ACOAs (Adult Children of Alcoholics) Psychotherapy
You need a therapist that sees and hears YOU
An ACoA is an Adult Child of an Alcoholic– someone who continues to use childhood survival strategies and behaviors in adulthood to cope with events and relationships. According to ACA literature and meeting content, an ACoA “brings fear and self-doubt into their adult relationships.” An ACoA often feels like a child internally, and therefore, gets triggered and panics when confronted by adult issues. ACoAs find setting boundaries, expressing wants and needs, and self-care very difficult since this wasn’t taught, modeled, or respected in their family system in childhood.
What does an alcoholic family system look like?
ACoAs often come from family systems that are painstakingly rigid, perfectionistic, and closed or manifest the opposite style of extremely loose, boundary-less, blurry, and inconsistent. Some alcoholic family systems fluctuate between the two. Whichever the case, ACoAs often don’t have the safe foundation of protective, consistent, and emotionally grounded parents. They lack the essential learning about what is healthy communication, appropriate boundaries, or trustworthy relationships. For a more detailed explanation of the alcoholic home, Jane Middleton-Moz & Lorie Dwinell give a great synopsis in After the Tears: Helping Adult Children Heal Their Childhood Trauma.
Examples of a Rigid Family System:
The house and relationships within are extremely controlled. Everything is hyper-clean. There is limited (if any) sharing of emotional information between family members even if it seems very clear there is dysfunction, it is kept secret.
At times, the system may be so rigid that it doesn’t allow any outside influences. In some homes, the blinds are always drawn. The children experience their lives as isolated from other adults and children. Their parents often have little contact with other adults and limited friendships.
There can be an air of overprotection. Sometimes children are not allowed to play outside. They are kept from activities for fear they might get hurt. They are to adhere to strict rules and strict guidelines around performance at school.
Many topics are deemed off-limits and are taboo, especially sex, drugs, peer relationships, world strife, and politics. Kids are not exposed to the age-appropriate information needed for their development and personal growth.
The system can be so tight that it doesn’t allow the individuality of each member to be expressed or seen: they aren’t allowed their own personal opinions, freedoms, expressions, or personalities.
There can be tightness around belief systems, religion, order, attire, and detail.
Very little physical affection or touch is given. There aren’t many terms of endearment shared or telling children they are loved.
Examples of a Loose System:
There is a feeling of chaos and potential neglect in these homes. The house is in disarray, there might not be food in the fridge, and details are often forgotten. Kids might not have new clothes and may even go without proper hygiene-care.
Kids are running around with no rules or boundaries. They are not given structure or limits so they feel unguided and perhaps even nervous about not knowing how to contain themselves or what to expect.
Over-sharing of information is common in these homes. Adults share adult information with their kids, often inappropriate for their developmental age. There might be triangulation where one parent will use their child as a confidant about all their troubles and difficulties with the other parent.
Kids are forced to grow up faster and are often parentified: they are cooking for themselves or left home alone at an early age. The older siblings might find themselves responsible for or having to protect younger siblings.
Strangers are often found in the family home or parents have a poor choice of adult friends that they welcome in the house.
Kids are exposed to inappropriate materials too early and are often unsupervised — so they might watch inappropriate movies or shows, learn about sex too early or be exposed to drugs and alcohol regularly (obviously.)
There are no doors closed or respect or privacy –especially when it comes to the bathrooms or the bedrooms!
There is too much physical contact and touch, especially that which might be unwanted– physical boundaries might often be violated.
Later in adult life, these family systems both offer some form of connection and attachment, so ACoAs will often return to this dysfunctional system in hopes of getting healthy support only to be disappointed again. ACoAs then waver between cutting off all family connections or negotiating with the unhealthy system while continually feeling something is wrong with themselves.
As a result, ACoAs often isolate themselves, and have distrustful relationships, or become overly dependent on others, becoming confused about setting healthy boundaries.They struggle with knowing the difference between unhealthy, codependent versus interdependent relationships.
What is the ACoA trauma syndrome?
