Understand your competing inner drives to address trauma or any type of mental health issue
Are you frustrated that in some ways you have your life together, and in others you seem totally stuck, or self-destructive?
Do you find yourself in cycles of ''weakness'' or dysfunctional behavior, followed by self-criticism or intense efforts to self-correct?
Do you cycle from anxiety to depression, whether the non-depressed state is bipolar mania or something less disruptive?
Have you tried different approaches for complex/chronic PTSD, and never found a method that seems to help you change?
What is Internal Family Systems?
Internal Family Systems (IFS) is a therapeutic approach that refers to the inner family of ‘’subpersonalities,’’ or ego ''parts,'' within the subconscious mind of every human. IFS helps people understand how different aspects of the psyche play various roles in reacting and directing behavior. We all intuitively reference this, making statements when conflicted such as ‘’Part of me wants to [do this], but another part of me wants to [do this other thing].’’
Although our psyches are clean slates at birth, initially only identifying with the presence of caregivers, ego parts develop through different aspects of upbringing and social conditioning, collectively creating our personality. Although the ego and its sense of ''I'' is necessary to create independence and allow interaction with the world, it also holds our emotional wounds, insults, and conflicted feelings. It then expresses them or tries to keep them in check through symptoms or personality traits. We end up operating from the conceit of an integrated personality (or a ''blended'' state, in IFS language), which is why we routinely identify fully with passing feelings, or project them onto others. In truth, we are almost always thinking, acting, and relating to others from ego parts.
An extreme example of this phenomenon is Dissociative Identity Disorder--formerly known as Multiple Personality Disorder--but that diagnosis applies when individuals move fully in and out ego states as a coping response to (typically severe) trauma. In other words, sometimes the need to disconnect from terror or pain strengthens ego parts into distinct, outward facing identities rather than keeping them blended at the subconscious level.
When ego parts are viewed on this continuum, you can understand why Internal Family Systems and similar models, which are sometimes referred to simply as ‘’parts work,’’ recognize subpersonalities as a universal component of psychological development, regardless of trauma history or lack thereof. As noted in this page on EMDR, everyone experiences emotional wounding (particularly through childhood) that we’re unable to fully integrate--and the resulting inner conflict leads to fractured aspects of the self: some in the background that hold our pain and associated negative beliefs, and others which suppress that pain in a combination of functional and self-destructive ways.
IFS normalizes inner multiplicity and provides a process for recognizing, ‘’unblending,’’ and befriending parts, allowing you to gain deeper insight into your triggers and translate it into mood and behavioral shifts. The overarching goal of IFS is development of a positive relationship with parts through connection to the ''Self''--the authentic, ‘’undamaged,’’ essence within everyone. The Self is a universal source of centeredness that can exert calm, healthy leadership over competing parts, even within a highly traumatized individual, and it can be recognized through expression of qualities like clarity, calmness, courage, and confidence.
Depending on your personal orientation, the Self can be conceptualized as your ''Higher Self,'' or simply your highest potential or healthiest locus of control--that which is greater than the sum of your limited ego parts. Regardless of how you prefer to define it, my experience helping clients through use of IFS indicates that the Self should be understood not just as a passive source of benevolence, but as an agent of change. Another important connotation of the Self is Self-parenting, or learning to provide your Exiled parts with the unconditional love or support that even the best parents could not deliver as accurately as the adult version of you.
What does Internal Family Systems treat?
Internal Family Systems was granted evidence-based status by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2015, rating IFS as effective for ''improving general functioning,’’ and rating it as promising for ''phobia, panic, and generalized anxiety disorders and symptoms; physical health conditions and symptoms; personal resilience/self-concept; and depression and depressive symptoms.''
As indicated above, IFS is an excellent approach for addressing problems resulting from trauma history, such as complex PTSD, anxiety, depression, addiction, and eating disorders (the creator of IFS, Richard Schwartz, actually began developing the approach to more effectively treat eating disorders). In fact, the criteria of a particular mental health diagnosis often reflect how different parts are operating in ways ''necessary'' for the individual to cope.
However, people certainly don't have to be expressing identifiable symptoms of any kind to be operating from ego parts; few humans can operate from Self at all times. The bottom line is that IFS is not only highly effective for just about any mental health diagnosis, but for anyone open to personal growth.
But what about the biochemical aspects of mental health disorders?
