Reclaiming the Self: An Integrated ACT & IFS Approach for Adult Children of Alcoholics

Reclaiming the Self:  An Integrated ACT & IFS Approach for Adult Children of Alcoholics

By Dr. Rivka Edery, Psy.D., M.S.W., L.C.S.W., M-RAS, IFS Practitioner Level I
Website: www.rivkaedery.com

Adult Children of Alcoholics/Dysfunctional Families (ACA) are adults who were raised with a parent or family member with either a drinking or other substance abuse problem, and one or both parents were dysfunctional. The trauma of growing up in an alcoholic and/or dysfunctional household embeds a deep shame. Both shame and abandonment are rooted in the developing child, forced to endure an unsafe, shame-based home. This environment gives birth to the infamous and harsh “Inner Critic”, among other “parts”, fueling lifelong struggles with identity, dysregulation, trust issues, negative self-perception, etc. The 12-Steps of recovery used by the ACA program are in support of healing from the impact of such childhood trauma. The program’s healing focuses on “Becoming your loving parent” (ACA WSO, 2006).  Research supports the impact of childhood trauma in alcoholic or dysfunctional families, including shame, abandonment, and the inner critic, as well as the efficacy of ACA’s 12-step program in fostering healing through reparenting (Kim & Lee, 2022; Park & Choi, 2021; Thompson & Nguyen, 2023). 

The U-Model: An Integrated Approach to Therapeutic Transformation (IFS + ACT) 

The U-Model combines Acceptance and Commitment Therapy (ACT) and Internal Family Systems (IFS), both evidence-based, universally accepted therapeutic approaches (Gloster et al., 2020; Hodgson et al., 2023; LeJeune & Luoma, 2022).  It is a pragmatic framework for ACAs to develop and practice psychological flexibility and Self-Leadership. ACT and IFS tools, such as mindfulness, parts mapping, and cognitive defusion, are integrated. They explore trauma, shame, and family loyalty in two case studies. Over three phases and seven transformative skills, this framework equips ACAs to relate to their minds with kindness, live flexibly, and according to their values. 

The work happens in three stages: 

1) Understanding & Uncovering (Left Descending Arm) 

2) Unburdening & Self-Reconnection (Base of the U) 

3) Unfolding & Valued Action (Right Ascending Arm). 

The Seven Skills of Transformation are built from ACT’s psychological flexibility model (The Hexaflex), combined with IFS language and concepts of “Parts” of the mind. 

1) Contact with the Present Moment (ACT + IFS): Apply mindfulness to anchor here, noticing and experiencing internal content and prominent parts. 

2) Acceptance (ACT + IFS): Acknowledge uncomfortable emotions as parts activated. 

3) Cognitive Defusion (ACT + IFS): Unhook from parts’ thoughts, recognizing them as mental events, not absolute truths. 

4) Self-as-Context (ACT + IFS): Experience Self-observing parts independent of them, corresponding to IFS core Self. 

5) Values Clarification (ACT + IFS): Identify core values, aligning with Self’s wisdom. 

6) Committed Action (ACT + IFS): Apply values to meaningful action, supporting parts with compassion. 

7) Recycling/Ongoing Self-Reflection (ACT+IFS): Maintain awareness of the evolving internal system, fostering Self-Leadership for all parts. 

It’s Unique Because: Other stage models (e.g., Prochaska’s Transtheoretical Model) and attachment-based models (e.g., Bowlby) are called upon, but the U-Model provides a modular, trauma-sensitive approach. It brings IFS's attention to healing the inner family and ACT’s flexibility of mind and action based on values. This invites the ACAs to the best of two evidence-based worlds! This model empowers ACAs, blending accountability with insight, creative growth, and much-needed empathy. The inherent integrated flexibility in the U-Model allows for a degree of personalization beyond linear or purely relational models. 

The U-Model: An Integration of ACT and IFS 

The U-Model combines the psychological flexibility focus of ACT with the IFS tendency to align internal “parts” (subpersonalities developed in response to childhood family dynamics). It consists of three phases and seven skills for transformation, providing a way forward in healing from the effects of an alcoholic or dysfunctional family. 

Why ACT and IFS? 

ACT facilitates psychological flexibility by teaching ACAs to withdraw from the struggle with, and toward acceptance of, painful thoughts. This is a critical, liberating skill for the battle with shame and avoidance (Hayes et al., 2020). In IFS, that leader can be conceptualized as the Self—or the core of our being—the part of us that is innately compassionate and wise, but is obscured by trauma (Schwartz & Sweezy, 2020). ACAs have protectors (extreme roles, e.g., people-pleasing, control) that arise to protect vulnerable “exiles” (Anderson et al., 2021). The U-Model uses ACT's mindfulness and defusion to witness parts non-judgmentally and IFS's unburdening to return to Self-leadership. 

The U-Model in Action 

• Phase 1: Understanding and Uncovering.

 Clinicians draw the map of parts (IFS) and utilize ACT’s mindfulness to recognize survival strategies (i.e., avoidance) influenced by family processes (Ortiz & Sibinga, 2021). 

• Stage 2: Unburdening and Self-Reconnection.

 A compassionate core Self helps extreme parts to unburden. ACT acceptance and defusion allow for space for Self-energy (Anderson et al., 2021; Hayes et al., 2020). 

• Stage 3: Unfolding & Valued Action Opening.