According to ACoA treatment expert Tian Dayton, the ACoA experiences the following during their development: “Intense feeling states get wired into kids, and rather than absorb skills of emotional calm and regulation from their homes they absorb states of emotional chaos and extremes. (You might say they get skilled at over-or under-reacting.)
Then as adults when they are in the midst of intense emotions, which are after all simply a part of life and relationships for anyone, they have trouble keeping their emotional reactions right-sized.” ACoAs tend to experience PTSD later in life. Their nervous systems have been hard-wired in childhood to be on-guard, hypervigilant, scanning the environment for threat. In essence, ACoAs tend to map their childhood feelings on to current relationships even if there might not be any threat at all(and if there is, there’s a choice to cut and run!)
What are the qualities and traits of an ACoA?
The most cited information for qualities and traits comes directly from ACA. The ACoA Laundry List was compiled by one of the founding members of ACA, Tony A in 1978. It’s a set of personality traits that ACoAs commonly share from growing upin dysfunctional, chaotic, and often unsafe homes.
The Laundry List – 14 Traits of an Adult Child of an Alcoholic
We became isolated and afraid of people and authority figures.
We became approval seekers and lost our identity in the process.
We are frightened by angry people and any personal criticism.
We either become alcoholics, marry them or both, or find another compulsive personality such as a workaholic to fulfill our sick abandonment needs.
We live life from the viewpoint of victims and we are attracted by that weakness in our love and friendship relationships.
We have an overdeveloped sense of responsibility and it is easier for us to be concerned with others rather than ourselves; this enables us not to look too closely at our own faults, etc.
We get guilty feelings when we stand up for ourselves instead of giving in to others.
We became addicted to excitement.
We confuse love and pity and tend to “love” people we can “pity” and “rescue.”
We have “stuffed” our feelings from our traumatic childhoods and have lost the ability to feel or express our feelings because it hurts so much (Denial.)
We judge ourselves harshly and have a very low sense of self-esteem.
We are dependent personalities who are terrified of abandonment and will do anything to hold on to a relationship in order not to experience painful abandonment feelings, which we received from living with sick people who were never there emotionally for us.
Alcoholism is a family disease, and we became para-alcoholics and took on the characteristics of that disease even though we did not pick up the drink.
Para-alcoholics are reactors rather than actors.
When ACoAs first read the Laundry List and can identify with the traits, it often brings some relief, pain, fear, and/or confusion. In many ways, since an alcoholic family system is often secretive and closed, the knowledge of the effects of growing up in the chaos is often denied and unknown. With this new knowledge, ACoAs can begin to uncover how they bring these traits into their lives. With gentleness and compassion, ACoAs begin the journey of understanding the particular impact their alcoholic system had on them, emotionally and in their beliefs about themselves and relationships.
Moreover, it is understood that ACoAs had to develop these traits in order to survive an unsurvivable home. The pain from continuing to use the same childhood survival methods in adulthood, however, is exactly what causes suffering for the ACoA. The traits can then be psychologically integrated with work overtime through therapy and recovery.
How does ACoA therapy work?
There is no one-size-fits-all format for therapy for anyone. And yet, for an ACoA, there are certain key points in therapy that can make the work happen more readily.
Confronting the story and truth of your history as an adult child growing up in a dysfunctional home
Identifying the parental and family messages that were internalized and consciously choosing the ones you would like to keep that are healthy, kind, and helpful and releasing those beliefs that are not beneficial
Learning to set boundaries, to find your voice, and speak up for yourself (especially when confronted by “authority figures”– whom you might soon find are not an authority on your life)
Learning how to locate, name/note, and experience your emotions in a contained way, without having to act them out or live in them
Tracking and understanding when and how you are using an old subconscious defence mechanism– this would also include becoming familiar with your particular triggers
Uncovering your own needs, wants, dreams, and aspirations that may have gone underground by living in chaotic, narcissistically-based and unsafe homes
Learning how to challenge and balance out “stinking thinking” to work with negativity and black and white thought patterns
Becoming familiar with the ACA family role you’ve played in your family to keep chaos and dysfunction in place: such as the Hero, the Mascot, the Rescuer, the Scapegoat, the Lost Child, and others
Learning how to regulate your own nervous system in the way that works best for you with neurofeedback, forest bathing, EMDR, Somatic Experiencing, meditation, aromatherapy and essential oils, and yoga
Learning how to generate presence in your life— this can happen through meditation and mindfulness practices, prayer, body-based awareness practices, Cognitive Behavioral Therapy, IFS and Gestalt Psychotherapy
Learning how to generate self-love, self-care, and self-esteem
A therapist will come up with a plan with you around your wants and needs in therapy. Session to session, therapy might look very different or it really might follow a track with themes. The cornerstone of good therapy is having a positive, supportive, and sometimes challenging relationship with the therapist. Therapy can be a place where you feel safe enough to access resources and at times become aware of when you are using false self-defences while experimenting with new ways of being, thinking, feeling and acting.
