Internal Family Systems–Skills Training Manual – Flashcards

presence, patience, persistence, perspective & PLAYFUL

Find, Focus, Flesh-out; ------Feel, beFriend & Fears

curiosity, calm, clarity, connectedness, confidence, courage, creativity, compassion

when a part is undifferentiated from another part or from the Self

Negative self-referential beliefs (unlovable, worthless) and intense trauma-related feeling states (terror, shame, rage), physical sensations or visions (flashbacks)

method of communicating with parts directly (vs. internal communication). use when protector will not unblend or when client rejects idea of parts (use if Self is unable to do insight; be v. careful if extreme polarization or therapist's Self isn't very stable.)

exile takes self back in time/place to heal, then comes back to present or other time

For all parts to differentiate from Self, to make room for Self to heal wounded parts

"How do you feel toward this part?"

WHAT IS YOUR JOB? HOW DID YOU GET IT? How old are you? Dow old do u think the client is? WHO DO YOU PROTECT? WHAT DO YOU WANT THE CLIENT TO KNOW? If you didn't do this job, what would u want to do instead?

Empathy = feeling with (blending); Compassion=feeling for (staying in self); clients often need to feel both; but empathy leads to burnout; compassion leads to resilience

1. will disappear, 2. if Self shows up, tx will end. 3. secret will be revealed. 4. client will be overwhelmed with pain. 5. therapist won't be able to handle exiled pain. 6. a polarized protector will show up if this part relaxes. 7. self-energy is dangerous ; will attract punishment. 8. there is no Self. 9. Therapist or other parts will judge protector for damage it has done. 10. change will destabilize client's inner system.

Do not try to use IFS with Exiles without training; use earlier steps to reveal protectors ; unburden them.

Q: "what r u afraid will happen if u stop doing this job? a1= wound ('i'll be alone') or a2 polarization ('suic part will take over')

is it a sympathetic response of parasym?

rage, panic, flashbacks, binge drinking, sometimes suicidality (if intense & impulsive)

numbness, dissociation, shame, highly intellectual, suicidality (if quietly looking for exit to avoid pain) --blunting & withdrawal,

1. when client unable to unblend from (sympathetically) activated part. 2. when client is in hypoaroused state/withdrawn/detached/numb/dissociated & bottom up strategies (tune in to senses, slow down) haven't helped. (Schwartz disagrees, just ask the numb Ness, fog to step aside)

top down--cognitive, affect, then sensations

"when ur protective parts are activated don't make decisions or do anything regarding the problem at hand, wait until your brain settles down and your parts can give you the room to have perspective again.' p. 75

The patient comes in very angry, the therapist tries to see something very validating, the client threatens killing self and significant other, therapist feels fear but tells his own anxious part 2 calm down, then he directly accesses the clients angry part it says the angry part is talking right, that's fine with me, and then makes validating comments about why it is so angry.

The client is talking about how he was angry at his son over the weekend it. The therapist indicated that he sees how angry he is as he is talking about it now. The therapist uses insight (v direct access), validates-- angry part that we understand why it would be upset. Then invited it to separate more so that we can really hear more what it's saying. The client, angry part, says are you afraid of my feelings, can you not handle it? The therapist is calm and says we want to hear those feelings we can definitely hear it and it's got important things to say, Etc tell us all about it.

(write all pt's symptoms, reactions, etc on paper). Introduction to parts-- Introducing Concept of Communicating with Parts You've mentioned all of these feelings and thoughts. (LN--addition--We all have different parts -- common to have internal conflicts or feel/act/think in very different ways at different times. This can be confusing &/or overwhelming at times.) (I often find that) when we focus on them internally and listen to them, we can learn important things about ourselves. Are you open to trying this? TX: 'SEE' (having pt introspect) WHICH PART NEEDS YOUR ATTN FIRST. Patient: I can't stop crying. Therapist: let's check on that. (directing attn in) 'ASK' (introspect; bolster self as leader) IF ANY OF THE OTHER PARTS OBJECT TO YOUR HELPING (the one who can't stop crying) TARGET PART. Switching to Parts Language & Getting Permission to Proceed Wecoming All Parts-- TX: "how do you feel about the part that doesn't want to be here?" (CHECKING SELF-ENERGY, GEIGER) Remember the Target Part-- First let's tell the part that can't stop crying that we'll come back to it. Making Connections.

