Information

What is the evidence for the efficacy of Internal Family Systems (IFS) therapy?

What is the evidence for the efficacy of Internal Family Systems (IFS) therapy?


We are searching data for your request:

Forums and discussions:
Manuals and reference books:
Data from registers:
Wait the end of the search in all databases.
Upon completion, a link will appear to access the found materials.

I've been reading about Internal Family Systems therapy recently. It's claims seem quite appealing, since it suggests it can do the work of other therapies like psychoanalysis only faster and more directly.

Has it been studied to determine how effective it is? Whether in comparison to to other therapies or not.


Internal Family Systems therapy have not been subjected to large rigorous clinical trials. Most of the studies were pilots with no confirmatory studies as yet. I am just repeating the IFS website which best summarises the three existing studies in rheumatoid arthritis, PTSD and depression. I could not find any decent trials in my preliminary search.

A pilot study of 13 patients with PTSD and comorbidities found a 92% improvement after completing 16 sessions.

A randomised trial of 79 patients with rheumatoid arthritis, the 39 patients receiving IFS had reduced pain and depressive symptoms, while improving physical function and self-compassion.

A study of female college students did not find any difference in the 17 students treated with IFS compared with the 15 students treated with usual care of IPT or CBT, which supports IFS's efficacy, but the therapists in the IFS arm mainly only had 1 year of IFS training and experience.

https://ifs-institute.com/resources/research


Eating Disorder Recovery with IFS

When working with eating disorders, the exploration of symptoms as parts can be a softer, more gentle approach toward exploring behaviors. This approach encourages clients to view their maladaptive coping strategies from a lens of self-compassion for their parts, which have taken on these roles to help.

Clients with eating disorders often report polarization regarding recovery, behaviors, etc. Working with client polarizations through the IFS parts work approach increases clients’ ability for self-regulation.

Through IFS, clients’ polarized parts can become aware of one another and their shared intentions, which reduces the polarization. When Self-led parts work occurs, increased harmony throughout the internal system is the result. [2, 3]

Helping clients learn how to understand and access Self as the place where internal healing occurs fosters increased self-efficacy and a sense of hope for healing and long-term recovery. The IFS concept of all parts having good intentions allows for clients to look at all their parts from a curious perspective to get to know the intention behind the roles their parts take on and ultimately transform those roles.

Through the use of this model, clients can live more Self-led when their parts increase trust in the Self, which allows clients to have a better ability to regulate their internal systems. [2, 3]

Holmes, T., Holmes, L., & Eckstein, S. (2007). Parts work: an illustrated guide to your inner life. Kalamazoo, MI: Winged Heart Press.

Lester, R. J. (2017). Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple Self in a US eating-disorders treatment center. American Ethnologist, 44(1) 23-35.

Schwartz, R.C. (2001). Introduction to the internal family systems model. Oak Park IL: Trailheads Publications, The Center for Self-Leadership.

The Internal Family Systems Model Outline. Retrieved from https://ifs-institute.com/resources/articles/internal-family-systems-model-outline

Fairhaven Treatment Center

Fairhaven Treatment Center is a Residential and Outpatient Treatment Center that offers an opportunity for full recovery from eating disorders and disordered eating in a structured, supportive, and tranquil therapeutic environment. We use proved evidence-based therapy for eating disorder symptoms and co-occurring problems such as trauma, anxiety, depression, obsessive-compulsive disorder, and other challenges that contribute to and perpetuate the disorder.

Brittney Williams, LPC/MHSP, earned a Bachelor of Science in Psychology at Mississippi State University and a Master of Arts in Clinical Mental Health Counseling (with a specialization in Marriage/Couples and Family Counseling) at the University of Alabama. She is a Licensed Professional Counselor and Mental Health Service Provider in the state of Tennessee. In addition to her state license, Brittney is a Nationally Certified Counselor, EMDR trained, and working on her CEDS and Internal Family Systems certifications.

While completing her Bachelor’s degree, Brittney trained in multiple Social Psychology research labs where she began studying the dynamics of trauma, social relating, and human behavior. While earning her Master’s degree, Brittney continued her education and trained experience further exploring the dynamics of trauma as a clinical intern. During this training, Brittney became increasingly aware of, and interested, in the connection between attachment trauma and eating disorders. Brittney has worked with the eating disorder population in various levels of care for the past 5+ years along with those suffering from trauma and other accompanying mental health-related issues. Brittney’s passion is to continue this complex work by offering evidenced-based, compassionate clinical care to the eating disorder population.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published October 19, 2020, on EatingDisorderHope.com
Reviewed & Approved on October 19, 2020, by Jacquelyn Ekern MS, LPC


National Registry of Evidence-based Programs and Practices (NREPP)

Internal Family Systems (IFS) Therapy is a psychotherapeutic modality developed in the mid-1980s, based on the observation that clients sometimes experience subpersonalities that come into internal conflict when dealing with challenges. The IFS model likens these subpersonalities to an “internal family.”

The IFS model uses mindfulness-based and other strategies to help people resolve internal conflicts in a satisfactory way. During sessions, therapists actively encourage participants to practice self-compassion toward subpersonalities and an internal dialogue. Participants attend individual sessions or group meetings with trained IFS therapists.

The Center for Self Leadership offers progressive levels of training in IFS, from beginning (Level 1) through advanced (Level 3). Participants in these trainings learn both IFS theory and technique, gaining the knowledge and skills needed to understand and actively use IFS with individuals, couples, children, families, and groups. Information and training regarding IFS is provided through multiple sources.

Evaluation Findings by Outcome

This program is effective for improving general functioning and well-being. The review of the program yielded strong evidence of a favorable effect. Based on one study and three measures, the average effect size for general functioning and well-being is .56 (95% CI: .30, .69).

Click here to find out what other programs have found about the average effect sizes for this outcome.

At the end of the 9-month intervention, participants in the intervention group reported a statistically significant reduction in two measures of joint pain and a measure of physical functioning, compared with participants in the control group (Shadick et al., 2014).

Shadick et al. (2014): RA Disease Activity Index (RADAI) joint score (total number of painful joints) the 100-mm visual analog scale (VAS) and the Short Form-12 (SF-12) physical function score

This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

This program is promising for reducing phobia, panic, and generalized anxiety disorders and symptoms. The review of the program yielded sufficient evidence of a favorable effect. Based on one study and one measure, the effect size for phobia, panic, and generalized anxiety disorders and symptoms is .32 (95% CI: -.12, .76).

Click here to find out what other programs have found about the average effect sizes for this outcome.

At the end of the 9-month intervention, participants in the intervention group showed a greater, but statistically nonsignificant mean improvement in anxiety, compared with the control group (Shadick et al., 2014).

Shadick et al. (2014): Spielberger State–Trait Anxiety Inventory (STAI)

This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

This program is promising for improving physical health conditions and symptoms. The review of the program yielded sufficient evidence of a favorable effect. Based on one study and one measure, the effect size for physical health conditions and symptoms is.23 (95% CI: -.22, .67).

Click here to find out what other programs have found about the average effect sizes for this outcome.

At the end of the 9-month intervention, there was no statistically significant difference in disease activity between the intervention and control groups (Shadick et al., 2014).

Shadick et al. (2014): Disease Activity Score–28–C–reactive Protein 4 (DAS28–CRP4)

This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

This program is promising for improving personal resilience/self-concept. The review of the program yielded sufficient evidence of a favorable effect. Based on one study and two measures, the average effect size for personal resilience/self-concept is .27 (95% CI: -.04, .43).

Click here to find out what other programs have found about the average effect sizes for this outcome.

At the end of the 9-month intervention, participants in the intervention group reported a statistically significant increase in self-compassion, compared with participants in the control group, but there were no significant group differences in arthritis self-efficacy (Shadick et al., 2014).

Shadick et al. (2014): Neff Self-Compassion Scale and Arthritis Self-Efficacy Other Symptoms Scale

This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

This program is promising for reducing depression and depressive symptoms. The review of the program yielded sufficient evidence of a favorable effect. Based on one study and one measure, the effect size for depression and depressive symptoms is .46 (95% CI: .01, .90).

Click here to find out what other programs have found about the average effect sizes for this outcome.

At the end of the 9-month intervention, participants in the intervention group showed a greater, but statistically nonsignificant mean improvement in depressive symptoms, compared with the control group (Shadick et al., 2014).

Shadick et al. (2014): Beck Depression Inventory (BDI)

This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

Study Evaluation Methodology

Shadick et al. (2014)
Study Design Narrative Through a computer algorithm, rheumatoid arthritis participants were randomly assigned to either the IFS program or a rheumatoid arthritis educational program. The rheumatoid arthritis education group served as a minimal-attention control, meeting once as a group and then receiving monthly mailed educational information about rheumatoid arthritis. These mailings were followed up by a phone call from a research assistant to reinforce the information.
Sample Description A total of 79 adults with a rheumatologist’s diagnosis of rheumatoid arthritis participated in the study (39 in the intervention group and 40 in the control group). The mean age was 58 years. Approximately 90% of the sample was female and 92% was white. Mean duration of the disease was approximately 16 years.

References

STUDIES REVIEWED

SUPPLEMENTAL AND CITED DOCUMENTS

OTHER STUDIES

Resources for Dissemination and Implementation *

* Dissemination and implementation information was provided by the program developer or program contact at the time of review. Profile information may not reflect the current costs or availability of materials (including newly developed or discontinued items). The dissemination/implementation contact for this program can provide current information on the availability of additional, updated, or new materials.

Implementation/Training and Technical Assistance Information

Training for IFS is organized through the Center for Self Leadership (CSL). Trainers attend two annual retreats and collaborate on training-related issues and curricular reviews through separate monthly conference calls. Trainers are experienced, licensed psychotherapy professionals who teach the IFS model across the United States and internationally. Trainings are held at conference or retreat centers or on university campuses. International trainings (averaging five trainings per year with 25–28 participants) have taken place at a number of locations. Three consecutive levels of extensive training are available, supported by a comprehensive training curriculum that involves the participants’ personal immersion in the actual model. Trainees learn both IFS theory and technique, gaining the knowledge and skills required to actively use the IFS model with individuals, couples, children, families, and groups.

Individuals who complete Level 1 Training may earn IFS certification by completing a rigorous process to ensure their proficiency in the IFS model. This process includes demonstrations of competence through recorded mock and live sessions, consultation sessions, and/or participation in advanced training. There are currently over 200 IFS-certified therapists and practitioners, who are accessible through a searchable online registry. Annual IFS conferences have been held for over a decade.

IFS provides an adherence manual that includes a definition of every construct and all stages of the unburdening process through integration. These constructs represent the basis for a recently developed 15-item fidelity scale, which is designed to ensure adherence. In addition, an IFS therapist-competency scale has been constructed.

Dissemination Information

The Center for Self Leadership operates a resource website (www.selfleadership.org), which includes a series of key IFS articles, along with an online store. The Foundation for Self Leadership’s website (www.foundationifs.org) was unveiled in late 2013 and is being expanded gradually. In addition, there are dozens of websites of IFS practitioners that include information and testimonials about IFS.

Summary Table of RFDI Materials

Internal Family Systems Therapy (Guilford, 1997), a book written for psychotherapists. The book has been published in several editions and translated into many languages, including French, Portuguese, and Korean.

Introduction to the Internal Family Systems Model (Trailheads Press, 2001), translated into French and Spanish

You Are the One You’ve Been Waiting For, Bringing Courageous Love to Intimate Relationships (Trailheads Press, 2008)

Demonstration DVDs, led and narrated by Dr. Richard Schwartz, have been produced to show clinical work using IFS for treating a number of mental disorders.

Training Level 1 (a foundational training of over 100 hours in two formats: two 1-week retreats or six long weekends)

Training Level 2 (an intermediate training of over 70 hours)

IFS fidelity scale (providing model constructs and research adherence tool)

The Foundation for Self Leadership’s website provides dozens of websites of IFS practitioners that include information, news, and testimonials about IFS.


Free 3-day IFS course

Get access to my 3-day IFS introductory online course and get to know IFS therapy in an experiential way.

IFS vs other psychotherapy models

Looking at our personality as a being consisting of many parts is nothing new. How is IFS different? There’s many points, but the following 3 are the most important:

Contrary to other therapeutic systems which consider working with subpersonalities, IFS focuses not only on particular parts, but most of all on the relationships between them. So the whole system is important, our internal family.

