Joanne H. Twombly and Richard C. Schwartz
From: HEALING THE HEART OF TRAUMA AND DISSOCIATION 2008
Although EMDR can be used successfully with the majority of clients, there are times when its effectiveness is limited, and clients for whom it simply doesn’t work. Often this occurs when affect is partially or completely unavailable and the flow of the processing becomes partially or completely blocked. The Internal Family Systems Model (IFS; Schwartz, 1995) is an elegant, efficient, and powerful ego state treatment modality that, when used with EMDR, can increase its range of effectiveness. This chapter will provide an introduction to IFS and describe ways of using it to enhance or enable EMDR processing.
THE UNTARNISHED HEALING SELF
The Internal Family Systems Model was developed by Richard Schwartz and is based on family systems theory and practice. The focus of IFS is on working within the network of internal relationships in which each ego state or part is embedded. This parallels the way family therapists work to understand and intervene within the family system, based on the realization that for anyone to change, the whole family system must change. Like other ego state modalities, IFS emphasizes the normal multiplicity of the mind. It can be differentiated from them by its belief in the universal presence of an undamaged Self that exists in everyone. The IFS concept of the Self is analogous to the spiritual concepts, present in many of the world’s religions, of a soul, a transcendent state of compassion and calm. Through Schwartz’s work with hundreds of clients, many severely abused, he came to believe that everyone has an untarnished, healing Self despite the fact that many people have very little access to it initially. The Self is the most authentic essence of a person—the person’s strongest, most resourceful, and wisest core, enfolding the individual’s most important values. This Self contains the qualities of compassion, confidence, curiosity, and perspective—that is, qualities of good leadership in any human system—making it best equipped to lead the family system. The belief in the existence of the Self has been difficult for many therapists because it requires trusting that an inherent healing wisdom exists in clients, even those with severe symptoms. Often therapists learn this kind of trust only after repeatedly witnessing the healing power of the client’s Self. Our observation, however, is that therapists who come to IFS trainings with EMDR experience already have witnessed clients’ innate healing abilities. As Shapiro (2001) states,
The natural tendency of the brain’s information-processing system is to move toward a state of mental health. However, if the system is blocked or becomes imbalanced by the impact of a trauma, maladaptive responses are observed. If the block is removed (here, through the use of EMDR), processing resumes and takes the information toward a state of adaptive resolution and functional integration. (p. 32)
The concept of innate healing is well known to EMDR therapists, so for them, the idea that clients have the capacity to heal themselves is familiar and comfortable, and leads to an easier acceptance of the existence of the Self.
THE INNER ECOLOGY: DYNAMICS OF THE SELF AND PARTS IN IFS
Central to IFS is creating access to the Self, and then working through the Self to heal the parts of the mind, which results in clients becoming able to live more fully in a state of self-leadership. Rather than dealing with a client whose Self is obscured and blended with parts, or dealing directly with a client’s parts, the IFS therapist works as a partner to the client’s Self, and the client’s Self becomes the compassionate therapist or leader with the parts. This decreases the possibility of the therapist developing a parentlike or hierarchical relationship with the client.
Along with the idea of the Self, IFS holds the belief that parts are multidimensional, each having feelings and beliefs. In other words, each part is a distinct personality, with a full range of emotions, desires, temperaments, talents, and varying perceptions of age and gender. For example, a sad part is not conceptualized as just a cluster of melancholy emotions and negative thoughts, but is seen as a childlike part that is sad because it carries the burden of sadness from unresolved traumatic childhood experiences. Along with sadness, the part also has the capacity to experience the range of normal emotions, and has a large degree of autonomy in the sense that the part might think, say, and feel things independently from the person in which the part exists. Most parts carry extreme beliefs and emotions or burdens that entered the person’s system from the outside world during charged or traumatic events and became lodged within the parts. Thereafter, these burdens govern the way the parts feel or behave, as if they are embedded viruses or computer programs. It is the burdens that parts carry, not the parts themselves, that cause problems. These burdens need to be expelled from the client’s inner system in order for healing to begin. Because IFS grew out of systems thinking and family therapy, the focus has not been on getting to know and change each part individually, but instead on working within the network of internal relationships in which each part is embedded. This parallels the way a family therapist does not try to understand and work with a child outside the context of the child’s family, but rather, realizes that for the child to change, other family members may have to change first or simultaneously. In IFS, symptoms are viewed as the result of traumatic life experiences that cause the Self to become blended with and obscured by parts that carry the burden or impact of the experiences. In working with internal families, it quickly becomes clear that parts are as highly polarized as the external families in which they developed. Many parts never relate directly to one another and hold extreme views of what others are like. For example, in many bulimic clients, the part that drives them to binge is polarized with an inner critic that harshly scolds them for bingeing. The more the inner critic attacks the part that binges, the more that part binges, and vice versa. Like families, parts also form alliances and coalitions and will interrupt one another with impunity. As is true in family therapy, long-standing polarizations often melt once two parts are encouraged to communicate directly and without interference from other parts. Finally, just like parentified children in families, some parts protect other more vulnerable parts or protect the inner system in general. These protectors will resist intrusions by well-meaning therapists if their fears are not respected and addressed. This phenomenon is what leads EMDR processing to become blocked at times.
