IFS for Addictions: Creating a Context for Collaboration and Hope
We have a bone to pick with this approach. A fact-finding interview with a narrow line of questioning (which coaxes tell-tale information about self-destructive behavior in excruciating detail) summons a fragile, shamed person to the punitive court of self-judgment. It’s intrusive and it establishes a hierarchical relationship that can easily evoke fear and defensiveness. It also fails to explore the ways in which the client is productive and tells us little about how they are navigating inner conflict, which is a crucial feature of addictive processes. The standard assessment approach puts the interviewer in a one-up manager position with authority over the one-down, troubled client and is a disservice to both parties. In these ways, it is antithetical to the IFS approach.
In our first therapy session with a client, we are careful not to start by urging them to expose their most shame-inducing secrets. Just like the client and the interviewer in a standard assessment, the client and the therapist are initially strangers to each other. Therefore, in IFS therapy, our first aim is to create a safe, collaborative context. We view assessment as a process that occurs over time. Instead of launching into an investigation, we get curious, avoid assumptions, and ask a lot of open-ended questions— and we continue in this vein in every session thereafter. We learn the client’s history and assess their functioning over time. We understand that larger institutions create standard criteria for evaluation in order to maintain a certain level of care and to ensure that clients get what they need, so we don’t mean to minimize the challenges of changing the standard approach. But we do have strong views about what works best for clients.
The importance of a first session is that it leads to a second session. We can’t help people if they don’t show up. In IFS, we take a nonjudgmental stance and offer compassion from the beginning, recognizing that the client’s willingness to disclose their struggles is hard-won and courageous. As therapists, we aim to embody what we call the 5 P’s: Our patience, perseverance, and perspective are reassuring and calming—while our presence and playfulness are engaging. We notice the client’s parts as they operate in the three categories of manager, firefighter, and exile. We offer a reframe to their struggles by eliciting and validating the positive intentions of polarized protective teams. And, above all, we offer hope: You can feel better, and I can be your guide.
In our new book, Internal Family Systems Therapy for Addictions, we’ve created therapist exercises to help you empathize with the fear and reluctance clients often feel when working through addictive or problematic firefighter behaviors.
Download these FREE exercises, and truly put yourself into your clients’ shoes to develop and enhance that therapeutic relationship.
This was an excerpt from Internal Family Systems Therapy for Addictions.
In this manual, therapists will learn how to access their core, compassionate Self and collaborate with clients in befriending protective parts who engage in addictive processes; healing the vulnerable, wounded parts they protect; and restoring balance in their system.
Cece Sykes, LCSW, ACSW, consultant and senior IFS lead trainer, specializes in trauma and addiction and educates therapists internationally on how to apply the IFS therapy model to addictive processes. Additionally, Sykes is exploring how psychotherapy affects the therapist’s personal narrative. She lectures, consults, and leads workshops on these and related topics and has a private practice in Chicago. Her recent book IFS Therapy for Addictions: Trauma-Informed, Compassion-Based Interventions for Substance Use, Eating, Gambling and More was released March, 2023.
Speaker Disclosures:
Financial: Cece Sykes maintains a private practice and has an employment relationship with Internal Family Systems Institute. She receives royalties as a published author. Cece Sykes receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Cece Sykes is a member of the National Association of Social Workers, the Academy of Certified Social Workers, and the Internal Family Systems Association.
Martha Sweezy, PhD, is a part-time assistant professor in psychiatry at Harvard Medical School, a research and training consultant at the Center for Mindfulness and Compassion at the Cambridge Health Alliance, and a psychotherapist at a private practice in Northampton, Massachusetts. She has published articles on IFS in peer-reviewed journals, co-edited two books on various applications of IFS, and co-authored three treatment manuals on IFS (on trauma, couple therapy, and now addictions), as well as the second edition of Internal Family Systems Therapy with Richard Schwartz. Her next book, which explores shame and guilt in the context of psychic multiplicity, will be published by Guilford Press in 2023.
Speaker Disclosures:
Financial: Martha Sweezy maintains a private practice and has employment relationships with Harvard Medical School and Cambridge Health Alliance. She receives royalties as a published author. Martha Sweezy receives book royalties from Psychotherapy Networker and PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Martha Sweezy has no relevant non-financial relationships.
Richard Schwartz, PhD began his career as a family therapist and an academic at the University of Illinois at Chicago. There he discovered that family therapy alone did not achieve full symptom relief, and in asking patients why, he learned that they were plagued by what they called "parts." These patients became his teachers as they described how their parts formed networks of inner relationship that resembled the families he had been working with. He also found that as 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 1980s.
IFS is now evidence-based and has become a widely-used form of 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.
In 2013, Schwartz left the Chicago area and now lives in Brookline, MA where he is on the faculty of the Department of Psychiatry at Harvard Medical School.
Speaker Disclosures:
Financial: Dr. Richard Schwartz is the Founder and President of the IFS Institute and maintains a private practice. He is a consultant with Portage-Cragin Mental Health and has a employment relationship with Harvard Medical School. He receives royalties as a published author. Dr. Schwartz receives a speaking honorarium, recording, and book royalties from Psychotherapy Networker and PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Richard Schwartz is a fellow of Meadows Behavioral Healthcare and is a member of the American Family Therapy Academy and the American Association for Marital and Family Therapy. He is a contributing editor for Family Therapy Networker. Dr. Schwartz serves on the editorial boards for the Journal of Feminist Family Therapy, the Contemporary Family Therapy, the Journal of Family Psychotherapy, and the Family Therapy Collections.