Noticing the key meaning of relationships between individual parts was possible for Schwartz mainly because of his practice as a family therapist. When he applied his knowledge about family systems to the inner world, he understood, that looking at relations between particular parts of personality helps us to learn the source of many troubles people struggle with.

It seems that it is hard to understand the actions of one subpersonality (and also to help it change its role and function in the system) in separation with other parts, with which it can be in conflict with, which it can try to protect or be protected by.

Even therapies most focused on working with subpersonalities (Transactional Analysis, Gestalt therapy) don’t pay attention to the relationships created between the parts of the personality.

The most important thing in many systems working with parts is interacting with what lives within us. Jung wrote about it, Perls (Gestalt therapy, empty chair technique) practised it, Hal and Sindra Stone (Voice Dialogue) talked about it.

But only IFS has the goal of A) establishing deeper relationships with our parts and B) supporting them in freeing themselves from blockades, emotional baggage and the roles they serve.

A) What does it mean to establish a relationship with a part? The members of our internal family can like or dislike us, they can trust or mistrust us, they may want to talk with us, or not. Just like with people we meet in the outside world, we can come into various relationships with our inner parts. A good relationship with members of this internal society is key in IFS therapy, because only when they are open to dialogue they will tell us what they are afraid of, what they run away from, what they desire and who they protect. Only then they are willing to cooperate with other parts.

B) IFS not only comes into dialogue and builds relationships with parts we find in ourselves. In this approach it is important to help the parts. Some of them need support to free themselves from their destructive roles (Perfectionist or Inner Critic), and others need support from their emotions or beliefs they learned through various experiences in the past (guilt, grief, regret or beliefs like “I’m not worthy of love”). To this end Schwartz created a process called “unburdening”.

Schwartz discovered that the biggest obstacle in making relationships with each part are other parts which burden us with fear, anger or regret. For example, when he asked one of his clients what is his attitude towards his Inner Critic, the client replied “Im mad at him”. In IFS it means that through the client spoke a part which feels anger towards the Critic and the client judges the Critic from the perspective of this part.

When Schwartz began to ask his clients to ask those judging parts to move aside, they entered a state of full openness, curiosity, peace and compassion - towards the part they wanted to work with. This was a state in which they didn’t identify with any part - they found some space for awareness and deep peace. Being in this state made creating relationships much easier and understanding the core of the problem - much quicker.

The founder of IFS called this state “Self” and described it as a state of mind, which is full of empathy and curiosity - a state in which we know what is good for all our parts. Every one of us has a Self in the core of our existence. Even people who went through heavy trauma or those afflicted with psychological disorders. According to Schwartz, Self is characterized by “8 C”: Compassion, Curiosity, Calm, Clarity, Courage, Connectedness, Confidence, Creativity.

Self is different from all other parts we have. It is both one of the parts (an active internal leader for other parts, with a broader perspective) and a higher state of consciousness. Achieving access to this state is often the first and the most important step of IFS therapy. Without this, effective work with parts proves to be difficult or even impossible.

Self is a state, which, except for the “8 C” has an inner wisdom about how to relate to other parts of personality in a harmonized, loving way. It is this aspect of our psyche which is responsible for the ability to self heal.

In IFS it is the Self that is the fragment of our psyche which meets each part and builds relationships with them. The more the subpersonalities trust the Self, the more space they give him to be a leader of the system and the more harmony we experience. The role of the therapist is to help the client enter the Self and, from this perspective, interact with members of the internal family. Thanks to this, the client doesn’t become reliant on the therapist.

The great trinity

Another difference between IFS and other systems of psychotherapy is highlighting of the 3 types of subpersonalities which live in our internal family. They are 1. Exiles, 2. Managers and 3. Firefighters.

They are those parts of personality, who (usually during childhood) were in some way hurt and then they were “frozen in time” in a particular memory, carrying within them various emotional baggage. Getting through to them and freeing them from this baggage is the main goal of IFS, however it doesn’t always happen from the beginning. To be able to meet the exiles we need the approval of managers - the parts which are responsible for the protection or imprisonment of the exiles in the dark cellars of our subconscious mind.

Many of us have quite a lot of these parts, without even knowing about them. We are raised to negate our weaknesses and troubling feelings. That’s why we are prone to trauma - when some parts of us suffer, we deny them, and what comes next - they not only suffer, but are also abandoned. This way, they become exiles.

For this to happen, we don’t need any “typical” big trauma (like abuse by our parents, death of a close relative or rape). Sometimes even simple events (a comment from a teacher, being left alone for a few hours by our parents) can become a wound that will later influence us for the whole life. Even though we don’t consciously remember, it influences us all the time - we experience it as lessened self-esteem, fear of failure or other emotional blockades, which are not a mental disorder, but still prevent us from living in harmony and satisfaction.

The exiles do everything they can to be noticed, that’s why they will constantly bring up memories and emotions, reminding us about them - so that we pay attention to them and take care of them. Sometimes they even flood us with troubling emotions and that’s what the managers fear most. Their role is to keep our psyche stable and that’s why they try to do whatever they can to enable us to function in our reality without constant breakdowns. They are the part which drives our everyday life.

The main goal of managers is to keep the exiles imprisoned for their own good and for the good of our whole psyche. They prevent the activation of those parts in various way - their favourite tools are: phobias, obsessions, compulsions, passivity, emotional indifference, panic attacks, depression, hyperactivity, nightmares.

The most common managers are:

- Controller - the part which wants to have control over everything, because it believes that any kind of surprise will unleash emotions connected to a wound,

- Perfectionist - when he will be perfect, no one will reject him and so - he will not recall any troubling emotions of abandonment,

- Passive Pessimist - he avoids interpersonal interaction though passivity and withdrawal, so that he won’t be close to other people (closeness can unleash denied, troubling emotions),

- Caregiver - he cares for everyone around, but not for himself, and uses this as a strategy to run away from his own emotions.

An important discovery by Schwartz, mostly about managers, is that the dominant behaviour of those parts is not their essence, but rather an extreme role they were put into. For example - Inner Critic doesn’t need to be a critic, his role is different - to motivate - when we are able to communicate with him and show him the damage he does with his criticism.

The change happens fastest when, during the IFS therapy, we slowly allow the exiles to free themselves from their emotional baggage. Then, the managers no longer need to protect us from the emotions which were dangerous before - because they were healed. In this moment the managers usually easily change their way of influencing us and we experience it as a lasting change on a deep level.

There are situation, in which managers can’t keep the exiles in their cages. Then, emotions overwhelm us and this is a fire that needs to be extinguished quickly. In those moments the firefighters come to the forefront of our mind - the parts that want to ease and soothe the troubling emotions.

Firefighters have the same goal as managers, but different roles and strategies. Managers are proactive (they prevent the emotions of going outside), but firefighters are reactive (they act, when the damage is already done).

They are responsible for addictions. Using various forms of substances is the easiest way to quench a fire. The most common strategies are: binge eating, eating sweets, smoking cigarettes, drinking alcohol, taking drugs, watching pornography, gambling or shopping.

What’s interesting is that firefighters come during the process of therapy. When the person, with the help of a therapist, starts getting close to the troubling emotions (and starts coming into contact with the exile) the firefighter comes and creates psychophysiological reactions like sleepiness, dizziness, distraction - everything that can help run away from what is important.

In summary, these are the most important assumptions of IFS therapy:

- We all have parts that create our internal family,

- We all have access to Self - a state in which we don’t identify with any part,

- Every part is good in itself and has positive intention. There are no “bad” parts, which would need to be eliminated,

- Our subpersonalities create a complex system of relationships between them.

IFS in self-growth and as a psychotherapy

IFS works great both for people who are completely healthy and those that suffer from various disorders.

In the first case, therapy can be about low self-esteem, chronic stress, impulsive anger, deep sadness or regret, dealing with bereavement, fear of failure, fear of intimacy, shyness and many other problems with destructive emotions or limiting beliefs.

In the second case, IFS method can be used to work with:

  • Trauma
  • Depression
  • Addiction
  • Post-traumatic stress disorder
  • Compulsive behaviours
  • Phobias
  • Neurosis (anxiety)
  • Bipolar disorder
  • Anorexia and bulimia

The method can be used for individual therapy, but also couples, family and group therapy.

The good news is that working with a therapist is not the only option to use the IFS method. Richard Schwartz also encourages autotherapy (self-work in your own home), but it’s worth to know the model and its techniques well to make autotherapy possible and safe.

Jay Earley wrote a long-titled book “Self-Therapy: A Step-By-Step Guide to Creating Wholeness and Healing Your Inner Child Using IFS, A New, Cutting-Edge Psychotherapy”. In this book he shows how we can use IFS for ourselves.

Since 2015 Internal Family Systems therapy is an evidence based psychotherapy according to NREPP (National Registry of Evidence-based Programs and Practices). This registry was created by Substance Abuse and Mental Health Services Administration (SAMHSA) which is a branch of the U.S. Department of Health and Human Services

IFS was judged as effective for improving general functioning and well-being and as promising for reducing phobia, panic, and generalized anxiety disorders and also for improving physical health conditions, psychological resilience and treating depression.

It’s important to mention, that although during the IFS therapy we deal with particular problems or emotions of a person, who searches for inner change, each session brings more, far-reaching, positive “side effects”. When we learn to listen to parts of our personality with openness and compassion (without judging or trying to change them), our relationship with ourselves changes. We acquire the ability to “detach” from our emotions and to observe them with curiosity and acceptance. We experience greater inner harmony and achieve greater emotional stability.

IFS therapy can be seen as a path, which leads us into love and self-compassion.

Every dialogue with a part of our subpersonality is an occasion to understand and love another fragment of yourself. The whole process can be an opportunity for deep and lasting transformation of how we perceive ourselves.

From my point of view the Internal Family Systems model is much more than a method of psychotherapy. It’s a way to experience yourself, a way to experience people around you and to experience life itself.

How does IFS therapy look like in practice?

Every IFS session is like a tiny trip deep into yourself, where you experience a slightly different state of awareness. You briefly remove yourself from the outside world and focus inwards seeing all the nooks and crannies inside your own subconscious mind. For many it’s quite an intensive experience after which you can hear words like: “I just touched something deep and important”.

In most cases IFS therapy is a process, during which you have your eyes closed. The role of the therapist is to guide you in establishing connections with particular parts, to help you converse or negotiate with them, to free the hurt parts from their burden. In some situations the therapist can use different techniques in which - instead of communicating with your parts by yourself - you act as if you are that part, by sitting on a chair. Then you go into a dialogue with the therapist from the perspective of your part (the “direct access” technique).

After the initial assessment and learning about your most important parts and the relations between them, the therapist will ask you to find the feelings you want to look at, which influence you in a negative way, or which are connected to the problem you want to work with. After you focus your attention on the feeling, he will ask you what image comes into your mind. People see their parts in various ways - sometimes cartoon characters, other times their parents or loved ones, sometimes items like chains, balls, carrots or clouds.

When you see the visual representation of this part, the therapist will begin guiding you through a dialogue with this part, proposing some questions and following what happens inside you. This process happens in a trance-like state. Your whole focus is put inwards.

The therapist may ask you to ask your parts questions such as:

  • What is your role? Why do you do what you do?
  • What are you afraid would happen, if you stopped doing your role?
  • What other part are you protecting?
  • With which part are you in conflict with?
  • What would have to happen to make you stop influencing part X?

Each of those questions allows you to better understand the essence of a particular part and also the dynamics of your inner world. The fascinating this is that you don’t need to consciously look for answers to those questions. When you have good contact with your parts (everyone, no exceptions, can have a good contact with his or hers internal family, sometimes you just need to learn it), the answers appear spontaneously. We know full well when the answer comes from the part we are speaking with.

It’s surprising how quickly and easily people recognize their parts of personality. When they break through the illusion of oneness of personality, the focus on subpersonalities becomes easy, the idea of multiplicity of mind begins to make great, intuitive sense.

Step one: relationship and trust

One of the most important goals of IFS therapy is reaching the exiles, and then healing them by releasing them from the burden they carry (and through taking them out of the past they are stuck in). This element brings the most important changes in the inner world. A side goal of the therapy is gaining access to the state of Self and distinguishing it from other parts, so that Self can become the leader for the whole internal family. When both those goal are realized, the client - step by step - discovers a great feeling of harmony, which radiates throughout his whole daily life.

But before the meeting with exiles becomes possible, the client has an important task to fulfill. It’s creating a good relationship with managers, who have a tough but important task. As I wrote earlier, this group protects or “imprisons” the exiles. Reaching the exiles without a care for managers can harm the client (treating the managers with contempt can lead to them becoming even more extreme in their actions).