Thus, IFS views a person as containing a Self and an ecology of relatively discrete, autonomous parts, each with qualities that want to play a valuable role within. The goal of IFS is for people to operate primarily from self-leadership with parts being informed and guided by the Self. Negative life experiences can cause parts to be forced out of their valuable roles as the system becomes reorganized to make survival and functioning possible. Through this reorganization, the Self becomes submerged and blended with parts that lose confidence in the Self, and lose their ability to learn and evolve on their own. A good analogy is that of an alcoholic family in which the children are forced into protective and stereotypical roles by the dynamics of their family. Although similar roles are found across alcoholic families (the scapegoat, parentified child, lost child, and so forth), these roles do not represent the essence of the children. Instead, all children are unique individuals and, once released from their role by therapy, can find out who they are, distinct from the demands of their chaotic family. The same process seems to hold for internal families in which parts are forced into extreme roles by external circumstances, and then continue functioning that way even when the external circumstances have passed. By learning about and respecting the inner ecology, IFS avoids power struggles with protective parts, releases the constraints that bind parts in their roles, and enables parts to transform into valuable inner family members. The therapist’s job is to help clients reach and maintain a state of self-leadership in which they can heal themselves. Once a person has been hurt, parts lose trust and respect for the leadership of the Self and, like parentified children, believe they have to take over to protect the system. The initial step in the IFS treatment process is to differentiate the parts from the Self or to unblend parts from the Self. Access to the Self can often be accomplished with remarkable speed and efficiency using IFS techniques. This is true for all clients, even those who have experienced complex abuse or neglect, although for some of these clients, parts must often be accessed directly to facilitate access to the Self.
THE THREE PRIMARY CATEGORIES OF PARTS
To begin to understand the tasks of helping the client unblend parts from the Self, the therapist must understand the functions of the parts. Parts are divided into three categories (Schwartz, 1995): exiles, who, having experienced the trauma or neglect directly, hold the burden of unresolved negative feelings; managers, who act as protective gatekeepers and not only protect the system from becoming overwhelmed by burdens carried by exiles, but protect the exiles from situations that might add to their
burdens; and firefighters, who react reﬂexively to bring the system back to its original balance whenever managers get overwhelmed and overridden, resulting in the exiles’ feelings being experienced on the surface. When that happens, firefighters do whatever they need to restore balance as quickly as possible. Exiles are most often vulnerable child parts that carry many of the emotions, sensations, memories, and beliefs (that is, the burdens from experiences of being abused, shamed, neglected, or terrorized). This means that if they take over the system, the person will re-experience some or all of those burdens. Symptoms indicative of the presence of exiles include flashbacks, anxiety, depression, somatic pain, and affect storms. Managers come in a number of familiar guises. They are at times inner critics who protect by using criticism to inhibit or motivate; codependent parts who decrease the possibility of abandonment by helping and pleasing everyone around them; workaholic parts who by overworking distract from any internal pain; parts who blunt affect, numb, or provide an obstructive blanket of confusion; and so forth. Incomplete resolution of EMDR targets and treatment failures are often the result of therapists not recognizing and dealing with the client’s managers, who are at times wrongly seen as manifestations of a client’s “resistance.” Managers are often exhausted by their task of protecting exiles and very much want the system to heal. However, they will work to maintain the status quo and work against any interventions undertaken before their concerns are fully understood and addressed. It is important for therapists to note that overriding the concerns of managers may result in the client going into crisis, as some negative-appearing symptoms protect clients from worse symptoms or from the system becoming unbalanced. Indications of manager interference include superficial processing, intense processing with no resolution, or the failure of EMDR. For managers to be willing to shift their roles, they must develop enough confidence in the Self, the therapist, and in the proposed treatment process. When managers become overwhelmed and are unable to function, exiles are triggered and firefighters go into action. Firefighters often act impulsively, frantically, or reflexively to find stimulation that will override or help dissociate from the overwhelming danger of the exile’s feelings. Bingeing on drugs, alcohol, food, or sex and self-destructive behaviors are common examples of firefighter activities. When a client has a history of dangerous firefighter activity, it is necessary for the therapist to focus on the firefighters first to develop agreements and cooperation before working with exiles. These parts are often tired of the restrictive roles they have been forced into and will welcome treatment that helps exiles unburden and gives them other behavioral options and the chance to move into a healthier mode of being.
