Using Internal Family Systems To Treat Eating Disorders

1. Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

2. Internal Family Systems Our internal system has different parts that interact in sequences and styles that are similar to the ways people interact. All parts are valuable, have good intentions, and want to play a positive role in the system. “All parts are welcome”

3. Internal Family Systems Maladaptive symptoms (eating disorders) occur when parts take on extreme roles due to life experiences. • Childhood abuse – physical, emotional, sexual… • Dysfunctional family systems – addiction, affairs… • Parent’s divorce, death of a sibling… • War, poverty, violence, trauma…

4. The Self – the seat of consciousness • Calm • Clarity • Curious • Creative • Confident • Courageous • Compassionate • Connectedness

5. Self-Leadership • We are born with Self-energy • Has all the qualities of healthy leadership • Self is invisible because it is the ‘you’ who is observing • Self may become obscured by parts in extreme roles • The seat of consciousness, flow, self-actualization…

6. Self-Leadership • When trauma occurs early in life, Self may not be present or able to protect the system. • Parts take over when they do not trust the Self.

7. Self-Leadership • Parts gets stuck at younger ages and keep doing the jobs they originally showed up for. • Parts do not see that the person has grown up, or that Self may be present to care for them.

8. THE PARTS

9. The System Managers Firefighters Exiles

10. Eating Disorders An Eating Disorder is a part, or coalition of parts, that is protecting one or more exiles.

11. Exiles • Young, vulnerable parts that have experienced distress and/or trauma. • Are isolated from the rest of the system for their own and the system’s protection. • May be extreme and desperate in an effort to be cared for and have their story told and validated.

12. Exiles • Exiles carry the memories, sensations, and emotions of prior painful events and are stuck in the past. Ex: Trauma, Shame, Attachment injuries • Exiles crave redemption from the person who hurt them or who reminds them of the one(s) who caused the hurt.

13. Exiles • Exiles may also hold much of our pleasure, wonder, exuberance, innocence, creativity, sensitivity…. • The joyful, tender, beautiful qualities of childhood over which have been laid the distress of burdensome feelings and beliefs.

14. Eating Disorders – the exiles • Shame – I’m too fat, I’m not good enough • Guilt – my parent’s divorce was my fault • Abandonment – I never felt loved or protected • Trauma – sexual, physical, emotional abuse

15. Managers Proactive parts that run the daily life of the person and work to keep the exiles banished by: • Controlling events, others, the body • Striving, achieving, pleasing, perfectionism • Caretaking others • Critical and judgmental (of self and others) • Anxiety, worry, apathy, passivity, pessimism

16. Eating Disorders – the managers • Go on a diet! • Get to the gym! • Read books on losing weight. • Buy clothing to hide the weight loss/gain. • Go to therapy and support groups. • Eat before you go out so you don’t look like a pig. • Have great hair/make-up so no one notices your weight

17. Helping Managers Ask the manager: • What is your job? • What would happen if you didn’t do your job? • If you didn’t have to have this job, what would you rather do? • If you could do your job (usually protection), without (usually controlling), would that be ok?

18. Firefighters Parts that react when exile pain is activated in an effort to distract or extinguish their feelings or dissociate the person from them. • Drinking, drugs, eating, and all addictive behaviors • Self-harm, suicidal ideation, suicide • Rage, violence, impulsivity • Dissociation

19. Socially Acceptable TV, internet, computer games, shopping, sarcasm, exercising, sleeping, working, chocolate, flirting …. Socially Unacceptable Addiction, affairs, rage, violence, abuse, suicide, stealing, cutting, anorexia, murder…. Firefighters

20. Eating Disorders – the firefighters Starve Binge Throw up Laxatives Over-exercise Surgery Cutting Suicide

21. Manager and Firefighter Goals • NEVER AGAINwill we let you feel that pain!!! • Keep the pain of the exiles at bay. • They don’t trust that the exiles won’t overwhelm the system. • They don’t trust that Self can take care of the system.

22. Managers Scan for danger Pre-emptive strikes Keep exiles down otherwise the Firefighters will get activated Firefighters Reactive, frantic energy Sleep, dissociation Damn the torpedoes Stop the pain at all costs, even if it costs everything Manager and Firefighters Goals

23. Managers Don’t you ever stop and think? You are totally out of control! You should be ashamed of yourself! You are hopeless! Firefighters @#$%^ off!! I just felt like it. I deserve this! Try and make me…. I don’t give a @#$%^& Watch out! What Managers and Firefighters Say to Each Other

24. Helping Firefighters Often, therapists are scared of firefighters because of their extreme consequences – cutting, starving, suicide can all lead to death.

25. Helping Firefighters Ask the firefighter: • What is your job? • What would happen if you didn’t do your job? • If you didn’t have to have this job, what would you rather do? • If you could do your job (usually protection), without (usually hurting), would that be ok?

26. The System No matter how much we may help managers and firefighters, unless they agree to let us work with and help the exiles, they will continue to do their job of protecting the system from being overwhelmed by the pain of the exiles. As long as our protective parts believe there is still a fire to control or put out, they will not change.

