Why Internal Family Systems?
Driven by my passion to find a better way to support the healing of individuals with OCD as well as their families, I’ve concluded that therapists need a greater variety of effective tools to address some of the missing pieces in OCD treatment. My experience and research over the past decade have demonstrated that the experiential nature of Internal Family Systems (IFS) therapy makes it an ideal therapy model and a true asset in the treatment of OCD.
IFS and ERP are commonly thought to be diametrically opposed. In the course of my clinical work with clients struggling with OCD, however, I have used both modalities and have not actually found them in conflict at all. In fact, it’s my experience that IFS and ERP have some fundamental differences but work together effectively.
IFS therapy alone is an approach gaining in popularity among many generalist therapists and other practitioners; they use it to treat trauma and addiction and to improve overall flourishing. With guidance and education in some of the complicating features of OCD, more therapists may be able to utilize the IFS approach to treat OCD.
Although it may not be immediately apparent, IFS is actually highly compatible with the frontline treatments for OCD. Both it and CBT with ERP prioritize the development of a witnessing capacity that allows a person to achieve a state of clarity, perspective, and balance while experiencing challenging emotions. In a specific type of ERP called imaginal exposure, for example, clients are guided to face an imagined version of their fears and to sit with the feelings rather than engage in neutralizing safety behaviors. IFS therapy involves an experiential process called “going inside” that is similar to imaginal exposure in that it facilitates the ability to be present with strong emotion rather than engulfed by it.
Like CBT with ERP, IFS is effective because it avoids the common therapy pitfall of just talking about symptoms; rather than being analyzed, understood, or explored, OCD requires a present-moment, therapeutic encounter. But unlike ERP, which conceives of thoughts and feelings as passing states of mind, IFS recognizes them as their own animated subpersonalities, the internal parts of us that think and feel, which is why an IFS approach can be extremely beneficial. (Richard Schwartz, founder of Internal Family Systems, chose to use the simple and straightforward term “parts” to designate these states of mind because that’s how his clients naturally referred to their various drives, urges, and moods: “Part of me wants to do this, but another part of me wants to do that.”)
One of the fundamental goals of Internal Family Systems therapy is to develop what is called “Self-leadership.” IFS conceives of the Self as the neutral, witnessing psychological entity that is able to discern and differentiate among the thoughts and feelings that may dominate people when they are triggered. The Self can clearly see the sometimes self-defeating ways in which a person’s different parts may work against one another. When our clear-seeing, calm Self is primary and we are aware of parts rather than being hijacked by them, we are Self-led. In this state we are capable of managing a wide range of internal experiences and even parts us that disagree with one another. This perspective is highly useful for people with OCD who may be told that they have made incorrect inferences or that they are not accurately distinguishing between imagination and reality.
From the viewpoint of IFS, psychological reality is much deeper and more nuanced: because our different parts see the world from different perspectives, and therefore hold beliefs and viewpoints that do not entirely describe the big picture of our current reality, they see only their limited viewpoint, their small sliver of the Self’s experience. Through understanding the existence of these parts—which are stable over time rather than fleeting impulses—we can integrate and update these perspectives rather than label them as dysfunctional and discard them as false. Through this process, therapists can facilitate the development of Self-leadership in clients which helps them to incorporate the wisdom of all of their parts, not just the rational.
IFS therapy is a modality that combines family systems thinking with a belief in the multiplicity of the mind, that is, that the mind can hold many different thoughts and feelings concurrently, even those that conflict. This mindfulness-based process of Self-inquiry “leads to greater self-understanding, self-compassion and the reduction of emotional intensity” (Spiegel, 2017, p. 3). Resting on the premise of multiplicity of mind, the family systems perspective of IFS effectively helps people develop harmonious relationships among their various internal “family members.”
In traditional treatment for OCD, clients easily connect with the concepts of internal parts. They frequently say things like, “it’s not me, it’s my OCD” or “it’s the bully in my brain.” From this perspective, they learn to distance themselves from their symptoms, as when Beck uses CBT language to say, “Thinking can be unrealistic because it is derived from erroneous premises; behavior can be self-defeating because it is based on unreasonable attitudes. Thus, psychological problems can be mastered by sharpening discriminations, correcting misconceptions, and learning more adaptive attitudes” (1976, pp. 19–20). In contrast, Schwartz and Sweezy speak in the terms of the Self and parts to say, “Extreme parts have a rationale for their behavior, and they feel driven to extremity by beliefs, emotions, and energies that enter our system from trauma or attachment injury” (2020, p. 55). Even when OCD may have a biological, rather than trauma-based, etiology for intrusive thoughts and compulsive behavior, therapists can help people embrace and release their old beliefs and, by doing so, let go of self-defeating behaviors.