In IFS treatment, the client’s Self is accessed and begins to relate to the parts in loving ways that lead to their unburdening the emotions and beliefs that they accrued from negative life experiences. As that happens the internal family system reconfigures in new, more harmonious and adaptive ways. IFS treatment consists of the following seven steps:
Step 1: Accessing the Self. Accessing the Self, or at least a critical mass of the Self, is accomplished through the process of unblending it from the parts. The presence of the Self is recognized when it exhibits qualities such as compassion and curiosity toward the parts. If the Self appears to be present, but has, for instance, no feelings toward a part, or feels angry or afraid of a part, it is a sign that a “Self-like” part is present and must be unblended from the Self.
Step 2: Witnessing. Once the Self is accessed and a part has been identified who is willing to work with the Self, then other parts are asked if they have any objection to the proposed work. Once the objections (if any) are dealt with, witnessing takes place. The goal is for the part to feel and trust that the Self knows and fully understands whatever the part needs the Self to know. This might include information about burdens the part holds, feelings it suffers, feelings it has toward the Self, beliefs it holds, and so forth.
Step 3: Retrieval. At times, before further work is possible, the part must be retrieved. As most parts believe they are still living in the past, it can be necessary to retrieve them from the past and bring them into the present before healing work can be done. As long as parts are living in the past, they tend to react as if the conditions in the past still exist in the present. First, the Self checks with the part to see if this is necessary, and if it is, the Self goes to where the part is (usually in the past), and brings it to the present. Note that sometimes retrieval is done after the unburdening phase.
Step 4: Unburdening. Once the first steps are accomplished, the parts are asked if they are willing to unburden feelings or beliefs they have been carrying. Twombly conceptualizes clients’ burdens as being held as tangled webs of energy. Once barriers to the burden being released are dealt with, the burden is released and energy returns to its normal state; that is, the toxic material is transformed. Any concerns the parts have about this process must first be addressed. Frequent concerns include the fear that the part is the burden and will disappear without it, or that the burden will
be released and pollute the world. The parts are given suggestions as to how they can release the burdens; for example, into the air, wind, light, water, fire, or earth. Sometimes one of these suggestions will feel right to a part or the suggestions will enable the parts to come up with their own ideas. Keep in mind that at times, the unburdening may need to be done in small increments as the parts feel safe and ready to manage the process.
Step 5: Replacing burdens with positive qualities. As burdens are released, space opens up and the part is invited to notice what positive qualities are coming into that space. Qualities often noticed include energy, peacefulness, hope, trust, and possibility.
Step 6: Integration and reconfiguration of the system. Parts who have unburdened may merge with other parts, develop a new position in the system, or need a new function.
Step 7: Checking for questions and concerns. At the end of an IFS session, the therapist asks the Self to check and see if there are any parts that have concerns or comments. Each concern and comment needs to be heard and addressed.