What is it to “reparent in the present moment?”
Luckily, there is an opportunity to reparent yourself in each moment — not the fear and anxiety of the future or the pain and confusion from the past. In the present, the Adult Child can learn to reparent themselves by starting to identify their internal loving parental voice/part. This part/voice was the same one that helped the Adult Child survive a difficult childhood, eventually got them to the care needed and continues to guide and look-after the Adult Child whenever needed. The loving parent voice/part finds resources whenever needed and learns new information whenever the whole self needs guidance.
In therapy, someone will begin to uncover this voice and deepen one’s connection to it — to make healthier choices, practice self-care and start to identify and meet needs. The ACoA’s nervous system needs support and real-time feedback to heal and leave the past where there were trauma, abuse and lack of safety and into the present where one can find calm, healthy choice and adult resources available.
Why do ACoAs have difficulty having fun?
Many ACoAs come to realize that they had very little fun in their childhood (though it may be of equal challenge to uncover whenever there may have been actual moments of fun and to begin to note these.) Many look back and feel that they were robbed of a childhood.
It can be a challenge to start to identify the Inner Child part, especially if this part has been lost, quiet, scared and confused for quite some time. Children in alcoholic homes regularly felt like the “other shoe was going to drop”. They then take this feeling into their adult lives and feel it’s difficult to let loose, for fear of losing control, lacking safety or that something bad will happen because the positive feelings can’t last.
When the Adult Child does get in contact with the Inner Child, they can begin to offer gentle reparenting as well as opportunities to connect with genuine needs for fun, spontaneity, and creativity.
The Inner Child might ask to ride a carousel– and the request is granted! The Inner Child might want to have a spontaneous playdate with a friend and go to an outdoor movie– and the request is granted! The ACoA can finally start to have permission to have fun.
What is “Inner Child” work?
Inner child work is a way of framing the stuck patterns of thoughts, emotions, and behaviours that are habits from growing up in an alcoholic family system. This work is related to the reparenting that is needed to become a healthy and content adult.
Throughout therapy and recovery work, the ACoA identifies the Inner Child and works to reparent them with nurturing, structure, discipline, education, and protection (boundaries and safety.) The Inner Child is the ACoA’s true self — the ultimate essence of the person before patterns and introjected messages got mapped on, prior to the abuse and trauma encountered.
Along the way, the Inner Child has built up long-stored emotions about his/her history and from being ignored, forgotten, abandoned, emotionally invaded, and/or emotionally squashed.
The unconscious acting out of the Inner Child is often what first shows as problematic. Unaware that their Inner Child is running the show, the Adult Child becomes defensive, violent, small, and/or fearful. The more one becomes conscious in therapy and recovery, the more one can access the Inner Child and have the adult self extend the work of parenting– offering whatever comfort, care, needs, protection, listening and company the Inner Child might need.
In therapy, this integration can be done with visualization, chair work/parts work, writing (for homework), and through some body-based psychotherapy at times.
Why do ACoAs struggle with intimacy and relationships?
ACoAs often find themselves in Push/Pull dynamics with other key people– they would love to have close relationships with friends, partners, spiritual advisors, and other guides, but find this incredibly difficult for fear of being left, hurt, abused or losing themselves. It whittles down to having a hard time setting boundaries, telling others No or disagreeing, and voicing hurts when they occur in the relationship. Or, due to low self-esteem, choosing unavailable/distant/dysfunctional people who will send them into a similar chaotic cycle familiar to their childhoods– to be left, hurt and abused all over again.
