Using the Family in Individual Treatment & IFS

Basics of Family Systems

  • systems

    • composed of elements and interconnections, which serve key functions

    • e.g., children in a school being connected to each other and serving social/learning functions

  • individuals

    • best understood through assessing the interactions within an entire family, as looking at the elements alone will miss the larger interconnections

  • families

    • the “client” to a family systems therapist

    • interactional units

    • a change in one member effects all members

    • must understand these interpersonal interactions to understand individual dysfunction

Family Systems, Structures, & Roles

  • systems are self-organizing and resilient, but are challenged by elements’ interactions with each other

    • e.g., a child’s difficult behaviors cause parents to become angry with each other

  • individual “difficult” client may not be the source of the problematic behaviors, which…

    • serve/served a purpose for the family

    • may be symptomatic patterns handed down across generations

  • client may instead be the person most vulnerable to systems pressures, and therefore is viewed as the symptom bearer

  • systems include structures in which individuals play particular roles

Family Therapy & Related Work

  • families and couples often come to therapy to deal directly with particular issues

    • e.g., marital- partner-related strife and conflict, poor behavior by children, etc.

    • traditional couples and family therapy is more fully covered in COUN533 - Marriage & Family Counseling

  • family members may also be involved in a range of disordered behaviors and/or most therapeutic work involving child and adolescent clients

    • e.g., pervasive developmental disorder (autism), traumatic brain injuries, psychotic disorders, etc.

  • it is also pertinent to understand relevant techniques and concepts from family work for individual therapy, as most approaches explore family and dynamics, both as past client experiences and in their impact on current client experiences

    • e.g., psychodynamic therapy, Adlerian therapy, etc. 

Family-Related Work with Individual Clients

  • family-related experiences will arise in individual work consistently, no matter the approach, but this is especially true with therapies derived from psychoanalysis

    • e.g., object-relations is based on the idea that infants develop internal mental representations of others (objects) based on experiences with caregivers

  • research has demonstrated the evidence for attachment theory, and it can be therapeutically helpful to conceptualize clients from this perspective

  • consistent with attachment theory, research supports the fact that family roles and structures likely influence future client interpersonal relationships through parent sensitivity

Family Roles & Structures

  • Roles

    • individuals serve specific roles in their familities

    • certain theories identify specific roles

      • e.g., hero, scapegoat, lost child, clown/,ascot, caretaker, enabler, golden child

    • roles are usually functioning but may become maladaptive if they become rigid or developmentally inappropriate

    • roles influence future behaviors in relationships

  • Structures

    • also known as subsystems

    • include unique relationships among family members

    • each individual may be involved in multiple different structures

      • e.g., parent subsystem, sibling subsystem, adult-eldest child

    • structures include hierarchies, alignments, coalitions, boundaries

    • structures may inadvertently force individuals into maladaptive roles

Family Role Issues

  • Hero

    • perfectionistic, takes responsibility (often inappropriately)

    • often compulsively inclined to portray family in positive light

  • Scapegoats

    • blamed for family issues

    • may be (viewed as) defiant and/or rebellious

  • Mascot

    • mediator, uses humor to avoid tension

    • difficulties with depth

  • Enabler

    • takes responsibility for others’ behavior, keeping the other from having to take responsibility

  • Lost Child

    • ignored, overlooked, lonely

    • often people-pleasing

    • internally confused and lacking confidence

  • Golden Child

    • “favorite”, idealized vision of parents

    • may be responsible for parents’ emotions

Family Structural Issues

  • adultification

    • children being coopted into adult roles due to a lack of parental capacity (e.g., due to parent depression or substance use) and/or lack of consistent opportunities to socialize with other children

    • parentification is a sub-role when adultified children must care for other children

  • triangulation

    • a process by which a third party (often a child) is recruited to reduce anxiety and stabilize a couples’ relationship

    • e.g., the child may become the target of anger or a conflict mediator

  • overly rigid boundaries

    • excessive adherence to family rules/expectations limits individual expressiveness and growth

  • enmeshment

    • blurred boundaries between two individuals, leading to a lack of individual accountability and autonomy

  • codependency

    • one family member relying too heavily on another for the fulfillment of self-worth and emotional needs

    • often leads to enabling of negative behaviors (e.g., substance use)

  • unclear hierarchies

    • poorly defined power structure leading to instability and chaos

    • may lead to difficulties with authority figures

  • unresolved conflicts

    • overly avoidant behaviors maintain internal distress

    • may lead individuals to avoid confrontation and ignore needs

Family Development and Client Issues

  • outside of the impact of early family experiences, counselors must consider family development changes as natural causes of distress

  • developmental changes may include

    • marriage

    • birth of a child

    • changing family composition (e.g., “empty nesters”)

    • death and mourning

  • natural links to adjustment disorder

Counselors’ Roles and Relevant Techniques

  • pertinent to distinguish family of origin from current family/living circumstances

    • the latter may not be literal family members, but the interactions with others likely still reflect early family

  • can be useful for therapist to watch family interactions and explore maladaptive substructures or roles

    • can reveal hierarchies, subgroups, etc.

