Treating traditional core issues of Adult Children of Alcoholics (ACoA), although effective, may not be enough. Typically, the ACoA client will seek counseling for the first time once they have reached a crisis state in a relationship--when their lives have become so out-of-control that they believe that they are “going crazy.” This crisis state most often follows many years of attempting to control their and others' lives by using coping and survival strategies acquired during childhood—a childhood filled, perhaps, with abuse, neglect, unpredictability, disapproval, anger, rejection....

When these coping and survival strategies fail to be effective in adulthood, the ACoA experiences emotional and mental distress--a sense of being “out-of-control” with concurrent feelings of loss of identity. Historically, therapists have focused on prevalent issues such as the fear over loss of control, lack of trust, suppressed feelings, sense of over-responsibility, and self-neglect. Often therapists “miss” in their diagnoses and subsequent treatment methods the inherent PTSD issues that may be suppressed or masked by other reported concerns.

Following is an excerpt from a client session:
Client: “When he leaves in the evening for work, I’m never sure if he’s coming back.”
Therapist: “Has he not come home in the past?”
Client: “No. He has always been very honest, responsible, and sincere.”
Therapist: “So where do you suppose these feelings are coming from?”
Client: “I’m not sure.”
Therapist: Further probing…
Client: “I remember when I was about 8 or 9, my dad came home in a drunken rage and
became physically violent with my mother. My mother left for what seemed like
weeks. I felt so abandoned. She didn’t call us. No one told us where she was or
when/if she would return.”
Therapist: “Wow!” “It sounds like that was very frightening for you.”
Client: “Yeah.” “It really ‘stuck’.”

In adulthood clients continue experiencing feelings of numbness, recurring thoughts of abuse, neglect, violence, etc., periodic or frequent dreams about their childhoods and awakening with feelings of fear and abandonment. Those whom have managed to acquire relative success often express feelings of guilt that their “less fortunate” siblings did not “fare” as well, with subsequent attempts to assuage their guilt. These feelings of guilt, born out of ones commitment to a sibling while sharing a childhood trauma experience, are not far removed from the survivor guilt experienced by soldiers returning from battle, leaving their deceased comrades behind.

Therapists often think of treating PTSD in its acuteness. ACoAs often survive and struggle for years before seeking treatment. When treating the ACoA client, therapists must assess, too, for the residual post-trauma-related disorder etiologic to this population.