Either way, the ACoA struggles to remain separate but close in relationship. Due to their tendency to approach the relationship in extremes, they have difficulty having the bound of “who they are” and “who the other person is” and that each is responsible for their own thoughts, feelings, and behaviours. At times, an ACoA might fall into Love Addiction, as explained in this article.
How do ACoA traits impact work performance and relationships?
There is also the Laundry List for ACoAs at work. The dysfunction in the family system can easily pass over into the new “work family” system. Bosses can be confused for parents and co-workers can be confused for siblings. Boundaries can be blurry and ACoAs may have a hard time saying “No” to certain projects and may want to please bosses and co-workers while undermining their own needs and professional growth.
Working through the ACoA Work Laundry List, an ACoA may start to set boundaries at work. They may begin to see their accomplishments as pleasing to themselves and less worried about the opinion of others, especially authority figures and superiors. They may start to focus on their own needs, professional growth, financial stability and becoming an expert in their field.
Many ACoAs can often struggle with Imposter Syndrome at work, feeling self-doubt and insecurity, not being able to take accurate note of accomplishments and skill-building. They are often taking their childhood feelings into the workplace. Since they have a hard time understanding what “normal” is at work and being able to solidly assess who they are and what they are capable of, they can often feel on shaky ground at work.
With therapy and support, they may be able to begin to challenge their fixed beliefs about themselves professionally and take in a more accurate view of themselves on the job. They might also begin to learn new skills to use in the workplace to deal with authority figures and co-workers.
How does the body play a part in trauma therapy and healing the adult child?
An ACoA is usually coming to therapy with a dysregulated nervous system due to the relational trauma experienced over time. Relational trauma is trauma that happens in the relationship: considering an ACoA grew up in a home where one or both parents were alcoholic, there is a high likelihood that the home felt unsafe. Children receive messages in the home like sponges; safety, nurturing and care is essential to their growth and development.
When children feel unsafe, fearful and neglected, their little bodies go into a stress response of fight/flight/freeze. Their brains go “off-line” and they will often dissociate (space out/act out) to protect from the incoming attack and threat. This is how so many gaps in memory can occur– the brain goes off-line but the body absorbs the attack and the memory, and at times the nervous system can remain stuck in this state.
In adulthood, events may end up being triggering for the Adult Child and trigger the stress response when it might not be needed– responding to NOW as if it was as threatening as then. The response might be to dissociate, isolate, run away, fight or self-destruct in some way. So the body and re-regulation of the nervous system are essential to the healing of the ACoA.
The ACoA can learn to find safety in their body again and can learn to feel feelings fully again while titrating their experience (keeping it tolerable enough to approach and process it.) The ACoA’s nervous system needs a large update to come out of the past where there were trauma, abuse and lack of safety and into the present where one can find calm, choice and adult resources available.
What are emotional sobriety and emotional addiction?
For many people stuck in addiction, one aspect that spurs it is the drive to manually soothe and medicate emotional experiences from the past which are re-appearing in the present. When people become sober, they are now faced with the emotional addiction and large feelings that were underneath.
ACoAs may have never taken a drink but become para-alcoholics. According to ACA, this means ACoAs can take on the characteristics of the alcoholic without ever taking a drink. One of the big characteristics is emotional addiction: using an “internal drug store” to offer the body and mind emotional “hits” that are familiar from the past. The most common emotional hit cycles are with shame, fear, anger, and misery.
Raised by alcoholics, children have no choice but to have their nervous systems fly into an emotional state and, with a drunk parent, were often left un-soothed, berated or emotionally abandoned. In adulthood, ACoAs may find themselves cycling through similar emotional states to when they were in childhood.
In therapy, you would become increasingly aware of your particular emotional cycles, what contributes to them and how to currently soothe them in the present. You will feel old feelings and be able to process them while using the resources of the present to offer comfort, solace, and kind words so as to no longer live in this state. In processing some old emotional wounds and traumas, you may use creative means to reparent through the trauma– such as with visualization, chair work, phrases, and bodywork.