OPTIMIZING THE THERAPIST’S ACCESS TO THE SELF
An important aspect of IFS practice is to help therapists develop their own access to the Self. Richard Schwartz strongly recommends that therapists be in their own Self as they work with clients. This recommendation is in fact useful when working in any treatment modality. All therapists have clients whose dysfunction or personality style pushes their buttons or whose issues touch on their own in such a way that counter transference takes on a presence in session or in the treatment relationship. This presence can be diagnostic, providing important information, as well as potentially damaging to the effectiveness of the treatment process. I recommend that therapists spend a few minutes before each session first noticing what parts get activated by their next client, and second noticing any parts of the therapist not connected to the client that are activated. The third step is to negotiate with the parts to step back and allow the therapist (in Self) to handle the session. The Self elicits the Self, so the therapist who works from the Self will facilitate access to the Self in the client. The following case study will illustrate how the seven steps of IFS treatment are carried out. The emphasis in this case is on working with the dynamics of the internal family system. A further case study later in the chapter will show how IFS treatment and EMDR can be used together.
JACK: RICHARD SCHWARTZ USES IFS TO RESOLVE RAGE
Jack came to treatment to deal with his rage, which had resulted in his being fired from several jobs. To begin the first step of the IFS process, I asked Jack to focus on where he felt rage in his body, which helped him connect with the part holding the rage. At this point, Jack’s Self was blended with the part. To facilitate presence of the Self (Step 1), I asked Jack to ask the part to separate himself from Jack. Note that communication with parts is almost always done through the client to support access to the Self. Sometimes this process is visualized as the part actually stepping back or out in front of the Self. I ascertained the presence of the Self by asking Jack what he felt toward the part. Jack’s answer, “compassion and curiosity,” indicated the presence of the Self. As the part holding rage felt the Self’s compassion and curiosity for him, the process of healing was well on its way. To begin witnessing (Step 2), Jack asked the part to tell Jack everything he wanted Jack to know about him. Jack learned that the part functioned to protect Jack from situations that would activate child parts, the exiles that carried burdens of terror and sadness left over from Jack’s childhood. In other words, the part holding the rage was a protective part that shielded Jack from becoming overwhelmed with old terror and sadness carried by the exiles or child parts. At work, Jack’s rages occurred when he felt taken advantage of by his bosses and colleagues. As Jack listened to the protective part, he learned that there was another part, a manager, who avoided conflict by approval seeking, which led to Jack’s taking responsibility for tasks that others would have normally done. Exiles became activated and triggered as Jack felt taken advantage of and as his own needs were not being met. When the exiles became triggered, the system became flooded with old feelings of exploitation, terror, and sadness, and the protective part, a firefighter, would rage in an attempt to correct injustices. As Jack understood more about how and why the firefighter operated, he developed more appreciation and respect for that part. Jack was surprised to learn that the firefighter was tired of raging and needing to be vigilant, and wanted Jack to stop the managers from their approval-seeking behavior so he could relax. As Jack continued to witness, he discovered that the firefighter had assumed this extreme role at a time when Jack was a child being bullied every day on his way to school. The firefighter was one of several parts who helped Jack deal with this, each in its own unique way. The approval seeking manager dealt with the bullies by doing anything he could to get their approval. When this didn’t work, the firefighter flew into a loud, fearless, fighting fury, which earned Jack the respect of bullies much
bigger than he. The child/exile parts ended up carrying the actual feelings of humiliation, vulnerability, and terror. As do all parts burdened with old roles and unresolved trauma, these parts functioned in the present as if it were the past. The approval-seeking manager sought approval because he thought that doing anything else would endanger Jack; the vulnerable child parts/exiles felt traumatized; and the protective firefighter ﬂew into rages, all in the service of protecting Jack and managing unresolved feelings from the past. This illustrates the basic assumption of IFS that each of one’s parts is performing an important role and is an important element in the psyche. Once Jack (in Self) witnessed the firefighter, he found that this part— whom he had always thought of as a curse—was actually working hard to protect him from unresolved terror and sadness held by child parts. The approval-seeking parts were also working hard, albeit in a different way, to manage situations in which they felt overpowered and at risk. In Step 3, Retrieval, I asked Jack to check with the protective firefighter and we learned that he was indeed living in the past. Retrieving the firefighter and bringing him into the present brought him some cautious relief, as he could then begin to see possibilities in the present that had been unavailable in the past. The firefighter was asked what he would like to do if he no longer had to ﬂ y into rages to protect the child parts, and he told Jack that he would like to help him judge who was safe to trust and who was not. The firefighter was burdened with old rage, which led to Jack becoming excessively angry in the present. For any part to unburden (Step 4), it needs to feel connected to and be fully witnessed by the Self in whatever way is necessary for that part to feel comprehensively known. For some parts, this includes the Self experiencing some or all of the affects and learning some or all of the experiences that engendered the burdens. Other parts may need much less, and unburdening can happen quickly. The firefighter felt fully witnessed by Jack, but before he felt safe enough to unburden the old rage and become the internal adviser he wanted to be, the approval-seeking manager had to stop putting Jack in positions where he was exploited. When I had Jack check with the approval-seeking manager, he found the manager unwilling to stop because he used approval-seeking behavior to prevent confrontations that triggered child parts into flooding the system with their burdens of old terror and sadness. As is often the case, the exiles needed to be worked with before system wide change could take place. When Jack initially turned his attention to the exiles, he said he felt contempt for them because they were so weak. This indicated that a part holding contempt was blended with Jack. I asked Jack to identify this part and ask it to step back and let Jack (in Self) deal with the exiles.
