The flexible and relational approach of IFS enhances EMDR’s eight phases: A composite case study
The first of these two articles was offered in reply to the EMDR Council of Scholars’ 2021 position paper on EMDR therapy, describing EMDR as being at a “crossroads”, and at risk of losing out to other trauma treatments, as it is frequently misconstrued as a mere protocol or tool, rather than a whole therapy. The article drew on the long history of EMDR as an integrative psychotherapy practice. It suggested that combining the Internal Family Systems model (IFS) as an adjunct to EMDR could help to fulfil EMDR therapy’s promise of treating the problems of daily living by reprocessing disturbing life experiences. Points of crossover and complementarity between the two approaches were identified and discussed, along with significant points of difference, with reference to the few works already published that consider IFS and EMDR side by side. This second article uses the story of a composite client to illustrate how integrating EMDR with IFS language and interweaves could help the therapy to flow, like water, around so many of the blockages frequently experienced when using only the standard protocol with complex cases.
This example of a composite client retains the essence of the interactions, while protecting confidentiality. Sandra (not her real name) is a 40-year-old woman. Her father died in front of her in the street when she was 11-years old. As a young child she had been sexually abused by her older stepbrother, then groomed by her stepfather. She came to see me having received a diagnosis of borderline personality disorder. She experienced dissociative seizures and panic attacks. She had a history of self-harm and binge-eating, along with drug and alcohol misuse.
The client was high functioning, holding down a demanding job (though only part time when we first met) and in a marriage with young children of her own. She had received CBT and talking therapy since she was a teenager.
Introducing IFS language
The client’s history informs the EMDR case conceptualisation and can help to identify potential negative cognitions (NC). Using the IFS model, outlined in Figure 1 (adapted from M Pastor), the client ’parts’ can be detected and introduced to the client.
The model describes the exiles, firefighters, managers, and Self in the centre of the psyche. Sandra was invited to read No Bad Parts (Schwartz, 2021) which is an accessible yet authoritative introductory text to IFS. I also find the language offered by O’Shea Brown to be useful: “I want to introduce you to a model of therapy that we will use together. It is based on the idea that we all have a core self that embodies our essence and all of our finest qualities, including calmness, curiosity, compassion, confidence, courage, clarity, connectedness, and creativity. We are born with these qualities; this is known as self-energy” (2021, p. 116).
Sandra made comments such as “I was so stupid at school”. She was shamed for showing any emotion as a child. Her core EMDR negative cognition (NC) was “I’m bad”. This indicated to me she had a ’critical manager’ (IFS term) on board. We used a genogram to obtain an early life history: this revealed both attachment trauma, and intergenerational trauma. In my experience, asking a client to identify the ten best and ten worst memories, as some EMDR trainers suggest, does not always elicit the most effective targets that match how unhelpful behaviours were first wired into the neural networks. Instead, I used Sandra’s parts to guide us to the memories that generated the need for this critical manager, by asking the manager when it first started to do that job. One memory was of being laughed at age 11 by her stepfather, for going to get her cardigan for her father’s funeral. He said to her “now it’s time for you to grow up and stop being such a horrible baby”. Sandra recalled this was the first time she dissociated. In other words, this was a touchstone memory. Not only did her critical manager step in to squash any of her needs, by telling her she was bad and pathetic, but this part worked in a tag team with her firefighter of dissociation to protect her from her critical stepfather. As the diagram in Figure 1 shows, there are two types of protectors in IFS that work in different, complementary ways to keep out the intense emotion held by the exile parts. These are managers who try to control the environment and firefighters who react to soothe and distract from the emotion once it is triggered. Sandra could not emotionally afford to be upset in front of her stepfather because he would shame and criticise her, so her critic did that internally first. When that did not work, and she still got upset by his cruel comments, the cloud of dissociation descended to distance her from the upset.
Sandra found the IFS model very de-shaming. The relational way of explaining her unhelpful behaviours as just “a part of her” was helpful. She appreciated that dissociation was a firefighter (an IFS term for a reactive protector, see Figure 1 above) trying to keep her safe, to protect her by not upsetting her angry stepfather. I explained that this part may be frozen in time using strategies that were helpful when she was a child but not today. To help with stabilisation, I encouraged her to engage with resources outside of therapy such as a community art class and a 12-Step programme. Twelve-Step programmes have been argued to share much with IFS, as Robert Falconer (2020) explained during an IFS Podcast: “The very first step of 12 steps, “‘we’re powerless over alcohol and our lives have become unmanageable’”, he said, referring to the first of the 12-Steps of Alcoholics Anonymous (AA World Service, 1952; 2002). He continued: “That’s what IFS says, our managers couldn’t do it. This part is in the civil war, the manager cannot do it. That’s the first message we want to get through in IFS, the manager cannot do this we have to turn to Self and that’s step two and three” – again, referring to the 12-Steps of Alcoholics Anonymous. He continued: “Came to believe that a power greater than ourselves could restore us to sanity. That’s Self. And then ‘turned our will and our lives over to the care of God as we understood him’. Basically, the first three steps are, the managers can’t do it we need to bring in Self, which is exactly what an IFS therapist will be doing with an addict”.