How do ACoAs get into people-pleasing behaviour?
ACoAs tend to people-please when they low self-esteem, and hence don’t believe they have certain human rights. In an alcoholic family, pleasing the authority figures in a child’s life could mean deflecting any onslaught of criticism or abuse that could be flung your way. Pleasing may have even gotten some love and occasional needs met in return. Pleasing helped when a child needed to survive and was a method for temporarily avoiding abandonment.
Cut to adulthood, that same defence is still being used and at the potential detriment of the adult. Boundaries become hard to set. Resentment and burn-out can ensue. Adult Children may feel they have to mould to their environment to get any needs met– so they may have to slough off certain parts of their identity and chameleon into what the environment is dictating (at work, school or home.)
In therapy and recovery, the work may focus on feeling feelings, sharing them authentically with others in a helpful/skillful way, and understanding personal wants and needs and getting them met. The ACoA can learn to get in touch with themselves, care for themselves and then develop genuine intimacy with others through this place of abundance and authenticity.
What are the internal critical parent and the internal loving parent?
Through recovery work and therapy, ACoAs become familiar with their internal dialogue and the way that they speak to themselves. Often, they begin to identify an internal critical parent voice that can be abusive, demeaning, and perfectionistic. This is the voice that is often bossing the wounded inner child part around, repeating the cycle of hurt, pain, fear, self-doubt, and negativity. The ACoA becomes so used to this dialogue that they feel this is who they actually are.
Over time, the ACoA can begin to identify with a more loving, kind, patient and flexible inner loving parental voice. The ACoA may need to be exposed to kind voices in meetings, in therapy and in other supports to start to internalize this other part, especially if there has been no reference for this frame. This is the voice/part that will eventually show the inner childcare, allowing the child part to be free, have fun, be creative and playful, and get his/her needs met. Aspects of therapy may also work with dialoging between these two parts and offering healing through visualization or creative means to heal the inner wounded child.
How do you find support when you’re an ACoA?
The first step of reaching out is the hardest. Many ACoAs have lived in fear and isolation for many years. ACoAs can be used to “doing it on their own”, not needing any help and holding on to their own personal stories and secrets with shame. It takes a great risk for an ACoA to begin to come out of isolation to start to share their experience with another, but once this starts the healing can begin. This can happen in ACA meetings or in therapy or both.
Many people find the combination of meetings and therapy to be great support — a skilled therapist should have an extensive background working with trauma and understanding that many ACoAs have PTSD.
The therapy portion of the work should offer support, relational healing, and trauma work which is different than what happens in a meeting setting (though some of that is there too, just indirectly!) It can be scary to start therapy, but it’s great to support recovery work when the therapist understands the value of meetings and therapy as a whole path.
What is ACA recovery?
ACA is a 12 step, 12 traditional programs where an Adult Child can recover from the impact of growing up in a dysfunctional household. A person does not have to have an alcoholic parent to attend; many members also had parents who had other addictions, were narcissistic or emotionally unavailable, or had a mental illness. However, members share the same understanding of growing up in these households and the effects– which often produced the ACoA traits and ACoA Laundry List. For many, it can feel relieving to connect with others over similar histories, hurts, difficulties and solutions.
Why go to therapy at the same time as attending ACA meetings?
ACA and Alanon meetings are great for ACoAs. Sometimes, ACoAs may not feel they are ready for meetings and going to therapy might be a great start to building intimacy and getting used to sharing one’s story. Moreover, therapy might be helpful conjunction to recovery because it can go deep with healing trauma–that being said, trauma work is particular and careful and is modulated for the client.
ACoAs will most likely have to process some familial, developmental and relational trauma with a professional. This may include working with the nervous system, working with the body as well as working with the story and internalized beliefs. Many ACoAs will work to come to a place of internal separation from their family systems in order to find and align with health (this is true even if there has been an external separation with distance and boundaries.)
Codependency Defined & How it is Treated
What is Codependency?