That’s why we can make the next step in therapy only after we gain the trust of a manager and when he allows us to meet the exile. There are many important reasons for this, but there is no space here to go into them. Caring for the safety of the whole system is key in IFS and there are plenty of elements in the process that support this.

Of course, not every session leads to getting access to exiles or freeing them from the prison they are in. You can’t always establish a relationship or gain the trust of a manager or firefighter. Each problem is different, each inner family is different and each client has a different rhythm of work. If the problem is tougher or if the mental disorder is deeper, establishing a relationship with a part can require multiple sessions.

Despite this, every meeting with members of this inner community brings us greater awareness, better understanding of ourselves and greater feeling of harmony.

Sometimes the very act of being open and curious towards a certain part of yourself makes all the difference - especially when, for many years, we had no idea it existed or when for years we hated it and fought with it.

What’s interesting, after an IFS session we can sometimes experience a so-called “change in system”. It’s a slight discomfort, because “bricks” in the mind were moved. If you wore braces it can feel similar to the process of tightening, when the dentist corrects teeth placement and we begin to get used to it after a few days of slight discomfort. Similar thing happens when we change our beliefs or free ourselves from difficult emotions in IFS - something we wore for many years in our head or body suddenly disappears - and you have to get used to this new, slightly alien, system.

Sometimes after a good IFS session, the clients Inner Sceptic appears and says: “this was too easy to be true/effective/lasting.” It’s a natural reaction, because we are not used to having deep changes in such a short amount of time. For therapists working with Internal Family Systems model it’s a common occurrence.

Internal Family Systems around the world

The IFS model gains more and more recognition around the world. Richard Schwartz gives lectures at major conferences about trauma and mental health, where he shares his discoveries. IFS therapist training gathers more people years, which can be seen mostly in USA and UK.

When I learned about this model of therapy I began reading all the books about IFS that I could find. After getting a solid base of knowledge about how IFS looks in practice, time came for months of experiments - both self-practice (in the form of autotherapy) and as a therapist for my friends and people who agreed to be my “lab rats”. I owe a great deal to my autotherapy. I will never forget how, lying in bed during one of my stays in Bali, Indonesia, I looked inside myself to find a small boy, bound by rope, all trembling with fear. Taking care of this part of myself and freeing it from the ropes brought a great change in the area of my relationships. I feel the effects of this change to this day.

Practicing IFS in the role of a therapist to support other people brought effects that exceeded my expectations. Soon I felt that’s what I was looking for. It became clear that I found an approach which resonates with me fully and gives me great possibilities to help other people.

At this point, I have finished the 3-level IFS training and I use this model exclusively to help people I work with. If you want to book an IFS therapy session with me, please click here.

In order to promote IFS therapy, I created a simple website - IFS Poland - with all information about IFS therapy you may be looking for. You can read there more about how a session looks like, IFS certification process, self-therapy and much more. Also by signing up for our newsletter, you will receive a free the “Self-therapy with IFS” ebook.

If you already have experience in IFS model and want to gain more confidence with the flow of the IFS model and bring more Self into your therapeutic relationships, I recommend you "The Self-led therapist" online course. It's created the therapist with nearly 30 years of experience – the IFS lead trainer, Osnat Arbel, PhD and will let you dive deeper into the IFS model.

The information I provided in this article is a drop in the ocean of what we already know about the functioning of our inner families and how to help them achieve balance, fulfillment and harmony.

I will gladly answer any of your questions about the IFS model, so if any come to you - leave a comment.


Special Topics in IFS Therapy: The Presence of the Therapist, Polarizations, Extreme Protectors, and the Cycle of Addiction - 6 CEUs

IFS is an evidence-based model of psychotherapy that provides a compassionate, respectful, non-pathologizing approach to understanding the organization and functioning of the human psyche. It provides therapists with a powerful and effective set of tools for empowering clients with a wide range of clinical profiles to heal the wounded and burdened parts of their internal systems, resulting in increased internal harmony, symptom reduction, and improved functioning. In this workshop, participants who are already familiar with the basic principles of IFS will deepen their understanding of the IFS approach to key elements of treatment, including the presence of the therapist, techniques for working with Parts in extreme roles, such as suicidality, self-harm, and dissociation, and working with polarizations between Parts, all of which are essential for effectively treating trauma survivors. Additionally, special focus will be given to conceptualizing and working with the cycle of addiction using IFS techniques.

*Please note that previous exposure to IFS theory (such as through an introductory IFS workshop, readings, or IFS experiential training programs) is strongly suggested before attending this workshop, as basic IFS theory will only be reviewed briefly.

*Also, please be aware that "Internal Family Systems" (IFS) is a very different model from "Family Systems" therapy. There has been some confusion in the past, so we really want to make sure everyone knows this is an IFS training and not Family Systems training. Thank you!

Presented by: Alexia Rothman, Ph.D.

Dr. Alexia Rothman is a clinical psychologist in private practice in Atlanta, GA, since 2004.She is a Certified Internal Family Systems therapist, an international speaker and educator on the IFS model, and a professional consultant for clinicians seeking to deepen their knowledge and practice of IFS through theoretical discussions, case consultation, technique practice, and deep, personal experiential work with their own internal systems. Dr. Rothman has received extensive training in the IFS model, primarily from IFS developer, Dr. Richard Schwartz. She has served as a Program Assistant for multiple Level 1, 2, and 3 experiential IFS trainings, and she offers workshops on the IFS model throughout the United States and abroad. She currently co-hosts an Internal Family Systems-informed podcast, Explorations in Psychotherapy.

Dr. Rothman is a United States Presidential Scholar who graduated summa cum laude from Emory University as a Robert W. Woodruff Scholar. She received her Ph.D. in Clinical Psychology from the University of California, Los Angeles (UCLA), where she was an Edwin W. Pauley Fellow and a National Science Foundation Graduate Research Fellow. She has held adjunct faculty positions at Emory University and Agnes Scott College.

  • 8:30 - 9:00 Registration
  • 9:00 - 10:30 Welcome and Morning Session
  • 10:30 - 10:45 Break
  • 10:45 - 12:15 Morning Session (Cont.)
  • 12:15 - 1:15 Lunch Break
  • 1:15 - 2:45 Afternoon Session
  • 2:45 - 3:00 Break
  • 3:00 - 4:30 Afternoon Session (Cont.)
  • 4:30 - Continuing Education Certificates Available

6 Core CE Clock Hours:

  • Psychologists: The Knowledge Tree (TKT) is approved by the American Psychological Association to sponsor continuing education for psychologists. TKT maintains responsibility for this program and its content.
    • For Georgia Psychologists, all online webinars (both live and on-demand) count the same as live for 2021 (including ethics). The Board states it will go back to the pre-COVID rules in 2022. You may complete all 40 CEUs this year while you have options.
    • Licensed in another state? The Knowledge Tree is a Continuing Education Sponsor Approved (CESA) by APA, so all of our workshops should satisfy your CE requirements, but please check your state rules regarding live webinars vs. live workshops.
    • Licensed in another state? Please see the highlighted section below.*
    • Licensed in another state? Please see the highlighted section below.*
    • Licensed in another state? Please see the highlighted section below.*

    To view our various workshop policies, including our refund policy, please click here.


    Eating Disorder Recovery with IFS

    When working with eating disorders, the exploration of symptoms as parts can be a softer, more gentle approach toward exploring behaviors. This approach encourages clients to view their maladaptive coping strategies from a lens of self-compassion for their parts, which have taken on these roles to help.

    Clients with eating disorders often report polarization regarding recovery, behaviors, etc. Working with client polarizations through the IFS parts work approach increases clients’ ability for self-regulation.

    Through IFS, clients’ polarized parts can become aware of one another and their shared intentions, which reduces the polarization. When Self-led parts work occurs, increased harmony throughout the internal system is the result. [2, 3]

    Helping clients learn how to understand and access Self as the place where internal healing occurs fosters increased self-efficacy and a sense of hope for healing and long-term recovery. The IFS concept of all parts having good intentions allows for clients to look at all their parts from a curious perspective to get to know the intention behind the roles their parts take on and ultimately transform those roles.

    Through the use of this model, clients can live more Self-led when their parts increase trust in the Self, which allows clients to have a better ability to regulate their internal systems. [2, 3]

    Holmes, T., Holmes, L., & Eckstein, S. (2007). Parts work: an illustrated guide to your inner life. Kalamazoo, MI: Winged Heart Press.

    Lester, R. J. (2017). Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple Self in a US eating-disorders treatment center. American Ethnologist, 44(1) 23-35.

    Schwartz, R.C. (2001). Introduction to the internal family systems model. Oak Park IL: Trailheads Publications, The Center for Self-Leadership.

    The Internal Family Systems Model Outline. Retrieved from https://ifs-institute.com/resources/articles/internal-family-systems-model-outline

    Fairhaven Treatment Center

    Fairhaven Treatment Center is a Residential and Outpatient Treatment Center that offers an opportunity for full recovery from eating disorders and disordered eating in a structured, supportive, and tranquil therapeutic environment. We use proved evidence-based therapy for eating disorder symptoms and co-occurring problems such as trauma, anxiety, depression, obsessive-compulsive disorder, and other challenges that contribute to and perpetuate the disorder.

    Brittney Williams, LPC/MHSP, earned a Bachelor of Science in Psychology at Mississippi State University and a Master of Arts in Clinical Mental Health Counseling (with a specialization in Marriage/Couples and Family Counseling) at the University of Alabama. She is a Licensed Professional Counselor and Mental Health Service Provider in the state of Tennessee. In addition to her state license, Brittney is a Nationally Certified Counselor, EMDR trained, and working on her CEDS and Internal Family Systems certifications.

    While completing her Bachelor’s degree, Brittney trained in multiple Social Psychology research labs where she began studying the dynamics of trauma, social relating, and human behavior. While earning her Master’s degree, Brittney continued her education and trained experience further exploring the dynamics of trauma as a clinical intern. During this training, Brittney became increasingly aware of, and interested, in the connection between attachment trauma and eating disorders. Brittney has worked with the eating disorder population in various levels of care for the past 5+ years along with those suffering from trauma and other accompanying mental health-related issues. Brittney’s passion is to continue this complex work by offering evidenced-based, compassionate clinical care to the eating disorder population.

    The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

    We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

    Published October 19, 2020, on EatingDisorderHope.com
    Reviewed & Approved on October 19, 2020, by Jacquelyn Ekern MS, LPC


    Free 3-day IFS course

    Get access to my 3-day IFS introductory online course and get to know IFS therapy in an experiential way.

    IFS vs other psychotherapy models

    Looking at our personality as a being consisting of many parts is nothing new. How is IFS different? There’s many points, but the following 3 are the most important:

    Contrary to other therapeutic systems which consider working with subpersonalities, IFS focuses not only on particular parts, but most of all on the relationships between them. So the whole system is important, our internal family.

    Noticing the key meaning of relationships between individual parts was possible for Schwartz mainly because of his practice as a family therapist. When he applied his knowledge about family systems to the inner world, he understood, that looking at relations between particular parts of personality helps us to learn the source of many troubles people struggle with.

    It seems that it is hard to understand the actions of one subpersonality (and also to help it change its role and function in the system) in separation with other parts, with which it can be in conflict with, which it can try to protect or be protected by.

    Even therapies most focused on working with subpersonalities (Transactional Analysis, Gestalt therapy) don’t pay attention to the relationships created between the parts of the personality.

    The most important thing in many systems working with parts is interacting with what lives within us. Jung wrote about it, Perls (Gestalt therapy, empty chair technique) practised it, Hal and Sindra Stone (Voice Dialogue) talked about it.

    But only IFS has the goal of A) establishing deeper relationships with our parts and B) supporting them in freeing themselves from blockades, emotional baggage and the roles they serve.

    A) What does it mean to establish a relationship with a part? The members of our internal family can like or dislike us, they can trust or mistrust us, they may want to talk with us, or not. Just like with people we meet in the outside world, we can come into various relationships with our inner parts. A good relationship with members of this internal society is key in IFS therapy, because only when they are open to dialogue they will tell us what they are afraid of, what they run away from, what they desire and who they protect. Only then they are willing to cooperate with other parts.

    B) IFS not only comes into dialogue and builds relationships with parts we find in ourselves. In this approach it is important to help the parts. Some of them need support to free themselves from their destructive roles (Perfectionist or Inner Critic), and others need support from their emotions or beliefs they learned through various experiences in the past (guilt, grief, regret or beliefs like “I’m not worthy of love”). To this end Schwartz created a process called “unburdening”.

