Internal Family Systems Therapy
304
Internal Family Systems Therapy
304eBookSecond Edition (Second Edition)
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Overview
New to This Edition
*Extensively revised to reflect 25 years of conceptual refinement, expansion of IFS techniques, and a growing evidence base.
*Chapters on the Self, the body and physical illness, the role of the therapist, specific clinical strategies, and couple therapy.
*Enhanced clinical utility, with significantly more "how-to" details, case examples, and sample dialogues.
*Quick-reference boxes summarizing key points, and end-of-chapter summaries.
See also Internal Family Systems Therapy for Shame and Guilt, by Martha Sweezy.
Product Details
| ISBN-13: | 9781462541478 |
|---|---|
| Publisher: | Guilford Publications, Inc. |
| Publication date: | 08/12/2019 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 304 |
| Sales rank: | 267,607 |
| File size: | 504 KB |
About the Author
Martha Sweezy, PhD, is Assistant Professor at Harvard Medical School, part-time; Program Consultant and Supervisor at Cambridge Health Alliance; and former Assistant Director and Director of Training for the Dialectical Behavior Therapy Program at Cambridge Health Alliance. She has a therapy and consultation practice in Northampton, Massachusetts, and has a particular interest in how shame and guilt affect human behavior. Dr. Sweezy has published several articles and books on Internal Family Systems (IFS) therapy.
Read an Excerpt
CHAPTER 1
The Origins of Internal Family Systems Therapy
We begin this introductory chapter with a bit of the story of how I (RS) developed the Internal Family Systems (IFS) model. I am the eldest of six boys born to Genevieve and Ted Schwartz. Ted was a highly successful academic physician who made a number of important discoveries in the field of endocrinology and was later the head of medicine at a big medical center in Chicago. While I am grateful for the many gifts I received from him, there were also some burdens. He wanted his sons to follow him into medicine and so, as the first of six sons, I was under a lot of pressure. But I didn't (and to a large degree still don't) have a head for hard science, and I was generally not interested in school — which angered my father. His frustration, conveyed through occasional outbursts of contempt when I brought home a report card, simmered on the back burner of my consciousness. From those episodes I acquired what, in this book, we call the burden of worthlessness, which was accompanied by a drive to prove my value to him. That drive became a valuable motivator in the early days of trying to birth this model of psychotherapy in the face of a lot of resistance.
Every summer throughout my college years, my father got me a job as an aide on the adolescent psychiatric unit of his medical center in Chicago. My job was to take patients bowling, swimming, or to the movies. As a result, the kids and I became friendly. Away from their families, I would feel good as I watched them get better through the summer, only to find that they were back in the hospital the next summer. Since I mostly worked weekends, I was often in the day room when families came to visit, and I could hear their angry parents letting loose about the ways in which their kids were shaming their family. After the parents left, I would offer them comfort. I also asked if their therapists were doing anything about their family dynamics. They replied that their therapists never talked to their families and rarely talked to them. While therapists might comment on the meaning of the kids' feelings or behavior, mostly they listened. And whole sessions could go by in silence if a kid wouldn't talk. Although I knew very little about psychotherapy, I knew something was wrong with that picture.
One summer I became particularly attached to a delightful 16-year-old girl who had been addicted to heroin. She told me privately that her father had molested her. One day when her parents visited, her father sat by passively while her mother ranted about the ways in which her selfishness was hurting them. The teen killed herself the next day. I felt a lot of different things, not least outrage at the injustice of what had happened to her. I decided I wanted to become a psychotherapist and do things better. A counselor at my college taught a course on clinical psychology. Here I learned about the psychoanalytic approach to therapy that was being used with these inpatient adolescents, including the rationale for excluding families from treatment and for therapists to stay relatively distant from the kids (psychoanalysis has subsequently evolved to become more relational and inclusive of clients' external contexts). He also introduced me to some therapies that were challenging the psychoanalytic approach.