After the part holding contempt stepped back, Jack spontaneously reported that he felt compassion toward the exiles and was curious to learn about them. Jack was silent as he witnessed the exiles. These parts showed Jack scenes from his childhood in which he was terrorized on his way to school. Once they felt fully witnessed, they realized that Jack now had many resources that were unavailable during his childhood. They allowed Jack to bring them into the present and were eager to unburden. As Jack watched, he saw “black balls of terror and sadness” leave their abdomens and ﬂ oat away into a stream of light. As the burdens floated away into the stream of light, the exiles were asked to notice that space and energy were being freed up, allowing them to receive important qualities (Step 5). Jack reported that during the process, the exiles became older boys who reported a new sense of lightness and now wanted to go and play. Jack noticed he too felt lighter and more positive. As parts no longer need to function as they did in the past, they gain awareness and their roles shift (Step 6, Integration and reconfiguration). In Jack’s case, once the exiles became unburdened, they became older boys who could relax and play. Once that happened, the approval seeking manager felt his job was easier and realized that confrontations at work weren’t the same as being bullied. The firefighter let go of most of the old rage but wanted to watch how Jack managed things at work. A plan was made to check in with him in the next session. In Step 7 (Checking for questions and concerns), the firefighter wondered if he was as important as before and if Jack (in Self) would pay attention when he noticed things about people they met. Jack assured him this would happen, and it was decided that Jack would check with him at least twice a day until the next session. Jack’s progress illustrates a segment of the IFS process. As parts were witnessed and unburdened, Jack no longer experienced the rage he had been troubled by. He became able to advocate for himself and found himself generally happier.
USING IFS WITH EMDR
Before we look more closely at integrating IFS and EMDR, a brief cautionary note is in order. Through our family therapy experience, we have developed a view of the inner family as a delicate ecology, which therapists must enter carefully and respectfully. Like several other powerful psychotherapy techniques, EMDR can sometimes override managers and access exiles before the system is ready to handle them. This results in what IFS calls “backlash,” in which managers or firefighters punish the client or the relationship with the therapist for violating their rules. Backlash can consist of reactions ranging from managers distancing from the therapist, threatening to stop therapy, numbing out, or dissociating, to firefighters responding with self-destructive behaviors, suicidal ideation, or substance or habit disorders. This is, in our opinion, one of the reasons why at times EMDR processing does not work, and explains occasions when apparently successful processing is followed by some kind of self-destructive behavior. Our experience is that EMDR therapists who understand the network of relationships among clients’ parts and know how to work respectfully and sensitively with these inner ecosystems will have greater success and fewer complications when using EMDR than those who use EMDR without regard for the inner terrain of multiplicity (Twombly, 2000). EMDR appears to activate a very similar healing process in many clients in which scenes from their past are witnessed and parts are unburdened spontaneously. Specifically, Shapiro’s (2001) hypothesis of Adaptive Information Processing states that there “is an innate physiological system that is designated to transform disturbing input into an adaptive resolution and a psychologically healthy integration” (p. 54). Thus, EMDR therapists learn to trust the innate physiological healing system released by the EMDR process, similarly to IFS therapists learning to trust the existence of the Self and the natural healing wisdom of their clients’ inner systems. This abiding trust in clients’ inner resources and the possibility of healing is an essential and fundamental commonality that EMDR shares with IFS. The search for efficient, comprehensive healing that resulted in many clinicians learning EMDR also has resulted in many clinicians learning IFS. Joanne Twombly came to learn IFS after working extensively with EMDR and with clients with ego state and dissociative disorders. In spite of (as one client put it) “knowing lots of tricks,” she encountered a few clients for whom EMDR did not work and processing stalled out or appeared to be occurring, but only at a superficial level. She also worked with several clients who appeared to have processed everything but still had symptoms. With these clients, the addition of IFS to the EMDR process has proved to be extremely useful. The Internal Family Systems Model can be used in partnership with EMDR in many ways. Some therapists combine it all the time, and some use it only when there is a problem with EMDR processing. IFS has been used with EMDR in the following ways:
- To check to see if there is any objection to using EMDR. Before EMDR is initiated, clients can be asked if they have any inner sense of an objection to doing EMDR. If they do, IFS can be used to determine the specific nature of the objection and figure out what needs to be done to allow processing. This process can be used to identify resources needed and reduce the possibility of failed processing.
