use, possible risk of HIV and other diseases if taken intravenously for the crack

variation, and possible slowing heart rate leading to coma or death if mixed with alcohol. C.F

also abuses alcohol, a substance linked to multiple cancers. Alcohol interferes with the brain’s

communication pathways causing changes in mood and behavior. In addition, alcohol abuse is

also linked to heart, liver, and pancreas issues that cause long-term effects such as stroke, fatty

liver, cardiomyopathy, and a weakened immune system (National Institute on Drug Abuse,

2021).

All of the elements presented in C.F’s case require a biopsychosocial model lens to

account for the reasons that the client abuses alcohol and drugs. Biologically and

psychologically, the client struggles with anxiety relative to performing and people pleasing.

There is also evidence of depression; on a famous talk show the client sang a song called “I’m a
4
A Clown’s Prayer

Clown but I Cry” that references “there’s no one quite as sad, though I make you go ‘ha ha hee

hee’” and “I’m not as happy as you” (Wotsitooyou, Youtube, 2009). In addition, client reports

taking antidepressants to help subside depressive symptoms and has been overweight his entire

life. A longtime friend describes anxiety and self-loathing as the client’s death sentence. The

social aspect of the client’s abuse involves the rise to fame and the continual pressure to be better

than his last performance. The client reports that the audience responds more to comedy that

involves fatty falling; he often forgoes his own self-esteem and feelings about his weight being a

punchline in order to make people laugh. The continued demand to make people laugh, be

successful in the box office, and have continued sketch comedy success actively causes the client

to continue self-deprecation for the sake of a few laughs. The holistic viewpoint of the

biopsychosocial model allows the client’s addiction to be examined from all aspects in his life

that contribute to the abuse.

Screening and Assessments

Per the criteria of substance use disorders as listed in the DSM-V, the client meets

expectations needed for diagnosis. The client experiences the specifications associated with

Criterion A of the diagnosis; his usage requires taking larger amounts over longer periods of

time, has had multiple unsuccessful attempts to decrease or discontinue usage, the client spends a

great deal of time obtaining and recovering his substances, and his daily activities revolve around

the substances. C.F. has reported experiencing a tolerance and needing more drugs for

intoxication, has had 17 attempts at rehabilitation, and spends a lot of time obtaining, recovering,

and scheduling around his usage. The next group of criteria, regarding social impairment, is met

by C.F’s failure to fulfill major role obligations at work, continued social and interpersonal

problems related to the effects of the substances, and substance use prioritized over important
5
A Clown’s Prayer

occupational and social activities. The client reported missing career opportunities because of his

usage including a formal dinner with other comedic idols and the head of Saturday Night Live

and multiple tapings that will not air due to his noticeable intoxication. In addition, his friends

and colleagues often intervene with his usage and plead with the client to get help from the likes

of rehabilitation and 12 step programs. C.F’s usage has also angered his loved ones to the point

of confrontation and tough love with one saying “when you overdose and kill yourself, you will

not have the same acclaim that John did…” referring to the client’s idol John Belushi who

tragically died at age 33 from a lethal combination of cocaine and heroin. The next criteria for

diagnoses include use of substances in risky situations, which the client does not meet, and a

physical or psychological issue exacerbated by the usage. The client’s extreme weight and

anxiety continue to worsen with his drug and alcohol abuse as seen from his continued

unsuccessful attempts at weight loss through various medicinal interventions and increased

depressive and anxiety symptoms such as his reaction to seeing a cut of his most recent film

which caused him to relapse. The last elements of criteria, tolerance and withdrawal, are

experienced per the client’s continued increase of dosage and difficulty avoiding relapse.

By meeting ten criterions of a substance use disorder, the client’s level of severity is

severe and he is currently in a controlled environment at the rehabilitation facility so his usage

has ceased in treatment. Specifically, the client meets criteria for stimulant use disorder because

of his active abuse of cocaine. C.F. meets the criteria of recurrent stimulant use resulting in

failure to fulfill major role obligations at work as well as the drug being prioritized over

important social and occupational activities as witnessed by the client’s missing career related

opportunities and prioritized cocaine over furthering his career and his friendships. In regards to

stimulant use disorder, he qualifies as severe and in a controlled environment. For the same
6
A Clown’s Prayer

reasons and met criteria, the client also qualifies for opioid use disorder for his dependence on

morphine and alcohol use disorder. Both additional diagnoses are severe and in a controlled

environment as he is currently enrolled in a rehabilitation facility as well as therapeutic services.

In addition, the client experiences depression and anxiety related symptoms and is

currently taking anti-depressant medication. Further assessment for severity of depressive and

anxiety-related symptoms and diagnosis is needed. Client has reported that he experiences

pressure from having to “one-up” himself with his comedy and career and recently had an

episode that resulted in relapse. This episode was triggered by viewing an uncut version of his

newest film and caused the client so much anxiety that it took hours for him to regulate

afterwards. C.F. also confided in one journalist about his anxiety stating that he “was always

terrified. Terrified of people and crowds, hence his outrageous behavior, as kind of a smoke

screen.” The list of fears continues and covers everything from losing weight to not ever finding

a wife or having kids. Most of his fears were related to his career, his weight, and his comedy.

Regarding the additional comorbid diagnosis of depression, C.F. often says remarks around

being incredibly sad about people making fun of his weight but he does it in a humorous way to

keep people entertained (Hedegaard, E. 2020). Without the audience, his jokes about how

depressed he is are eye-opening to how he really feels when performing and in his day-to-day

life.

Modes of Treatment

Due to the number of attempts that the client has made with rehabilitation, the different

types of substances he is mixing, and the danger involved, the client is recommended to attend

inpatient treatment at the rehab center he is currently enrolled in. The activities involved in this

intensity include group twice a day, lectures, family therapy, and 12-step attendance. Such an
7
A Clown’s Prayer

intense program is needed for this client and will address all elements of his abuse and recovery.