'Are you open to trying this? Is it ok to hear more? How do you feel toward the part that ... Would you like to find out how? Do you understand this fear? Is that part willing to relax? (separate)? If no, 'are u hearing from parts that have a different perspective?'

proactive; manage life to keep pain out of consciousness; motivate us to improve, work hard, etc. but can get extreme--perfectionistic, intellectualized, one-sided care-taking, people pleasing, conflict avoidant.

reactive--try to stop emotional pain as fast as possible without consideration of consequences. eg life-saving medicine with terrible consequences; addition, cutting, disssoc, bing/purge, suicidality.r8

(first Socratic, if pt can't come up with useful perspective ... 1. Provide a rationale perspective. Help the client make sense of her reaction. 2. Validate the client experience and put feelings into words, 'I'm guessing you feel... 3. Be clear, centered and Express Care, compassion. 4. If these strategies don't help the part on blend, move on to direct access.

1. are you aware of your feet on the floor? 2. can you take a deep breath? 3. can you look at me? 4. can you put in words what you are feeling? 5. can you move your finger? (at extreme, fully disconnected from sensations, feelings, mind blank, frozen; numb; extreme dissociation)

Slow down & Use Direct Access 1. use assessment qs. 2. if can move, pt not totally offline. 3. then tx--"I'm going to speak to the part who took over. I'm here. I'm with you. I'm not going to push you in any way. We can take as long as you need to feel safe. You're the boss ; I trust you." (use bottom-up strategies--senses, go slow, not too active, direct or controlling)

bottom-up--body work--run, music, shower, gardening, music.

bottom up strategies 1. assess level of withdrawal--can u hear me, etc. (see other card), breath, senses, can u move finger 2. help them sense their reactions--feelings, then emotions, then thoughts. 3. empathy--connection, nurturance. 4. let go of agenda--slow down, express trust. 5. if these don't work, go to direct access.

Find Jay -- I don't feel anything. Therapist - - say more. J - - well when you or anyone else for that matter - - including my wife or my kids - - ask me what I'm feeling I just don't know how to respond. I don't seem to feel things the way most people do Therapist - - do you want to explore this? J - - yeah. Therapist - - would it be okay to close your eyes? Good. Now noticed any thoughts or physical Sensations are come up.- starting with the body. J - - okay. J hyphen hyphen I'm aware of chest pains. Focus Therapist - - is it okay to focus on those to see what we can learn? J - - I've had chest pain for years. That's nothing new. I've seen several doctors and they keep saying nothing is wrong. Once I even thought I was having a heart attack. I called an ambulance and went to the ER. Still nothing was wrong with me. Therapist - - would it be okay to go inside and be *curious about the chest pain? I believe all physical Sensations hold important information for us. Flesh out J - - okay. I'll try. I saw myself as a boy. He must be 8 years old. Therapist - - what did you see? J - - the day my grandfather died. Therapist - - you look puzzled. J - - I am. Befriend. Therapist - - are you open to seeing more? Yes J - - Grandpa was very important to me. My father left when I was 4 years old. So he was my dad. Therapist - - is the chest pain connected? J - - yeah. I don't know how. Therapist-- are you open to hearing more? J - - I'm really curious now. Therapist - - send your curiosity to the chest pain and ask what it wants you to know. J - - this sounds strange but I'm getting that the chest pain helps me not to have feelings. assess protectors fears Therapist hyphen hyphen ask it to say more about why it's important not to have feelings. J - - I'm seeing this for I made in my bedroom. It was a blanket cave under a couple of chairs. I used to go in there when I was upset. Therapist. - - does that make sense to you? J - - totally Therapist - - let him know that you're getting the connection. Witness The exiles experience J - - I grew up in a family that was not into feelings. When Grandpa died, my mother had a birthday party for my older brother the next day. She baked a cake, wrap the presents and set the table. Her attitude was - the Show Goes On.