    Schwartz discovered that the biggest obstacle in making relationships with each part are other parts which burden us with fear, anger or regret. For example, when he asked one of his clients what is his attitude towards his Inner Critic, the client replied “Im mad at him”. In IFS it means that through the client spoke a part which feels anger towards the Critic and the client judges the Critic from the perspective of this part.

    When Schwartz began to ask his clients to ask those judging parts to move aside, they entered a state of full openness, curiosity, peace and compassion - towards the part they wanted to work with. This was a state in which they didn’t identify with any part - they found some space for awareness and deep peace. Being in this state made creating relationships much easier and understanding the core of the problem - much quicker.

    The founder of IFS called this state “Self” and described it as a state of mind, which is full of empathy and curiosity - a state in which we know what is good for all our parts. Every one of us has a Self in the core of our existence. Even people who went through heavy trauma or those afflicted with psychological disorders. According to Schwartz, Self is characterized by “8 C”: Compassion, Curiosity, Calm, Clarity, Courage, Connectedness, Confidence, Creativity.

    Self is different from all other parts we have. It is both one of the parts (an active internal leader for other parts, with a broader perspective) and a higher state of consciousness. Achieving access to this state is often the first and the most important step of IFS therapy. Without this, effective work with parts proves to be difficult or even impossible.

    Self is a state, which, except for the “8 C” has an inner wisdom about how to relate to other parts of personality in a harmonized, loving way. It is this aspect of our psyche which is responsible for the ability to self heal.

    In IFS it is the Self that is the fragment of our psyche which meets each part and builds relationships with them. The more the subpersonalities trust the Self, the more space they give him to be a leader of the system and the more harmony we experience. The role of the therapist is to help the client enter the Self and, from this perspective, interact with members of the internal family. Thanks to this, the client doesn’t become reliant on the therapist.

    The great trinity

    Another difference between IFS and other systems of psychotherapy is highlighting of the 3 types of subpersonalities which live in our internal family. They are 1. Exiles, 2. Managers and 3. Firefighters.

    They are those parts of personality, who (usually during childhood) were in some way hurt and then they were “frozen in time” in a particular memory, carrying within them various emotional baggage. Getting through to them and freeing them from this baggage is the main goal of IFS, however it doesn’t always happen from the beginning. To be able to meet the exiles we need the approval of managers - the parts which are responsible for the protection or imprisonment of the exiles in the dark cellars of our subconscious mind.

    Many of us have quite a lot of these parts, without even knowing about them. We are raised to negate our weaknesses and troubling feelings. That’s why we are prone to trauma - when some parts of us suffer, we deny them, and what comes next - they not only suffer, but are also abandoned. This way, they become exiles.

    For this to happen, we don’t need any “typical” big trauma (like abuse by our parents, death of a close relative or rape). Sometimes even simple events (a comment from a teacher, being left alone for a few hours by our parents) can become a wound that will later influence us for the whole life. Even though we don’t consciously remember, it influences us all the time - we experience it as lessened self-esteem, fear of failure or other emotional blockades, which are not a mental disorder, but still prevent us from living in harmony and satisfaction.

    The exiles do everything they can to be noticed, that’s why they will constantly bring up memories and emotions, reminding us about them - so that we pay attention to them and take care of them. Sometimes they even flood us with troubling emotions and that’s what the managers fear most. Their role is to keep our psyche stable and that’s why they try to do whatever they can to enable us to function in our reality without constant breakdowns. They are the part which drives our everyday life.

    The main goal of managers is to keep the exiles imprisoned for their own good and for the good of our whole psyche. They prevent the activation of those parts in various way - their favourite tools are: phobias, obsessions, compulsions, passivity, emotional indifference, panic attacks, depression, hyperactivity, nightmares.

    The most common managers are:

    - Controller - the part which wants to have control over everything, because it believes that any kind of surprise will unleash emotions connected to a wound,

    - Perfectionist - when he will be perfect, no one will reject him and so - he will not recall any troubling emotions of abandonment,

    - Passive Pessimist - he avoids interpersonal interaction though passivity and withdrawal, so that he won’t be close to other people (closeness can unleash denied, troubling emotions),

    - Caregiver - he cares for everyone around, but not for himself, and uses this as a strategy to run away from his own emotions.

    An important discovery by Schwartz, mostly about managers, is that the dominant behaviour of those parts is not their essence, but rather an extreme role they were put into. For example - Inner Critic doesn’t need to be a critic, his role is different - to motivate - when we are able to communicate with him and show him the damage he does with his criticism.

    The change happens fastest when, during the IFS therapy, we slowly allow the exiles to free themselves from their emotional baggage. Then, the managers no longer need to protect us from the emotions which were dangerous before - because they were healed. In this moment the managers usually easily change their way of influencing us and we experience it as a lasting change on a deep level.

    There are situation, in which managers can’t keep the exiles in their cages. Then, emotions overwhelm us and this is a fire that needs to be extinguished quickly. In those moments the firefighters come to the forefront of our mind - the parts that want to ease and soothe the troubling emotions.

    Firefighters have the same goal as managers, but different roles and strategies. Managers are proactive (they prevent the emotions of going outside), but firefighters are reactive (they act, when the damage is already done).

    They are responsible for addictions. Using various forms of substances is the easiest way to quench a fire. The most common strategies are: binge eating, eating sweets, smoking cigarettes, drinking alcohol, taking drugs, watching pornography, gambling or shopping.

    What’s interesting is that firefighters come during the process of therapy. When the person, with the help of a therapist, starts getting close to the troubling emotions (and starts coming into contact with the exile) the firefighter comes and creates psychophysiological reactions like sleepiness, dizziness, distraction - everything that can help run away from what is important.

    In summary, these are the most important assumptions of IFS therapy:

    - We all have parts that create our internal family,

    - We all have access to Self - a state in which we don’t identify with any part,

    - Every part is good in itself and has positive intention. There are no “bad” parts, which would need to be eliminated,

    - Our subpersonalities create a complex system of relationships between them.

    IFS in self-growth and as a psychotherapy

    IFS works great both for people who are completely healthy and those that suffer from various disorders.

    In the first case, therapy can be about low self-esteem, chronic stress, impulsive anger, deep sadness or regret, dealing with bereavement, fear of failure, fear of intimacy, shyness and many other problems with destructive emotions or limiting beliefs.

    In the second case, IFS method can be used to work with:

    • Trauma
    • Depression
    • Addiction
    • Post-traumatic stress disorder
    • Compulsive behaviours
    • Phobias
    • Neurosis (anxiety)
    • Bipolar disorder
    • Anorexia and bulimia

    The method can be used for individual therapy, but also couples, family and group therapy.

    The good news is that working with a therapist is not the only option to use the IFS method. Richard Schwartz also encourages autotherapy (self-work in your own home), but it’s worth to know the model and its techniques well to make autotherapy possible and safe.

    Jay Earley wrote a long-titled book “Self-Therapy: A Step-By-Step Guide to Creating Wholeness and Healing Your Inner Child Using IFS, A New, Cutting-Edge Psychotherapy”. In this book he shows how we can use IFS for ourselves.

    Since 2015 Internal Family Systems therapy is an evidence based psychotherapy according to NREPP (National Registry of Evidence-based Programs and Practices). This registry was created by Substance Abuse and Mental Health Services Administration (SAMHSA) which is a branch of the U.S. Department of Health and Human Services

    IFS was judged as effective for improving general functioning and well-being and as promising for reducing phobia, panic, and generalized anxiety disorders and also for improving physical health conditions, psychological resilience and treating depression.

    It’s important to mention, that although during the IFS therapy we deal with particular problems or emotions of a person, who searches for inner change, each session brings more, far-reaching, positive “side effects”. When we learn to listen to parts of our personality with openness and compassion (without judging or trying to change them), our relationship with ourselves changes. We acquire the ability to “detach” from our emotions and to observe them with curiosity and acceptance. We experience greater inner harmony and achieve greater emotional stability.

    IFS therapy can be seen as a path, which leads us into love and self-compassion.

    Every dialogue with a part of our subpersonality is an occasion to understand and love another fragment of yourself. The whole process can be an opportunity for deep and lasting transformation of how we perceive ourselves.

    From my point of view the Internal Family Systems model is much more than a method of psychotherapy. It’s a way to experience yourself, a way to experience people around you and to experience life itself.

    How does IFS therapy look like in practice?

    Every IFS session is like a tiny trip deep into yourself, where you experience a slightly different state of awareness. You briefly remove yourself from the outside world and focus inwards seeing all the nooks and crannies inside your own subconscious mind. For many it’s quite an intensive experience after which you can hear words like: “I just touched something deep and important”.

    In most cases IFS therapy is a process, during which you have your eyes closed. The role of the therapist is to guide you in establishing connections with particular parts, to help you converse or negotiate with them, to free the hurt parts from their burden. In some situations the therapist can use different techniques in which - instead of communicating with your parts by yourself - you act as if you are that part, by sitting on a chair. Then you go into a dialogue with the therapist from the perspective of your part (the “direct access” technique).

    After the initial assessment and learning about your most important parts and the relations between them, the therapist will ask you to find the feelings you want to look at, which influence you in a negative way, or which are connected to the problem you want to work with. After you focus your attention on the feeling, he will ask you what image comes into your mind. People see their parts in various ways - sometimes cartoon characters, other times their parents or loved ones, sometimes items like chains, balls, carrots or clouds.

    When you see the visual representation of this part, the therapist will begin guiding you through a dialogue with this part, proposing some questions and following what happens inside you. This process happens in a trance-like state. Your whole focus is put inwards.

    The therapist may ask you to ask your parts questions such as:

    • What is your role? Why do you do what you do?
    • What are you afraid would happen, if you stopped doing your role?
    • What other part are you protecting?
    • With which part are you in conflict with?
    • What would have to happen to make you stop influencing part X?

    Each of those questions allows you to better understand the essence of a particular part and also the dynamics of your inner world. The fascinating this is that you don’t need to consciously look for answers to those questions. When you have good contact with your parts (everyone, no exceptions, can have a good contact with his or hers internal family, sometimes you just need to learn it), the answers appear spontaneously. We know full well when the answer comes from the part we are speaking with.

    It’s surprising how quickly and easily people recognize their parts of personality. When they break through the illusion of oneness of personality, the focus on subpersonalities becomes easy, the idea of multiplicity of mind begins to make great, intuitive sense.

    Step one: relationship and trust

    One of the most important goals of IFS therapy is reaching the exiles, and then healing them by releasing them from the burden they carry (and through taking them out of the past they are stuck in). This element brings the most important changes in the inner world. A side goal of the therapy is gaining access to the state of Self and distinguishing it from other parts, so that Self can become the leader for the whole internal family. When both those goal are realized, the client - step by step - discovers a great feeling of harmony, which radiates throughout his whole daily life.

    But before the meeting with exiles becomes possible, the client has an important task to fulfill. It’s creating a good relationship with managers, who have a tough but important task. As I wrote earlier, this group protects or “imprisons” the exiles. Reaching the exiles without a care for managers can harm the client (treating the managers with contempt can lead to them becoming even more extreme in their actions).

    That’s why we can make the next step in therapy only after we gain the trust of a manager and when he allows us to meet the exile. There are many important reasons for this, but there is no space here to go into them. Caring for the safety of the whole system is key in IFS and there are plenty of elements in the process that support this.

    Of course, not every session leads to getting access to exiles or freeing them from the prison they are in. You can’t always establish a relationship or gain the trust of a manager or firefighter. Each problem is different, each inner family is different and each client has a different rhythm of work. If the problem is tougher or if the mental disorder is deeper, establishing a relationship with a part can require multiple sessions.

    Despite this, every meeting with members of this inner community brings us greater awareness, better understanding of ourselves and greater feeling of harmony.

    Sometimes the very act of being open and curious towards a certain part of yourself makes all the difference - especially when, for many years, we had no idea it existed or when for years we hated it and fought with it.

    What’s interesting, after an IFS session we can sometimes experience a so-called “change in system”. It’s a slight discomfort, because “bricks” in the mind were moved. If you wore braces it can feel similar to the process of tightening, when the dentist corrects teeth placement and we begin to get used to it after a few days of slight discomfort. Similar thing happens when we change our beliefs or free ourselves from difficult emotions in IFS - something we wore for many years in our head or body suddenly disappears - and you have to get used to this new, slightly alien, system.

