And why is it Internal Family Systems?
In the last fifteen or so years, EMDR has taken the podium for the preferred method of treating trauma but does it deserve to be there?
Trauma is extremely difficult to treat. It comes in so many shapes and sizes and yet it is arguably the most impactful and likely the most pervasive of all mental health issues and disorders. Everybody has a little bit or a lot of it. There is a push for therapists to be all be trauma informed and yet I don't know how any therapist worth their salt can't be at least somewhat trauma informed. Trauma is so pervasive, it's nearly impossible for a therapist to lack experience in this area. And yet, in the world of psychology and therapy, we are extremely poor at treating it. As common as it is, one would think and hope that therapists were effective at treating it and yet we're not.
A conversation with AI
PTSD wasn't even formally diagnosed in war veterans until just a few short decades ago. They were told they had "shell shock" and were essentially told to shake it off and what many of them did instead, because they couldn't shake it off, is develop a drinking problem. The result in the early years was a lot of child abuse and a lot of domestic violence. It took far to long for anyone to start pinning this diagnosis down. Which is wild when you think about it. Why has it taken humans so long to explore trauma and it's effects?
I decided to have a conversation with an AI chat program about it and it was a fascinating journey. I asked the AI why it took so long for humans to recognize and diagnose something that is so common and pervasive. It's a compelling question and left, perhaps, to debate but the AI mentioned that it is tied to the moral failings of human beings. Trauma and mental illness was once viewed as a symptom of a moral failing, the irony, of course, is the real moral failing was how mental illness had been viewed and treated.
Believe it or not, PTSD wasn't recognized as a formal diagnosis until 1980! That's how long it took us to pin it down and recognize it. This relatively new recognition coupled with the complexity of it are the most likely things that make it difficult to treat.
The brain encodes traumatic memories differently than other memories so there are some natural protective mechanisms that are placed in the psyche. Those mechanisms work against treatment. EMDR is intended to be the method that rewires the said encoding. In theory and in research, EMDR is an excellent and powerful approach to treating trauma so how has it lived up?
"EMDR has a much better reputation than it deserves."
In my professional opinion, the letter grade it would deserve is a D. Partially because of the hype around it. It's trendy and hip. Advocates for EMDR will tell you that it's effective for all issues and all populations. This is false, by the way, teens do poorly with it. It's far to abstract for teenagers. They don't grasp it and so they check out. They don't connect with the process and anyone that says that teens are benefitting from it aren't talking to teens about their experiences with it which is something I do. Teens don't like it, they don't get anything out of it.
The research behind EMDR is good and the theory is sound but the clinical outcomes are poor. Between the theory and the practice, there are a lot of reasons that it's breaking down. The short answer is, therapists aren't doing it well and so it does poorly in real life clinical outcomes. The proponents will tell you that it does great in clinical trials but they ignore the real life clinical outcomes and how it's impacting day to day people and their experience in therapy.
For starters, it's way to complicated. There are 8 phases in EMDR treatment. The most important ones are pushed through and not explored thoroughly enough. The more complicated a therapy method is, the more it tends to break down. DBT or dialectical behavioral therapy is the same way. It's far to complicated and it's difficult for therapists to do it correctly and apply effectively.
The other major problem with EMDR is that therapists are rushing to get the phase 4 which is the desensitization phase. There is what I call a trauma threshold which is the same as what I mentioned before, the protective memory encoding. If the trauma threshold isn't being respected and treated with extreme care, the person can easily be retraumatized in therapy which is exactly what's happening with a lot of EMDR therapists. So while EMDR is intended to reprogram that memory encoding, the trauma threshold must still be respected or therapy can cause additional harm.
In one case, a client told me that his wife had been doing EMDR and that one session had sent her deep into a dissociative state. The therapist sent her on her way even though the session and really put her in a bad position. My client told me that his wife called him, in distress, she didn't know what happened or where she was but she needed help. She was a grocery store and didn't know how she had gotten there or where she had parked her car. He told me that he and his son went and found her and drove her car home.
EMDR can easily spiral people into a deep state of dissociation and trigger intense dissociative episodes. A problem that, again, EMDR therapists don't want to acknowledge and so they just hit the throttle and plow forward, often unaware or even apathetic regarding the harm that's being caused. Sadly, many EMDR therapists are more dedicated to EMDR than those they treat. The EMDR world has honestly taken on some cult like aspects. They clinicians remain true to their ideology before their clients.
So it's common to seek EMDR for trauma only to watch your life deteriorate in the process. Unfortunately, therapists aren't willing to acknowledge these issues and they continue to plow forward even when the person is getting worse. If you go to EMDR therapy and you get worse, don't expect the therapist to catch it or alter course. You must be dedicated to advocating for your own wellbeing. It's okay to walk away if you're struggling.
