Good afternoon or good evening everyone. I'm Dr. David Stifler. I am on behalf of the American Academy of Addiction Psychiatry. I want to welcome you to the webinar today. This is our series titled Advanced Addiction Psychotherapy. It's a monthly series focused on evidence-based intensive psychotherapy training for addiction psychiatry fellows and faculty. It's hosted in partnership with Oregon Health and Science University and New York University. So we're excited you can join us today. These are live trainings. They're always held the second Wednesday of the month from 5 30 to 7 p.m eastern time. Today's presentation will focus on internal family systems therapy. Our next presentation will be in May. Dr. Kevin Johnson will be joining us to talk about psychotherapy when working with transgender patients and you can check the AAAP website for updates on other upcoming speakers. So I will turn it over to my colleague Dr. Blazes to introduce our speaker. Yes thanks everybody for joining. We're grateful for your attention and interest. We're very excited to introduce Dr. Richard Swartz who is a marriage and family therapy. He received his PhD in marriage and family therapy from Purdue University. He began his career as a family therapist in the academic setting at the University of Chicago and then Northwestern University. There he discovered the family therapy alone did not achieve full symptom relief and in asking his patients why he learned that they were plagued by what he called parts. And these patients became his teachers as they described how their parts formed networks of interrelationship that resembled the families he had been working with. He also found that they focused on and thereby separated from their parts. They would shift into a state characterized by qualities like curiosity, calm, confidence, and compassion. He called that inner essence the self and was amazed to find it even in severely diagnosed and traumatized patients. From these explorations the internal family systems IFS model was born in the early 80s and he created this. IFS is now evidence-based and has become widely used for psychotherapy particularly with trauma. It provides a non-pathologizing optimistic and empowering perspective and a practical and effective set of techniques for working with individuals, couples, families, and more recently corporations and classrooms. And I just have to say that more and more often I just hear patients coming in talking about how IFS has been the single most effective psychotherapy that they've ever experienced in their lives. I'm extraordinarily happy that you took the time out of your busy schedule to talk to us today so thank you Dr. Schwartz. Thank you Dr. Blazes and Dr. Stifler. Yeah I'm very honored to be invited and I was telling you guys that this is healing for me in a sense because I developed IFS just now 40 years ago in a department of psychiatry and was most of the time just ignored and then sometimes attacked for it. So to be invited back into the psychiatry world this way is meaningful to me and I appreciate it and also appreciate the work you're doing with addictions and that's become a big interest of mine as well is how do we bring this kind of work to that world and so that's what I want to talk about today. So before I do that though I think I need to probably introduce the model and so that's what I'm going to do. I'm going to introduce it and talk about how it applies to addictions and then with the remaining time I'll show a video that illustrates what I'm talking about with a woman who is addicted to food basically, binges on food. So yeah as I was saying I'm old and so this goes back 40 years at the time as you said I just was a fresh PhD in Maryland family therapy and this is back in the day where there was a big polarization between us cool family therapists and the more traditional psychotherapists who were trying to do this deep work and we cool family therapists thought we didn't need to do any of that because we could change symptoms just by reorganizing these external family systems and I was hired in this department of psychiatry at the University of Illinois Chicago you know it's called the Institute for Juvenile Research and decided I wanted to prove that and so I organized an outcome study with a colleague to show that we could do this work with bulimic kids in much the same way that Salvador Mnuchin who was my hero had claimed to have such great luck with anorexia and so we gathered together 30 bulimic kids and their families and what I found was that you you hinted at we could reorganize the families just the way the book said to and still my clients continued to binge and purge didn't realize that we cured them so out of frustration I began asking why and they actually started teaching me this model because they started talking about these what they call parts these different impulses and emotions but they were talking about these as if they were full-range personalities like it wasn't just a binging part it was a part that that had a lot of other feelings and emotions that happened to be in that role of taking them out and protecting them that way and at first I thought maybe these kids are crazier than I thought you know maybe they have some version of DID and then I settled down and I listened inside myself and oh my god I've got them too and some of mine are as extreme about food and other things as theirs and then I just got very curious and and was lucky that I didn't really have a background in traditional depth psychology or psychiatry so that I came with a kind of beginner's mind and I really had to listen to what they were saying about these parts and so I basically learned this from my clients and I had another advantage was that I was steeped in systems thinking from my family therapy background so as they were talking about one part I was asking about its relationship with others parts and I as I did that you know in family therapy we would map out family patterns and and study those and try to intervene in certain places and it turns out I could map out these internal family patterns and then that would give me guidance about where the leverage would be in terms of helping clients change their relationship with these parts and in the beginning I thought that they were what they seemed which is the way the field still most of these parts so the the critic they would describe I would think of as a kind of internalized parental voice and the binge was some kind of out of control impulse and when you think of them that way the way you have your client relate to them you're kind of limited because you're going to want to try and get them to argue with the critic and stand up for themselves or control the binge and so I was doing that I was trying to get my clients to do that even as they were describing these parts as having all kinds of of autonomy and full range and they were getting worse but I didn't know what else to do but do more of that until my first client that I was aware of that had a very