Find Therapist - - say more. Therapist - - do you want to explore this? Therapist - - would it be okay to close your eyes? Good. Now noticed any thoughts or physical sensations are come up.- starting with the body. Focus Therapist - - is it okay to focus on those to see what we can learn? Therapist - - would it be okay to go inside and be *curious about the [target]? I believe all physical Sensations hold important information for us. Flesh out pt--statemnet Therapist - - what did you see? J - -. Therapist - - you [whatever tx observes, eg you look puzzled.] Befriend. Therapist - - are you open to seeing more? Therapist - - is the [target part/problem] connected? Therapist-- are you open to hearing more? Therapist - - send your curiosity to the [target part] and ask what it wants you to know. assess protectors fears Therapist -- ask it to say more about why it's important to [target problem/part--not to have feelings.] Therapist. - - does that make sense to you? Therapist - - let him know that you're getting the connection. Witness The exiles experience

Turn your attention inside. ******* Therapist - - is it okay to focus on those to see what we can learn? Therapist - - would it be okay to go inside and be *curious about the [target]? I believe all physical Sensations hold important information for us. ****** do you know what that's about?

Can you see it? if yes, how does it look? if no, how do you experience it? how close are you to it? (can i ask it a question) Who does this part think you are? ******** pt--statemnet Therapist - - what did you see? J - -. Therapist - - you [whatever tx observes, eg you look puzzled.

Befriend. let x know that we are curious & want to know what it wants us to know about it. (What is its job?)How did it get this job? let x know we appreciate how hard ... How effective is the job? If it did not have to do this job, what would it do instead? How old is it? How old does it think you are? What else does it want you to know? ****** is it willing to trust you? how old does it think you are? does it see you now? would it be willing to let you help the X (target part)? ********** Therapist - - are you open to seeing more? Therapist - - is the [target part/problem] connected? Therapist-- are you open to hearing more? Therapist - - send your curiosity to the [target part] and ask what it wants you to know.

assess protectors fears Therapist -- ask it to say more about why it's important to [target problem/part--not to have feelings.] Therapist. - - does that make sense to you? Therapist - - let him know that you're getting the connection

Which part (of these parts) needs help first? find part in, on or around the body. where do you notice it ****** would the X (part) be willing to separate so you can get to know it better? client: i don't know how to do that tx: I can help. Think of a time when X (part's behavior or role) ****** Therapist - - say more. Therapist - - do you want to explore this? Therapist - - would it be okay to close your eyes? Good. Now noticed any thoughts or physical sensations are come up.- starting with the body.

How do you feel toward the part? (8C's--curiosity, calm, clarity, connectedness, confidence, courage, creativity, compassion) if no, ask blended part, 'are u willing to relax so we can talk to X (target part)? if not willing to relax, 'what do you need us to know?' (work to having all obstructive parts feel heard & validated). Once they agree, "how do you feel toward X (target part) now?

is this an exile (feel depressed) or a protector (motivated depression--functioning as avoidance)?

protectors (grandiosity) against shame/inadequacy

exiles (hurt, fear, abandonment), managers (avoid intimacy), firefighters (self-harm, suicidality)

exile vs. protector (anxiety functions as avoidance)

does it protect against pain of trauma? assess this.

which parts wants to know ; why, what do other parts think? (how do i address this? should i tell them or not that they have a dx??** g

which part needs help first? Any parts object? no. how do you feel about this Target part

(not where do you want to start) but ... follow up with parts you worked with last time, especially the ones said we would get back to. (schwartz)

Each focuses on getting other to change each has weapons out. work on having them take a u-turn each look at the own parts that need to heal. each partner caretaker to own's primary exile. then everything calms down. then arrows from other don't hurt as much. *both partner witnesses the work of the other; both of u hate a part. she saw u work with it ; all the pain it was protecting. if she has empathy for the part, ...