So Sandra found a safe place in a local Narcotics Anonymous meeting, the 12-step meeting for people in recovery from drug use. She found a place to share, to be heard, without judgement, to express her feelings, find friendship and belonging whilst beginning to form a relationship with a higher power. This helped her to manage intense emotions without marijuana, binge-eating or self-harm, which complemented our IFS-informed EMDR therapy well. She found a sponsor and healthy friends. The art group too gave her another safe community plus a way to express intense emotions as images on the page. The real missing element from 12-step programmes is trauma work, which is why they are such a good fit with IFS-informed EMDR therapy.
The IFS model considers resourcing and grounding techniques to be unnecessary. It holds that grounding may give parts such as Sandra’s exiles and firefighters the message that their affect is overwhelming, so needs to be resourced away i.e., are unwanted and repressed. Instead, IFS facilitates the client to establish a part-to-Self connection, as a form of internal soothing and affect regulation. IFS therapists usually spend time, sometimes many sessions getting to know the protectors before moving towards exile work. However, for Sandra, with her history of self-harm and suicidality this carried a risk that I was not prepared to take. A risk that is now clearly identified by Joanna Twombly (2022) who argues that highly dissociative clients do need resourcing because they are not always able to access self-energy. I taught her grounding techniques such as box breathing and supplemented the exercises with Parnell’s (2013) resource figures (nurturers, protectors and wise beings) and butterfly taps. We mapped her parts using Inner Active cards (Eckstein, 2012). This helped her to unblend from them, thus gradually establishing a part-to-Self connection. She chose this first image to represent her Self-led adult and named it her “big sister Self” (Image 1). This was particularly effective because it gave her an image of her Self-energy that was easy to connect with, to see the warm encouraging hand reaching out to her.
The Mother Bear (Image 2) was one of her main nurturing resource figures.
Her critic looked like the scowling schoolteacher (Image 3).
Finally, there was a part who played the flashback movies (Image 4), particularly of her father’s death early in our work. There is not space here to go into them all in detail, just to give you a flavour of some of Sandra’s parts.
Super-charging assessment and desensitisation with IFS
Initially, Sandra’s critic (image 3 above) attacked her verbally and blocked the processing when the focus of our sessions switched to early life targets. Integrating IFS into various phases of EMDR as outlined in this article, allowed her to understand and appreciate the survival function these parts had played for her. So rather than feeling that she was getting EMDR wrong, she was able to dialogue with her protectors during EMDR preparation and assessment to ask for their permission to process memories with EMDR. This was helpful, but at some point in every session her “grey cloud” of dissociation (a firefighter (FF) part) would appear during processing. Real change happened when the client’s Self was able to deeply appreciate how hard the dissociation cloud had worked to keep her safe. At one point Sandra cried when feeling that profound gratitude. Such expressions of gratitude helped the protectors feel heard and appreciated so they could begin to trust the adult Self-energy and were therefore able to relax their extreme behaviours.
Before the memory of her father’s funeral could be processed, we needed to dialogue with the cloud firefighter part. Utilising the six Fs: Find, Focus, Flesh it out (unblend), Feel towards, BeFriend, Fear, (These were explored in the first article as central to IFS therapy. They make useful interweaves for EMDR when dialoguing with parts). We worked to get to know the FF cloud, realising the cloud still believed there was danger My hunch was the cloud was stuck in childhood, so I asked how old it thought Sandra was today. The cloud thought she was about 11 years old; it did not know that she was 41. When Sandra gently informed the cloud of her age, the critic jumped in to say: “she is making it up”, then repeated its old strategy message that she has to be good so she won’t get shouted at. So, the “big sister Self” showed the cloud her life today. Her loving husband, job and young children. Sandra’s protectors relaxed, she felt calmer, and was then able to process the memory of her father’s funeral.
Once Self-energy is established and the EMDR target elements listed, the client can be asked for a SUD specifically for the active part. Hersey suggests: “Ask the part how intense the disturbance is from 0-10”. For Sandra’s 11-year-old part in the funeral memory, the SUD was eight.