extensive sex abuse history and also cut herself on her wrists and I decided one session I wasn't going to let that cutting part leave until it had agreed not to do it that week and after a couple hours of me badgering it and my client badgering it finally said okay I won't cut her this week and I opened the door the next session and she's got a big gash down the side of her face and emotionally I just collapsed and I just said I give up I can't beat you with this and the part said I don't want to beat you and that was a turning point in the history of this work because I shifted out of that part of me that wanted to control and you know fix these parts I was just purely curious and why do you cut her like that why do you do this to her and the part proceeded to talk about how when she was being abused as a child it needed to get her out of her body and it needed to control the rage that would get her more abused and so I shifted again now I don't just appreciate that it's not what I thought but I had a whole new appreciation for the heroic role it played in her life it literally saved her life and I could convey that to this cutting part and burst into tears because everyone had tried to get rid of it and villainize it finally somebody was listening to it and proceeded to tell more about where it got this role in the past and so after that I would try the same process with other clients where I would just help my client and me get curious about their parts and you know it might be hard to imagine but at the time I'd learned what's called the gestalt empty chair technique so I would have a client sitting in one chair imagining that part of them was in the other and I would have them and I was hearing about four or five parts so I would have lots of chairs and they'd be hopping around in that way and so I just began having clients instead of argue or fight with their parts get curious and ask what they wanted them to know and each time I would do that they would tell the story of how they got into these roles they were in how they didn't like the role they were in they really thought they had to do it to keep the client safe and so after having done that for a number of years I started to think maybe there aren't any bad parts and indeed my last book is called No Bad Parts because that's what I found over all these 40 years that all of these parts that create such symptoms in our patients are really just stuck in the past and think they have to protect our clients in the way they did back then and they carry what I'm going to call burdens which are the extreme beliefs and emotions that came into you from some trauma and then attached to these parts and drive them almost like a virus so the basic idea is that we all have parts what I call parts other systems call sub-personalities that it's the natural state of the mind to have them it's not they're not the product of trauma themselves but we're born with them and for good reason because they all have valuable qualities and talents to help us in our lives but trauma and attachment injuries and growing up in a family that didn't like certain parts of you all those things take them out of their their naturally valuable states into roles that can be very damaging and create a lot of symptoms like I was saying but that's not who they are that's the role they were forced into and again you were asking about the name internal family systems that's what I was finding in families that there you would find a kid who had who was the symptom bearer who who was causing problems and you would find that that kid was necessary in the family was playing a role wasn't who he was it was just he had to do this to distract from the parents marriage or something like that or he was protecting himself but it wasn't who he was and that if you fix the family he would be liberated from that role and he could do something he's much more inclined to do so it turns out the same is true with his inner family that there are these parts that get forced into these roles and get stuck there and they still think you're five years old and they still think they have to protect you the way they did back then and so as a systems guy I really tried to map out the territory across clients and so I'm going to describe this little map of that that's held up it's held up well over these 40 years because as I was listening for distinctions among them the big distinction that leaped out immediately and it's held up as the big one all these years was between parts that you would call these inner children initially and before they're hurt they give us all these great qualities like openness and playfulness and creativity and love and the desire to connect with people but once they're traumatized they take in the burden of emotional pain or terror or worthlessness and now they have the power to make us feel that way all the time and make it hard for us to function or and to pull us back into the scenes in which they're stuck and so we don't want to be around them anymore and so we try to lock them in inner basements or abysses and in my language exile them so that we can function not realizing that in doing that we're not just moving on from the memories or the motions of the trauma we're actually locking up our juice we're locking up our most precious qualities and parts just because they got hurt so for them it's insult to injury the injury was the trauma the insult is now you don't want anything to do with them and when you have a lot of exile parts like that you feel much more delicate the world seems much more dangerous so other parts are forced to become protectors to try and keep those exiles contained and to keep the world from triggering them or hurting them so other parts are forced out of their naturally valuable states into these protective roles some of whom are trying to manage your life and manage the outside world so that nothing triggers you and some of them are doing that by not letting anybody close enough again to hurt you or or to make you look perfect so that you don't get rejected or make you perform at a high level so you get accolades to counter the worthlessness or and particularly a lot of women in particular have these massive caretaking parts that are trying to take care of everybody else but never let them take care of themselves and so on and so on so these we all we call managers other systems call them the defenses maybe or the ego and and there's a lot of other common manager roles they all have in common the desire to preempt anything that might erupt these flames of exile emotion to overwhelm you and despite their best efforts the world has a way of breaking through those defenses and triggering your exiles at which point it's a big emergency because you swore you'd never feel any of that again and now you're in the middle of it and so there's another set of parts who go into immediate action to get you away from those feelings in a kind of emergency way and they tend to be very impulsive and damn the torpedoes i don't care about