Codependent relational patterning comes out of being raised in dysfunctional and abusive family systems. In essence, codependency is learned in the family system as a way of relating to others.
Pia Mellody defines codependent symptoms like the following:
Difficulty with having appropriate levels of self-esteem– either too low or too high and may also be defined by other-esteem (in comparison to others’ value and worth)
Difficulty with internal and external boundary systems and definitions
Difficulty knowing one’s own personal reality and what might be personally true or factual
Difficulty understanding one’s own personal wants and needs
Difficulty with moderation and often living in the extremes in realms of thinking, feeling and acting
This is a more expanded definition of these codependency symptoms by Pia Mellody.
Are ACoAs codependent?
Not always– It really depends on the Adult Child. Albeit, the pattern of codependency may show up in an Adult Child’s life because they have learned that this is how to be in a relationship. Either they take on the characteristics of the alcoholic and become one or take on the characteristics of the codependent in the relationship, or both. Adult Children learned in childhood that they had to be a certain way, or people please, in order to get any of their needs met– which may have even failed continuously but supported some kind of attachment to the parent.
Sometimes this pattern gets recreated in romantic relationships– pairing with emotionally or physically unavailable partners where the ACoA takes care of their partner’s needs while neglecting their own. Or pair with someone who can soothe internal feelings for them temporarily, serve as a parental figure or become enmeshed and boundaryless.
For some, it serves as a method of control coming from an out-of-control childhood; if the focus is on others and seemingly controlling how they are or how they act, then the focus doesn’t have to be on ourselves, our flaws, and internal experience (which can feel painful and messy at times.)
Adult Children learned to take on any role they thought will attract their parents’ support. This strategy formed their attachment: an insecure or ambivalent one at best (Read more about Attachment Styles here.) Even if a parent had achieved sobriety and was in active recovery in one’s childhood, there may still have been traits and emotional insobriety that got passed along– a recovered parent isn’t necessarily an emotionally sober one.
In adulthood, when codependency is in the picture, Adult Children continue people-pleasing patterns, deferring to their partners or authority, agreeing, not standing up for themselves, losing track of their own opinions and needs, and returning to unreliable/inconsistent people for support when that person is incapable of providing it.
How do you work through codependent tendencies?
Generally, the first tool offered is to turn the focus on one’s self. Whenever there is an impulse to focus on the other and “fix” for them, the note is to return the focus back on the self. In this way, one starts to learn how to take care of themselves emotionally and physically— this is often described as cleaning up your own side of the street. It may begin with sitting with one’s feelings and deciphering what they’re communicating.
This can lead to soothing one’s own emotional states internally and being able to contain, care for, accept and be gentle with one’s own experiences. This may lead to greater attention to one’s own personal health, space, relationships, and overall enjoyment in life and activity.
Moreover, attending to feelings and personal health in this way can lead to taking care of other aspects of life such as boundary-setting, finding stabilizing and regulating supports, exploring financial stability, and finding safe people to share experiences with. Learning to have healthier boundaries both internally and externally can be incredibly healing. This may include learning the difference between walls and boundaries, separating internally from the family system, and/or learning how to have more defined boundaries and communicate them clearly, precisely, and consistently.
Many ACoAs find it similarly helpful to attend Alanon meetings or to read up on codependency — such as with Pia Mellody’s work, Facing Codependence and the Intimacy Factor, or Melody Beattie’s work, Codependency No More.
Read more from Heather on Adult Child Coping Strategy: How to Say No & Mean It. Heather works extensively with those in recovery in Alanon and CODA or those just wanting to explore issues of codependency independently.
RESOURCES
Dayton, Tian. 2012. The ACoA Trauma Syndrome: The impact of childhood pain on adult relationships. Health Communications Inc, 1st edition, Deerfield Beach FL.
Middleton-Moz, Jane & Dwinell, Lorie L. 2010. After the Tears: Helping Adult Children of Alcoholics Heal Their Childhood Trauma. Health Communications, Inc, 2nd edition, Deerfield Beach FL.
Mellody, Pia. 2003. Facing Codependence. Harper & Row, 1st Edition, New York NY.