As indicated by the benefit of medication in most cases of complex PTSD, the commonly alternating presentation of anxiety, depression, and substance abuse or other dysfunctional behaviors can of course also be understood in the biochemical context. For example, stress hormones cause physical sensations of anxiety, which cause cravings for substances that can dampen that anxiety by impacting neurotransmitters.
However, IFS suggests that these symptoms should also be understood as a system of competing subpersonalities, often functioning in a cyclical manner. For example, psychiatrist and IFS expert Frank Anderson, M.D. synthesizes these perspectives by making sure all ''parts'' are in agreement about taking a particular medication. While the biochemical and psychological aspects of a disorder may seem contradictory, it's likely that neurotransmitters and emotions are modulated by the mind-body connection in a way not yet reflected in the mainstream mental health paradigm. Candace Pert, former researcher for the National Institute of Health, was known for discovering the link between emotions and neuropeptides, which are the building blocks of neurotransmitters such as serotonin and dopamine.
Recognizing yourself in IFS concepts
IFS identifies two broad categories of parts. Exiles carry the painful feelings we'd rather not encounter, as well as the associated negative beliefs we hold about ourselves or the world. Exiles represent what is often collectively referred to as the ''inner child,'' but through IFS, you may recognize multiple neural networks related to distinct adverse childhood incidents or circumstances. Protectors generally take two different forms to suppress the pain carried by the Exiles: Managers and Firefighters. You may feel more identified with your Managers or your Firefighters, or one category may express more internally than externally (think Black Sheep vs. High Achiever), but we all have both. Managers and Firefighters typically operate in pairs, causing a cycle between mood states (such as anxiety and depression) or habits (such as indulgence and restriction).
In preferred, or healthier roles, Managers suppress Exiles by keeping us motivated, on goal-oriented, on track, and resilient, but in the extreme, they manifest as forms of anxiety such as worry, terrorizing, self-berating, image-managing, obsessing, pessimism, and criticism.
In preferred roles, or healthier roles, Firefighters helps us relax and engage in self-care, but in the extreme they act on the continuum from vice to addiction. Like actual firefighters, Firefighter parts often act without concern for collateral damage, so their efforts to quell your pain may cause new problems. Examples of extreme Firefighter reactions include dissociation, lashing out or fighting, overspending, restricting, or hoarding; procrastination, oversleeping, overusing video games, TV, or the internet; binging, purging, or restricting; self-mutilating or making suicide attempts; or abusing alcohol or drugs.
These typically pathologized behaviors, when viewed through the compassionate lens of IFS, can be properly understood as ways to avoid overwhelming feelings. However, even if you lack trauma history, do not meet the criteria for a diagnosis, or don’t engage in overtly self-destructive behaviors, IFS can be used to develop awareness of unconscious wounds and associated parts that may be interfering with your optimal functioning. For example, loving parents often wonder why they find themselves being repeatedly over-reactive to their children, or high-functioning people often wonder why they can’t ever seem to truly relax.
How does Internal Family Systems work?
The essence of IFS is the use of a mindful, relaxed approach in order to identify parts, begin to understand and appreciate their roles in the system and the Exiles they suppress, and invoke the Self to activate change in various ways. For example, you can ask Managers and/or Firefighters to step back from problematic protective reactions, and translate that psychic energy into a more constructive expression (one tenet of IFS is that we never try to get rid of parts entirely--we only ask them to take on a healthier role in the system). Depending upon the needs of the client, there are different strategies for facilitating this process, but most people respond well to guided imagery exercises. For others, a somatic approach to exploring parts can be more effective than a visual one. After initial work is done, the characters in the ''family system'' start to become familiar, allowing parts to be easily referenced in complementary approaches like EMDR and Emotional Freedom Technique. Familiarity with your internal family system also enables you to work with challenging feelings or situations more constructively, as you can readily understand your reactions as triggered parts rather than insurmountable problems. Additionally, the Self can increasingly be experienced as a source of inner agency, versus an abstract idea.
It usually depends upon the extent of trauma history, or possibly the reliance on certain parts, how quickly and easily progress can be made. For example, for someone who easily moves into dissociation due to PTSD, it may take several IFS sessions before Protector parts feel comfortable ‘’unblending’’ enough to let Exiles come through and express their pain. Or, those with highly rational, versus intuitive, processing styles may struggle to get past a ''skeptical'' part, and in some cases, an extra tool such as ketamine-assisted psychotherapy may be helpful when IFS isn't. Interestingly, IFS emphasizes the importance of the therapist’s attunement to Self, as the more they intentionally connect to a sense of presence beyond their own parts, the more synergy there is to facilitate a client’s healing work with parts. I have absolutely observed this phenomenon to be accurate.