the collateral damage to your body or to your to your um relationships i've just got to get you higher than those flames or douse them with some substance or distract you until they burn themselves out and so we call those firefighters and in terms of the addictions world many people with an addiction started out as a firefighter and then sort of became a manager because they became so used to it that now it has to be around all the time but it just started out as a way to get away from some of these feelings in an impulsive way but it's it maintained that that lack of care about the collateral damage so that's the map it's pretty simple exiles and then protectors and then two classes of protectors managers and firefighters now the other thing you alluded to in the introduction is that i found because again trained by training as a family therapist and i'm learning about these parts i'm i'm trying to get my client to and especially after i learned that they weren't what they seemed that they deserve to be listened to i let's say i'm trying to get one of you guys to listen to your critic guys to listen to your critic and get to know it rather than fight with it and i'm having you do that and then all of a sudden you hate the critic and reminded me of family sessions where i'm having two people talk to each other in the family who've been polarized and it's going pretty well and then suddenly a third member of the family jumps in and takes it south and we were taught as family therapists to ask that one to give us the space to finish the conversation and quit interfering to have a better boundary around the diet that was doing the work i thought maybe the same thing's happening in this inner system maybe as i'm trying to get my client to to get to another critic some part that hates the critic has come in so i would ask people could you get that one to just give us a break here and relax back for a while and to my amazement clients could do that and when they did they would shift into this like another person took over who had all these great qualities and would know how to relate to the critic in a healing way qualities like calm and confidence and compassion and creativity and so on and courage and oddly enough they all begin with the letter c and there are eight of them so the ones i didn't mention would be clarity and connectedness and there might be one i didn't mention but there are eight c words that that describe this person who would pop out in everybody that i would work with if we got certain parts to open space and when i would ask people now what part of you is that and say that's not a part like these others that's myself so i came to call that the self with a capital s to distinguish it from the normal use of the word and now 40 years later we can safely say that that self is in everybody can't be damaged knows how to heal and it's just beneath the surface of these parts such that when they open space it comes out spontaneously and that's the big deal about ifs really i mean one of the big deals is that these parts aren't what they seem and they deserve to be listened to rather than trying to control but the other big deal is there is this person inside of people who know how to who knows how to do that and care contains these and that's who we are at our essence so that's the basics of the model and then in terms of addictions so as i said having now worked with a lot of addicts people with various kinds of addictions it's very typical kind of triangular system where in the inner world where generally you've got a very raw exile stuck in a very bad place and then you've got some kind of firefighter activity to try and get the client away from that and then there's a critic who's attacking the firefighter because it's taking the person out of control and often pissing off people around them and but that criticism that inner critic goes right to the heart of the exile who who feels worthless to begin with and now feels even more worthless because of the critic and it also is echoing the voices of all the people in their surrounding that are criticizing them for not being able to control themselves and for hurting people with their addiction and so you get into this vicious cycle where the more worthlessness the exile feels the more need there is for the firefighter activity and then the more the critic is coming in to try and control that and and people spiral out of control so with that map let me pause and just see if there are any questions or reactions so far and i'm happy to hear from the two of you as well we do actually have um somebody with the hand raised so maybe i'll just allow her to speak right okay um laura you should be you can unmute yourself and if you have a question Maybe it was an inadvertent hand raise, but she has her hand raised. So, Laura, if you're there, you're welcome to ask your question. In the meantime, I'll just comment how we were talking before how like this is, it's almost like this was some sort of like archetypal ideas that keep manifesting itself in different areas. It reminds me a lot of kind of the Jungian concepts of the personas. Yeah. And I was wondering if you can comment a little bit about that. Yeah, personas. He also talked about complexes and not so similar to the archetypes, but personas would be a class of managers, for example. But yeah, Jung traveled, traversed the same territory and had some similar observations about it. Looks like. Here we go. Here's a question from Rachel. Can you give us a hypothetical patient with an addiction and what the three parts say or represent? I can actually do better than that. Before too long, I'm going to start a video where I'm going to show a real example of a session with a client. She binges on food, but you can overlay that to virtually any addiction. You can overlay that to virtually any addiction. I'm also always intrigued by this concept of the self, it's like some people, it feels almost like there's a spiritual side to this, like when we're talking about non-dualism and some Eastern philosophies, and was any of your work informed by that? Not so much directly, although I was a child of the 60s and I got into transcendental meditation for a while, but I didn't do it for the spirituality, I did it mainly as a way to handle my anxiety. I was doing what they call a spiritual bypass, I was using the mantra to get higher than my pain and anxiety. But as I went along, and I couldn't reconcile traditional psychology with what I was discovering about self, because I'd been trained like probably you guys to believe that for people to have those kinds of qualities, they had to get it from a relationship. That's basic attachment theory, that it's not inherent in us, it has to come from good parenting, and in the absence of that, then you've got to get it from a good therapist or you get it from a good marriage, but it's not who we are, it's not inherent in us. And I was finding this untarnished self in people with horrible, horrible childhoods. I couldn't reconcile that