- To access the Self before processing is begun. This has the advantage of beginning the processing with attributes of the Self present (compassion, curiosity, and so forth) and ensures maintaining duality (Harper, Ortiz, & Radke, 2003). Once the Self has been accessed, its presence can be strengthened and reinforced with bilateral stimulation (BLS). For example, one man found that in Self he could think clearer and understand better, and that there was a “cleanness” to the way he felt. These feelings were installed. Using IFS to prepare a client for EMDR treatment can strengthen the relationship between the Self and parts, and make the EMDR treatment go more smoothly (J. Britta, personal communication, September 26, 2005).
- Sometimes it is helpful to have the Self and one or more managers observe the exile using EMDR to process traumas and burdens. If the manager gets too uncomfortable with the material or the feelings, the Self asks the manager to step back a little further, as with regular IFS (N. Robinson, LICSW, personal communication to J. Twombly, September 26, 2005).
- If there is difficulty in identifying parts, BLS can facilitate identification and communication among parts in clients with dissociative disorders (Twombly, 2005).
- An IFS-informed cognitive interweave can be often used effectively to intervene when there is looping by prompting the client to “Ask the part who’s blocking the processing to step back.” IFS can also be used to identify managers who have some concern and are not allowing processing (D. Korn, personal communication, September 9, 2005).
- To explore the underlying cause of firefighter activity when an apparently successful EMDR session is followed by acting out. For example, after a session that Joanne Twombly thought had gone well, the client reported that he had spent the next three days surfing the Internet and eating excessively. Using IFS, it was discovered that the target processed had caused one manager to relax, at which point two exiles got activated. A different manager used Internet surfing and eating as a way to calm the exiles.
- To identify targets not apparent on the surface. For example, after much successful EMDR processing, a woman felt she had completed treatment but wished that some somatic symptoms had been resolved. IFS was initiated and a manager was found who used somatic symptoms to keep an exile at bay. This exile was burdened from the impact of very early neglect and abandonment. Once the concerns of the manager were heard and the manager was retrieved from the past, EMDR was used to process the abandonment and neglect. This resulted in the somatic symptoms being reduced significantly.
- The unburdening process can be used in partnership with EMDR trauma processing. For example, a man with a history of chronic and severe child abuse used EMDR successfully until targeting a particularly bad trauma. Managers refused to consider allowing processing until the trauma was contained in a vault and only 10 percent of the trauma was accessed at a time. Even that small portion seemed excessive to the managers until it was agreed that EMDR processing would be combined with IFS unburdening into “a light that shone down from heaven.”
- To wrap up an incomplete session, IFS can be used to identify parts that can help contain unprocessed traumatic material, and to identify parts willing to help others who do not feel safe or need extra support (Harper et al., 2003). For instance, parts can be asked if they are willing to contain unprocessed material until the next session. It also helps to ask what parts need from the Self between sessions. Often it helps if the Self agrees to check in with parts every day, answer questions, or just to show an interest.