Where did the ''Self'' concept originate?
Although some IFS practitioners maintain that the IFS concept of the Self is unique in certain ways, the Self concept is generally common to transpersonal psychology models, which recognize a center of guidance across belief systems that supersedes limiting ego defenses (parts). Transpersonal therapy focuses on illuminating and integrating these so one can live more grounded in the present, operating from a sense of balanced inner authority. From the perspective of Jungian therapy, which is perhaps best-known transpersonal approach and source of the Self concept, IFS can illuminate how wounded parts maintain self-sabotaging patterns under the guise of victimization or fate. In other words, the more awareness you develop about unresolved inner baggage, the more your external world seems to change.
In the following passage, IFS creator Richard Schwartz describes how he observed the Self energy come alive in even the most traumatized individuals, and how he began to recognize that it reflected a common ancient idea among the world's major faiths:
“....almost no Western psychological theories could explain where this newfound and quite amazing ability to contain and understand their inner turmoil had come from. The more this happened, the more I felt confronted by what were in essence spiritual questions that simply couldn’t be addressed in the terms of problem solving, symptom-focused, results-orientated, clinical technique. I began my own novice’s exploration into the literature of spirituality and religion and discovered a mother lode of esoteric writings by sages, holy seekers, wise men and women, who emphasized meditative and contemplative techniques as a means of coming to know their Self. (“Esoteric” here means not exotic or far out, but derives from the Greek esotero, which means “further in.”) Though they used different words, all the esoteric traditions within the major religions – Buddhism, Hinduism, Christianity, Judaism, Islam – emphasized their same core belief: we are sparks of the eternal flame, manifestations of the absolute ground of being. It turns out that the divine within – what the Christians call the soul or Christ Consciousness, Buddhists call Buddha Nature, the Hindus Atman, the Taoists Tao, the Sufis the Beloved, the Quakers the Inner Light – often doesn’t take years of meditative practice to access because it exists in all of us, just below the surface of our extreme parts. Once they agree to separate from us, we suddenly have access to who we really are.”
IFS has a great deal of similarity with a model called Psychosynthesis, which was actually developed decades ago by a contemporary of Carl Jung’s named Roberto Assagioli. If you’re especially interested in the concept of the Self and are up for a deep and thought-provoking read about what it is, I recommend Assagioli’s article ‘’The Superconscious and the Self.’’
Internal Family Systems, the Self, and psychedelic-assisted therapy
After earlier research reflected that people in psychedelic-assisted therapy often naturally moved into parts work on their own, the Multidisciplinary Association for Psychedelic Studies (MAPS) began to formally evaluate Internal Family Systems as the therapeutic framework for MDMA-Assisted Therapy, which is expected to get FDA approval pending the replication of a successful Phase 3 clinical trial. However, a safe operative anesthetic that can create an altered state of consciousness, ketamine, is already FDA approved and now available as a treatment locally --both as a pharmacological approach for treatment-resistant depression or chronic pain, and as a therapeutic facilitating agent for addressing trauma and facilitating personal growth. Thanks to a resurgence in psychedelic research following suppression created by the War on Drugs, psychedelic-assisted therapy is on track to be the next big wave of progress in treatment of PTSD and other mental health problems. The Center for HBH is excited to now offer ketamine-assisted psychotherapy with application of the Internal Family Systems through Wellward Medical.
Like psychedelics, ketamine enables healing of trauma and other deep-seated psychological patterns by impacting strutures in the midbrain collectively known as the Default Mode Network (DMN). The DNM is the brain's seat of our individual identity patterns, sense of separateness from others, and collection of ego constructs and defenses--in other words, the source of our Internal Family System. Through application of intention, the Self uses ketamine's loosening effect on the DMN as a power tool for change.
While psychedelic use is often associated with ''bad trips,'' and terrifying states of total ego dissolution, ketamine-assisted psychotherapy uses a lower, controlled dose that creates an entheogenic effect, which has been described by IFS therapist Bob Grant as ''pleasure in Self.'' It changes the lens through which you see issues and, as one client stated, '''allows you to become aware of new connections,'' which in turn can change your relationship to a pattern and increase self-acceptance. The result is typically an incremental decrease in emotional and psychological burden as you progress through a series of ketamine treatments, and a net effect of significantly less burden. Read more about ketamine-assisted psychotherapy with me at Wellward Medical here.