problem, and so luckily I had some students that said, well, maybe this is like Buddha nature, or maybe this is like Christ consciousness, or maybe this is like Atman from Hinduism. So I started to look into those other systems, and lo and behold, virtually every spiritual tradition had a word for it, even though almost no psychologies did. And so the model has evolved in a much more spiritual direction as a result of that. And so for me, what I'm calling self is a drop of a much bigger ocean that people call the non-dual, or call the big self. Like quantum physics talks about photons being both a particle and a wave, this is the particleized state of that big wave state of self. And there's an inherent intelligence inside all of us that knows how to heal if we give it the space and the energy and the attention. Right. That's what I'm about to demonstrate. One more question just came in from Jeremy. How do you get the manager or critic part to relax back and unlock the juice of the self? Yeah, so it can be a tough sell. And I've become a really good salesman. I'm what I call a ho-virgin. So we first often will start with that critic. And if I was working with you, Dave, I would have you find it in your body. I'd ask you how you feel toward it. You'd say, I hate it because it drives me crazy. It calls me names all the time. So could you ask the parts that hate it to give us a little space to get to know it, and also maybe even help it change, which is a big selling point for a lot of these other parts, because they've tried all their lives to get it to stop, and they can't. But I can say, if you give us a chance, we can help it not do this. Give us a little space. So I'd say, then now, how do you feel toward it? And if they gave you space, you'd say, I'm just curious about why it calls me names all day. Seconds earlier, you didn't like it. But now, not only are you calm relative to it, but you have confidence and even often compassion for it. And from that place, I would have you start to interview it about what it was afraid would happen if it didn't call you names. And I would have you make a connection with it. And in answering that question, it often will tell you about what it's protecting. And then we would honor it, which sounds really crazy. But we would, you know, give it a lot of appreciation for trying its best to keep you safe. And the common answers to that question with these critics are some version of, if I didn't yell at you all day, you wouldn't try to be perfect. And if you weren't perfect, then you'd get hurt. Or if I didn't yell at you all day, you would try these things that would get you hurt. So I have to keep you small or else you're going to get hurt. But they're generally some kind of protective motive. And so we can honor it, even though it's very misguided. And these critics love that. And then they're much more apt to collaborate and give you space to work with other parts, like the attic part, or the exome. So Jeffrey Osborne has a question. We're going to unmute him. And if you're ready, Jeff, can you ask the question? Jeff, you still there? So joining it, I'm going to read the question, Jeff. And if at some point you're able to break in, just interrupt us. So what's the biggest obstacle you have seen for the therapist beginning their work with IFS? I found helping clients recognize the internal world and identifying parts is one thing. However, having them do the work has been much more challenging. Biggest obstacle is the parts of the therapist, really. So our training programs are really designed to help people stay in self as a therapist and get their protectors to open a lot of space, which is very palpable to the client. When you can be in that open-hearted place, your patients really sense that. And that helps their protectors relax. But if you're very nervous about how it's going to go or you're afraid to go to these vulnerable places yourself, so you're afraid to deal with your patients, then there's problems. So that's the biggest obstacle. I mean, it's so interesting. This is such a huge issue that comes up is that in our busy world, we have so many, you know, expectations and limitations on our time and other, you know, fires that are happening literally in the external world that limit our capacity to be completely present. And that prevents us from having an open heart. That's totally true. And it's more true with psychiatry than any other field, I think. And that's, you know, then you're limited in what you can offer patients. And it's just good to know that. And, you know, we try to really encourage therapists to find a way to do their own work so that they're not constantly bombarded that way. So... Yeah. Like you have to have a certain degree of health yourself in order to, you know, be a facilitator of health in others. Exactly right. That's exactly right. It's a big emphasis. So shall I go ahead and start this video? Yeah, go ahead. All right. Again, this is a real demo with somebody who volunteered in a seminar I was doing. And as I say, she'll talk about her binging on food. Okay, that's fine. It's a shame. Does it cover me up for everybody else then? Yes. Oh, okay, fine. Let's just go with this. I do spend a lot of time with your eyes closed, so... Yeah, it's fine. Okay. True. Yeah. And we do have some other people who haven't turned off their video. Yeah. So I'll go ahead and turn it off for those who are still on if you're having trouble or just click your stop video for us, if you could. Sorry, I should have skipped all this. Okay. So Claire, so I get that you're already triggered because you couldn't hide your video. But yeah, welcome and tell me something about what you'd like to work on. Yeah, well, I'd like to work on the... I'm struggling with food problems. And I've really noticed in the last few years that it seems as though the polarity is really strengthened between the different parts. And I've got some... I've always had a problem with... Not problem. I've always used food as a regulator my whole life. And then about 12 years ago, when I got divorced, then it turned into an addiction. I realized after two years that something had changed now and I couldn't actually stop eating. There seemed to be no control over the things that I ate. But there seemed to be a little... It didn't seem to be so intense in the polarities, though. But I think I've had some health issues the last couple of years. And so there's more pressure that's come in now in these parts that are saying, you need to get this eating sorted out because of my health. And then it seems to have strengthened, I think, the firefighters and it just feels... Yeah, and I've been in therapy for 30 years, but I've never worked with this. I've just started IFS last year. And I've just found it really difficult to bring this to therapy, to talk about this. In my system, it just suddenly feels like now feels like the time today. I'm honored by that. Yeah. I'm glad you feel safe to do that here. Yeah. It's amazing, isn't it, to suddenly do it in front