    Sometimes after a good IFS session, the clients Inner Sceptic appears and says: “this was too easy to be true/effective/lasting.” It’s a natural reaction, because we are not used to having deep changes in such a short amount of time. For therapists working with Internal Family Systems model it’s a common occurrence.

    Internal Family Systems around the world

    The IFS model gains more and more recognition around the world. Richard Schwartz gives lectures at major conferences about trauma and mental health, where he shares his discoveries. IFS therapist training gathers more people years, which can be seen mostly in USA and UK.

    When I learned about this model of therapy I began reading all the books about IFS that I could find. After getting a solid base of knowledge about how IFS looks in practice, time came for months of experiments - both self-practice (in the form of autotherapy) and as a therapist for my friends and people who agreed to be my “lab rats”. I owe a great deal to my autotherapy. I will never forget how, lying in bed during one of my stays in Bali, Indonesia, I looked inside myself to find a small boy, bound by rope, all trembling with fear. Taking care of this part of myself and freeing it from the ropes brought a great change in the area of my relationships. I feel the effects of this change to this day.

    Practicing IFS in the role of a therapist to support other people brought effects that exceeded my expectations. Soon I felt that’s what I was looking for. It became clear that I found an approach which resonates with me fully and gives me great possibilities to help other people.

    At this point, I have finished the 3-level IFS training and I use this model exclusively to help people I work with. If you want to book an IFS therapy session with me, please click here.

    In order to promote IFS therapy, I created a simple website - IFS Poland - with all information about IFS therapy you may be looking for. You can read there more about how a session looks like, IFS certification process, self-therapy and much more. Also by signing up for our newsletter, you will receive a free the “Self-therapy with IFS” ebook.

    If you already have experience in IFS model and want to gain more confidence with the flow of the IFS model and bring more Self into your therapeutic relationships, I recommend you "The Self-led therapist" online course. It's created the therapist with nearly 30 years of experience – the IFS lead trainer, Osnat Arbel, PhD and will let you dive deeper into the IFS model.

    The information I provided in this article is a drop in the ocean of what we already know about the functioning of our inner families and how to help them achieve balance, fulfillment and harmony.

    I will gladly answer any of your questions about the IFS model, so if any come to you - leave a comment.


    Mary-Anne Johnston

    Following my training as a Jungian analyst I became interested in two similar styles of ‘parts’ therapy–that is “Voice Dialogue” and “Internal Family Systems” (IFS)–both approaches expand upon Jung’s understanding of the complexity of the psyche. What they share is an understanding of the healthy personality as being made up of many subpersonalities, or parts.

    In the course of a day, many of us may think, for example, ‘a part of me wants to do this and yet, at the same time, another part of me wants just the opposite’. Sometimes, this is felt as an inner conflict or ‘stuckness’. Usually, we simply notice this conflict and override one of the arguments. In a healthy personality, there is a fluid shifting from one part to another depending on what approach is needed, what is appropriate, or what is necessary under the particular circumstances.

    Often, some of us feel stuck. We feel like we have run out of solutions. We don’t know how to move forward. In other words, our usual approach doesn’t work anymore. We may have difficulties with a partner or we may feel as if something is ‘missing’ in our life or we may feel depressed. Most of us have, over time, become dominated by a few strong parts that ‘run the show’ pretty successfully. If we are asked to describe our personality, we would list these parts as our qualities. But sometimes, they hit the wall– they become tired. These few parts have served us well with their approaches, such as pleasing others or being efficient and organized. As hard as we try to solve some life problem or crisis, our usual approach just doesn’t do the job and our inability to find new resources can feel hopeless. In this situation, a psychotherapy which offers relief and gratitude to the tired parts and revives the buried parts, can expand the potential of the psyche so that the individual is able to make use of formerly inaccessible creative solutions.

    When we begin to work therapeutically with our various parts, we listen to them all. At first, we listen to the parts that have worked so hard for so long– we listen to their fears, frustrations and beliefs about the situation. Eventually, we find that there are other parts that could contribute but they have been exiled– and with them go the creative dynamic approaches that could rise to the opportunities and problems appearing in life.

    Both IFS and Voice Dialogue initially drew on several styles of psychotherapy, including Jungian approaches as well as Gestalt therapy. The IFS model also has extensive roots in family therapy. For those who are interested in the relationship between “parts” work and the Jungian theory, I will give a brief explanation of Jung’s understanding of the complex at the end of this article.

    Because they share a similarity, and to avoid confusion, I will discuss Internal Family Systems (IFS) theory and leave Voice Dialogue to personal research. The Voice Dialogue websites listed below have a some articles which outline their process.

    Internal Family Systems (IFS)

    Richard Schwartz, who formulated IFS, began his career as a family systems social worker. Schwartz discovered that, in troubled families, individuals were often trapped in unconscious patterns of behaviour that caused conflict and unless these patterns could be made conscious, family dynamics were not likely to make significant changes. As his focus shifted to the client’s report of inner experience, Schwartz began to recognize that just as a family has individual members with different roles so too the individual psyche is comprised of what his clients referred to as “Parts”. A part, he began to realize, is not just a temporary emotional state of habitual thought patterns rather, it is a discrete and autonomous system that functions with a particular role– as a sort of ‘subpersonality ‘ . He learned about the autonomy of each part through experiences with his clients and his own Parts. While we are all made up of many parts, there is a central part or capacity which Schwartz calls the “Self” other disciplines have noticed and referred to the Self as “witness consciousness” or “aware ego” or “observing ego”. Qualitatively, the Self, in Schwartz’s understanding, is different from the parts in that it is designed to be the natural leader of the psyche. The Self will be explored in more detail below.

    Schwartz wove different approaches into his knowledge of family systems to formulate IFS therapy which he describes as collaborative, non-pathologizing and accepting. Rather than trying to get rid of our less desirable or difficult qualities, all parts of our personality are considered valuable.

    When we experience an internal conflict, it is easy to identify the opposing parts. For example, one part of me (that loves to learn) may want to take a university course while another part of me ( a Banker part) takes an opposing position, arguing strongly and rationally that I can’t afford it, while yet another part (the Critic) may point out that I’m not smart enough and will probably fail. In this internal free-for-all, I will inevitably feel torn and indecisive. Even if I do make a decision, my internal critic part may launch an attack to make sure I feel guilty, stupid, ugly, awkward or selfish. Then, noticing this downward spiral, another part may flood me with feelings of sadness and hopeless because, according to it, nothing ever happens or changes and probably never will. This is an example of any number of patterns that may keep me stuck and do not allow me to expand and explore my life.

    Our many parts function like members a large family, or tribe–with all its diversity. According to Schwartz, each part is with us from our birth, possessing its own temperamental style and gifts. Whether a Part takes a strong position in the psyche, or exists only in potential, has to do with the individual’s historical experience in her or his environment. Over the years, some parts are rewarded by the family or culture. With consistent positive reinforcement, they become stronger and achieve a centrality which would describe, what we think of as, our personality. These “Managers” initially helped us survive. Managers think ahead and help us fit in and be successful with others. Managers insure that people like us.

    By contrast, we have Parts that have been rejected and/or punished or ridiculed by the family, school system, or culture. These “Exiles” are banished and exist in a sort of exile in the unconscious. Very often, they are vulnerable infant or child parts– although Exiles can be any part which has been subjected to disapproval or considered threatening in some way to the family of origin. Surviving for these parts is often done by becoming invisible. They are still young because they are frozen in the original time of their exile. Still, years later, they carry the burdens of fear, fragility, doom, anxiety.

    All parts are valuable to the entire system in the same way that all parts of an ecosystem are necessary for the smooth running of that system. A “bad” part is simply a valuable part that has been driven into an extreme role by a traumatic situation. In IFS therapy, as Schwartz continually emphasizes, all parts are welcome.

    [On the Resources page on this site is an essay by Richard Schwartz detailing his theory of the Self].

    At the centre of this diverse collection of Parts is the Self, which we may experience as a ‘core self’ or ‘true self’. The Self, Schwartz discovered in his research, has two factors. “The first factor (Self Qualities)”, he writes, “contained items relating to the experience of being “in Self”, i.e. feeling calm, balanced, worthy, connected, confident, joyful, peaceful, etc.. The second factor (Self-Leadership) contained items relating to the ability to bring oneself back to balance when one has been hurt or stressed, i.e., the ability to resolve inner conflicts, to stay calm under pressure, to self-sooth, etc..” The amount of ‘Self-energy’ present can be noticed by the presence of those Self qualities.

    In an experience of trauma (including neglect of various degrees), certain parts take over the personality for survival purposes by assuming strong roles (a Pleaser, for instance). With a protective intention, they displace the leadership position of Self. In time, what was initially a protective measure, solidifies into patterns that are difficult to change– even though they may be clearly self-destructive. As protector parts continue to override the Self, the valuable, compassionate, internal leadership is lost. Other people may love and rely on their Pleaser part but the person who is dominated by a Pleaser may become exhausted with the demands of taking care of others by sacrificing the needs of her or his own parts.

    Schwartz has found that when this kind of internal domination happens, other parts in the system lose confidence in the leadership capacity of the Self. They come to believe that the domineering parts have taken over the personality. It is as if a ‘coup’ was staged subsuming true leadership of the psyche. The dominant parts come to believe that they are, in fact, the total personality. Whenever we describe ourselves as “procrastinators” or “weak-willed” or “bossy”, or any number of critical assessments, we are identified with a primary part which believes it is ‘who we are’ .

    A major goal of IFS therapy is to distinguish between the parts and the Self and reestablish relationship. This is the heart of the work. Through continual, patient efforts at consciously locating the nonbiased position of the Self and separating from the parts, the Self will resume its role as the calm, compassionate leader. Then, as a solid, democratic leader, the Self will consider all the arguments of the parts involved in the issue in question in order to arrive at decisions of benefit to the total personality. In that case, the system heaves a huge sigh of relief because democratic, compassionate leadership is restored. All parts are welcome at the new table.

    Like any tribe or community, the parts have different roles and they group into factions according to their interests and capacities. In the IFS model, the parts fall into three categories: Managers, Exiles and Firefighters.

    The Managers and their Exiles

    The “Manager” parts exhibit typical roles such as an inner Critic, Pleaser, Organizer, Judge, Intellectual. Our Managers work hard anticipating what others want from us and they feel anxious when criticized, rejected or abandoned. They like to keep us in line and in top form with their ambitions, goals, and lists. We all have (and need) primary Managers who have taken on (or react against) the rules of our culture, family, and experiences of trauma. They crack the whip to keep our behaviour in line with their rules and beliefs. Manager parts like to keep us well behaved (relative to our chosen group) so that the outcome is positive. Because of their work, we are more likely to be well-regarded.

    There are different styles of Managers– some keep us always on guard while others are more assertive. Some Managers dislike intense emotions and may also counsel against hoping if they fear other Parts will suffer disappointment. Other Managers protect by taking care of others. Some are great organizers, doers, thinkers. We usually have a good variety of Managers so that we can participate and survive in our relationships with family, friends and in the workplace.

    The strength of Managers is proportionate to the vulnerability of those they protect– our Exiles. Often child parts, these exiles are stuck in an earlier time, frozen in the pain and fear of those experiences.

    Locked away, hidden deep in the psyche, the younger parts are often barely detectable. Acting like Exiles, they are locked away in an earlier time, still feeling the same hurt, they are just as scared and sometimes speechless (if their origin is from preverbal times). These fragile young parts carry burdens of fear, shame and worthlessness. Any part can be exiled if it has been shamed, frightened or devalued by the family or cultural context. Because of their isolation, they are completely unaware that anything has changed since the times of the original trauma. In their time capsule, they are unable to understand that other parts (Managers) have grown up, learned skills and become competent in the world. While the Managers may be fully aware of how the individual’s life has changed, the Exiles live completely unaware, in the former time . They seem to be inaccessible in this ‘time-warp’. This is why our self-defeating behavioural, emotional patterns are so tenacious and resist our conscious desires and efforts to change. And it is also why we sometimes have a feeling of being a ‘fake’ or inauthentic. If a number of parts are not available and cannot bring their gifts to the total personality, we are, in fact, operating with a narrow version of our potential. Exiled parts are essential to the feeling of authenticity.

    Exiles exist undetected until they are triggered (by experiencing a situation similar to the original trauma or even, say,viewing it on television). Then, an Exile may break out of its isolation and flood the personality with strong feelings of grief or fear. The Managers consider this to be a dangerous situation and they react with punishing harsh criticisms (i.e. “You are such a baby!” “I hate myself when I explode with anger.” “You are lazy and useless!”). Manager parts expect “good” adult behaviour and use any means they can to make sure that we behave. If you listen more closely, you may notice that they sound much like parents or former teachers or coaches.