The witnessing and unburdening of parts is a crucial element in IFS. This can be integrated into the desensitisation phase of EMDR, and in doing so, the Self-to-Part relational frame can be extended. I prompted Sandra in various ways: when information was shared, I suggested she say if it resonated with her: “Let the part know you get that”, and to elicit all final parts of the memory: “what else does the part need you to know before we start the processing?” To reassure the exile part that Self was present and able to provide a reparative relationship, I said “Let the part know that you will remain present with it through the processing”. “Is the (exile) part able to be here with you and feel that feeling in your stomach, show you that image, and start with the thought; I’m bad?” (Hersey, 2013).
On other occasions, I established dual awareness in the memory by inviting the adult with lots of Self-energy to step into the target memory in childhood, then asking the ’feel towards’ question (this is part of the six F’s of IFS as mentioned above). Compassionate responses indicated that Self-energy was active and I was able to proceed by inviting Sandra to look through her child’s eyes. It was then possible to ask her how it felt for the child, to see her “big sister Self” there. The child was invited to share her story to be witnessed by the Self-led adult. Being seen and witnessed by another (Self-led Sandra) may be enough to unburden all the uncomfortable thoughts and feelings from the memory in IFS terms, especially with the addition of BLS. But, as discussed in the first article, IFS offers an additional ’unburdening ceremony’”. In this memory however, BLS and witnessing were enough to reduce Sandra’s SUD to zero.
Positive cognitions and Self-energy
Positive cognitions (PC) tend to arise as Self-energy increases. For Sandra I followed the suggestion of Hersey (2013) in using a relational question to elicit her PCs: “Is there anything you want to say to the protective part, or want it to know?” The answer to this came from Self-energy, she wanted to believe “It’s OK to feel… and I’m brave”. I directed the inquiry for the VOC specifically to the protective part: “Ask how much does the part believe this right now, from 1-7”. Her validity of cognition (VOC) was less than seven and this suggested that more BLS and dialoguing with the protective parts was needed to increase it to seven (completely true). In using this approach, she realised her stepfather was using ’coercive control’ to mock and humiliate her, in much the same way he did to her mother. Coercive control became illegal in the UK in 2015 because it is one of the identifiable stages of domestic violence. This was not widely understood when Sandra was a child. Her situation spiralled into more physically dangerous domestic abuse that she and her mother later had to flee. As the Self-led adult, Sandra felt healthy anger about this man, the protective cloud of dissociation then said it wanted to release its rain into a black hole. In IFS this is a form of unburdening, as mentioned earlier, and can take place when the part experiences the client is in Self-energy so it can release the burden of its role.
It followed that Sandra’s cloud firefighter (a protector) could find a new job, leading to a new configuration of her internal system. In IFS it is important that protectors choose a new job for themselves, rather than this being imposed on them by another part. Resolving internal conflicts is key here. We asked whether the cloud would like a revised job? The cloud said it would like to be an early warning system for danger because it can see the big picture from above. Her PC of “It’s OK to feel… and I’m brave” was then successfully installed, with a VOC of seven.
In EMDR, when we ask the client to do the body scan, we see this as a final check that there are no body sensations remaining following desensitisation, and in IFS language it is seen as checking all the burden has gone from the exile’s body during the ’unburdening ceremony’. It may be that another part emerges during an EMDR body scan (in IFS a new target part) who can receive the same relational six F’s approach. This did not happen with Sandra so I invited her to ask this child part what she needed to close the session. It is sometimes nice to say to a client “the session is almost over but the relationship continues, would you like to take your child part home, by tucking her up in a safe place in the body, and committing to check in with her every day to see how she is feeling until the next session?” Sandra’s child part said she wanted to be tucked up with the Mother Bear, then she could be stored in the body. Yes, she also wanted regular check-ins. The following week Sandra reported that she had been journaling with the 11-year-old part by drawing two columns, one for the Self-led adult to ask questions, the other for the child part to reply. This seemed to reinforce the internal attachment between Sandra’s child part and her Self-led adult, making Sandra’s inner world a safe and nurturing place to be.