- To check parts’ concerns and questions following a completed EMDR process. At the end of IFS sessions, any managers and firefighters who gave permission for work with exiles are asked if they have any concerns or questions about the process (Schwartz, 1995). Therapists who combine IFS and EMDR can also check back with parts to see if they have concerns and questions. Sometimes parts need new jobs, or have questions about how to now connect with the world as the processing shifts the old relationship. For example, the day after successful EMDR processing a client called to report that since the session she had been fine but completely unproductive. It turned out that an exile was feeling much better and the manager who had been working so hard to protect her was now out of a job and had absolutely no idea what to do. Checking with this manager before the end of the session would have prevented this problem.
- There appears to be a subset of clients for whom EMDR does not work but who have been able to use IFS effectively. These clients are often those with many managers who effectively stop any attempts to process in service of protecting the client. It is possible that once IFS has been used to connect and negotiate with managers, EMDR may be used to clear remaining targets.
The following composite case study will clarify the use of IFS to facilitate EMDR processing.
LUCY: JOANNE TWOMBLY USES IFS AND EMDR TO RESOLVE MEMORIES OF ABUSE AND NEGLECT
Lucy was a thirty-seven-year-old woman with a history of long-term neglect and emotional and sexual abuse. Her therapist of fifteen years referred her to me for EMDR, reporting that the client had made much progress but remained stuck on various issues, including relationship problems, difficulties with work, and transient substance abuse. Lucy agreed with the therapist’s assessment. A safe-space resource was developed (Twombly, 2001, 2005), and targets were identified. As Lucy began to process the ﬁ rst EMDR target, affects that had been readily available during the setup vanished and processing immediately stalled out. I attempted a number of strategies, including cognitive interweaves, exploring blocking beliefs, and returning to target, all to no avail. I gave a simplified explanation of IFS: “Everyone has parts and our parts are set up both to protect us and to hold unresolved feelings. It seems like a part of you does not agree with us doing EMDR. If it’s okay with you, I’d like you to tune into where in your body you feel your feelings are being blocked, and ask that part of you if it would be willing to relax and sit next to you so we can find out what’s going on.” Lucy replied that all she got in her head was a loud “No!” I asked her to ask that part what it thought would happen if the part relaxed and gave her some space. The part explained that if any feelings were gotten rid of, no one would ever remember or believe how much she had been hurt. The part’s function was to hold tightly to feelings, which effectively stopped the processing. I asked Lucy to tell the part we would not do any EMDR without its permission. With this condition in place, the part was again asked if it could relax and step away from her for just a few minutes, which would help us to figure things out. The part was reassured that if it felt something dangerous was going to happen, it could move right back in. With that understanding, the part was willing to sit next to Lucy, allowing Lucy to begin to access the Self. I then asked Lucy how she saw the part. She replied that she saw the part as a tenacious little girl who wouldn’t give up no matter what. I asked Lucy how she was feeling toward the part, and she said, “Frustrated because she won’t let me do what I need to do!” I asked Lucy to turn her attention to where she felt frustration in her body, and ask that part if it was willing to step back and let her work with the part that was blocking. Once the frustrated part stepped back, Lucy turned her attention back to the blocking part and noted she now felt grateful for the part’s toughness, and sad that it had to work so hard. This ability of the client to feel sadness and compassion and to be grateful to the blocking part indicated the presence of the Self. I then asked Lucy to let the part know that she felt sad about how much work the part had been doing, and how grateful she felt to her. As she did that, the part began to relax. Witnessing was initiated by having Lucy ask the part to tell her whatever the part wanted her to know about the past. The part reminded Lucy of all the times bad things had actually happened that her parents “totally forgot about” and then acted like she was making things up if she said anything. As a little girl she vowed to never forget, and the blocking part said her job was to keep the feelings because if she lost them, there would be no proof. I asked Lucy if it made sense to her that under those circumstances the blocking part would want to continue blocking the loss of the old feelings. She agreed it made sense and she let the part know that, but she admitted that she was tired of feeling anxious and depressed. Psycho education was provided to the part through the client/Self to help her realize that the only thing we wanted to unburden was painful stored up feelings. Getting rid of them would help her have more energy and feel better, and we would certainly not be getting rid of anything important like information about what happened and how awful it was. The part acknowledged that she was tired of holding the feelings, and that without all of them, she could get some rest and her job would be easier. With