Innovations and Elaborations in Internal Family Systems Therapy

Martha Sweezy, Ellen L. Ziskind, Martha Sweezy, Ellen L. Ziskind

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781138024380
• eBook ISBN: 9781317688471
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Martha Sweezy and Ellen L. Ziskind's Internal Family Systems Therapy: New Dimensions quickly established itself as essential reading for clinicians who are interested in IFS by illustrating how the model can be applied to a variety of therapy modalities and patient populations. Sweezy and Ziskind's newest volume, Innovations and Elaborations in Internal Family Systems Therapy, is the natural follow-up to that text. Here Richard Schwartz and other master IFS clinicians illustrate how they work with a wide variety of problems: racism, perpetrator parts, trauma, addiction, eating disorders, parenting, and grief. The authors also show creative ways of putting into practice basic IFS techniques that help parts to unblend and to unburden both personal and legacy burdens.

Chapter 1
Getting Unstuck

Pamela K. Krause, Lawrence G. Rosenberg and Martha Sweezy

Introduction

From neophyte to seasoned clinician, all therapists experience the occasional impasse or rupture in their work. These events are often embodied in behavior: something like forgetting an appointment, arriving late, avoiding uncomfortable content and not being willing to try something the therapist suggests; or something dramatic and urgent, like frequent phone calls and voice mail messages, intractable despair, crises in the therapy relationship, suicidal emergencies. Since these behaviors are generally about something that remains unspeakable for the client, most of the time we don’t easily understand their meaning. The moments in which we know something is amiss but feel uncertain about how to proceed can evoke our anxious, shaming and agenda-driven parts. In a parts-to-parts struggle, either internally or in the therapeutic relationship, we lose Self-leadership and fail to contain the moment with curiosity, clarity and calm. We are stuck. For this reason, therapeutic dilemmas have been of great interest to generations of clinicians from every school.

We (the authors) postulate that every therapy impasse occurs because the client, the therapist or both are so blended with their parts that they cannot access the qualities of the Self, ranging from curiosity to compassion, that are needed to proceed constructively. This is the internal family systems (IFS) equivalent of transference and countertransference. When blended parts assert their judgments, emotions and body sensations, they motivate all of us, client and therapist alike, to act as we wish, and we don’t have the perspective to recognize their influence. Instead we believe this is who I am and my view is correct.

When we (again, all of us) are in a balanced state, our protectors are bolstered by Self-energy and we rely on them to navigate and function in the world. However, when situations activate our exiles (usually out of awareness) and evoke feelings like loneliness, worthlessness and yearnings for redemption, our protectors take over or blend to prevent us from feeling overwhelmed. An activated protector may blend spontaneously, or it may remain chronically blended, doing its job so automatically, repetitively and compulsively over many years that its behavior is our dominant character style. When desperate exiles drive protectors to be powerfully assertive, leaving virtually no access to the clarity and calm of Self-energy, anyone can feel very ill and meet criteria for diagnoses like major depression, psychosis or PTSD. Metaphorically speaking, this is a coup d’état: The Self has been thrown into the trunk and a part is driving the car!

Chapter Overview

To get a clear perspective and see the best course of action during a difficult clinical interaction, we must have a critical mass of Self-energy. Therefore, the solution for resolving stuck moments in therapy for both therapist and client is unblending, a state in which parts are differentiated from the Self. We wrote this chapter because helping parts to unblend can be easier said than done. An exile may fear the invitation to unblend as a prelude to being banished again. A protective part may fear unblending for any number of reasons: the part needs to feel more connected to the therapist, it feels threatened by a polarized part, it is guarding a secret that has yet to be disclosed or the therapist does not have enough Self-energy to calm its fears. Whatever the reason, we can always be curious about the cause of stuckness. And the first target of our curiosity should be us: Am I (the therapist) leading from my Self or from a part?

We divide the chapter into four sections. The first offers some basic guidelines for preventing and working with stuckness. The second presents case vignettes that illustrate some options for helping a wary internal system take the leap of unblending. The third presents case vignettes that illustrate common obstacles to unblending: a Self-like part in the lead (in either therapist or client), polarities and a system that’s been through extreme trauma. And the fourth section presents a case that illustrates being innovative in response to feeling stuck.

Guidelines for Preventing and Working with Stuckness

Cultivate Self-Energy

The capacity to be calm, curious and compassionate is essential for preventing and working through therapeutic impasses. It is our responsibility, therefore, to know what triggers our system by use of introspection, supervision and personal therapy. When we are able to come to sessions without an agenda and trust the process, we are implicitly reassuring the client’s protectors (Schwartz, 1995).

Be a Good Parts Detector

In order for our parts to trust the Self in considering their differing perspectives and making wise decisions, we need to be excellent parts detectors. A perpetual stance of wonder can be very helpful in this regard: Who (in the other person) am I talking to? Who (inside me) is talking and reacting?

Be Aware of the Vulnerable Part Behind the Fierce Protector

Having identified a part, we must then wonder about its role: Is this a protector, an exiled protector (a part, often young, who seems to be an exile but when asked will endorse protecting another part), or an exile? Almost all internal systems lead with protectors. Again, curiosity is key: Who is being protected? As we illustrate later, one good way to find out is to ask the question: What are you afraid would happen if you stopped what you’re doing?

Be Aware of Polarizations

Extreme parts contribute a great deal to stuckness. Remember that they always come in pairs, and the anxiety their disagreements generate reinforces their polarization and drives their extremity. If one forceful protector is present, another is in the wings whether we hear its voice or not.

