Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT...

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Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Transcript of Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT...

Page 1: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Using Internal Family Systems

To Treat Eating Disorders

Presented by Judi Addelston, Ph.D., LMFT

Developed by Richard Schwartz, Ph.D.

Page 2: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Internal Family Systems

Our internal system has different parts that interact in sequences and styles that are similar

to the ways people interact.

All parts are valuable, have good intentions, and want to play a positive role in the system.

“All parts are welcome”

Page 3: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Internal Family Systems

Maladaptive symptoms (eating disorders) occur when parts take on extreme roles due to life experiences.

– Childhood abuse – physical, emotional, sexual…– Dysfunctional family systems – addiction, affairs…– Parent’s divorce, death of a sibling…– War, poverty, violence, trauma…

Page 4: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

The Self – the seat of consciousness

Calm Clarity Curious Creative Confident Courageous Compassionate Connectedness

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Self-Leadership

We are born with Self-energy Has all the qualities of healthy

leadership Self is invisible because it is the

‘you’ who is observing Self may become obscured by

parts in extreme roles The seat of consciousness, flow,

self-actualization…

Page 6: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Self-Leadership

When trauma occurs early in life, Self may not be present or able to protect the system.

Parts take over when they do not trust the Self.

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Self-Leadership

Parts gets stuck at younger ages and keep doing the jobs they originally showed up for.

Parts do not see that the person has grown up, or that Self may be present to care for them.

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THE PARTS

EXILES MANAGERS FIREFIGHTERS

hold the hurt, pain, and shame of the past; want to be seen and heard; protectors are worried their distress will overwhelm the system.

run daily life, are proactive, want us to look good, work to contain the exiles by staying in control of events and relationships.

are reactive and will work to put the fire (pain) out when a triggered exile erupts past a manager.

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The System

Exiles

Managers Firefighters

Page 10: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Eating Disorders

An Eating Disorder is a part, or coalition of parts, that is protecting one or more exiles.

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Exiles

Young, vulnerable parts that have experienced distress and/or trauma.

Are isolated from the rest of the system for their own and the system’s protection.

May be extreme and desperate in an effort to be cared for and have their story told and validated.

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Exiles

Exiles carry the memories, sensations, and emotions of prior painful events and are stuck in the past. Ex: Trauma, Shame, Attachment injuries

Exiles crave redemption from the person who hurt them or who reminds them of the one(s) who caused the hurt.

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Exiles

Exiles may also hold much of our pleasure, wonder, exuberance, innocence, creativity, sensitivity….

The joyful, tender, beautiful qualities of childhood over which have been laid the distress of burdensome feelings and beliefs.

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Eating Disorders – the exiles

Shame – I’m too fat, I’m not good enough

Guilt – my parent’s divorce was my fault

Abandonment – I never felt loved or protected

Trauma – sexual, physical, emotional abuse

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Managers

Proactive parts that run the daily life of the person and work to keep the exiles banished by:

– Controlling events, others, the body– Striving, achieving, pleasing, perfectionism– Caretaking others– Critical and judgmental (of self and others)– Anxiety, worry, apathy, passivity, pessimism

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Eating Disorders – the managers

Go on a diet! Get to the gym! Read books on losing weight. Buy clothing to hide the weight loss/gain. Go to therapy and support groups. Eat before you go out so you don’t look like a pig. Have great hair/make-up so no one notices your weight

Page 17: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Helping Managers

Ask the manager:

What is your job? What would happen if you didn’t do your job? If you didn’t have to have this job, what would you

rather do? If you could do your job (usually protection), without (usually

controlling), would that be ok?

Page 18: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Firefighters

Parts that react when exile pain is activated in an effort to distract or extinguish their feelings or dissociate the person from them.

– Drinking, drugs, eating, and all addictive behaviors– Self-harm, suicidal ideation, suicide– Rage, violence, impulsivity– Dissociation

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Firefighters

Socially Acceptable

TV, internet, computer games, shopping, sarcasm, exercising, sleeping, working, chocolate, flirting ….

Socially Unacceptable

Addiction, affairs, rage, violence, abuse, suicide, stealing, cutting, anorexia, murder….

Page 20: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Eating Disorders – the firefighters

Starve

Binge

Throw up

Laxatives

Over-exercise

Surgery

Cutting

Suicide

Page 21: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Manager and Firefighter Goals

NEVER AGAIN will we let you feel that pain!!!

Keep the pain of the exiles at bay.

They don’t trust that the exiles won’t overwhelm the system.

They don’t trust that Self can take care of the system.

Page 22: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Manager and Firefighters Goals

Managers

Scan for danger Pre-emptive strikes Keep exiles down

otherwise the Firefighters will get activated

Firefighters

Reactive, frantic energy Sleep, dissociation Damn the torpedoes Stop the pain at all

costs, even if it costs everything

Page 23: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

What Managers and Firefighters Say to Each Other

Managers

Don’t you ever stop and think?

You are totally out of control!

You should be ashamed of yourself!

You are hopeless!

Firefighters

@#$%^ off!! I just felt like it. I deserve this! Try and make me…. I don’t give a @#$%^& Watch out!

Page 24: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Helping Firefighters

Often, therapists are scared of firefighters because of their extreme consequences – cutting, starving, suicide can all lead to death.

Page 25: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Helping Firefighters

Ask the firefighter:

What is your job? What would happen if you didn’t do your job? If you didn’t have to have this job, what would you

rather do? If you could do your job (usually protection), without (usually

hurting), would that be ok?

Page 26: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

The System

No matter how much we may help managers and firefighters, unless they agree to let us work with and help the exiles, they will continue to do their job of protecting the system from being overwhelmed by the pain of the exiles.

As long as our protective parts believe there is still a fire to control or put out, they will not change.