I was particularly drawn to Carl Rogers and Fritz Perls. Rogers appealed to me because, in contrast to the detached stance of analytic therapists, his caring, empathic style made intuitive sense to me. I was drawn to Rogers's humanistic view that people get hurt but are basically healthy. Perls, on the other hand, struck me as a courageous, outrageous rebel who was breaking out of the analytic paradigm. Emotions should be fully expressed and experienced rather than interpreted. His "empty-chair" technique, in which the client would talk to "top-dog" and "underdog" parts who sat opposite in an empty chair, was my first exposure to the idea of inner conversations.
Despite the appeal of Rogers and Perls, I felt something important was missing from their approaches. I kept thinking about angry parents attacking their kids, an external factor that they ignored, too. This was 1970 and, unbeknownst to me, a small but growing group of therapists had come to the same realization some years earlier and were developing a new approach called family therapy. But I wouldn't learn about family therapy for another 4 years.
OVERVIEW OF INTERNAL FAMILY SYSTEMS THERAPY
Internal Family Systems (IFS) therapy is a synthesis of two paradigms: the plural mind, or the idea that we all contain many different parts, and systems thinking. With the view that intrapsychic processes constitute a system, IFS invites therapists to relate to every level of the human system — the intrapsychic, familial, communal, cultural, and social — with ecologically sensitive concepts and methods that focus on understanding and respecting the network of relationships among members. IFS therapy is also collaborative and enjoyable. And because we view people as having all the resources they need rather than having deficits or a disease, it is nonpathologizing. Instead of seeing people as lacking resources, we assume people are constrained from using their innate strengths by polarized relationships, both within and with the people around them. IFS is designed to help us release our constraints and, in so doing, also release our resources.
IFS is rated effective for improving general functioning and well-being on the National Registry for Evidence-Based Programs and Practices (NREFF) by the Substance Abuse and Mental Health Administration (SAMHSA); and is considered promising for improving phobia, panic, generalized anxiety disorder and symptoms, physical health conditions, and depressive symptoms. As a way of providing context and conceptual background to the IFS model, I (RS) tell my story in this chapter.
FAMILY SYSTEMS, FAMILY THERAPY
By 1973, the environmental movement had launched, and I was fascinated with its emphasis on interconnections, which are inherent to ecological and systems thinking in general. I read Ludwig von Bertalanffy and Gregory Bateson, unaware that a few years earlier their ideas had also begun to inspire family therapists. Changes in one aspect of any system, they said, could have unforeseen, unintended, and often powerful consequences in connected systems. In addition, systems would try to maintain "homeostasis." That is, a system would resist attempts to change it, especially if those attempts seemed ignorant of the context in which the behavior made sense.
As a result, I became convinced that it was unreasonable to expect individuals to change in isolation from their environment. When I heard of an incipient movement called "community psychology," which had incorporated some systems thinking, I searched for a graduate program that would focus on working with communities and found one nearby at Northern Illinois University. There I learned three important things about myself and my options: (1) I was too shy to be a good community organizer; (2) community work takes a long time to bear fruit, which did not suit me; and (3) a man named Earl Goodman, who had recently come to Northern Illinois, was teaching an approach inspired by systems thinking called family therapy. This approach appealed to me as a potentially quicker route to change.
I immediately joined a small group of students who spent many hours watching each other work with families from behind a one-way mirror under Earl's tutelage. Since this was shortly before the publication of several seminal family therapy texts that would give us clarity and direction, we were groping in the dark and basing our interventions on vague concepts like homeostasis and scapegoating. We thought that parents couldn't handle their own issues, so they needed a child as a scapegoat and would, perhaps unconsciously, undermine the therapist's attempts to help the child because they relied on the child's symptoms as a distraction. The goal was to help families shift their focus from the "identified patient" to the parents' troubled marriage, freeing the child from having to protect the parents by being symptomatic.