      • e.g, an overly enmeshed relationship between father and one son

  • if this isn’t possible, using theoretically-appropriate exploration

    • e.g., Adlerian family constellation worksheets, or family genograms to help clients understand familiar patterns

  • atheoretical concepts include family mapping, exploration of family structural elements like flexibility, communication, context, development, etc.

  • counselors work to identify possible maladaptive roles and structures and conceptualize clients from these perspectives

    • biosocial perspective

  • range of theoretically-consistent interventions to help change early patterns in current partnerships

  • techniques to help the client’s differentiation of the self to respond to maladaptive roles

    • a psychological separation from others

    • help clients learn how they might unhealthily close to or far from other family members

  • engaging family members, as individual change often only occurs in concert with other family members also changing

Examples of Theoretically-Consistent Change Interventions

  • psychodynamic therapy

    • reparenting

  • gestalt

    • roleplays, empty chair techniques, etc., to engage in-session with members of family of origin (living or dead)

  • behavior therapy

    • assertiveness training to establish boundaries and confront family

  • cognitive-behavioral therapy

    • exploration of “in whose voice” negative thoughts arise

    • belief modification to change negative automatic thoughts

Internal Family Systems

  • first theorized within Jung’s ‘complexes’ (1969), by Perls (1969) in Gestalt therapy, and most clearly by Eric Berne within transactional analysis

    • see Games People Play (Berne, 1964)

  • Later explored further within ego state theory (Watkins & Watkins, 1997), structural dissociation model (Nijenhuis, Van der Hart, & Steele, 2005), internal family systems (IFS, Schwartz & Sweezy, 2020)

  • IFS is developed by Richard Schwartz in the 1980s

    • IFS is all the rage these days, but these main concepts have been around for decades

    • be thoughtful of therapeutic fads, they’re kinda made up

IFS Basics

  • each person is composed of a range of ‘parts’ with their own roles & perspectives that interact, with different parts leading at different times

  • no parts are ‘bad’ or pathological, but their interaction explains many psychiatric disorders

    • parts may become blended into the self, and needs and wants therefore become confused

    • the burden of certain parts is not intrinsic, and need not evoke shame

    • as a result, counselors explore all parts with curiosity and kindness

  • change comes about as clients learn to provide the opportunity to each of their parts to share their burdens and process (e.g. being hypocritical), and have this witnessed and validated by the Self

    • this tends to be achieved via the repeated engagement with the different parts in session

Parts in IFS

  • managers

    • protective, organizing parts

    • sometimes perfectionistic, excessively worrying

    • may exile injured parts to keep pain out of awareness, and prevent them from overwhelming the whole system

  • exiles

    • associated with childhood

    • often traumatized

    • rife with emotional pain and fear

  • firefighters

    • “emergency” protectors, activated when exiles blend with us

    • divert attention from exile’s hurt and shame after the fact

    • may use substances or other compulsive behaviors

Self

  • also known as “the core”

  • state is pure, open awareness that arises when no parts are fully blended

  • self is kind, compassionate, wise

  • even when connected to the self, parts are often still partially blended so as to make us feel safer

  • self plays an active role in increasing alliances between parts, decreasing protection & polarization

  • ultimately, the self works to find an appropriate and tolerable role for each part

    • e.g., helping a firefighter feel that its overaction is understood and then finding a comfortable place (metaphorically) to persist

Using Parts in Therapy

  • psychoeducation about parts and open interventions to increase client awareness

  • therapist models to client the perspective of curiosity and compassion to every part that arises, exploring needs, wants, feelings, etc.

    • may involve visualization, including age, gender, location

    • clients explore their feelings towards parts, vice versa, and between parts themselves

  • particularly useful with protective parts, as this may allow clients to move past resistance

  • goal to have client acknowledge each part and find a means of fulfilling his/her/their needs

    • note that this does not mean eradicating parts

Criticisms of IFS

  • limited research, specifically RCTs

  • viewed by some as a fad and/or ploy (particularly due to high cost of formal training)

  • potential for depersonalization with clients with dissociative (e.g., dissociative identity disorder) or psychotic disorders

  • as with all therapies when working with trauma, counselors need to prioritize building trust before engaging with parts