(Schwartz) just talked at them (bc they weren't willing to). 'i get u wouldn't want to talk to me, white, authority fig, afraid in collusion with parents. i respect you not. but if u decide to, i can help u avoid places like this ; help u have a good life.

Schwartz-- All sessions are minimally 1 hr. negotiating with protects often takes 40 min. leaving only 5 min to work with exile, obviously not enough Can do witnessing; we'll finish next week. i'd like u to keep an eye on this part. *at beginning of session, not=what do u want to do today;; instead = let's check on the parts we explored last time. this isn't an in-session therapy, it's nurturing internal relationships outside.

Schwartz--therapist is crucial but not because therapist is giving them something they don't have, but helping them ...learn to be themSelf *Therapist being in self = 90% of the healing.

Schwartz--SERIOUS PHYSICAL THREAT --EG ANOREXICS. *we're going to take u to acenter.. we really get why you are doing what you are doing. really honor you. but need to keep her alive & override u for awhile. *we'll work at healing her & eventually liberate u.

SELF-HARM THOUGHTS DONT' STEP BACK if not life threatening, "I get why. appreciate. we can honor... we'll work at healing parts you are protecting so you can be liberated from this role. you're the boss. we can do it without overwhelming from pain. we're doing it to liberate it from pain." we give these thoughts a lot of latidude.

Q: 'accessing the protectors, can activate the pushing parts, especially between sessions.' A; ironically pushing part always slows things down, due to polarization; other side of the polarity digs heels in deeper. have that part push back.-- *i get that you've been pushing so much, & appreciate why. how's this working for you. would you like to learn something that does work? are you willing to step back?

IF TREAT CRISIS LIKE A PART, THE CRISIS ENDS v. medicate, hospitalize.

"ask the thinking part to stand back, turn inside, notice what you expense in or on your body.)

DISSOCIATES--client who has a part that takes her out for long periods of time. *Direct Access--I see that there is a part that is taking you out. Let me talk to that part. ... Am i talking to that part. i know u must have a good reason. what's the reason. (protecting from feeling). so ur protecting her from that feeling. u don't have to take her out. you can negotiate directly. *we can ask that emotion to be contained.

They always honor it! (Schwartz)

DID client adjustments clients don't have access to self at first. Direct Access--therapist talks to part; smoosing, love-bombing, honoring them for how heroic they've been. develop trust. at a certain part, ask them to step back (; exposing the self or letting things happen.) *They have tremendous fear of stepping back. *Perpetrators torture child if they see self. if they get self out, they can brainwash them. punished for experiencing/showing self. *transition to client's own self can feel like abandonment because attached to therapist (they didn't have any access to self).

therapist's issues--therapist has similar exiles, hard to stay with client when exiles triggered. *client goes to exile, therapist gets anxious, confused or lost, or angry, etc.. THERAPIST CHECKS IN WITH SELF--BODY/EMOTION SCAN. THERAPIST--SELF-LEADERSHIP SCRIPT 'i get that you're triggered right now, if u r just willing to relax & separate & let me stay, help the client, than i'll follow up after the session." V. health-promoting approach for therapists' selves too.

'i get that you're triggered right now, if u r just willing to relax & separate & let me stay, help the client, than i'll follow up after the session."

Countraindication not related to dx. 1. !!!clients parts represent therapist's painful unresolved stuff. 2. !!!situation that makes it unsafe to be vulnerable.

any extreme reaction? *How do you feel about the part (any extreme reaction is a part). *we know you hate it, WE WON'T LET IT TAKE OVER, WE JUST WANT TO GET TO KNOW IT. *explore. *now how do you hate it. do lots of exploring; eventually negotiate with it ; see if it will step back.