of over 300 people and I can't do it with my therapist. But I'm just trusting that. Yeah. You know, I think it's a tribute to all the vulnerable sharing people have already done. Yeah. There's no shame in talking about this stuff here. Yeah. It feels like there's enough self-energy in me now to be able to start looking at this. But there's been a lot of disturbance in my system for the last few hours since I realized I was going to be doing the demo. And I think it's the, I think it is the firefighters I can feel. I can't, you know, just real disturbance going on. Tell me more about the disturbance, what you're feeling. It makes it difficult to breathe. It's like takes my breath away. It feels like something big is something. Not something big is going to happen, but it feels it just feels so huge that I'm just even talking about it, talking about this because there's been so much shame and so many years of hiding. Yeah. And yeah, so it's a big thing. I hear how big it is. And if all we get out of this is that you had the courage to talk about it. That's, that's a big deal anyway so. But you want to start with the one who's so activated in your body. Hmm. I've been trying to think the last couple of hours what this part is, it just it feels like there's a lot of emotion here. Yeah just focus on the emotion and tell me how you feel toward that emotional part that's got your body going. Um I feel I feel curious because I don't I don't quite understand is it an exile or is it is it self that just feels a relief about finally having the courage to do this so I feel curious. And so let's ask the part who's trying to figure that out to give us some space um and then just follow your curiosity and ask ask about ask the emotion what what it wants you to know. So this is how we start so I wasn't sure what this agitation of her body was but we'll just start by having her focus on it and then the the question that determines how much self is present is how do you feel toward this part and if she says I don't like it or I I'm afraid of it that wouldn't be self so we would ask those parts to give us the space to just get open to it and get to know it in a curious place and as you can see she already knows something about IFS and she'd been doing it for half a year so so she knows the language and and knows that we like her to be curious about the whatever we're working with so she quickly got into that place of curiosity about whatever this agitation is so that for me is enough self to proceed we don't want to proceed unless we get a lot of what I call self-energy and don't think of the answer just wait until yeah okay so the feeling is that this is about all the suffering that this eating disorder has is causing and has caused it feels like um that in showing up somehow it's like I'm like knowing there's a wound there but there's something hiding it like a plaster and it's like taking the plaster off and actually really looking um and it being real yeah rather than a lot of denial that's normally there's a really really good at just shoving it away and denying so this feels the opposite of that that's right so thank that denying part for giving you the space to really look and and see what's real and to actually feel maybe the grief from the damage yeah is that what it is yeah that's that's absolutely what it is yeah let's just stay with that let's just welcome that grieving part to let you feel what she's been feeling it's so consuming like any addiction is um just consume so much of my time and um just affects just really affects a lot of my life um because I'm overweight because of the eating mainly eating chocolate and sweets that's my thing yeah um and so there's a lot of body shame which means that I don't like to socialize I you know I like want to hide away and it stops me doing a lot of it just stops me living in quite a few ways so let this part know that we got how many losses have come with this problem yeah just let it know you get that and that right now we're here to do some work on it for the first time maybe yeah and see how the grieving part reacts to that well when you said that I felt some kind of strength coming I'm not quite sure um yeah how that uh what happened to the grieving part but I felt some kind of strength come in some kind of alignment with what you were saying good yeah so maybe just ask if it's willing to let us work with the eating part the binging part so yeah help it it says yes yeah okay so Claire go ahead and focus on that that part that gives you that impulse to eat and find it in your body around your body okay so in most addicts there'll be this big polarization between the eating part in this case and parts that are grieving losses but also are very angry at it and critical of it which we call the critics and then the denying part that she mentioned also that really has kept her from even looking at it and looking at the consequences of it and so at this point and again it's the first time in her life really she's been had the courage to do this uh we're helping her actually look at the eating part and you'll see that this is a different way of working with an addict part than you might typically so but again we want to wait until she doesn't feel so angry at it or grieving of it and can just be curious about it okay it's my mouth so she finds it she noticed it there uh the immediate feeling is wanting to get rid of it of course but we're going to ask all the parts you know on that side of the table to use uh ceases technique we're going to ask all those parts who want to get rid of it to just relax back and give us the space to help it yeah because trying to get rid of it hasn't really worked very well see if they're willing yeah they are so then focus on it again and tell me how you feel toward it now i feel like i'm i want i want to hear more about it uh so there's some curiosity now yeah so let it know that you're open to learning more about it and just ask what it wants you to know about itself and don't think of the answer just wait and see what comes Well, I get a really strong sense of the protective element of it. That's just a sense of the energy of it. Maybe ask more about that. What's it afraid would happen if it didn't make you eat like that? So the first thing that comes is a feeling that I would have to be real, I would have to show up. So if it can keep you eating this way, then you don't have to show up. Yeah, because it's numbing in some way. Yeah, that makes sense. So what's it afraid would happen if you did start to show up? I know it sounds extreme. It feels like I would die. There's quite a strong feeling of terror attached to that. So let it know, you get that the stakes are very high, that it really believes you would die if it didn't make you eat all the time. So it's just desperately trying to protect you that way. Yeah. I can't tell you how often that's the answer of these addict parts to that question. What are you afraid would happen if you didn't do this? That the person would die. And sometimes they mean