    Manager parts arose in the face of threatening situations (such as abuse, neglect, or unavoidable trauma in infancy and childhood or a traumatic situation) in order to protect the vulnerable parts. The Self was too young to exert leadership over powerful external forces. Over time, however, Manager parts become extreme in their methods which they have learned from authority figures in our lives. These methods can be guilt and shame inducing, and critical to the point of rendering the person ineffective. Despite their often punishing techniques, the manager’s goal is to keep the fragile Exiles from feeling the powerful emotions which seemed (at the time of the original trauma) capable of destroying the Self and the total personality. Manager parts exist in a state of vigilance, anticipating these triggers. They are always on the job, exerting their control in their particular ways: by internal criticisms, or by having us please others, or by being “good” or “efficient”, or “intelligent”, or “entertaining”, or any number of behaviours based on their beliefs in what is necessary for survival. The goal of these protectors is to make sure that the person (the Exiled parts) never again feels that fear, humiliation, shame or helplessness. They are rarely off duty. Consequently, when asked, they will often admit that they are very tired, or that they’re worried because their strategies have lost their effectiveness. Hence the feeling of crisis.

    The Firefighters

    Another level of defensive parts can emerge which Schwartz calls the “Firefighters” –because of their tendency for quick rescue. The suddenness of their arrival is their signature. While they share the same goal as the Managers (to protect exiles), these parts are often associated with addictive behaviours. Whenever unbearable feelings are stirred up, a Firefighter suddenly appears with strategies involving a quick escape. Firefighters drown or bury (seemingly soothing) the threatening feelings with addictive behaviours involving, for instance, alcohol, drugs, food, the internet, tv, gambling, sex, shopping, or sleep. They can distract from the situation or numb the person or suddenly flare up into irritation or anger. Firefighters that react with anger are often triggered when they feel trapped or shamed, hurt or frustrated. They can disconnect us from thoughts, feelings, the body and threatening situations (including therapy) with, for instance, foggy thinking . There is a powerful driven quality to all Firefighter behaviours which is hard to resist or argue against. Will power strategies are often short-lived and ineffective against the compelling urgency of Firefighter energy.

    Sudden and destructive Firefighter reactions are designed to protect vulnerable parts but because their methods are so drastic, they are at odds with the Manager parts whose style tends more to anticipating, and thus preempting, threatening situations by controlling the personality. Where Managers are trying to please, appear perfect and be acceptable to others, the Firefighters tend to alienate, frustrate and anger other people. Their attitude is that they could care less. Firefighter tactics are judged as reactive and destructive. And invariably, when the dust settles, Firefighters will be soundly criticized in a big backlash by Manager parts who come in (for example) ‘the morning after’ with a list of shame inducing judgments.

    Schwartz named them “Firefighters” because they are completely geared for immediate rescue. Remember, ALL parts have good intentions for the personality. Initially, they arose out of necessity. In a traumatic, threatening situation, a firefighter protector emerged to save a vulnerable part with immediate action, often involving escape. Eventually, their escape would develop into the escape of self-soothing behaviours. Unfortunately, like the Managers, a once helpful (and normal) behaviour becomes, over time, entrenched in the personality as difficult, repetitive, stubborn and often destructive self-harming behaviour patterns.

    Having said all that, in a healthy system where the Self shows leadership, parts that react spontaneously and seem to live more in the moment can bring an aliveness to the personality with their soothing qualities or sudden pleasures and joys. If they are not self- destructive, their choices may be a little more vibrant and spicy than those a manager would make. A variety of these parts makes for a rich palate of a personality. It makes sense that the more aware we are of our the diversity of our parts, the more fully we will be equipped to participate in the diversity life offers.

    Multiplicity

    The overall personality is a diverse collection of parts. Schwartz describes this model:

    “…it is useful to think of an internal system as a collection of related people of different ages, like a tribe. Some of these inner-family members are young, sensitive, and vulnerable children others are older children, adolescents, and adults. In addition to different ages, they have different temperaments, talents, and desires. In a person whose Self is leading this group and the parts are relating harmoniously, the person will not experience each part distinctly and is likely to feel as if his or her mind is unitary. In this respect, the mind is like any other system, from an anthill to a basketball team to a corporation: When it functions well and all the members are in sync, it will seem like one unit. The individual members still exist and , once separated from the group, remain distinct and autonomous. Yet they are so coordinated that they create a kind of unity.

    It is in polarized systems, at any level, that the members stand out in bold relief. This is why troubled people report feeling so fragmented–not necessarily because they have more personalities than ‘normal’ people, but because their personalities are fighting with one another rather than working together. Thus, the goal is not to fuse all these smaller personalities into a single big one. It is instead to restore leadership, balance, and harmony, so that each part can take its preferred, valuable role.”

    As Schwartz points out, IFS works to restore the leadership of the Self so the more vulnerable parts may feel safe and the Protectors can relax in their strategies of defense. This work is gentle, respectful and increasingly amazing to therapist and client who work together towards retuning the psyche. IFS techniques work because they are not only about understanding one’s history but understanding in an experiential way We talk not about the parts of the personality but with the parts. Often for the first time, those parts feel seen and heard. They regularly sigh with relief and gratitude that they are heard and appreciated by the Self and the rest of the personality.

    Jung’s understanding of the psyche as a multiplicity of complexes:

    One of a group of ground breakers in the new field of psychiatry was C.G. Jung. Early in his career (1902-1903), Jung spent a term in France studying with Pierre Janet– a great pioneer in the modern psychiatry who first coined the term “subconscious” and identified the phenomenon of subconscious fixed ideas. At the same time, several of these early psychiatrists were trying to understand this new frontier–the subconscious–using word associations. In delayed reaction times to certain words, Theodor Ziehen discovered what he called emotionally charged complex of representations— more simply, a complex. Inspired by these leaders, Jung, in his position at the Bürgholzli Clinic (a psychiatric hospital in Zürich) developed and refined the word association test in order to detect and analyze the Ziehen’s complex (Ellenberger, 1970) . With a psychogalvonometer, Jung recorded a patients association (and physical response) to a list of words demonstrating that the complexes operate in the psyche, through the body. In his research, the young psychiatrist came to understand that, although the mind appears to act as a single entity, it is comprised of a number of subpersonalities. These internal structures, Jung noticed, acted independently and autonomously. Normal complexes (often characterized by Jung’s idea of gender roles) were distinguished from accidental (acquired in life) and permanent complexes (dementia praecox and hysteria).

    Years before his first meeting with Freud, Jung had published his research on the detection of complexes in “The Word Association Experiment”. In the ensuing years, personal crises and suffering led Jung deeper into his own inner work where he gained firsthand knowledge of psychic structures such as the complex, the unconscious and the collective unconscious.

    A complex, Jung concluded, is a psychic fragment consisting of a core (that is connected with one or more archetypes) around which cluster ideas and images collected from the person’s life experiences. Each complex has a definite emotional tone of, for example, irritation or love or anger. Complexes, Jung argued, are born during early life experiences and afterward they behave ‘like independent beings’ (The Structure and Dynamics of the Psyche, para. 253). Everyone has mother and father complexes, as well as money complexes, and so on. How charged they are depends upon personal experience. For instance, a missing father, or a punitive, or a loving father, would result in very different father complexes. Jung also asserted that the archetypal aspect of the psyche would carry the essence of ‘fatherness’ that he believed has existed in the human psyche for all time. The variety of complexes is expressed in dreams where they may show up as people (known or unknown), forces of nature, animals or situations. Jung considered the complex so fundamental and important that he referred to it as the ‘via regia’ to the unconscious.

    As long as a complex operates unconsciously, Jung concluded, it can rule with an uncanny power, feeling– as if it has a direct connection to a “truth”. When we become possessed by a complex we feel adamant that we are “right”. If our “truth” is challenged, we may become aggressive, upset, or in some way, touchy. Until we are able to question and critique our own truths, the complex rules. As Jung says, it “has” us. Complexes, then, live in our blind-spots as such, they are unknown to us but glaringly obvious to others. Our blind-spots are protected by the a variety of defenses– the primary one being denial. So while a complex may be obvious in another person we risk reproach by pointing them out (no matter how tactfully) and setting off the denial strategies. Complexes prefer to stay unconscious.

    A central part of the work of Jungian approach is to begin to make our complexes conscious so that they no longer rule our lives from the unconscious. As complexes enter the “adaptive process” in therapy, Jung said, “they personalize and rationalize themselves to the point where a dialectical discussion becomes possible.” (On the Nature of the Psyche, CW8, par 384). In analysis, the process of understanding the complex may begin with the personification of a strong feeling. One can have a dialogue with the personified feeling by journaling in a method which Jung called “Active Imagination.” Sometimes feelings can be expressed in colour, shape or line. The goal is to get to know them. Since complexes are the structures of the psyche, we will never get rid of them. Jung suggested that in the process of becoming conscious and therefore more known, our complexes become less like enemies and more like partners.

    IFS takes Jungian work a step farther– past ‘talk’ therapy (where we speak about the complex) into an intimate, respectful encounter where the complex (part) can speak for itself to a new relationship with an attentive, compassionate, curious Self. I was in analysis for several years previous to my training at the C.G. Jung Institute and analysis continued throughout the five and a half years at the Institute (300 hours of personal analysis are required to become a Jungian Analyst). So for nearly ten years, my ‘complexes’ were scrupulously journaled, painted, walked through labyrinths, detected in association experiments, danced and endlessly discussed. They entered (or were dragged) into years of psychodramas. In exasperation or to highlight our therapeutic insight, we students would point them out to each other (“I think you are in a complex..”). These insights were rarely happily received. Safe to say, I knew a lot about my complexes. I knew the stories inside out.

    Not until I began working with a ‘parts’ therapist who invited the parts to speak for themselves were they willing to shift. Not until they were invited to speak directly–to express their point of view, feelings, history in their own words to me (who was now present and connecting through ‘self energy’) and the therapist– did they feel heard and seen. It would be like working with a troubled family in which most of the family stays home and is subsequently described by other members. The storyteller may arrive at some understanding but the rest of the family would remain untouched. In my ongoing therapy, and with my clients, parts regularly express surprise (or astonishment) that they are finally given a chance to speak for themselves and that, most importantly, their Self is now present and willing to listen. The healing is in that relationship.

    Many times parts have thanked me for respecting their autonomy and giving them the chance to speak their own truth which usually differs in tone and content from the ‘story’ through which one part has learned to understand the past. When I say they thank ‘me’, I mean that when I am in ‘self’ energy and connect with them, they have learned that they are in a stable system in which the leadership is restored. There will be no more ‘coups’. The parts will be respected no matter how the managers judge them. It is a democracy. With that shift in my inner world, I experience a feeling of refreshment, of space, of possibility.

    For me, this is the real beauty of IFS.

    For more information on Internal Family Systems (IFS):

    This link will take you to a video of Dick Schwartz discussing the IFS model and lists teleconference archives listed on right side of page:

    www.personal-growth-programs.com is the informative website of IFS trainers Bonnie Weiss and Jay Earley.

    Schwartz, Richard, Ph.D.. (1995) Internal Family Systems. The Guilford Press, New York, N.Y..

    —(2001) Introduction to the Internal Family Systems Model. Trailheads Publications, Oak Park, Ill..


    National Registry of Evidence-based Programs and Practices (NREPP)

    Internal Family Systems (IFS) Therapy is a psychotherapeutic modality developed in the mid-1980s, based on the observation that clients sometimes experience subpersonalities that come into internal conflict when dealing with challenges. The IFS model likens these subpersonalities to an “internal family.”

    The IFS model uses mindfulness-based and other strategies to help people resolve internal conflicts in a satisfactory way. During sessions, therapists actively encourage participants to practice self-compassion toward subpersonalities and an internal dialogue. Participants attend individual sessions or group meetings with trained IFS therapists.

    The Center for Self Leadership offers progressive levels of training in IFS, from beginning (Level 1) through advanced (Level 3). Participants in these trainings learn both IFS theory and technique, gaining the knowledge and skills needed to understand and actively use IFS with individuals, couples, children, families, and groups. Information and training regarding IFS is provided through multiple sources.