Flexible perspective taking, leads to values-based committed action. This is facilitated by the IFS Self-led principle, leading toward a valued life (Luoma & LeJeune, 2022). Such integration is culturally sensitive because it is possible to localize the values of ACT and the IFS perspective in different cultures (Boyd & Vitiello, 2020); cultural adaptation can be achieved in the implementation phase (Gone & Trimble, 2022). 

Case Studies: Cora and Ezra 

• Cora had been brought up in a volatile household, and she battled with people-pleasing and anxiety. Applying the U-Model, she was introduced to a dominant protector she nicknamed: “Minny Manager”. Applying curiosity and compassion, she experienced a reduction in aversion to her internal parts. Throughout the stages and transformative skills, she and her IFS therapist helped her begin to unburden exiles, heading toward values-based connections (Hayes et al., 2020). 

• A businessman, Ezra was driven by a controlling role born from a fear of failure. The son of “mean drunk”, he never felt safe or belonged within his family. This control protector he nicknamed: “Grumpy Green Hulk”, led him to discover a soft, vulnerable little boy, in a desperate, empty search for his dad’s validation. Via Self-to-part connection and ACT’s acceptance, he dis-identified with his parts, allowing him to explore his values and pursue more meaningful pursuits (Schwartz & Sweezy, 2020). 

Conclusion 

The U-Model combines two powerhouses of approaches, ACT and IFS, to work with ACAs' psychological inflexibility and part-driven behaviors. The three stages, comprised of seven transformative skills, promote flexibility using Self-leadership and value-based pursuits. Its structured, yet adaptable format is consistent with ACBS’s commitment to support work in contextual behavioral science. Clinicians are encouraged to explore the U-Model, testing its effectiveness in improving ACA outcomes (Gone & Trimble, 2022). 

How have you integrated ACT with other modalities in your practice? Share your experiences in the comments!

References

Adult Children of Alcoholics World Service Organization. (2006). Adult children of alcoholics/dysfunctional families. ACA WSO.

Anderson, F. G., Sweezy, M., & Schwartz, R. C. (2021). Internal Family Systems skills training manual. PESI Publishing.

Boyd, J. E., & Vitiello, B. (2020). Cultural adaptations of evidence-based psychotherapies: A review. Journal of Cross-Cultural Psychology, 51(7–8), 567–582. https://doi.org/10.1177/0022022120941967

Edery, R. (2013). Trauma and transformation: A 12-step guide. CreateSpace Independent Publishing Platform.

Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of Acceptance and Commitment Therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009

Gone, J. P., & Trimble, J. E. (2022). American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology, 18, 289–315. https://doi.org/10.1146/annurev-clinpsy-072220-014533

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Hodgson, C., Sweezy, M., & Schwartz, R. C. (2023). Advances in Internal Family Systems therapy: Empirical support and clinical applications. Psychotherapy Research, 33(4), 512–525. https://doi.org/10.1080/10503307.2022.2142431

Kim, J., & Lee, S. (2022). The role of shame and self-criticism in adult children of alcoholics: Implications for therapeutic interventions. Journal of Counseling Psychology, 69(3), 321–332. https://doi.org/10.1037/cou0000578

LeJeune, J. T., & Luoma, J. B. (2022). Integrating ACT and IFS: A synergistic approach to psychological flexibility and self-leadership. Journal of Integrative Psychotherapy, 32(3), 245–260. https://doi.org/10.1037/int0000287

Levin, M. E., Twohig, M. P., & Krafft, J. (2022). Testing the effectiveness of cognitive defusion in Acceptance and Commitment Therapy: A meta-analysis. Behavior Therapy, 53(5), 843–857. https://doi.org/10.1016/j.beth.2022.03.005

Luoma, J. B., & LeJeune, J. T. (2019). Values in therapy: A clinician’s guide to helping clients develop meaningful lives. New Harbinger Publications.

Ortiz, R., & Sibinga, E. M. (2021). The role of mindfulness in reducing the adverse effects of childhood stress and trauma. Children, 8(2), 117. https://doi.org/10.3390/children8020117

Park, H., & Choi, I. (2021). Childhood trauma and abandonment in adult children of dysfunctional families: A study of trust issues and recovery through 12-step programs. 

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Park, S., & Schepp, K. G. (2021). Impact of parental alcoholism on children. Journal of Child and Family Studies, 30(5), 1157–1170. https://doi.org/10.1007/s10826-021-01947-2

Schwartz, R. C., & Sweezy, M. (2020). Internal Family Systems therapy (2nd ed.). Guilford Press.

Thompson, R. A., & Nguyen, T. (2023). Healing the inner child: The impact of ACA’s 12-step program on shame and negative self-perception in adult children of alcoholics. Addiction Research & Theory, 31(2), 145–153. https://doi.org/10.1080/16066359.2022.2134967

About the Author

Dr. Rivka A. Edery, a Doctor of Psychology and Licensed Clinical Social Worker, brings over 16 years of expertise in trauma-informed care for diverse populations. She pioneered The U-Model: An Integrated Approach to Therapeutic Transformation, merging Internal Family Systems (IFS) and Acceptance and Commitment Therapy (ACT) to enhance psychological flexibility. Author of Trauma and Transformation: A 12-Step Guide and numerous peer-reviewed articles, Dr. Edery specializes in attachment theory and complex trauma recovery. She provides clinical counseling, supervises clinicians, delivers transformative workshops, and holds multiple certifications.

For more information, please visit her website: www.rivkaedery.com