it because suicide is the next firefighter activity on the hierarchy. So if they didn't keep them binging, they would die. There's a real sense of like, the world's not safe. People are not safe, actually. And yeah. Okay. How are you feeling toward it now as you get this? I feel slightly kind of like, whoa, it's just so big and so powerful. So I feel a little bit part here. Yeah. Yeah. Yeah. A bit overwhelmed by like, oh, my God. Yeah. But that is a part, Claire. So let's see if that one can give us some space too. And just let that one know, it doesn't have to handle this. It can trust you and me to be with this part. That part's like, hoo, just walk off. Leave someone else to deal with it. It's just a little kid. It doesn't have to handle it. Yeah. Yeah. But how are you feeling toward it now, toward the eating part? It feels like my self-energy now feels like it's stronger again. And there's a feeling of, I don't know, it kind of feels, the only way I can describe it is it feels like I'm equal to it. Good. That's good. But now that you get how terrified it is of not doing this to you, how do you feel toward it? Can you ask me that again, please? Yeah. Now that you understand that it thinks it's saving your life by making you eat all the time, how do you feel toward it? I don't quite feel compassion, but I feel something. I feel softened. I feel soft towards it. So let it know that. Yeah. That you, you, yeah, and if it feels sincere, maybe you could apologize to it for trying to get rid of it all this time. I don't want to force that. No, no. I just have to be sure I'm not coming from a self like part. I've got some really, really skillful self like parts. Yeah, make sure it's it's coming from. I'm just feeling into my heart area. And sorry, can you remind me what I was to say to it. Well, only if it feels. Yeah. Sometimes it helps these parts if you could apologize to it for trying to get rid of it all these years. I don't know that I can apologize but what I can say is that I feel really sad that that this part. Yeah, I've been trying to get rid of this part there's been so much hatred. That totally works. Just let it know that. See how it reacts. I don't think it quite knows what to do with that, how to react to that. Yeah, no, it's very much not used to that. So we're just going to stay with that until it can figure out how to react. We're just going to extend this compassion to it for being in the role of really trying its best to keep you alive and then being attacked for that. Yeah, and I have a sense of this part of being really kind of the role that it's taken on is really black and dark and hated. And it feels in such a contrast to what I'm extending to it now. It's like the two things just don't kind of go together. We're going to bring them together. So just keep doing it. Okay. That part's very lacking in trust. That's right. That's why we need to keep doing it. We're going to have to earn its trust by just showing up this compassionate way. You know, it has really good reasons to not trust you because you've been so, you've let other parts be so mean to it. And this part has such, it's mission, if you like, or mission's the wrong word, it's brief, if you like, is if need be, we'll eat her to death. Sure. She'll eat to death. So it's a really strong. We get that, that's true of a lot of these parts. They'd rather have you die that way than kill somebody. Yeah. Just let it know that you get how committed it is to that job. And that's all it can see it. So it's so focused, so blinkered on. That's right. And that's why we're trying to help it connect with you. So it isn't so isolated in there. Claire, I'm so sorry. Can you unmute? I accidentally muted you. I feel like I'm just being here with it, with that part now. That's right. That's just right. Just kind of being. Perfect. How's it reacting now? Well, something's changed because it feels like in what I've just verbalized about it, it feels like it's really being seen and understood. So something has changed about it. I'm not quite sure yet how to put that, how to express that. You don't have to. It's just good to hear that it's starting to feel seen and understood rather than vilified. And again, if this is all we do today, we've done a lot. So just let it know you're really getting how committed it is to saving you, even if it takes killing you. I really suddenly just get how heroic that part is. It's so dedicated to... Yeah, let it know. You see that. Because if I die, that part dies. It's willing to die with you to keep you safe. Yeah, yeah. So let it know. You get it's a hero. So I feel like there's another part coming in now. I don't quite know what this is, but it's kind of like just coming in and just sort of saying, oh wow, what's happening. It's like, oh wow. But it must be a part because I could feel it come in. It's definitely a part. Ask why it's coming in right now. Yeah. So this part's changing now, actually what's happened is it's just sat down. I wasn't aware it was standing up, I wasn't aware, but it's somehow relaxed. The eating part you're talking about? Yeah, yeah, yeah. That part has just somehow, however, the equivalent of sitting down. Fantastic. And ask it if it protects particular other parts of you in there. it says yes and ask if we could go to those parts and heal them so they they weren't so hurt or vulnerable or whatever they feel would this one have to do this job as much no and this part is now just saying I just feel really really exhausted of course it's a hell of a job so ask if it'll give us permission to go to the parts of protects so we can heal them It's not quite sure yet. Ask about its fear or reluctance. Yeah, it feels, it's very, very exhausted, but it's saying it feels concerned about what might be in there. Okay. Is it concerned that there might be things in there you don't know, or what's its concern about what might be in there? Yeah, no, it's... That's a good question. Don't think though, just ask the part, wait for it to respond. So this part says, if I let you go in there, then I might not be able to come in and do my job if needed? No, that's not true, that we're not trying to take away its job at all, if it's needed. But if it does let us heal these parts, that job won't be so needed. Oh, okay. Ask it this, if it was freed up that way, liberated from this job, what might it like to do instead inside of you? Well it's answered me in the form of like an image of, so because it was black before it feels like it's showing me an image of like a black wizard, a wizard in black robes like a wise. Yeah, so let it go, we want to free it up so it can be a wizard, how's that sound to it? Yeah, it likes the idea of that, sounds like a better deal, better job, yeah, alright so ask it again if it'll let us go to one of these parts that it's been protecting. That says yes, okay, and then Claire as you anticipate that, see if there's any other fear that comes up from other parts. We want to go with permission so, I don't feel, I don't feel anything, okay, they may