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Polarizations

A state in which two parts (or coalitions) in the system relate in opposition or competition with each other.

Each side refuses to move out of fear the other side will take over.

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Eating Disorders - polarizations

FOOD

Starve Binge

Page 29: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Eating Disorders - polarizations

BODY

Nurture Abuse

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Eating Disorders - polarizations

SELF

Love Hate

Page 31: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Eating Disorders - polarizations

Polarized parts cannot and

will not change unilaterally.

We often make the mistake of asking our clients to “relax” or “eat” or “have a food plan”, not realizing we are activating the other side of the polarization, thus making both sides more extreme.

Page 32: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Eating Disorders - polarizations

Polarized parts do not see that Self is present

and can support the system.

Both sides of the polarization need to be

shown that Self is present and can

protect the vulnerable parts.

Page 33: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Eating Disorders - polarizations

Ask each side – what are you afraid will happen if you don’t do your job?

Typically – both sides have the same job – to protect a vulnerable exile.

When they realize this, in the presence of Self, they are more likely to relax, and take on a preferred role.

Page 34: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Burdens

Extreme beliefs or feelings that are carried by the parts and govern the clients’ life.

Burdens are left on or in a part from exposure to a person or event.

Page 35: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Eating Disorders - burdens

I’ll never be good enough If I eat, I will look better and get molested I’m so lonely, food is always there for me. Food soothes my anxieties and calms me. I was unwanted, food always wants me. Being thin makes me more popular. Being fat keeps me from being intimate.

Page 36: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Blending

When the extreme beliefs/feelings of a part merge with and commandeer the Self.

Client reports ‘This is me’, but it is really a part that is usurping the system.

– Anger, rage, anxiety, self-criticism, fear…– Axis II disorders

Page 37: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Eating Disorders - blending

I am fat and nothing you say will convince me otherwise!

I am evil, I deserve this pain

It’s hopeless, why bother trying to get better

Page 38: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Love up on the Protectors

As therapists, we may be drawn to exiles, and may want to get rid of protectors because they seem maladaptive.

We can only access exiles by getting permission from the protectors.

Remember – they are just doing their job.

Page 39: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Love up on the Protectors

Of course that part of you that says don’t eat is right – it thinks you will get molested again if you gain weight. Let’s thank it for doing its job.

If it could still protect you, and let you eat, how would that be?

Page 40: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Love up on the Protectors

So the part of you that can’t stop eating is trying to numb the pain. Sounds like its been working really hard to help you not hurt so much.

If that part could help you heal the pain, and have a healthy body, how would that be?

Page 41: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

ED as an Anxiety Disorder

People who have anxious parts dominating their system are typically driven by managers who are trying desperately to control the system so the pain of the exiles does not leak through.

Page 42: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

ED as Depression

Depressed parts feel utterly hopeless and have blended with and overwhelmed the system.

This may be the result of a protector depressing (exiling) parts. This takes so much life-force energy that there is little left for anything else.

Goal is to learn the part’s story, develop a relationship between the part and Self and have the Self provide Hope.

Page 43: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

ED as an Addiction

Addicts are driven by firefighters – extreme protectors working hard to keep extreme exile pain/shame away from the system.

Stop the pain at all costs,

even if it costs everything

Page 44: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

ED as PTSD

Trauma survivors have parts that are stuck in the past that need to be retrieved and unburdened.

“Trauma survivors don’t have memories, they have symptoms”.

Their “symptoms” (starving, binging) are protectors working to keep the painful memories exiled so the person NEVER AGAIN has to feel that pain.

Page 45: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.
Page 46: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Therapist Parts

Parts of the therapist that may interfere with therapy.

When you encounter a problem in IFS therapy, it is usually because a part is interfering, but you don’t know whose it is - yours or the client’s.

Judgmental

Approvalseeking

Pessimism

Caretaker

Angry

Striving

THERAPIST

Page 47: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Benefit to the Therapist

Unburden and release clients’ extreme beliefs, emotions, energies. (Many techniques do this.)

Promote Self-Leadership so the parts trust the client’s Self rather than the therapist or the technique. This leads to empowerment.

Page 48: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Benefit to the Therapist

You do not have to be the clever expert, even if it is rewarding.

You do not have to come up with insights, interpretations, or assignments because they will come from the client.

Less transference, projection, dependence.

Have a co-therapist (client’s Self) who lives with your client 24/7.

Feel energized, not drained, after a session due to the presence of Self-energy (yours and the clients).

Page 49: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Internal Family Systems

“Even the worst impulses and feelings -- the urge to drink, the compulsion to cut oneself, the paranoid suspicions, the murderous fantasies – spring from parts of a person that themselves have a story to tell and the capacity to become something positive and helpful to the client’s life. The point of therapy isn’t to get rid of anything but to help it transform.” Richard Schwartz, Ph.D.

Page 50: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Level 1: Mastering the Skills of IFS

In addition to thoroughly learning IFS theory and technique, the Level 1 training program invites participants to explore their own inner worlds in a safe, nurturing context. Participants:

– Develop an understanding of the conceptual basis of the IFS model; – Apply basic IFS techniques to various clinical populations; and – Take advantage of the opportunities the model offers for personal

development.

The format includes lecture, discussion, demonstration, experiential exercises, and small group supervision and practice.

Level 1 is six weekends over the course of one year, 108 CEUs.

Page 51: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

Level 1: Mastering the Skills of IFS

http://www.selfleadership.org/level-1-interestlist.html

If you are interested in bringing a Level One IFS Training to Orlando, please go to the above link and

add your name to the Orlando Interest list.

Page 52: Using Internal Family Systems To Treat Eating Disorders Presented by Judi Addelston, Ph.D., LMFT Developed by Richard Schwartz, Ph.D.

May The Self Be With You!