After a few successes with this approach, I became a zealot. We felt as if we were part of a revolution in understanding and treating human problems, and as such we believed we were superior to the rest of practitioners in the psychotherapy field. I became an obnoxious crusader, pointing families toward the errors of their ways and challenging psychodynamic therapists at conferences. The following year two books came out that fortified my inflated convictions: Families and Family Therapy by Salvador Minuchin (1974) and Change by Paul Watzlawick and his colleagues in California (Watzlawick, Weakland, & Fisch, 1974).
After reading these books, I read and reread the work of the intrepid souls who were spearheading the family therapy revolution and bashing the establishment. Salvador Minuchin and his colleagues (Minuchin, Rosman, & Baker, 1978) were claiming to have great success with anorexia, a condition that was considered very difficult to treat. Jay Haley (1976, 1980) made similarly bold claims about his work with young people with psychosis who couldn't leave home because they were protecting their families. The missing ingredient in psychotherapy, they said, was the patient's external context. Along with them, I was convinced that there was no need for mucking around with inner states and feelings because clients would achieve more therapeutic gains when we reorganized their external contexts. Families just needed clear boundaries, including rules about who interacted with whom and how, so that family members were not too close or too distant from each other.
Parents needed to be allied with each other and in charge. Every family needed a clear hierarchy of leadership so the children did not have to worry about their parents or side with one parent against the other. In addition, family members' beliefs about each other, which fueled repetitive patterns and boundary problems, would change once the therapist "reframed" the harmful or mysterious behavior of the child as the child's positive intent to protect the family. For example, a father yells at his son for being too shy, which makes the boy more self-conscious. As the boy withdraws further, the father gets increasingly frustrated, doesn't know what else to do, and criticizes his son more, and so on. We thought the family dynamic would shift if we could convince the father that his son aimed to protect his mother from facing an empty nest by being shy and not leaving home.
To assess families, we tracked their interactions and asked questions. We aimed to reveal the sequences and patterns that created vicious cycles, which generally consisted of a child allying inappropriately with one parent or being recruited to protect some other family member. The opposite was also true: Rather than being too enmeshed, some family members were too cut off from each other. We were alert to parents being overbearing or abdicating their responsibilities altogether. When we found such evidence, we pointed it out to the family, urged them to change according to our instructions, and dispensed reframing views of the identified patient's behavior liberally.
Since we were looking for pathology within the family rather than the psyche, we were no less pathology detectives than the therapists we disdained who gave clients diagnostic labels. We were the experts who knew what the family needed. When families didn't follow through and change as we had prescribed, we labeled them "resistant" and interpreted the resistance as their need to stay stuck. This diagnose-and-impose attitude worked reasonably for some families, but made antagonists of others and was the opposite of helpful. Our expert mindset led us to deal with the so-called "resistance" in families by trying to manipulate them with "paradoxical injunctions," which involved telling them to keep doing what they were doing in the hope that they would rebel. In short, we viewed families as intimidating adversaries who were so strongly attached to their symptoms that therapists needed either to jolt them into changing or impose change on them.
After graduating from the master's program at Northern Illinois, I carried that top-down mindset to my first job, at the same Department of Psychiatry at the Chicago hospital where I had been an aide when I was younger. Hired to work with the families of pain patients, I was the token family therapist in a psychoanalytic department. I stayed for a year, asking families a lot of annoying questions about the function of their symptoms with the intent of uncovering the role of pain in their family dynamics. While this approach struck pay dirt in a few cases, many families were simply insulted by the insinuation that their suffering was manipulative and put off by my prescriptions for change. Showing me how much I didn't know, this checkered outcome sent me back to school.
MURRAY BOWEN AND VIRGINIA SATIR
My choice for graduate work, Purdue University, was known for its engineering school, but it also housed a doctoral program in family therapy with a stellar reputation. After getting married, I moved to Purdue in West Lafayette, Indiana, where I studied with Doug Sprenkle, a well-known family therapy teacher and researcher. There I learned about Murray Bowen and Virginia Satir, family therapists who challenged my biases by focusing on the experience of individuals within families. Until then, still reacting against the psychoanalytic approach I had encountered at the hospital, I had assiduously avoided intrapsychic considerations, branding them "linear" rather than "systemic." Meanwhile, Virginia Satir (1970, 1972) was considering the importance of self-esteem and Murray Bowen (1978) the importance of self-differentiation. At times they also worked with individual family members rather than solely convening the whole family.