come in as we go if they have, yeah, alright so ask the eating part to point you to the part that it protects the most and see where you find that one, in your body or around your body. Okay I have a part and it feels in my body, kind of feels like it's in the whole of my body. That's fine. How do you feel toward it as you notice it? I'm curious now. Yeah, good. So ask what it wants you to know about itself, and just wait for the answer. sorry what was the question again I just ask this part what it wants you to know and just wait for the answer right so this part it wants me to know how unsafe she feels okay is it okay to know that yeah tell her you're ready to really get how unsafe she feels and if she's ready to let you know why she feels so unsafe and just again don't think just wait and see what comes She feels very unsafe because she was very visible. She attracted attention from men who abused her. Okay. Does that make sense? Yeah. So let her know why that would feel so unsafe. You starting to feel some of the feelings that come with this yeah, I can feel it in my body I can feel that whole body Experience of In my nervous system Is it okay to feel it? Yeah, so it's not overwhelming. I can just feel it. So let her know you're ready You're ready to feel it all Everything that whole thing was like for her with the man and the abuse Whatever she wants you to see and feel and sense about the whole experience I've got this part. That's just coming. This is my analytical pop. It's just like It's just coming is just saying oh, it's all making sense now Particularly what's been going on the last few weeks It's just needs to kind of We're glad it's making sense We wanted to stay out until Yeah, be a little firm with that tell it to wait till we're done And then we can we can totally go over how it all makes sense And just stay with her go back to her car And tell her you really want to get how bad all that was for her It just feels like She just can't exist. It feels like she just can't be in her body Yeah, of course. She can't be in her because nowhere is safe. That's right These men are everywhere They are actually for her Let her know you get that Do you get a sense of how old she is, Claire? Yeah, she's about five. Yeah. Okay. Yeah, so a five-year-old girl who has to deal with all that, of course she's going to be terrified. And of course she's going to think the world is dangerous and people are dangerous. Is it okay to say something about what she's showing me? Oh, yeah, please. So, so she was being sexually abused by her grandfather. Okay. Who she was living with. And, the family broke apart. My mother left, her mother left. And, she ended up going into foster care and foster homes and eventually ended up in a children's home. Okay. And when she was in the children's home, she was then sexually abused by somebody that was working there. Wow. And that's the bit I'm really feeling is that shock of um, feeling safe and then the shock. Of course. Of, um, well, it's not safe here either. Yeah. The relief of getting away from the grandfather and then finding it's not safe there either. Yeah. So tell her really let you get that shock. Okay. I think I'm going to pause here because I want to leave some time for discussion. And, uh, but just to say that we continue this what I call witnessing of what happened to this little five-year-old until the little girl feels finally like Claire gets it. And then there's a process we call a retrieval where I have her go into that scene in that home and get her out of there. And then we help the little girl unload the feelings and beliefs she got back there. And then we come back to the eating part and now it's feeling like it can do something entirely different. So, um, this is what we do with addictions. And I know it's quite different and probably hard for many people in your group to believe that this is possible, but it actually does work. So I'm going to stop the share and come back. It reminded me of the concept of the observing ego and it almost like the old psychoanalytic principle. It seems like part of what you're doing is giving attention and awareness and kind of strengthening the observing ego. Yeah. But it's not just an observing ego, as you could see it's a very active inner healer and leader. So it's not just that she's observing these parts, she's actually going to them. And if you watch more, she goes in and she hugs this little girl and it takes her out, you know, so it become, people become an active leader inside. We have some questions. Let's see if we can unmute people. We'll start with Dr. Paulson. Hi, I'm over in Portland. I am curious how these principles could be incorporated into more short-term visits. It seems like a big part of IFS is the culture of trust that you're able to cultivate. And sometimes I'm seeing people for only a handful of visits or less, but the parts work seems like it could be useful in those settings. So I'm curious what that would look like. Yeah, I'm glad you asked, because I know many of you are constrained to very short visits. And what I can say is that the language by itself really seems to help people just to acknowledge that I'm not an addict, there's a part of me that does this and that part's not even bad. It's just trying to protect me. It's just a very different way of understanding oneself. And so if you can just help people identify some of these parts that are driving their addiction and even soften in the way they think about them, that's doing a lot, even if you don't go in and do the kind of healing that I did with Claire. Dr. Hirschler, are you able to speak? I'm not sure if I can hear you. Can you speak? Yes, I was thinking this might relate to object relations theory, the psychoanalytic theory of object relations and that maybe these parts are in some way internal concepts of important figures in the person's life. So maybe the judgmental part about her eating behavior may be apparent or something, internal concept. Do you follow what I'm saying? I do, and the department I was in in psychiatry years ago was big into object relations. And I would say this is different in the sense that these parts are, some of them carry a parent's energy. And so they might even look like a parent, but if you get them to be who they really are, they're full range inner personalities that just took on that burden of the parent's energy. So it's very different than object relations in that sense that for me, these parts are quite real inner entities that deserve a lot of attention like a kid would. They're a bunch of inner children really. Dr. Leong, do you have a question? Yes. Okay, let me. Am I there? Yes. Okay, hi. Thank you for sharing that video. I guess my question is the woman that you were working with, you know, she had kind of a high level of access to her internal segments. And for example, you know, we work with veterans and we got a lot of repressed guys that can barely even describe a feeling, much less something from their internal world. Do you have any pearls to, you