1. "symptoms/problems/syndromes" = manifestation of parts in IFS. !!!!2. go to parts without initially trying to change them. eg part that is starving self. just learn about it, honor, go back in to hx to learn how it gained it's role, etc.

dysfunctional parts are either holding a wound or trying to protect against wounds

healthy part vs. dysfunctional part

'speaking' for vs. 'speaking in' (blending)

no meds until all parts on board. *parts can interfere with med compliance & awareness of benefits. *parts can push the biological buttons.

40%!

...; call me out on it, if you think I am in parts vs. Self.

Self really seems to get it/accept/care (i.e., in Self), understand the pain, intensity, where it came from,

think of a person who triggers your parts. Imagine they are in a room with a window & door. you are looking in at them. what parts of you are activated. separate from them. talk to one that is most prominent. get curious. ask them about themself. have them behind you. you go into the room, leaving the parts out. what's that like? what do you notice?

"I totally know that this trip will be really hard for you. I'll be thinking of you. I'll be here when you get back to deal with whatever happens." vs. grounding etc.

isn't disorganized at all--it's 2 ambivalent parts, one that desperately wants connection, the other that wants to get away bc connection is toxic. complex trauma. attachment trauma.

oh, i get it, that makes so much sense to me. what if you can get that in another way?

1. not getting permission from managers to get to exiles. 2. therapist's parts are interfering. e.g., often because therapists' manager's helper parts are doing too much (to assuage try to avoid anxiety).

'you're suicidal, great, i'm so glad you are here.' --bring curiosity & calm....

inevitable, regardless of whether u do good work out of curiosity or you blunder; just get curious & stay centered.

LN--part of you feels x, part feels y--ocd part, non-ocd part thinks this is 'ridiculous'/not true/no problem. I all have parts; we all have parts; .... It can be extremely helpful to learn more about these parts & what they are trying to do for us.

parts can turn down intensity. Ask target part, 'could you (part) turn down the dial. turn it down 20% can you do a sliver." parts can step back--that's a state change. "i totally get that you hate it--but can you step back." sometimes they do, if not, ask why--direct access. do this to unblend. parts want to talk to therapist directly becausue Self abandoned them. try not to participate with that. but if the protector simply is not willing to step back, do Direct Access.

If you ask a part, it will help you differentiate. progressing ; then get stuck. 'let's get curious, what's going on inside. pt: plexiglass over everything. tx: any parts in the way? pt: no. parts blurry underneath plexiglass. tx: how the parts think about. pt; they don't like it. doesn't seem to function as protection. *plexiglass wasn't a part--it affected the whole system; global example. pt;--'all parts want help with it.' Anxiety too. is it an anxious part, doing a job? is it a part. if so, does it have a biological component. patient answers--"80% parts related, 20% biological.

if meds aren't working, see whaht's going on in parts. p:: it's not little girl. 18 yo . wants me to be depressed. every time you get undepressed, you make bad dating choices & get hurt again. it's the way i protect you. *realized later was date raped. *sometimes parts want to be medicated. that's ok, if all parts agree.

*people come in with 'tons of side effects'= tons of parts. *In eating disorders, there are often many parts that eats for different reasons (managers--afraid of being abandoned & needing energy; eat to be soothed; eat as fire fighter--

take their reactions seriously & check in with self.

his part saying not ok to mistreatment me, rigid, led to teaching them about boundaries-- he should have been able to be curious, & of course you feel this way; can still set boundaries--i'm interested ; it's hard for me to hear it this way. or putting his parts in a room & seeing if he could get curious.

HOLD ON, I NEED TO CHECK IN WITH MYSELF.-- this is good modeling. I notice I checked out ...