Group will allow the client opportunity to assess his addiction with peers that have similar

addiction patterns; lectures will provide psychoeducation on addiction and further provide

insight to biological and psychological motivations. Because the client speaks so highly of his

siblings and parents, family therapy will allow the client to hear his family’s concerns regarding

his usage as well as communicate to his family how they can best help him in his journey of

sobriety. In addition, family therapy will allow C.F. to assess the support he has from his siblings

and parents needed during recovery. The client’s attendance of a 12-step program will continue

his work with peers as well as provide a sponsor that will add more social support and be an

advocate and ally for his recovery.

For further assessment and mapping of the client’s usage and triggers, he will participate

in an “ideal use plan” to increase motivation, set goals, and identify strategies to stay sober and

avoid another relapse. The information provided in this strategy will provide further information

about the patterns surrounding C.F’s usage, allow collaboration on strategies for the

implementation of the plan, and allow for any events following to be viewed as reason for

revision. A 60-day inpatient treatment plan will be put into place with a stay at a halfway house

to follow. In addition to the halfway house to sustain treatment goals, the continuation of a 12-

step program will be suggested to avoid future relapse and help with any cravings or triggers that

the client experiences.

Counseling Strategies

Motivational interviewing will be the best fit for this client because of its focus on

empathy and its ability to reduce defensiveness. Because C.F. is consistently confronted by his

loved ones about his dangerous usage, he has become defensive about his addiction and
8
A Clown’s Prayer

vehemently denies it negatively affecting his life in any way. This strategy will also allow the

client to find his own motivation to change because, as of yet, his admission into rehabilitation

services and other addiction-focused interventions have been because of external pressure from

his manager after the loss of job opportunities. Motivational interviewing will challenge the

client to move past his ambivalence towards recovery and discover his own motivation for

sobriety. In addition, this technique creates a partnership with client and counselor which will

further increase the client’s sense of support during his recovery. Using open-ended questions,

affirmations, reflections, and summarization will provide C.F. a time and space where he can

disclose information about his addictions without someone imposing an unwanted agenda on the

client such as managers and peers in the entertainment business. With this open space and the

process of evocation, the client will share more information about his motivations, anxiety, and

patterns of usage.

In addition, community reinforcement approaches will be utilized in C.F’s treatment to

decrease usage in his peer group. The movie and television business is notorious for substance

use, as witnessed by the accidental overdose of John Belushi, the client’s idol. Addressing the

sobriety of C.F’s peer group and creating an environment in which his sobriety is rewarded and

encouraged will create a long-term success plan for the client. Because his peer group is familiar

with loss associated with addiction and accidental overdose, this group should be willing to

reinforce and reward behaviors not associated with substance use. Using functional analysis will

identify his triggers, process consequences, and develop goals aimed to enforce avoidance of

relapse. Sobriety sampling will allow a collaborative short-term goal to be established and

decrease the chances of early discharge from rehabilitation. Finding the client activities of

interest outside of drinking and abusing drugs will help decrease the client’s usage in social
9
A Clown’s Prayer

settings and allow him to pursue other interests that contribute to increasing his self-esteem while

decreasing anxiety; an activity not related to show business, performance, or comedy will be best

for C.F to avoid possible triggers.

Because of the client’s history of relapse and numbered attempts at rehabilitation, relapse

prevention is an important aspect for his treatment plan. Specifically, encouraging self-awareness

with C.F. will allow him to explore his previous relapses and what triggers occurred before each

time. Identifying what has caused him to relapse before will help identify his risks and create a

plan around them. Figuring out his intrapersonal and interpersonal factors that relate to previous

relapses and usage also helps identify situations to avoid. Another technique to use for relapse

prevention with C.F is to observe irrelevant decisions and how they eventually lead to usage. For

example, being back on set at his former job may be a trigger the client is unaware of. Accepting

a hosting job back at this show may seem like an irrelevant decision as the job or location itself

are not an identified trigger but as he is back in this old space and sees a room where he used to

use may cause a relapse.

Treatment goals for this client include identifying triggers, increasing self-esteem,

decreasing anxiety, decreasing depressive symptoms, and identifying positive activities outside

his career or comedy. Progress for C.F. will look like finding his own motivation to change as his

treatment is still mandated by his management team. In addition, establishing other coping

mechanisms relative to his anxiety and depression will help decrease the possibility of self-

medication. Goals will also be made to get further appropriate assessment for comorbid

diagnoses such as depression and anxiety so the side effects may be treated appropriately.

Ultimately the long-term goal for this client is to avoid relapse, discontinue substance usage, and

find self-esteem outside of comedy.

References

(2009). YouTube. https://youtu.be/ZDKxbALmRsA.

CBS Publishers & Distributors, Pvt. Ltd. (2017). Diagnostic and statistical manual of mental
disorders: Dsm-5.

Engel, J. (2009, March 17). Tom Farley Addresses brother's addictions. Marquette Wire.

https://marquettewire.org/3672803/republican-national-convention/tom-farley-addresses-

brothers-addictions/.

Floorwalker, M. (2020, August 14). What the last 12 months Of Chris FARLEY'S life were like.

Looper.com. https://www.looper.com/236247/what-the-last-12-months-of-chris-farleys-

life-were-like/.

Hedegaard, E. (2020, May 25). Chris Farley: The wild ride and sad end. Rolling Stone.

https://www.rollingstone.com/tv/tv-news/chris-farley-the-wild-ride-and-sad-end-186660/.

National Institute on Drug Abuse. (2021, May 3). Commonly used drugs charts. National

Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/commonly-used-drugs-

charts#prescription-opioids.