Internal Family Systems Therapy with Children

Lisa Spiegel

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781134816361
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Internal Family Systems Therapy with Children details the application of IFS in child psychotherapy. The weaving together of theory, step-by-step instruction, and case material gives child therapists a clear roadmap for understanding and utilizing the healing power of this modality. In addition, any IFS therapist will deepen their understanding of the theory and practice of Internal Family Systems by reading how it is practiced with children. This book also covers the use of IFS in parent guidance, an important aspect of any therapeutic work with families or adult individuals with children. The poignant and humorous vignettes of children's therapy along with their IFS artwork make it an enjoyable and informative read.

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• Applies the increasingly-popular Internal Family Systems model to children

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• Integrates theory, step-by-step instruction, and case material to demonstrate to therapists how to use IFS with children

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• Contains a chapter on using IFS in parent guidance

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• Includes a foreword by Richard Schwartz, the developer of the Internal Family Systems model

1

My Introduction to Internal Family Systems

At the age of seventeen, sitting in my pediatrician’s office for a yearly checkup, I had the distinct feeling that I was entirely too old to be there. The waiting room was filled with rambunctious school-aged boys, babies held over their mothers’ shoulders, and a just-barely-toddling toddler.

I rolled my eyes at my mother and said, “I love Dr. Fox, but this is the last time I am coming here. I feel like a weirdo.”

My mother nodded, “Okay, okay, you can start seeing a grown-up doctor after this.”

Fiddling with a Highlights Magazine and a copy of Life, half a child, half a little grown-up, I scanned the room. I noticed that the little toddler was watching me. I looked back at her, and we began a silent conversation that marked the start of a trajectory, one that led to my studying Internal Family Systems therapy and the writing of this book today.

The big brown eyes of this little girl seemed to have so much to say to me. She stood apart from her distracted mother, her hand steadying herself on the arm of a chair. This very small child seemed to be on her own, and I could tell that she was sad. She looked up at me from her bowed head and I sensed her muted spirit in the stillness of her body. I remember saying to her through my eyes, “I see that something is wrong.” I gave her a gentle smile to make a loving contact. She seemed to take in the gesture and did not break her gaze from our wordless dialogue until I got up. I waved a small goodbye and she lifted her hand, as if to send me off to go see my childhood doctor for the last time.

From that day forward, I would work with children: as a counselor at a camp for the emotionally disturbed, as a nursery school teacher at Vassar College, in a therapeutic nursery for the infants and toddlers of adolescent mothers at Bellevue Hospital, and as a mother myself. My degree in Developmental Psychology from Teachers College, Columbia University was an immersion in the study of social–emotional, language, and cognitive development in the matrix of the attachment relationship as understood by John Bowlby (Bowlby, 1969) and Mary Ainsworth (Ainsworth, 1982).

From 1987 until today, I have worked with children and parents at Soho Parenting, the psychotherapy and parenting center I founded with my colleague and business partner Jean Kunhardt. Jean and I met while working in the Child Life Department in Outpatient Pediatrics at Bellevue Hospital. Bellevue in the 1980s was the frontline in treating families plagued by poverty, AIDS, and a crack epidemic. Jean and I ran adolescent parent groups, provided play therapy to children who were victims of sexual abuse, and worked collaboratively with both pediatricians and OB-GYNs to provide comprehensive care to families. We learned about human resilience in the face of tremendous trauma and challenge.