Because I had struggled so hard to differentiate from my father and family, I was drawn to Bowen's approach. I knew firsthand the challenge of developing my own views without rejecting family values and gifts. By this time my passion for (and modest success with) family therapy had quieted those you're-a-failure, you-have-to-change-the-world voices that I had gotten from my father. Meditating regularly also kept my head above water. I was feeling good about myself, regardless of what my father thought of my choices. I thought I was a classic example of someone who had successfully differentiated from their family of origin. Little did I know how much further I had to travel!
Satir's appeal for me lay in her emphasis on changing how people communicated their feelings. I judged myself generally quite happy. I would cry at times and feel closer to my wife, Nancy, which helped me feel good about myself. However, sometimes when Nancy said something quite innocent I would explode angrily. Although I had no idea why, I was aware of intense shame and self-loathing bubbling to the surface when I wasn't distracted. Satir asserted that clear and congruent communication would improve people's self-esteem and their relationships. If her style of communicating could change my behavior and the potential for my feelings to wreak havoc in my marriage, she was my new hero.
My dissertation explored the hypothesis that improving communication in a couple would improve the self-esteem of the individual partners. A fellow student and I taught a Couples Communication Program, developed by Sherod Miller, which fit closely with Satir's ideas. We also took pre-, post-, and follow-up samples of participant couples' communications and levels of self-esteem. And we did find a correlation between better communication skills and improved self-esteem immediately after the program. But at follow-up the correlation had not lasted. It seemed that self-esteem was a bit more difficult to transform than Satir and I had thought. Disappointed, I concurred with the judgment of many others in the field that Satir was too "touchy-feely." I moved away from her ideas, re-embracing the harder-edged, "expert" mindsets of Minuchin and Haley, only to realize much later as I developed IFS that I was standing on her shoulders more than the shoulders of any other family therapy pioneer.
In 1980, the same year our eldest daughter, Jessica, was born, I graduated from Purdue and took a job at the prestigious Institute for Juvenile Research (IJR) in Chicago as a family therapy trainer and researcher. IJR was essentially a state-supported think tank from which much of the early sociological research on juvenile delinquency had emerged. As it turned out, this setting was ideal for consolidating my ideas. I joined a few colleagues (including, at different points, Doug Breunlin, Howard Liddle, and Betty Karrer) to teach in a small family therapy training program within the institute that offered therapy to troubled kids and families from Chicago's west side. Since our teaching and clinical loads were light, we were able to log many hours watching each other and our students from behind one-way mirrors as we worked with disadvantaged families.
(Continues…)
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Table of Contents
I. An Overview of Internal Family Systems Therapy1. The Origins of Internal Family Systems Therapy
2. Individuals as Systems
3. The Self
4. Burdens
5. IFS and the Body
6. The Role of the Therapist in IFS
II. How to Practice IFS Therapy with Individuals
7. Setting the Table for Treatment
8. In-Sight and Direct Access
9. Finding, Focusing, and Fleshing Out Protectors
10. Feeling toward, Befriending, and Exploring Protector Fears
11. Changing Protector Polarizations
12. Unburdening Exiles
13. Doing Inner Work Safely
III. IFS Therapy with Families, Couples, and Larger Systems
14. The IFS Model's View of Families
15. Releasing Constraints in IFS Family Therapy
16. Unburdening in IFS Family Therapy
17. Treating Couples with IFS Therapy
18. Applying the IFS Model to Social and Cultural Systems
IV. Research and Conclusion
19. Research on IFS
20. The Laws of Inner Physics
Glossary of Terms
Interviews
Psychotherapists working with individuals, couples, and families, as well as students in mental health fields. Serves as a text for advanced courses in psychotherapy and family therapy.
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