I continued to re-evaluate Sandra throughout our sessions. Sandra had been repeatedly sexually abused by her older stepbrother and these targets responded well to the EMDR standard protocol with each clearing to SUD = 0. Despite this, she explained how she kept repeating the same patterns of self-sabotage, being unable to motivate herself to find a new job and have ambition. Each time, these present-day symptoms were traced back to a childhood bedroom, waiting for her stepbrother’s abuse. As an interweave, I invited her to ask her seven-year-old child: “Why does little Sandra keep returning there to that scene?” The reply came: “Dad was involved”. Immediately, protector-parts jumped in to say this was not true, that she was making it up and the cloud descended. In subsequent sessions we were able to go back to this exile child, gradually gaining permission from the protectors – both the cloud and the critic – to witness her exile’s story: “This is something I’ve always known to be true”, Sandra said.
Gradually, her behaviour changed. Sandra no longer suffers from dissociative seizures. She would regularly dissociate at work so she could only work part-time. In fact, all her symptoms have resolved so she no longer self-harms, binges on food, or abuses alcohol or drugs. She is now able to work full-time and any dissociation is so mild that she just goes quiet for a while and uses such moments of being triggered as something to bring to therapy to locate a target memory and a part.
Innovative EMDR clinicians such as Jim Knipe and Carol Forgash (2008) also use ego-states in EMDR and similarities can be seen between their work and IFS. Jim Knipe’s ‘ovals’ have come from the ego state work of Watkins and Watkins (1997). Knipe suggests taking the child out of the scene and sitting the child on the sofa next to the adult (2015, p. 171). Such an intervention is similar to IFS and those used with Sandra. What seemed to have the most therapeutic power was facilitating a deep appreciation for Sandra’s protective (dissociative) cloud. In gaining this, she cried and told it she had noticed how hard and tirelessly it had worked to protect her. This indicated that her “big sister Self” was unblended from the cloud, so the cloud could now be fully seen, feel safe and trust the adult knowing that the trauma and danger of the past was over, and the dissociative form of protection was no longer needed.
Self-energy: The centrepiece of IFS and EMDR?
For many, Self-energy is seen as the centrepiece and the agency of healing in IFS. Self-healing too is at the centre of the adaptive information processing (AIP) system and can be strengthened in the client by bilateral stimulation, interweaves and installing resources.
Korn (2021) summarises insights from neuroscience in attempting to account for the potency of BLS: “Among the hypotheses, researchers have shown that the eye movements in EMDR activate the parasympathetic nervous system, leading to a slowing of breathing and heart rate, and a reduction in arousal; others have shown that the eye movements compete with the recall of traumatic memories, making them less vivid and emotional; others still have suggested that the eye movements activate the same neurological processes that occur during rapid eye movement (REM) sleep, when our most intense dreaming occurs, leading to less negative emotions, new associations between memories, increased cognitive flexibility, and improved insight”.
Tarquinio and Tarquinio (2015) contend that the AIP is more of a metaphor than an actual model, lacking properly developed theoretical foundations and failing to fulfil its organising, heuristic, predictive, and measurement functions (in Rydberg & Machado, 2020, p. 3). As the first article mentioned, IFS does not use BLS, instead Self-energy is the agent of change, the spiritual source of healing: “The IFS concept of Self is analogous to the spiritual concepts, present in many of the world’s religions, of a soul, a transcendent state of compassion and calm” (Twombly & Schwartz, 2008, p. 296).
From a transpersonal perspective, Krystal et al, (2002) write that EMDR has “a surprising capacity to liberate expansive states of awareness” – arguing, in Shapiro’s edited collection, that EMDR offers a movement toward transcendence. “Each approach values clear self-observation, detachment, acceptance, compassionate understanding, and forgiveness” (Norcross & Shapiro, 2002 p.344) which is similar to the way IFS describes Self-energy. “EMDR appears to activate a very similar healing process in many clients in which scenes from their past are witnessed and parts are unburdened spontaneously” (Twombly & Schwartz, 2008, p.305).
IFS therapists spend time and effort ensuring they themselves can maximise Self-energy, firstly in unblending from their own parts and in contemplating a deep more transpersonal perspective on Self. Pam Krause suggests to supervisees: “If you cleave to the goal of Self-leadership by helping your parts unblend and healing your own exiles, you’ll find you can navigate with more clarity than you might expect given the potential complexities of consulting to multiple embedded systems” (2022, p. 58). So perhaps Self-energy is the fuel, the driver of the AIP? “It’s as if there’s a piece of God—for lack of a better word—in all of us and, as it turns out, in all of our parts” (Schwartz 2021, p. 38). In IFS, Self is not a part, but an energy shared by all the parts. The more burdened the system, the more self-energy is blocked and unavailable.
How does EMDR in its current form, particularly the standard protocol, help or hinder access to Self-energy?