Coincidentally, Jean and I both became pregnant within months of each other in 1986. We both planned on leaving Bellevue to focus on our new families. Our experience running the adolescent mothers’ groups sparked ideas about our post-Bellevue careers. We began to hatch a plan to recreate and retool the mothers’ groups and offer them to a different population. We devised a curriculum that balanced practical, developmental information about babies with the exploration of the psychological changes motherhood brings. We called our practice ParenTalk and ran our first groups in my living room on the Upper West Side of Manhattan. The support and guidance these groups provided became an essential part of these new mothers’ lives. Nothing like this existed in New York City at the time. We were inspired to grow this service and offer it to a wider audience. A colleague at Bellevue connected us with Drs. Marie Keith and Robert Coffey of Soho Pediatrics. These forward-thinking pediatricians were interested in providing psychological and parenting support to their clientele. We began a fruitful partnership with Soho Pediatrics, offering parenting groups and counseling sessions to their patients. As the practice grew and relationships with clients deepened, it was clear that parents also needed a safe place to explore their own individual issues from their families of origin and issues related to marriage. The scope of our service grew. Jean and I wrote a book with Jean’s sister, Sandra K. Basile, on the first year of motherhood, A Mother’s Circle (Kunhardt, Spiegel, & Basile, 1996). We moved to a beautiful new space with Soho Pediatrics and our baby, ParenTalk, became Soho Parenting, a comprehensive parenting and psychotherapy center.

I continued my training during these years for my own intellectual development and to keep current with new therapeutic modalities. The last 25 years have been an era of tremendous growth in the field of psychotherapy. Brain research, the importance of the mind–body connection, and the rise of Eastern practices and psychology in our Western world, as well as cognitive behavioral interventions, have flourished. My professional evolution has closely paralleled the growth in the field.

Like many clinicians in the 1980s, my early work was steeped in psychoanalytically oriented play and talk therapy. In fact, Dr. Anni Bergman, a disciple of Margaret Mahler and an important contributor to psychoanalytic thought in her own right, was one of my most influential mentors (Mahler, Pine, & Bergman, 1975). This theoretical framework provided a solid classical foundation on which I have built an eclectic and rich clinical practice. I have trained in Eye Movement Desensitization and Reprocessing (EMDR) (Shapiro, 1998, 2001; Parnell, 2006); LifeForce Yoga for anxiety and depression (Weintraub, 2004, 2012); Relational Life Therapy—Terrence Real’s model for couples counseling (Real, 2007); and divorce mediation. I have also practiced yoga for almost 20 years, studying the physical, spiritual, and psychological wisdom of this ancient system of self-care.

In 2010, I attended a weeklong workshop in Internal Family Systems therapy developed by Richard Schwartz, Ph.D., at the Cape Cod Institute. I had read Schwartz’s book, Internal Family Systems Therapy (Schwartz, 1995), and was intrigued by the way he described the workings of the human psyche. Internal Family Systems (IFS) is a psychotherapeutic modality that combines systems thinking and the belief in the multiplicity of the mind. This mindfulness-based self-inquiry process leads to greater self-understanding, self-compassion, and the reduction of emotional intensity.

Schwartz was a family therapist influenced by both Salvadore Minuchin and the structural school of family therapy (Minuchin, 1974), as well as Jay Haley, from the strategic school of family therapy (Haley, 1980). At the start of his career, Schwartz worked with eating-disordered clients, and in particular those suffering from bulimia. His initial approach was to see the illness in the context of the family. He used family therapy techniques to change and heal family imbalances that were thought to be at the root of the illness, but he was frustrated by the lack of symptom relief in his clients. As a result, Schwartz altered his focus from the external family to listen more closely to his patients’ descriptions of their internal experience. He heard about never-ending cycles of binging, purging, relief, guilt, and shame as if different subpersonalities were in charge at different times. Schwartz quotes his client, “I go from being a together professional to a scared, insecure child, to a rageful bitch, to an unfeeling, single-minded eating machine in the course of 10 minutes. I have no idea which of these ‘I’ really am. But whichever it is, I hate being this way” (Schwartz, 1995). Schwartz paid careful attention to these cycles. It seemed as if different parts or personalities were having conversations and conflicts with each other inside his clients’ minds.

Ideas about the multiplicity of the mind have been around for centuries. This concept has been posited by philosophers such as Plato and Hume (Hume, 1739), psychoanalysts such as Freud (Freud, 1976) and Jung (Jung, 1976), to more contemporary thinkers (Satir, 1972, 1978; Rowan, J. 1990; Carter, 2008; Steinberg, 2001; Schwartz, 1995; Schwartz & Goulding, 1995). Multiplicity of the mind is a way to understand the complexity of the human emotional experience. It explains why each of us can hold so many different and seemingly contradictory feelings states and thoughts at the same time. It embraces the idea that the natural state for the human mind is to have many different ­personalities or selves that make up the whole of who we are. Though this ­theory isn’t new, it was Schwartz’s direct experience with clients that led him to see the mind as a coherent system of different “parts” or subpersonalities, each with its own set of beliefs, feelings, actions, and goals.