27. Polarizations • A state in which two parts (or coalitions) in the system relate in opposition or competition with each other. • Each side refuses to move out of fear the other side will take over.

28. Eating Disorders - polarizations FOOD Starve Binge

29. Eating Disorders - polarizations BODY Nurture Abuse

30. Eating Disorders - polarizations SELF Love Hate

31. Eating Disorders - polarizations Polarized parts cannot and will not change unilaterally. We often make the mistake of asking our clients to “relax” or “eat” or “have a food plan”, not realizing we are activating the other side of the polarization, thus making both sides more extreme.

32. Eating Disorders - polarizations Polarized parts do not see that Self is present and can support the system. Both sides of the polarization need to be shown that Self is present and can protect the vulnerable parts.

33. Eating Disorders - polarizations Ask each side – what are you afraid will happen if you don’t do your job? Typically – both sides have the same job – to protect a vulnerable exile. When they realize this, in the presence of Self, they are more likely to relax, and take on a preferred role.

34. Burdens • Extreme beliefs or feelings that are carried by the parts and govern the clients’ life. • Burdens are left on or in a part from exposure to a person or event.

35. Eating Disorders - burdens • I’ll never be good enough • If I eat, I will look better and get molested • I’m so lonely, food is always there for me. • Food soothes my anxieties and calms me. • I was unwanted, food always wants me. • Being thin makes me more popular. • Being fat keeps me from being intimate.

36. Blending • When the extreme beliefs/feelings of a part merge with and commandeer the Self. • Client reports ‘This is me’, but it is really a part that is usurping the system. • Anger, rage, anxiety, self-criticism, fear… • Axis II disorders

37. Eating Disorders - blending • I am fat and nothing you say will convince me otherwise! • I am evil, I deserve this pain • It’s hopeless, why bother trying to get better

38. Love up on the Protectors As therapists, we may be drawn to exiles, and may want to get rid of protectors because they seem maladaptive. We can only access exiles by getting permission from the protectors. Remember – they are just doing their job.

39. Love up on the Protectors • Of course that part of you that says don’t eat is right – it thinks you will get molested again if you gain weight. Let’s thank it for doing its job. • If it could still protect you, and let you eat, how would that be?

40. Love up on the Protectors • So the part of you that can’t stop eating is trying to numb the pain. Sounds like its been working really hard to help you not hurt so much. • If that part could help you heal the pain, and have a healthy body, how would that be?

41. ED as an Anxiety Disorder People who have anxious parts dominating their system are typically driven by managers who are trying desperately to control the system so the pain of the exiles does not leak through.

42. ED as Depression Depressed parts feel utterly hopeless and have blended with and overwhelmed the system. This may be the result of a protector depressing (exiling) parts. This takes so much life-force energy that there is little left for anything else. Goal is to learn the part’s story, develop a relationship between the part and Self and have the Self provide Hope.

43. ED as an Addiction Addicts are driven by firefighters – extreme protectors working hard to keep extreme exile pain/shame away from the system. Stop the pain at all costs, even if it costs everything

44. ED as PTSD Trauma survivors have parts that are stuck in the past that need to be retrieved and unburdened. “Trauma survivors don’t have memories, they have symptoms”. Their “symptoms” (starving, binging) are protectors working to keep the painful memories exiled so the person NEVER AGAIN has to feel that pain.

46. Therapist Parts • Parts of the therapist that may interfere with therapy. • When you encounter a problem in IFS therapy, it is usually because a part is interfering, but you don’t know whose it is - yours or the client’s.

47. Benefit to the Therapist • Unburden and release clients’ extreme beliefs, emotions, energies. (Many techniques do this.) • Promote Self-Leadership so the parts trust the client’s Self rather than the therapist or the technique. This leads to empowerment.

48. Benefit to the Therapist • You do not have to be the clever expert, even if it is rewarding. • You do not have to come up with insights, interpretations, or assignments because they will come from the client. • Less transference, projection, dependence. • Have a co-therapist (client’s Self) who lives with your client 24/7. • Feel energized, not drained, after a session due to the presence of Self-energy (yours and the clients).

49. Internal Family Systems “Even the worst impulses and feelings -- the urge to drink, the compulsion to cut oneself, the paranoid suspicions, the murderous fantasies – spring from parts of a person that themselves have a story to tell and the capacity to become something positive and helpful to the client’s life. The point of therapy isn’t to get rid of anything but to help it transform.” Richard Schwartz, Ph.D.

50. Level 1: Mastering the Skills of IFS In addition to thoroughly learning IFS theory and technique, the Level 1 training program invites participants to explore their own inner worlds in a safe, nurturing context. Participants: • Develop an understanding of the conceptual basis of the IFS model; • Apply basic IFS techniques to various clinical populations; and • Take advantage of the opportunities the model offers for personal development. The format includes lecture, discussion, demonstration, experiential exercises, and small group supervision and practice. Level 1 is six weekends over the course of one year, 108 CEUs.