Believe me, I've offered my feedback to therapists about EMDR and they just don't want to hear anything negative about it. I don't even try anymore.
Internal Family Systems
Internal Family Systems therapy or IFS is a different approach to therapy. It's based on the inner workings of the psyche and is a structured way to approach shadow work. I wrote an entirely different article on shadow work that you can read here. Shadow work is working with the subconscious for the purpose of restructuring the psyche. There are different ways to go about restructuring the psyche but the work of Carl Jung is by far the most profound and effective. Even though he's been dead for decades, the quality of his work and his theory endures.
IFS works from the basic understanding the people are made up of a whole bunch of different parts. Think of them as pieces or fragments. When a person has endured trauma, it breaks off more pieces and causes them to have more parts. These parts essentially have their own agenda based on these traumatic experiences. Some of them hold onto pain while others make attempts to protect the individual. They pull the person left and right, creating problems and dysfunction.
IFS works to identify different parts and work with those individual parts to get them release pain or to discontinue misguided attempts at protecting the individual. The theory itself is quite abstract and a little bit fringe but I have found it to be profound and incredibly effective. The technique is also simple and uncomplicated to the point that with a few repetitive exercises, individuals can do it themselves on their own time without getting tripped up in jargon or confusing nuances.
As I already mentioned, trauma has a way of creating more parts or fragments. The more intense the trauma, the more parts there might be and the less integrated those parts are meaning that they are detached from the person and working completely on their own. The goal of IFS is to find those parts and support them compassionately which helps them to integrate. When they become integrated, the individual becomes more whole and wholeness is wellness.
I love IFS for several reasons:
It's not complicated - Therapy techniques need to be simple if they're going to be effective and IFS checks this box. In fact, it's one of the least complicated therapy models out there. Because of it's simplicity, it can be easily repeated and duplicated and the individual can essentially learn to become their own therapist. This is one of my biggest gripes with EMDR. It's just to damn complicated and it almost seemingly tries to make things complicated when they don't have to be complicated.
It gets to the root of the problem - The psyche is so complex with so many layers. IFS goes straight to the core without having to cut through the many layers of beliefs, attitudes, thoughts, emotions, behavior, etc. I like IFS because it doesn't waste any time with things that don't offer any help or value.
It's a highly compassionate approach - Unfortunately, therapy can seem like it's a sterile lab experiment. Patients of EMDR have sometimes found themselves feeling like a guinea pig in a medical lab. When they're experiencing significant emotional grief, the therapist remains distant and cold, committed to the process. IFS encourages empathy and compassion. Without these crucial elements, IFS isn't effective.
It addresses trauma without going into painful details - Perhaps the biggest myth about trauma therapy is that the person must 'process' the events by talking about them in specific detail when this is the perfect way to retraumatize someone. A therapist should never force you to talk about something you're not ready to talk about. IFS never talks about the specific events, it addresses the fear, pain and powerlessness that has been accrued by the event. As I've learned, we can release the pain and fear and reinforce feelings of safety and power to the parts that are holding onto the pain. We can resolve the effects of trauma without risking therapy that will retraumatize them. In all of the trauma work I've done with people, the details of the traumatic events have remained undisclosed and the client still gets better and improves which makes for very positive outcomes.
It's effective - Plain and simple, IFS gets results. People can start to see improvement quickly and they can start to feel better in a relatively short amount of time. This depends on the nature of the trauma, of course. Severe trauma becomes a lot more difficult and complicated. It's a process.
It creates true healing - When the pain is released and soothed, that individual part will integrate and help make the person whole. The nature of true healing is the release of pain and creating more personal integrity by helping parts release that pain and integrate into the whole self.
I've personally benefitted from it - I'm human and I've had my own issues and my struggles. One of my biggest goals in life has been to seek my own healing and wellness. Therapy isn't just a job for me, it's also been a vehicle for my own wellness and so I've explored many approach to mental health both personally and professionally. A few short years ago I started to map out one of my own theories on the psyche and healing that I basically referred to as the fragmented self. I was happy when I learned that someone else had developed a similar theory but had also taken the time to flesh out an entire therapy model based on this theory of the fragmented self. I found the process to be a helpful and healing one. The outcome has been so positive that I've wanted others to get the same benefit. I believe that I'm good at helping people through the process because I've done it myself.
I hope and believe that IFS will gain more momentum in the years to come and will help more people find healing. If you've struggled with trauma and the effects of it, consider seeking a therapist who uses it. Even if you can't access therapy, you can still learn the techniques on your own and learn to use them.
If you want to see some of it through yourself, I would recommend doing some homework and preparing yourself for the process. Especially understanding how to support yourself in a compassionate way.
As usual, all the best and happy journeys.
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