Multiplicity exists on a continuum, and “a healthy differentiation between inner selves permits us to enjoy psychological and emotional richness and adapt to the demands of everyday life. We can daydream and still bathe the children. We can feel angry at a friend and still give a presentation to the board of directors at work” (Goulding & Schwartz, 1995). At the other end of the continuum, we have dissociative identity disorder, where multiplicity is so severe that there is no cohesive identity but autonomously functioning parts that have no apparent awareness of one another (American Psychiatric Association, 2013).

In the middle of this continuum were Schwartz’s bulimic clients. For these women, parts were deeply engaged in conflict with one another. No matter how much Schwartz vigilantly and valiantly tried to effect change, their symptoms relentlessly persisted. As is often the case, frustration led to creativity. Schwartz began experimenting by talking directly to disparate voices and hearing about the problem from their perspectives. When many parts seemed to be talking at once and in conflict with one another, Schwartz began asking certain parts to step into an imaginary waiting room, just as he would in a family therapy session with a real flesh-and-blood family member.

Imagine a family therapy session with the focus on a bulimic client. The therapist might ask the critical father to step out into the waiting area to allow the rest of the family more freedom to speak honestly. New information is elicited for the therapist to work with. When Schwartz asked a critical part to step into the virtual waiting room, the same phenomenon occurred. Other parts felt safer to communicate their points of view. Though this approach was seemingly unconventional, clients immediately responded to it. Schwartz came to see these voices, or entities, as an internal system, functioning much like a family system.

Schwartz also came to see that there was another presence—a healthy, wise, compassionate center, or “Self,” that existed in each and every client. Time after time, after parts would agree to step aside, clients would report being in their “true self” or would report that this felt “like me.” This clinical epiphany led to a critical concept in IFS: the belief in the existence of Self. This nonjudgmental, loving, and healthy presence was able to bring compassion and a deep sense of care and connection to the parts of the client. When relating to the Self, it became apparent that even the most aggressive or self-sabotaging parts reported having a positive intention for the client. As the client’s Self was able to understand and appreciate this positive intention, rather than feeling attacked or shunned by other parts, Schwartz saw a change in his clients. As Self took the leadership role in the inner system rather than the reactive and extreme parts, there was more acceptance, compassion, and teamwork between parts. Remarkably, Schwartz and his clients saw ­symptoms abating. Schwartz was inspired by the psychic change he saw taking place and began to further develop his model out of these intimate therapeutic encounters and the positive change he witnessed. This experimentation in the inner laboratories of his clients’ minds led to the development of the IFS protocol.

Many psychotherapeutic modalities, and our culture in general, assume that whatever hurts us—anxiety, addictions, or even aggression—are our enemies and need to be banished or avoided. In contrast, Schwartz teaches that even these parts, in their own way, are trying to protect and care for us. Working directly and compassionately with these parts helps them to soften and feel taken care of. Schwartz came to see that when we can welcome all of our parts, even the ones that seem to wreak havoc in our lives, our inner systems settle down and our parts work in better harmony.

On the first day of the Cape Cod workshop, Richard Schwartz shared his professional story, and I was intrigued and eager to see the model in action. Early on, he led a meditation in which the group tried to access a part ...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• Acknowledgements
• Foreword
• 1 My Introduction to Internal Family Systems
• 2 Key Concepts in IFS
• 3 The IFS Protocol
• 4 Finding and Befriending Parts
• 5 Negotiating with Protectors
• 6 Externalizing Parts
• 7 Polarizations
• 8 Unburdening Parts
• 9 Using IFS in Parent Guidance
• 10 Bart’s IFS Therapy
• Conclusion
• Glossary
• Index