Proceed Slowly With Patience, Persistence, and Perspective

As we illustrate throughout the chapter, we should move only as quickly as the client’s system allows.

Unblending

Ways of Beginning a Session

We might start the session by asking What are you curious about today? Or Is there a part who needs your attention? The target part will be embedded in a cluster of concerned parts, and IFS has developed procedural options, called parts-detecting, for exploring this micro-system, especially by repeatedly asking the client How do you feel toward this (the target) part?

If the client names a feeling toward a target part that is not something along the lines of curiosity, caring or compassion, then a reactive part is speaking and we have a couple of options: (1) ask the reactive part for permission to continue with the target part; (2) externalize both the target part and the reactive part through the client’s imagination, on a whiteboard or paper, in a sand tray or with objects in the room like pillows or scarves, and then ask who needs attention first; or (3) use direct access with the reactive part, the technique (illustrated in Table 1.1) in which the therapist’s Self talks directly to the client’s part.

Proceeding With Either Direct Access or In-Sight

The IFS model presents two ways of working with a client’s internal system: in-sight and direct access. Unless we have reason to think otherwise, we begin by assuming that we will use in-sight, the technique in which the client’s Self communicates with the client’s parts. When this fails, we opt for direct access because a blended part will almost always talk to the therapist’s Self.

Table 1.1 Selecting a Target Part

1.	Ask the client directly: What shall we work on ? What are you curious about today ?
2.	Reflect back the client's words in parts language: I hear that a part of you is (angry, sad, doesn't know what to do, etc.). Wouldyou like to get to know your (anger, sadness, confusion .. .) better? If the client objects to the word part, you can switch to words like feeling, sensation or thought while you keep thinking in terms of parts.
3.	Guided awareness: Take a breath, go inside, open up space, and notice any feelings or concerns that would like your attention. Who wants to go first?
4.	Follow up on a part from a previous session: Last session, you were getting to know part X. Let's start by checking with that part to find out how it's doing.

While many clinicians prefer the ease of collaboration between the client’s Self and parts, both in-sight and direct access have benefits. The former is particularly efficient and helps clients engage with their parts between sessions; the latter is helpful in traumatized systems when hyper-vigilant protectors need to experience a connection with the Self of the therapist before they can trust the Self of the client (Schwartz, 1995). To complicate matters slightly, direct access has two modalities: explicit direct access in which the therapist openly asks permission to speak to the blended part, and implicit direct access in which the Self of the therapist appears to be talking directly to the client, but is, in fact, speaking directly to a blended part of the client, just as the client’s Self does with in-sight. This dialogue looks like regular talk therapy, but the therapist is mindful that she’s speaking to a part. We illustrate both kinds of direct access as well as in-sight next.

Explicit Direct Access

Explicit direct access is easy to identify because the therapist asks the client for permission to speak directly to a part. For example, Laura was a 20-year-old woman who had recently returned home from college following hospitalization for a suicide attempt. Laura started seeing me (Pam) weekly, and after several sessions she was able to use in-sight with some of her protectors. During the third month of therapy, Laura said, “I’ve been thinking of killing myself again.”

I replied, “Would you like to know more about the part who thinks about killing you?” Laura was interested. As she focused, the part appeared as a revolver. “How do you feel toward the revolver part?” I asked.

“I hate it!” Laura exclaimed. Despite much reassurance, neither the one who hated the revolver part nor a variety of other reactive parts were willing to allow direct contact between the revolver and Laura. They were all too afraid of what the revolver might do if Laura gave it attention. So I said to Laura, “Can I talk directly to the revolver? I don’t want to turn it loose in your system, but if I can find out more about it I’m confident we can address its concerns.” This statement served to raise at least some hope in her system and the other parts gave permission for direct access. “I’d like to talk with the revolver. Are you there?” I said.

Laura replied, “Yes.”

“You think about killing Laura?” I asked.

“Yes and don’t try to talk me out of it,” the revolver replied. “If you put me in the hospital again, I swear I’ll kill her. You know I almost succeeded the last time because those people in the hospital are so stupid.”

“I’m not talking about the hospital right now,” I said. “I just want to get to know you better. I know you’re trying to protect Laura, and I wonder why you do it this way. Would you be willing to tell me about yourself?” No one had ever asked the revolver to talk before. Intrigued, it replied, “I’m the end game. I’m here to stop all the pain when it gets to be too much.”

“What kind of pain?” I asked.

“That empty, hollow feeling. Nothingness,” the revolver replied.

“You think about killing her to keep her from feeling hollow and empty. Do you want to kill her?” I asked.

“Not really but nothing else has worked,” the revolver replied. “Therapy has been a huge flop. I hate feeling drugged out by all the crappy meds they have her on, her parents are a nightmare, and Tom just dumped her. I really don’t have a choice.”

“What if I told you that there is another way?” I said, being the hope merchant— the one who is certain that feelings can change and exiles can heal (Schwartz, 1995). “We can find ...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of Contributors
• Acknowledgments
• Introduction
• 1 Getting Unstuck
• 2 An IFS Lens on Addiction: Compassion for Extreme Parts
• 3 IFS and Eating Disorders: Healing the Parts Who Hide in Plain Sight
• 4 From Reactive to Self-Led Parenting: IFS Therapy for Parents
• 5 Self-Led Grieving: Transitions, Loss and Death
• 6 Perpetrator Parts
• 7 Dealing With Racism: Should We Exorcise or Embrace Our Inner Bigots?
• 8 What IFS Offers to the Treatment of Trauma
• 9 Expanded Unburdenings: Relaxing Managers and Releasing Creativity
• 10 Legacy Burdens
• Glossary
• Index