know, shake out the first one or something? Yeah, because we also work with, you know, we have programs in the VA and other places. And so there are people, like you were saying, Claire has done work already on herself and she knows this inner world, although she'd have these parts that didn't want her to go to a big piece of it, which we call exome. But in the VA and other places where people are more protected, then we just work more, we spend a lot more time with their protectors, but it's still, they can still identify them as parts. And I can spend more time, like I did in the beginning with Claire, just going over what they're afraid would happen if they allowed the veteran to go to these places. And, you know, many veterans have parts that are stuck in combat and they never want to go back there. They never want to remember any of that. And so it can be a tough style, but over the years we've learned how to counter those fears that they have so that we'll get permission ultimately with those guys too. Jeffrey Osborne, are you able to speak? I think so. Can you hear me? Yes, we can. Oh, yeah. Sorry about that earlier. I didn't have the right speaker on. But, you know, like Dr. Leong said, you know, we have, we're so limited in the amount of time we can spend with veterans. I really appreciate watching and observing you do the work. And I like the idea of, you know, a lot of the colleagues I work with are really good at just kind of the basics of internal family systems, getting them to recognize the addictive part and then, you know, just normalizing that and then in that softening their view on that. And that seems like there are many light bulb moments that come on with some of the veterans we work with. But I'm curious as to what kind of recommendations you might make that we, with such short availability with veterans, what kind of, short of being trained in IFS, which I'd love to do, what kind of recommendations you can make for us that are in that kind of scenario? Well, again, it's a challenge if you really don't have much time with somebody because it takes a period of time to get the permission to go to any vulnerable places. And, you know, by the time you get permission, the session's over and then what do you do? So, you know, if there were people that knew the model that you could collaborate with, that's ideal and had more time. But as I say, in the meantime, as you were finding, just introducing the idea that this is a protective part of you, it's not an addiction that you have to hate and fight with all the time, it's actually trying to keep you safe. And then as they do that, as they get to know it and soften it, they can start having conversations on their own about whether or not it really has to do this for them. Like I didn't do that with Claire, but a really valuable question, just once you're working with the addiction is to ask it how old it thinks you are. So the client would say, how old do you think I am? And most of the time, the answer is a single digit. These parts still think you're a little kid, but they got to protect you the way they did. And just helping them update and know that, know there's a self who's able to protect them and take care of them is a big revelation a lot of the time. It isn't that they aren't as vulnerable as these parts think. And so just that much as you're finding is a big shift. And before I have to stop, I just want to say one of the points of this video and that we find over and over, because we're doing more and more work with addicts. There's a treatment center called High Watch that's now totally IFS. And we also doing a lot of work in the Meadows and other treatment centers. And what people are finding is this, that these addict parts are just protectors. They're just trying their best. And often they are fearing if they don't do it, terrible things will happen. And often they cannot stop until what they heal, until what they protect has been healed. And so it's really a mistake to get into big battles with them, expecting them to change before that. So this is just a very different approach. And I really appreciate the interest in it here. Do you have time for one more question? Yeah, sure. So Karen Levy, are you able to speak? If not, I could just read the question. I'm curious if you have found that IFS is helpful for people with dissociative identity disorder who have these separate identities or parts. Yeah, there was a point in my career where, you know, I found this could work with bulimics and this could work with other kinds of problems. But what about people like that or personality disorders or so on, and also perpetrators of violence? And I consulted to a treatment center for that for years. But with the DID clients, I did find that I had to do a lot of what we call direct access, where I would talk to the part because there wasn't any self to be found in the beginning. And there are reasons for that along the lines of the oral abuse that these clients have gone through. So it would look in some ways like more traditional DID treatment, where I'm talking to each part, but I'm also helping them get to know each other and building trust in me. So that at some point I asked them to open space and the same damn self pops out in them that pops out in Claire and everybody else. And then I'll hand the baton over to the self. And then the self is the one they start to attach to. So what IFS is trying to do is have people's very vulnerable and needy parts attach to their self rather than to the therapist as the primary caretaker, primary attachment figure. And that's very liberating for people. And that's, again, quite different from most other therapies including object relations. So last question, how much training do you think is necessary to do this? So, yeah, we have what we call level one training that is sufficient to be able to do a lot of it. And then we have level two trainings that are more specialized and then level three training ultimately. But after level one, most people can get the ball rolling. And the problem is that for whatever reason, IFS has become wildly popular. And so for each of our level one trainings, there's literally thousands of people on a waiting list. So we're trying to find more and more trainers and we're also trying to have a more equitable system for people to get in. I still have a hope that IFS can infect psychiatry. I gave up when I left the department years ago, but now it's coming back around. So we can prioritize psychiatrists is what I'm trying to say. Well, once again, thank you very much for taking the time out of your day. I feel smarter for having been present at this lecture and have a great rest of your night. Thank you, Dr. Schwartz. All right, thank you both. Thank you, Dr. Schwartz, appreciate it. Welcome, bye-bye.

Internal Family Systems Therapy

IFS

Dr. Richard Schwartz

Claire

food addiction

parts within oneself

addictive behavior

feeling unsafe and shameful

trauma

vulnerable inner children

self-energy

healing and integration