that assurance, the part consented to EMDR processing. I then asked Lucy to ask all parts of her mind if anyone had any other objections to doing EMDR. There was no objection and EMDR processing was begun. This time the processing ﬂ owed and the initial target was cleared. After several sessions, processing again stalled out around beginning to work on targets related to physical abuse by Lucy’s mother. I again asked Lucy to tune into the part that was blocking the processing. With the assurance that no processing would be done, the part was willing to “sit next to her” so Lucy could find out more about this blocking part. She was asked what she felt toward the part, and she reported that she was afraid of it. This fear indicated that the Self was blended with at least one other part that held fear. I asked Lucy to tune into where she felt fear in her body and to ask that part if it would be willing to step back and allow her to work with the part doing the blocking. The fear part refused until the Self agreed to work with her first. Once the fear part relaxed and stepped out of Lucy, she could feel compassion for her (indicating the presence of the Self). She communicated that to the part, and the part began to relax. The part explained that she feared that if the traumatic material was accessed and worked on, she would lose her love and connection to her mother, the only parent who had given her any attention. This part was living in the past and felt that without the love and connection to her mother she might die. Again that information made sense to Lucy. Her understanding and compassion for the part, plus her willingness to listen, created the trust and connection that was necessary for the part to allow Lucy to retrieve her from the past and bring her into the present. Retrieving this part allowed the part to attach to Lucy in the present. This made it possible for the part to detach from the past dysfunctional relationship she had had with her mother. Once the part was retrieved, I asked Lucy again if she or any other parts had concerns about resuming the EMDR processing. Two concerns were voiced. The part that had been blocking much of the affect was concerned that it would disappear if all the material got processed, and the part holding the burden of the traumatic material was afraid it would be too overwhelming. The part was told through Lucy that no one is born holding traumatic material, that parts and people get stuck with it as a result of circumstances. Sometimes a part might think that all there is to the part is traumatic material, but it isn’t true! This explanation partially relieved the part, although not enough to allow processing. After Lucy negotiated that the traumatic material would be placed in a container and processed 10 percent at a time, processing was resumed. IFS was again used when Lucy came to a session reporting increased substance abuse. In this case, a firefighter had become activated when EMDR processing inadvertently opened up access to a pool of unbearably painful affects. This part acknowledged using alcohol to “numb things out” and was angry at the therapist for letting things get out of balance. After this session, IFS was used to check with the parts to see if they had any questions, concerns, or comments at the end of each session. This was done after both incomplete and completed processing in order to avoid further problems after sessions. This case is a good example of how a manager blocked EMDR processing until its concerns were dealt with. The addition of IFS to EMDR enabled this client to successfully complete her treatment.
It is clear that EMDR and IFS are in and of themselves each powerful, comprehensive treatment modalities that have helped many clients heal.
Many EMDR therapists have found that the addition of IFS can extend and facilitate EMDR processing, while some IFS therapists report that the addition of EMDR has extended and facilitated their work with IFS. The multiplicity of the mind resembles patterns of woven threads in a complex tapestry. The challenge for therapists is to tease this tapestry apart, shedding light on the multidimensional parts that exist within in order to heal the entire system. One way to do this is with the combined use of EMDR and IFS. Many questions remain to be answered. For example, are there occasions when, or client populations for whom, EMDR or IFS would be the sole treatment of choice? If so, what are they? Does one modality do something that the other does not do, or is the combination of the two ideal? These questions will continue to be a focus for therapists who work in both modalities. For more information on the Internal Family Systems Model of psychotherapy, visit the Center for Self Leadership at http://www.selfleadership.org/
Harper, J., Ortiz, T., & Radke, M. (2003, August). Expanding the IFS frontier through EMDR. Workshop presented at the Internal Family Systems Twelfth Annual Conference, Mundelein, IL.
Schwartz, R. C. (1995). Internal Family Systems therapy. New York: Guilford Press.
Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.). New York: Guilford Press.
Twombly, J. H. (2000). Incorporating EMDR and EMDR adaptations into the treatment of clients with dissociative identity disorder. Journal of Trauma and Dissociation, 1(2), 61–81.
Twombly, J. H. (2001, December). Safe place imagery: Handling intrusive thoughts and feelings. EMDRIA Newsletter [Special edition] 35–38.
Twombly, J. H. (2005). EMDR for clients with dissociative identity disorder, DDNOS, and ego states. In R. Shapiro (Ed.), EMDR solutions: Pathways to healing (pp. 88–120). New York: Norton.