In my experience, EMDR clinicians may at times be overly focused on finding the right target. So much so that clients report that they are “getting it wrong”. That goes for the therapists too, when they share in supervision their experience of sessions with clients (I have written about this much more extensively in a chapter on Therapists’ Parts in a forthcoming book on IFS-informed EMDR edited by Millia Begum, to be published in 2023 by Phoenix Press).
In critiquing the mono-mind paradigm, Schwartz & Falconer remind us that “most therapists try to fix the problems that clients bring them. This often means that they polarise with the parts of clients that are using their problems to protect or get messages through to the client’s Self, and resist such changes. The more these protective parts feel under attack, the more extreme they become. Consequently, these extreme parts often become the exclusive focus of the therapy, obscuring recognition of the healing qualities of ’Self within’” (2017, p. 158). In identifying and addressing parts, the IFS therapist is, Gilligan observes, “like a midwife” (in Shapiro 2002, p. 235), someone who recognises that the intense irrational processes of the symptoms are evidence of some attempt at healing and transformation.
As O’Shea Brown summarises: “IFS is a highly compatible adjunctive strategy to EMDR psychotherapy, as it capitalizes on a language optimized to understand the parts of the self in order to foster cooperation and self-energy… An IFS relational approach asserts the need for parts and provides the client with language to engage in a dialogue that facilitates self-compassion and positive resourcing… By applying concepts and methods from the structure, strategies, and narrative of family therapy and subpersonalities, the IFS model provides a language necessary to understand one’s parts and work through unresolved internal conflicts” (2021, p. 120). It was such conflicts inside of Sandra that fuelled her self-harm, dissociation, food, alcohol and drug misuse. These were her firefighter protectors who kept her distracted from the pain of the trauma memories along with her critic who told her off for feeling or remembering. Together they also stood in the way of reaching her exiles, the parts underneath holding the pain. Sandra did respond well to using the standard protocol during treatment, to process her stepbrother’s sexual abuse and witnessing the death of her father. However, as explained earlier, this was not enough to resolve all her symptoms – that required combining it with the IFS relational approach.
IFS therapists are trained to be aware of their own parts, and for them to “develop their own access to Self” (Twombly & Schwartz 2008, p. 301); a concept also known as transference and countertransference in psychodynamic therapy. If EMDR therapy is to be seen as distinctively relational as the Council of Scholars definition suggests, then further attention needs to be paid to what is happening inside the EMDR therapist, as well as the client.
Dworkin defines countertransference as “the activation of state-dependent memories in the clinician that have been sparked by the client, intentionally or not” (2005, p. 126). Not paying attention to it can inhibit a client’s EMDR processing (Dworkin & Errebo, 2010). He suggests though, that attention to transference and countertransference should be left until after the clinician has understood the EMDR model (Dworkin, 2005, p. 144).
Dworkin furthermore calls for therapists to be in the equivalent of Self-energy: “with a conscious intention to keep an open heart that pledges safety and compassion (i.e., to have unconditional positive regard) you will be less likely to be taken by surprise during processing and to become activated by the client’s pain” (2005, p. 143). He also offers an array of strategies for self-regulation within the therapist (2005, p. 149) that are very similar to those recommended by Twombly and Schwartz (2008, p. 301). As an EMDR consultant I raise the concept of counter-transference, or therapists’ parts regularly with supervisees, but it seems there is not sufficient attention paid to it within the EMDR community as a whole, which is why the new definition within last year’s position paper by the Council of Scholars represents a useful inflection point.
This second article uses a composite client story to suggest that integrating EMDR with IFS may help EMDR trainees to evolve from using just the standard protocol to working relationally with complex cases, using EMDR psychotherapy, as defined by the ‘What is EMDR’ workgroup of the EMDR Council of Scholars (CoS) position paper in 2021. In the composite client story, I show how integrating IFS-informed language with the EMDR standard protocol enabled a client with a complex presentation to find inner peace, transformation and healing. Combining these models enables a theory of multiplicity of the mind to be offered, providing a relational way for clients to work internally with their own parts, to enhance memory processing. In doing so it seems that the risks of resistance or transference issues with the therapist are minimised.
I agree with Francine Shapiro (2002, 2012, 2018) (and argued this in the first article) that EMDR was always intended and destined to evolve further by seeking out and combining with complementary approaches in other leading therapies including schema, psychodynamic and transpersonal therapies. This second article illustrates the argument that the Internal Family Systems model offers an especially propitious and fruitful field of integration. As one supervisee put it recently: “Using EMDR with IFS is like turning the lights on in a darkened room. Now I know who’s there in the room, whereas with just EMDR I feel like I’m working in the dark” (Saxby, 2022 ).
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