    Evaluation Findings by Outcome

    This program is effective for improving general functioning and well-being. The review of the program yielded strong evidence of a favorable effect. Based on one study and three measures, the average effect size for general functioning and well-being is .56 (95% CI: .30, .69).

    Click here to find out what other programs have found about the average effect sizes for this outcome.

    At the end of the 9-month intervention, participants in the intervention group reported a statistically significant reduction in two measures of joint pain and a measure of physical functioning, compared with participants in the control group (Shadick et al., 2014).

    Shadick et al. (2014): RA Disease Activity Index (RADAI) joint score (total number of painful joints) the 100-mm visual analog scale (VAS) and the Short Form-12 (SF-12) physical function score

    This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

    This program is promising for reducing phobia, panic, and generalized anxiety disorders and symptoms. The review of the program yielded sufficient evidence of a favorable effect. Based on one study and one measure, the effect size for phobia, panic, and generalized anxiety disorders and symptoms is .32 (95% CI: -.12, .76).

    Click here to find out what other programs have found about the average effect sizes for this outcome.

    At the end of the 9-month intervention, participants in the intervention group showed a greater, but statistically nonsignificant mean improvement in anxiety, compared with the control group (Shadick et al., 2014).

    Shadick et al. (2014): Spielberger State–Trait Anxiety Inventory (STAI)

    This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

    This program is promising for improving physical health conditions and symptoms. The review of the program yielded sufficient evidence of a favorable effect. Based on one study and one measure, the effect size for physical health conditions and symptoms is.23 (95% CI: -.22, .67).

    Click here to find out what other programs have found about the average effect sizes for this outcome.

    At the end of the 9-month intervention, there was no statistically significant difference in disease activity between the intervention and control groups (Shadick et al., 2014).

    Shadick et al. (2014): Disease Activity Score–28–C–reactive Protein 4 (DAS28–CRP4)

    This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

    This program is promising for improving personal resilience/self-concept. The review of the program yielded sufficient evidence of a favorable effect. Based on one study and two measures, the average effect size for personal resilience/self-concept is .27 (95% CI: -.04, .43).

    Click here to find out what other programs have found about the average effect sizes for this outcome.

    At the end of the 9-month intervention, participants in the intervention group reported a statistically significant increase in self-compassion, compared with participants in the control group, but there were no significant group differences in arthritis self-efficacy (Shadick et al., 2014).

    Shadick et al. (2014): Neff Self-Compassion Scale and Arthritis Self-Efficacy Other Symptoms Scale

    This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

    This program is promising for reducing depression and depressive symptoms. The review of the program yielded sufficient evidence of a favorable effect. Based on one study and one measure, the effect size for depression and depressive symptoms is .46 (95% CI: .01, .90).

    Click here to find out what other programs have found about the average effect sizes for this outcome.

    At the end of the 9-month intervention, participants in the intervention group showed a greater, but statistically nonsignificant mean improvement in depressive symptoms, compared with the control group (Shadick et al., 2014).

    Shadick et al. (2014): Beck Depression Inventory (BDI)

    This outcome was also assessed at a 21-month follow up (Shadick et al., 2014). Follow-up findings are not rated and therefore do not contribute to the final outcome rating.

    Study Evaluation Methodology

    Shadick et al. (2014)
    Study Design Narrative Through a computer algorithm, rheumatoid arthritis participants were randomly assigned to either the IFS program or a rheumatoid arthritis educational program. The rheumatoid arthritis education group served as a minimal-attention control, meeting once as a group and then receiving monthly mailed educational information about rheumatoid arthritis. These mailings were followed up by a phone call from a research assistant to reinforce the information.
    Sample Description A total of 79 adults with a rheumatologist’s diagnosis of rheumatoid arthritis participated in the study (39 in the intervention group and 40 in the control group). The mean age was 58 years. Approximately 90% of the sample was female and 92% was white. Mean duration of the disease was approximately 16 years.

    References

    STUDIES REVIEWED

    SUPPLEMENTAL AND CITED DOCUMENTS

    OTHER STUDIES

    Resources for Dissemination and Implementation *

    * Dissemination and implementation information was provided by the program developer or program contact at the time of review. Profile information may not reflect the current costs or availability of materials (including newly developed or discontinued items). The dissemination/implementation contact for this program can provide current information on the availability of additional, updated, or new materials.

    Implementation/Training and Technical Assistance Information

    Training for IFS is organized through the Center for Self Leadership (CSL). Trainers attend two annual retreats and collaborate on training-related issues and curricular reviews through separate monthly conference calls. Trainers are experienced, licensed psychotherapy professionals who teach the IFS model across the United States and internationally. Trainings are held at conference or retreat centers or on university campuses. International trainings (averaging five trainings per year with 25–28 participants) have taken place at a number of locations. Three consecutive levels of extensive training are available, supported by a comprehensive training curriculum that involves the participants’ personal immersion in the actual model. Trainees learn both IFS theory and technique, gaining the knowledge and skills required to actively use the IFS model with individuals, couples, children, families, and groups.

    Individuals who complete Level 1 Training may earn IFS certification by completing a rigorous process to ensure their proficiency in the IFS model. This process includes demonstrations of competence through recorded mock and live sessions, consultation sessions, and/or participation in advanced training. There are currently over 200 IFS-certified therapists and practitioners, who are accessible through a searchable online registry. Annual IFS conferences have been held for over a decade.

    IFS provides an adherence manual that includes a definition of every construct and all stages of the unburdening process through integration. These constructs represent the basis for a recently developed 15-item fidelity scale, which is designed to ensure adherence. In addition, an IFS therapist-competency scale has been constructed.

    Dissemination Information

    The Center for Self Leadership operates a resource website (www.selfleadership.org), which includes a series of key IFS articles, along with an online store. The Foundation for Self Leadership’s website (www.foundationifs.org) was unveiled in late 2013 and is being expanded gradually. In addition, there are dozens of websites of IFS practitioners that include information and testimonials about IFS.

    Summary Table of RFDI Materials

    Internal Family Systems Therapy (Guilford, 1997), a book written for psychotherapists. The book has been published in several editions and translated into many languages, including French, Portuguese, and Korean.

    Introduction to the Internal Family Systems Model (Trailheads Press, 2001), translated into French and Spanish

    You Are the One You’ve Been Waiting For, Bringing Courageous Love to Intimate Relationships (Trailheads Press, 2008)

    Demonstration DVDs, led and narrated by Dr. Richard Schwartz, have been produced to show clinical work using IFS for treating a number of mental disorders.

    Training Level 1 (a foundational training of over 100 hours in two formats: two 1-week retreats or six long weekends)

    Training Level 2 (an intermediate training of over 70 hours)

    IFS fidelity scale (providing model constructs and research adherence tool)

    The Foundation for Self Leadership’s website provides dozens of websites of IFS practitioners that include information, news, and testimonials about IFS.


    Special Topics in IFS Therapy: The Presence of the Therapist, Polarizations, Extreme Protectors, and the Cycle of Addiction - 6 CEUs

    IFS is an evidence-based model of psychotherapy that provides a compassionate, respectful, non-pathologizing approach to understanding the organization and functioning of the human psyche. It provides therapists with a powerful and effective set of tools for empowering clients with a wide range of clinical profiles to heal the wounded and burdened parts of their internal systems, resulting in increased internal harmony, symptom reduction, and improved functioning. In this workshop, participants who are already familiar with the basic principles of IFS will deepen their understanding of the IFS approach to key elements of treatment, including the presence of the therapist, techniques for working with Parts in extreme roles, such as suicidality, self-harm, and dissociation, and working with polarizations between Parts, all of which are essential for effectively treating trauma survivors. Additionally, special focus will be given to conceptualizing and working with the cycle of addiction using IFS techniques.

    *Please note that previous exposure to IFS theory (such as through an introductory IFS workshop, readings, or IFS experiential training programs) is strongly suggested before attending this workshop, as basic IFS theory will only be reviewed briefly.

    *Also, please be aware that "Internal Family Systems" (IFS) is a very different model from "Family Systems" therapy. There has been some confusion in the past, so we really want to make sure everyone knows this is an IFS training and not Family Systems training. Thank you!

    Presented by: Alexia Rothman, Ph.D.

    Dr. Alexia Rothman is a clinical psychologist in private practice in Atlanta, GA, since 2004.She is a Certified Internal Family Systems therapist, an international speaker and educator on the IFS model, and a professional consultant for clinicians seeking to deepen their knowledge and practice of IFS through theoretical discussions, case consultation, technique practice, and deep, personal experiential work with their own internal systems. Dr. Rothman has received extensive training in the IFS model, primarily from IFS developer, Dr. Richard Schwartz. She has served as a Program Assistant for multiple Level 1, 2, and 3 experiential IFS trainings, and she offers workshops on the IFS model throughout the United States and abroad. She currently co-hosts an Internal Family Systems-informed podcast, Explorations in Psychotherapy.

    Dr. Rothman is a United States Presidential Scholar who graduated summa cum laude from Emory University as a Robert W. Woodruff Scholar. She received her Ph.D. in Clinical Psychology from the University of California, Los Angeles (UCLA), where she was an Edwin W. Pauley Fellow and a National Science Foundation Graduate Research Fellow. She has held adjunct faculty positions at Emory University and Agnes Scott College.

    • 8:30 - 9:00 Registration
    • 9:00 - 10:30 Welcome and Morning Session
    • 10:30 - 10:45 Break
    • 10:45 - 12:15 Morning Session (Cont.)
    • 12:15 - 1:15 Lunch Break
    • 1:15 - 2:45 Afternoon Session
    • 2:45 - 3:00 Break
    • 3:00 - 4:30 Afternoon Session (Cont.)
    • 4:30 - Continuing Education Certificates Available

    6 Core CE Clock Hours:

    • Psychologists: The Knowledge Tree (TKT) is approved by the American Psychological Association to sponsor continuing education for psychologists. TKT maintains responsibility for this program and its content.
      • For Georgia Psychologists, all online webinars (both live and on-demand) count the same as live for 2021 (including ethics). The Board states it will go back to the pre-COVID rules in 2022. You may complete all 40 CEUs this year while you have options.
      • Licensed in another state? The Knowledge Tree is a Continuing Education Sponsor Approved (CESA) by APA, so all of our workshops should satisfy your CE requirements, but please check your state rules regarding live webinars vs. live workshops.
      • Licensed in another state? Please see the highlighted section below.*
      • Licensed in another state? Please see the highlighted section below.*
      • Licensed in another state? Please see the highlighted section below.*

      To view our various workshop policies, including our refund policy, please click here.


      IFS posits that the mind is made up of multiple parts, and underlying them is a person's core or true Self. Like members of a family, a person's inner parts can take on extreme roles or subpersonalities. Each part has its own perspective, interests, memories, and viewpoint. A core tenet of IFS is that every part has a positive intent, even if its actions are counterproductive and/or cause dysfunction. There is no need to fight with, coerce, or eliminate parts the IFS method promotes internal connection and harmony to bring the mind back into balance.

      IFS therapy aims to heal wounded parts and restore mental balance. The first step is to access the core Self and then, from there, understand the different parts in order to heal them.

      In the IFS model, there are three general types of parts: [4]

      1. Exiles represent psychological trauma, often from childhood, and they carry the pain and fear. Exiles may become isolated from the other parts and polarize the system. Managers and Firefighters try to protect a person's consciousness by preventing the Exiles' pain from coming to awareness. [5]
      2. Managers take on a preemptive, protective role. They influence the way a person interacts with the external world, protecting the person from harm and preventing painful or traumatic experiences from flooding the person's conscious awareness.
      3. Firefighters emerge when Exiles break out and demand attention. They work to divert attention away from the Exile's hurt and shame, which leads to impulsive and/or inappropriate behaviors like overeating, drug use or violence. They can also distract a person from pain by excessively focusing attention on more subtle activities such as overworking or over-medicating.

      IFS focuses on the relationships between parts and the core Self. The goal of therapy is to create a cooperative and trusting relationship between the Self and each part.

      There are three primary types of relationships between parts: protection, polarization, and alliance. [6]

      1. Protection is provided by Managers and Firefighters. They intend to spare Exiles from harm and protect the individual from the Exile's pain.
      2. Polarization occurs between two parts that battle each other to determine how a person feels or behaves in a certain situation. Each part believes that it must act as it does in order to counter the extreme behavior of the other part. IFS has a method for working with polarized parts.
      3. Alliance is formed between two different parts if they're working together to accomplish the same goal.

      IFS practitioners report a well-defined therapeutic method for individual therapy based on the following principles. In this description, the term "protector" refers to either a manager or firefighter.

      • Parts in extreme roles carry "burdens", which are painful emotions or negative beliefs that they have taken on as a result of past harmful experiences, often in childhood. These burdens are not intrinsic to the part and therefore they can be released or "unburdened" through IFS therapy, allowing the part to assume its natural healthy role.
      • The Self is the agent of psychological healing. Therapists help their clients to access and remain in Self, providing guidance along the way.
      • Protectors usually can't let go of their protective roles and transform until the Exiles they are protecting have been unburdened.
      • There is no attempt to work with Exiles until the client has obtained permission from the Protectors who are protecting it. This makes the method relatively safe, even in working with traumatized parts.
      • The Self is the natural leader of the internal system. However, because of past harmful incidents or relationships, Protectors have stepped in and taken over for the Self. One Protector after another is activated and takes the lead, causing dysfunctional behavior. Protectors are also frequently in conflict with each other, resulting in internal chaos or stagnation. The aim is for the Protectors to trust the Self and allow it to lead the system, creating internal harmony under its guidance.

      The first step is to help the client access the Self. Next, the Self gets to know the Protector(s), its positive intent, and develops a trusting relationship with it. Then, with the Protector's permission, the client accesses the Exile(s) to uncover the childhood incident or relationship which is the source of the burden(s) it carries. The Exile is retrieved from the past situation and guided to release its burdens. Finally, the Protector can then let go of its protective role and assume a healthy one. [7]

      IFS therapist Alexander Hsieh pointed out that the method of self-discovery can take extensive time and effort, which can be multiplied when dealing with multiple family members. [8] Therapist Sharon A. Deacon and Jonathan C. Davis said that working with one's parts "can be emotional and anxiety-provoking for clients", and that IFS may not work well with delusional, paranoid, or schizophrenic clients who may not be grounded in reality and therefore misuse the idea of "parts". [9]


      SAMHSA’s Evidence Basis for IFS Effectiveness and areas for further research

      Internal Family Systems (IFS) Therapy is a psychotherapeutic modality developed in the mid-1980s, based on the observation that clients experience subpersonalities that come into internal conflict when dealing with challenges. The IFS model likens these subpersonalities to an “internal family.”

      The National Registry of Evidence-based Programs and Practices (NREPP) is an evidence-based repository and review system designed to provide the public with reliable information on mental health and substance use interventions. All interventions in the registry have met NREPP’s minimum requirements for review. The programs’ effects on individual outcomes have been independently assessed and rated by certified NREPP reviewers.


      A randomized controlled trial of an internal family systems-based psychotherapeutic intervention on outcomes in rheumatoid arthritis: a proof-of-concept study

      Objective: To conduct a proof-of-concept randomized trial of an Internal Family Systems (IFS) psychotherapeutic intervention on rheumatoid arthritis (RA) disease activity and psychological status.

      Methods: Patients with RA were randomized to either an IFS group for 9 months (n = 39) or an education (control) group (n = 40) that received mailed materials on RA symptoms and management. The groups were evaluated every 3 months until intervention end and 1 year later. Self-assessed joint pain (RA Disease Activity Index joint score), Short Form-12 physical function score, visual analog scale for overall pain and mental health status (Beck Depression Inventory, and State Trait Anxiety Inventory) were assessed. The 28-joint Disease Activity Score-C-reactive Protein 4 was determined by rheumatologists blinded to group assignment. Treatment effects were estimated by between-group differences, and mixed model repeated measures compared trends between study arms at 9 months and 1 year after intervention end.

      Results: Of 79 participants randomized, 68 completed the study assessments and 82% of the IFS group completed the protocol. Posttreatment improvements favoring the IFS group occurred in overall pain [mean treatment effects -14.9 (29.1 SD) p = 0.04], and physical function [14.6 (25.3) p = 0.04]. Posttreatment improvements were sustained 1 year later in self-assessed joint pain [-0.6 (1.1) p = 0.04], self-compassion [1.8 (2.8) p = 0.01], and depressive symptoms [-3.2 (5.0) p =0.01]. There were no sustained improvements in anxiety, self-efficacy, or disease activity.

      Conclusion: An IFS-based intervention is feasible and acceptable to patients with RA and may complement medical management of the disease. Future efficacy trials are warranted. ClinicalTrials.gov identifier: NCT00869349.

      Keywords: BEHAVIORAL MEDICINE CLINICAL TRIALS DEPRESSION DISEASE ACTIVITY PSYCHOTHERAPY RHEUMATOID ARTHRITIS.


      American Association for Marriage and Family Therapy. (2017). MFT jobs with the VA. Retrieved from https://www.aamft.org/iMIS15/AAMFT/Content/Resources/VA_Jobs.aspx.

      American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association. doi:10.1176/appi.books.9780890425596.

      Eisen, S. V., Schultz, M. R., Vogt, D., Glickman, M. E., Elwy, A. R., Drainoni, M. L., Osei-Bonsu, P. E., & Martin, J. (2012). Mental and physical health status and alcohol and drug use following return from deployment to Iraq or Afghanistan. American Journal of Public Health, 102(S1), S66–S73. doi:10.2105/ajph.2011.300609.

      Forgash, C., & Knipe, J. (2008). Integrating EMDR and ego state treatment for clients with trauma disorders. Healing the Heart of Trauma and Dissociation with EMDR and Ego State Therapy, 1–59. doi:10.1891/1933-3196.6.3.120.

      Goff, B. S. N., & Smith, D. B. (2005). Systemic traumatic stress: The couple adaptation to traumatic stress model. Journal of Marital and Family Therapy, 31(2), 145–157. doi:10.1111/j.1752-0606.2005.tb01552.x.

      Gorman, L. A., Blow, A. J., Ames, B. D., & Reed, P. L. (2011). National Guard families after combat: Mental health, use of mental health services, and perceived treatment barriers. Psychiatric Services, 62(1), 28–34. doi:10.1176/appi.ps.62.1.28.

      Green, E. J. (2008). Individuals in conflict: An internal family systems approach. The Family Journal, 16(2), 125–131. doi:10.1177/1066480707313789.

      Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. doi:10.1007/bf00977235.

      Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22. doi:10.1056/nejmoa040603.

      Holowka, D. W., Marx, B. P., Gates, M. A., Litman, H. J., Ranganathan, G., Rosen, R. C., & Keane, T. M. (2014). PTSD diagnostic validity in Veterans Affairs electronic records of Iraq and Afghanistan veterans. Journal of Consulting and Clinical Psychology, 82(4), 569–579. doi:10.1037/a0036347.

      Jordan, B. K., Marmar, C. R., Fairbank, J. A., Schlenger, W. E., Kulka, R. A., Hough, R. L., & Weiss, D. S. (1992). Problems in families of male Vietnam veterans with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 60(6), 916–926. doi:10.1037/0022-006x.60.6.916.

      King, A. P., Block, S. R., Sripada, R. K., Rauch, S. A., Porter, K. E., Favorite, T. K., … Liberzon, I. (2016). A pilot study of mindfulness-based exposure therapy in OEF/OIF Combat Veterans with PTSD: altered medial frontal cortex and Amygdala responses in social–emotional processing. Frontiers in Psychiatry, 7, 154. doi:10.3389/fpsyt.2016.00154.

      Lang, A. J., Strauss, J. L., Bomyea, J., Bormann, J. E., Hickman, S. D., Good, R. C., & Essex, M. (2012). The theoretical and empirical basis for meditation as an intervention for PTSD. Behavior Modification, 36(6), 759–786. doi:10.1177/0145445512441200.

      Lavergne, M. (2004). Art therapy and internal family systems therapy: An integrative model to treat trauma among adjudicated teenage girls. Canadian Art Therapy Association Journal, 17(1), 17–36. doi:10.1080/08322473.2004.11432257.

      Mansfield, A. J., Kaufman, J. S., Marshall, S. W., Gaynes, B. N., Morrissey, J. P., & Engel, C. C. (2010). Deployment and the use of mental health services among US Army wives. New England Journal of Medicine, 362(2), 101–109. doi:10.1056/nejmoa0900177.

      Matheson, J. (2015). IFS, an evidence-based practice. Foundation for Self Leadership. Retrieved from http://www.foundationifs.org/news-articles/79-ifs-an-evidence-based-practice.

      Miles, S. R., Graham, D. P., & Teng, E. J. (2015). Examining the influence of mild traumatic brain injury and posttraumatic stress disorder on alcohol use disorder in OEF/OIF veterans. Military Medicine, 180(1), 45–52. doi:10.7205/milmed-d-14-00187.

      Miller, B. J., Cardona, J. R. P., & Hardin, M. (2007). The use of narrative therapy and internal family systems with survivors of childhood sexual abuse: Examining issues related to loss and oppression. Journal of Feminist Family Therapy, 18(4), 1–27. doi:10.1300/j086v18n04_01.

      Monson, C. M., Taft, C. T., & Fredman, S. J. (2009). Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development. Clinical Psychology Review, 29(8), 707–714. doi:10.1016/j.cpr.2009.09.002.

      Ouimette, P., Vogt, D., Wade, M., Tirone, V., Greenbaum, M. A., Kimerling, R., & Rosen, C. S. (2011). Perceived barriers to care among veterans health administration patients with posttraumatic stress disorder. Psychological Services, 8(3), 212–223. doi:10.1037/a0024360.

      Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., & Southwick, S. M. (2009). Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatric Services, 60(8), 1118–1122. doi:10.1176/appi.ps.60.8.1118.

      Schwartz, R. (1994). The internal family systems model. New York: Guilford Press.

      Schwartz, R. C. (1995). Internal family systems therapy. New York: Guilford Press.

      Schwartz, R. C. (2004). The larger self. Psychotherapy Networker, 28(3), 36–43. doi:10.1037/e415862005-008.

      Schwartz, R. C., Schwartz, M. F., & Galperin, L. (2009). Internal Family Systems Therapy. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: An evidence-based guide (pp. 82–104). New York: Guilford Press.

      Schwartz, R. C., & Sparks, F. (2014). The internal family systems model in trauma treatment: Parallels with Mahayana Buddhist theory and practice. In V. Follette, J. Briere, D. Rozelle, J. Hopper & D. Rome (Eds.),, Mindfulness-oriented interventions for trauma: Integrating contemplative practices (pp. 125–139). New York: Guilford Publications.

      Smith, R. T., & True, G. (2014). Warring identities: Identity conflict and the mental distress of American veterans of the wars in Iraq and Afghanistan. Society and Mental Health, 4(2), 147–161. doi:10.1177/2156869313512212.

      Toscano, C. L., & Roberts, K. A. (2014). Mental health services for military veterans with post-traumatic stress disorder. (Master’s thesis). Retrieved from http://scholarworks.lib.csusb.edu/etd.

      Twornbly, J. H. (2013). Integrating IFS with phase-oriented treatment of clients with dissociative disordered clients. Internal Family Systems Therapy: New Dimensions, 72. doi: 10.1037/e608922012-134.

      Twornbly, J. H., & Schwartz, R. C. (2008). The integration of the internal family systems model and EMDR. In C. Forgash & M. Copeley (Eds.), Healing the heart of trauma and dissociation with EMDR and ego state therapy (pp. 295–311). New York: Springer Publishing Company.

      United States Department of Veterans Affairs (2016a). How common is PSTD? Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp.

      United States Department of Veterans Affairs (2016b). Treatment. Retrieved from http://www.ptsd.va.gov/public/treatment/therapy-med/index.asp.

      Vogt, D., Fox, A. B., & Di Leone, B. A. (2014). Mental health beliefs and their relationship with treatment seeking among US OEF/OIF veterans. Journal of Traumatic Stress, 27(3), 307–313. doi:10.1002/jts.21919.

      Warner, C. H., Appenzeller, G. N., Warner, C., & Grieger, T. (2009). Psychological effects of deployments on military families. Psychiatric Annals, 39(2), 56–63. doi:10.3928/00485713-20090201-11.

      Zeiss, A. M., & Batten, S. V. (2012). Treatment for PTSD: Clinical practice guidelines and steps toward further knowledge. Journal of Rehabilitation Research & Development, 49(5), ix–xii. doi:10.1682/jrrd.2012.01.0015.


      Watch the video: Solidarity Hospital and Active Citizenship (June 2022).


Comments:

  1. Kunsgnos

    Honestly.

  2. Pierrepont

    I think I make mistakes. We need to discuss. Write to me in PM, it talks to you.

  3. Alafin

    Wonderful, very valuable answer



Write a message